Faculty Bibliography

Questions have arisen about the implications of notifying drug abusers of their HIV serostatus. One major concern is that awareness of HIV infection would have a negative impact on abstinence from drug abuse. In order to ascertain the effects of serostatus notification, the authors reviewed the clinical records of 73 methadone patients who learned of their serostatus within 20 weeks after enrolling in the clinic and thereafter remained in treatment for at least 1 year. They found that, at serostatus notification, seropositive patients were more likely to be socially disadvantaged and were younger than the seronegatives at first opiate use. After serostatus notification, seropositives had more 'fair hearings' for noncompliance with program norms and used more cocaine. Although the patients notified of HIV infection may have more behavioral problems, further research is needed to determine whether or not this reflects antecedent behavior patterns and drug use

BACKGROUND: Measuring critical-appraisal skills is a key step in assessing physicians' abilities to engage in self-directed learning. The authors developed an instrument to evaluate the abilities of residents to critically appraise a journal article. METHOD: In 1991, 62 residents in the categorical internal medicine program at the New England Medical Center were asked to respond to a questionnaire, evaluate a sample article, and complete a self-assessment of competence in evaluation of research. Critical-appraisal skill was determined by calculating the resident's deviations from a "gold standard" critique developed through a modified Delphi technique, using a panel of five physicians. Spearman correlation coefficients were used to compare the residents' actual and self-perceived abilities. RESULTS: Twenty-eight residents returned the questionnaire, for a response rate of 45%. The composite score for the residents' objective assessments was 63% of the gold standard, and was not significantly correlated with post-graduate year, prior journal club experience, or self-assessed critical-appraisal skill. CONCLUSION: After further validation in other settings, the assessment instrument in this study may be used to objectively assess critical-reading skills. It may also provide feedback and measure outcomes for interventions designed to improve critical reading.

After decades of decline, tuberculosis has emerged as a global health challenge. In the setting of HIV immunocompromise, TB occurs frequently, early, and often atypically. New infections can take an accelerated course. The usual tests for diagnosing Mycobacterium tuberculosis infection are less sensitive when CD4+ counts are low. Increased prevalence of treatment failure, drug-resistant strains, and nosocomial transmission of multidrug-resistant TB are discussed as are new diagnostic tests that will accelerate the time to diagnosis and allow better epidemiologic tracking. Early recognition, isolation, appropriate therapy, and environmental controls that will protect staff and patients from the risk of exposure are also described

WASHINGTON - AIDS has become the leading cause of death among all Americans ages 25 to 44, according to federal data released Monday. AIDS surpassed unintentional injury, the government's category for accidents, which dropped to second place in this age group, said Dr. Harold Jaffe, a top AIDS official at the Federal Centers for Disease Control and Prevention in Atlanta. Cancer and heart disease were third and fourth, followed by homicides and suicides. 'The dramatic rise is due to the accumulating toll from AIDS and is almost certain to continue because AIDS deaths reflect infections from HIV, the AIDS virus, that were acquired several years earlier,' Jaffe said

AIDS has become the leading cause of death among all Americans aged 25 to 44, new federal data show. The data were reported at a scientific meeting here Monday. AIDS surpassed unintentional injury, the government's category for accidents, which dropped to second place in this age group, said Dr. Harold W. Jaffe, a top AIDS official at the federal Centers for Disease Control and Prevention in Atlanta. Cancer and heart disease were third and fourth, followed by homicides and suicides. 'AIDS was expected to rise to the top of the list eventually, but no one had predicted which year,' Jaffe said at a meeting on human retroviruses and related infections

AIDS has become the leading cause of death among all Americans aged 25 to 44, new federal data show

AIDS has become the leading cause of death among all Americans aged 25 to 44, new federal data show. The data were reported for the first time at a scientific meeting here Monday. The federal data on mortality showed AIDS surpassed unintentional injury, the government's category for accidents, which dropped to second place in this age group, said Dr. Harold W. Jaffe, a top AIDS official at the Federal Centers for Disease Control and Prevention in Atlanta. Cancer and heart disease were third and fourth, followed by homicides and suicides

Newton Butler is a 41-year-old resident of the San Francisco Bay area who has been infected with HIV, the AIDS virus, for 10 years, possibly even 15. In the early 1980s, after the disease was recognized but before the virus was discovered, it was regarded as inevitably fatal within a few years. Those who lived with HIV infection for several years were seen as long-term survivors. Now there is evidence that 5 percent to 10 percent of HIV-infected people live for 10 years, perhaps even 20 or more, without developing any AIDS-related symptoms or having any laboratory evidence of progression to AIDS, experts said. The study of such individuals is a quickly growing area of AIDS research, spurred in part by advocates for people with AIDS. Many researchers now distinguish between long-term survivors - those who develop AIDS and live for many years with a damaged immune system; and long-term 'non-progressors,' those who are infected with the virus for 10 years or more without progressing from infection to AIDS, while their immune system shows little or no evidence of damage

The expression of FGF3 has recently been detected in 55% of fresh Kaposi's sarcoma lesions, but not in uninvolved skin for the same donors. Nude mouse transplanted with NIH3T3 cells transformed by human FGF3 cDNA developed KS-like tumors. These data suggest that FGF3 may be involved in the pathogenesis of KS. The expression of a splice variant of the FGF receptor 2 (FGF-R-2) which has recently been identified as a specific receptor for FGF3, was also detected in KS tumors. The mRNA transcripts of FGF3 and FGF- R-2 were detected in fresh KS tumor biopsies by the RT-PCR method, and confirmed by Northern blot analysis. The expression of the FGF-R-2 receptor is also studied in the FGF3 transformed NIH3T3 cells in vitro and in the mouse- induced tumors

Many of the exaggerated claims seen these days are made in news releases and press conferences by public-relations officials who get carried away with enthusiasm. Sometimes scientists become willing partners with institution officials and say things in releases they wouldn't dream of saying in a scientific paper. Sometimes releases describe human- interest elements, which journals generally proscribe and which may capture the public's attention