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Purpose: The aim of this study was to prove the efficacy of supervised self-training for individuals with aphasia. Linguistic and communicative performance in structured dialogues represented the main study parameters., Method: In a cross-over design for randomized matched pairs, 18 individuals with chronic aphasia were examined during 12 weeks of supervised home training. Intensive language training, assisted by an electronic learning device (B.A.Bar), was compared with nonlinguistic training. Language performance, communicative abilities, and cognitive abilities were controlled before and after each intervention and at follow-up. The language training was designed to facilitate dialogue skills as required in everyday life., Results: Robust and specific improvements in the participants' linguistic and communicative abilities were obtained using B.A.Bar dialogue training but not with nonlinguistic training. The transfer to general linguistic and communicative performance remained limited when the whole group was considered. For 30%-50% of the participants, individual analysis revealed significant improvements in spontaneous language and general communicative skills. Furthermore, individual participants demonstrated significant improvements regarding standardized aphasia assessment and proxy rating of communicative effectiveness., Conclusion: Supervised home training works. This study has proven that it is an effective tool for bolstering linguistic and communicative skills of individuals with aphasia.

Evidence suggests that persons living with HIV (PLWH) are at increased risk for anal cancer. Early detection of anal cancer is an important prevention measure, but screening rates have been low. This report describes the experience of a quality improvement initiative to increase anal cancer screening at an HIV-specialty clinic. Chart reviews were conducted for three time periods: baseline year, prior to program discussion; transition year, during planning; and implementation year, during program availability. Odds ratios using Fisher's exact test showed that the odds of receiving anal cancer screening increased significantly in the transition year, odds ratio (OR) = 2.859, 95% confidence interval (CI): [1.798; 4.546], Fisher's z = 4.40, p < 0.0001, and in the implementation year, OR = 7.446, 95% CI: [4.783; 11.588], Fisher's z > 8.2, p < 0.0001. Patients and clinicians reported high levels of satisfaction with the program. Referring clinicians were also more likely to discuss anal cancer screening.

Overview: The evolution of HIV infection into a chronic disease has implications across all clinical care settings. Every nurse should be knowledgeable about the prevention, testing, treatment, and chronicity of the disease in order to provide high-quality care to people with or at risk for HIV. It's important, therefore, to have an understanding of the changing epidemiology of the disease, the most recent testing recommendations, developments in screening technology, the implications of aging with HIV infection, and the nursing implications of the ongoing epidemic.

We conducted a demonstration project to design, implement, and evaluate a risk-reduction intervention delivered by medical providers to patients with HIV during routine care in 2005 and 2006. Medical providers at seven HIV clinics in the United States received training to deliver an intervention in which they screened patients for behavioral risks, gave targeted counseling, and delivered prevention messages. A longitudinal cohort (n = 767) of patients completed a baseline questionnaire and two follow-up questionnaires (6-month intervals) after the intervention was initiated. Logistic regression and generalized estimating equations (GEE) methods were used in analyses. The cohort had a median age of 41, was 58% black, 28% white, and 10% Hispanic; 32% were women and 42% self-identified as men who have sex with men. The 3-month prevalence of unprotected anal or vaginal intercourse (UAVI) with any partners declined significantly (p < 0.001) from baseline (42%) to follow-up (26% at first follow-up, 23% at second follow-up). The decline was significant with partners who were HIV-negative/unknown serostatus or HIV-positive. Cohort patients' self-reported receipt of safer-sex counseling at all, some, or no clinic visits during the interval between baseline and first follow-up showed a dose-response relationship with decline in prevalence of UAVI in that interval, with relative reductions of 45%, 35%, and 19%, respectively. All findings were confirmed in multivariate models that controlled for demographic factors and HIV clinical status of participants. This project demonstrated that with only brief training, HIV medical providers successfully conducted an HIV prevention intervention with their clinic patients. Our findings indicate that clinics that serve HIV patients can incorporate such programs as standard of care.

Recent therapeutic advances, in particular the use of anti-tumour necrosis factor (anti-TNF) agents, have revived interest in the seronegative spondyloarthropathies (SpA), a group of arthritides characterised by axial skeletal involvement and the absence of rheumatoid factor. The purpose of this article is to review the studies that have been done in the Asia Pacific region, as a broad understanding of the scope and severity of this group of diseases would enable rheumatologists and physicians in this part of the world to better manage their patients. The majority of genetic studies have focused on the associations of HLA-B27 with ankylosing spondylitis (AS) and SpA, while a few studies examined the associations of the CARD, IL-1, LMP2, TAP and TGF with AS. There are a handful of studies on the immunological responses to bacteria and cytokine levels in AS. The onset and clinical features of SpA have been reported from most countries in the region, but no data on patient outcomes, using current measurement tools such as the Bath Ankylosing Spondylitis Disease Activity index (BASDAI), is available. Validation of these instruments of measurement as well as classification criteria in different ethnic populations is necessary where no prior data exist. Future studies will likely be focused on better clinical characterisation of patient cohorts, particularly with regard to the use of currently used measurement tools for disease activity and spinal function and mobility, and the identification of the need for biologic therapy in each country.

The objective of this study was to identify the transcription factors that regulate the expression of growth hormone receptor (GHR) 1A mRNA, a major GHR mRNA variant in the bovine liver. A deoxyribonuclease I footprint analysis revealed that the GHR1A promoter region -69 to -30 (relative to the transcription start site for GHR1A mRNA) contained binding sites for bovine liver nuclear proteins. Using a yeast one-hybrid analysis, zinc finger binding protein 89 (ZBP-89) was identified as a binding protein to this promoter region. Binding of ZBP-89 to the GHR1A promoter region -69 to -30 was further confirmed by an electrophoretic mobility shift assay. In cotransfection analyses, overexpression of ZBP-89 enhanced (P<0.01) the activity of the GHR1A promoter and this enhancement was dependent on the putative ZBP-89 binding site in the promoter. These results together indicate that ZBP-89 is a transcription factor that regulates the expression of GHR1A mRNA.

Suicide by burning and other forms of self-injurious behaviors which involve burning are sometimes considered to have religious overtones. The ritual death of widows upon their husband's funeral pyre is closely associated with Hindu beliefs. Buddhists have used self-immolation as a form of protest. The Judaeo-Christian traditions have imagery of fire as cleansing and purifying; there is also secular imagery associating fire with images of condemnation and evil. Previous studies have described religiosity as a common theme among survivors. The present study describes the ways in which persons who inflicted self-injurious behaviors through burning, including attempted suicide, imagine the Divinity and use religious language to give meaning to their experience.

Primary prevention of HIV requires behavior changes to decrease the risk of sexual, drug using, and occupational exposure to infection. The difficulties associated with behavior change are related to social, cultural, and political constraints that reinforce heterosexism, sexism, and racism. These problems are compounded by concurrent epidemics of violence, poverty, and drug use, and are made more difficult by the absolutist mentality. Use of theory-based interventions, awareness of community attributes, and a change to pragmatic political agendas can help in the development of effective prevention programs.

Patients with human immunodeficiency viral (HIV) infection who also require dialysis present a complex constellation of challenges for dialysis personnel. The major challenges that health care providers (HCPs) face when working with HIV-infected patients are related to overcoming personal fears and to adapting to HIV-specific patient care needs. Dialysis personnel who encounter these concerns do so with a background of experience that has prepared them to cope effectively with HIV disease in the dialysis setting. This article explores the problems of occupational exposure to HIV and chronic health care issues common to patients with HIV infection and renal disease.

4-Vinylcyclohexene diepoxide (VCD) destroys small preantral (25-100 microns) ovarian follicles after repeated dosing in mice and rats. A previous study determined this follicular destruction is via apoptosis (physiological cell death). The purposes of this study were to examine the effects of VCD on amounts of mRNA for several genes that might be involved in this ovotoxic response and to determine the specificity of this response for small preantral follicles. The genes of interest were bax, a cell death gene; three forms of the antioxidant enzyme, superoxide dismutase (mitochondrial manganese-containing or MnSOD, cytosolic copper/zinc-containing or Cu/ZnSOD, and secreted or secSOD); and microsomal epoxide hydrolase (mEH), involved in detoxification of VCD. Female Fischer 344 rats were administered daily doses (10 days) of vehicle control (sesame oil) or VCD (80 mg/kg, ip). Four hours after the last injection, livers and ovaries were removed. Small (25-100 microns) and large (100-250 microns) preantral follicles were separated from the ovaries by gentle dissociation and collected by mouth pipeting. Total RNA was extracted from all tissues, reverse transcribed into first-strand cDNA, and amplified by polymerase chain reaction using oligonucleotide primers specific for each gene. Relative levels of mRNA were visualized by agarose gel electrophoresis and autoradiography and quantified by densitometric analysis. Coamplification of ribosomal protein L19 (constitutively expressed in ovarian tissue) was used for normalization in each sample. Increased levels of mRNA for bax (172 +/- 20% of control, p < 0.05), MnSOD (248 +/- 70% of control, p < 0.05), and mEH (352 +/- 120% of control, p < 0.05) were measured in 25- to 100-microns follicles collected from VCD-treated compared with control rats. Unlike 25- to 100-microns follicles (the targets of ovotoxicity), in 100- to 250-microns follicles (nontargets) there were no changes (p > 0.05) in mRNA levels for bax or MnSOD in VCD-treated rats; however, mRNA levels for mEH were significantly decreased (79 +/- 4% of control, p < 0.05), compared with control. No changes in levels of mRNA for mEH were observed in liver from VCD-treated rats relative to control. Additionally, in liver VCD caused a significant decrease in mRNA levels for bax (31 +/- 5% of control, p < 0.05) and Cu-ZnSOD (56 +/- 17% of control, p < 0.05). In summary, dosing of rats with VCD enhanced expression of mRNA encoding several genes that might respond during the induction of ovotoxicity. The selective increase in bax in the population of follicles destroyed by repeated dosing with VCD may reflect their susceptibility to apoptosis.

Previous studies have determined that 4-vinylcyclohexene diepoxide (VCD) causes specific destruction of oocytes contained in small pre-antral (primordial and primary) ovarian follicles of Fischer 344 rats following 30 days of daily dosing with VCD. The purposes of this study were to identify the type of VCD-induced cell death occurring in small pre-antral follicles and to determine the earliest time following the onset of dosing when evidence of follicular destruction could first be detected. A significant decrease in the number of oocytes contained in small pre-antral follicles in ovaries of rats after 15 days of daily dosing (ip) with VCD (80 mg/kg) had been observed in preliminary experiments. Therefore, a study was conducted to determine the time of the onset of this follicular destruction by examination of follicular DNA integrity. Female Fischer 344 rats were dosed daily (80 mg/kg, i.p.) for 6, 8, 10, 12, or 14 days, and ovaries were removed 1, 4, or 24 hr after the final dose. Small pre-antral follicles (25-100 microns) were isolated by gentle dissociation of ovaries with collagenase, and follicles were sorted with micropipets. Genomic DNA was isolated from follicles and radiolabeled with [32P]dideoxy ATP, and the degree of fragmentation quantified by agarose gel electrophoresis and autoradiography. Degradation of DNA was evaluated by 32P content in low-molecular-weight fragments ( < 4 kilobase pairs). Degradation of DNA was not observed in follicles collected 24 hr after the final dose on any day. However, a random pattern of DNA degradation was observed, and was significantly greater (p < 0.05) compared with controls, when follicles were collected 4 hr following VCD administration on Days 10 and 12, but not on Days 6 or 8, of dosing. Although not significant, there was also evidence of DNA degradation in dosed animals on Day 14. Histological evaluation of small pre-antral follicles in ovarian sections during the early stages of VCD-induced DNA degradation (Day 10; 4 hr) demonstrated margination of chromatin along the nuclear membrane in oocytes and disruptions in focal contact between granulosa cells and oocytes, both features indicative of apoptosis. Furthermore, there was no sign of ruptured membranes in granulosa cells or oocytes or of an inflammatory response, characteristics of necrosis (pathological cell death). Whereas biochemical and morphological evidence of follicular destruction was seen 4 hr after dosing on Day 10, numbers of oocyte-containing primordial and primary follicles in VCD-treated animals were not different from controls at that time. These results demonstrate that the initial evidence of impending destruction of small pre-antral follicles is first consistently visualized following 10 days of daily dosing with VCD, although a measurable reduction in oocyte numbers has not yet occurred. Despite the fact that internucleosomal cleavage of genomic DNA was not observed, morphological evaluations support that granulosa cells and oocytes in primordial and primary follicles are destroyed via the induction of apoptosis.

The mechanism of 4-vinylcyclohexene diepoxide (VCD)-induced oocyte destruction in small preantral follicles of rats and mice has not been elucidated. This study examined the effects of daily dosing of female rats with VCD on protein synthesis and follicle viability. An investigation of granulosa cells as a target for VCD was also made. Small preantral follicles (25 to 100 microns) isolated from untreated immature rats (day 28) as well as from rats injected daily for 10 d with VCD (0.57 mmol/kg, IP) or vehicle control (sesame oil) were incubated for 3, 6, or 10 h in vitro with or without VCD. Viability (trypan blue dye exclusion) or protein synthesis (3H-leucine incorporation) in follicles was measured. Large preantral follicles (100 to 250 microns), isolated oocytes or granulosa cells from small preantral follicles, hepatocytes, and adrenal cells served as controls. Viability was not compromised in small follicles isolated from untreated or VCD-injected rats. However, following in vitro incubation of small preantral follicles with VCD, there was a significant decrease in viability by 6 h. This loss in viability was observed in granulosa cells and was even greater in follicles from dosed as compared with undosed animals. The various cell types were incubated in vitro with or without VCD for 3 h and the rate of protein synthesis was measured by 3H-leucine incorporation during the last hour of incubation. Incubation of small preantral follicles from untreated animals with VCD for 3 h produced significant inhibition in the rate of protein synthesis. This effect was reversed and significantly stimulated after 6 and 10 h of incubation with VCD. Follicles from animals that had been dosed daily with VCD for 10 d demonstrated similar inhibition of protein synthesis following 3 h in vitro incubation with VCD; however, unlike those from undosed rats, follicles from dosed rats did not recover from this inhibition after 6 or 10 h of in vitro incubation with VCD. In vitro incubation with VCD stimulated the rate of protein synthesis in large preantral follicles; however, no effect on the rate of protein synthesis was observed in isolated oocytes and granulosa cells, hepatocytes, or adrenal cells. These observations suggest that VCD affects follicular viability via an effect on granulosa cells and that daily dosing of rats with VCD makes small preantral follicles more susceptible to ovotoxicity by VCD.

Promoting healthy behaviors at all levels of prevention is an important component of nursing care in the HIV epidemic. This paper explores two models that can be used to support behavior change efforts: the Transtheoretical Model, which describes stages in the change process, and the Harm Reduction Model, which offers an incremental approach to helping clients move toward safer and healthier habits. A review of the literature shows that these holistic and caring models can be combined effectively to assist clients who are dealing with HIV-related issues. The resulting theory-based approach can help nurses maintain consistency and direction in educational interventions for behavior change.

HIV infection is a chronic disease that can occur in conjunction with a variety of renal problems. When it does, nephrology nursing care is complicated by the interactive nature of dealing with two complex disease processes. Nephrology nurses already possess the skills needed to deal with this complexity, but may need additional knowledge specific to HIV. This article focuses on HIV infection and nursing care of infected patients in renal care settings.

Objective: Evaluation of the reliability of diagnostic codification by the Medical Codification Department (MCD) as a method of national hospital identification of multiple injury patients and description of epidemiology and mortality among the multiple injury group studied., Design: Prospective/retrospective and descriptive., Setting: Free University Hospital, Amsterdam., Method: The injuries of 207 severely injured patients presented at the Accident and Emergency department during the year 1992, were coded as an Injury Severity Score (ISS). Those having an ISS > or = 18 were reviewed on cause and outcome of the injury. The diagnose for codification (International Classification of Diseases-9 Clinical Modification) of the MCD, from which an Abbreviated Injury Score (AIS) and the ISS can be calculated, was evaluated., Results: 24 out of the 207 severely injured patients were transferred to other hospitals after stabilisation because of lack of room. Of the remaining 183 patients 124 had an ISS > or = 18.44 (35%) patients died during their stay in hospital. 21 (48%) of them died within 2 hours. 28 (64%) multiple injury patients died during the first 24 hours after admission. Neurological damage was the main cause of death (59%), followed by exsanguination (30%). A traffic accident was the cause of the injuries in 61% and a fall or jump in 27%. The mean ISS of these patients was 29 and the maximum score was 66. Head and neck injuries were present in 80% of the patients. The codification of brain damage by the MCD resulted in several mistakes. Brain damage in multiple injury cases results in a high AIS. Since the ISS is calculated by multiplication of AIS values, small differences in AIS create considerable variations in ISS., Conclusion: Multiple injury patients need fast and adequate help because of the high mortality, especially in the first 24 hours. The diagnostic codification of the MCD was found not reliable enough to be used for a hospital identification and registration of multiple injury patients.

The forecast for the HIV epidemic in the United States includes increasing numbers of infected women and children, the latter of whom will be born to infected mothers. As the epidemic progresses, nurses will be more frequently called on to assist women in making difficult reproductive decisions. Using four levels of analysis, this discussion explores current knowledge about reproduction in HIV-infected women and suggests interventions and nursing actions.

Emergency medical health care workers may face restrictions on their practices as state responses to federal mandates concerning human immunodeficiency virus (HIV) and hepatitis B virus (HBV) evolve. This article presents an analysis of legal, ethical, and scientific considerations for making decisions about the practices of HIV-infected health care workers (HCWs). A four-factor product analysis is proposed for risk assessment, and recommendations are developed related to decreasing the risk of HIV transmission in the health care setting while maintaining HCW rights.

This study assessed nurses' reactions to the possibility of working with HIV-infected clients by the use of a sentence-completion format. A random sample of 2,434 nurses was completed with 502 (20.6%) nurses who provided 3,180 responses on the survey tool. Card sorting was used to discover themes that included positive, neutral, and negative reactions. The thematic categories that evolved from the data were: caring (899 responses, 28%), care as usual (1198 responses, 37.6%), and avoidance (1083 responses, 34%). More than 88% of the respondents provided statements that were sorted into at least two of the thematic categories; more than 51% gave responses that sorted into all three of the major categories. This qualitative research project revealed that these nurses, when confronted with an anticipation of caring for HIV-infected clients, held a wide variety of opinions and concerns that were often expressed simultaneously.

Writing is frequently referred to as a skill. Its value, however, is most often judged by what it produces, when, ironically, studying the process of writing may be the best way to improve the product. This teaching plan asks students to develop a meaningful written product while focusing on context, content, and process evaluation. It also provides a learning experience that has the potential to enhance empathy and caring among nursing students.

The 1990 report of transmission of human immunodeficiency virus in a Florida dental office sparked a massive public fear reaction. In response, the Centers for Disease Control and Prevention produced six recommendations that provide few benefits, at what may prove to be an exorbitant cost. The author reviews those recommendations in light of the legal and ethical considerations of informed consent, significant risk, fear, confidentiality, privacy, and right to work. An alternative approach is recommended which would use human, economic, and leadership resources. This approach focuses attention on improved health care through research, product development, education, and enforcement of safety measures, and recognition and control of high-risk situations through education and government leadership.

Infection with the human immunodeficiency virus (HIV) and the development of the acquired immunodeficiency syndrome (AIDS) is a long-term process in many individuals. The progression of HIV disease is beginning to demonstrate many commonalities with other chronic diseases. Although research has not yet shown clear-out evidence that diet can make a difference in the course of disease in HIV-infected clients, nutrition should be viewed as an important component of holistic care for HIV-infected clients because: 1) wasting and symptoms of malnutrition are common problems associated with these clients; and 2) nutrition has proven to be a beneficial component of care in other chronic conditions. This paper uses the model developed by Winett, King and Altman (1989) to review nutritional support in HIV infection from a multilevel perspective ranging from personal psychology to institutional/societal controls. The author concludes that there is a potential benefit from integrating nutritional assessment, diagnosis and education into the holistic care of HIV-infected clients at the personal, interpersonal, organizational and societal levels.

In a 41-year-old stroke patient with bitemporal brain damage, we found severe signs of auditory agnosia 6 months after onset. Recognition of environmental sounds was extremely impaired when tested in a multiple choice sound-picture matching task, whereas auditory discrimination between sounds and picture identifications by written names was almost undisturbed. In a therapy experiment, we tried to enhance sound recognition via semantic categorization and association, imitation of sound and analysis of auditory features, respectively. The stimulation of conscious auditory analysis proved to be increasingly effective over a 4-week period of therapy. We were able to show that the patient's improvement was not only a simple effect of practicing, but it was stable and carried over to nontrained items.