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BACKGROUND: Alcohol consumption is associated with poor health outcomes in women living with HIV (WLWH), but whether medication can help to reduce drinking in non-treatment-seeking women, or whether reduction in drinking improves HIV outcomes is unclear. We conducted a randomized clinical trial (RCT) of daily oral naltrexone (50 mg) versus placebo in WLWH who met criteria for current unhealthy alcohol use. METHODS: WLWH with current unhealthy alcohol use (>7 drinks/week or >3 drinks/occasion) were randomly assigned to daily oral naltrexone 50 mg (n=96) or placebo (n=98) for 4 months. Drinking outcomes, including the proportion of women who reduced (

Objectives This study compared the accuracy of medical students in identifying pleural effusion in hospitalized patients using the physical examination versus lung ultrasound (US). Methods Fourth-year medical students (n = 14) received 20 hours of general practical US training (including 2 hours of specialized lung US training) plus theoretical and video documentation. The students used the physical examination alone versus the physical examination plus lung US to document the presence or absence of pleural effusion in the right and left hemithoraces of hospitalized patients (n = 11 patients; 22 hemithoraces examined 544 times in total). The reference standard for identification of pleural effusion was a lung US examination by 2 expert point-of-care sonographers. Results The odds of correctly identifying the presence versus absence of pleural effusion was 5 times greater with lung US as an adjunct to the physical examination compared to the physical examination alone (odds ratio [OR], 5.1 from multivariate logistic regression; 95% confidence interval, 3.3-8.0). The addition of lung US to the physical examination resulted in an increase in sensitivity from 48% to 90%, in specificity from 73% to 86%, and in accuracy from 60% to 88%. The benefits of using US were greater when pleural effusion was present versus absent (OR, 10.8 versus 2.4) and when examining older versus younger patients (OR, 10.2 versus 2.8). Conclusions These results demonstrate that medical students' ability to detect the presence or absence of pleural effusion is superior when using lung US as an adjunct to the physical examination than when using the physical examination alone.

Aim Treatment-resistant depression patients are more likely to suffer from comorbid physical and mental disorders, experience marked and protracted functional impairment, and incur higher health-care costs than non-affected individuals. Magnesium sulfate is a treatment option that may offer great potential for patients with treatment-resistant depression based on prior work in animals and humans. Methods Twelve subjects with mild or moderate treatment-resistant depression were randomized into a double-blind crossover trial to receive an infusion of 4 g of magnesium sulfate in 5% dextrose or placebo infusion of 5% dextrose with a 5-day washout in between the 8-day intervention period. Subjects were assessed before and after the intervention for serum and urine magnesium, lipid panel, the Hamilton Rating Scale for Depression, and the Patient Health Questionnaire-9. Results We found a difference in serum magnesium from day 2 to 8 (pre-infusion) (P < 0.002) and from baseline to day 8 (P < 0.02). No changes were noted on the Hamilton Rating Scale for Depression or the Patient Health Questionnaire-9 24 h post-treatment, but as serum magnesium increased from baseline to day 7, the Patient Health Questionnaire-9 decreased from baseline to day 7 (P = 0.02). Conclusion Magnesium sulfate did not significantly affect depression 24 h post-infusion, but other results were consistent with the literature. The association between changes in serum magnesium and the Patient Health Questionnaire-9 supports the idea that magnesium sulfate may be used to address treatment-resistant depression, an ongoing medical challenge.

Type 2 diabetes mellitus (T2D) results in several metabolic and cardiovascular dysfunctions, clinically characterized by hyperglycaemia due to lower glucose uptake and oxidation. Physical exercise is an effective intervention for glycaemic control. However, the effects of exercising at different intensities have not yet been addressed. The present study analysed the effects of 8 weeks of training performed at different exercise intensities on type 4 glucose transporters (GLUT4) content and glycaemic control of T2D (ob/ob) and non-diabetic mice (ob/OB). The animals were divided into six groups, with four groups being subjected either to low-intensity (ob/obL and ob/OBL: 3% body weight, three times/week/40 min) or high-intensity (ob/obH and ob/OBH: 6% body weight, three times per week per 20 min) swimming training. An incremental swimming test was performed to measure aerobic fitness. After the training intervention period, glycaemia and the content of GLUT4 were quantified. Although both training intensities were beneficial, the high-intensity regimen induced a more significant improvement in GLUT4 levels and glycaemic profile compared with sedentary controls (p < 0.05). Only animals in the high-intensity exercise group improved aerobic fitness. Thus, our study shows that high-intensity training was more effective for increasing GLUT4 content and glycaemia reduction in insulin-resistant mice, perhaps because of a higher metabolic demand imposed by this form of exercise.

Objectives The belief in medical care entitlement has recently resulted in major changes in the medical system in the United States. The objectives of this study were the following: to compare endorsement of three medical entitlement beliefs (I deserve the best medical care no matter what the cost [BMC], I am entitled to all of the medical care I want at no charge [NC], I shouldn't have to wait to see my doctors [W]) in community nonpatients without pain (CNPWP), acute pain patients (APPs), and chronic pain patients (CPPs) and to develop predictor models for these beliefs in APPs and CPPs. Design CNPWP, APPs, and CPPs were compared statistically for frequency of endorsement of each belief. All available variables were utilized in logistic regression models to predict each belief in APPs and CPPs. Those affirming/nonaffirming each belief were compared by t-test for affirmation of narcissism, dependency, and antisocial practices on three scales from established inventories. Results CPPs were significantly more likely than APPs to endorse BMC. No other comparisons were significant. The logistic regression models identified variables that related to narcissism, anger, doctor dissatisfaction, depression, and anxiety, which entered the models for both APPs and CPPs for some beliefs. Those APPs and CPPs who affirmed the beliefs of NC and W were more likely than their counterparts to affirm antisocial practices, but not narcissism or dependency. Conclusions Patient medical entitlement beliefs may be related to some psychiatric/psychological issues.

OBJECTIVES: To further explore the controversy as to whether childhood molestation is associated with chronic pain in adulthood. DESIGN: Community nonpatients without pain (CNPWP), community patients with pain (CPWP), acute pain patients (APPs), and chronic pain patients (CPPs) were compared for endorsement of affirmation of childhood molestation by chi-square. Logistic regression was utilized to predict affirmation in male and female CPPs. RESULTS: A significantly higher percentage of male APPs affirmed molestation versus CNPWP and CPWP. No other comparisons were statistically significant for males. For females, no comparisons were significant. For male CPPs, the behavior health inventory-2 (BHI-2) survivor of violence scale and 1 item from this scale predicted affirmation. The following BHI-2 scales and items predicted affirmation for female CPPs: muscular bracing and survivor of violence scales; the item "I have been a victim of many sexual attacks"; and the item "My father was kind and loving to me when I was growing up" (scored opposite direction). CONCLUSIONS: In female PWCP, the prevalence of childhood molestation is not greater than in a number of unique comparison groups. Unique predictors of childhood molestation are yet to be identified. Language: en

Natural killer (NK) cells are not only important in first line defence against viral and bacterial infections, but also in immune surveillance of malignant cells and thus NK cell cytotoxicity is primary indicator of immune function. Although chromium release assay is recognized as ‘gold standard’ for measuring NK cell activity, it has disadvantages like use of radioactive compounds, poor loading and high spontaneous release. It is difficult to perform this assay in clinical laboratory because of difficulties with disposal of radioactive waste and standardization problems. We describe a flow cytometry-based assay for the measurement of NK cell activity by incorporating fluorescent dye, DiO, into membranes of target cells. NK cell activity was measured at baseline, 1 and 4 weeks follow-up in 20 normal healthy individuals on a dietary supplement immunomodulator to enhance NK cell function. Mean baseline NK cell activity percentage (21.5; SD = 9.3) increased significantly to a maximum level at 1 week (31.3%; SD = 7.9; P = 0.007) and then returned to baseline level at 4 weeks (21.5; SD = 8.3). An important feature of flow cytometry-based assays is its ability to discriminate effector cells from target cells, and potential for explaining molecular interactions underlying target cell lysis. Under clinical settings, this assay will be of interest for frequently monitoring immunological status of patients on treatment for various diseases that affect their immune status. The assay is easy to perform without using radioactive material and thus could become a tool for monitoring pathogenesis and immune reconstitution.

OBJECTIVES: There has been a significant amount of research performed on the relationship between the presence of chronic pain and all forms of suicidality. This study explored which rehabilitation acute pain patient (APP) and rehabilitation chronic pain patient (CPP) variables are predictive of six suicidality items: wanting to die because of pain; wanting to die because life is hard; history of wanting to die; history of suicide attempts; recent frequent suicide ideation; and having a suicidal plan. METHODS: The six suicide items were contained within the Battery for Health Improvement-Research Version (BHI-R) and were administered to a healthy community sample (n = 1478), community patients (n = 158), rehabilitation APPs (n = 326), rehabilitation CPPs (n = 341) and rehabilitation patients without pain (n = 110). RESULTS: Affirmation of the six items in APPs/CPPs ranged from 6.13% to 34.90%. Logistic regression predictor models for each item for APPs/CPPs were developed utilizing available variables from the BHI-R. Predictor variables differed between APPs and CPPs and between items. Most predictor variables had previously been delineated in non-pain behaviour studies (e.g., substance abuse). Some novel variables such as perseverance were also identified. Contrary to the behaviour suicide literature, no demographic variables (except employment) were predictive. Correct patient classification ranged from 87% to 95%, in most cases being better than the base rate prediction. DISCUSSION: Suicidality predictor variables were differentially distributed between APPs and CPPs and between different forms of suicidality. Some suicidality predictor variables appeared to be specific to pain patients.

Objectives: One indirect line of evidence for opioid-induced hyperalgesia (OIH) in humans is decreased pain thresholds (PTREs) and tolerances (PTOLs) in opioid addicts on opioids. There are a number of such studies in opioid maintained addicts, but no such studies in chronic pain patients (CPPs) with current opioid addiction. The objective of this study was to determine if this group demonstrates hyperalgesia. Methods: CPPs were subdivided into those with psychoactive substance (opioid dependence) (PSOD) (n = 38) (addicted) and those taking opioids but without PSOD (n = 198) (not addicted). A group of opioid-free non-CPPs served as a control group (n = 36). PTREs/PTOLs were determined in each group by pressure pain stimulation in both the right and left index fingers. PTREs/PTOLs were compared by analysis of variance among the three groups controlling for sex/age and by analysis of covariance between the PSOD CPPs and non-PSOD CPPs controlling for duration of pain and visual analog scale pain level over the last 24 hours. Results: The PSOD and non-PSOD CPPs had significantly lower PTREs and PTOLs vs. the control group, ie, were hyperalgesic. However, they were not significantly different from each other. Conclusions: This study contributes to the human OIH literature. However, because of the potential confounders in this study, the issue of OIH in humans remains unresolved.

Controversy has surrounded the use of antidepressants and suicidal behaviors in youth. This study reviewed the Medical Examiner's Office records of 253 persons aged 24 years or younger classified as suicides in Miami-Dade County, Florida, from 1990 to 2007. Information was collected regarding demographic information, suicidal characteristics, psychiatric and psychosocial factors, and toxicology results. Eighty-five percent of the sample was men, and 53.4% of the subjects were Hispanic. Consistent with previous literature, the existence of antidepressants at autopsy was rare; present in only 6% (n = 15) of the victims. The occurrence of antidepressants was not significantly different between Hispanics (n = 7) and non-Hispanics (n = 8). The incidence of antidepressants was weakly correlated with a tendency to be men and no history of psychiatric illness. The presence of antidepressants in Hispanic youth suicide victims was similar to non-Hispanics. Language: en

Objectives: (1) Determine and compare prevalence of forms of anger (FOA; anger, hostility, aggression, anger-in, anger-out, chronic anger) in community nonpatients (n = 478), community patients (n = 158), acute pain patients (APPs; n = 326), chronic pain patients (CPPs; n = 341); and (2) develop FOA predictor models in APPs and CPPs. Design: A large set of items containing the FOA items was administered to the above groups, who were compared statistically for FOA endorsement. APPs and CPPs affirming the anger and chronic anger items were compared with those not affirming on all available variables including the Battery for Health Improvement (BHI-2) with significant variables (P ≤ 0.001) utilized in predictor models for anger and chronic anger in APPs and CPPs. Setting community plus rehabilitation facilities. Results: FOA affirmation ranged from 8.28% for chronic anger in nonpatients to 37.54% for anger in CPPs. Only CPPs were more likely to affirm anger (P ≤ 0.04) and chronic anger (P ≤ 0.01) at a significantly higher rate than community patients. In both APPs and CPPs, all FOA items except anger management-in were significantly correlated with other FOA items. For anger and chronic anger for CPPs and APPs, hostility was the strongest predictor. All models predicted anger and chronic anger significantly better than the base rate prediction. Conclusion: According to the results of this study anger and chronic anger are more frequently found in CPPs vs. community patients supporting the clinical perception that many CPPs are angry. As such,clinicians should actively screen CPPs for the presence of anger in order to engage these CPPs in anger management treatment.

Objectives: The objectives of this article were the following: (1) determine risk for self-predicted future psychopharmacological nonadherence in rehabilitation acute pain patients (APPs) and rehabilitation chronic pain patients (CPPs) vs. pain-free community controls and community patients, and (2) determine which variables predict nonadherence. Design: The Battery for Health Improvement 2 was developed utilizing a healthy (pain-free) community sample (N = 1,478), a community patient sample (N = 158), and a rehabilitation patient sample (N = 777) of which 326 were APPs, 341 were CPPs, and 110 were patients without pain. These groups predicted their future psychopharmacological treatment adherence. Risk for nonadherence was calculated for each group utilizing the healthy community sample as the reference group. Nonadherent and adherent APPs and CPPs were compared statistically on variables of interest. Significant variables (P ≤ 0.01) were utilized in APPs' and CPPs' logistic regression models to predict nonadherence. Setting: The participants in this article were from a variety of settings. Results: Of APPs and CPPs, 10.74% and 10.85%, respectively, predicted that they would be nonadherent. Risk for nonadherence was greater in both groups vs. healthy nonpain community subjects and nonhealthy community patients. The predictors for APPs' nonadherence were general resistance to using medications and a tendency to forget physicians' suggestions. For CPPs, the predictors were general resistance to using medications, fear of dependence on prescription medications, and fighting with loved ones. The models classified 90% and 89% of APPs and CPPs (respectively) correctly. However, these were no better than the base rate. Conclusions: APPs and CPPs are at greater risk for self-predicted psychopharmacological nonadherence than healthy community subjects and community patients. We cannot as yet predict self-predicted psychopharmacological nonadherence at greater than the base rate. However, the identified variables could be clinically useful.

Adult zebrafish exhibit hyperventilatory responses to absolute environmental CO2 levels as low as 0.13% ( mmHg), more than an order of magnitude lower than the typical arterial levels (∼40 mmHg) monitored by the mammalian carotid body. The sensory basis underlying the ability of fish to detect and respond to low ambient CO2 levels is not clear. Here, we show that the neuroepithelial cells (NECs) of the zebrafish gill, known to sense O2 levels, also respond to low levels of CO2. An electrophysiological characterization of this response using both current and voltage clamp protocols revealed that for increasing CO2 levels, a background K+ channel was inhibited, resulting in a partial pressure-dependent depolarization of the NEC. To elucidate the signalling pathway underlying K+ channel inhibition, we used immunocytochemistry to show that these NECs express carbonic anhydrase (CA), an enzyme involved in CO2 sensing in the mammalian carotid body. Further, the NEC response to CO2 (magnitude of membrane depolarization and time required to achieve maximal response), under conditions of constant pH, was reduced by ∼50% by the CA-inhibitor acetazolamide. This suggests that the CO2 detection mechanism involves an intracellular sensor that is responsive to the rate of acidification associated with the hydration of CO2 and which does not require a change of extracellular pH. Because some cells that were responsive to increasing also responded to hypoxia with membrane depolarization, the present results demonstrate that a subset of the NECs in the zebrafish gill are bimodal sensors of CO2 and O2.

Study Design: This is an evidence-based structured review. Objectives: The objectives of this review were to answer the following questions: (1) Are somatization/hypochondriasis associated with chronic pain? (2) Is the degree of somatization/hypochondriasis related to pain levels? (3) Does pain treatment improve somatization/hypochondriasis? (4) Are some pain diagnoses differentially associated with somatization/hypochondriasis? Methods: Fifty-seven studies which fulfilled inclusion criteria and had high quality scores were sorted by the above-mentioned objectives. Agency for health care policy and research guidelines were utilized to type and characterize the strength/consistency of the study evidence within each objective. Results: Somatization and hypochondriasis were both consistently associated with chronic pain (consistency ratings B and A, respectively). Study evidence indicated a correlation between pain intensity and presence of somatization and hypochondriasis (consistency rating A and B, respectively). Pain treatment improved somatization and hypochondriasis (consistency rating B and A, respectively). Some chronic pain diagnostic groups somatized more (consistency rating B). Conclusions: Somatization is commonly associated with chronic pain and may relate to pain levels.

Two self-buffer layers were grown on c-plane sapphire substrates by atmospheric MOCVD method using DEZn, tert-butanol as precursors and H2 as carrier gas. Then, they were respectively annealed in growth process and oxygen environment. After that, ZnO films were respectively grown on them. XRD spectra show that all the films were grown in [002] orientation. Furthermore, the film with a buffer layer annealed in oxygen exhibits much higher crystal quality. Its FWHM of the rocking curve is only 567 arcsec. Furthermore, its Raman scattering spectrum appears a much stronger E2 mode peak at 436 cm–1 and its PL spectrum appears a shoulder at 3.367 eV on the higher energy side. (© 2006 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

ZnO films were grown on sapphire substrates using vertical MOCVD system with DEZn and tertiary-butanol as precursors, respectively. The benefits of substrate treatment on the microstructure and morphology of the film were shown. The influences of growth temperature and partial pressure ratio RVI/II on crystal quality were investigated in detail. XRD, Electron Channeling Pattern and Raman spectra indicated that the highest crystal quality film was grown at 425 °C when the partial pressure ratio of tertiary-butanol (t-Bu) to diethylzinc (DEZn) was 8. X-ray rocking curves exhibit Full Width at Half Maximum (FWHM) of 607 arcsec. A strong exciton emission peak appears in the photoluminescence (PL) spectra. Furthermore, the peak position has a slight shift to low energy with increase of the growth temperature. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

This article presents an evaluation of a second-track diplomacy project sponsored by the U.S. Agency for International Development and organized between Georgian and Abkhaz youth and teachers. It examines the effects of interethnic contact and peace education components of the program on the participants and evaluates the potential of the entire program for the peace processes between the Georgian and Abkhaz sides. The findings indicate that the program succeeded in cultivating a willingness to engage in joint programs, despite more marginal attitudinal changes among the participants. Equally intriguing and significant was the observed impact of ethnicity.Georgians and Abkhaz experienced the program differently, an outcome that exposed the impact of the larger sociopolitical context of the conflicts on the program outputs. The resulting theoretical and policy implications of the study raise issues of program design and training development, in order to maximize the “transfer effects” of such programs for larger social and political environments of peace processes.

OBJECTIVE: To examine the degree and patterns of compliance with the Omnibus Budget Reconciliation Act (OBRA) regulations regarding the use of antipsychotic drugs in nursing homes. DESIGN: Retrospective chart review of all resident records. PARTICIPANTS: Eight nursing homes: five community, two county-owned, and one university-affiliated Veterans Administration facility. MEASUREMENTS: A structured assessment instrument to track compliance with each aspect of the OBRA regulations regarding antipsychotic drug use. RESULTS: A total of 1573 nursing home residents' pharmacy records were reviewed between August 1994 and March 1996. Two hundred seventy-nine residents were actively taking antipsychotic medications (prevalence = 17.7%). Mean compliance greater than 70% was found for (1) appropriate diagnostic indication (X = 70.9%), (2) dosage within recommended limits (X = 90.1%), and 3) documented appropriate target symptoms (X = 90.4%). Dosages were more likely to exceed limits in those patients with histories of major mental illness, particularly schizophrenia. CONCLUSIONS: Nursing homes were better able to comply with those guidelines that are most specific. Educational interventions now need to focus on behavioral interventions, monitoring of adverse effects, and efficacy. These data are useful in establishing threshold levels of performance and can be used by nursing homes for continuous quality improvement. OBRA continues to impact neuroleptic drug prescribing practices in nursing homes significantly.

Large, high-quality, single crystals of pure-silica ferrierite are synthesized, and the structure is described. Selected individual crystals (approximately 600 μm X 500 μm X 20 μm) are mounted in a membrane configuration so that only the 10-membered-ring channels (5.4 A X 5.4 A X 4.2 A) or the 8-membered-ring channels (4.6 A X 3.7 A X 3.0 A) are accessible for gas-molecule permeation. The first examples of transport exclusively through 8- or 10-membered-ring channel systems are reported and obtained through crystal orientation in the membrane. A series. of adsorption experiments are conducted to help select suitable probe molecules and evaluate the role of adsorption in the permeation process for single-crystal membranes. Methane, n-butane, isobutane and nitrogen probe molecules are used to study intracrystalline sorption and transport effects for different crystal orientations, pressures and temperatures. Both pure-gas selectivities and mixed-gas separation factors are reported. A mixed-gas separation factor of n-butane/isobutane = 116 for the 10-membered-ring orientation of the crystal at 383 K and a transmembrane pressure difference of 1.01 X 10^5 Pa are found using this technique. In addition, molecular sieving is observed for the 8-membered-ring orientation of the crystal since methane, but not butane, transport is observed for this crystal orientation.

Abstact Background. In 1990 a new disease-associated antinuclear antibody was first recognized as a specific immunologic marker for a chronic form of ulcerative stomatitis (cus). Methods. Another case is reported herein and the subject of chronic ulcerative stomatitis with stratified epithelium-specific antinuclear antibodies (SES-ANA) is reviewed. Intraoral biopsies from this patient were submitted for microscopic examination and direct immunofluorescence. Indirect immunofluorescence studies were also performed. Serial SES-ANA titers were obtained with the patient on maintenance treatment with hydroxychloroquine. A skin biopsy of a recent lichenoid eruption was obtained and skin explants grown in the serum of this patient were studied in tissue culture with reference to SES-ANA binding and complement fixation. Results. Biopsy and serum studies confirmed a diagnosis of cus with SES-ANA in the patient reported. Skin biopsy showed lichen planus. The patient was treated with hydroxychloroquine with a favorable response. Serial SES-ANA titers did not parallel the disease activity. Among the substantive observations made from skin explants cultured in the serum of this patient was widespread fixation of C3 to the nuclei of basal cells. Conclusions. The case described herein extends the findings in cus to include lichenoid skin lesions. Records show that at least four of 11 cases of cus had skin lesions, whereas all had oral lesions. Stratified epithelium-specific antinuclear antibodies serve as the key marker of cus. Skin explants grown in the serum of this cus patient bind SES-ANA in tissue culture. Sections of explants fix complement. Titers of SES-ANA have been reported to parallel disease activity in one case, but not in the present case. Thus, there appears to be case-to-case variation. The treatment of choice for cus is hydroxychloroquine.

Relatively large (up to 4 μm), needle-like crystals of the high-silica molecular sieve VPI-8 are synthesized by hydrothermal methods and are subsequently calcined to remove the pore-filling organic...

Eleven ferrocenium halogenopentelides (P, As, Sb, or Bi) have been prepared by the reaction of a group 5 element halide with ferrocene in an organic solvent; the structure of one of the products, [Fe(η5-C5H5)2][BiCl4], determined by X-ray crystallography, reveals an extended, one-dimensional anion of irregular, edgesharing BiCl63– octahedra.