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If I got an invite, it would signify, from an institutional standpoint, that the work I do matters, that toiling away on these black gay films--I've done four feature films and two seasons of a television show--has a place within the pantheon of this entertainment industry. --

OBJECTIVE:To respond to the question, “Do workplace health promotion programs work?” METHODS:A compilation of the evidence on workplace programsʼ effectiveness coupled with recommendations for critical review of outcome studies. Also, reviewed are recent studies questioning the value of workplace programs. RESULTS:Evidence accumulated over the past three decades shows that well-designed and well-executed programs that are founded on evidence-based principles can achieve positive health and financial outcomes. CONCLUSIONS:Employers seeking a program that “works” are urged to consider their goals and whether they have an organizational culture that can facilitate success. Employers who choose to adopt a health promotion program should use best and promising practices to maximize the likelihood of achieving positive results.

Central aortic systolic blood pressure (BP) is an important determinant of cardiac workload and cardiac hypertrophy. The relationship of central aortic systolic BP and brachial BP varies depending on the stiffness of blood vessels. It is not certain whether the different drug classes affect the brachial and aortic systolic BP in a similar manner. In a double-blind crossover study, we measured the effects of the four major drug classes compared with placebo on central aortic pressure. Central aortic pressure and various indices were determined using the Sphygmo Cor apparatus. The study was undertaken in patients aged 65 to 85 years with systolic BP >150 mm Hg at study entry. Results are reported for 32 patients who had satisfactory applanation tonometry in all five periods. Calcium channel blockers and diuretics caused a greater fall in brachial artery systolic BP than angiotensin-converting enzyme (ACE) inhibitors or β-blocking drugs. On placebo, central aorta augmentation pressure and index were 23 mm Hg and 33.3%; on ACE inhibitors the values were 18 mm Hg and 30%; on β-blockers, 26 mm Hg and 38.5%; on calcium channel blockers, 16 mm Hg and 28%; and on diuretics, 17 mm Hg and 28.8%. The augmentation pressure on β-blocking drugs was greater than on the other three drug classes ( P < .05), and augmentation pressures on ACE inhibitors, calcium channel blockers, and diuretics were less than on placebo ( P < .05). The lowest central aortic pressures were achieved with calcium blocking drugs and diuretics. Therapy based on brachial artery recordings may thus overestimate the effect of β-blocking drugs on central aortic systolic BP and underestimate the effectiveness of ACE inhibitors and calcium blocking drugs. The clinical importance of this discrepancy needs to be evaluated.

The objective of this study was to determine which of the common groups of antihypertensive drugs is most effective at lowering systolic blood pressure (SBP) in elderly patients with previously untreated hypertension and the percentage of patients controlled with single or sequential monotherapy. Subjects were recruited from patients attending other outpatient clinics and entered into the study if their SBP was more than 150 mm Hg after three visits. Patients were given a low and high dose of each of the main classes of drugs or placebo for 1 month each. The study was a balanced, randomized crossover design with five periods: placebo; angiotensin converting enzyme inhibitors; β-blocking drugs; calcium-blocking drugs; and thiazide diuretics. Blood pressure (BP) was measured 24 to 26 h after the previous dose. A questionnaire for side effects was administered at each visit. Seventy-four patients entered the study. β-Blockers could not be used in 15 patients because of asthma or bronchospasm and these had two placebo periods. There were 9 of 66 patients on P, 9 of 46 on β-blockers, 4 of 65 on calcium-blocking drugs, 4 of 65 on diuretic, and 1 of 62 patients on ACE inhibitors who did not progress to the higher dose because of side effects. Decreases in SBP compared to randomized placebo were calcium-blocking drugs 15 mm Hg = diuretic 13 mm Hg > ACE inhibitors 8 mm Hg = β-blockers 5 mm Hg. Blood pressure decrease correlated with placebo BP ( P < .0005, r = 0.53 to 0.70). When corrected for placebo, target SBP (<140 mm Hg) was reached in between 6% to 15% of patients on monotherapy. Sequential monotherapy achieved target in 29%. Angiotensin converting enzyme inhibitors, calcium-blocking drugs, and diuretics had no more side effects than placebo. Patients on β-blockers had more side effects and the well-being score was reduced. Diuretics and calcium-blocking drugs are more effective in elderly patients at lowering SBP pressure. β-Blockers were relatively ineffective, were frequently contraindicated, and had more side effects. Monotherapy achieved control in only a small number of patients. In elderly people with essential hypertension, therapy should be instituted with diuretics or calcium-blocking drugs, but combination therapy will usually be required to achieve goal.

A comprehensive analysis of the bovine spongiform encephalopathy (BSE) epidemic in cattle in Great Britain assesses past, present and future patterns in the incidence of infection and disease, and allows a critical appraisal of different culling policies for eradication of the disease.

Oral vaccination with Mycobacterium bovis Bacille of Calmette and Guerin (BCG) has provided protection against M. bovis to badgers both experimentally and in the field. There is also evidence suggesting that the persistence of live BCG within the host is important for maintaining protection against TB. Here we investigated the capacity of badger inductive mucosal sites to absorb and maintain live BCG. The targeted mucosae were the oropharyngeal cavity (tonsils and sublingual area) and the small intestine (ileum). We showed that significant quantities of live BCG persisted within badger in tissues of vaccinated badgers for at least 8 weeks following oral vaccination with only very mild pathological features and induced the circulation of IFN[gamma]-producing mononuclear cells. The uptake of live BCG by tonsils and drainage to retro-pharyngeal lymph nodes was repeatable in the animal group vaccinated by oropharyngeal instillation whereas those vaccinated directly in the ileum displayed a lower frequency of BCG detection in the enteric wall or draining mesenteric lymph nodes. No faecal excretion of live BCG was observed, including when BCG was delivered directly in the ileum. The apparent local loss of BCG viability suggests an unfavorable gastro-enteric environment for BCG in badgers, which should be taken in consideration when developing an oral vaccine for use in this species.

Background Accurate diagnosis of CDI remains challenging as there is no standalone laboratory test with adequate clinical sensitivity and specificity. Thus, many clinical laboratories currently employ a multistep algorithm incorporating a sensitive screening test followed by a specific toxin test. An automated ultrasensitive toxin immunoassay (Singulex Clarity® C. difficile toxins A/B assay) has demonstrated excellent performance compared with cell cytotoxicity neutralization assay (CCNA). In this study, the Clarity assay was evaluated relative to glutamate dehydrogenase (GDH), toxin EIA, toxin B gene PCR, multistep algorithms, and C. difficile culture with ribotyping. Methods Residual clinical stool samples (n = 293) were collected from patients with suspected CDI. The samples were tested on-site with GDH (C. DIFF CHEK™-60), PCR (EntericBio realtime® C. difficile assay), a membrane-type toxin EIA (Tox A/B Quik Chek®), and culture and ribotyping. In total, 188 samples were tested with GDH and 239 samples were tested by PCR. All PCR-positive samples (n = 148) and prospectively tested GDH samples (n = 97) were tested with the toxin EIA. Culture and ribotyping information were available for 205 samples. Results Three of the samples tested gave no result using the Clarity assay and were excluded from the analysis. The Singulex Clarity C. difficile toxins A/B assay had high positive percent agreement (PPA) and low negative percent agreement (NPA) compared with toxin EIA and multistep algorithms ending with toxin EIA. The Clarity assay had high NPA and low PPA compared with PCR, GDH, and the multistep algorithm ending with PCR (figure). Less than 70% of the detected C. difficile PCR positive samples had toxins present. There was no difference in toxin concentration between the ribotypes. Conclusion The Clarity assay had strong PPA compared with toxin EIA and strong NPA compared with PCR. The low NPA and PPA compared with toxin EIA and PCR, respectively, may reflect the poor sensitivity of current toxin EIAs and low specificity of PCR. The Clarity assay detected 30 different ribotype strains, and less than 70% of samples (by PCR) or strains (by ribotyping) had toxins present. The Clarity assay may be considered for use as a standalone test for CDI diagnosis. Disclosures All authors: No reported disclosures.

Arthritis and hypertension are frequent comorbidities in the elderly hypertensive population. Nonsteroidal anti-inflammatory drugs are often used to relieve pain in arthritic patients but a side effect is sodium retention and consequent elevation of blood pressure (BP). The effect of dihydropyridine calcium blocking drugs is relatively independent of sodium intake, whereas the angiotensin-converting enzyme (ACE) inhibitors’ effects can be blunted by a high-sodium diet. This study compared the effects of indomethacin with placebo in elderly patients with essential hypertension who had been controlled with amlodipine or enalapril. Indomethacin 50 mg twice daily or placebo was administered for 3 weeks in a double-blind crossover study to patients controlled with amlodipine or enalapril. The response was assessed by ambulatory BP measurement. Indomethacin raised BP and lowered pulse rates in patients taking enalapril but had little effect in patients receiving amlodipine. The difference caused by indomethacin between the two groups was 10.1/4.9 mm Hg increase in BP and a 5.6 beats/min fall in pulse in people taking enalapril. Addition of indomethacin to patients taking either drug caused a rise in weight and a fall in plasma renin. It is postulated that the effect is due to inhibition of prostaglandin synthesis, which causes sodium retention. In patients taking amlodipine, the fall in plasma renin ameliorates the effect of sodium retention on BP. In patients taking enalapril, plasma renin falls but this is not translated into an effect because of the blockage of converting enzyme. Thus, the full effect of sodium retention on BP is expressed. In patients treated with indomethacin, fewer patients may respond to ACE inhibitors. However, the major problem is the patient who intermittently takes indomethacin or other nonsteroidal anti-inflammatory drugs, which, if a person is treated by an ACE inhibitor causes BP to go out of control. In such patients amlodipine would appear to be a preferred choice to enalapril.

Monotherapy frequently does not cause adequate blood pressure (BP) reduction and goal BP is not achieved. This double-blind, randomized, crossover, placebo-controlled study investigated, using a factorial design, the interaction between a dihydropyridine calcium channel blocking drug (felodipine 5 mg) and an angiotensin type 1 receptor blocking drug (candesartan 16 mg) on the control of BP as assessed by 24-h ambulatory monitoring. A total of 31 elderly patients with systolic hypertension completed all four arms of the study. Candesartan and felodipine lowered mean 24-h BP to a similar extent (candesartan 12.2 ± 2.6/7.5 ± 1.8; felodipine 11.9 ± 2.2/5.7 ± 1.4 mm Hg). The combination lowered it by 21.0 ± 2.1/11.2 ± 1.2 mm Hg, and this fall was significantly greater than with either of the monotherapies ( P < .005) and was fully additive with no interactive term. The responder rate with the combination (90%) was greater than with candesartan (61%) or felodipine (55%). Microalbuminuria or proteinuria was present in 12 of 31 patients at randomization despite previous BP control. Candesartan and the combination both reduced urinary albumin excretion. Albumin excretion was not reduced by felodipine despite BP control similar to that achieved with candesartan. Side effects were infrequent and were fewer on the combination than on placebo or on the monotherapies. The combination of felodipine 5 mg and candesartan 16 mg has additive effects on BP in elderly patients with systolic hypertension. The combination was well tolerated and is suitable for use in patients who do not have an adequate response to monotherapy.

An important question is whether ACE inhibitors (ACE I) and AT1 blocking drugs (ARB) have an additive effect on blood pressure reduction when used in combination. This study investigated in a crossover design the effect of placebo, C 16mg, C 32mg, L 20mg, L 40mg, and C 16mg + L 20mg on blood pressure measured by an ambulatory monitor. 23 patients age >60 years with essential hypertension which had not been controlled on one drug or were on 2 or more drugs completed the study. The 24 hour blood pressure on placebo was 158 ± 3/82 ± 2 mmHg and the Plasma Renin Activity (PRA) was 1.4 ± 0.2. The falls in blood pressure achieved compared with the randomized placebo period and the plasma renin on the different treatments are shown in the Table.Falls in SBP mmHg and PRA C16 C32 L20 L40 C16+L40 24h 14 12 15 15 18 Day 14 12 14 14 16 Night 14 12 18 17 21 Morning 14 11 16 13 17 Clinic 13 14 12 15 19 PRA 4.6 4.8 3.6 4.2 4.8 The similar falls in blood pressure with C16 and 32, and with L20 and 40 and the similar rises in plasma renin indicated that a plateau for blood pressure response had been reached with each monotherapy. There was a small incremental fall in systolic and diastolic blood prressure (3.5 ± 1.7 mmHg p = 0.04/1.7 ± 0.9 mmHg p = 0.07) of the combination compared with maximum doses of monotherapy. Several patients responded to one drug class and not the other as indicated by similar changes on both doses of one drug which were 10 mmHg or more greater than the change in both doses of the other drug. In addition renin levels rose more markedly when on the drug to which they responded.This study in elderly patients with essential hypertension indicates that ACE inhibitors and ARB's have a small incremental effect when used together. It is possible that this is due to recruitment of new responders rather than an additive effect of the drug in individuals.