Trends in negative emotions throughout the COVID-19 pandemic in the United States.

OBJECTIVES: This study aimed to identify trends in the prevalence of negative emotions in the United States throughout the COVID-19 pandemic between March 2020 and November 2021. STUDY DESIGN: This was a descriptive, repeated cross-sectional analysis of nationally representative survey data. METHODS: Data originated from Gallup's COVID-19 web survey, encompassing 156,684 observations. Prevalence estimates for self-reported prior-day experience of sadness, worry, stress, anger, loneliness, depression, and anxiety were computed, plotted using descriptive trend graphs, and compared with 2019 estimates from the Gallup World Poll. Differences between estimates were evaluated by inspecting confidence intervals. RESULTS: Stress and worry were the most commonly experienced negative emotions between March 2020 and November 2021; worry and anger were significantly more prevalent than prepandemic. The prevalence of sadness, worry, stress, and anger fluctuated considerably over time and declined steadily to prepandemic levels by mid-2021. Distinctive spikes in the prevalence of several negative emotions, especially sadness and anger, were observed following the murder of George Floyd. CONCLUSIONS: Several negative emotions exhibited excess prevalence during the pandemic, especially in spring/summer 2020. Despite recent reductions to prepandemic levels, continued monitoring is necessary to inform policies and interventions to promote population well-being.

Using online tools at the Bovine Genome Database to manually annotate genes in the new reference genome.

With the availability of a new highly contiguous Bos taurus reference genome assembly (ARS-UCD1.2), it is the opportune time to upgrade the bovine gene set by seeking input from researchers. Furthermore, advances in graphical genome annotation tools now make it possible for researchers to leverage sequence data generated with the latest technologies to collaboratively curate genes. For many years the Bovine Genome Database (BGD) has provided tools such as the Apollo genome annotation editor to support manual bovine gene curation. The goal of this paper is to explain the reasoning behind the decisions made in the manual gene curation process while providing examples using the existing BGD tools. We will describe the sources of gene annotation evidence provided at the BGD, including RNA-seq and Iso-Seq data. We will also explain how to interpret various data visualizations when curating gene models, and will demonstrate the value of manual gene annotation. The process described here can be applied to manual gene curation for other species with similar tools. With a better understanding of manual gene annotation, researchers will be encouraged to edit gene models and contribute to the enhancement of livestock gene sets.

Experimental verification of principal losses in a regulatory particulate matter emissions sampling system for aircraft turbine engines.

A sampling system for measuring emissions of nonvolatile particulate matter (nvPM) from aircraft gas turbine engines has been developed to replace the use of smoke number and is used for international regulatory purposes. This sampling system can be up to 35 m in length. The sampling system length in addition to the volatile particle remover (VPR) and other sampling system components lead to substantial particle losses, which are a function of the particle size distribution, ranging from 50 to 90% for particle number concentrations and 10-50% for particle mass concentrations. The particle size distribution is dependent on engine technology, operating point, and fuel composition. Any nvPM emissions measurement bias caused by the sampling system will lead to unrepresentative emissions measurements which limit the method as a universal metric. Hence, a method to estimate size dependent sampling system losses using the system parameters and the measured mass and number concentrations was also developed (SAE 2017; SAE 2019). An assessment of the particle losses in two principal components used in ARP6481 (SAE 2019) was conducted during the VAriable Response In Aircraft nvPM Testing (VARIAnT) 2 campaign. Measurements were made on the 25-meter sample line portion of the system using multiple, well characterized particle sizing instruments to obtain the penetration efficiencies. An agreement of ± 15% was obtained between the measured and the ARP6481 method penetrations for the 25-meter sample line portion of the system. Measurements of VPR penetration efficiency were also made to verify its performance for aviation nvPM number. The research also demonstrated the difficulty of making system loss measurements and substantiates the E-31 decision to predict rather than measure system losses.

Aminooxyacetic acid: interactions with gamma-aminobutyric acid and the blood-brain barrier.

The hypothesis that the administration of aminooxyacetic acid, a competitive inhibitor of aminobutyrate aminotransferase, might allow gamma-aminobutyric acid to cross the blood-brain barrier was tested by analyzing the brains of rats for this compound after intraperitoneal injection of aminooxyacetic acid, or a mixture of both acids, and by observing behavioral and physiological changes in cats after similar drug administrations. The results do not support the postulate that gamma-aminobutyric acid enters the brain more readily after administration of aminooxyacetic acid.

Antioxidant supplementation during illness in dogs: effect on oxidative stress and outcome, an exploratory study.

OBJECTIVES: To assess whether combination antioxidant supplementation for 30 days in systemically ill dogs alters antioxidant status, degree of lipid peroxidation, clinical score and survival. MATERIALS AND METHODS: Forty client-owned systemically-ill hospitalised dogs were eligible for inclusion. Dogs were randomised to no supplementation (NS; n=19) or supplementation with N-acetylcysteine/S-adenosylmethionine/silybin and vitamin E (AS; n=20) for 30 days. Clinical score and oxidative biomarkers including glutathione, cysteine, vitamin E, selenium and urine isoprostanes/creatinine (F2 -IsoPs/Cr) were determined on days 0 and 30. Glutathione, cysteine, vitamin E and urine F2 -IsoPs/Cr were quantified by high-performance liquid chromatography, and selenium concentrations determined using atomic absorption spectroscopy. RESULTS: Thirty-two dogs completed the study (NS, n=16; AS, n=16). Vitamin E concentrations were significantly greater in the supplemented compared to the non-supplemented group. No other markers of oxidative stress significantly changed with supplementation. There was no difference in Day 30 clinical scores or survival between the two groups. CLINICAL SIGNIFICANCE: In this population of systemically-ill hospitalised dogs, combination antioxidant supplementation did not alter redox state or clinical outcome.

Atomic/molecular layer deposition of Cu-organic thin films.

The gas-phase atomic/molecular layer deposition (ALD/MLD) technique is strongly emerging as a viable approach to fabricate new exciting inorganic-organic hybrid thin-film materials. However, much less effort has been made to develop new precursors specifically intended for ALD/MLD; this applies to both the organic and inorganic precursors, and in the latter case in particular to transition metal precursors. Here we introduce copper bisdimethylaminopropoxide (Cu(dmap)2) as a promising transition metal precursor for ALD/MLD to be combined with a variety of organic precursors with different backbones and functional groups, i.e. hydroquinone (HQ), terephthalic acid (TPA), 4,4'-oxydianiline (ODA), p-phenylenediamine (PPDA) and 1,4-benzenedithiol (BDT). Hybrid Cu-organic thin films were obtained from all five organic precursors with appreciably high growth rates ranging from 1.0 to 2.6 Å per cycle. However, the Cu(dmap)2 + HQ process was found to yield hybrid Cu-organic films only at temperatures below 120 °C, while at higher temperatures metallic Cu films were obtained. The films were characterized by XRR, GIXRD, FTIR, Raman, XPS and UV-Vis spectroscopy.

Pheromone response elements are necessary and sufficient for basal and pheromone-induced transcription of the FUS1 gene of Saccharomyces cerevisiae.

The FUS1 gene of Saccharomyces cerevisiae is transcribed in a and alpha cells, not in a/alpha diploids, and its transcription increases dramatically when haploid cells are exposed to the appropriate mating pheromone. In addition, FUS1 transcription is absolutely dependent on STE4, STE5, STE7, STE11, and STE12, genes thought to encode components of the pheromone response pathway. We now have determined that the pheromone response element (PRE), which occurs in four copies within the FUS1 upstream region, functions as the FUS1 upstream activation sequence (UAS) and is responsible for all known aspects of FUS1 regulation. In particular, deletion of 55 bp that includes the PREs abolished all transcription, and a 139-bp fragment that includes the PREs conferred FUS1-like expression to a CYC1-lacZ reporter gene. Moreover, three or four copies of a synthetic PRE closely mimicked the activity conferred by the 139-bp fragment, and even a single copy of PRE conferred a trace of activity that was haploid specific and pheromone inducible. In the FUS1 promoter context, four copies of the synthetic PRE inserted at the site of the 55-bp deletion restored full FUS1 transcription. Sequences upstream and downstream from the PRE cluster were important for maximal PRE-directed expression but, by themselves, did not have UAS activity. Other yeast genes with PREs, e.g., STE2 and BAR1, are more modestly inducible and have additional UAS elements contributing to the overall activity. In the FUS1 promoter, the PREs apparently act alone to confer activity that is highly stimulated by pheromone.

Identification of a DNA segment that is necessary and sufficient for alpha-specific gene control in Saccharomyces cerevisiae: implications for regulation of alpha-specific and a-specific genes.

STE3 mRNA is present only in Saccharomyces cerevisiae alpha cells, not in a or a/alpha cells, and the transcript level increases about fivefold when cells are treated with a-factor mating pheromone. Deletions in the 5' noncoding region of STE3 defined a 43-base-pair (bp) upstream activation sequence (UAS) that can impart both modes of regulation to a CYC1-lacZ fusion when substituted for the native CYC1 UAS. UAS activity required the alpha 1 product of MAT alpha, which is known to be required for transcription of alpha-specific genes. A chromosomal deletion that removed only 14 bp of the STE3 UAS reduced STE3 transcript levels 50- to 100-fold, indicating that the UAS is essential for expression. The STE3 UAS shares a 26-bp homology with the 5' noncoding sequences of the only other known alpha-specific genes, MF alpha 1 and MF alpha 2. We view the homology as having two components--a nearly palindromic 16-bp "P box" and an adjacent 10-bp "Q box." A synthetic STE3 P box was inactive as a UAS; a perfect palindrome P box was active in all three cell types. We propose that the P box is the binding site for a transcription activator, but that alpha 1 acting via the Q box is required for this activator to bind to the imperfect P boxes of alpha-specific genes. Versions of the P box are also found upstream of a-specific genes, within the binding sites of the repressor alpha 2 encoded by MAT alpha. Thus, the products of MAT alpha may render gene expression alpha or a-specific by controlling access of the same transcription activator to its binding site, the P box.

Transcription of alpha-specific genes in Saccharomyces cerevisiae: DNA sequence requirements for activity of the coregulator alpha 1.

Transcription activation of alpha-specific genes in Saccharomyces cerevisiae is regulated by two proteins, MCM1 and alpha 1, which bind to DNA sequences, called P'Q elements, found upstream of alpha-specific genes. Neither MCM1 nor alpha 1 alone binds efficiently to P'Q elements. Together, however, they bind cooperatively in a manner that requires both the P' sequence, which is a weak binding site for MCM1, and the Q sequence, which has been postulated to be the binding site for alpha 1. We analyzed a collection of point mutations in the P'Q element of the STE3 gene to determine the importance of individual base pairs for alpha-specific gene transcription. Within the 10-bp conserved Q sequence, mutations at only three positions strongly affected transcription activation in vivo. These same mutations did not affect the weak binding to P'Q displayed by MCM1 alone. In vitro DNA binding assays showed a direct correlation between the ability of the mutant sequences to form ternary P'Q-MCM1-alpha 1 complexes and the degree to which transcription was activated in vivo. Thus, the ability of alpha 1 and MCM1 to bind cooperatively to P'Q elements is critical for activation of alpha-specific genes. In all natural alpha-specific genes the Q sequence is adjacent to the degenerate side of P'. To test the significance of this geometry, we created several novel juxtapositions of P, P', and Q sequences. When the Q sequence was opposite the degenerate side, the composite QP' element was inactive as a promoter element in vivo and unable to form stable ternary QP'-MCM1-alpha 1 complexes in vitro. We also found that addition of a Q sequence to a strong MCM1 binding site allows the addition of alpha 1 to the complex. This finding, together with the observation that Q-element point mutations affected ternary complex formation but not the weak binding of MCM1 alone, supports the idea that the Q sequence serves as a binding site for alpha 1.

Atomic layer deposition of nickel-cobalt spinel thin films.

We report the atomic layer deposition (ALD) of high-quality crystalline thin films of the spinel-oxide system (Co1-xNix)3O4. These spinel oxides are ferrimagnetic p-type semiconductors, and promising material candidates for several applications ranging from photovoltaics and spintronics to thermoelectrics. The spinel phase is obtained for Ni contents exceeding the x = 0.33 limit for bulk samples. It is observed that the electrical resistivity decreases continuously with x while the magnetic moment increases up to x = 0.5. This is in contrast to bulk samples where a decrease of resistivity is not observed for x > 0.33 due to the formation of a rock-salt phase. From UV-VIS-NIR absorption measurements, a change from distinct absorption edges for the parent oxide Co3O4 to a continuous absorption band ranging deep into the near infrared for 0 < x ≤ 0.5 was observed. The conformal deposition of dense films on high-aspect-ratio patterns is demonstrated.

Chronic Administration of Anacetrapib Is Associated With Accumulation in Adipose and Slow Elimination.

Anacetrapib is a novel cholesteryl-ester transfer protein (CETP) inhibitor in late-stage clinical development, shown in preceding clinical trials to have residual pharmacological activity after prolonged washout after chronic dosing. Preclinical findings suggest that white adipose tissue is a potential depot and that accumulation into adipose tissue governs the long-term kinetics of anacetrapib in mice. A phase I study performed to test this hypothesis in humans revealed that plasma exposure was correlated with fat content in food administered with the drug. Plasma concentrations of anacetrapib seemed to reach plateau faster than adipose concentrations. Anacetrapib continued to accumulate in adipose during the treatment period despite apparent plateau in plasma with only minimal decline in adipose levels up to 1 year postdose. Because of its high lipophilicity, anacetrapib partitions into adipose tissue, this likely forms a drug reservoir that, in turn, contributes to the long residence time of the drug in plasma.

Calcineurin in human heart hypertrophy.

BACKGROUND: In animal models, increased signaling through the calcineurin pathway has been shown to be sufficient for the development of cardiac hypertrophy. Calcineurin activity has been reported to be elevated in the myocardium of patients with congestive heart failure. In contrast, few data are available about calcineurin activity in patients with pressure overload or cardiomyopathic hypertrophy who are not in cardiac failure. METHODS AND RESULTS: We investigated calcineurin activity and protein expression in 2 different forms of cardiac hypertrophy: hypertrophic obstructive cardiomyopathy (HOCM) and aortic stenosis (AS). We found that the C-terminus of calcineurin A protein containing the autoinhibitory domain was less abundant in myocardial hypertrophy than in normal heart, which suggests the possibility of proteolysis. No new splice variants could be detected by reverse-transcription polymerase chain reaction. This resulted in a significant elevation of calcineurin enzymatic activity in HOCM and AS compared with 6 normal hearts. Increased calcineurin phosphatase activity caused increased migration of NF-AT2 (nuclear factor of activated T cells 2) in SDS-PAGE compatible with pronounced NF-AT dephosphorylation in hypertrophied myocardial tissue. CONCLUSIONS: Hypertrophy in HOCM and AS without heart failure is characterized by a significant increase in calcineurin activity. This might occur by (partial) proteolysis of the calcineurin A C-terminus containing the autoinhibitory domain. Increased calcineurin activity has functional relevance, as shown by altered NF-AT phosphorylation state. Although hypertrophy in AS and HOCM may be initiated by different upstream triggers (internal versus external fiber overload), in both cases, there is activation of calcineurin, which suggests an involvement of this pathway in the pathogenesis of human cardiac hypertrophy.

Induction of the yeast alpha-specific STE3 gene by the peptide pheromone a-factor.

The yeast Saccharomyces cerevisiae exhibits two mating types, a and alpha. Efficient mating of a and alpha cells requires the action of peptide pheromones secreted by each cell type. For example, a cells secrete a-factor, which alters the physiology of alpha cells, thereby preparing those cells for mating. To investigate the mechanism by which the pheromones act on the target cells, we have examined the effect of a-factor on expression of the STE3 gene, a gene which is required for mating by alpha cells and which is expressed only in alpha cells. We have monitored STE3 expression by two assays: RNA production from the chromosomal STE3 locus and beta-galactosidase activity produced from a plasmid-borne STE3-lacZ gene fusion. By both assays we show that a-factor induces a rapid increase in STE3 expression. Induction of STE3 RNA occurs even if protein synthesis is blocked by cycloheximide. Using temperature-sensitive cell division cycle mutants, we have also shown that induction occurs in cells arrested at several discrete positions in the cell cycle. These results demonstrate (1) that induction of STE3 expression by a-factor is a primary response to the pheromone, and (2) that alpha cells are capable of responding to a-factor regardless of their position in the cell cycle.

Expression of insulin-like growth factor-binding protein-2 and -3 messenger ribonucleic acid in the porcine ovary: localization and physiological changes.

Insulin-like growth factor-binding protein (IGFBP)-2 and -3 are the most prevalent IGFBPs in porcine follicular fluid, as determined on ligand blots, but little is known about the localization and regulation of their synthesis in vivo. This study was designed to investigate the localization and cyclic regulation of the mRNA for these two IGFBPs in the porcine ovary, RNA was extracted from whole ovaries morphologically classified as immature, preovulatory, and luteal. Northern hybridization analysis of this RNA showed no significant difference in the expression of IGFBP-2 mRNA in these ovaries (OD for preovulatory, luteal, and immature ovaries, 0.076 +/- 0.01, 0.071 +/- 0.01, and 0.10 +/- 0.008/micrograms RNA, respectively). IGFBP-3 mRNA was not different in immature and preovulatory ovaries, but was 10-fold greater (P less than 0.025) in luteal ovaries. Northern analysis of RNA extracted from ovaries also showed no significant change in IGFBP-2 mRNA on days (d) 11, 16, and 21 of the estrous cycle. IGFBP-3 mRNA tended to decrease between d11-16 with the onset of luteal regression and was significantly decreased in d21 preovulatory ovaries to 22% of the values in d11 ovaries. Granulosa, thecal, and luteal cells were also analyzed for IGFBP mRNA. IGFBP-2 mRNA was most abundant in granulosa cells, lower in thecal cells, and lowest in luteal cells. No IGFBP-3 mRNA could be detected in granulosa cells, and luteal cells expressed 15- to 63-fold greater levels than thecal cells. These results show that IGFBP-2 and -3 mRNAs are expressed in specific ovarian cell types and that their expression appears to be independently regulated during the reproductive cycle. This provides further evidence for the importance of these proteins as paracrine/autocrine regulators of ovarian function.

Systematic analysis of the regulatory and essential myosin light chain genes: genetic variants and mutations in hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) can be caused by mutations in genes encoding for the ventricular myosin essential and regulatory light chains. In contrast to other HCM disease genes, only a few studies describing disease-associated mutations in the myosin light chain genes have been published. Therefore, we aimed to conduct a systematic screening for mutations in the ventricular myosin light chain genes in a group of clinically well-characterised HCM patients. Further, we assessed whether the detected mutations are associated with malignant or benign phenotype in the respective families. We analysed 186 unrelated individuals with HCM for the human ventricular myosin regulatory (MYL2) and essential light chain genes (MYL3) using polymerase chain reaction, single strand conformation polymorphism analysis and automated sequencing. We found eight single nucleotide polymorphisms in exonic and adjacent intronic regions of MYL2 and MYL3. Two MYL2 missense mutations were identified in two Caucasian families while no mutation was found in MYL3. The mutation Glu22Lys was associated with moderate septal hypertrophy, a late onset of clinical manifestation, and benign disease course and prognosis. The mutation Arg58Gln showed also moderate septal hypertrophy, but, in contrast, it was associated with an early onset of clinical manifestation and premature sudden cardiac death. In conclusion, myosin light chain mutations are a very rare cause of HCM responsible for about 1% of cases. Mutations in MYL2 could be associated with both benign and malignant HCM phenotype.

Infectious waste surveys in a Saudi Arabian hospital: an important quality improvement tool.

OBJECTIVES: To analyze the composition by weight of the infectious waste stream, better segregate waste, reduce disposal costs, reduce the load on the hospital incinerator, identify inappropriate items having significant cost or safety implications, and provide a safer work environment for housekeepers. METHODS: Four infectious waste surveys were conducted between 1991 and 1999 that involved opening a total of 7364 bags of infectious waste. The contents of each infectious waste bag were separated into 20 different components and weighed. Inappropriately discarded items were removed and tagged with the date and hospital unit of origin. SETTING: Dhahran Health Center, a 410-bed hospital operated by the Saudi Arabian Oil Company (Saudi Aramco) in Dhahran, Saudi Arabia. RESULTS: The surveys show a continuing trend in a higher percentage of plastics and a decrease in paper due to increased use of disposables. Much of the infectious waste consisted of plastic intravenous bottles, intravenous lines, and paper wrappers for sterile instrument sets that were not infectious. Dhahran Health Center was producing a total of 1163 kg of infectious waste per day before the first survey. This was reduced to 407 kg per day after implementation of a waste segregation program in 1991 (a reduction of 65%). Incineration operation was reduced from daily to 3 days per week, with a corresponding reduction in incinerator emissions. Infectious waste from inpatient, surgical, and obstetric areas was reduced by a total of 70% between 1991 and 1999, from 2.8 kg (6.1 lb) to 0.85 kg (1.9 lb) per patient per day. This is in the range of 2 to 4 lb per patient per day that is generally reported. Numerous inappropriately discarded items were discovered during the surveys with cost or safety implications. Each survey, including the latest one of November-December 1999, has shown that further improvements are possible in the hospital's waste management program. Specific educational efforts and changes in procedures are described. CONCLUSIONS: We believe this is the first report of such an extensive analysis of a hospital's infectious waste. Many hospitals do not have the resources to conduct such detailed surveys of their waste streams. However, regardless of the method of treatment and disposal, such surveys are valuable quality improvement tools because all health care facilities want to reduce disposal costs, identify high-value items mistakenly discarded, and improve safety.

Maternal febrile morbidity associated with fetal monitoring and cesarean section.

The maternal febrile morbidity for 793 patients undergoing cesarean section was analyzed. The influence of length of labor, duration of ruptured membranes, and fetal heart rate monitoring was studied in both clinic and private patients. Morbidity among private patients was found to be consistently higher in monitored patients with comparable lengths of labor and durations of membrane rupture. The number of vaginal examinations, duration of monitoring, or number of fetal scalp electrode applications did not effect morbidity outcome.

Can progression of valvar aortic stenosis be predicted accurately?

BACKGROUND: It was the aim of the present study to elaborate criteria for the assessment of rapid hemodynamic progression of valvar aortic stenosis. These criteria are of special importance when cardiac surgery is indicated for other reasons but the established criteria for aortic valve replacement are not yet fulfilled. Such aspects of therapeutic planing were mostly disregarded in the past so that patients had to undergo cardiac reoperation within a few years. METHODS: Hemodynamic, echocardiographic, and clinical data of 169 men and 88 women with aortic stenosis, aged 55.2 +/- 15.7 years at their first and 63.4 +/- 15.6 years at their second cardiac catheterization, were analyzed. RESULTS: The progression rate of aortic valve obstruction was found to be dependent on the degree of valvar calcification ([VC] scoring 0 to III) and to be exponentially correlated with the aortic valve opening area (AVA) at initial catheterization. Neither age nor sex of the patient nor etiology of the valvar obstruction significantly influence the progression of aortic stenosis. If AVA decreases below 0.75 cm(2) with a present degree of VC = 0, or AVA of 0.8 with VC of I, AVA of 0.9 with VC of II, or AVA of 1.0 with VC of III, it is probable that aortic stenosis will have to be operated upon in the following years. CONCLUSIONS: The present data indicate that for clinical purposes and planning of valvar surgery the progression of asymptomatic aortic stenosis can be sufficiently predicted by the present aortic valve opening area and the degree of valvar calcification.

Potential risk factors for the transition to injecting among non-injecting heroin users: a comparison of former injectors and never injectors.

AIMS: To compare potential risk factors for the transition to injecting among non-injecting heroin users (NIUs) with different injecting histories. DESIGN: Cross-sectional data from baseline structured interviews with NIUs in a study on transitions to injecting. Sample recruited by outreach or chain-referral in New York City (NYC), 1996-1998. SETTING: Recruitment of sample and interviews conducted in a NYC neighborhood where many drug users reside and/or use drugs. PARTICIPANTS: Of 575 NIUs, 67% had never injected; 16% had injected one to nine times (infrequent former injectors (IFI)); and 18% 10 or more times (frequent former injectors (FFI)). MEASUREMENTS: Controlling for age and race/ethnicity, adjusted odds ratios were estimated in multivariate logistic regression, and differences in means tested by ANCOVA. FINDINGS: FFI (compared to never injectors and IFI) were more likely: to be homeless; to be unemployed; to be long-time users; to be younger at first heroin use; to not have initiated heroin use through non-injected routes; to not be afraid of injecting themselves with needles; to sniff heroin with former IDUs; and, for both men and women separately, to have sex partners who were former IDUs. Both FFI and IFI were twice as likely as never injectors to perceive that their friends thought that it was "OK" to inject drugs. CONCLUSIONS: FFI have multiple individual and network characteristics that may increase their risk of injecting drugs. Interventions among NIUs to prevent transitions to injecting need to ascertain NIUs' injecting history and address the many potential risks that FFI have for resuming injecting drug use.

Laparoscopic sterilization in a free-standing clinic: a report of 1,092 cases.

The five-year experience of 1,092 laparoscopic tubal sterilizations performed in a free-standing clinic in the U.S. with no anesthesiologist under local anesthesia is reviewed. The current technique of the Hasson "open" method and bipolar cauterization is felt to minimize major mishaps and is acceptably comfortable to the patient.

PIP: The experience of performing a conseceutive series of 1092 tubal sterilizations, using a local anesthesia, at a free standing outpatient clinic in the US between 1976-81 is reported. The clinic's experience demonstrated that low cost sterilizations could be performed safely in a facility lacking a general anesthesiologist, a blood bank, and a laporatomy set-up. Initially, unipolar forceps and closed laporscope tocar insertion was used, but in 1977 clinic personnel began using Kleppinger bipolar forceps to reduce the risk of ectopic burns and Hasson's open laparoscopy method to reduce the risk of extraperitoneal gas insufflation and vascular injury. Patient were initially screened over the telephone for cardiopulmonary disorders and other contraindications. 72 hours before the operation, they were counseled and informed of the risks. Preliminary laboratory examinations included blood counts, urinalyses, Papanicolaou smears, and gonorrhea cultures. In performing the sterilizations the local anesthestic, Xylocaine, was used. Surgical procedures included 1) administering a tranquilizing agent and an analgesic intravenously, 2) performing a paracervical block using a local anesthestic; 3) achieving uterine elevation; 4) infiltrating the subumbilical layers of the anterior abdominal wall with local anesthestic; 5) making a 1.5 cm incision; 6) inserting a 10 mm operating laparoscope; 6) creating pneumoperitoneum with nitrous oxide; 7) spraying and infiltrating the isthmic portion of the fallopian tubes with the local anesthestic; 8) cauterizing the tubes at 3 sites; and 9) releasing the pneumoperitoneum and closing up. Operating time is 15 minutes. The patient is observed for an hour and then discharged. The 1092 patient treated at the clinic had a median age of 31.7, a mean gravidity of 2.9, and a mean parity of 2.0. 17% had never delivered, 12.1% had never married, and 36% used no previous method of contraception. At the time of sterilization, 87 of the patients had IUDs removed, and 100 had abortions performed. Between 1976-81, complications associated with the sterilizations included 1) 2 cases of pelvic infection; 2) 7 cases of abdominal pain; 3) 6 cases each of incision bleeding, incision hematoma, and dysmenorrhea; and 4) 1 case each of vaginocervical laceration, vaginal bleeding, and paralytic ileus. 4 pregnancies were reported following sterilization, and 2 of these were ectopic pregnancies. 3 of the pregnancies occurred during the 1st 2 years of clinic operation, and only 1 during the last 3 years.