bluuebunny/crossref_metadata_2025 huggingface dataset:
An Evaluation of On-Site Testing for Syphilis
Authors: Patel A , Moodley D , Moodley J
Published: January 2017

One of the major obstacles to the eradication of perinatal transmission of syphilis is the delay in obtaining the results of syphilis serological tests. The availability of on-site syphilis testing lead to this study which attempted to evaluate on-site syphilis testing performed by nursing staff.

The seroprevalence of syphilis by laboratory rapid plasma reagin (RPR) was 8.2% ( n=42). Twenty-one of the 42 women were correctly identified by the on-site test. The overall sensitivity of on-site testing was 50% [95% confidence interval (CI)=34.4–65.6]; specificity of 90.9% (95% CI=87.8–93.2). The on-site test correctly identified as uninfected 429 of the 471 women reported as RPR negative by the laboratory, giving a specificity of 91.1% (95% CI=88.1–93.4).

The results of the study show that on-site RPR test had a sensitivity of 75% in respect of the clinically important titres of ≤ 1:8. The specificity of the on-site test was 91.1% and on-site testing only failed to detect syphilis in those patients with titres of 1:1 and 1:2. On-site testing is a practical and cost-effective option to prevent congenital syphilis, in settings of a high prevalence of syphilis and using skilled testers.
Prevalence of Anaemia and Iron Deficiency in Three Trimesters in Rural Vellore District, South India
Authors: Abel Rajaratnam , Rajaratnam Jolly , Gnanasekaran V Joseph , Jayaraman P
Published: January 2017

A multistage sampling technique was used to select 845 pregnant women from two blocks in Vellore district. Haematological measurement of haemoglobin (Hb) was done on all women and serum ferritin (SF) on a subsample of 445. The prevalence of anaemia (Hb <11 g/dl) was 56.6%, 70.2% and 69.5%, respectively among the first, second and third trimester women. The mean Hb of 10.7 g/dl was significantly higher among the first trimester than among the second and third trimester women, which was less than the recommended value of 11 g/dl. Iron deficiency (SF <12 μg/L) was significantly ( P < 0.05) more among the third trimester women than among the first. The high prevalence of anaemia in each trimester in pregnancy indicates the need for iron supplementation as early as possible starting from the fourth month of pregnancy.
Rural Men and Their Attitude towards Vasectomy as Means of Contraception in Ethiopia
Authors: Dibaba Asrat
Published: January 2017

A descriptive study on the attitude of rural men towards vasectomy as means of contraception was conducted in southwestern Ethiopia.

A total of 200 men who came to a rural health centre either for treatment or to accompany a patient were included for interview. The mean age of the interviewees was 30.9 and the main occupation was farming (67.5%). The mean number of offspring born to the respondents was 3.5 with 70% of the respondents wanting more children. Fifty-five per cent had heard about contraception before and in this group 31% of the wives used or were using one of the common methods. None of the respondents was against the use of contraceptives and none of them had heard previously of vasectomy as means of contraception. The acceptance of vasectomy as means of contraception was 79%. Twenty-one per cent opposed vasectomy because of the problem of possible loss of children due to death or divorce. The high acceptance rate of vasectomy indicates an unmet need for surgical contraception and the training of health personnel on the ‘no scalpel vasectomy’ technique. Making this service available, starting at health centre level, is recommended.
Maternal Comprehension of Home-Based Growth Chart in Bahrain
Authors: Musaiger Abdulrahman O , Abdulkhalek Nahed
Published: January 2017

The objectives of this study were to assess Bahrain mothers' understanding and interpretation of currently used home-based growth monitoring chart, and how their education effects their comprehension of it. A sample of 472 mothers of children who were less than 6 years old were selected from 18 health centres in Bahrain. About 73% brought the growth chart with them during their visits. The education of the mothers had a significant effect on the comprehension of the growth chart. Highly-educated mothers were more likely to read the information in the growth chart (69%) than middle (52%) and low-educated mothers (16%) ( P<0.0001). Also highly-educated mothers got more benefit from the growth chart ( P< 0.0001) and more of them understood the reason for the colour in the chart ( P< 0.0001) than other groups. The majority of husbands (85%) showed no interest in reading the growth chart. Of the mothers, 42% did not know at which age the growth chart should be used. It is important, therefore, that the current growth chart should be reviewed and the mothers and health workers should be involved in the process of designing the chart. Suggestions for improvement of the growth chart currently used were provided.
Visual Loss in Urban and Rural Chronic Glaucoma Patients in Ghana
Authors: Ntim-Amponsah C T
Published: January 2017

The visual acuity of newly diagnosed glaucoma patients in a rural and an urban area were compared in a hospital-based cross-sectional study in Ghana. Age at presentation was strikingly higher in the rural group due to local factors which result in a difference-in-age structure of the rural and urban population. The crude relative frequency of bilateral blindness was significantly higher for rural than urban. However, with age adjusted relative frequencies for bilateral blindness there was no significant difference between rural and urban patients. There was significant difference between them for those aged 51–71 when blindness in one or both eyes were considered together. There was more consistent blindness in the rural community: the difference was attributed to local factors such as better access to eye care in the urban group.
Changing Perspectives in Japanese Encephalitis in India
Authors: Sehgal Arvind , Dutta A K
Published: January 2017

Japanese encephalitis is a serious public health problem with significant mortality in children and old people. It occurs throughout much of Asia (43 000 cases worldwide per year). In recent years it has caused many epidemics in different parts of the country. In view of the high mortality and severe sequelae which often leaves behind highly dependent and disabled survivors, the disease is assuming great importance. A review of the pathogenesis, epidemiology, management and prevention together with changing perspectives in all these areas is presented.
Gastrointestinal Perforation in Children Due to Blunt Abdominal Trauma in Hazara, Northern Pakistan
Authors: Zafar Arshad , Orakzai Nasir , Ghafoor Aamir , Ahmad Sajjad
Published: January 2017

A retrospective study of 25 children with gastrointestinal perforation due to blunt abdominal trauma in a single region of Pakistan is presented. The age, sex, aetiology, site of perforation, abdominal and X-ray findings, associated injuries, surgical procedures and outcome were analysed. There were 20 boys and 5 girls: mean age was 10 years. The injuries were the result of road traffic accidents 12 (48%), falls 11 (44%) and ‘struck by animals’ two (8%). Associated injuries occurred in 19 (76%). On admission 20 (80%) patients had peritonitis while 18 (72%) had pneumoperitoneum. Mean time from trauma to admission was 10 hours and admission to operation was 5 hours. Ileum was the most common site of perforation. Simple closure was the most common surgical procedure. Complications occurred in nine (36%) patients — six (24%) died. Delay in presentation and operation was associated with increased morbidity and mortality. Frequent evaluation of the child and abdominal X-rays are still the important tools for early diagnosis of gastrointestinal perforation following blunt abdominal trauma.
HIV/AIDS Pandemic and Surgical Practice in a Nigerian Teaching Hospital
Authors: Owotade Foluso J , Ogunbodede Eyitope O , Sowande Oladayo A
Published: January 2017

The objective of the study was to determine the effects of the HIV/AIDS pandemic on surgical practice in a Nigerian teaching hospital. It involved a questionnaire survey of all the doctors practising in the surgical specialties at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, in order to obtain their attitudes and practices toward HIV-positive surgical patients.

Sixty-five doctors were interviewed, their ages ranged from 26 years to 62 years with a mean age of 35.1 years. The majority (35.4%) were in general surgery or obstetrics and gynaecology (24.6%). Almost half (47.7%) had operated on known HIV-positive patients and the majority were in support of preoperative HIV screening. Almost all (95.4%) were worried about occupational HIV infection – a significant number of consultants would refuse to be screened if their patient were allowed to know the results ( P=0.014). The cross infection control commonly employed included adequate instrument sterilization, presurgical hand washing and the use of gloves and facemasks. The wearing of eye goggles, double gloving, indirect instrument passing and wearing of water impervious gowns were used less frequently.

As HIV/AIDS infected individuals are presenting for surgical procedures in the hospital, there is a need to improve the use of universal infection control measures and to educate all categories of healthcare personnel in order to allay the fears and to prevent discrimination that could militate against effective management of HIV/AIDS patients.
Community Care for Chronic Psychotic Patients
Authors: Brook Michael Gary
Published: January 2017

The beneficial effects of a community psychiatric programme are described. During the year following the programme's introduction, admissions of violent chronic psychotic patients to prison were for a total of 1.5 patient months and none were sent abroad for treatment. This is compared with the previous year, in which patients spent a total of 24 patient months in prison and two were sent abroad for urgent treatment. In addition to the increase in patient well-being, a considerable reduction in financial costs was achieved.
Assessment of Prognosis in Nontraumatic Coma in a Tropical Environment
Authors: Rwiza H T , McLarty D G
Published: January 2017

Nontraumatic coma in 93 patients admitted to the medical wards of Muhimbili Medical Centre, Dar es Salaam, was associated with a grave prognosis. The most important indicators of outcome were the cause of coma, the presence of early neurological signs, and the Glasgow Coma Scale score on admission and on subsequent days. Of 37 patients admitted with cerebral malaria 25 (67.6%) regained independent existence at one month, as well as 2 (50%) of 4 patients admitted in diabetic coma and 2 (22.2%) of 9 patients admitted with meningitis. Apart from one patient with status epilepticus no patient in any other diagnostic category achieved either moderate or complete recovery. The prognostic chart developed by Levy and colleagues was useful in identifying patients with a serious prognosis. The Glasgow Coma Scale, which is simpler to use, was also found useful and should be further tested to confirm its value for nonspecialist doctors required to manage patients presenting in nontraumatic coma in a tropical environment. While therapeutic facilities are limited in most developing countries, it is doubtful if the acquisition of expensive intensive care facilities would significantly improve prognosis for patients in nontraumatic coma. Emphasis should instead be placed on the recognition and effective treatment of those problems associated with nontraumatic coma for which specific and effective remedies are available.
Endoscopic Sclerotherapy for Oesophageal Varices
Authors: Arigbabu A Olu , Akinola D O
Published: January 2017

Endoscopic sclerotherapy has gained the upper hand in the treatment of bleeding oesophageal varices. The procedure is safe and the complications are transient. In this centre 25 cases were treated with sclerotherapy, using Varigloban 8% as the sclerosing agent. Bleeding was controlled in all 25 patients and varices were obliterated in 24. There were 9 recurrences at a mean of 15 months. It can be assumed that sclerotherapy eradicates oesophageal varices satisfactorily for a minimum period of one year.
Paediatric Anaesthesia in a Developing Country
Authors: Wisborg T , Gravem P E
Published: January 2017

A suitable anaesthetic technique was needed for oral surgery in infants in a developing country. As an air compressor was present, and oxygen accessible, a continuous flow technique was chosen. Two Boyle's machines - useless due to lack of soda lime and nitrous oxide - were converted without increasing susceptibility to technical and supplemental deficiencies. The challenge to simplify techniques without reducing patient safety is discussed, and the solutions in an Ethiopian hospital are presented.
Laparoscopy as a Diagnostic Method in Internal Medicine: Experiences with 168 Procedures at Kilimanjaro Christian Medical Centre, Moshi, Tanzania
Authors: Missalek W , Mmuni K
Published: January 2017

One hundred and sixty-eight laparoscopies, performed for various indications between 1985 and 1989, were studied retrospectively and the findings and experiences are reported. The most frequent diagnoses were hepatocellular carcinoma (20%) and liver cirrhosis (18%). Correlation of macroscopic and histopathological diagnosis was satisfactory in hepatocellular carcinoma (74%) and poor in liver cirrhosis (38%). Laparoscopy was judged diagnostic in 45%, diagnostically helpful in 20% and non-contributory in 35% of all cases. The highest yield was obtained in hepatocellular carcinoma and liver cirrhosis, the poorest results in obstructive jaundice. It is concluded that for optimum diagnostic outcome the indication for laparoscopy should be strict and that it should be practised only in those centres where experienced clinicians and competent histopathologists are available.
Management of Bowel Perforation in Typhoid Fever
Authors: Richens John
Published: January 2017

The best survival rates after ileal perforation in typhoid fever are to be found in patients undergoing operation within 24 h. Conservative management of typhoid perforation, which was widely advocated after the introduction of chloramphenicol, appears to be associated with a substantially increased mortality compared to surgery, although randomized comparisons have never been conducted. Clinical, radiological and ultrasound examination assist in the diagnosis of perforation. After vigorous resuscitation, simple surgical closure of the perforation and abdominal irrigation will suffice for most cases. Antibiotics effective against S. typhi, coliforms and anaerobes are required.
How Well are Hospitals Preventing Iatrogenic HIV?: A Study of the Appropriateness of Blood Transfusions in Three Hospitals in the Ashanti Region, Ghana
Authors: Addo-Yobo Emmanuel O D , Lovel Hermione
Published: January 2017

A study on the appropriateness of blood and blood product transfusions took place in three hospitals over a 3-week period in July/August 1990 in the Ashanti region of Ghana. Clinical records of all blood transfusion recipients within the period were examined for the appropriateness of the transfusions based on preset criteria. Nearly 1 in 5 (17070) of all blood transfusion episodes in the hospitals were avoidable according to these criteria. Surgical practices wereassociated, perhaps habitually, with many more avoidable blood transfusions than non-surgical medical practices. The need to minimize the use of transfusion therapy is reemphasized since human immunodeficiency virus screening is imperfect. There is the need for hospitals to develop reasonable, practical guidelines for transfusions in all departments.
Bacterial Agents in Neonatal Septicaemia in Calabar, Nigeria: Review of 100 Cases
Authors: Antia-Obong O E , Utsalo S J
Published: January 2017

This study of bacterial isolates in 100 cases of proven neonatal septicaemia has shown Staphylococcus aureus and coliform bacteria as the dominant Gram-positive and Gram-negative organisms respectively. Most Gram-negative bacteria and Staphylococcus aureus were sensitive to gentamicin, while streptococci were sensitive to ampicillin and penicillin. On the basis of this antimicrobial sensitivity pattern, the combination of gentamicin with either ampicillin or penicillin appears appropriate in initial therapy of neonatal septicaemia.
Short-Stay Hernia Surgery with Local Analgesia
Authors: Yerzingatsian K L
Published: January 2017

This article documents the management of hernia operations in a Zambian General Hospital. Over a period of 28 months between 1979 and 1982, 146 patients were operated upon; 16 were managed under a general anaesthetic, eight with ketamine hydrochloride and 22 with spinal analgesia. The rest — 100 patients — underwent repair with local analgesia. There were two surgical readmissions; the few who were readmitted for various other reasons have not been included. No recurrences were noted during the period of study. Morbidity was minimal and known surgical mortality was nil.
Emergency Symphysiotomy for the Trapped Head in Breech Delivery: Indications, Limitations and Method
Authors: Pust Ronald E , Hirschler Richard A , Lennox Christopher E
Published: January 2017

Careful case selection can avoid most obstetrical emergencies. However, even with optimum management of breech labour, the fetal head may become trapped. Since doctors in developing nations must be prepared for this dire situation, this article reviews breech case selection and outlines the steps in breech delivery, illustrating symphysiotomy for the entrapped head. The limitations and precautions associated with symphysiotomy are stressed.
Sonographic Changes following Splenectomy for Portal Hypertension in Schistosoma Mansoni
Authors: Ali Qurashi M , Hammour Osman A , Rahim Ibrahim M Abdel
Published: January 2017

Eleven patients with portal hypertension due to infection with Schistosoma mansoni underwent splenectomy and devascularization operations. The patients were examined with ultrasound once preoperatively and twice postoperatively over a period of about 6 months. Following surgery there was significant and sequential reduction in the diameter of the portal vein at the hilum and the splenic vein at the pancreas. The liver lengths and index of liver size did not change significantly. No changes in the degree of periportal fibrosis could be detected.
Low-Cost Refractometer for Measurement of Protein Concentration and Specific Gravity of Body Fluids
Authors: Singh Sarman , Singh Niti , Karmarkar M G
Published: January 2017

The measurement of protein concentration in serum and other body fluids can be helpful in disease diagnosis and prognosis. It is commonly helpful to know whether a collection of fluid is transudate or exudate. The specific gravity of fluids, including urine, can also be a useful diagnostic tool. The estimation of protein concentration is usually possible only in hospitals where costly chemistry analysers are available. Specific gravity can be measured by standard methods only if large volumes of fluid are available: it is often not possible to measure the specific gravity of cerebrospinal, pleural, pericardial, or pancreatic fluids, or of urine if the volume is less than 50 μl. Recently, we have obtained a small and very handy device by which one can measure both the specific gravity of fluids in small volumes and also their protein content. The method is based on the refraction of light. Both purchase and running costs are very low by comparison with standard laboratory techniques.

We describe the use of this instrument and compare its performance with other available methods.
Tuberculosis Score Chart in Children in Aitape, Papua New Guinea
Authors: van Beekhuizen Heleen J
Published: January 2017

The diagnosis of tuberculosis (TB) in children is difficult, especially in developing countries with limited resources. In this retrospective review, we analyse the tuberculosis score chart (TSC) developed by Dr Keith Edwards. At the Raihu Health Centre, a rural hospital in Papua New Guinea, we analysed the diagnostic pathways to establish the diagnosis of TB and the use of the TSC during 1994 and 1995 and give a description of this TSC, as well as the data of 301 children in which the diagnosis of TB was likely.
Infertility Profile at King Edward VIII Hospital, Durban, South Africa
Authors: Chigumadzi P T , Moodley J , Bagratee J
Published: January 2017

A prospective observational study over a 6-month period on women presenting with infertility was conducted at King Edward VIII Hospital (KEH), South Africa. The aim of the study was to establish the patient profile and investigations performed on women presenting with infertility.

One hundred women were recruited. The mean age of the women was 31 years and 60% had secondary infertility. The mean duration of infertility was 7.2 years; 61% had histories suggestive of pelvic inflammatory disease and approximately half (49%), had had previous infertility investigations; 16% of the women were HIV (human immunodeficiency virus) antibody positive and 16% had positive syphilis serology. Tubal factors were identifiable in 77%, ovulatory factors in 21% and uterine factors in 21%. Male factor infertility was present in 21%. This study confirms that in developing countries, tubal factors are the commonest cause of infertility.
Neonatal Discharge and Follow up
Authors: Manzar Shabih
Published: January 2017

Increased intensive care for low birth weight and premature infants has made it essential to establish a well-organized plan for neonatal discharge and follow up. The preventive medical goal is improved care and outcome and in this article the organization of such a plan is discussed.
Otorrhoea: A Management Protocol for a Tropical Doctor
Authors: Kurien Mary
Published: January 2017

Ear discharge is a common symptom encountered in clinical practice in the tropics. The aim of this paper is to highlight the practical management of otorrhoea from a general practitioner's perspective with special reference to the tropics and developing countries.
Orogastric versus Nasogastric Feeding of Newborn Babies
Authors: Daga S R , Lunkad N G , Daga A S , Ahuja V K
Published: January 2017

Oxygen saturations were compared, 10 min before and 10, 20 and 30 min after orogastric and nasogastric feeds, in 10 stable newborns. The mean saturations were significantly lower with mere passage of nasogastric tube and continued to be so during feeds. There was no difficulty in securing the orogastric tube and no baby aspirated milk.
Maternal Brain Death
Authors: Sperling Daniel
Published: January 2017

Pregnancy is a biological process that usually takes forty weeks. The more advanced pregnancy is in terms of gestational age, the higher the chances that the fetus would survive in case of a premature and unnatural delivery. Hence, when a pregnant woman is struck by brain death, the fetus’ chances of survival are seriously and immediately threatened. Until recently, there were two choices in such a situation: letting the mother (and the fetus) naturally die without further intervention or delivering the fetus through a cesarean section when the death of the fetus was a tragic but likely result.

Recent advances in medical technology, however, have provided physicians with an ability to control over the time and manner of death in ways that were never previously considered by their patients.
The Obesity Agency: Centralizing the Nation's Fight against Fat
Authors: Thompson Brian
Published: January 2017

Fat. Many love to eat it, but hate to carry it. The majority of people in the United States struggle to get out of this love/hate bond. Unfortunately, they find themselves stuck in an abusive relationship.

Obesity is the “fastest-growing major health problem in the United States.” Approximately two thirds of American adults are overweight or obese. In addition, 15 percent of children are overweight. The number of people suffering from this chronic ailment dwarfs the number of people afflicted with other diseases such as HIV/AIDS, cancer, diabetes and heart disease. Obesity leads to over 400,000 deaths a year, and it costs the United States over $117 billion per year. The prevalence and cost of the disease “warrants an increased emphasis on prevention and treatment.”
Science, Politics, and the Regulation of Dietary Supplements: It's Time to Repeal DSHEA
Authors: Cohen Peter J.
Published: January 2017

Since the turn of the century, resourceful entrepreneurs have advertised a wide variety of purportedly simple and painless cures for cancer, including liniments of turpentine, mustard, oil, eggs, and ammonia; peat moss; arrangements of colored floodlamps; pastes made from glycerine and limburger cheese … [T]his historical experience does suggest why Congress could reasonably have determined to protect the terminally ill, no less than other patients, from the vast range of selfstyled panaceas that inventive minds can devise.

[Individuals have] the right to be treated by a health care practitioner with any medical treatment (including a treatment that is not approved, certified, or licensed by the Secretary of Health and Human Services) that such individual desires or the legal representative of such individual desires.

The makers of our Constitution undertook to secure conditions favorable to the pursuit of happiness. They recognized the significance of man's spiritual nature, of his feelings and of his intellect.
Potential Interactions of the Orphan Drug Act and Pharmacogenomics: A Flood of Orphan Drugs and Abuses?
Authors: Loughnot David
Published: January 2017

To overcome the unattractiveness of small markets, the United States government provides financial aid and incentives for drug manufacturers to create cures for rare diseases under the Orphan Drug Act (“the Act”). Recent research integrating genetic information and pharmacology holds promise for creating more effective drugs targeted at smaller populations than ever before. In the near future, it seems that a flood of new drugs targeted at small disease populations could take advantage of the government benefits under the Act. Drug applicants will include true orphan drugs along with “Trojan” applicants that seek to co-opt the benefits for drugs that should not qualify as orphans. Currently, the FDA appears ill prepared to discern between the two types of applicants and prevent abuse of the system.

In 1983, the federal government passed the Act. Congress designed the Act and subsequent modifications to provide incentives for companies to bring drugs for rare diseases to market.
Potential Barriers to HPV Immunization: From Public Health to Personal Choice
Authors: Zimet Gregory D.
Published: January 2017

Of the over 100 types of human papillomavirus (HPV), more than 40 can be sexually transmitted. Genital HPV infection is very common, with a point prevalence among women worldwide of approximately 10 percent. In most cases, HPV infection is either cleared or becomes undetectable and causes no disease; however, persistent HPV infection is causally related to all cervical cancers and genital warts. In addition, a large proportion of other cancers, such as vaginal, vulvar, anal, and penile cancers as well as many cancers of the head and neck, are associated with HPV infection. Moreover, recurrent respiratory papillomatosis (RRP) is a potentially serious disease caused by HPV types typically responsible for genital warts. RRP can lead to severe airways obstructions and may require repeated surgical interventions. HPV types are typically divided into high-risk types, most often associated with cancers, and low-risk types, typically associated with warts. High-risk types 16 and 18 are responsible for approximately 70 percent of cervical cancers worldwide, whereas low-risk types 6 and 11 are responsible for approximately 90 percent of genital warts.
Addressing Supply Side Barriers to Introduction of New Vaccines to the Developing World
Authors: McElligott Sean
Published: January 2017

Low-income countries experience significant morbidity and mortality from avoidable infectious diseases, but all too often life-saving innovative vaccines are only available in high-income markets. The Generic Open (GO) license proposal posits that an increase in generic entry will lower prices through greater competition and increase vaccine availability in low-income markets. However, the GO proposal, as currently structured, is unlikely to function as envisioned in the vaccine market. Innovator vaccine firms will be unlikely to participate in the program because the payments in the GO license do not adequately compensate firms for all lost profits. Additionally, the price reductions from competitive entry are unlikely because the vaccine market is already characterized by low, and in some cases unsustainable, prices. I propose a potential adaptation where developing world vaccine manufacturers serve as contract suppliers to innovator firms for a given period of time. Donors could also share in the initial costs of capacity with the developing world manufacturers. Sales of developing world manufactured vaccines would be sold solely to UN procurement agencies under a confidential pricing or rebate system. This would increase overall product availability, maintain market separation, and decrease costs to UN agencies.
Oil and Water: Mixing Individual Mandates, Fragmented Markets, and Health Reform
Authors: Hoffman Allison K.
Published: January 2017

The 2010 federal health insurance reform act includes an individual mandate that will require Americans to carry health insurance. This article argues that even if the mandate were to catalyze universal health insurance coverage, it will fall short on some of the policy objectives many hope to achieve through a mandate if implemented in a fragmented insurance market. To uncover this problem, this article sets forth a novel framework that disentangles three different policy objectives the individual mandate can serve. Namely, supporters of the mandate might hope for it to: (1) facilitate greater health and financial security for the uninsured (“paternalism”); (2) eliminate inefficiencies in health care delivery and financing (“efficiency”); and/or (3) require the healthy to buy insurance to help fund medical care for the sick (“health redistribution”). Health redistribution — the primary focus of this article — is a shifting of wealth from the healthy to the sick through the mechanism of risk pooling. Many see health redistribution as a means to enable all Americans to more equitably access medical care on the basis of need, rather than on the basis of ability or willingness to pay.

Drawing on evidence from the implementation of an individual mandate in Massachusetts's health reform in 2006, this article reveals that the fragmented American health insurance market will thwart the mandate's ability to achieve these objectives— in particular the goal of health redistribution. Fragmentation is an atomization of the insurance market into numerous risk pools that has been driven by market competition and regulation. It prevents Americans from sharing broadly in the risk of poor health and, in doing so, entrenches a system where access to medical care remains tied to ability to pay and individualized characteristics. The final section of this article examines how various policies, including some in the new law (e.g., insurance regulation and exchanges) and others not (e.g., expanded public insurance), can reduce fragmentation so that the mandate can successfully serve all desired objectives and in the process gain greater legitimacy over time.
The Anti-Patient Psychology of Health Courts: Prescriptions from a Lawyer-Physician
Authors: Farrow Freeman L.
Published: January 2017

Critics of the current medical malpractice tort system claim that adjudication of malpractice claims before generalist judges and lay juries contributes to rising costs of medical malpractice insurance premiums and medical care. They claim that properly deciding issues in this realm requires specialized knowledge of medicine and medical technology that juries, and even judges of general jurisdiction, do not possess. One lobbying group alleges there is a continuing medical malpractice litigation crisis in the United States, evidenced by increasing medical costs, deaths from needless medical errors, departure of physicians from the practice of medicine due to increasing medical malpractice insurance premiums, and random medical justice in medical malpractice cases. Whether there is a direct, causal correlation between the increasing cost of medical malpractice insurance premiums and medical malpractice litigation is debatable.
How the FDA Can Overturn Wyeth v. Levine
Authors: Gostanian Anthony
Published: January 2017

In Wyeth v. Levine, the Supreme Court held that an FDA-approved drug label did not preempt state tort law. Although the Supreme Court did not defer to the FDA's position, language in the opinion, and Breyer's concurring opinion, suggest that the FDA may be able to abrogate Wyeth v. Levine using the administrative law doctrine originally announced in Chevron v. Natural Resources Defense Council. That is, the FDA may claim deference to its position in a future case involving the same legal questions. This Note explains how Wyeth impacts the Chevron doctrine and identifies how the FDA assertion that drug labels preempt state law may win in a future case.
Follow the Money: Money Matters in Health Care, Just like in Everything Else
Authors: Hyman David A.
Published: January 2017

I suspect that our collective search for villains — for someone to blame — has distracted us and our political leaders from addressing the fundamental causes of our nation's health-care crisis. All of the actors in health care — from doctors to insurers to pharmaceutical companies — work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize healthcareover any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity and discourage transparent competition based on price or quality.
Health Reform: What's Insurance Got to Do with It? Recognizing Health Insurance as a Separate Species of Insurance
Authors: Mariner Wendy K.
Published: January 2017

Health reform debates in the United States are typically conducted using the language of insurance. President Barack Obama described his hopes for expanding access to care as “health insurance reform.” Both proponents and opponents of reform debated the merits of reform proposals leading to the Patient Protection and Affordable Care Act of 2010 in insurance terms. Yet, disagreements over the structure of reform reveal deep differences in what proponents and opponents of reform mean by insurance and the role it should play in mediating access to health care. Scholars of insurance law are likely to describe insurance somewhat narrowly as a risk spreading device. Industry representatives, among others, often view conventional indemnity insurance as the norm. From this perspective, reforms that move too far beyond underwriting risks can be seen as undermining actuarial fairness, threatening the very idea of insurance and possibly the industry itself.
Radioimmunolocalization of Tumours by External Scintigraphy after Administration of 131I Antibody to Human Chorionic Gonadotrophin: Preliminary Communication
Authors: Begent R H J , Searle F , Stanway G , Jewkes R F , Jones B E , Vernon P , Bagshawe K D
Published: January 2017

131Iodine (131I) labelled antibody directed against human chorionic gonadatrophin (hCG) was given on 21 occasions to 18 patients with hCG-producing neoplasms. Tumours were localized by external scintigraphy in 13 of 21 investigations. Positive results were obtained reliably when serum hCG exceeded 500 miu/ml and in some cases sensitivity was comparable to that of computerized tomography. A positive result probably implies viability in the tumour and this was of practical value in discriminating between necrotic deposits and living tumour before surgery.
Acute Abdominal Pain in Children
Authors: Drake D P
Published: January 2017

During a twelve-month period, 416 children with acute abdominal pain required emergency admission to Southampton General Hospital; 46% had operations. Appendicitis was the commonest organic cause of acute abdominal pain identified (31%). Constipation (9%) can present as acute abdominal pain simulating appendicitis. All children should have a urine sample examined microscopically and the finding of significant pyuria is suggestive, but not diagnostic, of a urinary tract infection (7%). Mesenteric adenitis, which can only be diagnosed with certainty at laparotomy, was less common (4%). Despite careful clinical assessment and follow up, 45% of children in this series remained undiagnosed. Sedation but not analgesia may assist in the diagnosis of the acute abdomen in children.
Setting up an Outpatient Diagnostic Index
Authors: Elkington A R , Davies J C
Published: January 2017

Clinical research in ophthalmology benefits particularly from an outpatient diagnostic index. The initial planning of such an index at an eye hospital is described and details are given of how the system was set up and is currently organized.
Blood Pressure Changes Resulting from Aortography
Authors: Snowdon S L , Whitehouse G H
Published: January 2017

Patients requiring aortography frequently suffer from generalized arteriosclerosis. Uncontrolled hypotension is therefore clearly undesirable, especially if associated with myocardial depression. Significant hypotension was observed following the use of conventional ionic contrast media, Urografin 370 and Cardioconray, and occurred following every injection in this study. Metrizamide, a non-ionic contrast medium, was found to be associated with a smaller fall in blood pressure of a shorter duration.
Laser Trabeculoplasty and Decay Effects in Glaucoma Patients
Authors: Fink Austin I , Jordan Alan J
Published: January 2017

Forty patients (47 eyes) with open-angle glaucoma who had been treated by laser trabeculoplasty to help reduce intraocular pressure were reviewed. The majority of patients had been followed for at least one year. Eighty-nine percent responded satisfactorily, with an average pressure decrease of 5 mmHg. There was no evidence of decay (pressure reversal) after one year. Seventy-six percent of patients who had been on carbonic anhydrase inhibitor medication were able to discontinue this therapy after laser treatment. Blacks, aphakic and diabetic patients responded satisfactorily, but hypertensive patients and those with narrow-angle glaucoma less so. Re-lasering was successful in only one of 6 patients.
Continuous Ambulatory Peritoneal Dialysis in Systemic Amyloidosis and End-Stage Renal Disease
Authors: Browning Michael J , Banks Richard A , Harrison Peter , Tribe Colin R , Fraley Clare T , Zachary Gill , Mackenzie Campbell
Published: January 2017

Three patients with end-stage renal failure complicating systemic amyloidosis have been treated with continuous ambulatory peritoneal dialysis for periods of 10, 14 and 18 months respectively. In each case satisfactory control of uraemia and fluid balance has been achieved.
Anorexia Nervosa Presenting as Reversible Hypoglycaemic Coma
Authors: Zalin A M , Lant A F
Published: January 2017

Hypoglycaemic coma was the presenting feature in two patients with anorexia nervosa, both of whom rapidly regained consciousness following intravenous administration of glucose. This uncommon complication of malnutrition does not appear to have been reported previously in anorexia nervosa.
Lineage-Specific and Differentiation-Stage-Specific Gene Expression in Normal and Leukaemic Human Myeloid Cells
Authors: Birnie G D , Burns Jennifer H , Clark Peter , Warnock A M
Published: January 2017

One example of each of two approaches to the isolation of molecular hybridization probes and their use for the comparative investigation of gene expression and its control during differentiation of normal and leukaemic leukocytes is described. RNA preparations from the peripheral blood leukocytes of human leukaemias of various types were assayed for the relative adundance of the mRNA homologous with a cellular oncogene, c-myc. All types of leukaemia except chronic lymphatic leukaemia (CLL) showed varying levels of myc-related RNA; the highest concentrations occurred in cell populations in which blast cells predominated. In contrast, a recombinant plasmid (pCG14), isolated from a cDNA recombinant plasmid library that represented polyadenylated RNAs from the peripheral blood leukocytes of a chronic granulocytic leukaemia (CGL), hybridized with an mRNA whose occurrence is diagnostic of CGL leukocytes. This mRNA was also found in normal bone marrow cells; in both bone marrow and in CGL leukocytes, pCG14-homologous RNA occurs only in cells around the myelocyte stage in differentiation. It is suggested that these probes, and others for mRNAs whose occurrence is specific to a particular cell lineage and/or stage in differentiation, detect a new series of potential diagnostic markers. These might usefully supplement existing ones to provide a more detailed, objective subclassification of the leukaemias which could have important implications for diagnosis and therapy.
Blood Loss Associated with Ring Uncemented Total Knee Replacement: Comparison between Continuous and Intermittent Suction Drainage
Authors: Wittmann F W , Ring P A
Published: January 2017

In a retrospective comparison of blood loss following uncemented total knee replacement, in which either continuous or intermittent suction drainage was used, measured blood loss was significantly greater with continuous drainage. However, a method of calculating actual blood loss demonstrated no significant difference. With intermittent drainage, more blood remains undetected around the knee joint; this technique should therefore be abandoned in favour of continuous suction drainage.
Tympanic Epithelium: An Ultrastructural, Experimental and Clinical Study
Authors: O'Donoghue Gerard M
Published: January 2017

Ultrastructural studies of the guinea pig tympanic membrane failed to reveal specific morphological features that could be associated with migration. A staining method was used to study epithelial migration on 68 normal guinea pig tympanic membranes. A very predictable migratory pattern emerged which was neither influenced by perforation or ventilating tube insertion. Clinical studies in children on 61 normal tympanic membranes revealed a rapid migration which was unchanged by middle ear effusion. A centrifugal pattern of migration was observed in relation to the 23 chronic perforations studied. The kinetics of epithelium in relation to 41 ventilating tubes and in 23 retraction pockets is described.
Predictors of Outcome at Two Years in Patients with Rheumatoid Arthritis
Authors: Reeback Jane , Silman Alan
Published: January 2017

The prognostic value of clinical and laboratory measures in 72 patients with rheumatoid arthritis (RA), seen initially within 18 months of disease onset, in predicting function outcome after a further two years was assessed. Limitation of wrist extension was associated with a slow disease onset, a high articular index and a high latex titre. A reduction in global functional capacity, as measured by the Stanford Health Assessment Questionnaire, was associated with a high initial articular index and a high latex titre. Neither outcome was associated with the initial level of acute phase reactants nor with patient or physician's initial assessment of disease activity. It is concluded, first, that factors predicting early disability outcome in RA are not identical to those associated with continuing disease activity; and secondly, that patients' and physicians' judgment of disease activity at diagnosis do not carry any prognostic value for functional outcome two years later.
Chemoprophylaxis in Major Head and Neck Surgery
Authors: Raine C H , Bartzokas C A , Stell P M , Gallway A , Corkill J E
Published: January 2017

Wound infections are a significant complication following major oncological head and neck surgery. In view of the controversy surrounding the use of chemoprophylaxis a controlled trial was designed. Intravenous Augmentin (amoxycillin and clavulanic acid) was shown to reduce significantly ( P < 0.025) the incidence of postoperative sepsis.
Variability of Heparin Levels and Bleeding with Low-Dose Heparin Prophylaxis following Transurethral Resection of the Prostate
Authors: Day T K
Published: January 2017

Plasma heparin levels and operative/postoperative bleeding were assessed in 16 patients of varying body weights who received subcutaneous low-dose heparin prophylaxis for deep vein thrombosis during and after transurethral resection for benign prostatic hypertrophy. The concentration of heparin in the blood at operation and subsequently was found to vary widely but did not correlate with the extent of blood loss. When adjusted for body weight, plasma heparin concentration showed significantly less variation from patient to patient. In this respect, body weight was a more effective parameter than lean body mass or surface area. Adjustment of heparin dosage by body weight may be advisable when using low-dose heparin prophylaxis.
Information about Strokes Lost between Post-Mortem and Reported Cause of Death
Authors: Peach Hedley
Published: January 2017

Pathologists' opinions of cause of death given at the end of post-mortem (PM) reports have often been used to validate clinicians' death certificates. Information about strokes, common coincident conditions and complications in 120 full PM reports was compared with the pathologists' opinions of cause of death given at the end of the reports. Intracranial haemorrhage and myocardial infarction were mentioned as frequently in the cause of death as in the full PM report. On the other hand, cerebral infarction, precerebral artery occlusion, severe cerebral atheroma, coronary artery occlusion, bronchopneumonia and pulmonary embolism were all under-cited in the causes of death. Whether a pathological condition mentioned in the full PM report also appeared in the cause of death varied with the decedent's age, the extent of the condition and type of stroke. Consideration should be given to using all the information in PM reports rather than just pathologists' opinions of cause of death given at the end of PM reports when studying the validity of clinicians' death certificates.
Use of Alfentanil in Short Anaesthetic Procedures
Authors: Collins K M , Plantevin O M
Published: January 2017

The pharmacokinetics of alfentanil, a new and very short-acting opioid, are discussed. Its use in day-case gynaecological procedures is described, and the results of the initial study presented. Alfentanil is a valuable adjunct to anaesthesia for day-case surgery and for short, painful procedures.
Acute Post-Streptococcal Glomerulonephritis without Proteinuria
Authors: Hart D H L , Scheinkestel C , Whitworth J A , Kincaid-Smith P
Published: January 2017

Two cases of histologically proven acute post-streptococcal glomerulonephritis presenting as congestive cardiac failure with normal blood pressure are reported. Proteinuria was not a finding. These features are discussed.
Ramstedt's Operation in District Hospitals — Is it Safe?
Authors: McDonald P J
Published: January 2017

Over a 10-year period, 47 infants with congenital hypertrophic stenosis underwent Ramstedt's pyloromyotomy in a district general hospital. The operations were carried out by 10 surgeons-6 consultants and 4 registrars. There were 3 major wound infections and 3 incisional hernias. One infant was referred to a specialist centre for reoperation.