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A model for regional muscle-flap coverage of experimental soft tissue defects of complex injuries of the rabbit lower leg is presented. This technique has provided reliable and generous coverage without the difficulty or risk of a free flap procedure, nor the limitations of other local flaps.
This is a report on 15 patients whose skin defects of the hand or foot were covered using an arterialized venous flap, with only arterial blood flowing through the vein of the flap. Success appeared to be influenced by the donor site and size of the flap. When a small-size flap from the forearm was used, the success rate was almost 100 percent; however, there was a 50 percent failure rate when a large flap from the leg was used. This technique provides not only flap coverage for exposed bone and tendon, but also provides one-stage procedures for digits in need of revascularization and skin coverage.
Although intrapartum antibiotics are beneficial to both the mother and newborn, there is no consensus as to the most efficacious antibiotic regimen in the treatment of intra-amnionic infection, especially with regard to anaerobic coverage. We randomized pregnant women with intra-amnionic infection to receive either dual agent therapy (ampicillin and gentamicin) or triple agent therapy (ampicillin, gentamicin, and clindamycin). The frequency of vaginal and cesarean delivery was similar in both groups. There was no significant difference in the incidence of endometritis between the two groups (10 of 69 versus 5 of 64; p = NS). There were no significant differences in either neonatal morbidity or mortality. The addition of clindamycin to provide anaerobic coverage for intra-amnionic infection does not significantly alter the incidence of endometritis in women delivered by cesarean section, although it may have an impact on women delivering vaginally.
BACKGROUND: Women without private health insurance are less likely than privately insured women to be screened for breast cancer, and their treatment may differ after cancer is diagnosed. In this study we addressed two related questions: Do uninsured patients and those covered by Medicaid have more advanced breast cancer than privately insured patients when the disease is initially diagnosed? And, for each stage of disease, do uninsured patients and patients covered by Medicaid die sooner after breast cancer is diagnosed than privately insured patients? METHODS: We studied 4675 women, 35 to 64 years of age, in whom invasive breast cancer was diagnosed from 1985 through 1987, by linking New Jersey State Cancer Registry records to hospital-discharge data. We compared the stage of disease and stage-specific survival among women with private insurance, no insurance, and Medicaid coverage through June 1992. We also estimated the adjusted risk of death for these groups, using proportional-hazards regression analysis to control for age, race, marital status, household income, coexisting diagnoses, and disease stage. RESULTS: Uninsured patients and those covered by Medicaid presented with more advanced disease than did privately insured patients (P < 0.001 and P = 0.01, respectively). Survival was worse for uninsured patients and those with Medicaid coverage than for privately insured patients with local disease (P < 0.001 for both comparisons) and regional disease (P < 0.001 for both comparisons), but not distant metastases. The adjusted risk of death was 49 percent higher (95 percent confidence interval, 20 to 84 percent) for uninsured patients and 40 percent higher (95 percent confidence interval, 4 to 89 percent) for Medicaid patients than for privately insured patients during the 54 to 89 months after diagnosis. CONCLUSIONS: The more frequent adverse outcomes of breast cancer among women without private health insurance suggest that such women would benefit from improved access to screening and optimal therapy.
BACKGROUND: The news media are an important source of information about new medical treatments, but there is concern that some coverage may be inaccurate and overly enthusiastic. METHODS: We studied coverage by U.S. news media of the benefits and risks of three medications that are used to prevent major diseases. The medications were pravastatin, a cholesterol-lowering drug for the prevention of cardiovascular disease; alendronate, a bisphosphonate for the treatment and prevention of osteoporosis; and aspirin, which is used for the prevention of cardiovascular disease. We analyzed a systematic probability sample of 180 newspaper articles (60 for each drug) and 27 television reports that appeared between 1994 and 1998. RESULTS: Of the 207 stories, 83 (40 percent) did not report benefits quantitatively. Of the 124 that did, 103 (83 percent) reported relative benefits only, 3 (2 percent) absolute benefits only, and 18 (15 percent) both absolute and relative benefits. Of the 207 stories, 98 (47 percent) mentioned potential harm to patients, and only 63 (30 percent) mentioned costs. Of the 170 stories citing an expert or a scientific study, 85 (50 percent) cited at least one expert or study with a financial tie to a manufacturer of the drug that had been disclosed in the scientific literature. These ties were disclosed in only 33 (39 percent) of the 85 stories. CONCLUSIONS: News-media stories about medications may include inadequate or incomplete information about the benefits, risks, and costs of the drugs as well as the financial ties between study groups or experts and pharmaceutical manufacturers.
We determined the binding energy of hydrogen to the closest packed surface for all nine group VIII transition metals as a function of surface coverage using quantum mechanics (density functional theory with the generalized gradient approximation) with periodic boundary conditions. The study provides a systematic comparison of the most stable surfaces of the nine group VIII transition metals, leading to results consistent with available surface science studies. We then use these to develop a simple thermodynamic model useful in estimating the surface coverage under typical heterogeneous catalysis conditions and compare these results to temperature programmed desorption experiments.
In this study, density functional theory calculations were performed to investigate the influence of oxygen preoccupation on the nitrogen oxide decomposition on rhodium. Besides gauging the coverage dependence of the adsorption energy of NO on the (111) rhodium facet, the influence of the initial oxygen coverage on the kinetics and thermodynamics of the nitrogen oxide decomposition reaction was also studied. The results are discussed with respect to a novel NOx decomposition catalyst. Furthermore, the influence of spin effects on the adsorption geometry as well as the adsorption energy is examined. It will be addressed why spin effects only have a minor influence on the behavior of NO on a rhodium surface.
We present data on the coverage and nearest-neighbor dependences of the diffusion of CO on Cu(111) by time-lapsed scanning tunneling microscope (STM) imaging. Most notable is a maximum in diffusivity of CO at a local coverage of one molecule per 20 substrate atoms and a repulsion between CO molecules upon approach closer than three adsites, which in combination with a less pronounced increase in potential energy at the diffusion transition state, leads to rapid diffusion of CO molecules around one another. We propose a new method of evaluating STM-based diffusion data that provides all parameters necessary for the modeling of the dynamics of an adsorbate population.
Hydrogen oxidation on Pt (111) surface is modeled by density functional theory (DFT). Previous DFT calculations showed too large O2 dissociation barriers, but we find them highly coverage dependent: when the coverage is low, dissociation barriers close to experimental values (approximately 0.3 eV) are obtained. For the whole reaction, a new pathway involving hydroperoxyl (OOH) intermediate is found, with the highest reaction barrier of only approximately 0.4 eV. This may explain the experimental observation of catalytic water formation on Pt (111) surface above the H2O desorption temperature of 170 K, despite that the direct reaction between chemisorbed O and H atoms is a highly activated process with barrier approximately 1 eV as previous calculations showed.
STATEMENT OF PROBLEM: The dental literature has shown a 3% to 25% pulpal necrosis rate as a result of tooth preparation for complete coverage restorations. PURPOSE: The purpose of this retrospective study was to examine clinical and radiographic records for evidence of pulpal necrosis in teeth prepared for complete coverage restorations at ultrahigh speed when air coolant alone was used. MATERIAL AND METHODS: The 1847 teeth in this study (182 fixed partial denture abutment teeth and 1665 single teeth restored with 21 all-ceramic, 1095 metal-ceramic, and 731 all-metal restorations) were prepared with diamond instruments (burs) in a sweeping or painting motion with the use of light pressure (1-3 oz) at ultrahigh speed with air coolant alone from the handpiece. New burs were used for each patient and then discarded. Each bur was used on no more than 4 teeth. All impressions were made with reversible hydrocolloid. Provisional restorations were fabricated on a stone cast and cemented with zinc oxide and eugenol cement. Provisional restorations were removed at 3 to 4 weeks and definitive restorations placed. Between 1970 and 1989, 6 different luting agents (zinc phosphate, resin, glass ionomer, ortho-ethoxybenzoic acid, carboxylate, and polycarboxylate) were used to place definitive restorations. All patients were questioned about symptoms of tooth sensitivity, tenderness, or pain at their regular (4- to 6-month) hygiene recall appointments. Success was defined as any definitively restored teeth that remained free of radiographic evidence of periapical radiolucency and clinical signs and symptoms of pulpal sensitivity or pain recorded in the clinical record. The results were compared with rates of pulpal necrosis for teeth prepared with water coolant as reported in the dental literature published between 1970 and 1997. RESULTS: Of 638 teeth prepared between 1970 and 1979, the pulpal necrosis rate was 2.19% (14 teeth: 12 single teeth and 2 fixed partial denture abutment teeth) (97.81% success rate). Of 1209 teeth prepared between 1980 and 1989, the pulpal necrosis rate was 0.66% (8 teeth: 7 single crown teeth and 1 partial denture abutment tooth) (99.34% success rate). Of 1825 teeth prepared between 1970 and 1989, radiographic evidence of pulpal necrosis was found in 0% (100% success rate). No clinical symptoms of pain or sensitivity were recorded in the patient records for the surviving teeth during the time period of this study, which was conducted in May 2001. No crowns were repaired or removed as a result of carious lesions. No higher incidence of pulpal necrosis relative to the type of luting agent was observed. CONCLUSION: Within the limitations of this retrospective study, it is suggested that tooth reduction procedures can be completed with minimal damage to the pulp when only air coolant from the dental handpiece is used.
PURPOSE: To determine which of two village-based strategies was more effective at recruiting residents for a trachoma mass treatment campaign. METHODS: The two strategies were to use either village government personnel to recruit residents for treatment, or to solicit interested community volunteers to recruit residents. Three were villages assigned to each strategy, and the outcome measured was treatment coverage of individuals, group and the villages. RESULTS: Self-selected community volunteers were significantly more effective than village government personnel in recruiting villagers for antibiotic treatment (p <.0001). The differences were strongest for the group at highest risk for active trachoma, pre-school children; 73% of children in community volunteer villages were treated, compared to 63% in village government villages (p <.05). Children in villages using community volunteers and from larger families were more likely to be treated. CONCLUSION: These findings support using motivated community volunteers, rather than traditional government workers, for mass treatment campaigns where high coverage is necessary.
Hip dysplasia is an important cause of osteoarthrosis of the hip, especially in Japanese. Recently, the role of the acetabular labrum in hip diseases has attracted the attention of researchers, but the condition of the labrum in the dysplastic hips has not been described. We used radial MRI to measure the degree of coverage of the femoral head by the acetabulum and the labrum, corresponding to 7 positions on the acetabular rim at every 15 degrees from anterosuperior 45 degrees via midsuperior to posterosuperior 45 degrees. 38 Japanese patients (51 hips) with dysplasia, and 11 healthy controls 122 hips) were studied. In the dysplastic hips, the labrum was larger than in the controls. We found no correlation between the coverage of the acetabulum in the anterosuperior positions and the size of the labrum among the dysplastic hips.
AIM: To estimate the magnitude and determinants of cataract prevalence and cataract surgical coverage and to evaluate their role in visual disability in Oman. METHODS: A cross-sectional study was conducted on 11,413 subjects in Oman in 1997. The presence and stage of cataract was noted on the basis of the history and an examination. The patient's phakic, pseudophakic or aphakic status and visual status were determined. The prevalence of cataract and the cataract surgical coverage were estimated. A causal relation was assumed between a backlog of cataract and age, gender and area of residence. The Attributable Risk (AR) and Population Attributable Risk (PAR) for these factors were estimated. RESULTS: The prevalence of cataract was 29.3/1000 (95% CI: 27.76 to 30.84). This was 4.97/1000 (95% CI: 3.68 to 6.26) for blinding cataract (vision < 3/60). The cataract surgery services covered 70.18% (95% CI: 69.52 to 70.84) of the blinding cataracts and 28.76% (95% CI: 28.11 to 29.41) of all cataracts. The AR and PAR of female gender in the cataract backlog were 35.5% and 1.06%, respectively. The AR and PAR of the residents of 'Group B' regions were 40.5% and 1.26%, respectively. The AR and PAR of subjects "less than 60 years old' were 55.6% and 1.66%, respectively. If the gaps in cataract surgery due to gender, regions and age groups were to be filled, the prevalence of cataract could be reduced by 1.06%, 1.21% and 1.66%, respectively. CONCLUSION: The health program should identify and address the barriers to cataract surgery among identified high-risk groups.
Five years of newspaper coverage of HIV and AIDS in Zimbabwe is examined. Both the number of items and the amount of space devoted to the topics has increased steadily over the 5 years. The nature and content of the items show a continuing bias towards issues more closely associated with western patterns of the epidemic, and comparative neglect of personal stories, local issues and items with a counselling focus. Language is also examined and found to reflect a victim and war imagery. The implications for health education in the country are considered and specific recommendations for more constructive media coverage are made.
HIV/AIDS coverage in five African American newspapers (Amsterdam [New York] News, Oakland [California] Post, Washington [District of Columbia] Afro American, Atlanta Inquirer, and Chicago Citizen) was analyzed from 1991 to 1996. During this period, HIV/AIDS became the leading cause of death of young adult African Americans. This study found that coverage of the disease was most prominent in the New York, Oakland, and Washington, D.C., African American newspapers. Although most of the 201 articles analyzed framed the story primarily as a health issue, a large proportion also exhibited a critical attitude toward the government and the "AIDS establishment" about their commitment to saving the lives of minorities. Articles often conveyed the message that fighting HIV/AIDS first requires substantial action regarding the larger contextual issues-economic, political, and social-that cause health inequities. Alternative theories of cause and treatment, such as the possibility that AIDS was created as an extermination plot against African Americans, or that the drug Kemron, endorsed by the Nation of Islam, was the most promising treatment for HIV, generally were discussed as legitimate even though much evidence exists to refute these theories. These frames reflect distrust and rational concerns rooted in the historical context of American race relations, including the legacy of the Tuskegee study. Increased understanding of the frames presented in the African American press may contribute to the ability of researchers, health practitioners, and health journalists to constructively respond to the concerns of the African American community.
PURPOSE: To determine the volume and focus of articles on four chronic diseases in newspapers targeting First Nations, Métis, and Inuit in Canada. METHODS: From a sampling frame of 31 Aboriginal newspapers published in English from 1996-2000, 14 newspapers were randomly selected allowing for national and regional representation. Newspaper archives were searched at the National Library of Canada and articles selected if the disease terms cancer, cardiovascular disease, diabetes, or HIV/AIDS appeared in the headline, or in the first or last paragraph of the article. Articles were coded for inclusion of mobilizing information (local, distant, unrestricted, not specified, none) and content focus (scientific, human interest, commercial, other). Cancer articles were categorized by tumor site specificity. Data were analyzed by frequency, cross tabulations, and chi-square analysis. RESULTS: Of 400 chronic disease articles, there were significantly more articles on HIV/AIDS (167 or 41.8%) and diabetes (135 or 33.8%) and few articles on cancer (56 or 14%) and cardiovascular disease (30 articles or 7.5%) (p<0.001). Slightly more than one third (36.5%) of the articles contained mobilizing information to enable readers to take further health action. Mobilizing information was virtually absent from cardiovascular (7/30 or 23%) and diabetes (29/135 or 21.5%) articles. Site specific cancer coverage differed significantly from chance (p<0.001) with 41% of the articles on breast cancer and no articles on lung or colorectal cancers. INTERPRETATION: Given the burden of tobacco-related cardiovascular disease and cancer in Canadian Aboriginal people, the lack of coverage and limited mobilizing information in ethnic newspapers are a missed opportunity for health promotion.
The aim of this study was to assess blood free naltrexone and 6-beta-naltrexol levels with time following treatment with sequential sustained-release naltrexone preparations. Data were collected from blood samples analysed independently for naltrexone and 6-beta-naltrexol and from clinical record review at a community heroin treatment clinic in Perth, Western Australia. Five patients received sequential 3.4 g (3.49+/-0.01 g and 3.36+/-0.05 g, respectively) naltrexone implants. The second implant was received on average within 131.2+/-15.67 days of the first implant. The mean length of follow-up was 307.2+/-18.28 days of the first implant. Blood naltrexone levels have the potential to remain above 2 and 1 ng/ml for a total of 390 and 524 days, respectively, and blood 6-beta-naltrexol was maintained above 10 ng/ml for a total of 222 days following insertion of these implants. No patient relapsed to dependent heroin use during the implant coverage period while blood naltrexone concentrations were above 2 ng/ml. Results indicate that blood naltrexone and 6-beta-naltrexol levels can be maintained above therapeutic levels for prolonged periods following use of sequential 3.4 g naltrexone implants. These extended periods of coverage will offer significant benefits for managing the heroin-dependent patient.
This article deals with the cultural framing of the near sequencing of the human genome and its impact on the media coverage in Germany. It investigates in particular the way in which the weekly journal Die Zeit and the daily newspaper Frankfurter Rundschau reported this media event and its aftermath between June 2000 and June 2001. Both newspapers are quality papers that played an essential role in framing the human genome debate--alongside the Frankfurter Allgemeine Zeitung--which became the most prominent genomic forum. The decoding of the human genome prompted a huge controversy concerning the ethics of human engineering, research on stem cells and Preimplantation Genetic Diagnosis. The main aim of this article is to show how this controversy was structured by metaphor. The media coverage of the genome generated DNA-factishes--a neologism designating the ambivalence of something as fact (fait) and as a fetish (fetiche)--that mostly propagated images of a new DNA-scienticism or biological determinism. Mediated by cultural experiences, the human genome became a highly artificial and social construct of a 'NatureCulture'.