Faculty Bibliography

David Landry, a senior research associate at the Alan Guttmacher Institute in New York, criticized the Heritage team's reliance on self-reports of sexually transmitted diseases. 'The underreporting problem is so severe that it makes that data highly questionable,' Landry said

The authors of the new studies, Dr. Robert Rector, a senior research fellow in policy studies at the foundation, and Dr. Kirk A. Johnson, a senior policy analyst there, said their findings contradicted those published in March in The Journal of Adolescent Health by Dr. Peter Bearman, the chairman of the sociology department at Columbia University, and Hannah Bruckner of Yale University. The earlier study found that a majority of teenagers who took the pledge did not live up to their promises and developed sexually transmitted diseases about the same rate as adolescents who had not made such pledges. It also found that the promise did tend to delay the start of intercourse by 18 months. Dr. Bearman said: ''Our analyses showed that pledgers are less likely to get tested for S.T.D.'s, be diagnosed as having an S.T.D. and to see a doctor because they are worried about having an S.T.D. Most S.T.D. infections are asymptomatic, and therefore, people don't know that they have an S.T.D. unless they get tested. The use of self-report data for S.T.D.'s is therefore extremely problematic.''

The agency said that about one-quarter of those with H.I.V. did not know they were infected because they had not been tested, limiting the number of H.I.V.-positive Americans whose lives might be extended by the use of newer and more effective drugs. C.D.C. officials said that some prevention programs were substantially reducing sexual risk behavior among people with H.I.V. and those at risk for the infection. Also, H.I.V. diagnoses have steadily declined among adolescent and young adult women in all ethnic groups. Leaders of the AIDS Foundation of Chicago, the Community H.I.V./AIDS Mobilization Project and other groups advocating for people with AIDS blamed the government for the increase, citing long-term underfinancing for efforts to prevent and treat H.I.V

CONTEXT: The traditional teaching that pulmonary tuberculosis characterized by lymphadenopathy, effusions, and lower or mid lung zone infiltrates on chest radiography represents 'primary' disease from recently acquired infection, whereas upper lobe infiltrates and cavities represent secondary or reactivation disease acquired in the more distant past, is not based on well-established clinical evidence. Furthermore, it is not known whether the atypical radiograph common in human immunodeficiency virus (HIV)-associated tuberculosis is due to a preponderance of primary progressive disease or altered immunity. OBJECTIVE: To analyze the relationship between recently acquired and remotely acquired pulmonary tuberculosis, clinical and demographic variables, and radiographic features by using molecular fingerprinting and conventional epidemiology. DESIGN, SETTING, AND POPULATION: A retrospective, hospital-based series of 456 patients treated at a New York City medical center between 1990 and 1999. Eligible patients had to have had at least 1 positive respiratory culture for Mycobacterium tuberculosis and available radiographic data. MAIN OUTCOME MEASURES: Radiographic appearance as measured by the presence or absence of 6 features: upper lobe infiltrate, cavitary lesion, adenopathy, effusions, lower or mid lung zone infiltrate, and miliary pattern. Radiographs were considered typical if they had an upper lobe infiltrate or cavity whether or not other features were present. Atypical radiographs were those that had adenopathy, effusion, or mid lower lung zone infiltrates or had none of the above features. RESULTS: Human immunodeficiency virus infection was most commonly associated with an atypical radiographic appearance on chest radiograph with an odds ratio of 0.20 (95% confidence interval, 0.13-0.31). Although a clustered fingerprint, representing recently acquired disease, was associated with typical radiograph in univariate analysis (odds ratio, 0.68; 95% confidence interval, 0.47-0.99), the association was lost when adjusted for HIV status. CONCLUSIONS: Time from acquisition of infection to development of clinical disease does not reliably predict the radiographic appearance of tuberculosis. Human immunodeficiency virus status, a probable surrogate for the integrity of the host immune response, is the only independent predictor of radiographic appearance. The altered radiographic appearance of pulmonary tuberculosis in HIV is due to altered immunity rather than recent acquisition of infection and progression to active disease

Dr. Peter Piot, who directs the United Nations AIDS program, said: ''The epidemic has yet to display a natural saturation point. In Swaziland, the country most affected by AIDS in the world, adult prevalence continues to climb; 42.6 percent of pregnant women there tested positive for H.I.V. in 2004. ''In East Africa, for example, in every big city'' there had been declines in the rates for young people, ''and particularly among women and girls,'' Dr. Piot said in an interview. He cited Addis Ababa, Kigali, Lusaka and Nairobi -- the capitals of Ethiopia, Rwanda, Zambia and Kenya -- largely because they are the places with the most extensive AIDS education and prevention programs, particularly for young people. For the first time, truly comprehensive responses to AIDS, including prevention and treatment, are emerging, Dr. Piot said. ''Iran has one of the best AIDS programs,'' he added, citing in particular its needle-exchange efforts

Surgeons can generally learn the on-pump operation faster than the off-pump technique because it is technically less demanding. Also, the report said, surgeons can generally perform more grafts, if necessary, in an on-pump bypass, and the grafts may stay open longer. A controversy has developed over some evidence that a small but significant number of on-pump bypass patients suffer a degree of cognitive impairment like memory and attention deficits and language problems. Such problems tended to occur less among patients whose bypasses were performed with the beating-heart technique compared with the stopped-heart technique, the team said. The extent of the decrease was not detailed. The most conclusive benefit of off-pump over on-pump operations was for patients who had deposits of calcium in their aortas, the body's main artery. When surgeons clamp the aorta in the on-pump technique, small pieces can break off to cause disabling and fatal strokes

The scientists analyzed the genetic makeup of patients taking warfarin in clinics at the University of Washington in Seattle and Washington University in St. Louis and found that they fell into three dosing groups -- low, intermediate and high. The genetic variations identified in the study correlated with the grouping, suggesting the findings hold promise for simplifying warfarin therapy, the scientists reported in The New England Journal of Medicine. The scientists identified genetic variations, matched them to the doses warfarin patients were taking, and found that patients with a particular variation of the gene usually took similar doses of warfarin. The VKORC1 gene accounted for 25 percent of the overall variation in warfarin doses in the studies -- what Dr. [Mark J. Rieder] said he believes is the largest genetic variation affecting warfarin

A novel series of selective ligands for the human glucocorticoid receptor is described. Structure-activity studies focused on variation of B-ring size, ketal ring size, and ketal substitution. These analogs were found to be potent and selective ligands for GR and have partial agonist profiles in functional assays for transactivation (TAT, GS) and transrepression (IL-6). Of these compounds, 27, 28, and 35 were evaluated further in a mouse LPS-induced TNF-alpha secretion model. Compound 28 had an ED(50) of 14.1 mg/kg compared with 0.5 mg/kg for prednisolone in the same assay.