Contrast-enhanced CT facilitates rapid, non-destructive assessment of cartilage and bone properties of the human metacarpal.

OBJECTIVE: The aim of this work is to establish the human metacarpal as a new whole joint surface early-stage osteoarthritis (OA) model that enables comparisons of articular cartilage and subchondral bone through high resolution contrast-enhanced CT (CECT) imaging, mechanical testing, and biochemical analysis. DESIGN: The fourth metacarpal was obtained from 12 human cadaveric donors and baseline µCT imaging was followed by indentation testing. The samples were then immersed in anionic (Ioxaglate) and cationic (CA4+) iodinated contrast agent solutions followed by CECT. Cartilage GAG content and distribution was measured using the 1,9 dimethylmethylene blue (DMMB) assay and Safranin-O histology staining. Linear regression was performed to compare cartilage and subchondral bone properties. RESULTS: Strong and significant positive correlations were observed between CA4+ CECT attenuation and both GAG content (R(2) = 0.86) and equilibrium modulus (R(2) = 0.84), while correlations using Ioxaglate were insignificant (R(2) ≤ 0.24, P > 0.05). Subchondral bone plate (SBP) thickness negatively and significantly correlated with SBP mineral density (R(2) = 0.49). Cartilage GAG content significantly correlated with several trabecular bone properties, including positive correlations with bone volume fraction (%BV/TV, R(2) = 0.67), trabecular number (Tb.N, R(2) = 0.60), and trabecular thickness (R(2) = 0.42), and negative relationships with structural model index (SMI, R(2) = 0.78) and trabecular spacing (Tb.Sp, R(2) = 0.56). Similarly, equilibrium modulus correlated positively with %BV/TV (R(2) = 0.50), Tb.N (R(2) = 0.59) and negatively with Tb.Sp (R(2) = 0.55) and SMI (R(2) = 0.60). CONCLUSION: This study establishes the human metacarpal as a new early-stage OA model suitable for rapid, high resolution CECT imaging, mechanical testing, and biochemical analysis of the cartilage and subchondral bone, and for examining their inter-relationships.

Supporting breastfeeding: how to implement agency change.

Health care agency policies and protocols that negatively influence breastfeeding initiation and continuance can be changed to provide a supportive milieu for breastfeeding mothers and their infants. This change must be systematic and purposeful to be effective. Agency personnel must become aware of the need for change and be guided by a credible change agent through a process of goal-setting, assessing the present, educating staff, educating consumers, assessing and documenting care, and evaluating results. Outcome and continuing evaluation can be measured against the WHO/UNICEF's (World Health Organization and United Nations International Children's Emergency Fund) "Ten Steps to Successful Breastfeeding."

Snap-Gauge band vs multidisciplinary evaluation in impotence assessment.

This study compares the findings of multidisciplinary evaluation to the two-night use of the Snap-Gauge band in 100 impotent men. An organic etiology was diagnosed in 52 percent of those evaluated. The Snap-Gauge band proved accurate as a screening device for organic disease. If no elements were broken over the two-night period, this finding correlated with multisystemic diagnosis of organic etiology in 86 percent of cases. Among the 52 patients in whom an organic etiology was diagnosed, 32 broke no elements for a 62 percent sensitivity. When more than one element was broken, the predictive value as to etiology of the erectile dysfunction diminished.

Snap-Gauge band versus penile rigidity in impotence assessment.

We examined the ability of the Snap-Gauge band to differentiate rigid from nonrigid erections in men complaining of impotence. A total of 80 patients was measured by a Snap-Gauge band and via technician assessment of erectile rigidity while undergoing nocturnal penile tumescence testing. The Snap-Gauge band correctly diagnosed 77.5 per cent of the patients with a sensitivity of 70 per cent and specificity of 80 per cent. The Snap-Gauge band is inexpensive compared to sleep laboratory testing and it is relatively reliable. We conclude that the Snap-Gauge band has a role in impotence assessment and it can function as a screening device in evaluation of this problem.

Secondary school students' attitudes and beliefs about breastfeeding.

The incidence and prevalence of breastfeeding has increased in the United States and Canada in the past decade, but in spite of its known benefits it is often abandoned before infants are two months of age. Society lacks the attitudes and knowledge necessary for breastfeeding success. A survey of the knowledge, beliefs and attitudes of 409 secondary school students in British Columbia, Canada, revealed misconceptions about the nature of breastfeeding. A high percentage felt it was unacceptable in social situations. The findings point to a need for the integration of information about breastfeeding into school health programs, biology, home economics/nutrition and family life/sexuality courses. Increased knowledge and discussion to foster positive attitudes could increase breastfeeding duration among parents in the future.

PIP: The incidence and prevalence of breastfeeding has increased in the United States and Canada in the past decade, but in spite of its known benefits it is often abandoned before infants are 2 months of age. Society lacks the attitudes and knowledge necessary for breastfeeding success. Most mothers assume that one either can or cannot breastfeed. They know little about normal or optimal frequency and duration of feeding and the supply and demand principle of the lactation process. The result is the early discontinuance of breastfeeding due to perceived insufficient milk. A survey of the knowledge, beliefs and attitudes of 409 secondary school students in British Columbia, Canada, revealed misconceptions about the nature of breastfeeding. The majority believed that it was an instinct rather than a socially learned behavior. Another misconception, although to a lesser degree, was the belief that breastfeeding capability is related to breast size. A prevalent belief (among 1/6 of the students) is that breastfeeding is associated with the lower socioeconomic class. This association is likely an extension of the belief that breastfeeding is "uncivilized." The survey also revealed a difference in the desired duration of breastfeeding compared to bottlefeeding. This is likely a reflection of observed feeding behavior in society. One does not see any older babies being breastfed openly while older infants and toddlers holding bottles are frequently observed. Also, a large % of women discontinue breastfeeding by the time their infants are 3 months old. These factors contribute to the feeling among students that breastfeeding is unacceptable in social situations. The findings point to the need for the integration of information about breastfeeding into school health programs, biology, home economics/nutrition and family life/sexuality courses. Increased knowledge and discussion to foster positive attitudes could increase breastfeeding duration among parents in the future.