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II. FACTS5 This case arises out of charges that the defendant committed forcible rape upon Sharon Narretta on August 13, 1995, and upon Mary Wyant on September 6, 1995. Both victims testified that, on separate occasions, they were overcome by force and vaginally raped by the defendant at his apartment after meeting the defendant at a bar for the first time. To the contrary, the defendant testified that the intercourse was consensual. With respect to the August 13, 1995 incident, Ms. Narretta testified that in the early morning hours of August 13, 1995, she and a friend were on Jefferson Highway when her truck stalled. The friend walked to her home, which was close to where the truck had stalled. Ms. Narretta walked to Wolfman Henry's, a nearby lounge, to obtain some aspirin. The defendant, who was also at the bar, struck up a conversation with Ms. Narretta. She also met the bartender, Janelle, and her boyfriend, "Boogie." When Janelle closed up the lounge, the four decided to have a drink elsewhere. Janelle and Boogie drove the defendant and Ms. Narretta to Winn Dixie, where the defendant purchased some liquor. Thereafter, Boogie and Janelle drove to the defendant's apartment, but did not come in. Ms. Narretta said she asked Janelle if she knew the defendant, and Janelle replied affirmatively. Ms. Narretta then accompanied the defendant inside his apartment, in Jefferson Parish. Once inside, the defendant began cutting up chicken to cook for them, and fixed drinks for Ms. Narretta and himself. Ms. Narretta, who lived with her father, went into.
HOW DOES RECALL TIMEFRAME AFFECT PAIN SCREENING IN ROUTINE OUTPATIENT CARE? K. Lorenz1; C. Sherbourne2; A. Cohen3; E. Hagenmaier4; K. Kroenke5; L.V. Rubenstein4; B. Simon6; A. Lanto7; S. Asch8. 1Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA; 2RAND Health, Santa Monica, CA; 3Veterans Administration Greater Los Angeles, Los Angeles, CA; 4University of California, Los Angeles, Los Angeles, CA; 5Indiana University Purdue University Indianapolis, Indianapolis, IN; 6VA Greater Los Angeles, Los Angeles, CA; 7VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA; 8Veterans Administration Greater West Los Angeles Healthcare System, Los Angeles, CA. Tracking ID # 169879 ; BACKGROUND: Routine pain screening e.g., Fthe 5th vital sign ; is in widespread use, and limited evidence suggests that its implementation has not changed care. Because typical screening focuses on pain Fnow , we examined the implications of Fnow vs. a longer timeframe in routine outpatient care. We compared these approaches and patient characteristics that might affect pain measure performance. METHODS: We surveyed randomly sampled patients at 2 hospital and 6 communitybased primary care, oncology, and cardiology clinics. After visits, patients stratified to select equal proportions with high and low health status using SF-1 ; rated pain on single 010 items Fnow e.g., F5th vital sign ; and Fthe last week BPI ; . We determined sensitivity and specificity of pain Bnow by identifying discordance between presence or absence of moderate 4 ; or severe 7 ; pain using Fnow as the time frame compared to one week as the time frame. We evaluated associations between patient demographic, functional-prognostic, and health status characteristics and discordance using logistic regression. RESULTS: Among 248 patients 62 years average age, 48% nonwhite, 37% with college or graduate degree, 37% PHQ2 3, 4% mild cognitive impairment, 5% with bathing dependence, 47% shopping dependence, 50% difficulty walking several blocks or pushing large objects ; , 42% reported moderate or severe pain Fnow and 56% had pain on average in Fthe last week . Ratings were discordant in 53 cases 21% ; . Moderate to severe pain Fnow was rarely mild in Fthe last week 9 false positives, 4% ; , but mild pain Fnow was more often moderate or severe in Fthe last week 44 false negatives, 18% ; . Associations with any or false negative discordant ratings included African-American race OR 2.955, p 0.11, 95% CI 1.2826.810 ; and moderate prognostic risk OR 3.475, p 0.005, 95% CI 1.4458.356 ; . CONCLUSIONS: Pain Fnow is a highly specific, but insensitive signal of moderate to severe pain in the last week. Clinicians relying on the pain Fnow measure may miss or underestimate clinically significant pain, particularly among African American or those at higher risk of death. Increasing the recall timeframe should be considered to improve routine outpatient pain detection e.g., Fthe 5th vital sign.
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References 1. Darlison, M. G., and B. E. Albrecht. GABA-A receptors: which, where and why? Semin Neurosci. 7: 115126 1995 ; . 2. McKernan, R. M., and P. J. Whiting. Which GABA-A receptor subtypes really occur in the brain? Trends Neurosci. 19: 139143 1996 ; . 3. Davies, P. A., M. C. Hanna, T. G. Hales, and E. F. Kirkness. Insensitivity to anaesthetic agents conferred by a class of GABA A ; receptor subunit. Nature Lond. ; 385: 820823 1997 ; . 4. Whiting, P. J., G. McAllister, D. Vassilatis, T. P. Bonnert, R. P. Heavens, D. W. Smith, L. Hewson, R. O'Donnell, M. R. Rigby, D. J. S. Sirinathsinghji, G. Marshall, S. A. Thompson, and K. A. Wafford. Neuronally restricted RNA splicing regulates the expression of a novel GABA-A receptor subunit conferring atypical functional properties [corrected; erratum to be published]. J. Neurosci. 17: 50275037 1997 ; . 5. Backus, K. H., M. Arigoni, U. Drescher, L. Scheurer, P. Malherbe, H. Mohler, and J. A. Benson. Stoichiometry of a recombinant GABA-A recep tor deduced from mutation-induced rectification. Neuroreport 5: 285288 1993 ; . 6. Chang, Y., R. Wang, S. Barot, and D. S. Weiss, Stoichiometry of a recombinant GABAA receptor. J. Neurosci. 16: 54155424 1996 ; . 7. Whiting, P. J., R. M. McKernan, and K. A. Wafford. Structure and function of vertebrate GABAA receptor subtypes. Int. Rev. Neurobiol. 38: 95138 1995 ; . 8. Pritchett, D. B., H. Sontheimer, B. D. Shivers, S. Ymer, H. Kettenmann, P. R. Schofield, and P. H. Seeburg. Importance of a novel GABAA receptor subunit for benzodiazepine pharmacology. Nature Lond. ; 338: 582585 1989 ; . 9. Pritchett, D. B., H. Luddens, and P. H. Seeburg. Type I and type II GABA-A benzodiazepine receptor produced in transfected cells. Science Washington D. C. ; 245: 13891392 1989 ; . 10. Hadingham, K. L., P. B. Wingrove, B. Le Bourdelles, K. J. Palmer, C. I. Ragan, and P. J. Whiting. Cloning of cDNA sequences encoding human 2 and 3 -aminobutyric acidA receptor subunits and characterization of the benzodiazepine pharmacology of recombinant 1-, 2-, 3-, and 5containing human -aminobutyric acidA receptors. Mol. Pharmacol. 43: 970975 1993 ; . 11. Luddens, H., D. B. Pritchett, M. Kohler, I. Killisch, K. Keinanen, H. Monyer, R. Sprengel, and P. H. Seeburg. Cerebellar GABAA receptor selective for a behavioural alcohol antagonist. Nature Lond. ; 346: 648651 1990 ; . 12. Hadingham, K. L., E. M. Garrett, K. A. Wafford, C. Bain, R. P. Heavens, D. J. Sirinathsinghji, and P. J. Whiting. Cloning of cDNAs encoding the human -aminobutyric acid type A receptor 6 subunit and characterization of the pharmacology of 6-containing receptors. Mol. Pharmacol. 49: 253259 1996 ; . 13. Pritchett, D. B., and P. H. Seeburg. -Aminobutyric acid type A receptor point mutation increases the affinity of compounds for the benzodiazepine site. Proc. Natl. Acad. Sci. USA 88: 14211425 1991 ; . 14. Wieland, H. A., H. Luddens, and P. H. Seeburg. A single histidine in GABAA receptors is essential for benzodiazepine agonist binding. J. Biol. Chem. 267: 14261429 1992 ; . 15. Stephenson, F. A., M. J. Duggan, and S. Pollard. The 2 subunit is an integral component of the -aminobutyric acidA receptor but the 1 polypeptide is the principle site of the agonist benzodiazepine photoaffinity labeling reaction. J. Biol. Chem. 265: 2116021165 1990 ; . 16. McKernan, R. M., K. Wafford, K. Quirk, K. L. Hadingham, E. A. Harley, C. I. Ragan, and P. J. Whiting. The pharmacology of the benzodiazepine site of the GABA-A receptor is dependent upon the type of -subunit present. J. Recept. Signal Transduct. Res. 15: 173183 1995 ; . 17. Duncalfe, L. L., M. R. Carpenter, L. B. Smillie, I. L. Martin, and S. M. J. Dunn. The major site of photoaffinity-labelling of the -aminobutyric acid type A receptor by [3H]flunitrazepam is histidine 102 of the subunit. J. Biol. Chem. 271: 92099214 1996 ; . 18. Ymer, S., A. Draguhn, W. Wisden, P. Werner, K. Keinanen, P. R. Schofield, R. Sprengel, D. B. Pritchett, and P. H. Seeburg. Structural and functional characterization of the 1 subunit of GABAA benzodiazepine receptors. EMBO J. 9: 32613267 1990 ; . 19. Wafford, K. A., C. J. Bain, P. J. Whiting, and J. A. Kemp. Functional comparison of the role of subunits in recombinant human -aminobutyric acidA benzodiazepine receptors. Mol. Pharmacol. 44: 437442 1993 ; . 20. Luddens, H., P. H. Seeburg, and E. R. Korpi. Impact of and variants on ligand binding properties of -aminobutyric acid type A receptors. Mol. Pharmacol. 45: 810814 1990 ; . 21. Hadingham, K. L., K. A. Wafford, S. A. Thompson. K. J. Palmer, and P. J. Whiting. Expression and pharmacology of human GABAA receptors containing 3 subunits. Eur. J. Pharmacol. 21: 301309 1995 ; . 22. Benke, D., M. Honer, C. Michel, and H. Mohler. GABA-A receptor subtypes differentiated by their gamma-subunit variants: prevalence, pharmacology and subunit architecture. Neuropharmacology 35: 14131423 1996 ; . 23. Wingrove, P. B., K. A. Wafford, C. Bain, and P. J. Whiting. The modulatory action of loreclezole at the -aminobutyric acid type A receptor is determined by a single amino acid in the 2 and 3 subunit. Proc. Natl. Acad. Sci. USA 91: 45694573 1994.
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The Red B a n Register h a s ranged with t h e office of the A r m Service t o answer questions pertaining, to servicemen a n d veterans * Requests for information on t h Arniy, Q, I * Bill of Rights a n d laws , affecting vet * grans should be addfressed to G, I * Question B o s , S51, R e d ' Bank, N , J , Q, If a placed en a p job b y the t r a school while he Is u the necessary t r a complete t h e course, will he forfeit his right for subsistence rena t h e you a r e paid for work performed as p a your apprentices h i p training, t h e a sistenpe you receive w h e added to wages received cannot exceed t h e beginning wages paid a regular w o r the s a m occupation * Q, I a m aver to a t while at the s a m time I espect to continue m y own buM * ness. Will I b e able to get, a, f a r m loan If I d wlli not * A v e can get a f a guaranteed, only If he personally directs a n d operates the farm * T o u can ef course hire all t h e help you need * b u t you will not be permitted to operate t h e someone else, T o u need not actually live e n t farm, b u t you m u s live n e a enough to personally direct a n d supervise toe operation of the farm * Q, W h a could I expect t o get in the way of g r and pay if I ret u r n tha f allowing qualineatiens; separated Decemberj IBiO * after five yr * service In g r staff sergeant, MOS 060, Cook, 21 m o n have a wife a n d children * A * W i qualifioations you have mentioned you m a y enlist in g r Staff Sergeant * T e u homo would be f25 * while in United States, S0, while overseas. See y o u local, recruiting" officer * Qs W h obt a i n leave pay If he h lost his discharge? A * T o will h a v plication for obtaining a certificate in lieu of diicharge, These applications m a y obtained a t a LOOAI * M A N TAMIMX N a t Keenig * s&n of Mr * and Mrs: --Samuel -Koenig--ef - Freehold will a t t the- U N R R conference in Geneva, Switzerland, as esceutlve a s s the S e c Agrigultu.
Vaginal Hysterectomy The three common reasons for vaginal hysterectomy are pathology in the uterus fibroids adenomyosis ; , abnormal uterine bleeding and as part of a prolapse repair operation. The ratio of vaginal hysterectomy simply as a method of removing the uterus to vaginal hysterectomy as part of a repair operation is increasing. This may reflect increasing use of newer techniques such as laparoscopically assisted vaginal hysterectomy. Discomfort after vaginal hysterectomy is less than after abdominal hysterectomy. This is reflected in the shorter hospital stay, most patients are now home within five days of the operation. Most gynaecologists routinely use prophylactic antibiotics for vaginal hysterectomy cases, but despite this, urinary tract infection remains a common complication of the operation. Table 5 Age Incidence of patients having vaginal hysterectomy 1996-98!
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The laboratory tests of an impotent patient aim to identify treatable conditions or previously undetected medical illnesses that may contribute to ED Carroll et al. 1992 ; . The value of routine endocrinologic testing in the evaluation of impotent men is controversial, as the overall incidence of endocrinopathy in impotent patients varies from 1.7% to 35%, with most large series reporting incidences closer to 1.7% Johnson & Jarow 1992 ; . The effectiveness of hormonal replacement in the treatment of hypogonadal impotence has also been rather disappointing. Morales and associates 1994 ; reported a total response rate of only 9% among patients treated with oral androgen replacement. Up to 20% of elderly men who undergo estrogen therapy or surgical castration for prostate cancer are able to maintain erections adequate for intercourse despite the castrate levels of testosterone Ellis & Grayhack 1963 ; . Therefore, some investigators have suggested that an evaluation of endocrinopathy is only necessary in men who demonstrate clinical evidence of hypogonadism bilateral testicular atrophy ; or report decreased libido Johnson & Jarow 1992, Friedman et al. 1986 ; . If hormonal evaluation is done, it is enough to assess serum testosterone. The National Institutes of Health NIH ; suggested the use of an a.m. serum testosterone value NIH Consensus Conference 1993 ; . Serum testosterone levels, however, vary widely in normal men and are related to the episodic secretion of LH Spratt et al. 1988.
If it is possible to feel good about being hospitalized, it is most likely that you will feel this way when you are the one making the decision to enter that protected environment. I feel best about the hospitalizations that began with me walking to the hospital with a friend, signing myself in, and spending the time it took to be admitted in my friend's company. That has happened enough for a pattern to develop. After my friend and I spend a few hours together an argument starts. I want my friend to go home and get some sleep. The clock says that it is past 3: 00 A.M. On separate occasions, several of my friends all insisted on staying until I was admitted and medicated. They sat with me on tiled floors and in padded evaluation rooms for hours. Two of my friends made sure I was treated like a human during a dehumanizing process. They fought for my rights when I was too weak to utter a word on my own behalf. Another friend even said he was my brother so he could get past the nurses to visit me after hours. I wouldn't trade 20 ordinary friends for the kinds of friends I've had during my most difficult times. I feel comfortable telling them things I would feel uneasy revealing to my parents. They are the rope with which my safety net is braided. Having been around me for years and seen me in many different situations, they can judge the difference between manic and happy or between blue and depressed. When the dirt hits the fan you know what I mean to say ; , I can rely on them to help me ride out the storm and kytril.
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Culture and its nSMase activity was measured. Finally, the positive clone encoding magnesium-dependent nSMase cDNA from zebrafish was isolated and sequenced. Determination of nucleotide sequence The nucleotide sequence was determined by DNA sequencer ABI 310; Perkin Elmer, Shelton, CT ; . The nucleotide sequence of the isolated ZNSMase cDNA was deposited to the DNA DataBank of Japan DDBJ ; GenBank European Molecular Biology Laboratory EMBL ; database under accession number AB196 165. Transfection of ZNSMase cDNA into COS-7 cells The ZNSMase cDNA containing the complete open reading frame ORF ; was amplified by polymerase chain reaction PCR ; with the isolated full-length cDNA as template with sense primer: 5 -TCAGGAGCGGACTGAAGCGGCATCATGGCA-3 and an antisense primer: 5 -CCGTCGAGTCCTTTCAAACGGGAGGAATAA-3 . PCR was carried out by 25 cycles of denaturation at 94C for 30 seconds, annealing at 63C for 30 seconds, and extension at 72C for 2 minutes. The amplified product was subcloned downstream of the human cytomegalovirus promoter of the pTARGET Mammali Expression Vector Promega, Madison, WI ; according to the manufacturer's instructions. The nucleotide sequence of the PCR product was confirmed by sequence analysis. This vector was named as pTARGET-ZNSMase. At approximately 80% of confluence, each dish of cells was transiently transfected with 5 g DNA of pTARGET-ZNSMase vector or mock vector with Lipofection Amine 2000 reagent Invitrogen ; according to the manufacturer's instructions. At 24 hours after transfection, cells were washed once with phosphate-buffered saline PBS ; and homogenized in lysis buffer, and nSMase activity was measured. Morpholino oligonucleotide injection Morpholino oligonucleotides MOs ; were solubilized in water at the concentration of 50 g The resulting stock solution was diluted to a working concentration in water before injection into 1-cell or 2-cellstage embryos. Injected embryos were cultured in 10% Hanks saline until use. The sequences of MOs used in this study were based on cDNA cloned by us T.Y., H.T., Y.T., S.Y., Y.I., T.O., manuscript in preparation; Expression cloning of zebrafish neutral sphingomylinase cDNA by using E coli expression system based on neutral sphingomylinase activity ; , and as follows: nSMase-invert-morpholino, 5 -CCGTAGTACCGTGGTGTCGTCGGG-3 ; and nSMase-antisense-morpholino, 5 -GGGCTGCTGTGGTGCCATGATGGCC-3 . Detection of human endothelial marker genes by reverse transcriptionPCR The total RNA of the HUVECs was extracted using TRIZOL reagent Invitrogen ; according to the manufacturer's instructions. For the firststrand synthesis of complementary DNA cDNA ; , 3 g messenger RNA mRNA ; used in a 20- L reaction mixture using a ThermoScript RT-PCR System Invitrogen ; according to the manufacturer's instructions. Resulting reverse transcription RT ; products were diluted 10 times and stored at 20C until later use. The polymerase chain reaction PCR ; primers of Flk-1, neuropilin-1, neuropilin-2, and -actin were synthesized as follows: Flk-1; upstream 5 -CTGGCATGGTCTTCTGTGAAGCA-3 , downstream 5 -AATACCAGTGGATGTGATGCGG-3 PCR product, 790 base pair [bp] ; , NRP-1; upstream 5 -AGGACAGAGACTGCAAGTATGAC-3 , downstream 5 -AACATTCAGGACCTCTCTTGA-3 PCR product, 209 bp ; , NRP-2; upstream 5 -AGCACTAATGGAGAGGACTG-3 , downstream 5 -CCGTTTAGGCTGTAGGAGAC-3 PCR product, 606 bp ; , -actin; upstream 5 -GAGACCTTCAACACCCCAGC-3 , downstream 5 -TCTTCATTGTGCTGGGTGCC-3 PCR product, 606 bp ; . PCR was carried out in a total volume of 40 L reaction mixture using Premix Taq Ex Taq Version; Takara ; . Reaction conditions were 94C for 2 minutes, followed by 30 cycles -actin for 25 cycles ; , 1 minute denaturation at 94C, 1 minute annealing at 58C, 2 minutes of polymerization at 72C, and 7 minutes extension at 72C. -actin was chosen as an internal control. All.
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About 2 hours later, at the end of your shift, EMS calls and is bringing in a patient with a self-inflicted gunshot wound to the abdomen. She arrives without vital signs. After a short resuscitation, the patient you had a brief encounter with earlier is now pronounced dead and lactulose.
Christmas I could see a restless expression in her face that I never saw before. Her eyes began to shine in a strange way, and sometimes she'd break off short in her talk and run out of the room. Then she'd pretend to wish we were gone, and that she'd never seen us again. I could hardly tell what to make of her, and many a time I wished we were on blue water and clear away from all chance of delay and drawback.
Normal men, ages 1851 years, were recruited by advertisement on bulletin boards, in newspapers, and on the radio. Inclusion criteria were the following: a normal medical history and phys and lantus.
This is the story of a collaboration between a national financial institution looking to focus a portion of its charitable contributions, and a charity needing the resources of a national network to communicate their message. The case can be a model for corporate charitable partnerships. Charitable organizations increasingly need the participation of corporate Canada. And corporate Canada's brands have much to gain from these partnerships as well. CIBC is one of Canada's significant philanthropists. A strategic decision was made to concentrate on a cause that mattered most to employees and customers. This partnership was the result. The case focuses on the "Pinnie" campaign, which launched in 2001 and has run each August - October through 2004. Each year, participation rates, and funds raised, have reached new records. Meanwhile, the banks' image has improved among employees, customers, and Canadians in general. Crossover Note 32.
A Multi-centre Randomised Controlled Trial Comparing Jejunal and Gastric Nutritional Support In Critically Ill Patients. Andrew Davies Background: In critically ill patients, artificial nutritional support is now considered to be the standard of care as it improves wound healing, reduces complication rates and improves clinical outcomes. Current evidence suggests that enteral nutrition EN ; should be preferred to parenteral nutrition, and that it should be administered early after admission. A recent clinical trial demonstrated that improvements in the proportion of nutritional support delivered to ICU patients led to reduced hospital length of stay and mortality. Objectives: The primary objective of the study is to establish whether jejunal delivery of EN increases the amount of EN delivered calculated as the proportion of EN administered divided by the predicted energy requirements ; in mechanically and lavender.
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Antigenic difference is not detectable by this method. marked response following injections of lymphoma The cells ACKNOWLEDGMENTS This research project began at the Biology Division of the Oak and leuprolide.
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A 60-year-old hypertensive right-handed woman develops right hemiparesis and double vision with left external rectus weakness. The likely site of the lesion is the A ; B ; C ; Left paracentral region Left pons Right midbrain Right lateral medulla Mesencephalon and levalbuterol.
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