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Latent reservoirs of HIV: obstacles to the eradication of virus.

The use of highly active antiretroviral therapy (HAART) in the treatment of HIV-1-infected individuals has provided a considerable amount of information regarding the dynamics of viral replication and has resulted in enormous advances in HIV therapeutics. The profound suppression of plasma viremia in HIV-infected individuals receiving HAART has resulted in a highly beneficial clinical effect and a dramatic decrease in the death rate attributable to AIDS. Nonetheless, the persistance of reservoirs of HIV, including latently infected, resting CD4+ T cells that can give rise to infectious HIV upon stimulation in vitro, has posed a sobering challenge to the long-term control or eradication of HIV in infected individuals receiving HAART. Although a recent study has demonstrated th at the size of the pool of latently infected, resting CD4+ T cells can be markedly diminished with intermittent interleukin (IL-2) and continuous HAART, complete eradication of HiV in infected individuals remains extremely problematic. Here we discuss recent developments in studies of the latent reservoir of HIV in patients receiving HAART and implications for the long-term treatment of infected individuals and eradication of the infection.

Anti-HIV Agents↗

Female healthcare managers and the glass ceiling. The obstacles and opportunities for women in management.

Despite the large number of women in the healthcare field, healthcare management resembles other industries in its severe lack of women in upper-management positions and in the "glass ceiling" that contributes to this dearth. Although not enough has been specifically written on women healthcare managers, the author reviews what is available, along with some of the general management literature.

Career Mobility↗

A theory-based treatment of psychotic symptoms in schizophrenia: treatment successes and obstacles to implementation.

This study investigated the use of the immediacy theory to explain the existence of auditory hallucinations and delusions in individuals with schizophrenia and to develop treatment strategies. In a 2-phase approach, a therapist trained 6 individuals with schizophrenia to stop responding to the immediate stimuli ostensibly evoking their symptoms and instead to respond to more remote stimuli unrelated to the problem behavior. Two other participants received nonspecific supportive psychotherapy to control for rater bias and to provide some comparison to the experimental treatment. Following 6 weeks of therapy, participants in the experimental group improved on 66% of the symptom measures. By contrast, participants in the control group improved on only 11% of the measures. The individuals in the experimental group retained some of these benefits during the follow-up period. The findings are discussed in light of several contributory factors.

Adult↗

Risk factors for work-related low back pain in registered nurses, and potential obstacles in using mechanical lifting devices.

Back pain disability is a serious and costly problem affecting the nursing profession. The purposes of this study were to determine risk factors for work-related low back pain (WRLBP) in registered nurses and to record the reported use or reasons for nonuse of mechanical lifts. Our hypothesis was that workers who attributed the cause of WRLBP to their own actions would be knowledgeable about back safety, would be more likely to use lifts, and would report less WRLBP. A random sample of 270 registered nurses was selected from two acute care hospitals in central Illinois to identify WRLBP risk factors. This cross-sectional study gathered information on individual, physical workload, psychological, and organizational factors that may present a risk for WRLBP. Information was also collected on the use of safety devices and back pain symptoms. The response rate was 50.4%. Nearly 84% of respondents had WRLBP in the past, and 36.2% had WRLBP in the past year that limited movement or interfered with routine activities. Among the risk factors significantly associated with WRLBP were more years worked in nursing, frequent lifting, and low social support. Only 11% reported that they routinely used mechanical lifting devices, and the primary reason given for failure to use lifting equipment was unavailability of equipment. The reasons for the lack of use of mechanical lifts should be investigated and addressed.

Adult↗