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Biomedical subjects

A B Williams

Publications and source records attributed to A B Williams.

At least 55 records · Page 3Linked to original sources
PubMed1992

Women and the AIDS epidemic: no longer hidden.

1. Women acquire HIV infection along one of three routes: parenteral, sexual, or vertical (perinatal). The HIV/AIDS epidemic among women in the US is growing primarily through parenteral and heterosexual exposures, which are tightly linked to social issues of substance abuse. 2. The majority of AIDS clinical trial participants have been white men. Differences in male and female physiology, hormonal influences on drug pharmacokinetics, and the social context of disease may render protocols ineffective or even harmful for women. 3. To respond effectively to the AIDS epidemic among women in the US, major public health issues, such as access to care, availability of family planning and drug treatment services, and racial discrimination, must be addressed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Women at risk: an AIDS educational needs assessment.

In order to acquire the information nurses need to develop education and support programs for women at risk for Acquired Immunodeficiency Syndrome (AIDS), a qualitative needs assessment of women at risk was conducted. Interviews were conducted with 21 women who were at risk for AIDS through their own injection drug use or as the heterosexual partners of injection drug users. Results were analyzed using the variables of the Health Belief Model, including the concept of self-efficacy. The perception of AIDS as a serious and a personal health threat motivated these women to practice both "safe sex" and "safe drug use." However, they did not always believe that recommended health behaviors would be effective; and they noted significant costs associated with these behaviors. In addition, the impact of AIDS was seen to be a heightening of the isolation and mistrust which were characteristic of the injection drug using community before the epidemic. AIDS programs for women at risk should facilitate discussion of social and community issues and should emphasize hope rather than fear.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A new algorithm for use in computer identification.

On 9 May 1987, a Soviet-made IL-62M Polish airliner, LOT Flight 5055, crashed, exploded, and burned, killing the crew and 183 passengers. A forensic science team from the Armed Forces Institute of Pathology, comprised of 6 dental officers, 3 forensic pathologists, and 3 medical photographers, worked in concert with the Polish forensic science team. The small number of antemortem records and the extreme fragmentation of the remains presented a new scenario for computer use. Typically, the Computer-Assisted Postmortem Identification (CAPMI) software is used to compare remains against an antemortem database. Results are listed by the number of tooth-to-tooth matches based on restorative or other characteristics or both. The Polish disaster confounded this approach to some degree, however, and suggested a reconsideration of the theory on which the sort is made, that is, that the cases with maximum number of matches to preexisting dental records would be the most likely identification (ID) match. A hypothesis was constructed that, if searches were accomplished for fragments with a minimum number of mismatches, the correct matches would appear higher in the rank order. Six antemortem records (that had all dental information) were sorted against one hundred and twelve postmortem fragmented records. The resulting report was reordered so that records were listed by minimum number of mismatches. There was significant improvement in rank placement for all of the records. Thus it was accepted that in the situation of highly fragmented remains a different sorting based on the number of mismatches is indicated. Programming changes to make this option available have been implemented in the new version of CAPMI.

Accidents, Aviation↗
PubMed1989

Direct surgical treatment of atrioventricular node reentrant tachycardia.

Atrioventricular node reentry tachycardia is a common type of supraventricular tachycardia. Rarely is it incapacitating and refractory to drug therapy, but when it is, the only option in therapy until recently has been atrioventricular node ablation or antitachycardia pacemaker insertion. The purpose of this paper is to review the case histories of four patients in whom we have surgically abolished atrioventricular node reentrant tachycardia while intentionally preserving atrioventricular node conduction. All four patients had atrioventricular node reentrant tachycardia confirmed by electrophysiologic study as diagnosed by established criteria. One patient had a left posterior atrioventricular accessory pathway, in addition to atrioventricular node reentrant tachycardia. All patients underwent intraoperative epicardial and endocardial mapping. Direct surgical dissection of the atrioventricular node node was performed in all four patients during normothermic cardiopulmonary bypass. Early and late postoperative electrophysiologic studies were used to evaluate the success of the surgical dissection. None of the patients had any evidence of dual atrioventricular node pathways or spontaneous or inducible atrioventricular node reentrant tachycardia postoperatively. At last follow-up (15 weeks to 21 months postoperatively), all patients were free from arrhythmias and cardiac medications, all were in normal sinus rhythm, and all had a subjectively improved life-style. This technique of direct surgical dissection of the atrioventricular node during normothermic cardiopulmonary bypass has allowed for complete cure of atrioventricular node reentrant tachycardia, while maintaining normal atrioventricular node function in these four patients.

Adult↗
PubMed1989

Race/ethnicity as a risk factor for HIV-1 infection among Connecticut intravenous drug users.

This cross-sectional study of 341 entrants to drug abuse treatment in four Connecticut cities in 1986-1987 evaluated whether demographic, behavioral, viral serologic, or economic differences explained the disproportionate risk of human immunodeficiency virus type 1 (HIV-1) infection among black and Hispanic intravenous drug users (IVDUs), relative to non-Hispanic white IVDUs. Blacks [odds ratio (OR) = 9.0, 95% confidence interval (CI) = 5.1-15.9] and Hispanics (OR = 4.1, 95% CI = 1.9-8.8) were at increased risk of HIV-1 infection, relative to non-Hispanic whites. Those who lived closer to New York City, injected drugs more frequently, used intravenous drugs for a longer duration, used shooting galleries, had greater numbers of sexual partners, had human cytomegalovirus (CMV) or hepatitis B virus (HBV) antibodies, and had the lowest annual incomes were also at increased risk. However, none of these other factors accounted for the black and Hispanic HIV-1 risk in stratified analysis. Black race, Hispanic ethnicity, proximity to New York City, and number of drug injections in the past year each also remained significant, independent risk factors in a multivariate analysis. The increased HIV-1 risk of nonwhite IVDUs remained unexplained. Behavioral, sociologic, and/or biologic factors not identified in this study may modulate HIV-1 transmission dynamics in IVDUs.

Acquired Immunodeficiency Syndrome↗
PubMed1988

A comparison of oxygen therapy devices used in the postoperative recovery period.

Seventy-one patients scheduled to undergo upper or lower abdominal surgical procedures were allocated at random to one of seven treatment groups: in the recovery room they were to receive oxygen via a 40% Ventimask with 10 litres/minute oxygen flow, or via either a Hudson mask or a nasal cannula with 3, 6 or 9 litres/minute oxygen flow. The 40% Ventimask gave the most consistent, satisfactory postoperative values of PaO2 but the much cheaper nasal cannula at 6 or 9 litres/minute was generally adequate in conscious patients. The performance of the intermediately priced Hudson mask was similar to that of the nasal cannula at these flows. The unconscious state was associated with a 45% lower PaO2 than the rousable or awake states. Differences between the treatments with regard to postoperative PaCO2 were small and non-significant. The nasal cannula with 6 litres/minute humidified oxygen flow is recommended for routine treatment, and the Ventimask for unconscious patients.

Abdomen↗
PubMed1988

The control of post-thoracotomy pain. A comparative evaluation of thoracic epidural fentanyl infusions and cryo-analgesia.

This is a comparative study of two methods to relieve postoperative thoracotomy pain. Continuous thoracic epidural infusion of fentanyl produced superior analgesia when compared with cryo-analgesia of the relevant thoracic nerves. Linear analogue pain scores were consistently lower in the epidural group reaching significance (p less than 0.05) at 32 and 40 hours after operation. All 36 patients in the cryo-analgesia group required additional analgesia, while 12 out of the 32 patients in the epidural group did not. This difference was significant at p less than 0.001. Respiratory and cardiovascular measurements were similar in both groups and the only side effect attributable to the epidural fentanyl was itching but this was not a problem.

Analgesia↗
PubMed1986

Public health implications of HIV infection.

Acquired immunodeficiency syndrome is the most extreme of a range of immune abnormalities that have been linked to infection with a recently described retrovirus. From a public health viewpoint, the most important advance to date has been the development of serum tests that detect exposure to this virus. Serologic screening has greatly reduced the risk of infection for transfusion recipients and facilitated surveillance studies and research. False negative tests clearly occur, and prognostic implications of positive antibody tests are not yet well-described. Primary care providers have a major role to play in public education for prevention of this new and frightening epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Blood glucose homeostasis in rats with a deficiency of liver phosphorylase kinase.

The glycogen storage disorder (gsd/gsd) rat has little or no phosphorylase kinase activity in the liver and is unable to break down liver glycogen on fasting. Nevertheless, gsd/gsd rats do not become hypoglycaemic on fasting. Gsd/gsd rats showed a decreased rate of glucose turnover measured with [6-3H]glucose. Perfused livers from gsd/gsd rats showed decreased rates of gluconeogenesis from lactate and alanine when the results were expressed per gram of liver, but the total glucose produced per liver was normal. Measurement of gluconeogenesis in vivo using [14C]-bicarbonate showed that gsd/gsd rats had a decreased rate of glucose production from substrates that enter the gluconeogenic pathway before pyruvate. We conclude that gsd/gsd rats have adapted to unavailability of liver glycogen by decreasing peripheral uptake of glucose and not by increasing gluconeogenesis.

Animals↗
PubMedDate not supplied

Prospective assessment of interobserver agreement for endoanal MRI in fecal incontinence.

BACKGROUND: Endoanal magnetic resonance (MR) imaging is a new technique for the assessment of anal sphincter integrity in fecal incontinence and an alternative to anal endosonography. The present study aimed to determine interobserver variation for assessment of anal sphincter integrity using endoanal MR imaging. METHODS: Fifty-two consecutive anally incontinent patients underwent MR imaging by using a purpose-built endoanal receiver coil and static 1.0-T magnet. T2-weighted axial, coronal, and sagittal scans were independently assessed by two radiologists who noted external and internal sphincter integrity. Findings were compared and agreement was assessed with the kappa statistic. RESULTS: There was disagreement in 18 of 49 technically adequate studies (37%; kappa = 0.46), indicating "moderate" agreement. Agreement was strongest if the sphincters were either both intact or both disrupted. Observers agreed in only one diagnosis of an isolated internal sphincter defect and in no diagnosis of an isolated external sphincter defect. CONCLUSION: The overall interobserver agreement for assessment of sphincter integrity using endoanal MR imaging is "moderate." Interobserver agreement using endoanal MR imaging is less than that reported for anal endosonography.

Adolescent↗
PubMedDate not supplied

Reproductive concerns of women at risk for HIV infection.

This qualitative, exploratory study investigated knowledge about perinatal transmission of human immunodeficiency virus (HIV) and perceptions of the childbearing role among women at risk for acquired immunodeficiency syndrome (AIDS) through injection drug use. Content analysis was used to analyze the results of 21 face-to-face, semistructured interviews with women who had a personal history of injection drug use or who were the sexual partners of men who injected drugs. Contextual variables influencing women at risk for HIV infection that were identified included fear of HIV antibody testing, a belief that perinatal HIV transmission is inevitable, support for pregnancy termination in the event of HIV-associated pregnancy, a strong desire for children, pride in mothering behavior, and guilt about the possibility of transmitting HIV to unborn children. AIDS education and counseling for these women will be most effective if these variables are considered.

Female↗
PubMedDate not supplied

Evaluation of two self-care treatments for prevention of vaginal candidiasis in women with HIV.

Vaginal candidiasis (VC) is a common concern for women living with HIV infection. The authors evaluated the effectiveness of two self-care approaches to prophylaxis of VC among HIV-infected women, weekly intravaginal application of Lactobacillus acidophilus or weekly intravaginal application of clotrimazole tablets, in a randomized, double-blind, placebo-controlled trial. VC was defined as a vaginal swab positive for Candida species in the presence of signs/symptoms of vaginitis and the absence of a diagnosis of Trichomonas vaginalis or bacterial vaginosis. Thirty-four episodes of VC occurred among 164 women followed for a median of 21 months. The relative risk of experiencing an episode of VC was 0.4 (95% CI = 0.2, 0.9) in the clotrimazole arm and 0.5 (95% CI = 0.2, 1.1) in the Lactobacillus acidophilus arm. The estimated median time to first episode VC was longer for clotrimazole (p = .03, log rank test) and Lactobacillus acidophilus (p = .09, log rank test) compared with placebo. Vaginal yeast infections can be prevented with local therapy. Education about self-care for prophylaxis of VC should be offered to HIV-infected women.

Administration, Intravaginal↗
PubMedDate not supplied

HIV in China.

A team of American nurse and physician educators collaborated with the Nursing Department of the Hunan Medical University, Changsha, Hunan Province, People's Republic of China, to develop a "train-the-trainer" program for Chinese nurses. The program included didactic and experiential learning activities intended to increase Chinese nurses' level of comfort when discussing culturally sensitive issues such as sexual behavior and drug use. The program emphasized collaborative development of educational materials that reflected the local cultural content. Chinese nurses responded enthusiastically but remained uncomfortable with sexual information after an initial workshop. Follow-up training programs are essential. Successful HIV/AIDS education requires teachers and students to examine personal and cultural values to address the affective learning domain.

Attitude↗
PubMedDate not supplied

New horizons: antiretroviral therapy in 1997.

Exciting advances in basic and clinical science brought a new strategy for antiretroviral therapy and new hope to people living with HIV in 1996. There are now three major categories of antiretroviral agents available for clinical use. All require replicating virus, and none are virucidal. The goal of antiretroviral therapy is a significant and prolonged reduction of the amount of actively replicating HIV (viral load). Carefully chosen combinations of antiretroviral drugs significantly reduce HIV load and are likely to extend life. However, not all patients respond to highly active antiretroviral therapy (HAART), and, for those who do, adjustment to demanding regimens and management of side effects may be difficult. The development of drug resistance is a serious concern, because resistance is associated with rising viral loads and with poorer prognosis in advanced disease.

Anti-Bacterial Agents↗
PubMedDate not supplied

Social support for HIV-infected mothers: relation to HIV care seeking.

A cross-sectional survey was conducted to identify sources of social support for 92 HIV-seropositive mothers and to examine the relationship between social support and initiation of health care after a positive test for HIV antibody. Main outcome measures were self-reported source and amount of social support and length of time between the first positive HIV antibody test and the first visit for HIV care. Results indicated that HIV-infected mothers frequently delay seeking medical care and report attenuated social support networks. A limited program of HIV counseling and testing during pregnancy is unlikely to ensure that they will enter the healthcare system.

Adult↗