bluuebunny/crossref_metadata_2025 huggingface dataset:
Analyzing Hospital Market Share along Product Lines
Authors: Shi L.
Published: January 2017

This article illustrates a method of analyzing market share based on product lines or specific hospital services, using 1990 data from a health service catchment area in South Carolina. Hospital discharges from two specific services: vascular and cardiac surgery; and obstetrics, were used to compute market rates of retention, discharge, escape, commitment, opening, and capture. The results confirm that as hospitals become more specialized, market share analysis based on total discharges is often misleading. Rather, discharges should be disaggregated and separate service areas with different boundaries constructed for different product lines. This method of market analysis can be performed easily and periodically by hospitals to monitor the market situation of their product lines.
Resource Constraints and Strategic Change in a Public Hospital System
Authors: Champagne F. , Langley A. , Denis J-L. , Contandriopoulos A-P. , Cazale L. , Rivard Michèle
Published: January 2017

It has been suggested that strategic management in public services tends to be oriented towards preserving and perpetuating current patterns of service provision, rather than changing priorities. However, faced with severe resource constraints combined with growing demand and rapidly developing technology, public hospitals in Canada have come under increasing pressure. Based on an empirical study of strategic management and change in 32 Montreal hospitals, this paper examines the relationship between financial adversity and the extent and nature of strategic change in these organizations. Strategic change indicators considered in the study include overall product mix, product diversity, product complexity, market demographics, efficiency, and revenue diversification. Results suggest that resource constraints have indeed stimulated changes within these organizations. In particular, hospitals suffering more severe financial difficulties have reduced their size and focused on a narrower range of services. Moreover, there is evidence that greater complementarity has been achieved among the entire sample of hospitals.
Profiling Primary Care Physicians for a New Managed Care Network
Authors: Ozminkowski R. J. , Noether M. , Nathanson P. , Smith K. M. , Raney B. E. , Mickey D. , Hawley P. M.
Published: January 2017

We developed methods for comparing physicians who would be selected to participate in a major employer's self-insurance program. These methods used insurance claims data to identify and profile physicians according to deviations from prevailing practice and outcome patterns, after considering differences in case-mix and severity of illness among the patients treated by those providers. The discussion notes the usefulness and limitations of claims data for this and other purposes. We also comment on policy implications and the relationships between our methods and health care reform strategies designed to influence overall health care costs.
Managerial Perceptions of the Incentives Inherent in National Health Service Capital Charging
Authors: Heald D. , Scott D. A.
Published: January 2017

Capital charging was introduced into the National Health Service (NHS) in 1991 in order to stop capital being treated as a ‘free’ good and to encourage managers to use their assets more efficiently. This article seeks to examine the extent to which managerial thinking has been influenced. It uses as evidence interviews with NHS managers conducted in Scotland in 1994. The following uses of capital charges data are explored: capital programme; disposal programme; maintenance programme; contract pricing; and budgetary devolution. New capital programmes required more justification and capital charges were seen as relevant to estate rationalization. Less effect was found with regard to the maintenance programme, though this may have been due to a downgrading of the estates function in most Trusts. Although the capital charge costs included in contract prices affect the competitive position of providers, there was criticism of the lack of development of the purchasing function. Budgetary devolution was proceeding relatively slowly but, among those Trusts which had devolved capital charges, evidence was found that some clinicians were becoming aware of the full costs of equipment use. This article concludes, with cautious optimism, that capital charges are beginning to influence decisions and that, despite some incentives being dysfunctional, they will lead to a better managed NHS.
Rape and HIV
Authors: Claydon E , Murphy S , Osborne E M , Kitchen V , Smith J R , Harris J R W
Published: January 2017

The risk of contracting HIV infection as a result of rape is unknown. We describe 4 female patients who were found to have antibodies to HIV-1 following rape, only one of whom had another recognized risk factor for HIV infection. The need for careful follow-up of rape victims, and the potential for HIV acquisition by the assailant is discussed.
Human Papillomavirus DNA is Not Transmitted by Semen
Authors: Nieminen Pekka , Koskimies Aarne I , Paavonen Jorma
Published: January 2017

We studied by dot blot DNA hybridization semen samples of 17 regular partners of women with proven HPV infection and 16 controls, to find out whether the human papillomavirus (HPV) DNA is transmitted via semen. Although all women were positive for HPV DNA, the semen samples from their partners and controls were negative. This suggests that HPV DNA is not transmitted via semen.
Azithromycin vs Doxycycline in the Treatment of Non-Gonococcal Urethritis
Authors: Whatley J D , Thin R N , Mumtaz G , Ridgway G L
Published: January 2017

Azithromycin is a novel azalide macrolide active against Chlamydia trachomatis and Ureaplasma urealyticum. High persistent tissue concentrations allow short courses or even single doses to be considered. Sixty-two patients were studied, 19 received azithromycin 1 g in a single dose, 22 received azithromycin 500 mg in a single dose on day 1 followed by 250 mg once daily for 2 days and 21 received doxycycline 200 mg in a loading dose followed by 100 mg every 12 h for 7 days. Efficacy of these 3 regimens was compared in the treatment of non-gonococcal urethritis (NGU). Clearance of C. trachomatis from post-treatment cultures was satisfactory with all regimens. Response defined as the absence of symptoms and reduction in polymorphonuclear leucocytes in a Gram stained smear of urethral secretion to <5 cells per hpf (×100 objective) was statistically better for the 3 day regimen of azithromycin than for the other 2 regimens. All treatments were well tolerated. Three days or single doses of azithromycin compared to 7 days of tetracycline (or 10–14 days as is often prescribed) have obvious advantages for patient compliance.
Does First Episode Genital Herpes Have an Incubation Period? A Clinical Study
Authors: Thin R N
Published: January 2017

A retrospective survey of the notes of 146 patients with culture-positive first episode genital herpes simplex infection produced 37 men and 37 women in whom the incubation period could be established from their own and their partners' notes. In 9 patients the period was 1–12 days, in 20 men it ranged from 1 to 49 days and in 11 women from 1 to 28 days. In 7 patients it was much longer. In 28 patients a first episode of genital herpes developed during an ongoing monogamous relationship. These findings indicate that the incubation period of genital herpes may be longer than hitherto recognized and have implications for counselling and control.
Comparison of Ofloxacin and Metronidazole for the Treatment of Bacterial Vaginosis
Authors: Nayagam A T , Smith M D , Ridgway G L , Allason-Jones E , Robinson A J , Stock J
Published: January 2017

The efficacy and safety of ofloxacin, 200 mg twice daily for 7 days, was compared with metronidazole, 400 mg twice daily for 7 days, for the treatment of bacterial vaginosis (BV). Diagnosis of BV was confirmed by at least 3 of the following 4 criteria: the presence of an abnormal vaginal discharge on examination, clue cells on microscopy of vaginal specimens, vaginal pH>5.0 and a positive amine test. Vaginal specimens were examined for Mobiluncus spp, analysed for the succinate/lactate (S/L) ratio and cultured for Trichomonas vaginalis, Gardnerella vaginalis, Bacteroides spp. and Mycoplasma hominis. Patients were reviewed on completion of treatment (visit 2) and 14 days later (visit 3). The diagnosis of BV was accepted in 119 of 149 patients recruited, 60 of whom received treatment with ofloxacin and 59 received metronidazole. Sixty-two patients, 31 in each treatment group, completed the study. Diagnostic cure at visit 2 was significantly better in the metronidazole group with cure rates of 56% (metronidazole) vs 23% (ofloxacin) ( P=0.001); this was associated with higher eradication rates for G. vaginalis (100% vs 56%) and Bacteroides spp. (97% vs 49%). There were no significant differences between the two groups in clinical cure at either visit 2 or 3 or in diagnostic cure at visit 3. Both treatments were well tolerated. We conclude that metronidazole is likely to remain the first choice of treatment for BV but ofloxacin offers a safe and effective alternative.
Anogenital Non-Gonococcal Neisseriae: Prevalence and Clinical Significance
Authors: McKenna J G , Fallon R J , Moyes A , Young H
Published: January 2017

Over a 13-year period non-gonococcal neisseriae (NGN) were isolated from 114 of 88 670 patients (0.13%) screened for anogenital gonorrhoea at a Genitourinary Medicine Unit. During the same period there were approximately 9000 anogenital gonococcal infections (10%). The prevalence of NGN was 0.09% (27/31 500) in women, 0.04% (20/52 800) in heterosexual men and 1.5% (67/4370) in homosexual men: the differences in prevalence between women and heterosexual men ( P<0.01) and between heterosexual patients and homosexual men ( P< 0.001) are highly significant. Neisseria meningitidis was isolated most frequently and accounted for 85% (99/114) of the NGN. Whenever possible, N. meningitidis was serogrouped and its occurrence correlated with patient symptoms. Eleven of 18 heterosexual men who had meningococci isolated from their urethras had urethritis but co-existing chlamydial infection was excluded in only 5. None of 9 women with cervical colonization had clinical evidence of pelvic inflammation. Only one of 49 men with rectal colonization had proctitis. The management of anogenital NGN infection is discussed in relation to our findings and those of previously published studies.

Within each patient group the prevalence and incidence of anogenital NGN were similar at the beginning and end of the study period indicating that levels have not been influenced by the advent of AIDS.
Genital Human Papillomavirus Infections: Correlation of Cytological, Colposcopic and Histological Features with Viral Types in Women and Their Male Partners
Authors: Monsonego J , Zerat L , Catalan F , Coscas Y
Published: January 2017

To determine the incidence of anogenital papillomavirus infections and to assess the value of available diagnostic methods, we compared the cytological, colposcopic and histological features of anogenital papillomavirus-related lesions with their associated human papillomavirus types (HPV) in 300 women and in their male partners. HPV-type deoxyribonucleic acid was detected by blot hybridization in 398 out of 624 subclinical and clinically defined anogenital lesions.

Whatever the site of the lesion, condylomas and low-grade intraepithelial neoplasia (IEN) were found in 84% of lesions associated with HPV 6–11, compared with 32% of lesions containing HPV 16–18 ( P<0.001). Among the HPV 16–18 associated lesions, high-grade cervical, vaginal, vulvar and anal intraepithelial neoplasias represented 45% ( P<0.001) of the lesions. In 65% of 23 cases of squamous anogenital cancer, HPV 16–18 and mixed types were present ( P<0.001). In 54% (161/300) of cases, the lesions were multicentric (161/300). On cytological examination, 27% of the samples gave false negative results. In cervical lesions, there was a good correlation between virological and colposcopic findings, but this was not true for extracervical mucous epithelia in the vagina or on the vulva. With peniscopy in the male partners 220 out of 410 had penile condylomatous lesions and more than half of the 350 male specimens examined by molecular hybridization contained HPV DNA. A correlation was found between the virus types in penile lesions or in cells of the distal urethra and in the cervical lesions of the sexual partner. We concluded that in the majority of cases of cervical lesions there is a correlation between the type of HPV DNA identified by blot hybridization and the cytohistocolposcopic findings.

In practice, viral typing may be indicated in cases of colpohistologic discordance and in condyloma low-grade CIN that cannot be distinguished from presumably innocuous human papillomavirus infection.
Partner Notification for Human Immunodeficiency Virus Infection in Colorado: Results across Index Case Groups and Costs
Authors: Spencer NE , Hoffman R E , Raevsky C A , Wolf F C , Vernon T M
Published: January 2017

To evaluate human immunodeficiency virus (HIV) partner notification and referral across index case groups, we analysed results of services provided by the Colorado Department of Health during 1988. Services were offered to 231 index cases; 226 (98%) accepted; 124 (65%) with unsafe behaviours identified 239 partners; 79% of partners were notified; 68% accepted counselling. Seropositivity was 21% in newly tested partners. Index cases chose patient referral for 25% of partners and referred 20% of eligible partners; the provider referred 71%. Index case acceptance of service, proportion of index cases with newly identified HIV positive partners, and choice of partner referral method were similar across groups. Gay men identified fewer partners, had a lower proportion of partners accepting new counselling and testing and referred a lower proportion of partners than heterosexual men. The total costs of the service were $19 496. Twelve new cases of HIV were identified through patient and provider referral and cost per case identified was $1625. Partner notification and provider referral should be offered to all HIV infected individuals in Colorado, as few differences across groups emerged and only 20% of located and eligible partners received counselling through patient referral.
Beta-2 Microglobulin as a Marker of HIV Disease Status in Nairobi, Kenya
Authors: Garden G A , Moss G B , Emonyi W , Bwayo J , Velentgas P , Kreiss J
Published: January 2017

Serum beta-2 microglobulin (β2-M) has prognostic value similar to lymphocyte profiles for predicting disease progression in those infected with the human immunodeficiency virus (HIV). However, the relationship between β2-M and HIV disease progression among inhabitants of countries with endemic tropical diseases has not been evaluated. To determine the relationship between serum β2-M levels and HIV infection and disease status in an African population, serum β2-M levels were measured in 369 patients attending a sexually transmitted disease (STD) clinic in Nairobi, Kenya. Mean serum β2-M was significantly higher in HIV seropositive than in HIV seronegative individuals. Among HIV infected patients, higher mean β2-M levels were observed in those with HIV associated symptoms or laboratory markers of advanced HIV disease. Significant inverse correlations between β2-M and the percentage of CD4 lymphocytes or CD4/CD8 ratio were found. These findings suggest that β2-M measurements may have prognostic value for HIV infected populations in developing countries.
Human Papillomaviruses, Tumour Suppressor Genes and Cervical Cancer
Authors: Inman G J , Cook I D , Lau R K W
Published: January 2017

There is now a considerable body of evidence that links HPV infection with anogenital squamous carcinoma, particularly for specific ‘high risk’ HPV types (HPV16 and 18) and invasive carcinoma of the cervix. Recent advances in the molecular study of these viruses have elucidated some potential mechanisms by which they may contribute to the development of these diseases.

In this review we concentrate on the interactions of 2 of the HPV encoded proteins, E6 and E7, with cellular tumour suppressor gene products. We provide a model of how these interactions may be important in tumourigenesis and draw together current knowledge of this exciting and rapidly evolving field.
The Potential Requirement for HIV Counselling and Voluntary Testing in Women of Childbearing Age
Authors: Low Anne M , Lacey Charles JN , Buchan Peter C , Franks Antony J , Waugh Michael A
Published: January 2017

This paper compares estimates of the potential HIV counselling and testing requirements in a genito-urinary medicine (GUM) clinic, where a formal HIV counselling service is provided, and in an antenatal clinic (ANC), where there is no formal HIV counselling service. Data were collected by means of questionnaires completed by women attending both clinics.

Only 31% and 16% of counselling needs were being met at the GUM clinic and antenatal clinic respectively. At the GUM clinic 11% of respondents had had an HIV antibody test, and at the antenatal clinic 1% had been tested. In contrast 68% and 58% of respondents at the GUM and antenatal clinics respectively would accept the offer of an HIV antibody test.

In low prevalence areas the universal offer of testing would greatly increase specialist counselling requirements, but alternative models of provision and selective testing may lead to a more efficient use of resources.
A Unique Community of Family-Oriented Prostitutes in Nepal Uninfected by HIV-1
Authors: Bhatt P , Gurubacharya V L , Vadies G
Published: January 2017

In the Mid Western and Far Western regions of Nepal live a unique group of prostitutes which maintains strong bonds resulting from ‘untouchable’ caste status and family tradition. Known as the Badis (pronounced ‘bod ee’), it is estimated that well over 5000 Badi prostitutes are now actively engaged in the sex trade in Nepal. In 1991, a study of some of the social and cultural practices of this unique group was completed. In addition to the provision of counselling and information about STDs and AIDS, over 300 prostitutes were interviewed about their sex practices within the Badi community. Two hundred and twenty-eight Badi prostitutes consented to voluntary confidential testing for VDRL, and 250 consented to anonymous, unlinked serosurveillance for HIV-1. As previous studies have shown moderate to high rates of HIV-1 infection among prostitutes in general, and even higher rates of infection in low class prostitutes, some prevalence of VDRL as well as HIV-1 was expected. However, of the 228 Badi prostitutes tested, 154 (70%) were found to be VDRL positive, while none were found positive for HIV-1. At the same time, many of these prostitutes reported a history of constant and often untreated STDs. The implications for the future prevention of HIV infection in this group are obvious and striking. With immediate and effective STD treatment as well as counselling, the Badis represent one high risk group in which the global AIDS epidemic could be drastically reduced, or even averted.
Ondansetron Usage in HIV Positive Patients: A Pilot Study on the Control of Nausea and Vomiting in Patients on High Dose Co-Trimoxazole for Pneumocystis Carinii Pneumonia
Authors: Gompels M , McWilliams S , O'Hare M , Harris J R W , Pinching A J , Main J
Published: January 2017

This was an open, single centre study, to evaluate the safety and efficacy of ondansetron in the treatment of co-trimoxazole associated nausea and vomiting in AIDS patients. Sixteen patients presenting with their first episode of HIV-associated Pneumocystis carinii pneumonia (PCP) on high dose co-trimoxazole were given ondansetron 8 mg orally, every 8h. Measurements were made from data recorded by each patient on diary cards.

In this study 11 out of 16 (69%) patients on ondansetron experienced good control of emesis (2 or less emetic episodes) on their ‘worst day’ of therapy and 8 out of 16 (50%) of patients demonstrated good control of emesis throughout their treatment with co-trimoxazole. Good control of nausea (mild or none) was achieved in 7 out of 16 (47%) patients. A total of 7 patients were able to complete the full course of co-trimoxazole whilst on ondansetron. One serious adverse event (Stevens-Johnson syndrome) was reported and felt to be unrelated to ondansetron.

If conventional anti-emetics fail to achieve control of symptoms or have unacceptable side effects, ondansetron may represent a possible alternative.
A Study Comparing Cervical Cytology Results from a Genitourinary Medicine Department with Those of Two other Local Populations
Authors: Young S M , Malet R M
Published: January 2017

A retrospective study compared one year's cervical smear results from 4920 women from the following 3 populations in Leicestershire; the Genitourinary Medicine (GUM) Departments; the city family planning clinic (FPC); and a general practice (GP) in a local University town. The results were standardized for age by logistic regression. Cytological abnormality was divided into: dyskaryosis (all grades), borderline, and inflammatory changes.

The GUM attenders had an excess of total cervical smear abnormalities compared to both the FPC ( P<0.001) and GP population ( P<0.001) after adjusting for age. The FPC and GP rates of smear abnormality were similar at 60 and 63 per 1000 women screened, respectively, while the rate for the GUM clinic was 155 per 1000 women screened.
Chlamydial Urethritis in Heterosexual Men Attending a Genitourinary Medicine Clinic: Prevalence, Symptoms, Condom Usage and Partner Change
Authors: Zelin J M , Robinson A J , Ridgway G L , Allason-Jones E , Williams P
Published: January 2017

A prospective study of 356 consecutive heterosexual male patients attending the Department of Genitourinary Medicine at University College Hospital was carried out to determine the prevalence of Chlamydia trachomatis. Patients were asked about their symptoms, use of condoms and change of sexual partner.

The prevalence of non-gonococcal urethritis (NGU—chlamydia positive and negative urethritis) was 37% (131 of 356). C. trachomatis was shown to be the causative organism in 24% (31 of 131) of patients with NGU. The prevalence of other STDs in men with C. trachomatis and with non-chlamydial urethritis was 15% and 10% respectively. Men with C. trachomatis were significantly more likely than men with non-chlamydial urethritis to be asymptomatic (56% vs 35%).

The prevalence of C. trachomatis was highest in men who had changed partner in the previous 3 months (20 of 32 men). A third of men never used condoms in the first 3 months of a new relationship and over half failed to use them after 3 months. There was no evidence that the reported use of condoms reduced the rate of infection with C. trachomatis.
Syphilis and HIV Infection among Prisoners in Maputo, Mozambique
Authors: Vaz Rui Gama , Gloyd Stephen , Folgosa Elena , Kreiss Joan
Published: January 2017

A cross-sectional study was carried out among 1284 male and 54 female prisoners to assess the prevalence of and risk factors for sexually transmitted diseases (STD) in 4 correctional institutions of Maputo, Mozambique. Among the men, 32% reported a history of prostitute contact and 41% reported a history of STD. Only 9% reported having ever used condoms. Seventy (5.5%) men reported having had sexual intercourse while in prison, in all but one instance this involved sex with another man. There was no reported intravenous drug use. One hundred and four (7.8%) inmates had positive serological tests for syphilis and 8 (0.6%) had antibodies to HIV. Among men, syphilis was associated with a history of genital ulcer [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.4, 6.4] and uncircumcised status (OR = 1.5, 95% CI = 1.0, 2.5). This study demonstrates that syphilis is common among inmates in Maputo and that risk behaviours for STD transmission exist within Maputo prisons. There is a need for STD screening and treatment programmes within prisons in Mozambique and the introduction of educational interventions, including condom promotion.
Are You Sure It's Syphilis? A Review of False Positive Serology
Authors: Nandwani R , Evans D T P
Published: January 2017

This article on false positive serological reactions for syphilis reviews the rapid developments which have taken place in the serodiagnosis of syphilis in recent years since the advent of the AIDS epidemic. An overview of non-specific and specific treponemal serological tests in relation to acute and chronic biological false positive reactions is followed by closer consideration of syphilis serology in the context of HIV infection, pregnancy and other conditions which may produce false positive reactions.
Self-Treatment of Female External Genital Warts with 0.5% Podophyllotoxin Cream (Condyline®) vs Weekly Applications of 20% Podophyllin Solution
Authors: Hellberg Dan , Svarrer Tove , Nilsson Staffan , Valentin Jack
Published: January 2017

Sixty women with genital warts were randomly allocated to treatment with either weekly application of 20% podophyllin solution or self-treatment with 0.5% podophyllotoxin cream twice daily for three days in weekly intervals. After a maximum of 4 treatment cycles a final assessment was carried out after 3 months. Primary clearance after termination of treatment was 82% for podophyllotoxin and 59% for podophyllin solution. After excluding relapses at the 3-month follow-up, final clearance for podophyllotoxin (71%) was significantly better ( P < 0.05) than that for podophyllin solution (48%). The total frequency of warts eradicated was 94% with podophyllotoxin and 74% with podophyllin solution ( P < 0.001). Local adverse effects were generally mild or moderate. Podophyllotoxin cream provides a mode of easy application for women with external genital warts and had in this study a significantly better effect than podophyllin solution.
Sexually Transmitted Diseases and Human Immunodeficiency Virus Infection among Women with Genital Infections in Burkina Faso
Authors: Meda N , Ledru S , Fofana M , Lankoandé S , Soula G , Bazié A J , Chiron J P
Published: January 2017

This study reports the prevalence of sexually transmitted diseases (STDs) among gynaecological outpatients presenting at the Bobo-Dioulasso Hospital (Burkina Faso) with genital infections and examines the factors associated with HIV infection in this population. Of 245 eligible non-pregnant women, 220 consented to participate in the study. Seventy-seven per cent had sexually transmitted infections. The most common were: Trichomonas vaginalis (28%), Chlamydia trachomatis (27%), bacterial vaginosis (20%), Candida albicans (17%), Neisseria gonorrhoeae (11%). The prevalence of HIV infection was 42% (95% ci. 35.3, 48.3). Logistic regression analyses revealed Neisseria gonorrhoeae to be the only STD significantly associated with infection with HIV ( P = 0.04). A sedimentation rate greater than or equal to 100 mm in the first hour was also associated with HIV infection ( P < 0.001). Women consulting for genital infections constitute a high risk group for HIV infection and other STDs. Management of these women should focus on the early diagnosis and treatment of STDs.
Chlamydia Trachomatis as a Possible Cofactor for Kaposi's Sarcoma in AIDS
Authors: Peters B S , Thomas B J , Yi C , Beck E J , Weber J , Pinching A J , Taylor-Robinson D
Published: January 2017

AIDS-associated Kaposi's sarcoma (KS) is much more frequent in patients acquiring HIV infection via the sexual route. Epidemiological studies have confirmed the likely involvement of a sexually acquired cofactor in the pathogenesis of this form of KS. We have formulated a set of postulates, epidemiological and experimental, to fit a single unifying hypothetical agent. Chlamydia trachomatis is one of 3 agents to fit the epidemiological criteria. Our data suggest a possible association between increased IgG serum antibody to C. trachomatis and the occurrence of KS. Conversely, higher titres of IgG serum antibody to C. pneumoniae were associated with the absence of KS. We feel that it is important to study further the relationship between C. trachomatis and KS.
Psychosocial Differences between Recently HIV Tested and Non-Tested Gay Men Who Reside in Smaller US Cities
Authors: Heckman T G , Kelly J A , Roffman R A , Sikkema K J , Perry M J , Solomon L J , Winett R A , Norman A D , Hoffmann R G , Stevenson L Y
Published: January 2017

While a number of studies have examined behavioural and psychosocial correlates of HIV test seeking, most of this research has relied on samples of urban gay men. Less is known about HIV testing rates and factors associated with testing among gay and bisexual men who live in smaller cities. The present research administered surveys to 3969 non-exclusively partnered gay and bisexual men attending gay bars in small American cities to determine (a) rates of HIV test seeking, and (b) how tested and non-tested men differed on a battery of psychosocial indices. A total of 68% of men had been tested for antibodies to HIV-50% in the past year. Men tested for HIV in the past year, compared to men never tested for HIV, knew more people who were HIV positive or were diagnosed with AIDS, had a closer relationship with someone who had died of AIDS, were more likely to be ethnic minorities, reported more conversations with friends about safer sex, and had stronger intentions to use condoms during their next intercourse occasion. Our results indicate that HIV counselling and testing programmes comprise an important component of HIV prevention efforts assisting gay men residing in smaller USA cities.
Prevalence of Blood-Borne Viruses among Intravenous Drug Users and Alcoholics in Hiroshima, Japan
Authors: Ichimura Hiroshi , Kurimura Osamu , Tamura Ikuo , Tsukue Ichiro , Tsuchie Hideaki , Kurimura Takashi
Published: January 2017

We investigated the prevalence of human immunodeficiency viruses-1 and 2 (HIV-1 and HIV-2), human T-lymphotropic virus type I and II, hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus among intravenous drug users (IVDU) in Hiroshima, Japan, where little is known about their present levels. From June to December 1993, serum samples were collected from 47 IVDU and 98 alcoholics in Hiroshima, Japan, and examined for markers of virus infection. The prevalence of antibody to HCV (anti-HCV) and/or HCV-RNA was significantly higher in IVDU than alcoholics (74.5% vs 20.4%, 44.7% vs 10.2% respectively, P < 0.001). In contrast, the prevalence of antibody to hepatitis B surface antigen and/or core antigen (anti-HBs and/or anti-HBc) showed no significant difference between the 2 groups (57.4% vs 66.3%). HIV-1 infection was found in one (2.1%) IVDU and genome analysis indicated that it was subtype B according to Myers' classification. Thus, an extremely low level of HIV infection and a high level of HCV infection was found in IVDU. Careful follow-up of this group is thought to be needed to minimize an outbreak of HIV-1 infection in Japan.
Lifetime Cost of Treating a Person with HIV Infection
Authors: Jebakumar S P R , Woolley P D , Curless E
Published: January 2017

A study was conducted to examine the inpatient, outpatient and drug therapy costs incurred from initial presentation with HIV infection or AIDS to death, where death occurred between 1990 and 1994. The average lifetime cost per patient was £18,729 being made up of £8428 for inpatient care, £2086 for outpatient care and £8215 for drug therapy. Sixty per cent of patients died at home. Active cytomegalovirus infection was the most common condition encountered in the high cost patients. Escalating drug costs may eventually lead to priority setting for the management of certain opportunistic infections.
Possibilities and Limits in The Monetarisation of External Costs of Energy Use
Authors: Schlomann Barbara
Published: January 2017

The use of energy leads to so-called external costs and benefits which are not covered by the present energy prices. A major part of the energy-related external costs is caused by damage from environmental pollution stemming from energy conversion and energy use. In order to internalise these costs into the energy prices (e.g. by emission standards or energy taxes), it is necessary to identify, quantify, and also monetarise them.

This paper is an overview of attempts to monetarise energy-related environmental costs in the FRG, clearly showing the limited state of art in this field. Also, methodological problems of monetarisation are referred to showing different methods (damage cost approach, control cost approach, willingness-to-pay approach) which all have their specific drawbacks. One insufficiency associated with all approaches applied is the long-term impacts of environmental damage not being adequately reflected.
Allocating Sulfur Dioxide Emission Reductions for Acid Deposition Control: An Assignment Problem Formulation
Authors: Briassoulis Helen
Published: January 2017

The allocation of sulfur dioxide emission reductions for the purpose of controlling acid deposition has been based on several criteria, one of which is minimization of the cost of control measures. The paper reviews two of the most well known methodological approaches and suggests a new one based on the prototype idea of the assignment problem. The assignment problem formulation addresses the question of how to assign one and only one emissions reduction amount to one and only one source region within a system of regions relevant for the control of acid deposition, in a way that minimizes the total costs of control. The methodology based on this framework is described and the analytical procedure to be followed in applications is detailed. An illustrative example of the application of the methodology and its sensitivity to different deposition and control cost structures is given. The paper concludes with remarks on the proposed methodology and suggestions for further research.
Relevance of carcinogenicity bioassays in mice in assessing potential health risks associated with exposure to methylene chloride
Authors: Liteplo Robert G , Long G W , Meek M E
Published: January 2017

Considerable research has been conducted to identify possible mechanisms of the carcinogenicity of methylene chloride in rodents, and to ascertain whether the observed increased incidences of liver and lung tumours in mice exposed to this substance, are relevant in assessing the potential hazards and risks to human health. On the basis of a study that purported to show qualitative differences between murine and human tissues, in the subcellular localization of the Theta-class glutathione S-transferase enzyme responsible for converting methylene chloride to a putative highly unstable, but reactive genotoxic metabolite, it was suggested that the mouse is an inappropriate model for human health risk assessment. However, other studies conducted in vitro with intact cells do not support the hypothesis that a putatively reactive metabolite of methylene chloride must be generated only within the nucleus in order to be able to interact with genomic DNA. Moreover, investigations employing semi-quantitative methods of mRNA hybridization are not convincing in identifying the subcellular localization of active Theta class glutathione S-transferase, and do not support the hypothesis of the differential subcellular localization of this enzyme within the nucleus of mouse, but not human cells. There is therefore, insufficient evidence to support the view that qualitative differences between humans and mice in the subcellular distribution of Theta-class glutathione S-transferase, renders carcinogenicity studies conducted with mice irrelevant in human hazard identi-fication and risk assessment.
Transgenerational effect of a single neonatal benzpyrene treatment on the glucocorticoid receptor of the rat thymus
Authors: Csaba György , Inczefi-Gonda Ágnes
Published: January 2017

Hormonal imprinting is provoked perinatally by the appropriate hormone on its receptor, causing a life-long adjustment of the connection between the two participants. Faulty imprinting is caused by the presence of molecules similar to the hormone in this critical period, which results in a persistent alteration of the receptor. In the present experiment the transgenerational imprinting effect of a steroid-like environmental pollutant, benzpyrene, on the receptor binding capacity of filial thymic dexamethasone and uterine estrogen receptors was studied. The receptor density (Bmax) of the thymic glucocorticoid receptors of the males was reduced up to the third (F2) generation. In females this reduction was observed only in the F1 generation of treated animals. There was no change in receptor affinity (Kd). Uterine estrogen receptors were not subjected to transgenerational imprinting. The experiments demonstrate (1) the possibility of the transgenerational transmission of imprinting effect, (2) the differences of steroid receptors in different organs, and (3) the differences of male's and female's reactions from this aspect. The results call attention to the dangers of perinatal aromatic hydrocarbon exposition to the progeny generations.
Composition and toxicity of petroleum products and their additives
Authors: Henry John A
Published: January 2017

1 All petroleum based products are highly complex chemical mixtures. Although almost exclusively composed of hydrocarbons, the composition varies with the crude oil source.

2 Their toxicity for man is generally low but there are exceptions. Although irritancy and sensitization to specific ingredients may be demonstrated in animals, animal experiments are not a reliable indicator of sensitization potential in man.

3 Both product complexity and commercial considerations can make acceptable and meaningful compositional disclosures difficult. A nomenclature system exists which solves these problems.

4 Frame formulations would have some value to poisons centres dealing with petroleum product enquiries.

5 As legislation for the European Union is developed, the balance must be reached between disclosure of the (often confidential) precise chemical composition of products and a practical and useful composition for the guidance of users and medical personnel. This is a key issue with some petroleum products, mainly due to the additives used in them.

6 For several reasons, such as climatic conditions or logistics of supply, the various components, including additives, used in a branded product may vary because the final product composition is determined not by chemistry but by performance in service.

7 Lubricants may contain between 10 and 20% of additives; fuels contain additives only at parts per million levels. However, for both fuels and lubricants, toxicity from additives is rarely a matter of concern.
Human ochratoxicosis and nephropathy in Egypt: A preliminary study
Authors: Wafa E W , Yahya R S , Sobh M A , Eraky I , El-Baz M , El-Gayar H AM , Betbeder A M , Creppy E E
Published: January 2017

This preliminary study was designed in a trial to delineate the size of the problem of ochratoxicosis and its relation to genesis of lesions mounting to end stage renal disease (ESRD) or urothelial tumors in Egypt. This study comprised five groups of patients having renal diseases of different presentations; they are: patients with (ESRD) under conservative medical treatment (group 1), patients with (ESRD) under treatment with regular hemodialysis (group 2), renal allograft recipients (group 3), patients with nephrotic syndrome (group 4) and patients with urothelial tumors (group 5). In addition, two reference groups: potential related donors for renal transplantation (group 6) and healthy control with negative family history of renal disease (group 7).

For all groups, laboratory, radiological and histopatho-logical evaluation of kidney status were carried out coupled with determination of ochratoxin A level in serum, in urine and in biopsy specimens of patients with urothelial tumors.

High ochratoxin serum levels were found in patients with ESRD (groups 1 and 2) (P50.01), higher serum levels were detected in the group without dialysis (group 1) in comparison with the reference groups possibly due to ochratoxin. A clearance by dialysis. Ochratoxin A was detected in serum and urine of renal transplant recipients (group 3) (P50.01) and especially higher levels were found in patients with nephrotic syndrome (group 4) (P50.001). For the group with urothelial tumor (group 5), positive serum, urine and tissue biopsy specimens for ochratoxin levels were found (P50.01).

The results could lead to the conclusion that ochratoxin A could be correlated to the genesis of renal disease leading to (ESRD) or causing urothelial cancer. A thorough and in depth study of the problem of ochratoxicosis and renal disease causation in Egypt is now recommended.
Mechanistic model predicts a U-shaped relation of radon exposure to lung cancer risk reflected in combined occupational and US residential data
Authors: Bogen Kenneth T
Published: January 2017

A mechanistically based cytodynamic two-stage (CD2) cancer model was shown recently to predict both ecologic US county data and underground-miner data on lung-cancer mortality (LCM) vs radon concentration, indicating biological plausibility of the apparent negative dose-response relation exhibited by the ecologic data.6 To further investigate this hypothesis, the CD2 model was fitted to combine age-specific LCM data vs estimated radon-exposure in white females of age 40+ years in 2821 US counties during 1950-1954 using new estimates of county-specific mean residential radon exposure, and in five cohorts of underground nonsmoking miners. The negative association of radon levels and corresponding county-level LCM rates apparent in women dying in 1950-1954 (11% of whom never smoked) was also apparent in women of age 60+ years (5% of whom never smoked). The CD2 fit obtained to the combined residential and occupational data was found to predict the combined data using biologically plausible parameter values, and also to predict inverse dose-rate effects exhibited in nonsmoking miner data to which the CD2 model was not fit. These results are consistent with the hypothesis that residential radon exposure has a nonlinear U-shaped relation to LCM risk, and that current linear extrapolation models substantially overestimate such risk.
Frequency of flutamide induced hepatotoxicity in patients with prostate carcinoma
Authors: Çetin Mustafa , Demirci Deniz , Ünal Ali , Altinbaş Mustafa , Güven Muhammed , Ünlühizarci Kürşat
Published: January 2017

To identify and describe the frequency and severity of hepatotoxicity in patients who received flutamide therapy for prostate cancer, 22 patients were treated with the combination of flutamide and goserilin or orchiectomy. After diagnosis and staging of prostate cancer, baseline results were obtained for a set of five liver function tests (LF Ts). Hepatotoxicity was assessed according to the WHO criteria. After initiation of flutamide therapy, LF Ts were performed at 4, 8 and 12 weeks and every 2 months thereafter. Severe hepatotoxicity appeared in two of 22 (9%) patients. Following the discontinuation of flutamide, one patient died due to acute liver failure. On the other patient an improvement of LF Ts occurred after cessation of flutamide. The observed severe hepatotoxicity in two of 22 (9%) patients occurred more frequent than is predicted in the literature. Patients treated with flutamide, having symptomatic or asymptomatic liver enzyme elevations, should be taken off therapy as soon as possible.
Non-parametric comparison of relative versus cause-specific survival in Surveillance, Epidemiology and End Results (SEER) programme breast cancer patients
Authors: Gamel John W , Vogel Robert L
Published: January 2017

Cancer-related mortality can be measured by two dissimilar methods: NAcause-specific survival (based on mortality attributed to a specific cause), and relative survival (based on mortality relative to a matched cohort). We used both methods to determine actuarial survival in a population of 119 502 breast cancer patients from the Surveillance, Epidemiology and End Results (SEER) programme data set, with 20 years of follow-up. The population was divided into four strata by patient age and tumour stage. In all strata, there was only minimal deviation between the two survival methods. Of particular interest was the cause-specific treatment of patients recorded as dead of unknown cause, i.e. those deaths that could not be attributed with certainty to either ‘breast cancer’ or to ‘other causes’. Findings suggest that the most reliable results may be obtained by apportioning these deaths between ‘dead of cause’ and ‘withdrawn at the time of death’. This apportionment is based on the relative number of deaths attributed to ‘breast cancer’ versus ‘other causes’.
Statistical methods in genetic research on smoking
Authors: Heath Andrew C , Madden Pamela AF , Martin Nicholas G
Published: January 2017

A growing body of evidence suggests that genetic factors have an important influence on the onset and course of smoking. Here we review some of the statistical methods that have been used to test for genetic influences on smoking behaviour, with a particular focus on studies of large national twin samples. We show how many of the hypotheses that have been tested using a genetic model-fitting approach have also been reformulated using logistic regression models that will be more familiar to epidemiologists. Such an approach is more easily extended to allow for sociocultural, as well as genetic, influences on smoking behaviour. Using either approach, data are consistent in indicating that certainly in men, and possibly in women, genetic factors play an important role in predicting which individuals who become cigarette smokers progress to being long-term persistent smokers.
‘It seems he is an Enthusiast about Tibet’: Lieutenant-Colonel James Guthrie, OBE (1906–71)
Authors: McKay Alex
Published: January 2017

Of the more than 20 officers of the Indian Medical Service who served in Tibet during 1904–50, when British Indian diplomats were stationed in that Himalayan state, James Guthrie was perhaps the most successful both in gaining the goodwill of the Tibetans and in advancing the reputation of medicine there. A Scotsman, Guthrie served in various military hospitals in India before his posting to Gyantse in southern Tibet in 1934–36, and during World War II he rose to be Assistant Director of Medical Services at the 10th Army headquarters in Teheran and Baghdad. Guthrie preferred the more remote imperial postings, however, and in 1945 he was posted to the Tibetan capital of Lhasa as Medical Officer to the British mission there. With his wife, who had nursing experience, he remained there until 1949, enjoying the variety of medical challenges and displaying an ability to accommodate Tibetan cultural beliefs within the practice of medicine. After service in Kuwait he returned to the UK, where he practised in the Shetland Islands for five years before establishing his own practice near Lyme Regis, where he died in 1971.
Florence Rena Sabin (1871–1953), William Osler (1849–1919) and Tuberculosis
Authors: Wooley Charles F
Published: January 2017

Florence Rena Sabin received her MD from the Johns Hopkins University in 1900. She was one of the first women to become a medical intern at Johns Hopkins and worked for the year of her internship (1900–01) under William Osler. At Johns Hopkins from y>1902 to 1925, Sabin studied embryology and histology with mentor Franklin Mall. She became the first woman professor of histology at an American school. Recruited to the Rockefeller Institute (1925), she focused on tuberculosis immunology, tubercle-bacillus biochemistry and haematology. She was the first woman department head at the Rockefeller and, in 1925, the first woman elected to the National Academy of Sciences. Settling in Colorado in 1938, she entered public health, emphasizing tuberculosis control. She received the Trudeau Award in 1945 and the Lasker Award in 1951. Her experience with tuberculosis under Osler's tutelage defined the shape of her work in basic tuberculosis research and in public health.