Lumbar Puncture: Creation and Resident Acceptance of a Low-Cost, Durable, Reusable Fluoroscopic Phantom with a Fluid-Filled Spinal Canal for Training at an Academic Program.

Simulation-based medical training provides learners a method to develop technical skills without exposing patients to harm. Although fluoroscopic phantoms are already adopted in some areas of radiology, this has historically not been for lumbar puncture. Commercially available phantoms are expensive. We report a cost-effective, accessible solution by creation of an inexpensive phantom for resident training to perform fluoroscopically guided lumbar puncture, as well as instructions on how to make a phantom for residency education. An anthropomorphic ballistics-gel phantom that contains a plastic lumbar vertebral column and simulated CSF space was created. Radiology residents with minimum or no experience with fluoroscopically guided lumbar punctures were given a brief education and practiced fluoroscopically guided lumbar punctures on the phantom. A survey from the residents was then done. The phantom was qualitatively quite durable and deemed adequate for educational purposes. All the residents surveyed expressed the desire to have this phantom available and it increased comfort, knowledge, and perceived likelihood of success. Few articles have been published that focused on low-cost phantom creation for fluoroscopic-procedure training. This study supports the benefits of using phantoms for fluoroscopic training as well as step-by-step instructions for creation of this phantom. The residents responded positively and felt more confident in their fluoroscopically guided techniques. The ability to make a long-term training device for resident education would be inexpensive and relatively easy to implement in academic programs.

Quantifying morphological heterogeneity: a study of more than 1 000 000 individual stored red blood cells.

BACKGROUND AND OBJECTIVES: The morphology of red blood cells (RBCs) deteriorates progressively during hypothermic storage. The degree of deterioration varies between individual cells, resulting in a highly heterogeneous population of cells contained within each RBC unit. Current techniques capable of categorizing the morphology of individual stored RBCs are manual, laborious and error-prone procedures that limit the number of cells that can be studied. Our objective was to create a simple, automated system for high-throughput RBC morphology classification. MATERIALS AND METHODS: A simple microfluidic device, designed to enable rapid, consistent acquisition of images of optimally oriented RBCs, was fabricated using soft lithography. A custom image analysis algorithm was developed to categorize the morphology of each individual RBC in the acquired images. The system was used to determine morphology of individual RBCs in several RBC units stored hypothermically for 6-8 weeks. RESULTS: The system was used to automatically determine the distribution of cell diameter within each morphological class for >1 000 000 individual stored RBCs (speed: >10 000 cells/h; accuracy: 91·9% low resolution, 75·3% high resolution). Diameter mean and standard deviation by morphology class were as follows: discocyte 7·80 ± 0·49 µm, echinocyte 1 7·61 ± 0·63 µm, echinocyte 2 7·02 ± 0·61 µm, echinocyte 3 6·47 ± 0·42 µm, sphero-echinocyte 6·01 ± 0·26 µm, spherocyte 6·02 ± 0·27 µm, stomatocyte 1 6·95 ± 0·61 µm and stomatocyte 2 7·32 ± 0·47 µm. CONCLUSIONS: The automated morphology classification procedure described in this study is significantly simpler, faster and less subjective than conventional manual procedures. The ability to evaluate the morphology of individual RBCs automatically, rapidly and in statistically significant numbers enabled us to perform the most extensive study of stored RBC morphology to date.

Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: a prospective, double-blinded, placebo-controlled trial.

OBJECTIVE: To examine the immunologic, metabolic, and clinical effects of broad spectrum micronutrient supplementation in HIV-infected patients taking highly active antiretroviral therapy (HAART). DESIGN: A prospective, randomized, double-blinded, placebo-controlled trial. METHODS: Forty HIV-infected patients taking a stavudine and/or didanosine-based HAART regimen were prospectively randomized to receive micronutrients or placebo twice daily for 12 weeks. Data were collected at 4-week intervals including immunologic, metabolic, and clinical measurements. The study examined the effect of micronutrient supplementation on immunologic parameters as the primary end point. The secondary end points were metabolic and clinical effects and distal symmetrical polyneuropathy. RESULTS: The mean absolute CD4 count increased by an average of 65 cells in the micronutrient group versus a 6-cell decline in the placebo group at 12 weeks (P = 0.029). The absolute CD4 count increased by an average of 24% in the micronutrient group versus a 0% change in the placebo group (P = 0.01). The mean HIV-1 RNA decreased in the micronutrient supplementation group, although not significantly. Neuropathy scores improved in the micronutrient group by 42% compared with a 33% improvement in the placebo arm. This difference did not reach statistical significance. Fasting serum glucose, insulin, and lipids were not adversely affected in the patients taking the micronutrients. CONCLUSIONS: Micronutrient supplementation can significantly improve CD4 cell count reconstitution in HIV-infected patients taking HAART. The micronutrient supplement tested was well tolerated and may hold promise as an adjuvant therapy in the treatment of HIV. Further investigation is warranted.

The Akoya pearl oyster shell as an archival monitor of lead exposure.

The Akoya pearl oyster (Pinctada imbricata) was experimentally exposed to (a) constant levels of lead (Pb) at 180 microg L(-1) for nine weeks, or (b) two short term (pulse) exposures of Pb at 180 microg L(-1) (three weeks each) with an intervening depuration period (three weeks), to assess its utility as an (i) accumulative monitor of Pb contamination and an (ii) archival monitor for discriminating constant versus pulsed Pb exposure events. P. imbricata showed similar reductions in growth (based on shell morphology and wet weight) and Pb accumulation patterns for whole tissue and shell in response to both Pb exposure regimes. Thus the whole oyster was deemed an inappropriate accumulative monitor for assessing short-term temporal variation of Pb exposure and effect. However, using secondary ion mass spectrometry, Pb was shown to accumulate in the successively deposited nacreous layers of the shell of P. imbricata, documenting the exposure history of constant versus pulsed Pb events. Patterns of Pb deposition not only reflected the frequency of Pb exposure events but also their relative durations. Thus, the shell of P. imbricata may be employed as a suitable biological archive of Pb exposure.

Discrimination or discretion? Exploring dentists' views on treating patients with hepatitis C.

BACKGROUND: People with hepatitis C (over 259 000 Australians) experience stigma and discrimination, whether perceived or actual, in health care settings. They are less likely to access health care, presenting a major barrier to preventive care and treatment. This study aims to identify factors contributing to such discrimination, barriers to optimal care and strategies to overcome these. METHODS: A purposive sample of 25 Victorian dentists took part in semi-structured interviews to investigate their experiences and attitudes in providing care to people with hepatitis C. Interviews were taped, transcribed and coded for thematic analysis. RESULTS: All dentists interviewed were aware of Standard Precautions. However, there were some who changed practices when seeing a client with hepatitis C, suggesting that they lack confidence in Standard Precautions. When prompted, these dentists were concerned that patients may perceive these actions as discriminatory. All participants, including a small minority who expressed negative views about injecting drug users, felt a professional obligation to treat all patients. CONCLUSIONS: Most dentists have appropriate attitudes regarding patients with blood-borne viruses. However, it is important for dentists to understand how their actions may be interpreted by those who feel sensitive about their status. Dentists need to feel genuinely confident about Standard Precautions and have a realistic view of the infection risk posed by patients with blood-borne viruses.

Quantification of in situ nutrient and heavy metal remediation by a small pearl oyster (Pinctada imbricata) farm at Port Stephens, Australia.

The use of pearl oysters has recently been proposed as an environmental remediation tool in coastal ecosystems. This study quantified the nitrogen, phosphorus and heavy metal content of the tissue and shell of pearl oysters harvested from a small pearl oyster farm at Port Stephens, Australia. Each tonne of pearl oyster material harvested resulted in approximately 703 g metals, 7452 g nitrogen, and 545 g phosphorus being removed from the waters of Port Stephens. Increasing current farm production of 9.8 tyr(-1) to 499 tyr(-1) would balance current nitrogen loads entering Port Stephens from a small Sewage Treatment Plant (STP) located on its southern shores. Furthermore, manipulation of harvest dates to coincide with oyster condition would likely remove substantially greater quantities of nutrients. This study demonstrates that pearl aquaculture may be used to assist in the removal of pollutants from coastal waters while producing a commercially profitable commodity.

The impact of injecting drug use status on hepatitis C-related referral and treatment.

More than 160,000 people are living with chronic hepatitis C virus (HCV) infection in Australia, however, rates of medical treatment are low. The aim of this study is to examine uptake and predictors of HCV-related health care services among a community-based sample of people with HCV. A self-administered questionnaire was completed by a largely non-clinical sample of 362 women and 308 men with HCV living in the state of Victoria. Analyses were performed according to injecting drug use (IDU) status: no history of injecting (non-IDUs), previous history of injecting (past-IDUs) and current (within the last 12 months) history of injecting (current IDUs). Bivariate and multivariate predictors of referral to a specialist liver clinic were also assessed. Fifty-one percent of participants were current IDUs, 33% past-IDUs and 16% non-IDUs. Fifty-two percent of women and 37% of men reported ever being referred to a specialist liver clinic and 18% of women and 20% of men reported previous HCV antiviral therapy. Although there were many factors related to an increased likelihood of referral (e.g. being female, longer time since diagnosis, longer consultation time at diagnosis, experiencing HCV-related symptoms), multivariate analysis revealed that not being a current IDU and seeing a GP specifically for HCV were the most important independent predictors of referral. For those who had been referred to a liver clinic, a history of IDU was associated with a lower chance of receiving antiviral therapy. IDU status is associated with both referral and treatment. The extension of HCV treatment services to involve GPs and drug and alcohol practitioners should be explored as models to improve access to antiviral therapy.

Functional characterization of HUVEC-CS: Ca2+ signaling, ERK 1/2 activation, mitogenesis and vasodilator production.

While many endothelial cell lines exist, few are of human origin with characteristics close to the parent endothelial cell. We derived a subline (HUVEC-CS) of immortalized human umbilical vein endothelial cells (HUVEC-C) that proliferate in standard growth media and exhibit positive acetylated low-density lipoprotein (AcLDL) uptake, express eNOS, CD31 and ve-cadherin, and spontaneously form capillary-like structures when grown on Matrigel. HUVEC-CS also maintain endothelial cell characteristics at the level of mitogenesis, kinase activation and vasodilator production. Like primary HUVEC cells, HUVEC-CS express many of the key proteins necessary for vasodilator production, including epithelial nitric oxide synthase (eNOS), HSP 90, cav-1 and -2, cPLA2, and COX-1 and -2. Prostaglandin I synthase (PGIS) was not detectable by Western blot analysis, consistent with primary HUVEC in which PGI2 production is minimal. Receptors were detected for angiotensin II (AII), bradykinin, ATP and growth factors. ATP induced a dose- and time-dependent rise in the intracellular free Ca2+ concentration ([Ca2+]i). Initially, ATP stimulates P2Y receptors rather than P2X receptors, as demonstrated by the inability of ATP to initiate a Ca2+ response subsequent to emptying of the internal Ca2+ stores by thapsigargin. AII, bradykinin, epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) also caused a rise in [Ca2+]i in a subset of the cells. ATP, basic fibroblastic growth factor (bFGF), EGF and VEGF induced mitogenesis and caused a rise in ERK 2 activation within 10 min. L-Arginine to L-citrulline conversion assays showed that ATP, EGF and VEGF induced a significant rise in eNOS activity, and this correlates with an ability to induce Ca2+ mobilization and ERK 2 activation. In conclusion, HUVEC-CS are indeed endothelial cells and appear to be functionally very similar to primary HUVEC. These cells will prove a valuable tool for future studies in both basic and therapeutic sciences.

Macroalgal biomonitors of trace metal contamination in acid sulfate soil aquaculture ponds.

Earthen shrimp aquaculture ponds are often impacted by acid sulfate soils (ASS), typically resulting in increased disease and mortality of cultured organisms. Production losses have been attributed to either low pH or to elevated concentrations of toxic metals, both direct products of pyrite oxidation in ASS. The standard farm management practice to minimise effects of pyrite oxidation is to maintain pH of pond waters above 5, based on the assumption that dissolved metal bioavailability is negligible at this pH. This study aimed to test the validity of this assumption, and therefore elucidate a possible role of toxic heavy metals in observed decreases in farm productivity. Metal bioaccumulation in four genera of macroalgae, Ulva sp., Enteromorpha sp., Cladophora sp. and Chaetomorpha sp., sampled from ASS-affected shrimp aquaculture ponds were measured using inductively coupled plasma-optical emission spectroscopy (ICP-OES) to assess the relative bioavailability of dissolved metals within the system. Results showed that all four genera of macroalgae accumulated appreciable quantities of Fe, Al, Zn, Cd, Cu, As and Pb. Iron and Al, the most common metals mobilised from ASS, were both accumulated in all algal genera to concentrations three orders of magnitude greater than all other metals analysed. These findings indicate that dissolved heavy metals are indeed bioavailable within the aquaculture pond system. A literature search of heavy metal bioaccumulation by these algal genera revealed concentrations recorded in this study are comparable to highly contaminated environments, such as those exposed to urban, industrial and mining pollution. The results of this study indicate that dissolved metal bioavailability in many earthen shrimp aquaculture ponds may be higher than previously thought.

Pearl aquaculture-profitable environmental remediation?

Bivalve molluscs are filter feeders, with pearl oysters able to filter water at rates up to 25 lh(-1)g(-1) of dry wt. tissue. Since this process leads to rapid bioaccumulation of recalcitrant pollutants such as heavy metals, organochlorine pesticides and hydrocarbons from impacted sites, it has prompted the widespread use of molluscs as biomonitors to quantify levels of marine pollution. This paper proposes pearl oyster deployment as a novel bioremediation technology for impacted sites to remove toxic contaminants, reduce nutrient loads and lower concentrations of microbial pathogens. Estimates extrapolated from the literature suggest that a modest pearl oyster farm of 100 t oyster material per year could remove 300 kg heavy metals plus 24 kg of organic contaminants via deposition into the tissue and shell. Furthermore, it was estimated that up to 19 kg of nitrogen may be removed from the coastal ecosystem per tonne of pearl oyster harvested. Pearl oysters are also likely to filter substantial amounts of sewage associated microbial pathogens from the water column. Method of cultivation and site selection are the key to minimising negative environmental impacts of bivalve cultivation. Deployment of oysters at sites with high nutrient and contaminant loadings would be advantageous, as these compounds would be removed from the ecosystem whilst generating a value-added product. Future potential may exist for harvesting bio-concentrated elements for commercial production.

Update on D-ala-peptide T-amide (DAPTA): a viral entry inhibitor that blocks CCR5 chemokine receptors.

Peptide T, named for its high threonine content (ASTTTNYT), was derived by a database search which assumed that a relevant receptor binding epitope within env (gp120) would have sequence homology to a known signaling peptide. Binding of radiolabeled gp120 to brain membranes was displaced by peptide T and three octapeptide analogs (including "DAPTA", Dala1-peptide T-amide, the protease-resistant analog now in Phase II clinical trials) with the same potency that these four octapeptides blocked infectivity of an early passage patient isolate. This 1986 report was controversial due to a number of laboratories' failure to find peptide T antiviral effects; we now know that peptide T is a potent HIV entry inhibitor selectively targeting CCR5 receptors with minimal effects on the X4 tropic lab adapted virus exclusively in use at that time. Early clinical trials, which demonstrated lack of toxicity and focused on neurological and neurocognitive benefits, are reviewed and data from a small ongoing Phase II trial--the first to assess peptide T's antiviral effects--are presented. Studies using infectivity, receptor binding, chemotaxis, and blockade of gp120-induced neurotoxicity in vitro and in vivo are reviewed, discussed and presented here. Peptide T and analogs of its core pentapeptide, present near the V2 stem of numerous gp120 isolates, are potent ligands for CCR5. Clinical data showing peptide T's immunomodulation of plasma cytokine levels and increases in the percentage of IFNgamma secreting CD8+ T cells in patients with HIV disease are presented and suggests additional therapeutic mechanisms via regulation of specific immunity.

Study of the murine allantois by allantoic explants.

The murine allantois will become the umbilical artery and vein of the chorioallantoic placenta. In previous studies, growth and differentiation of the allantois had been elucidated in whole embryos. In this study, the extent to which explanted allantoises grow and differentiate outside of the conceptus was investigated. The explant model was then used to elucidate cell and growth factor requirements in allantoic development. Early headfold-stage murine allantoises were explanted directly onto tissue culture plastic or suspended in test tubes. Explanted allantoises vascularized with distal-to-proximal polarity, they exhibited many of the same signaling factors used by the vitelline and cardiovascular systems, and they contained at least three cell types whose identity, gene expression profiles, topographical associations, and behavior resembled those of intact allantoises. DiI labeling further revealed that isolated allantoises grew and vascularized in the absence of significant cell mingling, thereby supporting a model of mesodermal differentiation in the allantois that is position- and possibly age-dependent. Manipulation of allantoic explants by varying growth media demonstrated that the allantoic endothelial cell lineage, like that of other embryonic vasculatures, is responsive to VEGF(164). Although VEGF(164) was required for both survival and proliferation of allantoic angioblasts, it was not sufficient to induce appropriate epithelialization of these cells. Rather, other VEGF isoforms and/or the outer sheath of mesothelium, whose maintenance did not appear to be dependent upon endothelium, may also play important roles. On the basis of these findings, we propose murine allantoic explants as a new tool for shedding light not only on allantoic development, but for elucidating universal mechanisms of blood vessel formation, including vascular supporting cells, either in the intact organism or in existing in vitro systems.

The social and cultural context of risk and prevention: food and physical activity in an urban Aboriginal community.

One of the key public health challenges facing indigenous and other minority communities is how to develop and implement effective, acceptable, and sustainable strategies for the prevention of non-insulin-dependent diabetes mellitus (NIDDM). In this article, the authors describe how an ethnographic approach was used to contextualize the behavioral risk factors for NIDDM and applied to the development of a more meaningful and appropriate epidemiological risk factor survey instrument for an urban Aboriginal population in Australia. The overall research design comprised a mixture of qualitative and quantitative methods. The ethnographic study showed that the complex web of meanings that tie people to their family and community can and should be taken into account in any social epidemiology of health and illness if the findings are to have any effective and long-term potential to contribute to successful public health interventions targeting these behavioral risk factors.

Trying to keep a balance: the meaning of health and diabetes in an urban aboriginal community.

Although the predominant paradigm of epidemiological investigation continues to focus narrowly on the individual and on individual risk factors, there is a growing body of work that calls for a rethinking of the current epidemiological models. In this paper we illustrate the need for a more comprehensive epidemiological approach towards understanding the risks for diabetes, by exploring the lived experiences of diabetes and lay meanings of risk among Aborigines living in Melbourne, Australia. Ethnographic fieldwork was conducted within the Melbourne Aboriginal community in the state of Victoria over a 22-month period (1994-1996). Melbourne Aborigines see non-insulin dependent diabetes mellitus (NIDDM) as the result of living a life out of balance, a life of lost or severed connections with land and kin and a life with little control over past, present or future. The lay model regarding diabetes that is derived from the narratives of Melbourne Aborigines, consists of three levels of connectedness important in determining an individual's susceptibility not only to diabetes but to all disease--(1) family, (2) community and (3) society. This structure of interactive systems at successive levels from the individual to the population fits within the framework of an ecological paradigm. The strength of ethnography as applied to epidemiology is that it has the capacity to discover previously unknown components of a system at several different levels, and to build models to explain how these components interact. This framework, developed using an ethno-epidemiological approach, has application in other indigenous populations who have been dispossessed of their land, their pasts and their future. There is great potential to apply this approach to the major public health challenges presented by rapid global socio-cultural and environmental change that are impacting negatively on population health.

Vascularization in the murine allantois occurs by vasculogenesis without accompanying erythropoiesis.

The aim of this study was to determine whether the blood vessels of the murine allantois are formed by vasculogenesis or angiogenesis. Morphological analysis revealed that differentiation of allantoic mesoderm into an outer layer of mesothelium and an inner vascular network begins in the distal region of the allantois, which is most remote from other tissues, as early as the late neural plate stage (approximately 7.75 days postcoitum). Nascent blood vessels were not found in the base of the allantois until 4-somite pairs had formed in the fetus (approximately 8.25 days postcoitum), and vascular continuity with the yolk sac and fetus was not present until the 6-somite-pair stage (approximately 8.5 days postcoitum). Immunohistochemical analysis demonstrated that flk-1, a molecular marker of early endothelial cells, is expressed in significantly more distal than basal core cells in the early allantois and never in mesothelium. Furthermore, synchronous grafting of donor yolk sac containing blood islands into blood islands of headfold-stage host conceptuses provided no evidence that the yolk sac contributes endothelial cells to the allantois. Finally, when removed from conceptuses and cultured in isolation, neural plate and headfold-stage allantoises formed a conspicuous vascular network that was positive for Flk-1. Hence, the vasculature of the allantois is formed intrinsically by vasculogenesis rather than extrinsically via angiogenesis from the adjacent yolk sac or fetus. Whether allantoic vasculogenesis is associated with erythropoiesis was also investigated. Benzidine-staining in situ revealed that primitive erythroid cells were not identified in the allantois until 6-somite pairs when continuity between its vasculature and that of the yolk sac was first evident. Nevertheless, a small number of allantoises removed from conceptuses at a considerably earlier stage were found to contain erythroid precursor cells following culture in isolation. To determine whether such erythroid cells could be of allantoic origin, host allantoises were made chimeric with lacZ-expressing donor allantoises that were additionally labeled with [3H]methyl thymidine. Following culture and autoradiography, many lacZ-expressing benzidine-stained cells were observed in donor allantoises, but none contained silver grains above background. Moreover, no cells of donor allantoic origin were found in the fetus or yolk sac. Hence, vasculogenesis seems to be independent of erythropoiesis in the allantois and to involve a distal-to-proximal gradient in differentiation of allantoic mesoderm into the endothelial cell lineage. Furthermore, this gradient is established earlier than reported previously, being present at the neural plate stage.

Risking for protection: discourses around 'safe sex' among Chilean, Turkish and second-generation Greek women living in Melbourne, Australia.

The aim of this study was to identify the ways in which women from Turkish, second-generation Greek and Chilean backgrounds living in Melbourne, Australia, understand risks to their sexual health with a focus on STDs including HIV/AIDS. Data were derived from in-depth qualitative interviews with 20 women from each ethnic group (N = 60). Interviews were guided by a theme list, conducted in the woman's language of preference, tape-recorded and fully transcribed. Transcripts were double coded for key themes and analysed using ethnographic content analysis. The key findings are that for many women, reducing the risk of STDs to protect their physical health introduces risks to their social health and to the well-being of their family and community. Thus, women place priority over the protection of their social health as opposed to their physical health. Despite specific cultural differences in understandings of sexual health risks and illnesses, all women shared gendered commonalities in the ways in which they contextualise STDs within the wider context of social relationships and their everyday life. We conclude by arguing for interventions that specifically take into account social models of risk in STD and HIV/AIDS prevention and we consider the practical implications of this for harm reduction strategies in multicultural societies such as Australia.

Safe sex or safe love: competing discourses?

The way in which sex may be constructed as safe through its relationship with 'love' is the concern of this study. Interviews with 112 heterosexual women and men from discos and bars in Melbourne, Australia, catering to single adults revealed the pervasive construction of sex within the discourses of 'love' and 'romance'. The relationship of these discourses to unsafe practices is discussed and the article presents an analysis of the normative function of the sex-as-love/sex-as-desire opposition in terms of safe sex and HIV/AIDS prevention. We conclude that health messages which emphasize that 'sex is unsafe' may be counterproductive. We illustrate how women and some men construct casual sex as a strategy for obtaining the possibility of 'love'. For these women and men, 'safe sex' as 'unprotected sex' is viewed as a strategy for maximizing the possibility that the casual encounter will result in a longer term relationship. On the other hand, 'unsafe sex' as 'unprotected sex' is viewed as a strategy that is more likely to interrupt the construction of romance in the causal encounter thus risking the possibility of love as the desired outcome.

PIP: Interviews with heterosexual men and women recruited at discos and bars in Melbourne, Australia, in 1993 revealed a tendency--especially among women--to construct sex as "safe" within the discourses of "love" and "romance." The 112 respondents (mean age, 27.4 years) were asked to narrate their experiences of sex, love, romance, and safety, with particular emphasis on casual sexual encounters. Casual sex was viewed as an essential strategy in the search for love, and sexual safety practices were related more to their anticipated impact on finding love than on an assessment of the potential of sexually transmitted disease transmission. This view is consistent with cultural notions of femininity in sex as the relinquishment of control for the sake of love. Both men and women commented on the difficulties of raising the issue of condom use and HIV/AIDS prevention with someone they had just met. This difficulty was even more pronounced among women, who tended to believe insistence on condom use would result in the loss of a sexual encounter with romantic potential. Many men reported they use this perception of potential rejection to convince women to engage in unprotected sex. These findings suggest that current HIV/AIDS prevention messages may be disregarded by individuals--especially unmarried women--who view condom use as an obstacle in their quest for love. Needed are messages that incorporate condom use into the search for love.

Narratives of risk in occupational health and safety: why the 'good' boss blames his tradesman and the 'good' tradesman blames his tools.

Risk and its control are important themes in occupational health and safety. In the current regulatory framework, risk is conceptualised as a probabilistic expression of hazard potential. However, social meanings of risk in the workplace may be different. The social context of work shapes the ways that risk is understood in the workplace, yet little research in occupational health and safety acknowledges it. A few studies of risk have used qualitative research methods to elicit understandings of risk at work; however, little research explores the experiences of both employers and employees. This study describes the narratives of risk in occupational health and safety of employers and employees in the Victorian painting industry. Using ethnographic methods, we collected data about the contexts in which risk is experienced and the sources of risk that each group identifies. These narratives reveal that risk in the painting industry is constructed through the interactions of three factors: the social context, the hierarchical structure of the industry and the shared assumptions about risk control through the individual skills and responsibilities. The narratives explain why occupational health and safety strategies focusing solely on individual behaviour change or technical measures will be unsuccessful.