Pain, No Gain?: A Narrative Analysis Exploring the Accounts of Older African American Patients and Their Discussion of Pain Management Related to Chronic Illness.

Drawing from interviews conducted as part of a study of older African Americans with multimorbidity, we argue how various forms of racism work together to shape communication between doctors and patients. By focusing on what patients say about pain, we highlight patient descriptions of their relationships with pain management, their interactions with healthcare providers, and how they navigate understanding their chronic conditions. Our documentation of patient experience with stigmas and biases suggests what is needed for more empathetic and effective communication within the doctor and patient relationship. We conclude by using the interview data to propose addressing racial inequality in health care in the United States through educational reform and training initiatives grounded in rhetorical research.

Changes in phytoplankton concentration now drive increased Arctic Ocean primary production.

Historically, sea ice loss in the Arctic Ocean has promoted increased phytoplankton primary production because of the greater open water area and a longer growing season. However, debate remains about whether primary production will continue to rise should sea ice decline further. Using an ocean color algorithm parameterized for the Arctic Ocean, we show that primary production increased by 57% between 1998 and 2018. Surprisingly, whereas increases were due to widespread sea ice loss during the first decade, the subsequent rise in primary production was driven primarily by increased phytoplankton biomass, which was likely sustained by an influx of new nutrients. This suggests a future Arctic Ocean that can support higher trophic-level production and additional carbon export.

Vitamin D deficiency in pregnant women of ethnic minority: a potential contributor to preeclampsia.

OBJECTIVE: We investigated risk for comorbidities and preeclampsia at low vitamin D levels in ethnic minorities. STUDY DESIGN: Umbilical cord vitamin D (25(OH)D) concentration was determined in urban minorities: 80.9% African American and 17% Hispanic mothers-baby pairs. To identify the correlation between vitamin D levels and high-risk comorbidities which result in preeclampsia, multivariate logistic regression analyses were performed. RESULT: Below the Institute of Medicine threshold of 25(OH)D for pregnant women (25 ng ml⁻¹), obesity (P=0.055) and pregestational diabetes (odds ratio (OR)=2.056) were observed. The study median was 16 ng ml⁻¹ (<25th percentile), at which gestational hypertension (P=0.042), chronic hypertension (OR=4.842) and pregestational diabetes (OR=3.45) became relevant. The risk for preeclampsia increased 12-fold with gestational hypertension (P=0.003) and 14-fold with combined chronic and gestational hypertension (P=0.001). CONCLUSION: Pregnant women of ethnic minority had lower median vitamin D levels which may contribute to a potential risk for preeclampsia.

Evaluating the role of substance P in the growth of brain tumors.

Recent research has investigated the expression and secretion of neuropeptides by tumors, and the potential of these peptides to facilitate tumor growth and spread. In particular, substance P (SP) and its receptor NK1 have been implicated in tumor cell growth and evasion of apoptosis, although few studies have examined this relationship in vivo. The present study used both in vitro and in vivo models to characterize the role of SP in tumor pathogenesis. Immunohistochemical assessment of human primary and secondary brain tumor tissue demonstrated a marked increase in SP and its NK1 receptor in all tumor types investigated. Of the metastatic tumors, melanoma demonstrated particularly elevated SP and NK1 receptor staining. Subsequently, A-375 human melanoma cell line was examined in vitro and found to express both SP and the NK1 receptor. Treatment with the NK1 receptor antagonist Emend IV resulted in decreased cell viability and an increase in cell death in this cell line in vitro. An animal model of brain tumors using the same cell line was employed to assess the effect of Emend IV on tumor growth in vivo. Administration of Emend IV was found to decrease tumor volume and decrease cellular proliferation indicating that SP may play a role in tumor pathogenesis within the brain. We conclude that SP may provide a novel therapeutic target in the treatment of certain types of brain tumors, with further research required to determine whether the role of SP in cancer is tumor-type dependent.

Comparison of regenerated and non-regenerated oxidized cellulose hemostatic agents.

BACKGROUND: Oxidized cellulose is a well known and widely used surgical hemostat. It is available in many forms, but manufactured using either a nonregenerated or regenerated process. OBJECTIVE: This study compares the fiber structure, pH in solution, bactericidal effectiveness, and hemostatic effectiveness of an oxidized nonregenerated cellulose (ONRC; Traumastem®) and an oxidized regenerated cellulose (ORC; Surgicel® Original). METHODS: In vitro, fiber structures were compared using scanning electron microscopy, pH of phosphate buffer solution (PBS) and human plasma were measured after each cellulose was submerged, and bactericidal effect was measured by plating each cellulose with four bacteria. In vivo, time to hemostasis and hemostatic success were compared using a general surgery nonheparinized porcine liver abrasion model and a peripheral vascular surgery heparinized leporine femoral vessel bleeding model. RESULTS: Ultrastructure of ONRC fiber is frayed, while ORC is smooth. ORC pH is statistically more acidic than ONRC in PBS, but equal in plasma. No difference in bactericidal effectiveness was observed. In vivo, ONRC provided superior time to hemostasis relative to ORC (211.2 vs 384.6 s, N = 60/group) in the general surgery model; and superior hemostatic success relative to ORC at 30 (60 vs. 15 %; OR: 13.5; 95 % CI: 3.72-49.1, N = 40/group), 60 (85 vs. 37.5 %; OR: 12.3; 95 % CI: 3.66-41.6), and 90 s (97.5 vs 70.0 %; OR: 21.1, 95 % CI: 2.28-195.9) in the peripheral vascular model. CONCLUSION: ONRC provides superior hemostasis and equivalent bactericidal effectiveness relative to ORC, which is likely due to its fiber structure than acidity.

Diminazene diaceturate for treatment of chronic Cytauxzoon felis parasitemia in naturally infected cats.

BACKGROUND: Cytauxzoon felis is a hemoprotozoal parasite that causes substantial morbidity and mortality during the acute phase of infection in cats. However, cats that survive the acute illness remain persistently infected and may serve as a reservoir for the tick-transmitted pathogen. OBJECTIVE: We investigated the ability of the antiprotozoal compound diminazene diaceturate to eliminate the pathogen from naturally infected C. felis carriers. ANIMALS: Seven healthy, chronically infected domestic cats housed in a research setting. METHODS: Prospective clinical trial. Cats were treated in a masked fashion with diminazene diaceturate (3 mg/kg) or placebo IM in a series of 2 injections 7 days apart. Clearance of the organism was assessed by light microscopy and real-time polymerase chain reaction (PCR) at 0, 3, 6, and 10 weeks. In addition, cats were monitored for behavioral changes or for changes on physical examination, CBC, plasma biochemical profile, and urinalysis periodically. Cats that remained parasitemic at the end of 10 weeks were switched to the alternative treatment and similarly monitored for an additional 10 weeks. RESULTS: Adverse events associated with treatment were limited to self-resolving hypersalivation and injection site soreness; the former was ameliorated by premedication with atropine. Parasite burden, as assayed by both light microscopy and real-time PCR, was similar between diminazene- and placebo-treated cats. CONCLUSIONS AND CLINICAL RELEVANCE: Diminazene diaceturate was unable to eliminate the pathogen or decrease parasite burden in healthy, chronically infected cats.

Note: A simple, convenient, and reliable method to prepare gold scanning tunneling microscope tips.

A simple method to prepare gold tips for scanning tunneling microscopy has been introduced. In this method, electrochemical etching without a hazardous electrolyte was employed. The setup uses basic laboratory instrumentation to control the etching process. This avoids purchasing complicated, expensive, and dedicated equipment for tip preparation. A procedure to optimize the etching parameters by setting the current limit is described. Etched tips were checked with both optical and scanning electron microscopy.

A novel explosive process is required for the gamma-ray burst GRB 060614.

Over the past decade, our physical understanding of gamma-ray bursts (GRBs) has progressed rapidly, thanks to the discovery and observation of their long-lived afterglow emission. Long-duration (> 2 s) GRBs are associated with the explosive deaths of massive stars ('collapsars', ref. 1), which produce accompanying supernovae; the short-duration (< or = 2 s) GRBs have a different origin, which has been argued to be the merger of two compact objects. Here we report optical observations of GRB 060614 (duration approximately 100 s, ref. 10) that rule out the presence of an associated supernova. This would seem to require a new explosive process: either a massive collapsar that powers a GRB without any associated supernova, or a new type of 'engine', as long-lived as the collapsar but without a massive star. We also show that the properties of the host galaxy (redshift z = 0.125) distinguish it from other long-duration GRB hosts and suggest that an entirely new type of GRB progenitor may be required.

Method for determination of pentobarbital in dry dog food by gas chromatography/mass spectrometry.

A procedure has been developed and validated for measuring the concentration of pentobarbital residues in dry, extruded animal feed in the range of 3-200 ng/g (ppb) with an estimated limit of quantitation of 2 ppb. The method was developed for surveillance purposes: to measure the concentration of euthanizing agent which might be present in feeds incorporating rendered products which themselves might include some fraction of euthanized animals. A previously published qualitative procedure was modified by adding isotopically labelled pentobarbital as an internal standard. Dry feed was ground and extracted with methanol. The extract was loaded on a mixed-mode (C-18, anion exchange) solid-phase extraction cartridge designed for barbiturate residues. Pentobarbital was eluted and derivatized for gas chromatography/mass spectrometry in positive ion chemical ionization mode. Quantitation was based on the ratio of dimethyl-pentobarbital MH+ (m/z 255) vs dimethyl-pentobarbital-d(5) (m/z 260) in standards and extracts. Accuracy ranged from 112% at 3 ppb to 96% at 200 ppb, with relative standard deviations ranging from 4% at 3 ppb to 2% at 200 ppb.

Association of sex of the fetus in isolated fetal choroid plexus cysts.

We sought to determine if an association exists between sex of the fetus and the finding of isolated fetal choroid plexus cysts. Of 131 fetuses, 62 were male (47.3%) and 69 were female (52.7%). No statistically significant differences were found in the maternal demographic parameters studied (age, race, gravidity, parity, sonogram timing) or descriptive cyst information obtained (location, number, dimensions, resolution), although bilaterality was more common in male fetuses. The determination that isolated choroid plexus cysts are seen equally frequently in male and female fetuses adds to basic information about such a common sonographic finding.

Glycosylated hemoglobin as a predictor of fetal pulmonic maturity in insulin-dependent diabetes at term.

In insulin dependent diabetic (IDDM) gestations, fetal pulmonary maturity is delayed in the presence of suboptimal glycemic control. Serum glycosylated hemoglobin (HbA1c) provides a means of assessing glycemic control. We evaluated maternal HbA1c in IDDM pregnancies at term undergoing amniocentesis for lung maturity to establish if euglycemia is associated with improved fetal lung maturity. Between July 1995 and June 1996, IDDM patients undergoing amniocentesis at term for lung maturity studies had a maternal serum sample analyzed for HbA1c. Fetal lung maturity was established by the presence of phosphatidylglycerol (PG) in amniotic fluid. HbA1c was considered elevated if >6.2%. Mean HbA1c level was 6.8% (range 4.4 to 9.9%). PG was present in 54% of patients with elevated HbA1c (7/13) versus 80% of those with normal HbA1c (8/10) (p = 0.4). Although birth weight was higher in the elevated than in the normal HbA1c group (3770 +/- 514 vs. 3215 +/- 610 g), no association was present between birth weight and HbA1c level (r = 0.22, p = 0.4). The rate of a mature pulmonic profile at term is not significantly different between IDDM women with good or poor glycemic control. HbA1c values should not be used to predict the presence or absence of amniotic fluid PG.

The risk of infection with HIV and hepatitis B in individuals who inject steroids in England and Wales.

Data on injecting anabolic steroid users, within the national Unlinked Anonymous HIV Prevalence Monitoring Survey of injecting drug users (IDUs) were analysed to determine their risk of acquiring blood borne viruses. One hundred and forty-nine participants who had injected anabolic steroids in the previous month were identified from 1991-6, contributing 1.4% of all participation episodes in the survey. Rates of needle and syringe sharing by steroid users were low. Three of the 149 (2.0%) had anti-HBc and none had anti-HIV in their salivary specimens. The prevalence of anti-HBc in steroid injectors was significantly lower than in heroin injectors, 275/1509 (18%) (P < 0.001), or in amphetamine injectors, 28/239 (12%) (P < 0.001). The risk of blood borne virus transmission amongst these steroid injectors is low, probably due to hygienic use of injecting equipment and low levels of sharing. It is important to distinguish steroid injectors from other IDUs because they are a distinct group in terms of lifestyle and injecting practice.

Complications of intrauterine placement of a vesicoamniotic shunt.

BACKGROUND: Fetal obstructive uropathies complicated by severe oligohydramnios can cause neonatal death due to renal dysplasia and pulmonary hypoplasia. CASE: A 31-year-old multigravida was referred at 19.6 weeks with sonographic evidence of fetal megacystis and bilateral hydroureteronephrosis, and severe oligohydramnios. A vesicoamniotic shunt was placed for urinary diversion. Complications included shunt migration, intestinal evisceration, amniorrhexis, preterm labor, and preterm delivery. Bowel characteristics were assessed by measuring the intestinal lumen diameter for evidence of obstruction. The lumen diameter remained stable at 3-5 mm, and the luminal wall remained stable at 2.5 mm. After birth at 31 weeks, the infant underwent exploratory laparotomy and extraction of malpositioned shunts, vesicostomy, and closure of abdominal wall defect. He was discharged at 61 days of life after resolution of neonatal pulmonary and infectious complications. CONCLUSION: Operative management of complete fetal obstructive uropathy is beneficial despite potential complications.

Prenatal diagnosis of an infant with mosaic trisomy 16 of paternal origin.

We present the first case of an infant with paternally-derived mosaic trisomy 16. Amniocentesis following an elevated maternal serum alpha-fetoprotein level and early fetal growth restriction at 19 weeks detected a high level of mosaicism with 25/33 colonies demonstrating trisomy 16 and 8/33 colonies with a normal 46,XX karyotype. Molecular studies revealed a paternal origin of the trisomy which was present in amniotic fluid cells, representing either a post-zygotic error or a meiosis II non-disjunction without crossing-over. In addition, there was normal biparental inheritance in the normal cell line. The symmetrically growth-restricted fetus was closely monitored for the remainder of the gestation. Decreased fetal movements at 36 weeks in conjunction with electronic fetal monitoring showing evidence of fetal distress necessitated abdominal delivery. Severe growth restriction, mild facial dysmorphism, and cardiac anomalies were identified. Microsatellite analysis demonstrated biparental inheritance in skin fibroblasts with a paternal origin for the trisomy in the placenta. Follow-up cytogenetic studies of additional tissues revealed 85 per cent trisomy 16 mosaicism in the placenta, yet only cytogenetically normal cells in lymphocytes and fibroblasts.

Mid-trimester prenatal sonographic diagnosis of a pericardial cyst.

Prenatal diagnosis of pericardial masses are infrequent and usually consist of intrapericardial teratomas or haemangiomas. We present the first report of prenatal diagnosis of a suspected pericardial cyst at 14 weeks' gestation which was subsequently confirmed by neonatal computed tomography.

Prenatal color and pulsed Doppler sonographic documentation of intrathoracic umbilical vein and ductus venosus, confirming extensive hepatic herniation in left congenital diaphragmatic hernia.

Prenatal sonographic diagnosis of an unusual case of a large left congenital diaphragmatic hernia is presented. The fetal stomach was located within the right thorax, posterior to the dextropositioned heart. Color and pulsed Doppler ultrasonography documented intrathoracic umbilical vein and ductus venosus vessels and respective waveforms, confirming extensive herniation of the left hepatic lobe.

Computer automated sperm head morphometry analysis (ASMA) of goat spermatozoa.

The development of computer automated sperm morphometry analysis (ASMA) allows for the objective analysis of sperm head dimensions. A number of studies have been performed to optimize the efficiency of these systems when analyzing spermatozoa from a variety of species. In this study, frozen semen from 10 fertile goat bucks was thawed and prepared on slides for morphometric analysis to evaluate technical variation and to standardize ASMA procedures for goat spermatozoa. Methods of staining, the number of spermatozoa necessary to sample and optimal microscopic magnification were assessed. Staining for 20 min in hematoxylin (HEM) was found to be optimal. The most efficient method of analyzing goat sperm morphometry was to evaluate 100 sperm cells at x20 objective magnification. Using these techniques, a sample could be analyzed in approximately 2 min. The system properly recognized and digitized spermatozoa 96% of the time with a target recognition error rate of less than 1%. The morphometric measurements of sperm heads for all 10 bucks were the following: length = 7.69microm, width = 3.80microm, width/length ratio = 0.5, area = 22.82microm and perimeter = 20.15microm. The mean coefficients of variation (CV) for all bucks ranged from 3.4% for length to 5.8% for area. Standardized sample preparation techniques and analysis were found to improve the efficiency of ASMA.

Effects of dietary testosterone on growth and sex ratio in juvenile Atlantic salmon (Salmo salar).

Diets to which testosterone (1 or 10 ng/g diet) had been added were fed to juvenile Atlantic salmon (Salmo salar) for nine months beginning for months after hatching (Experiment 1) and upon completion of yolk absorption (Experiment 2) to determine the effects on growth, gonadal development, and sex ratio. Dietary testosterone at 10 ng/g fed to juvenile salmon at four months after hatching (Exp. 1) induced significant changes in condition factor (0.69±0.01) compared to controls (0.79±0.01) at the end of the test period. In both experiments, salmon treated with 10 ng/g diet induced a significantly higher percentage of male fish compared to controls. Dietary testosterone at 1 ng/g fed to juvenile salmon beginning four months after hatching induced significant increases in weight (18.95±0.99) and length (13.58±0.23) compared to controls (14.55±1.50 and 11.94±0.43, respectively). In Experiment 1 or 2, there was no apparent influence of dietary testosterone on precocious male sexual development. Dietary testosterone at 1 or 10 ng/g fed to juvenile salmon upon completion of yolk absorption (Exp. 2) induced no consistent changes in growth in juvenile Atlantic salmon. These studies indicate that low levels of dietary testosterone may influence physiological responses in juvenile Atlantic salmon dependent upon timing of treatment.