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California State University Monterey Bay (CSUMB) is a new comprehensive university founded in 1994 at the Old Fort Ord Army Base. One of its core missions is to serve the diverse people of California and to provide access to traditionally undeserved populations. To reach this goal, CSUMB has taken a different approach to typical college organizational structure. The institution is organized around Centers and Institutes that cluster related but historically separate disciplines. The goal is to facilitate better cross discipline collaboration and communication among disciplines. Cultural diversity is customarily ignored and is almost never considered in developing a delivery strategy. During the process of designing the initial instructional design course we began to wonder if there was a way to better integrate cultural differences within traditional instructional design methodology. To do this would be consistent with the mission of the university of not just providing access but also helping to ensure the success of typically undeserved student populations within computer science disciplines. The authors used an approach by Samovar, Porter and Stefani that divides cultures into 2 basic groups that they call High and Low Context. This paper reports on their findings and recommendations.

Virus load is a major risk factor for disease in many human viral infections, especially human immunodeficiency virus (HIV) disease. The effect of cytomegalovirus (CMV) load on disease progression and the influence of antiviral chemotherapy on surrogate markers of replication was investigated in 310 patients with advanced HIV disease in a randomized controlled trial that compared the effects of valacyclovir with those of acyclovir. Sequential blood and urine samples were analyzed by polymerase chain reaction (PCR), for human CMV (HCMV) DNA. In multivariate analyses, elevated virus load in both blood and urine at baseline was associated with increased risk of HCMV disease (relative hazard, 1.49 and 1.44 per log increase, respectively). Elevated virus load in blood at baseline was also associated with a significantly shorter survival time (log rank, P=. 0001). In time-updated analyses, valacyclovir significantly suppressed the virus load in subjects who were PCR positive at baseline (in blood or urine), when compared with the combined acyclovir arms.

A prospective longitudinal study of 87 renal allograft recipients identified 31 patients with cytomegalovirus (CMV) viraemia. Previous studies have identified CMV viraemia, donor positivity, and CMV load in urine as independent risk factors for disease following renal transpl antation. We used quantitative-competitive polymerase chain reaction (QC-PCR) to quantify the CMV DNA load in blood from these patients, and report that it is a significant and independent risk factor for CMV disease. Patients with symptomatic CMV infection had significantly higher maximum CMV loads than those with no disease (P = .0003). We also found that peak loads were significantly higher in individuals experiencing primary CMV infection (P.01), and CMV re-infection (P.05) compared with recipients reactivating endogenous CMV. Univariate analysis revealed that CMV DNA load in blood, donor seropositivity, and receipt of antithymocyte globulin (ATG) were all significantly associated with disease (P = .005, .04, and .05, respectively). However, the association of donor/recipient serostatus, and receipt of ATG became nonsignificant in multivariate analyses whereas the significance of the quantity of CMV DNAemia was maintained, illustrating that CMV load plays a central role in the pathogenesis of CMV disease.

Samples of blood and urine were collected at baseline, week 4, and week 8 and then every 8 weeks from 310 patients entering a controlled trial of prophylaxis with valaciclovir versus acyclovir. Samples were tested under code by polymerase chain reaction (PCR) in one laboratory. The median number of samples collected from each patient was 5 for blood (range, 0-15) and 5 for urine (range, 0-15). Both baseline PCR viremia and PCR viruria were significantly associated with future cytomegalovirus (CMV) disease (P = .002 and P = .02, respectively). The greatest effect of valaciclovir on CMV disease was seen in patients who were PCR-positive in blood at baseline (P = .002), although a significant effect was also seen in those who were PCR-negative in urine (P = .02). Thus, PCR viremia provides prognostic information about CMV disease in AIDS patients, and valaciclovir showed activity as both a preemptive and prophylactic agent.

Studies have shown that risk factors for human cytomegalovirus (HCMV) disease after renal transplant include primary infection (virus of donor origin infecting a non-immune individual), re-infection (virus of donor origin infecting a immune individual), and the detection of viraemia (as a marker of virus dissemination). We now report that viral load in the urine is also a significant factor in HCMV disease and is one of the main mechanisms underlying the risk associated with viraemia and donor serostatus. Longitudinal analysis of a group of 196 renal recipient identified 35 recipients who were PCR positive for HCMV in urine. Elevated viral loads were present in symptomatic patients, viraemic patients, and patients experiencing primary HCMV infection. Disease was associated with the peak quantity of virus present in the urine during the post-transplant period (P = 0.0001), with viraemia (P = 0.0003), and with transplantation of a seropositive donor (P = 0.03). Univariate logistic regression analysis showed that increases of 0.25 log10 in viral load were associated with a 179% increased risk of disease (odds ratio = 2.79; 95% C.I. 1.22-6.39; P = 0.02). This effect persisted in a multivariate logistic analysis when viraemia was incorporated (odds ratio = 2.77; 95% C.I. 1.07-7.18; P = 0.04). In contrast, the significant association between viraemia and disease observed in univariate analysis (odds ratio = 23.75; 95% C.I. 3.69-152.90; P = 0.0009) became marginally non-significant in multivariate analysis once viral load had been controlled for (odds ratio = 34.54; 95% C.I. 0.75-1599.00; P = 0.07). The computed probability of disease showed that a rapid transition occurred at viral loads between 10(5.7) and 10(6.5) genomes/ml urine in non-viraemic patients compared to viral loads between 10(5.0) and 10(5.7) genomes/ml urine in patients with concurrent viraemia. The implications of these findings for understanding HCMV pathogenesis, improving patient management, and optimising trials of antiviral treatment are discussed.

To describe the rate of development of immunodeficiency in human immunodeficiency virus (HIV) infection and to relate this to the risk of death.Inception cohort followed up for up to 12 years from HIV seroconversion until January 1, 1992.A regional hemophilia center based in a major teaching hospital.All 111 patients with hemophilia who seroconverted to HIV-1 between 1979 and 1985 were registered at the center. Patients have been closely followed up clinically and immunologically.Development of immunodeficiency, defined by a CD4 lymphocyte count falling beneath 0.20 and 0.05 x 10(9)/L, and death.Kaplan-Meier estimates suggest that almost half (46%; 95% confidence interval [CI], 26% to 66%) of patients alive 12 years after seroconversion will have a CD4 lymphocyte count that has remained above 0.05 x 10(9)/L. Thirty-five percent (95% CI, 22% to 48%) remain above 0.20 x 10(9)/L. Thirty-seven patients died of HIV-related causes, and there was a 52% probability (95% CI, 35% to 69%) of HIV-related mortality by 12 years from seroconversion. Mortality risk was closely associated with severe immunodeficiency. There was only a 15% chance (95% CI, 6% to 25%) of HIV-related death occurring before a CD4 count of below 0.05 x 10(9)/L had been reached. There was an average of one HIV-related death per 96.7 patient-years of observation before the CD4 count had fallen below 0.05 x 10(9)/L, as compared with one death per 2.5 patient-years of observation after the CD4 count had fallen below this level (P.0001).In patients with HIV infection who are closely followed up, the risk of death is low before the CD4 lymphocyte count has fallen to 0.05 x 10(9)/L, a count many patients remain above up to 12 years after seroconversion.

The possible role of sympathoadrenal stimulation and endothelin release in cyclosporine (CS)-induced hypertension was ascertained in intact and pithed rats. CS (20 and 40 mg/kg), administered by i.v. infusion over 10 min, produced a dose-dependent increase in blood pressure: 19 +/- 5 and 31 +/- 2 mm Hg in intact rats and 13 +/- 4 and 18 +/- 2 mm Hg in pithed rats. In intact rats, pretreatment with reserpine (5 mg/kg, i.p.) or hexamethonium (10 mg/kg, i.v.) greatly blunted the pressor responses to CS (40 mg/kg) (7 +/- 3 and 11 +/- 2 mm Hg, respectively). In pithed rats, the blood pressure responses to CS (40 mg/kg) were significantly impaired, but were not further modified by phenoxybenzamine (3 mg/kg, i.v.), whereas adrenalectomy completely abolished the CS-induced pressor responses (0 +/- 1 mm Hg). CS (40 mg/kg) did not potentiate pressor responses to sympathetic nerve stimulation (0.1 and 0.3 Hz) or vasoconstrictors, including angiotensin II (0.03 microgram/kg, i.v.), phenylephrine (1 microgram/kg, i.v.) and arginine vasopressin (0.075 microgram/kg) in pithed rats. In addition, CS (40 mg/kg, i.v.) did not cause elevation of plasma immunoreactive endothelin-1 and -3. Furthermore, phosphoramidon (0.25 mg/kg/min x 30) abolished pressor response to big endothelin-1 (5 micrograms/kg, i.v.) but failed to affect CS-induced hypertension. It is concluded that the acute blood pressure response to CS manifests great dependence on sympathetic nervous system but appears independent of endothelin release.

Neural tube defects and periconceptional folic acid in England and Wales: retrospective study {#article-title-2} The risks of a first occurrence and a recurrence of neural tube defects have been shown to be reduced by periconceptional folic acid supplementation—that is by taking folic acid from 3 months before conception to 3 months after conception.1 2 The Expert Advisory Group in the United Kingdom recommended in 1992 that women who were trying to conceive should take 0.4 mg folic acid per day.3 We assessed whether there had been any change in the incidence of neural tube defects since this recommendation was made. The number of live births, stillbirths, and pregnancies terminated because the fetus had a neural tube defect (spina bifida, anencephaly, or encephalocele) as well as the total number of live births, stillbirths, and abortions among residents of England and Wales from 1972 to 1996 were obtained from the Office for National Statistics. The true incidence of these abnormalities was defined as the number of affected infants (born alive or dead) plus the number of pregnancies terminated after prenatal diagnosis of a neural tube defect and expressed as a proportion of 100 000 live births, stillbirths, and terminations for neural tube defects. The number of prescriptions dispensed and the number of preparations sold over the counter containing 400 μg to 500 μg folic acid were provided by the Department of Health and Self Medication UK, a department of Intercontinental Medications Statistics-Health, (Pinner, Middlesex), respectively. The total number of prescriptions dispensed was available but data for over the counter sales do not include information from Boots pharmaceutical …

The effect of nonhydrostatic stresses on the solid phase epitaxial growth rate of crystalline Si(100) into self-implanted amorphous surface layers has been measured. Uniaxial stresses of up to 6 kbar (0.6 GPa) were attained by bending wafers over SiO2 rods and annealing at a temperature too low for plastic deformation to relieve the stress in the crystal, but high enough for solid phase epitaxial growth to proceed. The growth rate on the tensile side was greater than that on the compressive side of the wafer, in marked contrast to the enhancement observed from hydrostatic pressure. The phenomenology of an “activation strain”, the nonhydrostatic analogue of the activation volume, has been developed to characterize the results. Combined with the measurement of the activation volume, the measurement reported here permits us to characterize to first order the entire activation strain tensor corresponding to the transition state for solid phase epitaxy of Si(lOO). We conclude that the transition state for this process is “short and fat”; that is, the fluctuation to the transition state involves an expansion in the two in-plane directions and a contraction in the direction normal to the surface large enough to make the overall volume change negative. The symmetry of the measured activation strain tensor is inconsistent with all bulk point defect mechanisms for solid phase epitaxy. The relevance of the activation strain formalism to heteroepitaxy and vapor phase epitaxy is discussed.

SCH 33844 is a new non-sulfhydryl-containing angiotensin converting enzyme (ACE) inhibitor. SCH 33844 diacid inhibited hydrolysis of the synthetic substrate hippuryl-histidyl-leucine by rabbit lung ACE in vitro with an IC50 (concentration inhibiting enzyme by 50%) of 0.81 nM. The ester was 83 times less active. Intravenous administration of SCH 33844 and its diacid inhibited pressor responses to angiotensin I (AI) in anesthetized rats with calculated ID50's of 16 and 8 micrograms/kg, respectively. Oral administration of SCH 33844 (0.03-1 mg/kg) inhibited AI pressor responses in conscious rats with a duration of 24 hr at the highest dose. The diacid was inactive. Intravenous administration of SCH 33844 (100-1000 micrograms/kg) or its diacid (30 micrograms/kg) to anesthetized dogs inhibited AI pressor activity and potentiated the depressor response to bradykinin. SCH 33844 inhibited AI responses in conscious dogs following oral administration of 0.3-3 mg/kg. Oral administration of SCH 33844 (1 mg/kg) to conscious monkeys inhibited AI pressor responses for the 4 hr duration of study. In conclusion, SCH 33844 is a potent, orally effective ACE inhibitor in rats, dogs and monkeys.

Two within household telephone sampling techniques for collecting citizen survey data for community mental health center's needs assessments were compared on the basis of respondent demographic characteristics; response, completion, and refusal rates; and, administrative costs. Initially, all households were chosen via random digit dialing. Then, one technique allowed the surveyor to interview any adult member of a household who answered the phone. The other technique used was developed by Troldahl and Carter and required the use of a reference table procedure to determine the appropriate respondent. While more expensive, the Troldahl-Carter method produced significantly better representativeness of the population for a rural county. Factors relating to a decision regarding which technique to employ are discussed.

The venous compartment plays a critical role in circulatory control. The present series of experiments was conducted to assess simultaneously effects of vasoactive drugs on arterial resistance and venous capacitance vessels of the rat hindquarters perfused with physiological salt solutions (SS). Retrograde infusion of SS into rat hindquarters via the vena cava resulted in an increase in hindquarters venous pressure (Pv). The range of mean volumes required to increase Pv to 20 and 30 mm Hg was 1.7 +/- 0.1 to 2.9 +/- 0.4 and 3.8 +/- 0.3 to 6.9 +/- 0.3 ml, respectively, in various groups of rats during a control period. Perfusion of the hindquarters with an SS containing 80 mM K+ reduced the volume required to increase Pv to 20 and 30 mm Hg to 47 +/- 2 and 42 +/- 2% of control, respectively, indicating venoconstriction. K+ (80 mM) SS also increased aterial perfusion pressure (Pa; measured from a sidearm off of the inflow catheter) to 141 +/- 9 mm Hg, indicating arterial vasoconstriction. Arterial and venous responses to 80 mM K+ were attenuated markedly by perfusion with SS containing zero Ca and 2 mM ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid, indicating dependence on extracellular Ca. Phentolamine (10(-5) M) attenuated the arterial and venous response to 80 mM K+, indicating an alpha adrenergic contribution. Arterial responses to 80 mM K+ were attenuated markedly by the Ca entry blockers nifedipine (10(-6) and 10(-5) M) and verapamil (10(-6) and 10(-5) M). In contrast, venous responses were not affected by nifedipine and were reduced slightly only at the high concentration of verapamil.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper describes the Biomedical Services of Northern Montana Hospital, a separate corporation under the parent corporation of Northern Montana Health Care Inc. Located in Havre, Montana, a rural area of north central Montana, the hospital is a 120-bed, non-profit organization. The two BMETs work as part of the Engineering Department and service almost every piece of equipment in the building (approximately 1100 items), as well as a telephone system for another facility. This paper shows that a non-urban hospital, located far from any service company outlet, can be self-supporting as far as equipment service and maintenance are concerned.

Paw-shake responses (PSRs) were evoked by wrapping masking tape around the hind-paw in nine cats spinalized at the T12 level either at 2 or 12 wk of age or as young adults (10-12 mo). Electromyographic responses of ankle extensors (LG and SOL) and one ankle flexor (TA) were recorded through the 6th mo after cord transection. Activity of the LG was used to determine the cycle characteristics. Cycle characteristics did not differ among cats spinalized at different ages. The average PSR, consisting of 11 cycles with a cycle time of 85 ms, was similar to the PSR of normal adult cats (16). Activity in the TA and LG muscles alternated with the onset of the flexor burst occurring at 52% of the extensor cycle. Burst durations averaged 39 and 57 ms for LG and TA muscles, respectively. Relatively normal PSRs were evoked within 48 h following cordotomy of the young-adult cats; differences being that the responses were elicited less frequently with fewer and slightly longer cycle times than normal. Within 2 wk following cord transection, PSR parameters returned to normal values. In the spinal cats, the SOL was active during PSR, showing either tonic low-level activity or discrete bursts that were coactive with the LG. In normal adult cats, the slow extensor (SOL) is usually inactive (16). In spinal cats, participation of the SOL may depend on a conversion of muscle units from slow to fast contracting (8, 13) or on the absence of inhibition of slow motor units from descending tracts (11). Both mechanisms are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

SCH 33844 is a new, potent and long-acting inhibitor of angiotensin converting enzyme (ACE). Antihypertensive, hemodynamic and autonomic actions of SCH 33844 were examined in the present series of experiments. Oral administration of 0.3-30 mg/kg reduced blood pressure of spontaneously hypertensive rats. The magnitude of the response was significantly enhanced by pretreatment of the animals with hydrochlorothiazide. Blood pressure remained significantly depressed 24 hr following doses of 3 and 10 mg/kg. Administration of SCH 33844 (3 mg/kg) twice daily to nonpretreated rats or once daily to diuretic-pretreated animals for 5 days resulted in a progressive decrease in blood pressure. The compound did not reduce blood pressure in nephrectomized rats demonstrating the dependence of its action on renal renin. SCH 33844 (1-10 mg/kg orally) also produced dose-related decreases in pressure in diuretic-pretreated conscious normotensive dogs. However, only a small fall in pressure occurred in non-pretreated dogs. Hemodynamic actions were examined in anesthetized dogs. SCH 33844 (1 mg/kg i.v.) reduced blood pressure, increased cardiac output and caused a large fall in peripheral resistance. Autonomic actions were assessed in pithed rats. The compound (10 mg/kg orally) tended to decrease pressor responses to sympathetic activation and to i.v. norepinephrine. This profile is probably due, at least in part, to vasorelaxation following suppression of angiotensin II generation. In conclusion, SCH 33844 is a potent, long-lasting antihypertensive agent which reduces peripheral vascular resistance and possesses only slight autonomic effects.

Introduction In a recently published paper 1 data were described which showed that the amount of convergence associated with a given change in the dioptric stimulus to accommodation is greatly increased when the eyes are under cycloplegia induced by homatropine over that when they are in the normal state. This phenomenon was first described by Maddox and more recently by Morgan. 2 As measured quantitatively, homatropine causes a marked increase in the accommodative convergence-accommodation (stimulus) ratio [(A — C)/A] over that ratio measured normally. The increase seems to vary as a function of the degree of cycloplegia. The data were obtained by the fixation-disparity technique. With this technique of measuring ocularmotor imbalance, extrafoveal binocular vision and fusion are maintained throughout the test and both eyes are subjected simultaneously to the same dioptric stimulus to accommodation. Most interestingly, the data showed that in the presence of homatropine cycloplegia the change in

To the Editor: —At a meeting of the Herkimer County Medical Society on Tuesday evening it was my pleasure to introduce a resolution that the society donate $5 toward the fund which is being raised for the Memorial Salon of Pershing Hall. This motion was unanimously carried and a check for this amount will be mailed your office. When this worthy proposition was begun byThe JournalI thought that it would go across with a bang, there being about 150,000 physicians in the United States. The memorandum inThe Journalof April 11 shows that the response has been anything but encouraging. This apparent failure to a worthy cause should be considered an affront of the so-called organized profession in this country. May we hope for better success in this worthy undertaking.

Here, we aimed to gain a comprehensive picture of HIV-1 diversity in the north-east and south-east part of Brazil. To this end, a high-throughput sequencing was used to characterize the near full length (NFLG) and partial HIV-1 proviral genome in blood donors at four major blood centers in Brazil: Pro-Sangue foundation (Sao Paulo state (SP), n 48), Hemominas foundation (Minas Gerais state (MG), n 41), Hemope foundation (Recife state (PE), n 97) and Hemorio blood bank (Rio de Janeiro (RJ), n 90).