Prolonged postictal hemianopsia after a focal extraoccipital onset seizure.

We report a case of a prolonged postictal hemianopsia occurring after a focal extraoccipital seizure. A 55-year-old man with a history of neurosyphilis, treated with penicillin, presented to our epilepsy monitoring unit (EMU) for diagnostic evaluation of his spells occurring for 2 years. The spell semiology was stereotypical, described as oral and manual automatisms, speech difficulty and unresponsiveness. During the EMU stay, after his typical seizure was recorded, he experienced right hemianopsia lasting for 2 hours. Electrographically, the ictal pattern was prominent over the left temporal derivation and propagated to the left occipital derivation as the seizure progressed. Interictal epileptiform activity was over the left temporal derivations. We support the view that postictal phenomenon may represent merely a seizure termination zone and not be necessarily localising to the seizure onset zone. Furthermore, prolonged isolated postictal symptom of hemianopsia could also be noted in rare situations.

Correlates of HIV risk behaviors among homeless and unstably housed young adults.

OBJECTIVES: Homeless young adults are exposed to multiple risk factors for HIV infection. We identified HIV risk behaviors and their correlates among homeless young adults in Portland, Oregon. METHODS: We conducted a community-based, cross-sectional survey of HIV risk behaviors among homeless young adults aged 18-25 years in 2010. Participants completed three study components: (1) an interviewer-administered survey of HIV risk behaviors; (2) a brief, client-centered HIV risk-based counseling session; and (3) rapid HIV testing. RESULTS: Among 208 participants, 45.8% identified as racial/ethnic minority groups, 63.8% were male, and 35.7% self-identified as nonheterosexual. Six participants, all from sexual minority groups, had positive HIV screening results (two newly identified, four previously known) for a seropositivity rate of 2.9%. Female sex, belonging to a sexual minority group, frequent traveling between cities, depression, and alcohol use to intoxication were significantly associated with unprotected sex in univariate analysis. Female sex and high perceived risk of HIV were significantly associated with unprotected sex in multivariate analysis. CONCLUSIONS: Our findings support the need for enhanced HIV prevention interventions for homeless young adults.

Outpatient antibiotic prescribing in a low-risk veteran population with acute respiratory symptoms.

BACKGROUND: Acute respiratory tract infections are usually caused by viruses and are self-limited in healthy adults. Providers frequently provide antibiotic prescriptions for sinusitis, bronchitis, pharyngitis, and nonspecific upper respiratory tract infections, despite no evidence of improved clinical outcomes. We sought to determine: 1) primary care providers' antibiotic prescribing practices for acute respiratory tract infections in low-risk outpatient veterans and 2) short-term health outcome differences between those receiving and not receiving an antibiotic prescription. METHODS: We performed a retrospective electronic medical record review for veterans presenting to 1 of 3 primary care outpatient Veterans Affairs clinics in Portland, OR between July 1, 2008 and June 30, 2009 for acute respiratory symptoms. Demographics, signs and symptoms, antibiotic prescriptions, nonantibiotic prescriptions, and laboratory and imaging study variables were abstracted from medical charts. Descriptive frequencies, bivariate analyses (t tests, rank sums, Chi square tests, and Fisher's exact tests), and multivariate analyses (logistic regression) were performed. RESULTS: 35.4% of patients received antibiotic prescriptions. Of those antibiotics, 87.8% were not indicated. Antibiotic regimen prescriptions varied widely for each diagnosis. Short-term outcomes of hospitalization, follow-up visits, later antibiotic prescriptions, and death at 30 days were not associated with receipt of antibiotics. CONCLUSION: Many low-risk veterans received antibiotics for acute respiratory tract infections despite guidelines indicating that symptomatic treatment is sufficient for most patients. Novel interventions are required to reduce unnecessary and potentially harmful antibiotic use for low-risk outpatients with acute respiratory complaints.

Polystyrene-poly(ethylene oxide) diblock copolymer: the effect of polystyrene and spreading concentration at the air/water interface.

Polystyrene-block-poly(ethylene oxide) (PS-PEO) is an amphiphilic diblock copolymer that undergoes microphase separation when spread at the air/water interface, forming nanosized domains. In this study, we investigate the impact of PS by examining a series of PS-PEO samples containing constant PEO (~17,000 g·mol(-1)) and variable PS (from 3600 to 200,000 g·mol(-1)) through isothermal characterization and atomic force microscopy (AFM). The polymers separated into two categories: predominantly hydrophobic and predominantly hydrophilic with a weight percent of PEO of ~20% providing the boundary between the two. AFM results indicated that predominantly hydrophilic PS-PEO forms dots while more hydrophobic samples yield a mixture of dots and spaghetti with continent-like structures appearing at ~7% PEO or less. These structures reflect a blend of polymer spreading, entanglement, and vitrification as the solvent evaporates. Changing the spreading concentration provides insight into this process with higher concentrations representing earlier kinetic stages and lower concentrations demonstrating later ones. Comparison of isothermal results and AFM analysis shows how polymer behavior at the air/water interface correlates with the observed nanostructures. Understanding the impact of polymer composition and spreading concentration is significant in leading to greater control over the nanostructures obtained through PS-PEO self-assembly and their eventual application as polymer templates.

Cervical cancer screening among HIV-infected women in a health department setting.

HIV-infected women are at increased risk of developing invasive cervical cancer and present for care at a later stage of disease. Because of this susceptibility, the US Preventive Services Task Force and Centers for Disease Control and Prevention recommend that HIV-infected women receive two Pap smears during their first year after diagnosis, then annually thereafter. The aim of this study was to determine adherence to these screening guidelines and associations between demographic factors and receipt of Pap smears at a local health department in Florida. Demographic and Pap smear data were extracted from randomly selected medical records of 200 HIV-infected women receiving care between January 2000 and May 2006. Descriptive statistics and chi(2) associations were determined. Overall, 83% of women received at least one Pap smear in their first year after enrollment; 24.5% received the recommended two Pap smears. The women were predominantly minorities (57.4% African Americans; 22.8% Hispanics) and economically disadvantaged (mean income $8,180). First year Pap smear rate was significantly associated with type of insurance (p = 0.0185) and Pap smear facility (p < 0.0001), with a trend toward association with HIV risk behavior (p = 0.0593). First-year Pap smear rate was not associated with age, income, ethnicity, or incarceration history. Although this health department provided similar cervical cancer screening levels to those reported elsewhere, rates fall short of evidence-based guidelines. Future research must address low second Pap smear rates in the context of patient and provider barriers to improve early detection and prevention of cervical cancer in HIV-infected women.

Disparities in influenza immunization among US adults.

In the United States, health disparities exist among ethnic minority groups, the uninsured, and those with other barriers to health care access. Health disparities exist for many diseases, but are especially pronounced for preventive health services and preventable diseases. Persons affected by disparities experience higher incidences of vaccine-preventable diseases, such as influenza, and are more likely to die from those diseases as well. Although influenza vaccines are relatively safe, inexpensive, and effective in reducing infection and disease complications, many groups in the United States do not yet benefit from this potentially lifesaving intervention. Possible explanations for disparities in influenza vaccination include: (1) barriers to access such as cost, insurance status, and language differences; (2) underestimation of personal risk and misunderstanding of vaccination risks; (3) mistrust toward the health care system. Proposed strategies to minimize these disparities include: (1) changes to health care system structural factors that serve as access barriers, (2) education to increase awareness and improve demand for vaccines, (3) involvement of community-based organizations to assess local needs and design responsive solutions.

Polystyrene-block-poly(ethylene oxide) stars as surface films at the air/water interface.

Star diblock copolymers containing polystyrene (PS) and poly(ethylene oxide) (PEO) were investigated as surface films at the air/water interface. Both classic and dendritic-like stars were prepared containing either a PS core and PEO corona or the reverse. The investigated polymers, consisting of systematic variations in architectures and compositions, were spread at the air/water interface, generating reproducible surface pressure-area isotherms. All of the films could be compressed to higher pressures than would be possible for pure PEO. For stars containing 20% or more PEO, three distinct regions appeared. At higher areas, the PEO absorbs in pancakelike structures at the interface with PS globules sitting atop. Upon compression, a pseudoplateau transition region appeared. Both regions strongly depended on PEO composition. The pancake area and the pseudoplateau width and pressure increased in a linear fashion with an increasing amount of PEO. In addition, minimum limits of PEO chain length and mass percentage were determined for observing a pseudoplateau. At small areas, the film proved less compressible, producing a rigid film in which PS dominated. Here, the film area increased with both molecular weight and the amount of PS. Comparison with pure linear PS showed the stars spread more, occupying greater areas. Among the stars, the PEO-core stars were more compact while the PS-core stars spread more. The influence of architecture in terms of the core/corona polymers and branching were also examined. The effects of architecture were subtle, proving less important than PEO chain length or mass percentage.

AFM study of micelle chaining in surface films of polystyrene-block-poly(ethylene oxide) stars at the air/water interface.

A series of three-arm star block copolymers were examined using atomic force microscopy (AFM). These stars consisted of a polystyrene core composed of ca. 111 styrene units/branch with poly(ethylene oxide) (PEO) chains at the star periphery. Each star contained different amounts of PEO, varying from 107 to 415 ethylene oxide units/branch. The stars were spread as thin films at the air/water interface on a Langmuir trough and transferred onto mica at various surface pressures. Circular domains representing 2D micelle-like aggregated molecules were observed at low pressures. Upon further compression, these domains underwent additional aggregation in a systematic manner, including micellar chaining. At this point, domain area and the number of molecules/domain increased with increasing pressure. In addition, it was found that longer PEO chains led to greater intermolecular separation and less aggregation. These AFM results correspond to attributes seen in the surface pressure-area isotherms of the stars. In addition, they demonstrate the viability of AFM as a quantitative characterization technique.