Human immunodeficiency virus transmission through artificial insemination.

Six human immunodeficiency virus type 1 (HIV-1) seropositive semen donors were identified during an antibody screening program initiated at an artificial insemination clinic in New York City in 1985. A total of 176 women underwent artificial insemination with fresh semen from these six donors between 1978 and mid-1985. Of these 176 women, 134 women were HIV-1 antibody tested and 1 was found to be seropositive; she denied all other AIDS-associated risk behavior and her husband was seronegative. The results of this investigation provide additional evidence that HIV-1 transmission can occur through artificial insemination with semen from an infected donor although the risk of HIV-1 transmission appears to be lower than that reported by other investigators. It is clear that HIV-1 screening of all potential semen donors should be routine practice whenever artificial insemination is performed.

A bridge to treatment: the needle exchange pilot program in New York City.

The needle exchange pilot program in New York City is one element in a spectrum of drug prevention and treatment modalities under way to slow the spread of the human immunodeficiency virus. The program's aim is to help us learn about the addict behaviors that spread the AIDS virus, including whether needle exchange can help reduce the frequency or eliminate those behaviors. Thus far, its primary value for clients lies in drug counseling and referral to treatment. Where an active IV drug user has taken the first step in changing the direction of his or her life by seeking treatment, needle exchange has been a significant means of helping keep that change in focus. Because of its value in helping change, and save, the lives of intravenous drug users and their sex partners and children, it should be expanded, and should be considered for adaption by other communities according to their needs as one relatively small element in a comprehensive AIDS prevention program.

AIDS in the black community: public health implications.

As of the end of September 1988, 16,600 cases of acquired immunodeficiency syndrome (AIDS) have been reported in New York City, including 5,248 cases among blacks, 32 percent of the total. Of these, 4,220 (80 percent of adults) are men, 1,028 (19 percent of adults) are women, and 195 are children.The major source of the spread of human immunodeficiency virus (HIV) infection within the black community is the intravenous (IV) drug user. Half of New York City's 200,000 IV drug users are estimated to be black; almost half of the women infected with AIDS through sexual contact with IV drug users are black. Every option for breaking the AIDS-IV drug abuser connection must be explored.AIDS among blacks is especially charged with the potential for discrimination or widespread backlash. AIDS education efforts must be increased, and legislation to protect against unauthorized disclosures of confidential health records must be supported. Comprehensive education programs must destigmatize AIDS among health care workers.To keep up with the epidemic, a national prevention strategy must consist of a massive national public health education program; voluntary, confidential counseling and HIV antibody testing expanded into every public and private clinical facility; and major efforts to curtail AIDS transmission by the IV drug user.

A comprehensive clinical evaluation of 20,000 Persian Gulf War veterans. Comprehensive Clinical Evaluation Program Evaluation Team.

In response to the health concerns of Gulf War veterans, the Department of Defense instituted the Comprehensive Clinical Evaluation Program (CCEP). Although not designed as a research study, the CCEP provided valuable clinical data. An analysis was conducted of CCEP findings from systematic and comprehensive examinations of 20,000 U.S. Gulf War veterans. Among 20,000 participants, the types of primary and secondary diagnoses varied widely. Also, among veterans with an ICD-9-CM diagnosis of "symptoms, signs, and ill-defined conditions," no single subcategory of illness predominated, and no characteristic physical sign or laboratory abnormality was identified. In-total, there were 74 (0.4%) cases of connective tissue disease; 52 (0.3%) noncutaneous malignancies; 42 (0.2%) peripheral neuropathies; 14 (0.07%) cases of interstitial pulmonary fibrosis; 12 (0.06%) cases of renal insufficiency; and no new cases of viscerotropic leishmaniasis. No clinical indication of a new or unique illness was identified in this self-referred population, and the types of physiologic disease that could result from postulated hazardous wartime exposures were uncommon.

Delivery systems for pediatric parenteral nutrition.

Delivery systems for parenteral nutrition have to be based on fundamental principles regarding venous access, choice of intravenous line, need for inline filters, infusion rate control and mode of packaging into "all in one" bags/two line/or the older three line system and, above all, the aseptic maintenance of this delivery system. Delivery systems need to be modified as per the available resources and hospital where they are to be used. Central venous access and handling of lines demand a high level of dedication and discipline, ideally left to a dedicated team of nurses and doctors. Staff training is the key factor in developing an efficient delivery system.

Permanent refractive-index modification in germanium-doped optical fibers by use of red light.

We observed photoinduced birefringence in elliptical-core optical fibers by using a continuous-wave krypton-ion laser. We induced the birefringence by injecting 20 mW of 647-nm or 50 mW of 676-nm light into the fiber at 45 degrees to the slow axis. The rate of change of the refractive index was found to be proportional to the square of the average power. Polarization mode couplers written into the fibers have been stable for more than 2 years and can be erased by use of light polarized perpendicularly to the original writing beam.

Current and future trends in AIDS in New York City.

Over the past five years, the proportion of AIDS cases among gay and bisexual men in New York City has fallen as the proportion of AIDS cases has risen among IV drug abusers, the major channel of HIV infection to children and heterosexuals in New York City. By 1991, there will be over 40,000 cumulative AIDS cases in New York City, with close to 30,000 deaths. Controlling the spread of HIV infection among drug addicts, children, and heterosexuals requires education, outreach, and exploration of strategies such as increasing the legal availability of sterile needles and syringes. For at least the next several years, massive programs of public health education and voluntary, confidential risk-reduction counseling and HIV antibody testing will remain our critical weapons for reducing the spread of HIV infection among people engaged in high-risk behavior as well as among the general public.

Evidence for gonococcal transmission within a correctional system.

In a study to examine sexually transmissible disease occurring within a large correctional system where sexual activity is prohibited, 27 male inmates acquired culture-proven gonorrhea from in-jail sexual activity during a three-month period. These results provide evidence to encourage inmate education about the acquired immunodeficiency syndrome (AIDS) and to support condom distribution programs in correctional facilities.