Characteristics of research-related HIV testing programmes contribute to detection of more HIV infections.

HIV prevalence estimates from bathhouse testing programmes differ widely, ranging from 3% to 11%. The observed difference may be a consequence of whether the programme was part of a research project or a community-based programme. A research-funded testing programme was offered at a bathhouse between May 2001 and December 2002. A local community-based organization began a testing programme in July 2006 at the same bathhouse; the data for this analysis cover the period July 2006 through December 2007. County-wide HIV prevalence estimates were available across the two time periods (i.e. 2001-2002 and 2006-2007). The research-funded testing programme recruited fewer men but identified more positive individuals (10.7% of those testing in the research programme) than were identified among men who tested in the area clinics (3.8% of those men who have sex with men [MSM] testing throughout the county in the same time period). However, the community-based testing programme identified about the same proportion of positive MSM (2.6%) as county clinics (2.7%) in the same time period. In conclusion, results confirmed that even in the same venue, a community-based HIV testing programme identified a similar proportion of positive MSM as the area clinics; however, the research-funded programme identified appreciably more. Incentives may contribute to the difference.

Correlation of glycosylation forms with position in amino acid sequence.

We surveyed published reports on about 50 glycoproteins whose amino acid sequence, glycosylation sites, and type of glycosylation at a particular site have been established. We note that high-mannose substances were rarely found at the N-terminal side of a previously glycosylated complex site. There was a very definite distribution of complex sites about the N-terminal region. Furthermore, secreted glycoproteins usually contained only complex oligosaccharides whereas membrane proteins contained both types. We suggest that the position of the glycosylation site with respect to the N-terminus affects the extent of oligosaccharide processing and subsequent presentation of complex or high-mannose structures in the mature glycoprotein. This review relates glycosylation type to its position in the known sequence of given proteins and discusses these observations in light of known glycosylation processing reactions.

Communications Satellites: Countdown for INTELSAT VI.

Since the formation of COMSAT 20 years ago, the number of international telephone circuits made through satellites has grown 400 times and the cost of a telephone call has decreased by 12,000 percent. Worldwide communications linking 109 nations are achieved with 14 satellites in earth-synchronous orbit. Advances in microwave technology have expanded the transmission bandwidth per satellite from 50 to more than 3000 megahertz. Improvements in solar cell, battery, stationkeeping, and microwave amplification technology have increased satellite lifetime from 1.5 years to 10. The sixth generation of INTELSAT satellites, now being manufactured, will be introduced into the system in 1986, and each satellite will carry more than 40,000 telephone channels plus two television programs. The next generation of satellites, now under design for expanded capacity, will be needed by the middle 1990's to meet the traffic demand. These satellites are likely to add new frequencies (20 and 30 gigahertz), onboard signal processing and switching, and more bandwidth-efficient modulation, to achieve larger communication capacity at each orbital location.

Health care policy. U.S. priorities-HIV prevention.

One of the scientific anomalies of the AIDS epidemic is the large difference in infection rates across populations. Given limited resources and segregated epidemics, prevention funding should be directed to population segments with high HIV prevalence and incidence. However, recent surveys of U.S. populations indicate that the allocation of prevention dollars is not consistent with the distribution of HIV in the population.

Immunization with an antigen identified by cytokine tumor vaccine-assisted SEREX (CAS) suppressed growth of the rat 9L glioma in vivo.

We have reported previously that s.c. immunization of rats with IL-4 transduced 9L gliosarcoma cells (9L-IL-4) induced a potent antitumor immunity against intracranial, parental 9L tumors. Subcutaneous implantation of 9L-IL-4 influenced the systemic humoral response, which was demonstrated by Th2-type isotype-switching and the induction of cellular immune responses, which played a critical role in the rejection of tumors. Serological analyses of recombinant cDNA expression libraries (SEREX), has recently emerged as a powerful method for serological identification of tumor-associated antigens (TAAs) and/or tumor rejection antigens (TRAs). Because IL-4 is known to activate B cells and to promote humoral responses, and inasmuch as induction of humoral responses by central nervous system tumors has been reported to be minimal, we investigated whether the induction of a potent humoral immune response against 9L TAAs or TRAs in rats immunized s.c. with 9L-IL4 could be demonstrated. Screening of 5 x 10(5) independent clones of 9L-expression cDNA library for the presence of reactive antibodies in the serum from a 91-IL-4 immunized rat led to the identification of three different TAAs. One 9L TAA (clone 29) was demonstrated to be calcyclin, a member of the S-100 family of calcium-binding proteins. The second 9L TAA (clone 37) was demonstrated to be the rat homologue of the J6B7 mouse immunomodulatory molecule. The third TAA (clones 158 and 171) was determined to be the rat homologue of the mouse Id-associated protein 1 (MIDA1), a DNA-binding, protein-associated protein. Northern blotting demonstrated that message for calcyclin was overexpressed in 9L cells. Message encoding MIDA1 was highly expressed in parental 9L cells and thymus and, to a lesser degree, in testis, suggesting that MIDA1 was comparable with the cancer/testis category of TAAs. Sera obtained from animals bearing 9L-IL-4 were found to have a higher a frequency and titer of antibodies to these antigens when compared with sera obtained from rats bearing sham-transduced 9L (9L-neo) cells. To determine whether immunization with these TAAs induced antitumor immunity, animals were immunized by intradermal injection with expression plasmids encoding calcyclin or MIDA1. Subsequent challenge of rats with parental 9L resulted in significant suppression of tumor growth in animals immunized with MIDA1, but not with calcyclin. These results indicate that MIDA1 is an effective 9L TRA and will be useful for the investigation of specific antitumor immunity in this glioma model. Furthermore, these results suggest that this approach, termed "cytokine-assisted SEREX (CAS)," may serve as an effective strategy for identification of TRAs for in animal-glioma models of cytokine gene therapy, and potentially in humans undergoing cytokine gene therapy protocols as well.

Bringing HIV/STI testing programmes to high-risk men.

The aim of this study was to examine the meaning of significantly higher proportions of positive test results through outreach HIV/sexually transmitted infection testing programmes at gay bathhouses compared with clinic programmes among high-risk men who have sex with men. We conducted a random digit dial survey of men who have sex with men in New York, Los Angeles, Chicago, and San Francisco. Half of the men in the sample did not test in the past year. Among those who did not test, a sizeable minority (17%) reported engaging in high-risk sexual behaviour with a casual or secondary partner. Over half of these non-testing, high-risk men went to bathhouses. These findings strongly support the potential value of locating outreach-testing programmes in bathhouses. Although further studies are necessary, such programmes have the potential to increase testing among the high-risk segment of the population. This is particularly noteworthy given that many men among those who do not test regularly engage in high-risk behaviours.

Disclosing HIV seropositivity to significant others.

OBJECTIVES: To examine gay men's patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues; to assess the effects of disclosure; and to identify reasons for not disclosing to particular individuals. DESIGN: Longitudinal questionnaire survey of gay men. METHODS: A total of 163 HIV-positive men participating in the AIDS Behavioral Research Project, a longitudinal study of San Francisco gay men, completed questionnaires about their self-disclosure patterns, health status, and psychological well-being. RESULTS: HIV-positive men were most likely to disclose their status to lovers and closest gay friends. Asymptomatic men were less likely to disclose to relatives and colleagues than symptomatic men. Friends and lovers were rated as responding more helpfully than relatives and colleagues. Men who perceived their significant others as responding more helpfully were less depressed and anxious currently and 1 year later. A variety of reasons were given for not disclosing, including not wanting to worry others, fear of discrimination, fear of disrupting relationships, and emotional self-protection. CONCLUSION: While disclosure can have advantages for both HIV-positive individuals and their significant others, HIV-positive individuals must be assured that the benefits of doing so will outweigh the potential costs.

How many HIV infections cross the bisexual bridge? An estimate from the United States.

OBJECTIVE: Most heterosexual women with AIDS have been infected by male sex partners who acquired HIV via injecting drug use or sex with men. The contribution of bisexuality to heterosexual HIV however, has been poorly quantified. In this paper, we estimate the number of HIV infections that spread from the homosexual community to women who have sex with bisexual men. METHODS: We developed an HIV transmission model and assigned values to the model's parameters using data from a probability survey of US cities with a high risk of HIV. RESULTS: We estimated that these are about 400 HIV infections transmitted annually from HIV-infected bisexual men in high-risk cities to their female sex partners; two-thirds of these infections are transmitted to main female partners and one-third to casual partners. Uncertainties in the value of model parameters lead to variation in expected HIV infections mostly within the range 200 to 600, and for one parameter up to nearly 800. CONCLUSION: We conclude that transmission via bisexuality is a relatively minor component of the estimated 40,000 annual HIV infections in the USA.

Mobilizing young gay and bisexual men for HIV prevention: a two-community study.

BACKGROUND: To develop, implement and evaluate a community-level HIV prevention program (the Mpowerment Project) for young gay men in two US communities. DESIGN: Using a multiple baseline design, a cohort of young gay men was recruited independently of the intervention in each community and surveyed twice (1 year apart) regarding sexual risk behavior and psychosexual variables. The intervention was then implemented sequentially in each community. The cohorts were resurveyed immediately post- and 1-year post-intervention. Since there were few differences between the two communities, data were pooled to increase statistical power. INTERVENTION: The program had four components: peer outreach, whereby young gay men encouraged other men to engage in safer sex; peer-led small groups; a publicity campaign; and a young men's center. RESULTS: Baseline rates of unprotected anal intercourse were stable. Following intervention, the proportion of men who engaged in unprotected anal intercourse decreased from 38.3 to 30.9% (-19.3% relative reduction), with a reduction from 19.2 to 13.6% (-29.2% relative reduction) with non-primary partners, and a reduction from 57.7 to 41.8% (-27.6% relative reduction) with boyfriends. Reductions were sustained 1 year later with non-primary partners, but mixed results were found regarding sex with boyfriends. CONCLUSIONS: Mobilizing young gay men to support each other about safer sex is an effective approach to HIV prevention, but programs must be sustained. To reach young gay men, HIV prevention activities must be embedded into the satisfaction of needs for social and community belonging.

Many people who seek anonymous HIV-antibody testing would avoid it under other circumstances.

Decreases in high-risk behavior have been observed when people have sought anonymous or confidential HIV-antibody testing accompanied by counseling. HIV-antibody testing also benefits those who are tested, since people who find that they are seropositive can receive closer medical follow-up, and, in certain cases, medical treatment. However, debates continue about appropriate testing policy. This study concerns the conditions under which people who are currently seeking anonymous testing at an alternative test site would be willing to obtain testing. On self-administered questionnaires all sexual orientation/gender groups expressed reluctance to obtain testing if anonymity were not assured. Bisexual men were especially concerned about seeking testing if there was mandatory reporting. Believing that one was infected with HIV was slightly associated with a decreased inclination to obtain testing under non-anonymous circumstances.

Relapse from safer sex: the next challenge for AIDS prevention efforts.

Prevention campaigns to reduce sexual transmission of human immunodeficiency virus (HIV) typically emphasize the initial adoption of safer sex techniques. We present data from a 5-year prospective study to show that the vast majority of resident gay men in San Francisco have made these initial risk reductions. Rather, relapse from safer sex techniques is now the predominant predominant kind of high-risk sex, accounting for approximately two thirds of all prevalent high-risk sex in the 1988 wave of data collection. Predictors of relapse from safer sex are identified, and these are discussed in terms of their implications for preventing relapse from the exclusive practice of safe sex. In communities that have already manifested widespread behavioral risk reductions and in which HIV infection is highly prevalent, finding ways to prevent relapse of behavioral risk reductions will be the next important challenge in the fight against acquired immune deficiency syndrome.

United States neonatology practice survey: personnel, practice, hospital, and neonatal intensive care unit characteristics.

BACKGROUND: The efficiency and access to existing perinatal resources has become a focus of debate. Despite inconsistent references to the number of neonatologists and unsubstantiated personnel requirement recommendations, recent commentaries have suggested a current 30% to 50% excess in workforce. OBJECTIVE: To describe the current neonatology workforce and its practice patterns. DESIGN: Using a questionnaire developed by the Committee on Practice of the Section on Perinatal Pediatrics of the American Academy of Pediatrics and distributed to 675 neonatology practices identified in the United States Neonatologists Directory 1996, a survey was conducted from July 1, 1995 to June 30, 1996 requesting specific information relating to personnel, type and size of practice, and clinical services provided at practice hospitals. RESULTS: Respondents included 420 neonatology practices (62.2% response rate) representing 2006 neonatologists providing clinical care in 695 hospitals, 652 with delivery services that accounted for 1 646 881 live births in 1994. More than 95% of practices and neonatologists identified themselves as based in university, private, or hospital settings. Eighty percent of neonatologists were <50 years old. There was an overall 2:1 male to female gender distribution. Sixty percent of practices consisted of 4 or fewer neonatologists, 25% of practices 5 to 7 neonatologists, and 15% of practices 8 or more neonatologists. Sixty percent of practices provided clinical care in only 1 hospital and 1 neonatal intensive care unit (NICU) as compared with 15% of practices in 3 or more hospitals and <5% of practices in 3 or more NICUs. Of the total 478 NICUs (22 in children's hospitals), 67% had <501 annual admissions and 33% had more then 500 admissions. Of the 456 NICUs in 652 practice hospitals with delivery services, 61% of hospitals had <2501 annual deliveries (57% with NICUs) and 39% of hospitals had more than 2500 annual deliveries (90% with NICUs). The average inborn admission rate for these practice hospitals was 11.7%. University, private, and hospital practices had consistent rates of admissions for inborn and outborn NICU and special care nursery admissions. More than 60% of neonatology practices were involved in normal newborn care on a routine basis, in addition to staffing developmental clinics and providing inpatient and outpatient pediatric care. Additional information was analyzed for utilization of residents and neonatal nurse practitioners. By 1999, 50% of practices anticipated hiring 279 neonatologists and 575 neonatal nurse practitioners. CONCLUSION: Significant discrepancies between earlier projected neonatologist requirements and current neonatology workforce and service responsibilities are discussed in relation to demands of reallocation of subspecialty resources within an evolving health care system.

Stress, coping, and high-risk sexual behavior.

We examined the relation between stress, coping, and a high-risk sexual behavior (unprotected anal intercourse) in 398 nonmonogamous gay and bisexual men from the AIDS Behavioral Research Project in San Francisco. Unprotected anal intercourse during the previous month, the amount of stress experienced during the previous month in each of 10 domains, six types of coping (self-controlling coping, escape-avoidance, distancing, planful problem-solving, seeking social support, and positive reappraisal), and spiritual beliefs and spiritual activities were assessed through self-report. There was no relation between stress and unprotected anal intercourse. However, there was a relation between coping and unprotected anal intercourse. Subjects who reported unprotected anal intercourse used sex more of the time to help cope with stressful situations than did subjects who did not report unprotected anal intercourse. Unprotected anal intercourse was negatively associated with seeking social support and spiritual activities and positively associated with self-controlling coping, which involves keeping one's feelings to oneself, and positive reappraisal. The findings suggest that social aspects of coping may be a key to understanding differences between those who engage in high-risk sexual behavior and those who do not.

Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men's Health Study.

AIMS: To measure the prevalence and independent associations of heavy and problematic use of alcohol and recreational drugs among a household-based sample of urban MSM (men who have sex with men). DESIGN: Cross-sectional survey. PARTICIPANTS: Men who identified as being gay or bisexual or who reported sex with another man in the prior 5 years were included in this analysis (n = 2172). SETTING: A probability telephone sample of MSM was taken within Zip Codes of four large American cities (Chicago, Los Angeles, New York and San Francisco) estimated to have total concentrations of at least 4% of all households with one resident MSM. MEASUREMENTS: Standard measures of alcohol use, problems associated with alcohol use, and recreational drug use were administered by trained telephone interviewers. FINDINGS: Both recreational drug (52%) and alcohol use (85%) were highly prevalent among urban MSM, while current levels of multiple drug use (18%), three or more alcohol-related problems (12%), frequent drug use (19%) and heavy-frequent alcohol use (8%) were not uncommon. The associations of heavy and/or problematic substance use are complex, with independent multivariate associations found at the levels of demographics, adverse early life circumstances, current mental health status, social and sexual practices and connection to gay male culture. CONCLUSIONS: The complex pattern of associations with heavy and/or problematic substance use among urban MSM suggests that heavy and/or problematic substance use is grounded in multiple levels: the individual, the interpersonal and the socio-cultural.

An intrasylvian "fibroma" in a child with cystic fibrosis: case report.

OBJECTIVE AND IMPORTANCE: Intracranial fibrous tumors are uncommon during childhood. An unusual case of benign intrasylvian "fibroma" that has remained clinically and radiographically stable more than 3 years after a subtotal resection is described. CLINICAL PRESENTATION: A 9-year-old girl with cystic fibrosis presented with new-onset focal seizures referable to a large calcified left sylvian fissure mass. INTERVENTION: An open biopsy with subtotal resection of the lesion revealed a benign process characterized by exuberant fibrocollagenous tissue intermeshed with chronic inflammatory cells and foreign body giant cells, encompassing islands of gliotic brain tissue. Immunohistochemical analysis showed staining for epithelial membrane antigen and reticulin within some of the spindle cells, although the majority were nonreactive. The majority of tumor cells exhibited staining for laminin; CD34 staining was absent. Ultrastructural studies were also suggestive of a fibroblastic rather than a meningothelial origin of the lesion, with elongated cells separated by abundant extracellular collagen. Although dense adherence of the mass to the pial surface and the middle cerebral artery vessels precluded a complete resection, the patient remains seizure-free without anticonvulsant therapy more than 3 years postoperatively with no evidence of growth of the lesion. CONCLUSION: The lesion in this patient bears morphological similarity to a rare group of tumors referred to as "intracerebral fibromas," although a variety of other rare mesenchymal neoplasms were also considered within the differential diagnosis. However, the absence of any definite neoplastic features, the finding of chronic inflammatory changes, and the lack of growth of the residual tumor during an extended follow-up interval indicate that the mass may represent either an extremely indolent neoplasm or a nonneoplastic process. The differential diagnosis of intracranial fibrous tumors is contrasted with that of the reported case.

Vein valve transplantation.

The vein valve transplantation has, in our experience, subjectively relieved symptoms in the majority of patients. More importantly, elevated venous pressure has been decreased in most patients. Thus, patients exhibiting signs of venous insufficiency syndrome as well as elevated venous pressure and proved valvular incompetence should be considered candidates for vein valve transplantation after an unsuccessful trial of medical management.

Continuous ambulatory venous pressure for diagnosis of venous insufficiency. Preliminary report.

We have found that the venous pressure slope during minimal exercise is a sensitive measurement of venous disease. This parameter differed greatly in our two study populations. Due to increased venous pressure, venous insufficiency syndrome patients have a greater volume of pooled blood, which results in smaller pressure changes with each muscle contraction. In patients with incompetent valves, blood flows in a retrograde fashion in the vein, which leads to a higher steady state minimal pressure and notably to a decreased venous pressure slope. Venous pressure slope is a particularly sensitive measurement and a good prognosticator of venous insufficiency syndrome before symptoms become disabling to the patient. Our data indicate a strong correlation between venous pressure slope and venographic results. In fact, patients with abnormal venographic results invariably have demonstrated venous pressure slopes in the abnormal range.