A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction.

METHOD: The cosmetic and psychological outcomes of patients who underwent reconstructive surgery, conservative surgery or simple mastectomy for breast cancer between 1995 and 2002 were compared. RESULTS: There was a significant correlation between good psychological adjustment and good cosmetic outcome scores (p=0.01-0.05). There was no difference in cosmetic outcome between different reconstruction methods. Reconstruction patients rated their cosmetic outcome better than conservative surgery patients, and conservative surgery patients better than mastectomy patients. There were no differences in psychological outcome between patient groups. CONCLUSION: Good perception of cosmetic outcome is associated with good psychological adjustment. There is no cosmetic advantage of one type of reconstruction over another. Reconstruction patients have a better body image compared with other treatment groups but there are no other psychological advantages of one type of treatment over another.

Indices of lactate threshold and their relationship with 10-km running velocity.

PURPOSE: The object of this study was to determine the relationship of three measures of running velocity at lactate threshold (LT) with 10-km running velocity. The methods used to determine LT velocity (m.s(-1)) during submaximal treadmill running were: 1) LT(1), the velocity preceding two consecutive increases in blood lactate > or = 1 mmol.L(-1); 2) LT(D), the velocity associated with the maximum perpendicular distance between the nonlinear regression line and the straight line formed by the two end data points of the blood lactate profile; and 3) LT(4), the velocity corresponding to a blood lactate concentration of 4 mmol.L(-1). METHODS: Thirty competitive and recreational runners (11 female and 19 male) undertook two 10-km time trials (7 d apart), three treadmill familiarization sessions over the following 21 d, and then completed an incremental submaximal treadmill run. From blood lactate samples taken during the submaximal run, mean LT velocity (+/- SD) at LT(1) (3.76 +/- 0.57), LT(D) (3.79 +/- 0.58), and LT(4) (4.11 +/- 0.64) was determined. Pearson product moment correlation analysis revealed a strong relationship between all mean LT speeds and mean 10-km running velocity (3.77 +/- 0.57), with the strongest relationship observed for LT(D) (r = 0.86, P < 0.001). Correlations by gender between LT(D) and 10-km velocity were r = 0.84 (female) and r = 0.78 (male). Male subjects had significantly higher LT velocities than female subjects using all methods (P < 0.001), and velocity at LT(4) was significantly faster than 10-km velocity and velocity at LT(1) and LT(D) (P < 0.001). CONCLUSION: Of the methods measured, LT(D) appears to be the most sensitive and valid measure of LT velocity and may be of benefit in monitoring the training program of 10-km distance runners.

Correlation between gastric irritancy and anti-inflammatory activity of non-steroidal anti-inflammatory drugs.

Gastric irritancies and anti-inflammatory potencies of 25 commercially available non-steroidal anti-inflammatory drugs (NSAIDs) have been measured in the rat. When irritancy is measured as the dose required to produce a specified level of gastric mucosal damage, it is found that irritancy increases with anti-inflammatory potency. However, when irritancy is measured as the level of gastric mucosal damage at the anti-inflammatory ED50 (which is a clinically realistic measure) then irritancy decreases as anti-inflammatory potency increases. Hence it should be possible to design high-potency, low-irritancy NSAIDs.

Quantitative modelling and prediction of development times of the free-living stages of Ostertagia ostertagi under controlled and field conditions.

The development of the free-living stages of Ostertagia ostertagi incubated at constant temperatures from 5 to 27 degrees C and in dung pats in the field was observed. The death rates were adequately described by a single exponential functional and the distribution of times for development by a delayed gamma density function. The times of appearance of selected development stages such as maximum numbers of embryonated eggs and half the maximum number of infective larvae, were highly dependent on temperature. The relationships between these times and temperature were adequately described by the Arrhenius equation. The parameters of this equation and mean hourly temperature recorded in dung pats in the field were used to predict development times in the field. A comparison of predicted and observed times showed that an initial delay accounted for a large proportion of the time required for development in dung pats, particularly the embryonation of eggs. This delay was attributed to lack of aeration associated with high moisture content of the dung pat.

A model for statement of privileges of medical students within the AHEC systems.

A combination of factors has resulted in medical students being placed in hospitals not accustomed to their presence. These factors include expansion of the number of medical students in United States schools, an increasing emphasis on primary care education, and the strengthening of medical education programs in hospitals and area health education centers (AHEC) not previously utilized as medical education facilities. The introduction of the students has caused some confusion in these hospitals which may contribute to less than optimal medical education. Some of the confusion is attributable to the lack of a clearly defined role for the medical student and the lack of delineation of the responsibility of other personnel in providing and permitting student access to the system. Presented here is a model of privileges and responsibilities which has been introduced in an AHEC with positive effects on the quality of medical education and improvement of interdisciplinary relations.