bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Aspects of Hemimegalencephaly by Means of a Nationwide Survey
Authors: Sasaki Masayuki , Hashimoto Toshiaki , Furushima Wakana , Okada Mari , Kinoshita Satoru , Fujikawa Yoshinao , Sugai Kenji
Published: January 2017

We surveyed Japanese patients with hemimegalencephaly by means of a questionnaire. Clinical findings, including intellectual and motor function levels and epileptic symptoms, were investigated. All 44 patients (28 males and 16 females) with hemimegalencephaly were sporadic. Sixteen patients had underlying neurocutaneous syndromes. The number of patients with right-sided hemimegalencephaly ( n = 29) was almost twice that of patients with left-sided hemimegalencephaly ( n = 15). Forty-one patients had mental retardation and hemiparesis and 14 patients were bedridden. All patients had epileptic seizures, which first appeared within a month in 18 cases and within 6 months in 11 cases. In 42 patients, magnetic resonance imaging revealed both cortical and white-matter abnormalities in the affected hemisphere. Antiepileptic drugs were not very effective. Fifteen patients were surgically treated. Eleven patients underwent functional hemispherectomy, which resulted in fairly good seizure control and improved development. There is a correlation between the onset of epilepsy and the degree of clinical severity of motor deficit and intellectual level. Neither underlying disorders nor laterality of the affected side was related to the degree of clinical severity. ( J Child Neurol 2005;20:337—341).
Pathologic Features of Dysplasia and Accompanying Alterations Observed in Surgical Specimens from Patients with Intractable Epilepsy
Authors: Kakita Akiyoshi , Kameyama Shigeki , Hayashi Shintaro , Masuda Hiroshi , Takahashi Hitoshi
Published: January 2017

Malformations caused by abnormalities of cortical development, or cortical dysplasias, were examined in surgical specimens from 108 patients with medically intractable epilepsy to determine the scope of histopathologic changes. The relevance of the clinical findings was also evaluated. Various types and degrees of dysplastic features were observed in various combinations, including architectural abnormalities, an increased number of neurons in the molecular layer and/or cortical layer II, neuronal clustering, an increased number of satellite oligodendrocytes, abnormal gyration, single and/or aggregates of heterotopic neurons in the white matter, and the appearance of cytologically abnormal cells, such as giant or dysmorphic neurons and balloon cells. In the temporal lobe specimens, microdysgenesis (corresponding to mild malformations caused by abnormalities of cortical development and type IA/B focal cortical dysplasias) was more frequently observed than Taylor-type focal cortical dysplasia (type IIA/B), whereas in the frontal lobe specimens, the frequency of occurrence of both types was even. The ages at seizure onset and surgery of patients with the latter type were significantly lower than those of patients with the former. On the other hand, prominent astrocytosis in the cortex and white matter was evident in all cases, and many corpora amylacea and neurofibrillary tangle—like inclusions were observed in a subset of cases. An ultrastructural investigation revealed dilatation of the postsynaptic dendritic spines and shafts in the cortex and features indicating the occurrence in the white matter of demyelination followed by remyelination. Thus, with regard to the epileptogenic lesions, although dysplastic changes constitute the pathogenetic basis, the overlapping subsequent degenerative processes involving synapses, dendrites, and axons might contribute to the development of epileptogenic processes. Astrocytes might also actively participate in the development of the pathogenesis of epilepsy. ( J Child Neurol 2005;20:341—350).
Electroencephalographic Recordings of Focal Seizures in Patients Affected by Periventricular Nodular Heterotopia: Role of the Heterotopic Nodules in the Genesis of Epileptic Discharges
Authors: Battaglia Giorgio , Franceschetti Silvana , Chiapparini Luisa , Freri Elena , Bassanini Stefania , Giavazzi Alessio , Finardi Adele , Taroni Franco , Granata Tiziana
Published: January 2017

Patients affected by periventricular nodular heterotopia are frequently characterized by focal drug-resistant epilepsy. To investigate the role of periventricular nodules in the genesis of seizures, we analyzed the electroencephalographic (EEG) features of focal seizures recorded by means of video-EEG in 10 patients affected by different types of periventricular nodular heterotopia and followed for prolonged periods of time at the epilepsy center of our institute. The ictal EEG recordings with surface electrodes revealed common features in all patients: all seizures originated from the brain regions where the periventricular nodular heterotopia were located; EEG patterns recorded on the leads exploring the periventricular nodular heterotopia were very similar both at the onset and immediately after the seizure's end in all patients. Our data suggest that seizures are generated by abnormal anatomic circuitries, including the heterotopic nodules and adjacent cortical areas. The major role of heterotopic neurons in the genesis and propagation of epileptic discharges must be taken into account when planning surgery for epilepsy in patients with periventricular nodular heterotopia. ( J Child Neurol 2005;20:369—377).
Recurrent Intractable Seizures in Children With Cortical Dysplasia Adjacent to Dysembryoplastic Neuroepithelial Tumor
Authors: Sakuta Ryoichi , Otsubo Hiroshi , Nolan Melinda A. , Weiss Shelly K. , Hawkins Cynthia , Rutka James T. , Chuang Nathaniel A. , Chuang Sylvester H. , Carter Snead O.
Published: January 2017

The purpose of this study was to identify the pathologic features that predict postoperative outcome in children with cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumors. We reviewed the records of children with dysembryoplastic neuroepithelial tumor who underwent epilepsy surgery and who had at least 1 year of surgical follow-up. We divided the dysembryoplastic neuroepithelial tumors into three pathology classes (simple, complex, and nonspecific), categorized adjunctive cortical dysplasia into four types, and compared histopathology with seizure outcomes. We identified 26 children with dysembryoplastic neuroepithelial tumors. Dysembryoplastic neuroepithelial tumors were complex in 19 patients (73%), simple in 6 (23%), and nonspecific in 1 (4%). Cortical dysplasia was adjacent to dysembryoplastic neuroepithelial tumors in 18 patients. Six patients had type IA cortical dysplasia, 5 had type IB, 3 had type IIA, and 1 had type IIB. The 3 remaining patients had repeated surgeries; of these, 2 patients had cortical dysplasias of type IA/IB and 1 was type IIA/IIB. Eight (39%) of 18 patients with dysembryoplastic neuroepithelial tumors and cortical dysplasia required further surgery for recurrent intractable seizures ( P < .05), whereas none of 8 patients without cortical dysplasia required additional surgery. Of 13 patients with type I cortical dysplasia, only 4 had a poor seizure outcome, whereas all 5 patients with type II had a poor seizure outcome postoperatively ( P < .05). Children with dysembryoplastic neuroepithelial tumor and cortical dysplasia often had recurrent intractable seizures postoperatively and required further epilepsy surgery. Cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumor can play a role in the epileptogenicity of dysembryoplastic neuroepithelial tumor. Complete resection of a dysembryoplastic neuroepithelial tumor and its adjacent cortical dysplasia should be considered. ( J Child Neurol 2005;20:377—384).
Polymeric micelles based on PEGylated chitosan-g-lipoic acid as carrier for efficient intracellular drug delivery
Authors: Liu Gongyan , Li Kaijun , Wang Haibo
Published: January 2017

To develop a drug delivery system with long circulation and controlled drug release in cancer cells, polymeric micelles based on PEGylated chitosan-g-lipoic acid were prepared to use as a drug delivery platform. These micelles possessed good stability and were stable in physiological environment and high salt concentrations. The in vitro drug release results implied that the drug carrier could maintain their stability and minimize the payload leakage in systemic circulation, but release drugs faster under intracellular redox condition. Furthermore, the cellular uptake and therapeutic efficacy of the drug carrier were evaluated in vitro, and the results demonstrated that the drug carrier could escape from the endo/lysosomes of tumor cells effectively and present high cytotoxicity to tumor cells. Therefore, this drug delivery system has the potential to serve as a drug carrier for cancer therapy.
Gastrointestinal Decontamination
Authors: Oderda Gary M.
Published: January 2017

Gastrointestinal decontamination plays an important role in the management of poisoned patients. The use of ipecac syrup has declined, and the use of activated charcoal has increased, during the period 1983 to 1991. If an emetic is used, ipecac syrup is the emetic of choice. If gastric emptying is done in an emergency department, gastric lavage is preferred. Recent studies in animals, human volunteers, and poisoned patients suggest that activated charcoal and a cathartic is as effective, or more effective, than ipecac or lavage plus activated charcoal and a cathartic. As such, activated charcoal and a cathartic should be considered the primary decontamination procedures to be used in a hospital.
Longitudinal Assessment of Cocaine Toxicity in Emergency Department Patients
Authors: Watson William A.
Published: January 2017

Longitudinal data are necessary to identify changes in drug abuse and resultant toxicity. The development of COC-LOG, a longitudinal database used to assess cocaine-associated emergency department patient visits at Truman Medical Center, the University of Missouri-Kansas City, is described. COC-LOG currently contains 1,054 patient visits. The data demonstrate that cocaine toxicity has remained relatively constant in our emergency department (ED) over the last 4 years. The majority of cocaine use is through smoking crack, and major differences in toxicity are not seen between this route and IV cocaine use. The relatively low prevalence of severe cardiac toxicity and deaths has lead to a series of projects to evaluate cocaine toxicity's clinical course. Electrocardiographic abnormalities are common, but do not frequently indicate severe clinical toxicity. In the first 3 years after ED discharge, deaths in cocaine patients occur almost twice as frequently as in age-, race-, and sex-matched control ED patients. Urine drug testing of pregnant patients suggests that documentation of recent cocaine use by history alone underestimates the prevalence of cocaine use in ED patients approximately four-fold. COC-LOG is a useful method of following cocaine's impact on department patients. Study results can be applied to patient care and the education of ED faculty, residents, students, and personnel.
Clinical Utility of Toxicology Testing
Authors: Krenzelok Edward P.
Published: January 2017

Toxicology testing is an extremely valuable asset to the pharmacist in the evaluation and management of the poisoned patient. There is extensive use of toxicology screens and expensive and time-consuming quantitative analysis for toxins that could be more appropriately directed by the pharmacist who has an extensive background in toxicokinetics and pharmacology. Application of the results of toxicology testing by the pharmacist can contribute to decisions regarding the patient's therapy and prognosis.
Quality of Service in Nursing Homes
Authors: Curry A. , Stark S.
Published: January 2017

This paper illustrates the relevance of using the Servqual instrument as a service quality measurement tool in the healthcare context. The expectations and perceptions of nursing home residents and their relatives are compared and contrasted to determine the priorities and satisfaction levels of both groups with respect to the services provided. Some interesting differences emerged between the two respondent groups, which gave more accurate and relevant pointers as to potential areas of future improvement. Because a number of nursing homes were surveyed, it was also possible to ascertain which homes might serve as useful examples of the best practice and which were in need of improvement action. In frail, elderly respondent groups it is not especially easy to elicit views as to quality of service. Servqual, carefully and sympathetically designed and applied, proved appropriate for this task.
The Effects of Structure, Strategy and Market Conditions on the Operating Practices of Physician-Organization Arrangements
Authors: Alexander J. A. , Vaughn T. E. , Burns L. R.
Published: January 2017

Research to date has documented weak or inconsistent associations between market and organizational factors and the adoption of physician-organization arrangements (POAs) (e.g. physician-hospital organizations, management service organizations and independent practice associations) designed to increase physician integration. We argue that POAs may mask considerable variation in how these entities are operated and governed. Further, because the operating policies and practices of POAs are likely to influence more directly the behaviour of physicians than the structural form of the POA, they may be more sensitive to the market and organizational contingencies that encourage integration. This study attempts to test empirically the relative effects of POA type and market, strategic and organization factors on the operating policies and practices of market-based POAs. Results suggest that type of POA, and market, strategic and organizational factors affect risk sharing, physician selection practices, physician monitoring practices and ways in which monitoring information is used to influence physician behaviour in POAs.
The Relationship between Hospital Characteristics and the Cost of Hospital Care
Authors: Rivers Patrick Asubonteng , Bae Sejong
Published: January 2017

This article examines the relationship between hospital characteristics and costs of hospital care, using the 1991 American Hospital Association Annual Survey of Hospitals. The results discussed herein have implications for hospital executives, researchers and policymakers.
Enzywell Recombinant Enzyme Immunoassay for the Serological Diagnosis of Syphilis
Authors: Young H , Aktas G , Moyes A
Published: January 2017

The aim of this study was to evaluate Enzywell TP, a new rapid enzyme immunoassay (EIA) that uses 2 recombinant Treponema pallidum antigens for the serological diagnosis of syphilis. Specificity was evaluated by screening 1055 unselected bloods requesting serological tests for syphilis in parallel with Enzywell TP and the Syphilis ICE EIA which is our standard screening test for syphilis. Sensitivity was evaluated using a panel of 159 known treponemal sera representing various stages of syphilis and 5 treponemal sera detected on screening. The specificity of Enzywell TP on initial and repeat testing (99.6% and 99.7% respectively) was similar to that of the Syphilis ICE test (99.8% and 99.9% respectively). The sensitivity of Enzywell TP (100%) was similar to that of Syphilis ICE (99.4%): both tests were significantly more sensitive ( P=0.01) than the fluorescent antibody absorbed test (94.5%) but not the T. pallidum particle agglutination (TPPA) assay (99.4%). Both Enzywell TP and Syphilis ICE were positive with sera from 16 known HIV-infected patients who had been treated for syphilis many years previously (mean 9.4 years) confirming the value of these tests in excluding previous syphilis in HIV-infected individuals. We conclude that the Enzywell recombinant EIA is simple, rapid, highly sensitive and specific, and is a welcome addition to the range of currently available diagnostic tests for syphilis.
Uptake of HIV Testing and Treatment in an Isolated Population with Access to Free and Universal Healthcare
Authors: Gillieatt Sue J , Mallal Simon A
Published: January 2017

This Western Australian study analysed clinical information from 344 people with AIDS, and experiential data from a sample of 36 people with AIDS to investigate 2 relevant issues: the timing of HIV testing and uptake and experiences of HIV drug treatment. We found that the proportion of people presenting with AIDS before being diagnosed with HIV infection (‘AIDS-presenters’) fell from 47% in 1985–1987 to 20% in 1991–1993. Since antiretroviral therapy (ART) became available in 1987, two-thirds of Western Australian people with AIDS who knew of their HIV infection prior to the development of AIDS have consistently elected to take recommended HIV treatment. Four phases of the treatment experience were identified. It is concluded that ‘AIDS-presentation’ is unlikely to reduce further and that the timing of testing and issues of treatment acceptance are only understood when the experiences of people with illness are examined using a patient-centred approach.
Occurrence and Treatment of Mycoplasma Genitalium in Patients Visiting STD Clinics in Sweden
Authors: Johannisson G , Enström Y , Löwhagen G-B , Nagy V , Ryberg K , Seeberg S , Welinder-Olsson C
Published: January 2017

Two hundred and thirty-three men and 85 women visiting STD clinics in western Sweden between April 1997 and March 1998 were examined for Mycoplasma genitalium and Chlamydia trachomatis. The bacteria were identified by the polymerase chain reaction (PCR) technique. Three women (3.5%) and 18 men (7%) were positive for M. genitalium. Seventeen (14%) of the 115 men with urethritis were infected but only one of the men was without urethritis. After treatment with tetracyclines for 10 days, one woman and 8 of the 13 men still harboured M. genitalium. M. genitalium-infected men did not have more life-time partners than other men visiting STD clinics. More men positive for M. genitalium gave a history of previous urethritis but the difference was not significant.
Epidemiology of Syphilis in Hungary between 1952 and 1996
Authors: Várkonyi Viktória , Tisza Timea , Horváth Attila , Takácsy Teréz , Berecz Margit , Kulcsár György , Sárdy Miklós
Published: January 2017

Trends in morbidity from syphilis in Hungary between 1952 and 1996 were analysed. The incidence of syphilis/100,000 inhabitants declined rapidly owing to the public health and therapeutic measures of the early 1950s (1952: total=73.6, early infections=60.2; 1962: total=13.7, early infections=8.7). After a temporary, slight increase until 1973 the number of reported syphilis cases declined continuously between 1978 and 1989 (1989: total=0.9, early infections=0.84). In 1994 a marked increase occurred when compared with 1993 (1993: total=early: 1.4. 1994: total=2.3, early infections=2.2).

Incidence trends were statistically analysed using Chi-square test and linear regression. Chi-square analysis showed that the changes in the incidence of total and early syphilis are significant ( p<0.00001) comparing the time intervals 1952–1962 with 1962–1966 and 1975–1979 with 1988–1992. The same trends were found using the linear regression test, except for the time interval of 1960–1973.
Amyl Nitrite Induced Acute Haemolytic Anaemia in HIV-Antibody Positive Man
Authors: Costello Christine , Pourgourides Effie , Youle Mike
Published: January 2017

Volatile nitrites (amyl and butyl) are popular recreational drugs, especially in the homosexual population. Haemolytic anaemia is a rare complication of nitrite inhalation and occurs when the reducing capacity of the red cell enzymes is overcome by the oxidizing effect of the nitrite. We describe here a patient with HIV infection who developed a profound haemolytic anaemia after repeated inhalation of large quantities of amyl nitrite.
Short-Term Prediction of HIV Infection and AIDS: A Critique of the Working Group's Report to the Department of Health
Authors: Rees Malcolm
Published: January 2017

The Report of the Working Group on the Short-Term Prediction of AIDS/HIV (the Cox Report) is reviewed mainly to assess its calculations of the numbers of people in England and Wales who are infected with the human immunodeficiency virus (HIV). Two main methods are used in the report to estimate this total—the direct method and the back projection method.

The direct method estimates the number of people infected with HIV by attempting to specify the numbers of people in various at-risk groups, and the percentage infected in those groups. Of particular significance are the estimates given for male homosexuals. The Cox Report suggests that between 4.0% and 4.7% of the male population aged between 16 and 59 are homosexual, and that between 1.9% and 4.5% of these are HIV antibody-positive. The basis on which these estimates are made is not substantiated by the Report, and it is quite possible that the upper limit given for HIV prevalence in male homosexuals represents an understatement of the actual number by a factor of 2.5 or more.

The back projection method estimates HIV prevalence from the numbers of cases of the acquired immunodeficiency syndrome (AIDS) and the incubation function, the relationship between HIV infection and the probabilities of AIDS in each of the years following infection. Using this method the Cox Report fails to produce results that are in accordance with our knowledge of how the epidemic developed during the 1980s. As a consequence of this the various calculations of numbers of HIV antibody-positives to 1987 given in the Cox Report are all almost certainly underestimates.

In both the procedures adopted and the results obtained the Report is found deficient. Its assertion that the number of HIV infections to 1987 is likely to be at the lower end of the 20,000 to 60,000 range has not been established. Even less credible is the later model proposed by Anderson et al. in the subsequent Royal Society report that presents results suggesting only 10,000 to 15,000 people were infected with HIV in England and Wales ‘at the period of peak incidence’. (Presumably from their other work this must be up to the end of 1987.) The available evidence suggests that the actual number is greater than 60,000, could be over 100,000, though tighter estimates must await either accurate surveys of population prevalence or further knowledge about character of the AIDS incubation function, and the degree to which AIDS statistics are understating the numbers of AIDS cases and deaths.
Potential Risks of Ultraviolet Radiation in HIV Infection
Authors: Flegg P J
Published: January 2017

The hazards of ultraviolet radiation (UVR) include immunosuppression, activation of human immunodeficiency virus (HIV) type 1 expression, and photocarcinogenesis particularly in immunosuppressed individuals. Fifty-eight male homosexuals positive for HIV antibody and 61 controls not at risk for HIV infection answered a questionnaire on their attitudes and exposure to natural and artificial sources of UVR. Controls were matched for sex but were not from an at-risk group for HIV infection. Mean ages were similar for both groups. HIV seropositives had greater recreational UVR exposure than controls: 12/58 versus 4/61 had regular use of a sunbed ( P<0.05), and experienced 11.6 weeks versus 9.5 weeks of prolonged natural UVR exposure ( P=0.056) over a four-year period. One reason for this difference may be the misconception present in two-thirds of the HIV seropositive group that a suntan would improve their health and the outcome of their HIV infection. Those with HIV infection must be made aware that there is a potential for further immunosuppression and viral activation from UVR and they should be advised to avoid undue recreational exposure.
Antimicrobial Susceptibility of Non-Penicillinase and Penicillinase-Producing Neisseria Gonorrhoeae Strains Isolated in Tripoli, Libya
Authors: Elghoul M T , Joshi R M
Published: January 2017

Neisseria gonorrhoeae culture gave a positive result in 42 of 64 male adults with purulent urethral discharge. The majority of the infections were acquired outside Libya Twenty-seven strains (64.3%) were non-penicillinase producing (NPPNG) and 15 (35.7%) were penicillinase producing (PPNG) by starch paper technique. Antimicrobial susceptibility of the strains to 5 antibiotics was carried out by agar-plate dilution technique. Twenty-three NPPNG strains (54.8%) were susceptible to penicillin with a minimum inhibitory concentration (MIC) of ≤0.5 μg/ml. In 4 strains (9.5%), a high resistance to penicillin (MIC ≥16 μg/ml) appeared to be chromosomally-mediated (CMRNG). All PPNG strains were resistant to penicillin (MIC ≥1 μg/ml). While resistance to erythromycin (MIC ≥ 1 μg/ml) and tetracycline (MIC ≥ 1 μg/ml) was observed in 5 strains, resistance to kanamycin (MIC 32 μg/ml) and spectinomycin (MIC 64 μg/ml) was present in only one strain. Whereas no significant differences were recorded in MICs of erythromycin, tetracycline, kanamycin and spectinomycin between NPPNG and PPNG strains, one PPNG strain was found to be resistant in vitro to all 5 antibiotics.
Inhibition of Urethane Leukaemia Virus, a Murine Retrovirus, in Mice by Zidovudine
Authors: Harvey T T , Tuffrey M , Wedderburn N , Alexander F , Curtis J , Taylor-Robinson D , Doré C
Published: January 2017

The purpose of the study was to characterize in vivo an immunodepressive murine retroviral ‘model’ for the possible testing of drugs against HIV infection. Urethane leukaemia virus (ULV) injected into adult BALB/c mice (105 focus-forming units/mouse) caused a small, significant splenomegaly from 2 to at least 9 weeks after virus inoculation. Virus was also present in up to 60% nucleated splenocytes (XC ‘infectious centre assay’).

Effects on splenomegaly and virus in splenocytes were assayed following various regimens of zidovudine given as 0.5 mg/ml or 0.25 mg/ml in drinking water. Regimens included continuous treatment both before and after ULV only before, and only after ULV inoculation. Zidovudine was also given for limited period immediately after virus or initiated after virus infection was established.

Zidovudine given continuously at and following ULV infection completely prevented splenomegaly and virus expression in splenocytes. No other regimen was as effective; however, limited zidovudine treatment immediately after virus moculation greatly reduced the effects of virus, while the same dose initiated after virus infection was established had only a small ameliorating effect.

We conclude that ULV may prove to be a useful addition to other available murine systems, and this is discussed.
The Role of Bronchoscopy in Patients with HIV Disease
Authors: Coker R J , Mitchell D M
Published: January 2017

Pulmonary involvement is a frequent feature of patients infected with the human immunodeficiency virus (HIV). Pneumocystis carinii pneumonia (PCP) is still the commonest AIDS defining diagnosis despite the advent of effective prophylaxis and antiretroviral treatment. Other pulmonary manifestations of AIDS, including tuberculosis, may pose a greater problem in the future. The clinical manifestations of HIV-disease are many and varied, and changing as the disease is modified by therapeutic interventions. With specific and increasingly effective treatments the need for definitive diagnosis is obvious. Fibreoptic bronchoscopy is a well established tool for the diagnosis of HIV-related pulmonary complications. This article aims to give an account on the use of bronchoscopy in a unit providing care for many HIV seropositive patients.
Comparison of Four Survey Methods Designed to Estimate the Prevalence of HIV among Female Prostitutes Who Inject Drugs
Authors: Goldberg David , Green Stephen T , Taylor Avril , Frischer Martin , McKeganey Neil
Published: January 2017

In Glasgow, during the period January 1990 to December 1992, 4 different methods were used to determine HIV prevalence among female prostitutes who inject drugs: the surveillance of prostitutes undergoing voluntary named tests, an unlinked anonymous survey of prostitutes attending a health care drop-in centre, a community-wide voluntary anonymous survey of injecting drug users including female prostitutes, and a voluntary anonymous survey of female prostitutes recruited in Glasgow's red-light area. HIV prevalence varied from 1.2 to 4.7% though overlapping confidence intervals indicated no significant differences. A comparison of each approach leads the authors to suggest that the former 2 methods which are relatively inexpensive should be conducted, if possible, on high risk groups such as prostitutes and injecting drug users on a continuous basis. If these indicate HIV rates which are stable and less than 5%, implementation of more sophisticated voluntary anonymous approaches need only be done every 3 to 4 years. However, if rates are unstable and/or greater than 5% then such surveys should be initiated more frequently, perhaps biannually.
Magic Lite Chlamydia Immunoassay in Urogenital Samples and Urine versus Chlamydial Culture
Authors: Bygdeman S M , Johansson M , Jonasson J , Lidbrink P , Nilsson U , Teichert C , Viktorsson S
Published: January 2017

Magic Lite Chlamydia assay (commercial test kit for the identification of Chlamydia trachomatis) was evaluated on urogenital samples and urine with chlamydial culture as the reference method. The sediment of the transportation buffer of specimens which were Magic Lite positive but culture negative or toxic was investigated for elementary bodies with fluorescein-labelled anti-chlamydial antibodies. The prevalence of chlamydial infection among the 577 men investigated was 13.7% as estimated by culture and direct immunofluorescence and 6.4% among the 173 women. In order to improve the sensitivity a cut-off value below that recommended by the manufacturer was used. The sensitivity of Magic Lite in male urethral specimens was then 60.8% and that in female urethral/cervical specimens 90.9%. The specificity was 99.6% and 100%, respectively. In urine specimens the sensitivity of Magic Lite was 63.3% (men) and 63.6% (women). The specificity was 99.4% and 100%, respectively.

The sensitivity of Magic Lite on male urethral specimens was related to the number of inclusion bodies per well in culture and it was higher among men attending with clinical findings of urethritis (69%) than among asymptomatic men sampled as a screening procedure (36%) ( P < 0.05). Corresponding differences between the sexes and between those with and without symptoms were not noted for Magic Lite applied on urine samples.
Outpatient Treatment of Intrameatal Warts in a Genitourinary Medicine Department
Authors: Nathan Mayura
Published: January 2017

With the use of a meatourethroscope, 18 patients with intrameatal and distal urethral warts were treated by Nd-Yag laser. Further treatment was carried out with cryotherapy using 140 CryoUnit as required. Sixteen patients were cured of their warts and remained wart-free over a 3–8 month period. Meatourethroscopy proved to be a simple, safe and effective way of treatment of intrameatal and distal urethral warts. It is also an outpatient-based and painless procedure that will complement the treatment of external anogenital warts to achieve complete cure.
Chlamydial Ocular Infection: Efficacy of Partner Notification by Patient Referral
Authors: Patel H C , Viswalingam N D , Goh B T
Published: January 2017

Records on 254 patients with chlamydial ocular infection observed over a period of 67 months at the Moorfield's Eye Hospital were reviewed retrospectively in relation to sexual partners in the 6 months prior to diagnosis. Contactable partners were given an appointment through index patients to attend our clinic. Those unable to attend were issued contact slips, as used by the sexually transmitted disease (STD) clinics in the United Kingdom, to attend elsewhere: 175/328 (53%) of all partners were seen in our clinic: 161/218 (74%) of current regular partners compared to only 7/57 (12%) of ex-regular and 7/53 (13%) of casual partners. However, of those given appointments 175/201 (87%) attended: 161/179 (90%) of current regular, 7/14 (50%) of ex-regular and 7/8 (88%) of casual partners. Seventy of 328 (21%) of all partners were issued contact slips, of whom 47/70 (67%) were reported to have attended elsewhere. No contact slips were returned by other clinics, indicating a failure in the contact slip system. Thirty-five of 53 (66%) of casual, 22/57 (39%) of ex-regular and none of the current regular partners were untraceable. One hundred and five of 196 (54%) female partners were examined, of whom 59/105 (56%) had chlamydial genital infection, 45/105 (43%) had other genital infections and 35/105 (33%) had multiple genital infections. Seventy of 132 (53%) male partners were examined, of whom 58/70 (83%) had chlamydial or non-specific urethritis, 5/70 (7%) had other genital infections and 4/70 (6%) had multiple genital infections. Partner notification is important to interrupt chlamydia transmission. This study shows that proactive appointment-based partner notification is effective in ensuring compliance with attendance.
Long-Term Impact of HIV Diagnosis on Mood and Substance Use—St Stephen's Cohort Study
Authors: Jadresic D , Riccio M , Hawkins D A , Wilson B , Shanson D C , Thompson C
Published: January 2017

Twenty HIV positive and 68 HIV negative subjects were assessed by the Hospital Anxiety and Depression Scale and by the Alcohol and Drugs Frequency Schedule immediately prior to notification of their HIV serostatus and 6 months after serodiagnosis. The 2 groups did not differ significantly in levels of anxiety or depression at baseline or follow-up. There were borderline levels of pathological anxiety prior to notification of HIV serostatus in both groups. The drop to normal levels of anxiety which had occurred by follow-up was significant in the HIV positive group. About a third of subjects in both groups were regularly making use of alcohol and/or drugs, both at baseline and follow-up. Mean levels of weekly alcohol intake for both groups ranged from about 20 to 30 units per week. The drugs most commonly used (in any frequency) were nitrates (‘poppers’) and cannabis.
Effect of Sexual Practices on T Cell Subsets and Delayed Hypersensitivity in Transsexuals and Female Sex Workers
Authors: Ratnam K V
Published: January 2017

To determine whether ano-receptive unprotected sexual intercourse (SI) practised by transsexuals produces immunological abnormalities we compared delayed hypersensitivity skin tests (DTH) and T cell helper (CD4) and suppressor (CD8) subsets in 57 transsexuals and 69 female sex worker controls. The populations were matched for age, duration of prostitution, number of clients and previous use of antibiotics. Heterosexual males and females and transsexuals who practised protected SI, were also included as controls. All were HIV negative. There were significantly increased absolute CD4 and CD8 counts and decreased DTH and CD4/CD8 ratios in those who practised unprotected ano-receptive SI. These changes were unlikely to be due to any of the microbial agents tested. We conclude that ano-receptive sexual intercourse results in increased immunological abnormalities in these sex workers possibly as a result of rectal exposure to seminal alloantigens.

These abnormalities could play an important role as co-factors in disease transmission.
Epidemiological Characteristics on Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome in Japan
Authors: Miyazaki Motonobu , Naemura Mitsuhiro
Published: January 2017

The first case of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) in Japan was diagnosed in a homosexual male in 1985. The Ministry of Health and Welfare formed the AIDS Surveillance Committee, which publishes HIV seropositive and AIDS data at 2–month intervals. Excluding persons infected through blood products there were 971 HIV seropositives by April 1993, and 204 reported cases of AIDS. One of the epidemiological characteristics of HIV infection and AIDS in Japan is the rapid increase of cases of transmissioin through heterosexual contact since 1991. Before this, homosexual transmission was the commonest reported mode of transmission. Sporadic cases of mother-to-child transmission and some cases due to injecting drug use were also reported. It is predicted that heterosexual contact will be the primary mode of transmission of HIV in the future. Virtually all the diagnosed AIDS cases so far have been reported to this surveillance network, and it will be an important task of the network to monitor the HIV seropositive cases.
Survival and Medical Intervention in Southern Brazilian AIDS Patients
Authors: Santos B , Beck E J , Peixoto M F
Published: January 2017

The aim of the study was to describe survival patterns of Southern Brazilian AIDS patients: 224 predominantly working class AIDS patients were treated in an AIDS referral centre in Porto Alegre between October 1986 and September 1991. The caseload increased progressively, as did the number of female AIDS cases treated at the Hospital during the study period. Self-referred patients were more likely to present with an AIDS defining condition ( P < 0.03) and they ( n = 106) had significantly worse survival patterns compared with patients referred by other health care professionals ( n = 112; P < 0.04). Median survival from the time of AIDS diagnosis was 5 months which did not change significantly during the study period ( P = 0.38). Patients ( n = 42) presenting with opportunistic infections other than mycobacterial disease ( n = 42), Pneumocystis carinii pneumonia ( n = 37) or candidiasis ( n = 18), had significantly worse survival patterns ( P = 0.001). Patients treated with zidovudine ( n = 33) survived significantly longer from time of AIDS diagnosis than those not on zidovudine ( n = 185; P = 0.0002). No significant survival differences were observed from time of AIDS diagnosis between those who commenced on zidovudine before developing AIDS ( n = 17) and those who were treated with zidovudine since diagnosed with AIDS ( n = 16; P = 0.80). During the study period zidovudine was only available through private prescriptions. Survival of Southern Brazilian AIDS patients has not improved: earlier access to HIV-related services and the provision of effective and affordable therapeutic interventions are two measures which could improve future survival patterns.
When to Perform the Final HIV Antibody Test following Possible Exposure
Authors:   The British Co-operative Clinical Group, Waugh M A , Carne C A , Meaden J D , Arya O P , Radcliffe K , Shamanesh M , Pattman R S , Haye K R , Isaacson J R , Taylor P K , Goh B , Lawrence A G , Thin R N , Nayagam A T , Bignell C J , Willmott F E , Wilson J , Maw R D , McMillan A , O'Mahoney C , Mercy D , Dinsmore W , Nicoll A , Catchpole M , Harris J W
Published: January 2017

The senior consultant and senior health adviser in all genitourinary medicine clinics in the UK were sent a questionnaire on HIV testing practice in seven clinical scenarios. For each scenario the recommended time interval between possible exposure and final HIV antibody test varied from a minimum of 3 months to a maximum of over 5 years. The results show 2 broad patterns: when the contact was not someone known to be HIV positive the commonest recommended time interval was 3 months; for a known exposure to HIV the commonest recommendation was 6 months. Only 16 out of the 151 clinics replying had a written policy setting out the interval to elapse between possible exposure to HIV and the final test for HIV antibodies. Variation of practice within clinics is less where written policies exist. Some staff in clinics are recommending inappropriately long intervals before the final HIV test.
Hospital Service Utilization by HIV/AIDS Patients and Their Management Cost in a Provincial Genitourinary Medicine Department
Authors: Nageswaran A , Kinghorn G R , Shen R N , Priestley C J F , Kyi T T
Published: January 2017

The hospital management of 108 HIV/AIDS patients cared for by the genitourinary medicine department, Sheffield, UK between 1984–93 was retrospectively studied to quantify the services utilized by these patients and to detail the management costs (1993 price) of outpatient (OP) services, inpatient (IP) care, investigational services and therapeutic provisions. The services utilized and cost are presented separately for the different clinical stages of the infection and as per patient year. Of the 108 patients, 95 (88%) were males and 13 (12%) females; most males (76.8%) acquired the infection through homosexual exposure, while 46% of females acquired it heterosexually. The mean number of OP consultation per asymptomatic, symptomatic non-AIDS and AIDS patient years were 11.6, 16.4 and 32.8 respectively; the mean number of IP episodes for each of these clinical groups were 0.15, 0.83 and 3.88 with IP stays 0.7, 3.5 and 40.6 days per patient year respectively. The annual costs of OP care (£45.26 per consultation), drugs and investigations were, respectively £525, £213 and £153 per asymptomatic patient year, £742, £2097 and £224 per symptomatic non-AIDS patient year and £1485, £2928 and £382 per AIDS patient year. The average annual OP drug cost per patient year showed little change since 1988, However, in the AIDS group, contributions from differing drug classes showed significant changes; while the contribution of antiretroviral drugs fell from 80.2% of the drug cost per AIDS patient year in 1990 to 31.3% in 1993, that from antibiotics rose from 0.3% in 1990 to 26.4% in 1993 and other antivirals from 9.4% in 1988 to 22.6% in 1993. These changes were related to lower recommended daily dosage of zidovudine and to wider prescription of antibiotics for atypical mycobacterial infections and domiciliary gancyclovir for CMV infection. The costs of annual mean IP care, IP drugs, IP investigations and IP procedures per AIDS patient year were £5926 (£146 per IP stay), £2983, £282 and £145 respectively. The overall management cost of one AIDS patient year was £14 131 and lifetime AIDS management cost, based on a mean survival of 17 months, a little more than £20 000. The annual management cost of an asymptomatic and symptomatic non-AIDS patient year is approximately 1/14th and 1/4th of the cost of an AIDS patient year.
Epidemic Spread of Plasmid-Mediated Tetracycline Resistant Neisseria Gonorrhoeae in Zaire
Authors: Van Dyck E , Laga M , Manoka Abib Thiam , Behets F , Piot Peter
Published: January 2017

A cohort of 650 prostitutes from Kinshasa, Zaire, was followed at monthly intervals for sexually transmitted diseases as part of an HIV intervention project. Neisseria gonorrhoeae isolates, obtained during a period of 30 months, were auxoryped, serotyped and tested for antimicrobial susceptibility. Among 1085 gonococcal isolates tested, 725 (67%) produced β-lactamase (PPNG) and 323 (30%) showed plasmid-mediated resistance to tetracyline (TRNG). Over time, the prevalence of PPNG varied between 60 and 73%, while the level of TRNG increased from 11 to 45%.
Gonorrhoea as an Indicator of Altered Sexual Behaviour and as a Surrogate Marker of HIV Concern: A 13-Year Analysis in Newcastle
Authors: Wardropper A G , Pattman R S
Published: January 2017

It has been proposed that changes in sexual behaviour arising out of concerns regarding HIV infection can be inferred by changes in the incidence of gonorrhoea. We have reviewed data on gonococcal isolates in Newcastle over the last 13 years and looked at changes in relation to HIV test requests, new cases of HIV infection and media campaigns. HIV testing has been available in the clinic since late 1985. There was a steady decline in cases of gonorrhoea from 1985–1991 and then as in other areas an increase in incidence was seen among homosexual and bisexual men. The majority of this recent increase was due to pharyngeal infection. Sexual behaviour may have changed but this cannot be purely attributed to HIV concerns. HIV testing began after the incidence of gonorrhoea in England was already falling and we found no relationship between trends in gonorrhoea, HIV test requests and new cases of HIV infection.
The Environmental Impact of Fusion Reactors
Authors: Hancox R.
Published: January 2017

Fusion power, based on the nuclear fusion of light elements to yield a net gain of energy, has the potential to extend the world's resources in a way which is environmentally attractive. Nevertheless, the easiest route to fusion — the reaction between deuterium and tritium — involves hazards from the use of tritium and the neutron activation of the structural materials. These hazards have been considered on the basis of simple conceptual reactor designs, both in relation to normal operation and decommissioning and to potential accident situations. Results from several studies are reviewed and suggest that fusion reactors appear to have an inherently lower environmental impact than fission reactors. However, the realization of this potential has yet to be demonstrated.
Energy Efficiency Incentives and Uk Households
Authors: Boardman Brenda
Published: January 2017

The energy efficiency of a domestic property depends upon the way that it was built and subsequent improvements. The latter could have been installed by the landlord, if it is rented, or with the aid of a Government grant, or because the occupant wished to reduce running costs. In all circumstances, the external trigger could have been rising energy prices, a desire to improve the value of the property, to minimize maintenance, or simply to be warmer. The relative importance of these and other factors in stimulating energy efficiency improvements is poorly understood. A better analysis of who has paid for energy efficiency - and why - will help determine future policies and ensure the appropriate level of investment expenditure if environmental targets are to be met.
Strategic Management of Utilization of New and Renewable Energy in The Rural Areas of Tunisia
Authors: Chaibi M.T.
Published: January 2017

In Tunisia, the rural people have the smallest amounts of energy available. Their energy is used mainly for basic needs, and it often comes from noncommercial fuels, especially wood.

Therefore, the rural areas are facing severe and interrelated problems of energy and environment. The environmental impacts of intensified production processes aggravate the degradation of ecologic systems.

The analysis of the energy situation in rural areas of Tunisia has shown that a growing energy consumption can be expected over the entire spectrum of economic and social activities.

To cope with this crisis, technologies for energy requirements should not only meet energy needs; they must also be geared to particular economic, social and environmental conditions.

Technically efficient, decentralized systems for the utilization of new and renewable energy can help in this by meeting the demand for higher quality energy.

This article attempts to propose precepts upon which a strategy can be formulated for a rational use of renewable energy in the rural areas.
Evidence from the Scandinavian Tree Line Since the Last Ice Age
Authors: Karlén Wibjörn , Kuylenstierna Johan
Published: January 2017

The focus of this paper is to investigate the possible correlation between changes in the Scandinavian climate and solar activity. Information about climatic changes in Sweden and Norway has been obtained from three sources: the carbon-14 dating of pine wood retrieved from above the present pine tree limit, studies of glacial sediments and the carbon dating of alpine glacier moraines. Alpine tree limits reveal that summer temperatures in general were warmer during the millennia following the last ice age. Superimposed on this general trend are fluctuations of a few hundred years duration. A period probably as cold as the last several hundred years occurred around 8200 years ago. Other severe cooling took place around 4500,2200 and 1200 years ago. The timing of major climatic events has been compared with solar activity as measured by carbn-14 changes and shows a good correlation with cold periods in Scandinavia for most of the last 8000 years. Deviations between carbn-14 anomalies and the climatic record may be due to volcanic eruptions increasing the concentration of sulfate aerosols in the atmosphere.

A similarity between the periods of cold climate and carbon-14 levels indicates that solar variability may be an important factor for climate change.