Endovascular Treatment of Cerebrovascular Lesions Using Nickel- or Nitinol-Containing Devices in Patients with Nickel Allergies.

Nickel is used in many cerebral endovascular treatment devices. However, nickel hypersensitivity is the most common metal allergy, and the relative risk of treatment in these patients is unknown. This retrospective analysis identified patients with nickel or metal allergies who underwent cerebral endovascular treatment with nickel-containing devices. Seven patients with nickel and/or other metal allergies underwent treatment with 9 nickel-containing devices. None experienced periprocedural complications. No patient received treatment with corticosteroids or antihistamines. At a mean clinical follow-up for all patients of 22.8 months (range, 10.5-38.0 months), no patients had symptoms attributable to nickel allergic reactions. The mean radiographic follow-up for all patients at 18.4 months (range, 2.5-37.5 months) showed successful treatment of the targeted vascular pathologies, with no evidence of in-stent stenosis or other allergic or hypersensitivity sequelae. The treatment of cerebrovascular lesions with a nickel-containing device resulted in no adverse outcomes among these patients and was safe and effective.

Relationships between host viremia and vector susceptibility for arboviruses.

Using a threshold model where a minimum level of host viremia is necessary to infect vectors affects our assessment of the relative importance of different host species in the transmission and spread of these pathogens. Other models may be more accurate descriptions of the relationship between host viremia and vector infection. Under the threshold model, the intensity and duration of the viremia above the threshold level is critical in determining the potential numbers of infected mosquitoes. A probabilistic model relating host viremia to the probability distribution of virions in the mosquito bloodmeal shows that the threshold model will underestimate the significance of hosts with low viremias. A probabilistic model that includes avian mortality shows that the maximum number of mosquitoes is infected by feeding on hosts whose viremia peaks just below the lethal level. The relationship between host viremia and vector infection is complex, and there is little experimental information to determine the most accurate model for different arthropod-vector-host systems. Until there is more information, the ability to distinguish the relative importance of different hosts in infecting vectors will remain problematic. Relying on assumptions with little support may result in erroneous conclusions about the importance of different hosts.

West Nile virus infection rates in Culex nigripalpus (Diptera: Culicidae) do not reflect transmission rates in Florida.

We describe the first documented field transmission of West Nile (WN) virus by a North American mosquito. WN was first detected in northern Florida in 2001. An intensive mosquito trapping and surveillance program was conducted in this region for four nights to assess mosquito transmission of WN. Four mosquito traps, each with a single sentinel chicken, were placed at five different locations on each of four nights. A total of 11,948 mosquitoes was collected, and 14 mosquito pools were found to contain WN, giving a minimum infection rate between 1.08 and 7.54 per 1,000. Only one of the 80 sentinel chickens seroconverted to WN, demonstrating a single mosquito transmission event during the study and a mosquito transmission rate of between 0.8 and 1 per 1,000. Culex nigripalpus Theobald was responsible for WN transmission to the sentinel chicken, although both Cx. nigripalpus and Culex quinquefasciatus Say were found infected with WN. Mosquito transmission rates are reported in this study for the first time for a WN outbreak. This information is essential to determine risk of human and animal infection.

Effect of superficial heat, deep heat, and active exercise warm-up on the extensibility of the plantar flexors.

BACKGROUND AND PURPOSE: Warm-up prior to static stretching enhances muscle extensibility. The relative effectiveness of different modes of warm-up, however, is unknown. The purpose of this study was to evaluate the effectiveness of superficial heat, deep heat, and active exercise warm-up prior to stretching compared with stretching alone on the extensibility of the plantar-flexor muscles. SUBJECTS: Ninety-seven subjects (59 women, 38 men) with limited dorsiflexion range of motion (ROM) were randomly assigned to 1 of 5 groups. Female subjects had a mean age of 27.6 years (SD=7.68, range=17-50), and male subjects had a mean age of 26.8 years (SD=6.87, range=18-48). METHODS: The first group (group 1) was a control group and did not perform the stretching protocol. The 4 experimental groups (groups 2-5) performed a stretching protocol 3 days per week for 6 weeks. Group 2 performed the static stretching protocol only; group 3 performed active heel raises before stretching; group 4 received 15 minutes of superficial, moist heat to the plantar-flexor muscles before stretching; and group 5 received continuous ultrasound for 7 minutes before stretching. Dorsiflexion ROM measurements were taken initially and after 2, 4, and 6 weeks. RESULTS: All experimental groups increased active and passive range of motion (AROM and PROM). The mean AROM/PROM differences at 6 weeks were 1.11/1.39 degrees for group 1, 4.10/6.11 degrees for group 2, 4.16/4.21 degrees for group 3, 4.38/4.90 degrees for group 4, and 6.20/7.35 degrees for group 5. The group receiving ultrasound before performing the stretching protocol (group 5) displayed the greatest increase in both AROM (6.20() and PROM (7.35(). DISCUSSION AND CONCLUSION: Among the modalities tested, the use of ultrasound for 7 minutes prior to stretching may be the most effective for increasing ankle dorsiflexion ROM.

Determination of the thermal offset of the Eppley precision spectral pyranometer.

Eppley's precision spectral pyranometer (PSP) is used in networks around the world to measure downwelling diffuse and global solar irradiance at the surface of the Earth. In recent years several studies have shown significant discrepancy between irradiances measured by pyranometers and those computed by atmospheric radiative transfer models. Pyranometer measurements have been questioned because observed diffuse irradiances sometimes are below theoretical minimum values for a pure molecular atmosphere, and at night the instruments often produce nonzero signals ranging between +5 and -10 W m(-2). We install thermistor sondes in the body of a PSP as well as on its inner dome to monitor the temperature gradients within the instrument, and we operate a pyrgeometer (PIR) instrument side by side with the PSP. We derive a relationship between the PSP output and thermal radiative exchange by the dome and the detector and a relationship between the PSP output and the PIR thermopile output (net-IR). We determine the true PSP offset by quickly capping the instrument at set time intervals. For a ventilated and shaded PSP, the thermal offset can reach -15 W m(-2) under clear skies, whereas it remains close to zero for low overcast clouds. We estimate the PSP thermal offset by two methods: (1) using the PSP temperatures and (2) using the PIR net-IR signal. The offset computed from the PSP temperatures yields a reliable estimate of the true offset (+/-1 W m(-2)). The offset computed from net-IR is consistent with the true offset at night and under overcast skies but predicts only part of the true range under clear skies.

Polymerase chain reaction assay to identify all immature stages of two species of the Anopheles quadrimaculatus sibling species complex (Diptera: Culicidae).

A polymerase chain reaction assay that detects differences in the 2nd internal transcribed spacer of ribosomal DNA was tested as a means to identify all immature stages of 2 species in the Anopheles quadrimaculatus sibling species complex. The technique was successful in amplifying DNA from eggs, 1st-4th instars, and pupae of An. quadrilmaculatus Say and An. inundatus Reinert.

Comparison of electrostatic versus nonelectrostatic ULV sprays of Aqua Reslin against Anopheles quadrimaculatus adults.

An electrostatic truck-mounted spray system (Spectrum, Houston, TX) and a nonelectrostatic spray system (Micro-Gen G-4, San Antonio, TX) were tested to determine the feasibility of electrostatically charging Aqua Reslin, a water-based permethrin insecticide, and ascertain whether an electrostatic charge would increase the efficiency of Aqua Reslin against Anopheles quadrimaculatus adults. Parameters tested for both machines included mean mass median diameter (MMD) of droplets, number of drops per cm2, and posttreatment percent mortality at 1, 12, and 24 h. Results indicated that the electrostatically charged droplets produced greater mortality at each distance and hour posttreatment. Correlation coefficients and linear equations were calculated for distance-mortality, MMD-mortality, drops per cm2-mortality, distance-drops per cm2, distance-MMD, and MMD-drops per cm2. Results indicated that the electrostatic drops demonstrated strong correlations between each paired variable, whereas the nonelectrostatic drops showed poor correlation between drops per cm2-mortality, distance-drops per cm2, and MMD-drops per cm2. However, from this trial, these differences cannot be attributed purely to the electrostatic charge because significant differences in droplet size can affect spray performance.

Mosquito (Diptera: Culicidae) host compatibility and vector competency for the human myositic parasite Trachipleistophora hominis (Phylum Microspora).

Microsporidian spores of Trachipleistophora hominis Hollister, isolated from a human, readily infected larval stages of both Anopheles quadrimaculatus Say sensu lato and Culex quinque-fasciatus Say. Mosquito infections with T. hominis were located, primarily, in abdominal muscles in segment numbers 4 through 6; other spores were found in the hemocoel and proboscis. Nearly 50% of the infected mosquito larvae survived to the adult stage. Spores recovered from adult mosquitoes were inoculated into mice and resulted in significant muscle infection at the site of injection. Preliminary observations also showed that T. hominis spores can be passively transferred from infected mosquitoes to a sugar water substrate.

An experience with "research by committee".

The Nursing Research Committee of a community hospital describes the difficulties and unexpected pitfalls encountered during an attempt to conduct "research by committee." The steps of the process, from initial development of a research question through research design and implementation and termination of the project, are related. A retrospective analysis of the difficulties encountered serves as a basis for recommendations to others who might consider research by committee. Although a valid means for conducting research, the experiences of this committee indicate how forces, in their control and beyond their control, might influence completion of a project.

Sensitizing students to functional limitations in the elderly: an aging simulation.

BACKGROUND AND OBJECTIVES: Using activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as a focus, faculty at Eastern Virginia Medical School provide an aging simulation exercise for a mandatory fourth-year clerkship in geriatrics. The specific aims of the simulation are to 1) experience the physical frailties of aging, 2) develop creative problem-solving techniques, 3) identify feelings regarding the experience of functional loss, and 4) develop proactive clinical approaches to the care of the elderly. METHODS: Students are assigned one of four diagnoses (Parkinson's disease, rheumatoid arthritis, advanced diabetes, or stroke) and are then impaired to simulate the frailties of the condition, using a variety of clothes, bindings, and other devices. In their "impaired states," they perform ADLs and IADLs, such as paying bills, organizing their pills, shopping, toileting, dressing, and eating. RESULTS: Evaluation results show the aging simulation to be the highest rated program in the clerkship. A pre- and post-course survey on attitudes toward the elderly showed a statistically significant improvement in students' attitudes toward the elderly following the course. CONCLUSIONS: Simulation exercises in aging are useful activities for helping students better understand the feelings and needs of the elderly.

Dialysis adequacy and self-reported health status in a group of CAPD patients.

The purpose of the study was to describe in a cross sectional manner the self-reported level of health of a group of continuous ambulatory peritoneal dialysis (CAPD) patients and to establish whether any clinical or laboratory variables correlated with this measure of health. While undergoing routine baseline and 6 monthly measurements of weekly total urea over volume distribution (Kt/V) and weekly creatinine clearance (Ccr)/1.73 m2 body surface area (BSA), 57 patients voluntarily completed the Short Form 36 health status questionnaire (SF36) (a self-report, multidimensional, generic measure of health status). Weekly Kt/V was correlated with weekly Ccr (r = 0-81, p < 0.001). Thirty-one of the 57 patients were recorded as having Ccr < 65 L/week. A comparison with Australian interim normative data demonstrated that this group of CAPD patients reported lower scores on the eight physical and mental health components that are measured by the SF36 than did the general population. Patients who were most impaired in their physical functioning were more likely to be older, overweight, and to have a lower normalized protein catabolic rate (nPCR). Patients who were adequately dialyzed (Ccr > or = 65 L/week/1.73 m2) reported greater vitality than those patients recorded as having Ccr < 65 L/week/1.73 m2.

Validation of a ribosomal DNA-polymerase chain reaction species diagnostic assay for the common malaria mosquito (Diptera:Culicidae) sibling species complex.

A polymerase chain reaction method for identifying individuals in the Anopheles quadrimaculatus Say sibling species complex was validated for wild mosquitoes from Louisiana and Mississippi. This method distinguished An. quadrimaculatus species A, B, C, and D by detecting species-specific differences in the 2nd internal transcribed spacer of ribosomal DNA and was 100% specific and 95% sensitive.

The doctor, the patient: a first-year course for personal and professional growth.

BACKGROUND AND OBJECTIVES: Medical education has tended to focus primarily on the biomedical aspects of care while neglecting the human side of patients and students. To help students become aware of student, patient, and family issues that may impact the doctor-patient relationship, a first-year course was developed. METHODS: This course consists of 12 didactic sessions and 10 small-group meetings led by family medicine faculty. Topics include self-assessments, analysis of videotaped doctor-patient interactions, genogram development, and family systems. Students have evaluated the course for content, strengths, weaknesses, and impact. RESULTS: This course was highly rated by the students. The students reported gaining insight into personal issues that might impact their interaction with patients. Students also became aware of the importance of family issues to their patients' health and well-being. CONCLUSIONS: Through courses like this, students may gain deeper insight into issues that impact them, their patients, and the doctor-patient relationship.

Record of Anopheles quadrimaculatus species C in Louisiana.

Sibling species C of the Anopheles quadrimaculatus species complex was found south of Abbeville (Vermilion Parish), Louisiana, during a state-wide survey in 1993. This constitutes a new state record and currently represents its westernmost distribution.

Knowledge of pregnancy symptoms among abortion patients: is race a predictor?

This cross-sectional study characterizes first-trimester abortion patients who perceived inadequate knowledge of pregnancy symptoms and identifies net predictors of inadequate symptom knowledge. Data were collected at an abortion facility in Hampton Roads, Virginia. Study subjects were women surveyed on the day of their abortions, prior to termination procedures. Self-reported knowledge of pregnancy symptoms was the study's dependent variable. Of 342 women, 120 (35%) perceived inadequate symptom knowledge. These women more often were young, black, single, and poorly educated. Only black race was a net predictor of inadequate symptom knowledge when study variables were entered into a multiple logistic regression. Black race was the only net predictor of inadequate symptom knowledge among first-trimester abortion patients. This racial difference was not explained by socioeconomic or access factors. Future research should consider an alternative hypothesis, the possibility that more effective communications with black abortion patients are needed. Additionally, health-care providers should not presume that first-trimester abortion patients are familiar with pregnancy symptoms and should not stereotype patients who perceive knowledge limitations with regard to socioeconomic status.

Energy metabolism and thermoregulation in the golden lion tamarin (Leontopithecus rosalia).

Energy metabolism and body temperature were examined in Leontopithecus rosalia, the golden lion tamarin. Total standard metabolic rate (SMR), defined as the metabolic rate of resting, fasted animals within thermoneutrality and during the inactive (nighttime) phase, averaged 381.5 +/- 65.2 ml O2.h-1 (mass-specific metabolic rate 0.520 +/- 0.089 ml O2.g-1.h-1). This value ranges from 73 to 89% of the expected SMR for animals of this body size depending on the predictive equation used. Active-phase resting metabolic rate within thermoneutrality was significantly greater than SMR, averaging 509.0 +/- 44.6 ml O2.h-1 (0.709 +/- 0.062 ml O2.g-1.h-1). Thermal conductance during the inactive phase was 20.3 +/- 2.7 ml O2.h-1.degrees C-1 (0.029 +/- 0.003 ml O2.g-1.h-1.degrees C-1) or 70% of that during the active phase (28.5 +/- 3.2 ml O2.h-1.degrees C-1, 0.042 +/- 0.004 ml O2.g-1.h-1.degrees C-1). These values are about 85% of the mammalian predicted value. Body temperature fluctuated substantially between day (39.6 degrees C) and night (37.4 degrees C). However, none of these differences between circadian phases are unusual for primates (or, indeed, mammals) of similar body size. Although the metabolic rate of Leontopithecus is lower than the predicted one, it is higher than those rates reported for small nocturnal primates with similar food habits. Leontopithecus' modest rates of energy turnover may reflect a combination of phylogenetic constraints, feeding ecology and/or an energy-saving tactic that comprises part of a strategy to maximize reproductive effort. Although callitrichids are often cited as having rapid growth and high reproductive effort, the moderately low SMR of Leontopithecus is consistent with its intrinsic rate of natural increase, which is 90-94% of that expected for a mammal of its body size.