Pulmonary tuberculosis due to bacille Calmette-Guérin

Summary Immunotherapy using bacille Calmette-Guérin (BCG) has gained increasing acceptance in the management of superficial bladder cancer. Systemic reactions after intravesical instillation of BCG are rare. However, when the therapy is complicated, the lung often becomes involved. Since the pathogenesis of lung infiltrates after immunotherapy is unknown, we report on a patient who developed a lung infiltrate after receiving BCG immunotherapy for bladder cancer. The infectious etiology was established by culture confirmation of a BCG strain in the broncheoalveolar lavage fluid.Abbreviation BCG bacille Calmette-Guérin     

Calibration of Earphone-Transmitted Sounds

The intensity of acoustic stimulation is frequently a variable of interest in psychophysiological studies but calibration procedures, particularly when earphones are employed, are not always adequate. The present study demonstrates that intensity is underestimated, more seriously at low frequencies, when calibration does not employ an appropriate coupler. Several standardized calibration methods are discussed in terms of their suitability For routine laboratory use.     

Gestational Women’s Perceptions About the Harms of Cigarette and E-Cigarette Use During Pregnancy

Objectives

The purpose of this study was to examine differences between perceived harm of cigarette and electronic cigarette (e-cigarette) use while pregnant and differences between healthcare providers’ communication about these products during pregnancy.

Methods

A convenience sample of gestational women (n?=?218; ages 18–45) living in the US completed an online survey between May and December 2017. Participants reported perceived likelihood of adverse health outcomes (e.g., low birth weight, sudden infant death syndrome) among infants/children born to mothers who used cigarettes/e-cigarettes. T-tests and two-way ANOVAs examined differences between risk perceptions of using cigarettes/e-cigarettes while pregnant based on pregnancy status (previously pregnant, currently pregnant, future pregnant). Chi-square analyses examined differences between healthcare provider communication about cigarette/e-cigarette use during pregnancy.

Results

Overall, participants believed adverse health outcomes were significantly more likely to be caused by maternal use of cigarettes than e-cigarettes. Participants who planned to be pregnant reported higher endorsement that smoking combustible cigarettes would cause a miscarriage (p?<?.05) or increased blood pressure (p?<?.05) for a child than currently pregnant participants. Participants reported healthcare providers asked about (p?<?.05), advised them not to use (p?<?.001), and talked to them about health effects of smoking combustible cigarettes while pregnant (p?<?.001) significantly more than e-cigarettes.

Conclusions for Practice

Healthcare providers working with pregnant women should perform the 5As behavioral intervention method to provide pregnant women with tobacco cessation care. They should also discuss the absolute harm nicotine exposure (via cigarettes or e-cigarettes) can have on fetal health and development.

     

The Relationship Between Violence Syndemics and Sexual Risk Behaviors Among African American Adolescents: Implications for Future Research

PurposeWe present a conceptual framework based on a review of the literature to highlight the interconnecting and reinforcing elements of a violence syndemic and how this syndemic influences sexual risk behaviors among African American heterosexual adolescents.MethodsWe review existing peer-reviewed published research from 2000 to 2020 that links a violence syndemic (i.e., racism and race-related stress, neighborhood and police violence, peer violence, and family violence and disruptions) to adolescent sexual risk behaviors. Empirical findings and theoretical underpinnings are used to document this relationship and illuminate the factors that mediate this relationship.ResultsEmpirical studies support the links between specific types of violence and sexual risk behaviors among African American adolescents. Further, existing studies point to the important relationships among the specific types of violence, supporting a violence syndemic approach.ConclusionsWhile more researchers are examining socio-ecological contextual factors as important predictors for sexual risk behaviors, there remains inadequate understanding about how violence types reinforce one another to heighten sexual risk behaviors among African American heterosexual adolescents. This article presents new directions for adolescent research, especially how a violence syndemic approach can be used to explain sexual risk, but also to refocus intervention design on the complex burdens experienced by this population.     

A clinical comparison of indices of pulmonary gas exchange with changes in the inspired oxygen concentration

Several indices have been introduced as convenient alternatives to calculation of the physiological shunt fraction (Qs/QT) for the assessment of pulmonary gas exchange. These include: the arterial-alveolar oxygen tension ratio (a/APO2), the arterial oxygen tension-inspired oxygen concentration ratio (PaO2/FIO2), the respiratory index (RI), [A-a)DO2/PaO2) and the alveolar-arterial oxygen tension difference [A-a)Do2). These indices are in use clinically despite the fact that they may not accurately predict gas exchange in situations where FIO2, Qs/QT or arterial-venous oxygen content is changing. The clinical stability of each of these indices, relative to the behaviour of the physiological shunt, was therefore investigated prospectively in ten mechanically ventilated postoperative adults as FIO2 was varied from 0.30 to 1.00. None of the indices studied reliably reflected the behaviour of the physiological shunt. As FIO2 was increased incrementally from 0.30 to 1.00, 42 to 55 per cent of the measured changes in these indices were opposite in direction to the corresponding changes in the physiological shunt. The maximum magnitudes of the opposite changes were substantial; 24 and 22 per cent for the a/APO2 and PaO2/FIO2 ratio respectively, 67 per cent for the RI and 101 per cent for the (A-a)DO2. We conclude that the use of any of these indices for clinical assessment of a patient's gas exchange defect when FIO2 is varying can be substantially misleading.     

Case-based hospital financing: the case of Norway

Several European countries are experimenting with new ways of organising and financing the hospital sector. This paper discusses the present Norwegian reform, where a system of fixed grants is replaced by a combination of payment per case and fixed grants. Initially implemented in four hospitals only, the decision to move to a full-scale reform will be based on the evaluation of this pilot project. The paper presents two alternative hypotheses on how a system with case-based financing will influence the performance of hospitals. Given that hospitals adjust passively to the constraints imposed by the financing system, increased efficiency is to be expected. If hospitals and hospital owners (i.e. the counties) interact in a game dominated by the hospital, however, the efficiency of the hospital will not be influenced by the financing system. We argue that the design of the pilot project limits the possibility of discriminating between these two hypotheses. Nevertheless, a comparison of key variables in the pilot hospitals with a set of reference hospitals indicates that the change of financing system has not had any substantial effect on hospital efficiency. Thus we are inclined to believe that hospitals in fact are able to set the level of efficiency independent of whether they are financed by fixed grants or a payment per case.     

Blue toe syndrome from a “coral reef” aorta

An endoaortic calcified mass, sometimes referred to as a coral reef aorta, is an unusual cause of distal leg microembolization. When discovered it is usually in the suprarenal aorta. We present an unusual case of infrarenal coral reef aorta with symptoms of distal atheroembolism. A review of the literature is also presented.     

Effects of moderate doses of alcohol on immediate recall of numbers: some implications for information technology

OBJECTIVE: Moderate doses of alcohol will have detrimental effects on memory functions used in various aspects of human interaction with information technology. The need to deal with multidigit numbers while under alcohol intoxication (e.g., making telephone calls) is a reality of life. To determine these relations, the effects of alcohol on immediate ordered recall were studied in a practical number-dialing task. METHOD: Immediate ordered recall of eight-digit numbers, presented visually or auditorily, was tested in read-and-dial or listen-and-dial forced ordered recall tasks with male subjects (N = 11) under two levels of blood alcohol concentration (BrAC = 0.05% and BrAC = 0.1%) and a no-alcohol placebo control condition (BrAC = 0.0%). RESULTS: With increasing alcohol level, immediate ordered recall of whole numbers (all eight digits correct and in the right order) fell by 9% (visual presentation) and 15% (auditory presentation). No significant interaction effect between alcohol level and digit position in the number was found for visually presented numbers, while a weak, but significant, effect was found for auditorily presented numbers (most prominent at digit positions 5, 6 and 7). This is probably due to the difference in rehearsal opportunities in the two presentation modes. No significant interaction effects between alcohol level and presentation modality were found. CONCLUSIONS: The results, tailored to a practical everyday task of dialing unfamiliar eight-digit telephone numbers, show that even moderate doses of alcohol will affect the performance of an already fragile short-term memory system engaged whenever reproduction of digit strings is required.     

Abortion as “deviance”

Summary The paper focuses on the relationship between changing societal norms toward women's roles and actual, emotional acceptance of them for oneself, specifically as the norms relate to abortion and sexual behavior. Elective abortion still is regarded by many as a deviant activity. Such a view has sprung from an uncritical acceptance of the traditional role of women. The implications are that women who have abortions accept traditional norms for sexual behavior, in spite of their own sexual activity, and have a generally traditional view of women's roles. They are considered to behave stereotypically and to have failed. Traditional norms for women's roles have been challenged in recent years, however, especially by the feminist movement. The authors hypothesized that women who sought early abortions would tend to have feminist orientations. The paper is based on a study of 1598 women with problem pregnancies, part of a larger study conducted throughout Michigan during 1974–75. The women studied showed little lag in emotional acceptance of changing norms about women's roles. They indicated a non-traditional female role orientation, and seemed to see themselves as competent, selfdirected, and legitimately sexual persons. Most did not have any great conflict over the decision to have an abortion. The findings by and large substantiated the authors' hypotheses.This research is supported by Grant Number 1 RO 1 HD0773901, National Institute of Child Health and Human Development, Washington, D. C.