A simple HEPA filtering facepiece.

Shortages of efficient filtering facepiece respirators leave the public vulnerable to transmission of infectious diseases in small particle aerosols. This study demonstrates that a high-filtration-efficiency facepiece capable of filtering out >95% of 0.05µm particles while being worn can be simply produced with available materials.

Modified African Ngoma Healing Ceremony for Stress Reduction: A Pilot Study.

OBJECTIVE: Indigenous people's ceremonies using rhythm and dance have been used for countless generations throughout the world for healing, conflict resolution, social bonding, and spiritual experience. A previous study reported that a ceremony based on the Central African ngoma tradition was favorably received by a group of Americans. The present trial compared the effects of the modified ngoma ceremony (Ngoma) with those of mindfulness-based stress reduction (MBSR) in a randomized pilot study. METHODS: Twenty-one women were randomized to either Ngoma or MBSR. Both groups had sessions on a weekly basis for 8 weeks and completed questionnaires at baseline, week 8, and 1 month after the intervention. Participants completed questionnaires, which included self-report of depressive and anxiety symptoms, health status (e.g., quality of life and functioning), social bonding, and perception of the credibility of the two interventions. RESULTS: Both groups showed improvements in depression, anxiety, emotional well being, and social functioning as measured by respective scales. Social bonding also increased in both groups during the study and may be a mechanism for both interventions. Participants found both interventions credible. CONCLUSIONS: In this pilot study, Ngoma showed significant and durable beneficial effects comparable to MBSR. The effects of Ngoma and other indigenous rhythm-dance ceremonies on distress and health status in western culture should be investigated in larger clinical studies.

Therapeutic Potential of a Drum and Dance Ceremony Based on the African Ngoma Tradition.

OBJECTIVE: Ngoma ceremonies are used throughout Central and South Africa to help people address "difficult issues," including medical illness. They are examples of ceremonies that use strong rhythms and dance for this purpose in indigenous cultures throughout the world. This study sought to modify an ngoma ceremony to make it appropriate for biomedical use and to determine its acceptance and potential for benefit for people living in the United States. METHODS: The Congolese Zebola ceremony, an African healing practice, was modified to be religion-neutral and to involve only moderate exercise. Seventeen participants were recruited for the current study. Most participants were living with a chronic illness (n=15), and a few had no medical diagnoses (n=2). Participants spent 10 minutes in a focused activity, such as meditation, yoga, or prayer. They then danced to the Congolese rhythm Zebola for an hour and a half, with a rest every 20 minutes. Afterward, they indicated whether the experience was positive, neutral, or negative and wrote a narrative describing their experience and what they saw as strengths and weaknesses of the ceremony. They then participated in a focus group discussion. Data from the narrative and focus group discussion were coded, tabulated, and analyzed for themes. RESULTS: Sixteen of seventeen participants found the ceremony to be a positive experience. None found the form uncomfortably foreign or disturbing. Participants described diverse benefits, including increased exercise tolerance, stress reduction, feelings of group support, and beneficial spiritual experiences. CONCLUSIONS: Further study of the modified ngoma ceremony is warranted. Global health programs should consider the potential benefits of transferring technologies in both directions rather than only from technologically advanced countries to less technologically advanced ones.

Medicine's missing dimension.

In medicine we tend to restrict practice to using a purely intellectual understanding grounded in science to conceptualize patients and their illnesses. This approach is radically different from the experientially rich healing practices found throughout the world that presumably date to the beginning of humanity. Shamanistic healing is often typified as involving magical thinking and communication with beings other than human. These aspects of traditional healing are difficult to merge with science, the backbone of our medical practice. However, we can also describe traditional healing as meeting patients beyond the conventional self and beyond conceptual filters to directly face sickness and death in a larger context. There are a variety of traditions for learning to live our lives in this larger context, including contemplative religious practices and secular mindfulness practice. Although self discipline, effort and courage are likely to be required to take these paths, they can transform the practice of medicine into a richer experience. Using Zen Buddhism as an example of a contemplative spiritual approach, I will explore how it is possible to preserve a respectful relationship to science while engaging in healing as what the African Bushmen called "a life thing, a death thing".

A comparison of the effectiveness of lipid-lowering therapy between HIV- and non-HIV-infected subjects with hyperlipidaemia.

This retrospective cohort study conducted at the Durham Veterans Affairs Medical Center evaluated the effectiveness and safety of lipid-lowering therapy (LLT) in a HIV-infected population as compared with a general population with hyperlipidaemia. Fifty-three HIV-infected subjects who developed dyslipidaemia and 53 age-matched non-HIV-infected subjects receiving LLT were selected. Efficacy of LLT was assessed after three and six months. Non-HIV-infected subjects were more likely to achieve total cholesterol (TC) goals at three and six months (P = 0.045, P = 0.005) and triglyceride (TG) goals at six months (P = 0.017). Less than 45% of HIV-infected subjects met National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) goals at three or six months. While non-HIV-infected subjects were more likely to achieve TC and TG goals than HIV-infected subjects, overall achievement of NCEP III goals was poor. This result was likely due to treatment with inappropriately low doses of statins.

Association between pharmacy medication refill-based adherence rates and cd4 count and viral-load responses: A retrospective analysis in treatment-experienced adults with HIV.

BACKGROUND: Current guidelines and most contemporary statements in the literature indicate that, like other medical conditions, HIV infection requires exceptionally high adherence to highly active antiretroviral therapy (HAART) for successful treatment. OBJECTIVE: This study was conducted to determine the association between pharmacy medication refill rates-a surrogate marker for adherence to HAART- and CD4-count/viral-load responses in patients with HIV METHODS: This retrospective study was conducted at the HIV Clinic, Veterans Affairs Medical Center, Durham, North Carolina. Male and female patients aged >/=18 years with a history of HIV who attended clinic appointments on 3 consecutive clinic days were enrolled. Pharmacy medication refill-based adherence rates over the 6 months before the study were determined by examining electronic pharmacy records. The most recent viral load and the change (Delta) in CD4 count over the past year-surrogate measures of outcome-were also collected from each patient's electronic medical record and compared with refill adherence rates. The incidence of AIDS-related events and past antiretroviral experience were also compared with the DeltaCD4 count and adherence rates. RESULTS: Data from 58 patients were included in the study. Thirty-nine patients were black men; the mean age was 51.5 years. There was a nonsignificant correlation between 6-month pharmacy medication refillbased adherence rates and viral loads (r = 0.10). The relationship between DeltaCD4 count and adherence was complex. With adherence rates >70%, the DeltaCD4 count ranged from +414 to -238, with no indication that increasing adherence led to a greater CD4 count increase. The DeltaCD4 count progressively declined with adherence rates 70%, there was no significant correlation between adherence rates and DeltaCD4 counts or viral-load responses.

Comparison of fecal biota from specific pathogen free and feral mice.

Specific pathogen free (SPF) rodents are derived from germfree animals that are colonized with Schaedler's flora, a cocktail of eight bacterial strains isolated from the natural biota of mice. During successive generations SPF animals acquire a complex biota, but it is not known how similar it is to natural mouse biota. Therefore, fecal pellets of two feral mice and three SPF mice were studied by small subunit ribosomal DNA sequence analysis. After amplification of 16S rDNA by Bacterial Kingdom-specific primers, 132 rDNA clones from feral mice and 219 clones from SPF mice were placed phylogenetically. Forty-four percent of recovered rDNAs from feral mice were from organisms belonging to the Ribosomal Database Project's Bacteroides Group with significant proportions also coming from lactobacilli, the Clostridium coccoides Group and the Clostridium leptum Group. Although the SPF biota appeared equally complex at lower phylogenetic levels, the major phylogenetic groups represented were less diverse in that 92% of rDNA's from SPF mice mapped to groups of clostridia with 79% to the C. coccoides Group alone. Given the number of physiological parameters influenced by the gut biota and the importance of mice in biomedical research, further investigations are warranted.

Benefits and harms of doxycycline treatment for Gulf War veterans' illnesses: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: It has been hypothesized that certain Mycoplasma species may cause Gulf War veterans' illnesses (GWVIs), chronic diseases characterized by pain, fatigue, and cognitive symptoms, and that affected patients may benefit from doxycycline treatment. OBJECTIVE: To determine whether a 12-month course of doxycycline improves functional status in Gulf War veterans with GWVIs. DESIGN: A randomized, double-blind, placebo-controlled clinical trial with 12 months of treatment and 6 additional months of follow-up. SETTING: 26 U.S. Department of Veterans Affairs and 2 U.S. Department of Defense medical centers. PARTICIPANTS: 491 deployed Gulf War veterans with GWVIs and detectable Mycoplasma DNA in the blood. INTERVENTION: Doxycycline, 200 mg, or matching placebo daily for 12 months. MEASUREMENTS: The primary outcome was the proportion of participants who improved more than 7 units on the Physical Component Summary score of the Veterans Short Form-36 General Health Survey 12 months after randomization. Secondary outcomes were measures of pain, fatigue, and cognitive function and change in positivity for Mycoplasma species at 6, 12, and 18 months after randomization. RESULTS: No statistically significant differences were found between the doxycycline and placebo groups for the primary outcome measure (43 of 238 participants [18.1%] vs. 42 of 243 participants [17.3%]; difference, 0.8 percentage point [95% CI, -6.5 to 8.0 percentage points]; P > 0.2) or for secondary outcome measures at 1 year. In addition, possible differences in outcomes at 3 and 6 months were not apparent at 9 or 18 months. Participants in the doxycycline group had a higher incidence of nausea and photosensitivity. LIMITATIONS: Adherence to treatment after 6 months was poor. CONCLUSION: Long-term treatment with doxycycline did not improve outcomes of GWVIs at 1 year.

Endocarditis caused by Staphylococcus aureus with reduced susceptibility to vancomycin.

Clinical management of infective endocarditis (IE) is expected to become more difficult with the emergence of Staphylococcus aureus with reduced susceptibility to vancomycin (SARV) in the United States and worldwide. We report the strain characterization and treatment of a patient with SARV IE.

Ribosomal DNA sequence analysis of mucosa-associated bacteria in Crohn's disease.

BACKGROUND: Enteric bacteria are implicated in the pathogenesis of Crohn's disease (CD); however, no specific causative organisms have been identified. AIMS: This study was undertaken to correlate disease activity with changes in intestinal biota in patients with CD. SUBJECTS: Ribosomal DNA analysis was used to explore the composition of the intestinal biota in patients with (1) CD undergoing colonoscopy, (2) CD undergoing surgical resection, and (3) no inflammatory bowel disease. METHODS: Primers targeting bacterial 16S ribosomal DNA (rDNA) were used to amplify bacterial DNA associated with active CD lesions, comparable normal tissue from patients with CD, and normal control tissue. Each amplicon was cloned. Seven hundred thirty-nine rDNA clones were sequenced from 16 biopsies from CD patients, 15 surgical samples, and 10 biopsies from normal control patients. RESULTS: Known extracellular or intracellular pathogens were not found. No rDNA sequence, phylogenetic group, or subgroup was consistently associated with CD lesions compared with normal tissues from the same patients. Colonic biopsies from CD-afflicted patients compared with biopsies from normal control subjects had an increase in facultative bacteria; in small bowel, CD patients had an increase in the Ruminococcus gnavus subgroup with a decrease in the Clostridium leptum and Prevotella nigrescens subgroups. However, differences in small bowel may have reflected individual variation rather than disease association. Surgical samples showed differences when compared with biopsy-derived samples. CONCLUSIONS: These findings suggest that CD is not caused by invasive pathogens associated specifically with the sites of lesions but that dysbiosis exists in this condition.

High-density microarray of small-subunit ribosomal DNA probes.

Ribosomal DNA sequence analysis, originally conceived as a way to provide a universal phylogeny for life forms, has proven useful in many areas of biological research. Some of the most promising applications of this approach are presently limited by the rate at which sequences can be analyzed. As a step toward overcoming this limitation, we have investigated the use of photolithography chip technology to perform sequence analyses on amplified small-subunit rRNA genes. The GeneChip (Affymetrix Corporation) contained 31,179 20-mer oligonucleotides that were complementary to a subalignment of sequences in the Ribosomal Database Project (RDP) (B. L. Maidak et al., Nucleic Acids Res. 29:173-174, 2001). The chip and standard Affymetrix software were able to correctly match small-subunit ribosomal DNA amplicons with the corresponding sequences in the RDP database for 15 of 17 bacterial species grown in pure culture. When bacteria collected from an air sample were tested, the method compared favorably with cloning and sequencing amplicons in determining the presence of phylogenetic groups. However, the method could not resolve the individual sequences comprising a complex mixed sample. Given these results and the potential for future enhancement of this technology, it may become widely useful.