Adamantane-1-ammonium acetate

In the title compound, C10H18N+·C2H3O2 −, the ammonium H atoms of the cation are linked to three acetate anions via N—H⋯O hydrogen bonds, forming a chain structure extending along the b axis

Routine Rapid HIV Screening in Six Community Health Centers Serving Populations at Risk

In 2006, to increase opportunities for patients to become aware of their HIV status, the Centers for Disease Control and Prevention released updated guidelines for routine, opt-out HIV screening of adults, adolescents, and pregnant women in healthcare settings. To date, there are few documented applications of these recommendations. To measure the impact of application of the guidelines for routine screening in health centers serving communities disproportionately affected by HIV in the southeastern US. A multi-site program implementation study, describing patients tested and not tested and assessing changes in testing frequency before and after new guidelines were implemented. All patients aged 13 to 64 seen in participating health centers. Routine rapid HIV screening in accord with CDC guidelines. The frequency of testing before and after routine screening was in place and demographic differences in offering and receipt of testing. Compared to approximately 3,000 patients in the year prior to implementation, 16,148 patients were offered testing with 10,769 tested. Of 39 rapid tests resulting in preliminary positives, 17 were newly detected infections. Among these patients, 12 of 14 receiving referrals were linked to HIV care. Nineteen were false positives. Younger patients, African Americans and Latinos were more likely to receive testing. By integrating CDC-recommended guidelines and applying rapid test technology, health centers were able to provide new access to HIV testing. Variation across centers in offering and receiving tests may indicate that clinical training could enhance universal access

Routine Rapid HIV Screening in Six Community Health Centers Serving Populations at Risk

In 2006, to increase opportunities for patients to become aware of their HIV status, the Centers for Disease Control and Prevention released updated guidelines for routine, opt-out HIV screening of adults, adolescents, and pregnant women in healthcare settings. To date, there are few documented applications of these recommendations. To measure the impact of application of the guidelines for routine screening in health centers serving communities disproportionately affected by HIV in the southeastern US. A multi-site program implementation study, describing patients tested and not tested and assessing changes in testing frequency before and after new guidelines were implemented. All patients aged 13 to 64 seen in participating health centers. Routine rapid HIV screening in accord with CDC guidelines. The frequency of testing before and after routine screening was in place and demographic differences in offering and receipt of testing. Compared to approximately 3,000 patients in the year prior to implementation, 16,148 patients were offered testing with 10,769 tested. Of 39 rapid tests resulting in preliminary positives, 17 were newly detected infections. Among these patients, 12 of 14 receiving referrals were linked to HIV care. Nineteen were false positives. Younger patients, African Americans and Latinos were more likely to receive testing. By integrating CDC-recommended guidelines and applying rapid test technology, health centers were able to provide new access to HIV testing. Variation across centers in offering and receiving tests may indicate that clinical training could enhance universal access

Clinical Case Conference 892 Bipolar Disorder and Pregnancy: Maintaining Psychiatric Stability in the Real World of Obstetric and Psychiatric Complications

sulting in relapse and ultimately the reinstatement of medications that had previously maintained the patient's clinical stability over an extended period. This report describes the complex, real-life issues faced by a woman with bipolar disorder who was determined to do all that she could to conceive and bear a healthy child while remaining psychiatrically well. What will become clear is that using an organized algorithm derived from evidencebased data is complicated by realities confronted on a daily basis in the context of unpredictable but not unexpected variables, such as miscarriage, abnormal or questionable prenatal screening tests, gestational diabetes, and the emergence of fetal decelerations, preterm labor, and psychiatric decompensation. The importance of family dynamics and beliefs, the viability of an available support system, and education regarding preconception planning as well as the risks and benefits of using psychotropic medications during pregnancy will be discussed in the context of real-life events. It should be noted that even when evidence-based decisions are made, clinicians and patients are often faced with newly published data that is inconsistent with prior data. The references cited below reflect both the literature available at the time of this patient's presentation and the literature published since then. Case Presentation Patient Description "Ms. M" was a 29-year-old Caucasian married woman, gravida 0, with a history of bipolar disorder diagnosed at Bi polar disorder poses uniquely gender-specific challenges for women considering the health and well-being of their unborn children. They struggle with decisions about taking mood stabilizers and other psychiatric medications during pregnancy and whether to breastfeed their babies. Recognizing these concerns, treatment guidelines have been published to provide clinicians and patients with recommendations for moving forward to conceive and bear children in the safest way possible (1-7). While these thoughtful guidelines are based on available perinatal psychopharmacologic data, psychiatrists in tertiary centers for women with reproductive psychiatric concerns have found that in the real world of perinatal psychiatry, strict adherence to these clear and logical guidelines is not always possible. In order to maximize the likelihood that maternal mood and behavioral stability will be maintained, treating bipolar disorder during pregnancy frequently requires polypharmacy with potentially teratogenic medications that may result in adverse side effects for both mother and fetus. Women with bipolar disorder often have complicating comorbid medical conditions such as hypothyroidism and polycystic ovary syndrome that affect their fertility and their psychiatric and medical stability. Routine assessments of prolactin levels are important in bipolar women who require certain neuroleptics for stability. Not infrequently, obstetric complications such as gestational diabetes further complicate psychiatric and obstetric management. Furthermore, despite the severity of bipolar illness, decisions on whether or not to use medications are often based on the patient's wishes and available data (which are sometimes limited and sparse), re- This article describes complex, real-life issues faced by a woman with bipolar I disorder who wished to bear a healthy child while remaining psychiatrically well. The therapeutic issues include balancing treatment decisions that affect fetal and maternal risks. The authors address the importance of carefully considering the patient's history of response to medications when evaluating risks to maternal and fetal health. They discuss the role of the psychiatrist as a part of the treatment team faced with unpredictable but not unexpected complexities, such as miscarriage, abnormal or questionable prenatal screening tests, gestational diabetes, and the emergence of fetal decelerations, preterm labor, and psychiatric decompensation. The article presents and evaluates treatment decisions made in the setting of multiple obstetric and psychiatric complications that do not clearly fit published algorithms. The importance of incorporating family and social supports as an integral part of the treatment plan is emphasized

Cavia porcellus as a Model for Experimental Infection by Trypanosoma cruzi

The guinea pig (Cavia porcellus) is a natural reservoir for Trypanosoma cruzi but has seldom been used as an experimental infection model. We developed a guinea pig infection model for acute and chronic Chagas disease. Seventy-two guinea pigs were inoculated intradermally with 104 trypomastigotes of T. cruzi strain Y (experimental group); 18 guinea pigs were used as control group. Eight animals from the experimental group and two from the control group were sacrificed 5, 15, 20, 25, 40, 55, 115, 165, and 365 days after inoculation. During the acute phase (15 to 55 days), we observed parasitemia (with a peak on day 20) and positive IgM and IgG Western blots with anti-shed acute-phase antigen bands. The cardiac tissue showed vasculitis, necrosis (on days 40 to 55), moderate to severe inflammation, and abundant amastigote nests. Smaller numbers of amastigote nests were also present in kidney, brain, and other organs. In the early chronic phase (115 to 165 days), parasitemia disappeared and anti–T. cruzi IgG antibodies were still detectable. In cardiac tissue, the number of amastigote nests and the grade of inflammation decreased. In the chronic phase (365 days), the cardiac tissue showed vasculitis and fibrosis; detectable parasite DNA was associated with higher grades of inflammation. The experimental T. cruzi infection model in guinea pigs shows kinetics and pathologic changes similar to those of the human disease