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PubMed2004

The modern theory of biological evolution: an expanded synthesis.

In 1858, two naturalists, Charles Darwin and Alfred Russel Wallace, independently proposed natural selection as the basic mechanism responsible for the origin of new phenotypic variants and, ultimately, new species. A large body of evidence for this hypothesis was published in Darwin's Origin of Species one year later, the appearance of which provoked other leading scientists like August Weismann to adopt and amplify Darwin's perspective. Weismann's neo-Darwinian theory of evolution was further elaborated, most notably in a series of books by Theodosius Dobzhansky, Ernst Mayr, Julian Huxley and others. In this article we first summarize the history of life on Earth and provide recent evidence demonstrating that Darwin's dilemma (the apparent missing Precambrian record of life) has been resolved. Next, the historical development and structure of the "modern synthesis" is described within the context of the following topics: paleobiology and rates of evolution, mass extinctions and species selection, macroevolution and punctuated equilibrium, sexual reproduction and recombination, sexual selection and altruism, endosymbiosis and eukaryotic cell evolution, evolutionary developmental biology, phenotypic plasticity, epigenetic inheritance and molecular evolution, experimental bacterial evolution, and computer simulations (in silico evolution of digital organisms). In addition, we discuss the expansion of the modern synthesis, embracing all branches of scientific disciplines. It is concluded that the basic tenets of the synthetic theory have survived, but in modified form. These sub-theories require continued elaboration, particularly in light of molecular biology, to answer open-ended questions concerning the mechanisms of evolution in all five kingdoms of life.

Animals↗
PubMed2001

Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia.

BACKGROUND: Iron deficiency and iron deficiency anaemia (IDA) are common in young children. It has been suggested that the lack of iron may have important effects on children's psychomotor development and cognitive function. OBJECTIVES: To determine the effects of iron therapy on psychomotor development and cognitive function in iron deficient children less than 3 years of age. SEARCH STRATEGY: The following databases were searched: COCHRANE LIBRARY (2000 ISSUE 4) MEDLINE (1966-August 2000) EMBASE (1980-August 2000) Latin American Database (LILACS) PsycLIT Journal articles (1974-August 2000) PsycLIT Chapters and Books (1987-August 2000) The references of identified trials and of important review articles were scrutinised. Citation searches on trials from the primary search were performed within the Science Citation Index. Key authors were contacted. SELECTION CRITERIA: Studies were included if children less than 3 years of age with evidence of iron deficiency anaemia were randomly allocated to iron or iron and vitamin C versus a placebo or vitamin C alone and assessment of developmental status or cognitive function was carried out using standardised tests by observers blind to treatment allocation. DATA COLLECTION AND ANALYSIS: Abstracts and titles of studies identified on searches of electronic databases were read to determine whether they might meet the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by two independent reviewers. Differences of opinion about suitability for inclusion were resolved by discussion. Data were analysed separately depending on whether participants had iron assessments were performed within one month of beginning iron therapy or later. MAIN RESULTS: Five trials, including 180 children with IDA, examined the effects of iron therapy on measures of psychomotor development between 5 and 11 days of commencement of therapy. Data from four trials could be pooled. The pooled difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups was -3.2 (95%CI -7.24, 0.85) and in Bayley Scale MDI, 0.55 (95% CI -2.84, 1.75). Two studies, including 160 randomised children with IDA, examined the effects of iron therapy on measures of psychomotor development more than 30 days after commencement of therapy. Aukett et al reported the mean number of skills gained after two months of iron therapy, using the Denver test. The intervention group gained 0.8 (95% CI -0.18, 1.78) more skills on average than the control group. Idjrandinata et al reported that the difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups after 4 months was 18.40 (95%CI 10.16, 26.64) and in Bayley Scale MDI, 18.80 (95% CI 10.19, 27.41). REVIEWER'S CONCLUSIONS: There is no convincing evidence that iron treatment of young children with IDA has an effect on psychomotor development discernable within 5-11 days. The effect of longer term treatment remains unclear but the data would be compatible with clinically significant benefit. There is urgent need for further randomised controlled trials with long term follow up.

Anemia, Iron-Deficiency↗
PubMedDate not supplied

The effect of context on the processing of type-shifting verbs.

Recent research in lexical semantics has suggested that verbs such as begin and enjoy semantically select for a complement that denotes an activity or an event. When no such activity or event is specified in the form of a progressive or infinitival complement, as in John began (to read/reading) the book, the verb is said to "coerce" the NP direct object to shift its role to encompass the activity that begin requires as complement (e.g., writing, reading). Empirical support for this view has been provided by McElree, Traxler, Pickering, Seely, & Jackendoff (2001). In the present study, however, in two self-paced reading experiments, type-shifting effects (taken to be longer reading times engendered by the computation of the coercion process) were not obtained with sentences in isolation (Experiment 1) or with sentences embedded in contexts that specified the nature of the activity performed over the complement NP (Experiment 2). It is argued that type-shifting verbs are similar to non-preferred verbs for given contexts and that type-shifting operations are pragmatic inferences computed over underspecified semantic representations.

Cognition↗
PubMed2003

Managing menopause: a qualitative analysis of self-help literature for women at midlife.

This article reports on a qualitative social constructionist analysis that aims to examine the ways in which menopause and women's bodies are represented in self-help texts. In particular, we aim to compare texts with a more traditional 'medical' approach and others taking a more 'woman-centred' perspective. Four diverse self-help books on menopause and HRT available in England were analysed to examine the ways in which women, menopause and midlife were portrayed, and to investigate the construction of notions of knowledge, expertise and responsibility. The selected texts were published between 1992 and 1996 and covered a range of perspectives, including medical, alternative and feminist. Results showed that menopause was constructed as a 'deficiency disease' in all four texts, although in three of the texts this 'disease' discourse was counterposed by the simultaneous use of a 'menopause as natural' discourse. Menopause was also constructed as inherently complex and confusing, as were women's bodies. A discourse of 'change' was drawn upon in which menopause was portrayed as only one of the stressful events women must cope with at midlife. Finally, most of the texts drew on a discourse of 'management' rather than one of 'treatment' or 'cure' when discussing how menopause, and women's relationship to menopause should be handled. The medical profession was constructed as the primary source of expertise on menopause and women's bodies, although responsibility for the 'management' of menopause as a chronic condition lay solely with individual women. Although there were a number of differences in representations of menopause in medically oriented self-help texts and those adopting a more woman-centred perspective, our analysis also revealed several areas of similarity and overlap with regard to the construction of menopause and its 'management'. The implications of these findings for the construction of menopause in self-help texts for women are discussed.

Attitude to Health↗
PubMed1998

Fermented milk products are associated to ulcer disease. Results from a cross-sectional population study.

BACKGROUND: Prevalence of peptic ulcer disease has been associated to diet. Some dietary factors seem to have bactericidal effect which may modify the risk of peptic ulcer disease. The objective was to analyze associations between dietary habits and peptic ulcers. DESIGN: A cross sectional population study. SUBJECTS: One thousand, one hundred and thirty-five subjects out of 11700 randomly invited men and women, aged 46-67 y, participating in a diet and disease study during 1991-1993. The study population comprised of 764 cases with reported peptic ulcer, 142 with dyspeptic symptoms and 229 randomly selected controls. METHODS: X-ray examinations and endoscopies were reviewed and 332 out of 764 peptic ulcer cases were verified. Mean daily intake of foods and nutrients were assessed with a combined 7d menu book and a quantitative food frequency questionnaire, including dietary supplements. RESULTS: Subjects with verified ulcer had lower intake of fermented milk products and vegetables and higher intake of milk, meat and bread than controls. Intake of total fat, saturated and monounsaturated fatty acids and linolenic acid were higher in the ulcer group. Higher intake of fermented milk products, by quintiles showed a decreased ulcer risk; odds ratio 0.82 (0.71-40.95), adjusted for covariates below. Higher intake of milk, by quintiles, was associated with an increased risk of ulcer; odds ratio 1.17 (1.03-1.32). Smoking, foreign ethnicity and being unmarried or divorced were covariates associated to ulcer. CONCLUSION: This study indicates the multifactorial etiology of peptic ulcer including dietary factors. High intake of fermented milk products was associated with decreased risk for ulcer, whereas increased risk was noted for high milk intake.

Aged↗
PubMed2002

Training peer counselors to promote and support exclusive breastfeeding in Bangladesh.

Exclusive breastfeeding is rare in Bangladesh. About 90% of women have home deliveries, so the Baby-Friendly Hospital Initiative has no mechanism to reach them. Mother support groups do not exist, and community health workers do not have time to promote and support exclusive breastfeeding. To provide this kind of support at the community level, an area in Dhaka was selected for a peer-counseling intervention program. Using certain selection criteria, 1 woman from each community was trained as a peer counselor. The training was based on the World Health Organization/United Nations International Children's Emergency Fund 40-hour breastfeeding counseling course and related books. Counseling skills were taught using demonstrations and role play, followed by practical training in the project area. The intervention was very successful, as 70% of the mothers in the project area breastfed their infants exclusively for 5 months compared to only 6% in the control area. The authors describe the peer counseling training, strategies used for peer counseling visits, and lessons learned.

Bangladesh↗
PubMed1995

[The work of Hernandez and its repercussions in the natural sciences].

The most important source of knowledge and diffusion of the great American work from Hernández, was carried out starting from the selection and summary produced by the Napolitan physician Nardo Antonio Recchi. Starting from his manuscript they published the Rerum Medicarum Novai Hispaniae Thesaurus (Rome 1651), piece prepared by the Accademia dei Lincei, and the four Books of Nature (Mexico, 1615), carried out by Brother Francisco Ximénez with the intention--intention that also had Recchi--of having a practical handbook of medicine utilizing the American products. This paper treats, essentially, of those works.

Americas↗
PubMed1993

Accuracy of references and quotations in veterinary journals.

The accuracy of references and quotations used to substantiate statements of fact in articles published in 6 frequently cited veterinary journals was examined. Three hundred references were randomly selected, and the accuracy of each citation was examined. A subset of 100 references was examined for quotational accuracy; ie, the accuracy with which authors represented the work or assertions of the author being cited. Of the 300 references selected, 295 were located, and 125 major errors were found in 88 (29.8%) of them. Sixty-seven (53.6%) major errors were found involving authors, 12 (9.6%) involved the article title, 14 (11.2%) involved the book or journal title, and 32 (25.6%) involved the volume number, date, or page numbers. Sixty-eight minor errors were detected. The accuracy of 111 quotations from 95 citations in 65 articles was examined. Nine quotations were technical and not classified, 86 (84.3%) were classified as correct, 2 (1.9%) contained minor misquotations, and 14 (13.7%) contained major misquotations. We concluded that misquotations and errors in citations occur frequently in veterinary journals, but at a rate similar to that reported for other biomedical journals.

Periodicals as Topic↗
PubMed2004

Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery.

BACKGROUND: Post-operative atrial fibrillation is a common complication of cardiac surgery and has been associated with increased incidence of other complications including post-operative stroke, increased hospital length of stay and increased cost of hospitalisation. Prevention of atrial fibrillation is a reasonable clinical goal and, consequently, many randomised trials have evaluated the effectiveness of pharmacological and non-pharmacological interventions. We systematically reviewed the literature and prepared meta-analyses to better understand the role and effects of various prophylactic therapies against post-operative atrial fibrillation. OBJECTIVES: To assess the effects of pharmacological and non-pharmacological interventions for preventing post-cardiac surgery atrial fibrillation. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE and CINAHL from earliest achievable date to June 2003. We hand searched references from reports and earlier reviews. We searched abstract books and CD-ROMs from annual scientific meetings of American College of Cardiology, American Heart Association, North American Society of Pacing and Electrophysiology and European Heart Organization between 1997-2003. No language restrictions were applied. SELECTION CRITERIA: Randomised controlled trials comparing pharmacological interventions or non-pharmacological interventions with control treatment, placebo or usual care for the prevention of post-operative atrial fibrillation in post-coronary artery bypass grafting or combined CABG and valvular surgery. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Fifty eight studies were included with a total of 8565 participants. Interventions included were amiodarone, beta blockers, solatol and pacing. Results favoured treatment for post-operative atrial fibrillation. The data for stroke favoured treatment by a non-significant effect size of 0.81, 95% confidence interval 0.51 to 1.28. Similarly, a positive indication for length of stay was derived but it too was not significant with a weighted mean difference of -0.66, 95% confidence interval -0.95 to -0.37. A positive result for cost of hospitalisation in favour of treatment was achieved, but the statistic is not significant due to low power and large standard deviations: a weighted mean difference of -2717, 95% confidence interval 7518 to 2084. Beta-blockers had the greatest magnitude of effect across 28 trials (4074 patients) with an odds ratio (random) of 0.35, 95% confidence interval 0.26 to 0.49. Across all treatment, the odds ratio favoured treatment with a ratio (random) of 0.43, 95% confidence interval 0.37 to 0.51. REVIEWERS' CONCLUSIONS: Intervention is favoured across the three pharmacological interventions studied and the one non-pharmacological intervention, pacing. The length of stay data favoured treatment (-0.66, 95% confidence interval -0.95 to -0.37).

Adrenergic beta-Antagonists↗
PubMed1992

Recent developments in neurosurgical spinal cord monitoring.

In a review 8 years ago, the then current status of intraoperative spinal cord monitoring (SCM) was discussed. Concerning future developments, that article concluded that the major challenge lay in (a) the improvement of the reliability and clinical relevance of somatosensory evoked potential (SEP) monitoring, where the incidence of false-negative and false-positive results had to be reduced, and (b) the application of new techniques like motor evoked potential (MEP) monitoring, which might turn out to be a method complementary to the SEP approach. Since that time, there has been a considerable amount of newly published results from intraoperative SCM, although clinical articles on exclusively neurosurgical SCM are rare (Table I). A selective literature search for the present review (primarily for the time from 1988 to 1992) yielded more than 200 citations. Eighty-one studies entered into the final evaluation; among these were 3 conference proceedings, 6 book chapters, and 10 review articles. Further, 40 clinical articles, and 22 articles on experimental work were counted. In particular, experimental studies in animals have given support to clinical monitoring by exploring the usefulness of new stimulation and recording techniques. This reappraisal only considers recent work on SEP and MEP in neurosurgical SCM with some experimental studies relevant to clinical SCM. Spinal cord monitoring in orthopaedic surgery is not evaluated in this review for reasons detailed in the article.

Evoked Potentials↗
PubMed2006

Changes in the scrotal temperature of subjects in a sedentary posture over a heated floor.

As Koreans habitually sit on the heated floor in their residential buildings, the male testis is directly exposed, and is therefore affected by the floor surface temperature. The purpose of this study was to investigate the changes in the scrotal temperature of the subjects in a sedentary posture over the heated floor. A rigid screening test was performed to select healthy subjects. Finally, six college students volunteered to participate in the experiments. Two experiments were performed in a controlled environmental chamber. Experiment I was designed for a low metabolism state, with the subjects reading a book in a sedentary posture for 50 min. The floor surface temperature (tf) was controlled by varying the temperature of water (tw) flowing into the floor coil from 15 to 50 degrees C, at 5 degrees C intervals. Experiment I revealed that the final scrotal surface temperature was 32.27, 32.62, 33.51, 33.34, 34.14, 34.28, 34.34 and 35.04 degrees C at the tw 15 degrees C (tf 17.0 degrees C), 20 degrees C (tf 20.8 degrees C), 25 degrees C (tf 24.1 degrees C), 30 degrees C (tf 27.8 degrees C), 35 degrees C (tf 31.7 degrees C), 40 degrees C (tf 35.9 degrees C), 45 degrees C (tf 38.6 degrees C) and 50 degrees C (tf 42.2 degrees C), respectively. At tf 17.0 and 20.8 degrees C, the scrotal temperature exhibited a declining pattern and a low temperature for spermatogenesis. At tf 24.1, 27.8 and 31.7 degrees C, however, the thermal regulatory system of the scrotum and testis was activated appropriately. On the contrary, scrotal temperature ascended at tf 35.9, 38.6 and 42.2 degrees C. Of the six subjects, two subjects demonstrated scrotal temperatures above 35 degrees C at tf 38.6 degrees C and four subjects exhibited scrotal temperatures above 35 degrees C at tf 42.2 degrees C. Experiment II was designed for a high metabolism state, with the subjects playing a card game in a sedentary posture for 180 min. The tf was controlled by varying the tw from 30 to 40 degrees C, at 5 degrees C intervals. Experiment II revealed that the final scrotal temperature was 33.43, 34.78 and 35.61 degrees C, and the difference between the initial and final scrotal temperatures was +0.34, +1.06 and +2.24 degrees C, at tw 30 degrees C (tf 27.8 degrees C), 35 degrees C (tf 31.7 degrees C) and tw 40 degrees C (tf 35.9 degrees C), respectively. The scrotal temperature was affected by the floor surface temperature and by the rate of metabolism of the subject in a sedentary posture. As derived from regression analysis, the recommended surface temperature of a heated floor is within 23-33 degrees C under the assumption that scrotal and consecutively testicular temperature above 35 degrees C impairs spermatogenesis.

Body Temperature↗
PubMed2005

[Genitourinary tuberculosis in the urologic works of Professor Rafael Mollá Rodrigo].

OBJECTIVES: Professor Rafael Molla Rodrigo is considered by some the author who contributed with his scientific work and solid technique to consolidate Urology as a speciality in Valencia. Such importance is also perceived in a national level, as demonstrated by the fact that he belonged to the first board of the Spanish Association of Urology and contributed to its foundation in the two-year period 1910--1911, from his position of head of the department of Surgical Therapy and Operations at the Central University. Genitourinary tuberculosis is one of the most outstanding chapters of his extensive works. METHODS: We reviewed all his works, selecting all original articles about genitourinary tuberculosis. Original articles have been obtained from the journals Revista de Higiene y Tuberculosis, La Medicina Valenciana, Revista Valenciana de Ciencias Médicas y Policínica, and from his two most important books, Clinical Lessons In Urology and Clinical Lessons in Urology and Genitourinary Surgery. RESULTS: Throughout his work he analyzes features of relevance about this disease, such as diagnosis, about which he emphasizes the clinical and bacteriological difficulties, and treatment, which was only feasible by precocious nephrectomy. CONCLUSIONS: He dedicates a great part of his work to the study of this pathology and defends a precocious diagnosis in order to perform the only treatment that had demonstrated efficacy. He also exposes the symptoms and variety of clinical presentations, as well as diagnosis through separate kidney catheterization with the aim to determine unilateral involvement.

History, 19th Century↗
PubMed1995

Experience-based teaching of therapeutics and clinical pharmacology of antiepileptic drugs. Sudden unexplained death in epilepsy: do antiepileptic drugs have a role?

The contents of this paper have been written to be used in a teaching program specifically designed for medical postgraduate education of resident physicians and fellows in training interested in the clinical pharmacology of antiepileptic drugs and their role in the treatment of epilepsy and/or in the prevention of sudden unexpected death associated with this disease. With some modifications, such as a specific lecture to provide an overview of the numerous concepts presented in the text, the article could be used when teaching fourth-year medical students. The format of the paper is a combination of didactic review and eight case reports in a self-learning format. A quiz for self-assessment is included at the end of the article (see Appendix). This material was covered in part in the 1992 Board Review Course for Clinical Pharmacology sponsored by the American College of Clinical Pharmacology. The format or setting of instruction for this material could include small learning groups composed of 10 to 15 students. When used in combination with other topics prepared in similar formats, this could become a take home course for those preparing to take the Boards in Clinical Pharmacology. Each instructor could select specific publications from the reference list for assigned readings depending upon the material emphasized by the instructor. The questions included at the end of the text could be used as either a closed or an open book quiz to assess student learning.

Adolescent↗
PubMed2005

Past challenges faced: an overview of current educational activities of IUTOX.

Over the past decade, educational programmes have been the main focus of the activities of the International Union of Toxicology (IUTOX). The IUTOX educational programmes are dynamic and have been growing in scope and frequency each year. It is envisaged that this growth will continue with guidance from our member societies and the continuing support of our sponsors. Presently, IUTOX is engaged in the following educational programmes: (1) International congresses that provide the opportunity for direct communication of current toxicological information. Fellowships are sponsored to facilitate attendance at these congresses for toxicologists in need. (2) Workshops that permit interaction on a more localised level of topics of more regional interest. Workshops have served to help stimulate formation of toxicology societies by bringing together sufficient scientists to facilitate these discussions. (3) Continuing educational (CE) programmes at member society meetings. Topics are prioritized based on input received from the local societies. Programmes often are those from CE courses given at meetings, such as conferences of the US Society of Toxicology (US SOT) and EUROTOX from the previous year. (4) Biennial Risk Assessment Summer School (RASS), an intensive week-long interaction between senior toxicologists who serve as faculty with attendees providing individual training. (5) Dissemination of donated printed toxicological books from publishers and syllabi from continuing education courses to regional locations. (6) Web-based interactive training programmes in regions where formal toxicological educational programmes are limited or lacking. (7) Preparation and distribution of monographs on selected topics of very current interest. Monographs on environmental oestrogens and genetically-modified foods have been published. The recent activities in each of these programmes are reviewed in this paper.

Education↗
PubMed1997

Methods for predicting carcinogenic hazards: new opportunities coming from recent developments in molecular oncology and SAR studies.

Without epidemiological evidence, and prior to either short-term tests of genotoxicity or long-term tests of carcinogenicity in rodents, an initial level of information about the carcinogenic hazard of a chemical that perhaps has been designed on paper, but never synthesized, can be provided by structure-activity relationship (SAR) studies. Herein, we have reviewed the interesting strategies developed by human experts and/or computerized approaches for the identification of structural alerts that can denote the possible presence of a carcinogenic hazard in a novel molecule. At a higher level of information, immediately below epidemiological evidence, we have discussed carcinogenicity experiments performed in new types of genetically engineered small rodents. If a dominant oncogene is already mutated, or if an allele of a recessive oncogene is inactivated, we have a model animal with (n-1) stages in the process of carcinogenesis. Both genotoxic and receptor-mediated carcinogens can induce cancers in 20-40% of the time required for classical murine strains. We have described the first interesting results obtained using these new artificial animal models for carcinogenicity studies. We have also briefly discussed other types of engineered mice (lac operon transgenic mice) that are especially suitable for detecting mutagenic effects in a broad spectrum of organs and tissues and that can help to establish mechanistic correlations between mutations and cancer frequencies in specific target organs. Finally, we have reviewed two complementary methods that, while obviously also feasible in rodents, are especially suitable for biomonitoring studies. We have illustrated some of the advantages and drawbacks related to the detection of DNA adducts in target and surrogate tissues using the 32P-DNA postlabeling technique, and we have discussed the possibility of biomonitoring mutations in different human target organs using a molecular technique that combines the activity of restriction enzymes with polymerase chain reaction (RFLP/PCR). Prediction of carcinogenic hazard and biomonitoring are very wide-ranging areas of investigation. We have therefore selected five different subfields for which we felt that interesting innovations have been introduced in the last few years. We have made no attempt to systematically cover the entire area: such an endeavor would have produced a book instead of a review article.

Animals↗
PubMed1998

'Expert' analysis of menstrual and ultrasound data in pregnancy--gestational dating.

The expected date of delivery (EDD) using a precise ultrasound day rule was compared with the scan EDD alone in 219 singleton pregnant women who were certain of their last menstrual period, and booked in the obstetric department of a district general hospital. The system compared the ultrasound biometric measurement with the normal range of a published chart of fetal size and, using the day rule concept, the final EDD selected by an 'expert' computer system. Statistical analysis using similar methods as in other published studies showed that the 'expert' system correlated with the actual date of the onset of spontaneous labour at least as well as scan dates alone. Menstrual data should not be rejected in favour of ultrasonic biometry in all cases and a computer system using a precise day rule should be a valuable addition to computerised maternity databases and ultrasound machines.

Journal Article↗
PubMed1985

Victor von Bruns (1812-1883) and his contributions to plastic and reconstructive surgery.

Victor von Bruns was an active surgeon in Germany during the nineteenth century. His work is accompanied by many illustrations, and a selected few are presented in this survey. His original contributions to plastic and reconstructive surgery are notable, mainly in lip and cheek reconstruction. These are still valid today and have been adopted by many plastic surgeons. His books dealt not only with plastic surgery, but with almost every surgical event, such as amputation, larynx surgery, galvanosurgery, and war surgery. His publications and illustrations give an excellent picture of the advances made by him and other plastic surgeons during the second half of the nineteenth century, thus making him an important contributor to the renaissance of plastic surgery.

Cheek↗
PubMed2002

Are medical savings accounts a viable option for funding health care?

AIM: To summarize the international experience of medical savings accounts (MSAs), make a preliminary evaluation of the impact of MSAs, and assess their feasibility in other countries, particularly Central and Eastern Europe. METHOD: A review of published literature in academic journals, books, Internet sources, and other "gray" literature. RESULTS: Most published studies were theoretical. Advocates argued that MSAs improved the efficiency of insurance, increased consumer choice, and reduced health care expenditures. Critics argued that MSAs led to adverse selection, reduced equity, resulted in cost inflation, and deterred necessary utilization. MSAs have been implemented in China, Singapore, the United States of America, and South Africa. The organization of MSAs varied between countries. MSAs were combined with either a public or private insurance element to cover catastrophic expenses. Few empirical studies of MSAs have been conducted and, therefore, the evidence on their impact is limited. CONCLUSION: More empirical evaluations are needed on the impact of MSAs. Results of empirical evaluations cannot be easily generalized but depend on the complementary systems of financing and the extent of state regulation. MSAs are not likely to be feasible in countries where the unemployment rate is high, savings rates and average earnings low, and the state weak.

China↗