Gender differences in HIV risk behaviors in an adult emergency department in New York City

Background The human immunodeficiency virus (HIV) epidemic in the US increasingly involved urban heterosexual adults, particularly women, belonging to ethnic minority groups. An understanding of gender-based differences in HIV risk behaviors within these groups would be of value in the ongoing struggle to limit HIV transmission in metropolitan centers. Methods This was a prospective study of demographic and historical characteristics and HIV risk behaviors. The study utilized a structured interview format, which was administered to all patients treated by participating emergency department physicians. Results On univariate analysis of data obtained from 1,460 patients who had neither a known HIV infection nor a chief complaint or final emergency department diagnosis associated with HIV risk behaviors, men were more likely to be older, homeless, to have ever injected drugs, used crack, engaged in same-gender sex, paid for sex, been incarcerated, or had syphilis or gonorrhea. Women were more likely to report prior chlamydia infection or to report that their sole sex partners had other partners within the past year. On multivariate analysis, variables independently associated with male gender included homelessness, injection drug use, crack use, any prior sexually transmitted disease (in subjects 35 years of age or older), and sex with prostitutes. In a separate analysis of patients admitting to drug use, the male predominance of other risk behaviors was not observed; the only significant differences between genders were a higher rate of prostitution among women and a higher rate of sexual contact with a prostitute among men. Conclusions In patients visiting an inner-city emergency department in the Bronx, HIV risk behaviors are generally more common in men, but rates of risk behaviors among male and female drug users are comparable. This work was supported in part by a collaborative agreement with the Centers for Disease Control and Prevention (U64/CCU200714). Drs. Shuter, Alpert, and DeShaw were supported in part by a training grant (5-T32-AI070183) from the National Institute of Allergy and Infectious Diseases. This study was presented in part at the 32nd Annual Meeting of the Infectious Diseases Society of America, October 1994, Orlando, Florida.     

Influence of Δ9 and cannabidiol on photically evoked after-discharge potentials

Two cannabinoids, ⁹ and cannabidiol, and several reference drugs were compared relative to their effects in a recently developed anticonvulsant test system, the after-discharge potentials of the visually evoked response; the potentials were recorded electrophysiologically from electrodes permanently mounted over the visual cortices of conscious rats. In anticonvulsant doses, trimethadione and ethosuximide produced an extensive depression of after-discharge activity, whereas diphenylhydantoin and cannabidiol exerted no such effect. In contrast, anticonvulsant doses of ⁹ and subconvulsant doses of pentylenetetrazol markedly increased after-discharge activity, which may represent a manifestation of their central nervous system excitatory properties. The data from the present study support our previously published observations from several other anticonvulsant tests that indicate the anticonvulsant characteristics of cannabidiol resemble those of diphenylhydantoin rather than those of trimethadione and that the central excitatory properties of ⁹ distinguish it from cannabidiol. The results consistently suggest that the cannabinoids will be effective against grand mal but not absence seizures.     

Time trend in height,weight, and obesity prevalence in school children from Northern France, 1992-2000

OBJECTIVE: The aim of this study was to evaluate the changes in height, weight and in the prevalence of overweight and obesity between 1992 and 2000 in children living in two towns of northern France. METHODS: Two cross-sectional studies were performed in every pre-school (last section) and primary schools of the two towns in 1992 (383 girls and 421 boys enrolled) and 2000 (296 girls and 305 boys). Children were 5 to 12 year old in both studies. MEASUREMENTS: Body height and weight were measured, and BMI was calculated (weight/height(2)). Prevalence of overweight and obesity was determined according to the gender- and age- specific cut-offs of the new international reference (IOTF). We also used the 90(th) and the 97(th) percentiles of the French reference gender- and age-specific BMI curves to define two grades of overweight. RESULTS: After adjustment for age, boys were on average 1.5 cm taller in 2000 than in 1992 (p<0.001), and the same trend was observed in girls (+ 0.9 cm, p<0.075). Height-adjusted or age-adjusted weight and BMI were significantly higher in 2000 than in 1992. In girls, obesity defined by IOTF criteria increased from 1.6 to 4.4% (p<0.03) and overweight from 14.1 to 18.6% (p<0.11). In boys, the change in prevalences was significant only when the less stringent criteria (i.e. the 90(th) percentile of French references) was used (13.8% in 1992 vs 20% in 2000, p=0.03). CONCLUSION: Over an 8 years period, there was an increase in height and BMI in both boys and girls. These results show that the increase in the prevalence of obesity is accompanied by a global trend of accelerated growth.     

The trans/cis photoisomerization in hydrogen bonded complexes with stability controlled by substituent effects: 3-(6-aminopyridin-3-yl)acrylate case study

The association of aminopyridine-based acrylic acid and its salt was studied by NMR titration experiments. The AA (acceptor, acceptor) hydrogen-bonding pattern present in the salt forms a complex readily with a DD (donor, donor) hydrogen-bonding pattern of the substituted ureas even in polar and competitive environment. The double carbon–carbon bond in the acrylic acid derivative is subjected to photoisomerization. This is dependent on the association with substituted urea derivatives. The substituent in ureas influences the trans/cis isomerization kinetics and position of the photostationary state. Two mechanisms that influence the photoisomerization were proposed. To the best of our knowledge, the trans/cis photoisomerization influenced by the substituent in such a hydrogen-bonding pattern has not observed previously. It was shown that interaction with urea derivatives causes lowering of the trans-to-cis photoreaction rates.

The association of aminopyridine-based acrylic acid and its salt was studied by NMR titration experiments.     

EPODE approach for childhood obesity prevention: methods, progress and international development

Childhood obesity is a complex issue and needs multi-stakeholder involvement at all levels to foster healthier lifestyles in a sustainable way. 'Ensemble Prévenons l'Obésité Des Enfants' (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity. This paper describes EPODE methodology and its objective of preventing childhood obesity. At a central level, a coordination team, using social marketing and organizational techniques, trains and coaches a local project manager nominated in each EPODE community by the local authorities. The local project manager is also provided with tools to mobilize local stakeholders through a local steering committee and local networks. The added value of the methodology is to mobilize stakeholders at all levels across the public and the private sectors. Its critical components include political commitment, sustainable resources, support services and a strong scientific input--drawing on the evidence-base--together with evaluation of the programme. Since 2004, EPODE methodology has been implemented in more than 500 communities in six countries. Community-based interventions are integral to childhood obesity prevention. EPODE provides a valuable model to address this challenge.     

Effects of differential habitat warming on complex communities

Food webs unfold across a mosaic of micro and macro habitats, with each habitat coupled by mobile consumers that behave in response to local environmental conditions. Despite this fundamental characteristic of nature, research on how climate change will affect whole ecosystems has overlooked (i) that climate warming will generally affect habitats differently and (ii) that mobile consumers may respond to this differential change in a manner that may fundamentally alter the energy pathways that sustain ecosystems. This reasoning suggests a powerful, but largely unexplored, avenue for studying the impacts of climate change on ecosystem functioning. Here, we use lake ecosystems to show that predictable behavioral adjustments to local temperature differentials govern a fundamental structural shift across 54 food webs. Data show that the trophic pathways from basal resources to a cold-adapted predator shift toward greater reliance on a cold-water refuge habitat, and food chain length increases, as air temperatures rise. Notably, cold-adapted predator behavior may substantially drive this decoupling effect across the climatic range in our study independent of warmer-adapted species responses (for example, changes in near-shore species abundance and predator absence). Such modifications reflect a flexible food web architecture that requires more attention from climate change research. The trophic pathway restructuring documented here is expected to alter biomass accumulation, through the regulation of energy fluxes to predators, and thus potentially threatens ecosystem sustainability in times of rapid environmental change.Natural systems are inherently complex entities, wherein organisms act as agents of material and biomass transport (1) weaving food webs through a mosaic thermal environment. Direct temperature effects on trophic interactions arise through thermal regulation of an organism’s physiology and behavior (2–5). For ecotherms (that is, organisms whose body temperature is aligned with ambient temperature), several biological rates show unimodal responses to temperature (2, 3, 6), and correspondingly, studies have shown that consumption rates initially rise with warming to a peak rate and then fall rapidly approaching a critical temperature (6). Understanding the ways that these organism responses alter food webs, and how these food web responses affect ecosystem function, are key requirements to predicting climate change impacts on ecosystems (7–11).A simple way to think about temperature’s effects on any single trophic interaction is through the general linear consumption function:Consumption(per?capita) = a?t_s?R, [1]where a is the attack rate, t_s is the time searching, and R is the resource biomass density. The direct effects of temperature on an organism’s ability to encounter and capture resources in a given habitat may largely depend on a, and t_s (with potential indirect effects relative to the consumer through temperature influences on R). The argument for the temperature dependence of attack rate (a) is relatively straightforward. Temperature mediates foraging velocity (3), and considering all else equal, velocity determines encounter rates and prey capture success. The influence of temperature on time searching is a little more complex, but the general expectation is that its influence will be shaped by the requirement that the organism allocate its feeding time in different patches or habitats to increase its fitness (5). Such thermal limitation of search time would lead to reductions of interaction strength in warming habitats—in effect, temperature would mediate prey availability (e.g., when temperature exceeds physiological limits). What remains to complete the consumption equation above is the effect of temperature on R, both the direct effects (for example, the impact of warming on R’s productivity) and indirect effects (for example, impact of warming on the number and consumption capabilities of consumers competing for R) (12, 13). Note that the numerical response (i.e., biomass accumulation) of the consumer may depend on additional vital rates (e.g., conversion efficiency). The conversion of prey biomass to predator biomass (often denoted e) may not change with temperature (2, 3), although recent research suggests that e may be temperature dependent if consumers switch among resources with different elemental composition to balance changing metabolic and somatic demands (14). Nevertheless, we focus on consumption (a, t_s, R) as a means to build an argument for temperature’s influence on trophic structure.Here, we extend the logic that underlies this simple representation of temperature-dependent consumption to develop hypotheses that link temperature differentials, through direct and indirect means, to spatial food web structure. Spatially simple laboratory studies of food webs suggest that larger-bodied, higher trophic level organisms are likely to have high extinction risk with ambient warming (15). In natural systems, these higher-order predators provide a spatially unifying component to food webs: their high mobility enables them to forage among different habitats, coupling food chains with unique basal resource groups (16–18). This coupling structure can be an important part of sustaining higher-order consumers with consequences for food chain length, trophic control, and ecosystem stability (16, 19–21). For example, theory argues that reduced access to a novel resource compartment may decrease a consumer’s biomass (19, 20), thereby increasing the chance of local extinction from a random event. When accessibility is limited, reduced coupling may alter food chain length if habitats contain prey that differ in trophic position (22) or if higher level prey increase, with reduced trophic control, and consequently predators become less omnivorous (19, 21). Given that temperature change can drive asymmetric responses in species that differ in thermal tolerance, the influence of spatially structuring elements on the response of a food web to warming will depend not only on the direct responses of consumers to temperature (2, 3, 5) but also those responses of other interacting community members (i.e., resources and competing predators) (12, 13, 23). We test notions of the structuring effects of differential temperature on spatially coupled food webs (thermal-accessibility hypothesis), using boreal lakes as a natural study system (Fig. 1). To make this test, we assembled one of the largest comparative food web datasets on record: 54 ecosystems, characterized using >3,000 isotope (N and C) samples.Open in a separate windowFig. 1.Simple schematic showing expected effects of differential warming on habitat coupling (horizontal axis) and habitat use (vertical axis) by lake trout in cold (Upper) and warm (Lower) lakes. A thermal accessibility argument predicts that lake trout couple into the thermally exposed near-shore resource channel less and should use (proportionally) that habitat less under warmer conditions (indicated by lake trout position). The arrow direction and thickness indicate coupling direction and strength. The letters in the upper diagram identify trophic groups used in both cold (Upper) and warm (Lower) lake depictions: lake trout (a), pelagic forage fish (b), pelagic invertebrates (c), pelagic phytoplankton (d), littoral fish (e), littoral invertebrates (f), and benthic algae (g). To the right in the diagram, we show thermal profile data contrasting temperature at depth from Victoria Lake [cold; summer air temperature, 15.5 °C; latitude (lat), 49.62306; longitude (long), −91.54889] and Charleston Lake (warm; summer air temperature, 19.7 °C; lat, 44.53611; long, −76.01194) taken at the time of sampling. Temperature is visually highlighted with darker blue (cold) and darker red (warm) hues. These lakes experience temperatures near the cold and warm endpoints for our dataset and are of the same order of magnitude in size, and both had thermal profiles recorded to 30 m.Freshwater lakes are particularly sensitive to climate change as lake habitats are structured by climate-driven water temperature and many biota are vulnerable to ambient temperature change (24). A key habitat feature of boreal lakes is thermal stratification, an effect of antagonistic physical forces of mixing by wind energy and resistance to mixing by solar heating that separates cold, more dense water (hypolimnion) from warmer, less dense surface water (epilimnion) (25). The stratification process creates a potential for temperature differentials between deeper offshore and shallower near-shore subhabitats within a lake, as temperatures remain relatively constant in deep habitats, whereas shallower near-shore temperatures are strongly influenced by air temperatures (26). Monitoring in the boreal region (27, 28) has shown that rising air temperature warms surface waters, accelerates the stratification process, and extends the duration of stratification; thus, air temperature is a primary determinant of lake thermal heterogeneity.Most aquatic organisms (e.g., invertebrates, amphibians, fish) are ectotherms; therefore, the demands of the thermal environment arguably form the most influential set of abiotic factors aquatic organisms must satisfy (29, 30) (including increased oxygen requirements in warmer water). Thermal differentiation in lakes typically corresponds with the species differences that characterize offshore and near-shore habitats. Conveniently, biomass flow from these habitats through a food web can be traced using stable carbon and nitrogen isotope ratios due to isotope differences at the base of the food web between phytoplankton (offshore) and benthic algae (near-shore) (18, 22, 31, 32).We focus our study on the trophic pathways that flow from basal resources to lake trout (Salvelinus namaycush), a vulnerable, cold-adapted (10–12 °C preference) apex predator (33) estimated to reside in 66,500 Canadian lakes (34) (Fig. 1). Previous studies show that lake trout play a keystone structural role in integrating resource pools in offshore and near-shore habitats (18, 21, 22, 31). In what follows, we test the direct and indirect effects of differential warming on this natural system (lake trout food web) across a summer mean temperature gradient ranging 15–20 °C. At the warmer end of this range, surface water temperatures will often exceed the physiological tolerance of lake trout and should restrict accessibility into the near-shore habitat (Fig. 1, Lower). Given this thermal mechanism, we predict that lake trout in warmer climates may change their habitat use to deeper waters and this spatial behavior may shift the degree that near-shore resource pools are coupled by this predator relative to cooler climates (Fig. 1). We further consider whether spatial responses are associated with a shift in the length of the apex predator’s food chain. This thermal-accessibility–mediated restructuring of fundamental food web structure is considered along with complementary notions of warm-tolerant competitor effects and relative prey abundance changes with climate.     

Pelvic osteoid osteoma in a skeletally mature female

Osteoid osteoma is the most common bone-producing tumor that typically presents with "throbbing night pain" and that improves dramatically with use of low-dose salicylates. Few cases of pelvic osteoid osteoma have been reported, and most have involved patients younger than age 30. Surgical excision classically has been the treatment of choice, but, recently, less invasive modalities, including radiofrequency ablation, have begun to supplant surgical management of osteoid osteoma, resulting in a decrease in the need for definitive surgical diagnosis and treatment. We present a rare case of osteoid osteoma in the pelvis of a woman older than age 30.