The nature of the HIV epidemic in the United States and Canada has changed with a shift toward rural areas. Socioeconomic factors, geography, cultural context, and evolving epidemics of injection drug use are coalescing to move the epidemic into locations where populations are dispersed and health care resources are limited. Rural–urban differences along the care continuum demonstrate the implications of this sociogeographic shift. Greater attention is needed to build a more comprehensive understanding of the rural HIV epidemic in the United States and Canada, including research efforts, innovative approaches to care delivery, and greater community engagement in prevention and care.

Vital organ transplantation is premised on 'the dead donor rule': donors must be declared dead according to medical and legal criteria prior to donation. However, it is controversial whether individuals diagnosed as 'brain dead' are really dead in accordance with the established biological conception of death-the irreversible cessation of the functioning of the organism as a whole. A basic understanding of brain death is also relevant for giving valid, informed consent to serve as an organ donor. There is therefore a need for reliable empirical data on public understanding of brain death and vital organ transplantation. We conducted a review of the empirical literature that identified 43 articles with approximately 18,603 study participants. These data demonstrate that participants generally do not understand three key issues: (1) uncontested biological facts about brain death, (2) the legal status of brain death and (3) that organs are procured from brain dead patients while their hearts are still beating and before their removal from ventilators. These data suggest that, despite scholarly claims of widespread public support for organ donation from brain dead patients, the existing data on public attitudes regarding brain death and organ transplantation reflect substantial public confusion. Our review raises questions about the validity of consent for vital organ transplantation and suggests that existing data are of little assistance in developing policy proposals for organ transplantation from brain dead patients. New approaches to rigorous empirical research with educational components and evaluations of understanding are urgently needed.

Regulatory T cells, a subset of CD4(+) T lymphocytes, play a pivotal role in the maintenance of the balance between the tissue-damaging and protective effects of the immune response. These cells have immunosuppressive function and have been intensely studied in the context of autoimmunity, cancer, allergies, asthma, and infectious diseases. Their role in chronic and persistent viral infections is well appreciated. In acute viral infections, the function of these cells is still unclear. The host and pathogen factors that control the generation and activity of regulatory T cells and the role of these cells in modulating expansion, contraction, and development of immune memory in acute respiratory virus infection need to be further elucidated.

To probe the. macromolecular structure of the scrapie agent and explore conditions for monomerization, the stability of the agent in low concentrations of inorganic ions was determined. A reduction by a factor of 105 in scrapie titer was found on exposure ofthe agent to .1 M KSCN or 0.3 M NaOH. In addition to the inactivation by thiocyanate ions, other chaotropic ions such as guanidinium and trichloroacetate inactivate the scrapie agent. Removal of thiocyanate ions by dialysis or glass permeation chromatography prevented the reduction in scrapie agent infectivity. Addition of equimolar amounts of (NH4)2SO4, a nonchaotrope, to preparations containing 1 M KSCN also prevented the loss ofscrapie infectivity. In contrast, neutralization ofthe alkali-treated fractions with HCI did not restore infectivity. Acidification ofpartially purified fractions did not cause inactivation of the agent but did result in precipitation of the infectious agent. Inactivation by rel atively low concentrations of chaotropic ions is consistent with many observations, all ofwhich suggest that the scrapie agent contains a protein component that is essential for the maintenance of infectivity. Thus, it is unlikely that the agent is composed only of a "naked" nucleic acid. Certainly, ifthe agent were a naked nucleic acid, its lability in alkali virtually eliminates the possibility that it is composed of a single-stranded molecule of DNA. A wealth ofexperimental data has established that inorganic ions play a significant role in determining the stability and reactivity of conventional viruses (1). Modification of the ionic environment can result in a variety of inactivation processes. The unconventional viral-like agent causing scrapie is extraordinarily resistant to thermal inactivation and unaffected by salts such as NaCl. However, the scrapie agent is exquisitely sensitive to the neutral salts of thiocyanate and trichloroacetate (2). The scrapie agent, which infects sheep and goats, is thought to be prototypic ofthe viral-like agents that cause two progressive and fatal neurological disorders in humans: Creutzfeldt-Jakob disease and kuru (3). In Enzyme-grade ammonium sulfate was purchased from Schwarz/ Mann. Potassium thiocyanate of analytical grade was obtained from Mallinckrodt. Proteinase K was purchased from Merck. The hamster-adapted scrapie agent was passaged and prepared as described (2).Assay of the Scrapie Agent. Scrapie titers were determined by measuring the incubation time intervals from inoculation to the onset of neurological illness and to death. Weanling female hamsters (LVG/LAK) were inoculated intracerebrally with 50 A1 of suspension at the dilutions indicated. This bioassay is a modification of the incubation-period assay (2, 4).Partial Purification of the Scrapie Agent. A partial purification of the scrapie agent from hamster brain was performed. Typically, 200 hamster brains were removed 60 days after intracerebral inoculation with a brain extract containing 107 mean infective dose (IDW) units ofthe scrapi...

Of the participants tested, 1.4% tested reactive for HIV, which is significantly higher than the reported prevalence in Manitoba and in other similar studies conducted in North America. Furthermore, all individuals were linked to timely care. The present study demonstrated that this particular busy tertiary care ED is an important and feasible location for HIV POC testing.