Vascularized Composite Allograft Donation and Transplantation: A Survey of Public Attitudes in the United States.

Vascularized composite allograft (VCA) transplantation has emerged as a groundbreaking surgical intervention to return identity and function following traumatic injury, congenital deformity, or disfigurement. While public attitudes toward traditional organ/tissue donation are favorable, little is known about attitudes toward VCA donation and transplantation. A survey was conducted of 1485 U.S. residents in August 2016 to assess VCA donation attitudes. Participants also completed the Revised Health Care System Distrust Scale. Most respondents were willing to donate hands/forearms (67.4%) and legs (66.8%), and almost half (48.0%) were willing to donate the face. Three-quarters (74.4%) of women were willing to donate the uterus; 54.4% of men were willing to donate the penis. VCA donation willingness was more likely among whites and Hispanics (p < 0.001), registered organ/tissue donors (p < 0.001), and those with less health care system distrust (p < 0.001) and media exposure to VCA transplantation (p = 0.003). Many who opposed VCA donation expressed concerns about psychological discomfort, mutilation, identity loss, and the reaction of others to seeing familiar body parts on a stranger. Attitudes toward VCA donation are favorable overall, despite limited exposure to VCA messaging and confusion about how VCA donation occurs. These findings may help guide the development and implementation of VCA public education campaigns.

La flexicorticotomia como procedimiento para la mesialización de un molar inferior en pacientes adultos: reporte de un caso / Flexicorticotomy as a procedure for mesial movement of molars in adults

La mesialización de segundos molares al espacio residual del primer molar extraído, parece una tarea muy inteligente, pero muchas veces, nada sencilla de realizar, especialmente cuando la extracción del primer molar es de larga data y las corticales óseas se encuentran fusionadas, dejando muy poco hueso esponjoso para remodelar, enlenteciendo, y muchas veces, impidiendo el movimiento ortodóncico. El propósito de este artículo consiste en definir y mostrar un caso donde se llevó a cabo la técnica de flexicorticotomía alveolar para lograr la mesialización de un segundo molar inferior, al espacio edéntulo del primero en una paciente femenina de 42 años. Discusión: se realizó el cierre ortodóncico del espacio edéntulo al mesializar el segundo molar permanente, se disminuyó el período de tratamiento, y se logró estabilidad oclusal del paciente

The mesial movement of the second molar to the first molar residual space removed, seems a task very smart, but often, not simple to do, especially when the first molar extraction is longstanding and cortical bone are fused, leaving little cancellous bone to remodel, slowing, and often preventing orthodontic movement. The purpose of this article is to define and show a case where conducted technique of flexicorticotomy for mesial movement of a lower second molar, to the first edentulous space of a female patient of 42 years. Discussion: orthodontic closure was achieved edentulous space to mesialize the second permanent molar, decreased the period of treatment, and the occlusal stability of the patient

Aceleración del movimiento ortodóntico mediante corticotomías alveolares / Orthodontic movement acceleration with alveolar corticotomies

Los dientes se mueven a través del hueso, generando tejido óseo en el lado de tensión y removiendo el mismo en el lado de presión, en respuesta a cargas terapéuticas y funcionales, proceso llamado remodelación ósea. Esta remodelación ósea depende de múltiples factores como la densidad y la consistencia de los maxilares, la edad del paciente, entre otros y en algunos casos, se ve comprometida, por defectos óseos, corticales alveolares fusionadas, dientes anquilosados o impactados, entre otros. Por todo esto, se ha propuesto el uso de corticotomías alveolares para coadyuvar el movimiento ortodóncico y se ha utilizado en pacientes de todas las edades, para ayudar a reducir notablemente el lapso de tiempo del tratamiento, y en muchos casos, lograr movimientos que antes eran prácticamente imposibles de realizar. Este artículo tiene por objeto examinar la bibliografía relativa a la corticotomía, como técnica quirúrgica que permite la aceleración del movimiento ortodóncico. El análisis de esto, permite concluir que, la corticotomía alveolar pudiese servir como coadyuvante en el movimiento de ortodoncia en algunos casos, acelerando el mismo hasta un 30 % y permitiendo el paso de los dientes a través del hueso esponjoso de manera más eficiente, y en otros casos pudiendo realizar movimientos ortodóncicos que son difíciles de lograr sin la realización de corticotomías

Teeth move through bone, causing new bone tissue at the side of tension and stirring the same on the pressure side, in response to therapeutic and functional loads, a process called bone modeling. This bone modeling depends on many factors such as density and consistency of the jaws, age of the patient, and in some cases, those factors are compromised by bone defects, collapse in cortical tables, impacted and ankylosed teeth. For all this, it has been proposed the use of alveolar corticotomies to assist orthodontic tooth movement which has been used in patients of all ages, helping significantly in the reduction of treatment time period, and also allowing movements that were previously virtually impossible. This article aims to review the literature on the corticotomy, as a surgical technique that allows accelerated orthodontic movement. The analysis allow to conclude, that the alveolar corticotomy could help in the acceleration of orthodontic movement in some cases until 30%, allowing teeth to pass through the spongy bone more efficiently, and in other cases carrying out orthodontic movements that are difficult to achieve without the realization of corticotomies

Improved photoluminescence of vertically aligned ZnO nanorods grown on BaSrTiO3 by pulsed laser deposition.

ZnO nanorods were grown on a variety of substrates such as Si, SiO(2)/Si and sapphire in a large-area pulsed laser deposition chamber designed for sensor device fabrication. Processing conditions were optimized to grow ZnO nanorods with or without seed layers. Au, Cr and BaSrTiO(3) (BST) seed layers were investigated to compare their effects on the diameter and orientation of ZnO nanorods. ZnO nanorods were observed to align better when grown on sapphire, Cr or BST seed layers as compared to Au or Si layers. The highest quality nanorods were those grown on BST seed layers, as shown by 4 K photoluminescence donor-bound-exciton linewidths of only 0.5 meV.

Cost consequences of elimination of the routine group B streptococcus culture at a teaching hospital.

OBJECTIVE: To evaluate the cost consequence of the elimination of routine Group B streptococcus (GBS) cultures in pregnancy utilizing risk factor assessment management recommendations of the Center for Disease Control. METHODS: This retrospective study cohort population included all delivering patients from June 1, 1996, to May 31, 1997, managed by the Morbidity Mortality Weekly Report (MMWR) guidelines May 31, 1996, for GBS in pregnancy compared to the previous 29 months cohort from January 1, 1994, to May 31, 1996, managed with routine GBS cultures done at 35-37 weeks. RESULTS: Of the 7,681 culture management control cohort patients, there were four neonates with culture-positive GBS sepsis (1/1,900). The cost for detection of a single positive culture in an affected neonate was $8,627 ($34,509/4) and there were 2,875 personnel hours expended. In contrast, of the 2,011 patients in the risk factor management cohort, there were two cases of neonatal GBS sepsis ($111,005). The cost for detection of a positive culture in an affected neonate was $1,579 ($3,159/2) and there were 263 personnel hours expended in the risk factor management group. In spite of these significant laboratory savings, we noted a concurrent increase in the total cost in the newborn nursery for septic work-ups and treatment from $2.4 million to $3.1 million. CONCLUSION: Risk assessment management of GBS provided a savings of both money ($7,048/positive neonatal culture) and laboratory time (586 personnel hours/positive neonatal culture). However, these savings were more than offset by cost increases occurring in the newborn nursery ($400,000), demonstrating the necessity of practice patterns to undergo concurrent evaluation to verify cost savings and prevent shifting of expenses.

Felodipine as an alternative to more expensive calcium antagonists in mild to moderate hypertension.

We studied the therapeutic substitution of a less expensive but equally effective antihypertensive agent and assessed patient outcome. The medication of 39 patients with hypertension was changed from once-daily diltiazem hydrochloride (Cardizem CD) or nifedipine (Procardia XL) to felodipine (Plendil). Titration to a final dose was based on home and office blood pressure measurements assessed over subsequent follow-up clinic visits. Self-administered questionnaires measured different aspects of well-being and symptoms before and after the change in medication. Eighty percent of the cohort switched successfully to felodipine. Office systolic and diastolic pressures improved after the medication change (systolic: 150 mm Hg versus 144 mm Hg; diastolic: 92 mm Hg versus 87 mm Hg). No statistically significant differences were found among the 39 symptoms measured. A yearly savings potential for our institution was estimated to be $72,000.

Cost savings using a stepped-care prescribing protocol for nonsteroidal anti-inflammatory drugs.

OBJECTIVE: To lower nonsteroidal anti-inflammatory drug (NSAID) costs while maintaining quality patient care and clinician satisfaction. DESIGN: Before and after 21-month trial with one study site and two control sites and a questionnaire that was sent to 203 clinicians. SETTING AND SUBJECTS: Two military medical centers and two affiliated primary care clinics. All beneficiaries filling outpatient NSAID prescriptions. INTERVENTIONS: An NSAID prescribing protocol was implemented requiring a trial of either ibuprofen or indomethacin before new prescription of more expensive NSAIDs. One control center used an NSAID computer cost-prompt and the other had no intervention. MAIN OUTCOME MEASURES: The proportion of expensive NSAIDs prescribed at each institution and total NSAID costs adjusted for prescription volume. Clinician acceptance and patient impact were assessed by the questionnaire. RESULTS: Study site clinicians (n=158) reported very few protocol-related patient care problems. A minority (9%) of study site clinicians considered the protocol very bothersome, and only 2% felt it should be discontinued. Quarterly use of expensive NSAIDs at the study site fell from 34% to 21%, decreasing costs by 30% (P<.001). In contrast, the site with a computer cost-prompt had only a 5% decrease in NSAID costs, while costs at the site with no intervention increased 2%. CONCLUSIONS: For drugs with similar benefits and adverse effects, a "stepped formulary" approach requiring an initial trial of one of the less expensive agents can maintain physician prescribing choices and satisfaction while lowering costs.