Intracortical haematogenous osteomyelitis.

We present an unusual case of haematogenous osteomyelitis in the diaphysis of the tibia of an adult leading to a subacute presentation with an extracortical abscess. Fluid from the abscess grew methicillin resistant Staphylococcus aureus (MRSA) on culture; MRSA with the same antibiogram had been grown from the patient's blood seven years earlier following a bowel resection. Drainage of the abscess and curettage of the bone lesion together with appropriate antibiotic therapy led to resolution of the osteomyelitis.

Learning curves in orthopaedic surgery: a case for super-specialisation?

INTRODUCTION: The objective of this study was to assess if there is a significant learning curve in the treatment of developmental dysplasia of the hip. PATIENTS AND METHODS: We followed up cases of developmental dysplasia of the hip treated by a single surgeon over a 12-year period. There were 96 cases, 56 treated by open reduction and 40 treated by closed reduction. Assessment was made of the incidence and degree of avascular necrosis in the treated hips, as a radiological outcome measure. RESULTS: Plotting the cumulative percentage of satisfactory outcomes demonstrated an increasingly high percentage of satisfactory results with increasing number of procedures performed, i.e. as the surgeon progressed up the 'learning curve'. CONCLUSIONS: This study demonstrates a learning curve in the treatment of developmental dysplasia of the hip. It may be possible to draw parallels to other treatments, and also support for the growing trend to specialisation.

Pressure characteristics of pelvic binders.

We present a study of the pressures developed at the bony prominences (greater trochanter, iliac crest and sacrum) when a pelvic binder was applied to 10 healthy individuals. The pressures developed between the pelvic binder and the skin over the prominences were all greater than the pressure recommended at interfaces to avoid the development of pressure sores. This suggests that patients with pelvic fractures who are treated with temporary pelvic binders are at risk of developing pressure sores. This should be recognised and the skin inspected if the binder is to be in place for a prolonged period.

Virological Methods for the Generation and Characterization of Influenza Viruses with Reduced Sensitivity to 4-Guanidino-Neu5Ac2en.

The compound 4-guanidino-Neu5Ac2en (zanamivir) has been described as a selective inhibitor of the influenza virus neuraminidase (NA) (1). Viruses that are less sensitive to this inhibitor can be isolated after several passages in MDCK cells in the presence of the inhibitor. Variants isolated so far have had mutations predominantly in the hemagglutinin (HA) gene (2). Many of these mutations appear to lower the affinity of the HA for the cellular receptor, so that there is less requirement for significant NA activity for the newly synthesized progeny virus to elute. There are three reports of a mutation in the NA gene, all at the same conserved site, glu 119 (3-5). In this chapter, the authors describe methods for the isolation of the mutants, and for their characterization in cell culture based assays.

Migrating to learn and learning to migrate: a study of the experiences and intentions of international student migrants.

"The research reported here evaluates whether students come to the UK mainly for educational reasons, and therefore perceive their stay as temporary, or whether emigration for study is being used as part of a conscious strategy by people intending to become future labour migrants.... The simplest interpretation of the results appears to be that migration, experienced as a result of international moves for study purposes, does not influence planning of further migration moves. But the research also indicates that migration for education is closely tied to other types of population redistribution and should be treated by population geographers as an integral part of international migration systems." Data were collected by questionnaire survey from 349 engineering students at Hong Kong universities and 82 Hong Kong students studying engineering in the UK.

The British who are not British and the immigration policies that are not: the case of Hong Kong.

"While 'closed-door' immigration policies are adopted by most countries, 'exceptionalist' legislation is often made to permit entry of special immigrant groups. An example is the British Nationality (Hong Kong) Act 1990, which was passed in the run-up to the change in sovereignty of Hong Kong in 1997. Britain's increasingly restrictive immigration policies prior to 1990 [have] resulted in the majority of Hong Kong citizens having British nationality (as British Dependent Territories citizens) but without the right of abode in the U.K. The 1990 Act conferred full British citizenship status on 50,000 heads of households in Hong Kong." The authors conclude that "in a world of marked global inequalities, immigration pressure will become even more extreme and is likely to produce an increasing number of cases of exceptionalist immigration legislation in countries with both ¿open' and 'closed'-door policies.'

Discourse on migration and ethnic identity: interviews with professionals in Hong Kong.

"This paper has revealed a complex set of relationships between migration, place and ethnic identity [in Hong Kong]. On the one hand, ethnic identity is shaped by the places where people have lived, particularly the places where they have spent the early years of their life; on the other [hand], places--being the context for socialization--provide the milieux where people learn who and what they are and how to act...." The authors note that "while legislation clearly regulates levels of immigration, international migration is also self-regulated by potential migrants in relation to interpretations of their ethnic identities and their perceptions of 'other' places."

Age-heaping: contrasting patterns from China.

"The purpose of this article is to draw attention to the remarkable variation in the accuracy of age reporting in China's 1982 census data, between the nation as a whole and one of its constituent provinces, namely the Uygur Autonomous Region of Xinjiang." The authors find that "the standard of age reporting among the Han Chinese, and among many of the ethnic minorities, is very good....However,...in the Xinjiang Autonomous Region, age heaping and age exaggeration are as bad as they are in many other developing countries. The authors show that the poor quality of age reporting in Xinjiang is confined to three of the region's ethnic communities, the Uygur, Kirgiz and Tajik...."

(-)-2'-deoxy-3'-thiacytidine is a potent, highly selective inhibitor of human immunodeficiency virus type 1 and type 2 replication in vitro.

The (-)-enantiomer of 2'-deoxy-3'-thiacytidine (3TC) was found to be a potent and selective inhibitor of human immunodeficiency virus types 1 (HIV-1) and 2 (HIV-2) in vitro. We determined its antiviral activity against a number of laboratory strains of HIV-1 and HIV-2 in a range of CD4-bearing lymphocyte cell lines (mean 50% inhibitory concentration [IC50] range, 4 nM to 0.67 microM). 3TC was also active against a range of HIV-1 strains in peripheral blood lymphocytes (mean IC50 range, 2.5 to 90 nM). The IC50 for cytotoxicity in seven lymphocyte cell cultures, including human peripheral blood lymphocytes, ranged from 0.5 to 6 mM. 3TC had no detectable antiviral activity against a range of other viruses or in cells chronically infected with HIV-1 or HIV-2. The effects of time of addition of the compound and varying the multiplicity of infection on the antiviral activity of 3TC were determined. The results showed that 3TC is a potent and selective inhibitor of HIV-1 and HIV-2 replication in vitro.

The demographic responses to famine: the case of China 1958-61.

The author uses recently available official data from China to examine the demographic impact of the previously unpublicized famine that occurred during the period 1958-1961, after the Communists came to power. "Over the four years..., China suffered some 25-30 million more deaths and experienced some 30-35 million fewer births than might have been expected under normal conditions."

Mainland China: a national one-child program does not exist (part two).

PIP: This is part 2 of a 2-part paper discussing mainland China's 1-child policy. In part 1, Jowett argues that a national 1-child program does not exist in China. Instead, China has a series of regional policies which vary between and within provinces. Part 2 discusses these variations in childbearing policy. 1 table contrasts the developed coastal province of Liaoning and the underdeveloped interior province of Guizhou. In Liaoning, more than 75% of the women are literate, and infant mortality is less that 20/1000. In Guizhou, fewer than 33% of the women are literate, and infant mortality is over 60/1000. The per capital gross national product is 4.5 times higher in Liaoning. The birth rate is almost 10 points higher and the fertility rate almost 2.5 times greater in Guizhou than in Liaoning. The defiance of the 1-child policy is partially linked to the shift in social values taking place in mainland China. A trend toward earlier marriage and earlier childbearing has contributed to the rising birth rates in the 1980s. Unlike the outcome of the student protests in Tiananmen Square, conflict over family size has generally been resolved in favor of individual wished rather than government objectives.^ieng

Mainland China: a national one-child program does not exist (part one).

PIP: This is part 1 of a 2-part paper examining mainland China's national 1- child program. Jowett argues that mainland China is not pursuing a national 1-child policy. As a result, there is no possibility that the People's Republic can keep its population within the 1.2 billion target for the year 2000. The target has already been raised to 1.25 billion and some Chinese demographers are speaking of a 1.3 billion population by 2000. 1-child policies do exist in China, as do 2-child policies, 3- child policies, 1-son policies, and no population policies at all. There is no national policy, but a series of regional policies which vary between and within provinces. Resistance to restrictive policies has been greatest in the rural areas of China. About 75% of China's population live in the rural areas and work in agriculture. These rural families require more children to work in the fields. The conflict between the government's desire to restrict childbearing and the population's desire for more children has generated defiance and deception. Some women have their IUDs removed illegally. Family planning workers are threatened and physically assaulted. Birth in excess of quota are not registered. Part II of this paper discusses the regional differences between population policies and practices in China.^ieng

Patterns of literacy in the People's Republic of China.

"The recent publication of data from the 1982 census permits an assessment of the patterns, progress and problems of illiteracy in China. Educational progress, since the communists came to power in 1949, has been particularly impressive, especially in relation to the low levels of income within the People's Republic. Nevertheless, nearly a third of the country's population are still unable to read and write and major variations in literacy exist between the developed and less developed regions, between men and women, between the urban and rural areas, between the various age groups and among the many ethnic groups that constitute the People's Republic of China.... By stressing the value of labour, including child labour, the agricultural responsibility system has generated a surprising decline in school attendance which may jeopardise future improvements in literacy, particularly so among the poorer people in the poorer areas of China."

China: population change and population control.

PIP: Changes in population trends and policy in China since 1949 are reviewed. Having noted the devastating demographic impact of events occurring during the years 1958-1961, the author focuses on the development of the antinatalist policy and program since the 1970s. It is observed that the total fertility rate declined from 6.4 in 1968 to 2.2 in 1980 and the level of contraceptive usage rose to levels currently experienced in the developed world. Consideration is also given to changes in age at marriage and female education, the impact on fertility of successful socioeconomic development, and differences between rural and urban areas.^ieng