Who mixes with whom among men who have sex with men? Implications for modelling the HIV epidemic in southern India.

In India, the identity of men who have sex with men (MSM) is closely related to the role taken in anal sex (insertive, receptive or both), but little is known about sexual mixing between identity groups. Both role segregation (taking only the insertive or receptive role) and the extent of assortative (within-group) mixing are known to affect HIV epidemic size in other settings and populations. This study explores how different possible mixing scenarios, consistent with behavioural data collected in Bangalore, south India, affect both the HIV epidemic, and the impact of a targeted intervention. Deterministic models describing HIV transmission between three MSM identity groups (mostly insertive Panthis/Bisexuals, mostly receptive Kothis/Hijras and versatile Double Deckers), were parameterised with behavioural data from Bangalore. We extended previous models of MSM role segregation to allow each of the identity groups to have both insertive and receptive acts, in differing ratios, in line with field data. The models were used to explore four different mixing scenarios ranging from assortative (maximising within-group mixing) to disassortative (minimising within-group mixing). A simple model was used to obtain insights into the relationship between the degree of within-group mixing, R0 and equilibrium HIV prevalence under different mixing scenarios. A more complex, extended version of the model was used to compare the predicted HIV prevalence trends and impact of an HIV intervention when fitted to data from Bangalore. With the simple model, mixing scenarios with increased amounts of assortative (within-group) mixing tended to give rise to a higher R0 and increased the likelihood that an epidemic would occur. When the complex model was fit to HIV prevalence data, large differences in the level of assortative mixing were seen between the fits identified using different mixing scenarios, but little difference was projected in future HIV prevalence trends. An oral pre-exposure prophylaxis (PrEP) intervention was modelled, targeted at the different identity groups. For intervention strategies targeting the receptive or receptive and versatile MSM together, the overall impact was very similar for different mixing patterns. However, for PrEP scenarios targeting insertive or versatile MSM alone, the overall impact varied considerably for different mixing scenarios; more impact was achieved with greater levels of disassortative mixing.

Subjective and objective measures of physical activity in relationship to bone mineral content during late childhood: the Iowa Bone Development Study.

OBJECTIVE: This study compared accelerometry to self-report for the assessment of physical activity (PA) in relation to bone mineral content (BMC). In addition, we compared the ability of these measures to assess PA in boys versus girls. METHODS: Participants in this cross-sectional study included 449 children (mean age 11 years) from the Iowa Bone Development Study. PA was measured via 3-5 days of accelerometry using the Actigraph and 7 day self-report questionnaire using the Physical Activity Questionnaire for Children (PAQ-C). Hip, spine, and whole body BMC were measured via dual energy x ray absorptiometry (DXA). RESULTS: Partial correlation analysis (controlling for height, weight, and maturity) showed the Actigraph was significantly associated with hip (r = 0.40), spine (r = 0.20), and whole body (r = 0.33) BMC in boys, as was the PAQ-C (r = 0.28 hip, r = 0.19 spine, and r = 0.22 whole body). Among girls, only the Actigraph was significantly associated with hip (r = 0.18) and whole body (r = 0.16) BMC. Both the Actigraph and PAQ-C were significant in hip, spine, and whole body multivariable linear regression models (after controlling for body size and maturity) in boys. Only the Actigraph entered hip BMC regression model in girls. CONCLUSIONS: Our study supports previous work showing associations between everyday PA and BMC in older children. These associations are more likely to be detected with an objective versus subjective measure of PA, particularly in girls.

Children's emotional and behavioral disorders: attributions of parental responsibility by professionals.

In the wake of the neurobiological "revolution," do mental health professionals still assign etiological responsibility for emotional and behavioral disorders to deficient or harmful parenting? This study investigated differences in attributions of causality by theoretical orientation, professional discipline, areas of practice, familiarity with parent support groups, and demographic characteristics. Implications for policy, research, and practice are discussed.

Car seatbelts in pregnancy: the practice and knowledge of pregnant women remain causes for concern.

OBJECTIVE: To evaluate current knowledge and practice among pregnant women about the use of car restraint systems during pregnancy. DESIGN: A structured questionnaire. SETTING: District hospital antenatal clinic. PARTICIPANTS: Two hundred pregnant women attending for their routine mid-pregnancy anomaly scan. MAIN OUTCOME MEASURES: The women were asked about seatbelt and airbag usage, source of information about restraint systems and the legal requirements and recommendations regarding car safety systems. RESULTS: One hundred fifty-nine women (80%) completed the questionnaire. Ninety-eight percent wore seatbelts in the front, 68% wore seatbelts in the back of a car, 48% correctly identified where to place the seatbelt and 37% had received information on seatbelt use while pregnant. The latter were more likely to correctly position their restraints than those who had received no information (P = 0.03). Thirty-nine percent had an airbag system fitted and one woman had de-activated it. Fifty-eight percent were aware seatbelt use was a legal requirement for driver and passengers when fitted. CONCLUSIONS: Many pregnant women are ignorant of the correct usage of seatbelts, their positioning and legal requirements. This puts their own wellbeing, and that of the fetus, at risk. Women should receive written instructions and advice from well informed health professionals and be encouraged always to wear a correctly positioned seatbelt. Education increases compliance and correct usage.

Monoclonal antibody KS1/4-methotrexate immunoconjugate studies in non-small cell lung carcinoma.

The antigen reactive with murine monoclonal antibody (MAb) KS1/4 is expressed on epithelial malignancies and some normal epithelial tissues. Studies were undertaken to evaluate KS1/4-methotrexate (KS1/4-MTX) immunoconjugate in patients with advanced non-small cell carcinoma of the lung. Eleven patients in two different groups received KS1/4-MTX in two different escalating dose infusion schedules with a maximal tolerated dose of 1,750 mg/M2 and a cumulative dose of MTX of 40 mg/M2. Toxicities were similar in both groups and included fever, anorexia, nausea, vomiting, diarrhea, abdominal pain, guaiac positive stool, and hypoalbuminemia. Two patients had an associated aseptic meningitis. One patient had a 50% decrease in two lung nodules without a change in lymphangitic infiltrates. This patient received a second course of treatment and developed an immune complex-mediated arthritis and serum sickness. Four patients mounted a human antimouse antibody response. Post-treatment tumor biopsies documented binding of MAb KS1/4. These studies document the feasibility and potential usefulness of a MAb directed against tumor-associated antigens with the targeting of chemotherapeutic drugs in patients with non-small cell lung carcinoma.

Borderline clients: practice implications of recent research.

Current research on treatment of borderline clients with medication, individual counseling, and family interventions is reviewed. Recent studies indicate that the borderline personality is a heterogeneous condition in which different underlying disorders (affective, schizotypal, and neurological) may be present. Research on biological treatments has shown that a range of medications may be helpful depending on the biological substrate of the borderline disorder. Research on psychotherapeutic and socioenvironmental approaches indicates that providing a structured, supportive, consistent "holding" environment is helpful for most borderline clients, whereas intensive psychodynamic therapy is effective [corrected] for only a small subset. Behavioral interventions have been effective in reducing parasuicidal (self-destructive) behaviors that are characteristic of the borderline client.

Effects of thromboxane synthetase inhibition on immune complex glomerulonephritis.

To determine the role of thromboxane A2 in the pathogenesis of experimentally induced immune complex glomerulonephritis, 12 concanavalin A-immunized Beagles were infused with 1 mg of concanavalin A via each renal artery and treated twice daily for 8 days with either 30 mg of CGS 12970/kg, PO, a specific thromboxane synthetase inhibitor, or placebo. The effect of treatment was assessed by measuring endogenous creatinine clearance and urine protein and eicosanoid excretion, and by evaluating changes in glomerular morphometric characteristics. On postinfusion day 8, urine protein, thromboxane B2, and 11-dehydro-thromboxane B2 excretion, glomerular epithelial crescent formation, and glomerular cell proliferation in the CGS 12970-treated dogs were significantly decreased when compared with values in the placebo-treated group. Differences were not observed in endogenous creatinine clearance, urine prostaglandin E2 and 6-keto-prostaglandin F1 alpha excretion, or glomerular polymorphonuclear leukocyte infiltration between groups in this study. These findings suggest thromboxane A2 has a role in the development of immune complex glomerulonephritis and that thromboxane synthetase inhibition may be beneficial in attenuating some of the functional and histological changes associated with immune complex glomerulonephritis.

Effects of a specific thromboxane synthetase inhibitor on thromboxane generation and excretion in healthy dogs.

A specific thromboxane synthetase inhibitor, 3-methyl-2 (3-pyridyl)-1-indoleoctanoic acid (CGS 12970) was administered orally to 6 healthy adult Beagles at a dosage of 30 mg/kg of body weight. Blood generation of thromboxane B2 and urinary excretion of thromboxane B2 were measured before and after administration of CGS 12970. Although 97 +/- 0.4% inhibition of thromboxane B2 generation was observed within 2 hours after a single dose of CGS 12970 was administered orally, an effect on urinary excretion of thromboxane B2 was not observed. Additionally, oral administration of 30 mg/kg every 12 hours resulted in 80 +/- 14% inhibition of thromboxane B2 generation but had no effect on urinary thromboxane B2 excretion.

Diverticular disease. Current trends in therapy.

Colonic diverticulosis is a common problem in the United States, apparently related to low dietary intake of fiber. Diverticula may bleed or cause local infection or perforation. When antibiotic treatment of infection fails, surgical intervention is necessary. Currently, the most common procedures are primary resection and anastomosis for limited disease and a two-stage Hartmann procedure for severe disease or abscess. If the fiber hypothesis of diverticular formation is correct, then addition of fiber to the diet should prevent diverticular disease.

Effects of anxiety-reducing hypnotic training on learning and reading-comprehension tasks.

The effect of anxiety-reducing hypnotic training on learning and reading-comprehension tasks was examined. Fifteen college students who reported having test-taking anxiety were randomly assigned to an experimental or a control group. The experimental group received hypnotic training to reduce anxiety prior to taking a learning and reading-comprehension test. No significant difference was found between the experimental and the control group on the simple-recall task. However, on the reading-comprehension test the experimental group scored significantly higher than the control group. Further examination of the total score revealed that the experimental group difference was due to superior performance on the inference items. There was no difference between groups on items that required the recall of information from the passage. These findings support the notion that hypnotic training may be useful to reduce anxiety and improve test performance.

Celiac sprue: correlation with murine T cell responses to wheat gliadin components.

Celiac sprue is a disease in humans that is characterized by small intestinal mucosal injury and malabsorption. Dietary exposure to gliadin and similar proteins in rye and barley activates the disease in susceptible individuals. Celiac sprue appears to be the only disease with a marked HLA-association in which the proteins that activate the disease currently are well known. However, bread wheat gliadins are a complex mixture of proteins that contain at least 40 different components. In the present study we have purified the major gliadin components of Scout 66 wheat and used these proteins to examine murine T cell proliferative responses to gliadin. Differences in T cell proliferation stimulated by alpha-, beta-, gamma-, and omega-gliadins paralleled the known structural differences among these proteins. After priming with whole gliadin, the components that stimulated T cell proliferation were the same as those recognized to activate celiac sprue in humans. Studies with reduced and alkylated A-gliadin (i.e., S-methyl A-gliadin) suggested that epitopes determined by the native conformation of A-gliadin may be important in its interaction with T cells. By using three different A-gliadin peptides that span the entire molecule, T cell proliferative responses were shown to be stimulated predominantly by antigenic determinants on the NH2-terminal peptide.

Traditional admissions variables as predictors of minority students' performance in medical school. A cause for concern.

This study explored the relationship between traditional admissions criteria, performance in the first semester of medical school, and performance on the National Board of Medical Examiners' (NBME) Examination, Part 1 for minority medical students, non-minority medical students, and the two groups combined. Correlational analysis and step-wise multiple regression procedures were used as the analysis techniques. A different pattern of admissions variables related to National Board Part 1 performance for the two groups. The General Information section of the Medical College Admission Test (MCAT) contributed the most variance for the minority student group. MCAT-Science contributed the most variance for the non-minority student group. MCATs accounted for a substantial portion of the variance on the National Board examination.