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Examines the impact of psychological stress on the steady-state expression of herpesvirus latency at the United States Military Academy. Stressors experienced by cadets; Increase of antibody titers following Cadet Basic Training; Growth of Epstein-Barr virus antibody titers.

Objective: African Americans experience preterm birth at nearly twice the rate of whites. Chronic stress associated with minority status is implicated in this disparity. Inflammation is a key biological pathway by which stress may affect birth outcomes. This study examined the effects of race and pregnancy on stress-induced inflammatory responses., Methods: Thirty-nine women in the second trimester of pregnancy (19 African American, 20 white) and 39 demographically similar nonpregnant women completed an acute stressor (Trier Social Stress Test). Psychosocial characteristics, health behaviors, and affective responses were assessed. Serum interleukin (IL)-6 was measured at baseline, 45 minutes, and 120 minutes poststressor., Results: IL-6 responses at 120 minutes poststressor were 46% higher in African Americans versus whites (95% confidence interval = 8%-81%, t(72) = 3.51, p = .001). This effect was present in pregnancy and nonpregnancy. IL-6 responses at 120 minutes poststressor tended to be lower (15%) in pregnant versus nonpregnant women (95% confidence interval = -5%-32%, p = .14). Racial differences in inflammatory responses were not accounted for by demographics, psychological characteristics, health behaviors, or differences in salivary cortisol. Pregnant whites showed lower negative affective responses than did nonpregnant women of either race (p values ≤ .007)., Conclusions: This study provides novel evidence that stress-induced inflammatory responses are more robust among African American women versus whites during pregnancy and nonpregnancy. The ultimate impact of stress on health is a function of stressor exposure and physiological responses. Individual differences in stress-induced inflammatory responses represent a clear target for continued research efforts in racial disparities in health during pregnancy and nonpregnancy.

Objectives: We sought to determine whether poorer outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (MI) during off-hours are related to delays in treatment, circadian changes in biology, or differences in operator-related quality of care., Background: Previous investigation has suggested that patients undergoing primary PCI during off-hours are more likely to have adverse cardiac events than routine-hours patients, but the reasons for this remain poorly defined., Methods: Clinical, angiographic, and procedural characteristics were compared in consecutive patients (n = 685) undergoing primary PCI in the National Heart, Lung, and Blood Institute Dynamic Registry between 1997 and 2006 that were classified as occurring during routine-hours (07:00 to 18:59) or off-hours (19:00 to 06:59). The primary end points were in-hospital death, MI, and target vessel revascularization., Results: Median time from symptom onset to PCI was similar (off-hours 3.4 h vs. routine-hours 3.3 h). Patients presenting in off-hours were more likely to present with cardiogenic shock and multivessel coronary artery disease but were equally likely to present with complete occlusion of the infarct-related artery. Procedural complications including dissection were more frequent in off-hours patients. In-hospital death, MI, and target vessel revascularization were significantly higher in off-hours patients (adjusted odds ratio [OR]: 2.66, p = 0.001), and differences in outcomes were worse even if the procedure was immediately successful (adjusted OR: 2.58, p = 0.005, adjusting for angiographic success). Patients undergoing PCI on weekends had better outcomes during the daytime than nighttime., Conclusions: Patients undergoing primary PCI for acute MI during off-hours are at significantly higher risk for in-hospital death, MI, and target vessel revascularization. These findings appear related to both diurnal differences in presentation and lesion characteristics, as well as differences in procedural complication and success rates that extend beyond differences in symptom-to-balloon time.

A performance test of NIOSH Method 5524/ASTM Method D-7049-04 for analysis of metalworking fluids (MWF) was conducted. These methods involve determination of the total and extractable weights of MWF samples; extractions are performed using a ternary blend of toluene:dichloromethane:methanol and a binary blend of methanol:water. Six laboratories participated in this study. A preliminary analysis of 20 blank samples was made to familiarize the laboratories with the procedure(s) and to estimate the methods' limits of detection/quantitation (LODs/LOQs). Synthetically generated samples of a semisynthetic MWF aerosol were then collected on tared polytetrafluoroethylene (PTFE) filters and analyzed according to the methods by all participants. Sample masses deposited (approximately 400-500 micro g) corresponded to amounts expected in an 8-hr shift at the NIOSH recommended exposure levels (REL) of 0.4 mg/m(3) (thoracic) and 0.5 mg/m(3) (total particulate). The generator output was monitored with a calibrated laser particle counter. One laboratory significantly underreported the sampled masses relative to the other five labs. A follow-up study compared only gravimetric results of this laboratory with those of two other labs. In the preliminary analysis of blanks; the average LOQs were 0.094 mg for the total weight analysis and 0.136 mg for the extracted weight analyses. For the six-lab study, the average LOQs were 0.064 mg for the total weight analyses and 0.067 mg for the extracted weight analyses. Using ASTM conventions, h and k statistics were computed to determine the degree of consistency of each laboratory with the others. One laboratory experienced problems with precision but not bias. The precision estimates for the remaining five labs were not different statistically (alpha = 0.005) for either the total or extractable weights. For all six labs, the average fraction extracted was > or =0.94 (CV = 0.025). Pooled estimates of the total coefficients of variation of analysis were 0.13 for the total weight samples and 0.13 for the extracted weight samples. An overall method bias of -5% was determined by comparing the overall mean concentration reported by the participants to that determined by the particle counter. In the three-lab follow-up study, the nonconsistent lab reported results that were unbiased but statistically less precise than the others; the average LOQ was 0.133 mg for the total weight analyses. It is concluded that aerosolized MWF sampled at concentrations corresponding to either of the NIOSH RELs can generally be shipped unrefrigerated, stored refrigerated up to 7 days, and then analyzed quantitatively and precisely for MWF using the NIOSH/ASTM procedures.

Driver education classes were once seen as a remedy for young drivers' overinvolvement in crashes, but research results from the early 1970s were disappointing. Few changes in the content or methods of instruction occurred until recently, but this could change rapidly. Personal computers (PCs) can now present videos or photorealistic simulations of risky, cognitively demanding traffic scenarios that require quick responses without putting the participant at risk. As such programs proliferate, evaluating their effectiveness poses a major challenge. We report the use of a fixed-base driving simulator to study the effects of both experience on the road and PC-based risk awareness training on younger drivers' part-task simulator driving performance in risky traffic scenarios. We ran three groups of drivers on the simulator: one group first trained on the PC (younger, inexperienced drivers) and two groups who received no PC training (younger, inexperienced and experienced drivers). Overall, the younger, inexperienced drivers who were trained on a PC operated their vehicles in risky scenarios in ways that differed measurably from those of the untrained younger, inexperienced drivers and, more important, in ways that we believe would decrease their exposure to risk considering that, on average, their behavior was more similar to the behavior of the untrained, experienced drivers. More research is needed to demonstrate whether these findings apply on the open road to the larger population of younger drivers. However, at least initially, the research suggests that PC-based risk awareness training programs have the potential to reduce the high crash rate among younger, inexperienced drivers.

The influence of appraisal support on age-related differences in cardiovascular function was examined. Resting assessments of heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory sinus arrhythmia (RSA), and preejection period were obtained from 45 young and 20 elderly women. Consistent with prior research, results revealed that the elderly women had higher blood pressure and lower RSA than the young women. More important, appraisal support predicted age-related differences in SBP and DBP: Age predicted elevated blood pressure for women low in appraisal support, whereas age was unrelated to blood pressure for women high in appraisal support. These preliminary data suggest that appraisal support may be an important predictor of long-term physiological function and health.

In 1989, when the number of applicants to medical schools had been comparatively low for several years, trustees of Alpha Omega Alpha commissioned Louis Harris and Associates to conduct a survey to investigate the attitudes that led college undergraduates toward or away from choosing medical careers. A total of 1,780 college students and 93 premedical advisors from 100 U.S. schools were interviewed in early 1990. The students were in three groups: a national cross-section of 1,003 undergraduates who were not applicants to medical school; 500 medical school applicants for the entering class of 1990; and 277 students who had taken the Medical College Admission Test (MCAT), were qualified for admission, but had not applied. The authors acknowledge that the reasons that the medical school applicant pool was so low in the late 1980s and has fluctuated so widely in the last two decades are only partly understood. The data gathered indicate that job satisfaction was an extremely important factor in career choice for high percentages of students in all the groups surveyed; that 77% of all the students had never seriously considered applying to medical school; and that 70% saw no attraction in becoming a physician. Data on other problems that many of the students saw in medical education and the practice of medicine are reviewed, the role of premedical advisors is examined, and the advisors' views on what makes a promising applicant are described. Regarding the students who took the MCAT exam but did not apply to medical school, 81% indicated that they eventually planned to or were likely to apply.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of the present study was to determine the effects of 10-in [0.25-m] versus 16-in [0.41-m] wheelchair handrims on cardiorespiratory and psychophysiological exercise responses during wheelchair propulsion at selected velocities. Fifteen male paraplegics (27.0 +/- 5.5 yrs) performed three discontinuous exercise tests (ACE = arm crank ergometer; WERG = wheelchair roller ergometer) and two 1600-m performance-based track trials (TRACK) under simulated race conditions. There were no significant differences in HR, VO2, VE, HLa, or category-ratio ratings of perceived exertion (RPE) using different handrims during wheelchair propulsion at 4 km.h-1. In contrast, at 8 km.h-1 subjects demonstrated a 13% lower steady state VO2 (p less than .05) using the 10-in handrims, coincident with a 23% lower VE. Steady state HR during WERG at 8 km.h-1 using the 10-in (124.4 +/- 3.9 b.min-1) or 16-in (130.6 +/- 4.6 b.min-1) handrims were not significantly different. There were also no significant differences between ACE or WERG conditions during maximal effort for VO2 or VE. However, HRpeak during ACE was 7% higher than HRpeak during WERG16 (183 +/- 15 b.min-1 vs. 171 +/- 12 b.min-1, p less than .05), and whole blood HLa during ACE was also significantly higher (by 2.3-2.5 mmol; p less than .05) compared to WERG. There were no significant differences for HR, performance time, or RPE between trials using different handrim diameters during the 1600-m event.(ABSTRACT TRUNCATED AT 250 WORDS)

The growth of prepaid medical-care programs has caused the leaders of a number of academic medical centers to begin to have an increased interest in affiliating with or sponsoring centers in prepaid programs -- otherwise known as health-maintenance organizations (HMOs)--is motivated by a number of potential benefits. An HMO may provide an academic medical center with an additional source of patients for teaching and research; generate additional revenue; increase resources for education in primary care; increase the exposure of students, residents, and faculty to the characteristics of prepaid medical practice; and improve the delivery of health services locally. Issues of importance to the academic medical center include the pros and cons of sponsorship of, as opposed to affiliation with, an HMO and the additional costs attributable to medical education in the HMO setting. Problems may arise between HMOs and medical centers as a result of disparate styles of practice, the high cost of clinical services at the medical center, and the differing perspectives of HMO and medical-center policy makers.