Retrovirus-induced immunodeficiency in mice exacerbates gastrointestinal candidiasis.

Dysfunction of neutrophils in patients infected with human immunodeficiency virus is at least partly responsible for secondary microbial diseases in these individuals, including invasive gastrointestinal (GI) candidiasis. Immunoregulatory disturbances associated with the development of AIDS in human immunodeficiency virus-infected patients exacerbates Candida albicans infection of the upper GI tract and frequently leads to oropharyngeal and esophageal candidiasis. In this article, we present the first report of a murine model of invasive GI candidiasis associated with an AIDS-related murine immunodeficiency syndrome that results from infection of C57BL/6 mice with a previously described retrovirus complex (LP-BM5). Mice of the inbred strain were infected with C. albicans by oral-intragastric inoculation as infants and with the retrovirus by the intraperitoneal route 30 days later. Control mice of the same strain were infected with C. albicans as above and subsequently infected with the avirulent, ecotropic helper virus (MBI-5). Animals were killed 90 days after retroviral challenge. Total and differential blood cell counts, CD4+ T-cell counts in the spleen, and the histopathology of the gastric mucosa of experimental and control animals were determined. The virulent LP-BM5-infected animals developed murine AIDS and showed eruptive and suppurative lesions, with associated C. albicans mainly in regions of the cardial-atrium fold of the stomach. Well-defined abscesses with entrapped C. albicans hyphae were observed in the region of the cardial-atrium fold of control mice. A significant increase in the number of C. albicans CFU in homogenized and plated segments of the GI tract was recognized in mice with murine AIDS versus the control animals. The murine model of GI candidiasis reported here permits examination of the nature of C. albicans interaction with the gastric mucosa both in the immunocompetent host under conditions in which the yeast exists predominantly as a commensal organism and in the immunosuppressed host during progressive stages of AIDS induced by a retroviral infection.     

Measurement of diet in a large national survey: comparison of computerized and manual coding of records in household measures

A diary method using household measures was employed to obtain dietary records in a large national prospective survey and a computer program, DIDO (Diet In Data Out), was designed for direct entry of the diaries. The accuracy of this computerized coding system was examined alongside that of the manual coding used for a similar diary in a previous wave, 7 years earlier, of the same survey. Accuracy was assessed by analysis of the errors in the coded and checked records by stringent re-checking of nominal 2% random subsamples of the diet diaries coded by each method. The mean time to code and check each of the 2086 7-day records in the whole survey using DIDO was 58 minutes (SD 30) compared with reported results of 1–4 hours for manual methods. The mean error rate of computerized coding and checking with DIDO was 2.3% (SD 2.1; range 0–8.9) per diary in the subsample. Correcting these mistakes made insignificant changes to the calculated mean energy and nutrient intakes for the subsample. The percentage of individuals changing to an adjacent third of nutrient distribution after correcting unambiguous errors ranged from none (for alcohol) to 11% (for carbohydrate and calcium intake). The mean error rate on a similar subsample of diaries from the earlier survey which had been coded manually was significantly higher at 5.9% (SD 4.1; range 0–17) per diary. Emphasis is laid on the importance, in coding, of dealing with ambiguities in the subjects' records, since this can affect the accuracy and the precision of the nutrient results obtained. We conclude that the DIDO coding method has the advantages of greater accuracy, speed, consistency and efficient data handling, and affords greater data accessibility for checking, compared with manual systems.     

An international comparison of rhinomanometry between Canada and Japan.

International discussions concerning rhinomanometry have been held but no numerical comparisons have been reported. In an attempt to make international comparisons between different rhinomanometric results, nasal resistances were measured by active posterior rhinomanometry with a head-out body plethysmograph produced in Canada and by active posterior and anterior methods with a Japanese commercial rhinomanometer, and the results were compared. No significant differences were found between measurements obtained from the two types of equipment. It is believed that this study is the first project of international comparison of rhinomanometry.     

A quality-adjusted survival meta-analysis of adjuvant chemotherapy for premenopausal breast cancer

The purpose of this paper is to develop and apply a meta-analysis methodology, that does not require patient-level data, for comparing treatments in terms of quality-of-life-adjusted survival. As a motivating example, we considered adjuvant chemotherapy for breast cancer. This therapy has been shown to offer an improvement in recurrence-free and overall survival, especially for youger women, but its acute toxic effects discourage some physicians from prescribing it. To determine whether the benefit of adjuvant chemotherapy treatment outweighs its costs in terms of toxic effects, we performed a meta-analysis of quality-adjusted survival based on data from 1229 patients, 49 years of age or younger, randomized in eight clinical trials that compared chemotherapy versus no adjuvant systemic therapy. We conducted the meta-analysis by performing a quality-adjusted survival analysis known as a Q-TWiST analysis on each trial. A Q-TWiST analysis allows one to make treatment comparisons that incorporate differences in quality of life associated with various health states. In this analysis, we define as health states the periods of time patients spend: (i) with subjective toxic effects of chemotherapy; (ii) without symptoms of recurrence and toxicity, and (iii) following disease recurrence. We assigned weights to each health state which reflect their relative value in terms of quality of life and allowed them to vary in a sensitivity analysis. We then combined the individual trial results in a meta-analysis, using a multivariate regression model, in such a way that we could easily perform an overall sensitivity analysis. Individual patient-level data are not required to perform this meta-analysis methodology if the individual Q-TWiST analysis results for each trial are available.     

Control over uplifts and hassles and its relationship to adaptational outcomes

The relationship of perceived control over daily uplifts and hassles to depression and restraint was examined in a sample of 140 middle-class sixth graders. Results indicated that greater control over uplifts was associated with better functioning and lower control over hassles with poorer functioning, even after partialing out the respective number of uplifts and hassles reported. Moreover, when directly compared, control over uplifts showed more powerful associations with adaptational outcomes than did control over hassles. In a separate analysis, the number of uplifts over which children reported high control showed opposite relationships to adaptational outcomes than did the number of uplifts over which children reported low control. A different pattern appeared for hassles. Although the number of hassles with low control was associated with poorer functioning, the number of hassles over which children had high control was unrelated to adaptational outcomes. The possibility that control operates somewhat differently for positive and negative events is discussed.This research was supported by a grant to the second author from the Stanford Center for the Study of Families, Children and Youth. The authors are grateful to Rachelle Hacket for data analysis, Tom Gehring for data collection, and Susan Nolen-Hoeksema for critical comments.     

Amphetamine impairs the discriminative performance of rats with dorsal noradrenergic bundle lesions on a 5-choice serial reaction time task: New evidence for central dopaminergic-noradrenergic interactions

A series of experiments examined the effects of lesions of the dorsal noradrenergic bundle (DNAB), induced by 6-hydroxydopamine (6-OHDA), on the behavioural response to systemic and intra-accumbens amphetamine, using a rat analogue of Leonard's 5-choice serial reaction time task for humans. Although the 6-OHDA DNAB lesion produced a profound depletion of cortical noradrenaline (NA) (to around 5% of control levels) it did not impair any aspect of performance on this task. Both systemic and intra-accumbens amphetamine increased behavioural measures of impulsivity of responding, but neither impaired discriminative accuracy in the sham-operated control rats. However, the DNAB lesioned rats did show a discriminative impairment following both low doses of systemic amphetamine, and intra-accumbens amphetamine. The latter effect was antagonised by systemic administration of the specific dopaminergic (DA) antagonist alpha-flupenthixol. The DNAB lesion did not alter the effect of amphetamine on any other behavioural measure, including speed and impulsivity of responding. These results suggest that although DA and NA participate in qualitatively different behavioural processes, the effects of DNAB lesions on attentional processes depend on the level of DA activity within the nucleus accumbens.     

Advanced practice nurses in emergency care settings: A demographic profile.

INTRODUCTION: Very little is known about clinical nurse specialists and nurse practitioners (advance practice nurses [APNs]) who practice in emergency care settings. The Advanced Practice Committee of the ENA sought to determine a profile of these individuals. METHODS: Surveys were distributed to all registrants at 2 ENA conferences and posted on the ENA Web site. This survey asked 17 questions concerning the demographic characteristics of the APN respondents (eg, education, experience, certification, state recognition, and practice area). The survey was completed by 166 APNs. RESULTS: APNs had considerable experience as ED registered nurses before becoming an APN. They obtained their APN education at the master's degree or post-master's degree level. State recognition was required for 89.2% of the APNs. The majority of APNs (61.4%) obtained their certification through the American Nurses Credentialing Center. Nurse practitioners were predominantly family nurse practitioners (43%), and clinical nurse specialists were either critical care clinical nurse specialists (8.9%) or had other certifications (5.9%). APNs provided services in both the main emergency department and the fast track (45.7%) and were relatively new to their role as an APN. DISCUSSION: Consistent with current educational and certification requirements, the vast majority of APNs held a master's degree. Although relatively new to their role as APNs in emergency care, they were nonetheless very experienced as ED registered nurses. The majority of APNs were certified, even though that is not required for practice in all states. Continued research is needed to identify the most effective utilization of APNs, document their contributions to patient care outcomes, and develop strategies to meet their educational and practice needs.