Model-based optimization of infectivity parameters: a study of the early epidemic in San Francisco.

By combining dynamic modeling of human immunodeficiency virus (HIV) transmission with mathematical optimization techniques, we calculate values of epidemiological parameters characterizing the early epidemic (1978-1986) among homosexual and bisexual men in San Francisco. The seroconversion fraction data reported by the San Francisco hepatitis B vaccine trials cohort study for this period is accurately simulated by a model assuming varying infectivity among three stages of HIV infection (early antigen stage, HIV antibody-positive stage, and AIDS stage). Using optimization techniques, we generate curves of the annual number of new partners and the annual number of risk contacts as functions of time. We project future case rates using optimized parameter values, and we study the sensitivity of these projections to variations in parameters, including the population size and the incubation period.

Practice parameter: risk of driving and Alzheimer's disease (an evidence-based review): report of the quality standards subcommittee of the American Academy of Neurology.

Studies of automobile accident frequency among drivers with AD have yielded conflicting results about the risk of accidents. To develop a practice parameter regarding driving and AD the authors performed a systematic review of the literature. The authors identified well-designed, controlled studies of driving and AD using the National Library of Medicine's MEDLINE database. The authors also compared the relative rates of crashes and other performance measurements of driving ability in the populations studied. Driving was found to be mildly impaired in those drivers with probable AD at a severity of Clinical Dementia Rating (CDR) 0.5. This impairment was no greater than that tolerated in other segments of the driving population (e.g., drivers age 16 to 21 and those driving under the influence of alcohol at a blood alcohol concentration [BAC] < 0.08%). Drivers with AD at a severity of CDR 1 were found to pose a significant traffic safety problem both from crashes and from driving performance measurements.

Risk factors for development of proteinuria by type II (non-insulin dependent) diabetic patients.

1. Renal involvement in non-insulin dependent diabetes mellitus patients is the single most important cause of renal failure. The aim of this study was to evaluate the clinical features and to assess the risk factors for the development of proteinuria by non-insulin dependent diabetic patients. 2. Risk factors (expressed as an odds ratio) were calculated by multiple logistic regression analysis taking into account age, sex, body mass index, known duration of diabetes, presence of arterial hypertension, fasting plasma glucose, cholesterol and triglycerides as independent variables and proteinuria as the dependent variable. Sixty-four normoalbuminuric (24-h albumin excretion rate < 30 micrograms/min, 27 females, mean age 53.7 years) and 53 proteinuric (24-h proteinuria > 0.5 g, 31 females, mean age 59.3 years) were studied. 3. Proteinuric patients were older, with a longer mean known duration of diabetes (12.4 vs 5.6 years), higher mean fasting plasma glucose (214 vs 168 mg/dl) and plasma creatinine (1.5 vs 1.1 mg/dl) and more frequently presented diabetic retinopathy (94% vs 23%), peripheral neuropathy (94% vs 23%) and arterial hypertension (73% vs 16%) than normoalbuminuric patients. Age > 50 years, body mass index > 28.6 kg/m2, known duration of diabetes > 10 years, presence of arterial hypertension, and fasting plasma glucose > 160 mg/dl were significantly and independently associated with development of proteinuria.

Does concomitant use of paracetamol potentiate the gastroduodenal mucosal injury associated with aspirin? A prospective, randomised, pilot study.

BACKGROUND: Paracetamol is commonly prescribed for first-line symptomatic treatment in patients with osteoarthritis and aspirin is often co-administered for cardiovascular prophylaxis. It is not known if an interaction exists between aspirin and paracetamol in regards to gastroduodenal mucosal injury. AIM: To investigate whether or not co-administered aspirin with paracetamol results in an increased rate of endoscopic gastroduodenal mucosal injury as compared to either agent alone. METHODS: In this prospective, double-blind, randomised, three-arm, placebo- and active-controlled, parallel-group pilot study healthy adult subjects (18-75 years old) with a normal baseline trans-nasal oesophagogastroduodenoscopy (TN-EGD), received oral paracetamol 4000 mg q.d.s. (n = 21), aspirin 325 mg q.d.s. (n = 19) or paracetamol 4000 mg q.d.s. and aspirin 325 mg q.d.s. (n = 20). Upper gastrointestinal mucosal injury was evaluated after 7 days of treatment with TN-EGD. RESULTS: The rate of gastric ulcers in subjects receiving paracetamol (0/21, 0%) alone or aspirin (3/19, 16%) or both (2/20, 10%) was not different. There were, however, significantly more subjects with one or more lesions (erosion or ulcer) per subject in the paracetamol and aspirin (16/20, 80%) treated subjects as compared to the aspirin (8/19, 42%, P < 0.001) or the paracetamol (3/21, 14%, P < 0.01) exposed subjects. The mean number of lesions per subject was also greater (7.9 vs. 0.7, P < 0.01) in those treated with aspirin and paracetamol compared to paracetamol alone. CONCLUSIONS: Co-administration of paracetamol and aspirin was not associated with a significant difference in endoscopic ulcer rates compared to either drug alone. There was a strong signal for increased endoscopic erosions and ulcers in the combined group compared to either aspirin or paracetamol alone.

Actividad física y salud percibida en pacientes con enfermedad coronaria / Physical activity and perceived health in patients with coronary artery disease / Actividade física e saúde percebida em pacientes com doença coronaria

La enfermedad coronaria es una de las principales causas de morbilidad y mortalidad en el mundo y se asocia con importantes consecuencias emocionales y sociales. La actividad física parece ralentizar el inicio y la progresión de las enfermedades cardiovasculares pero también presenta beneficios sobre la salud psicosocial. El presente estudio tiene como objetivo el análisis de la relación entre la práctica de actividad física y la calidad de vida, el bienestar psicológico y la depresión en pacientes con enfermedad coronaria. La muestra estaba compuesta por 275 personas, con edades entre 54 a 98 años. Se aplicó un Cuestionario Sociodemográfico, el Cuestionario de Salud SF-36, la Escala de Depresión Geriátrica (GDS), la Escala de Bienestar Psicológico (EBP) y el Cuestionario de Actividad Física de Yale (YPAS). Los resultados obtenidos pusieron de manifiesto que la práctica de actividad física se asociaba en pacientes con enfermedad coronaria a una mejora en las distintas escalas del Cuestionario de Salud SF-36 y en la Escala de Depresión Geriátrica, confirmando su importancia para el mantenimiento de la calidad de vida relacionada con la salud en estos pacientes (AU)

Coronary artery disease is one of the main causes of morbidity and mortality in the world and associates with important emotional and social consequences. Physical activity seems to slow down the start and the progression of the cardiovascular illnesses but also presents benfits on psychosocial health. The present study is amied to analyze the relationship between the practice of physical activity and quality of life, psychological wellbeing and depression in patients with coronary illness. The sample was composed by 275 subjects, aged between 54 to 98 years. They were applied a Sociodemograpahic Questionnaire, the Questionnaire of Health SF-36,the Scale of Geriatric Depression (GDS), the Scale of Psychological Welbeing (EBP) and the Yale Physical Activity Scale (YPAS). Results obtained indicated that the practice of physical activity associated in patients with coronary illness to an improvement in the distinct scales of the Questionnaire of Health SF-36 and in the Scale of Geriatric Depression, confirming his importance for the maintenance of health-related quality of life in these patients (AU)

A doença coronaria é uma das principais causas de morbilidad e mortalidade no mundo e associa-se com importantes consequências emocionais e sociais. A actividade física parece reduzir o início e a progressão das doenças cardiovasculares mas também apresenta benefícios sobre a saúde psicosocial. O presente estudo tem como objectivo a análise da relação entre a prática de actividade física e a qualidade de vida, o bem-estar psicológico e a depressão numa mostra de pacientes com doença coronaria. A mostra estava composta por 275 pessoas, com idades entre 54 a 98 anos. Aplicou-se um Cuestionario Sociodemográfico, o Cuestionario de Saúde SF-36, a Escala de Depressão Geriátrica (GDS), a Escala de Bem-estar Psicológico (EBP) e o Cuestionario de Actividade Física de Yale (YPAS). Os resultados obtidos puseram de manifesto que a prática de actividade física se associava em pacientes com doença coronaria a uma melhora nas difrentes escalas do Cuestionario de Saúde SF-36 e na Escala de Depressão Geriátrica, confirmando sua importância para a manutenção da qualidade de vida relacionada com a saúde nestes pacientes (AU)

Variable visual habitats may influence the spread of colourful plumage across an avian hybrid zone.

Several studies have shown that hybridization can be a creative process by acting as a conduit for the spread of adaptive traits between species, but few provide the mechanism that favours this spread. In the hybrid zone between the golden- (Manacus vitellinus) and white-collared (Manacus candei) manakins, sexual selection drives the introgression of golden/yellow plumage into the white species; however, the mechanism for the yellow male's mating advantage and the reasons why yellow plumage has not swept further into the white species remain mostly speculative. We quantified the colour properties of male plumage, the background and the ambient light at the hybrid zone, and allopatric golden and white populations. As measured by the perceived difference in colour between plumage and background, we found that yellow plumage appears more conspicuous than white plumage in the hybrid zone and allopatric golden-collar habitats, whereas white plumage appears more conspicuous than yellow plumage in the allopatric white-collared habitat. These results suggest a mechanism for the unidirectional spread of yellow plumage across the hybrid zone but slowed movement beyond it.

Anterior cervical fusion using a modified tricortical bone graft: a radiographic analysis of outcome.

A technique was developed to resist graft extrusion by means of mechanical interlocking between graft and vertebrae. A 4-mm burr is used to create a transverse trough (mortise) across the posterior aspect of each endplate. A reversed tricortical graft is shaped to have a ridge (tenon) composed of cortical bone on the upper and lower surfaces of its posterior portion. The ridges lock into the troughs to form a double mortise and tenon joint. Of 117 discs (102 patients) treated, adequate radiographs were available of 106 discs (in 92 patients) of which 89% were fused at last follow-up. Radiographic analysis showed significant (p < 0.001) increases in disc height and extension immediately postoperatively and a return to the preoperative values by the time of fusion. This technique completely eliminated graft extrusion without any reduction in fusion rate compared with most other reported results with the standard tricortical technique.

Treatment of protracted bilateral mandibular dislocation with Proplast-Vitallium prostheses.

A case of bilateral protracted mandibular dislocation complicated by the presence of unusual degenerative changes in the temporomandibular joints is presented. A synopsis of treatment modalities that have been used previously to treat similar conditions is given. Our treatment consisted of bilateral condylectomies, eminectomies, and insertion of Proplast-coated Vitallium condylar prostheses. These procedures resulted in the re-establishment of normal TMJ anatomy, the maintenance of proper posterior mandibular vertical dimension, correction of malocclusion, and relief of the patient's symptoms.

Risk factors for development of proteinuria by type II (non-insulin dependent) diabetic patients

1. Renal involvement in non-insulin dependent diabetes mellitus patients is the single most important cause of renal failure. The aim of this study was to evaluate the clinical features and to assess the risk factors for the development of proteinuria by non-insulin dependent diabetic patients. 2. Risk factors (expressed as an odds ratio) were calculated by multiple logistic regression analysis taking into account age, sex, body mass index, known duration of diabetes, presence of arterial hypertension, fasting plasma glucose, cholesterol and triglycerides as independent variables and proteinuria as the dependent variable. Sixty-four normoalbuminuric (24-h albumin excretion rate < 30 micrograms/min, 27 females, mean age 53.7 years) and 53 proteinuric (24-h proteinuria > 0.5 g, 31 females, mean age 59.3 years) were studied. 3. Proteinuric patients were older, with a longer mean known duration of diabetes (12.4 vs 5.6 years), higher mean fasting plasma glucose (214 vs 168 mg/dl) and plasma creatinine (1.5 vs 1.1 mg/dl) and more frequently presented diabetic retinopathy (94 per cent vs 23 per cent ), peripheral neuropathy (94 per cent vs 23 per cent ) and arterial hypertension (73 per cent vs 16 per cent ) than normoalbuminuric patients. Age > 50 years, body mass index > 28.6 kg/m2, known duration of diabetes > 10 years, presence of arterial hypertension, and fasting plasma glucose > 160 mg/dl were significantly and independently associated with development of proteinuria