A rare case of pycnodysostosis: Technical difficulties in managing long bone fractures.

Pycnodysostosis is a rare inherited disorder of autosomal recessive trait causing cathepsin K deficiency, leading to failure of osteoclastic activity. Brittle and sclerotic bones which are prone for frequent fractures is the characteristic feature of this congenital disorder. Despite good healing potential there are few issues in the management of fractures in pycnodysostosis patients. In this article we report the challenges faced in managing a fracture of the femoral shaft in a 12 year old girl with pycnodysostosis. For early rehabilitation and to avoid deformity and shortening, we opted for surgical fixation over conservative treatment. Narrow medullary canal ruled out the option for titanium elastic nail fixation. 4.5mm dynamic compression plate was used to fix the fracture. Sclerotic bone made drilling extremely difficult. Deformed femoral shaft allowed plating over the anterior surface only, instead of the routine lateral surface plating. Postoperative fracture healing was satisfactory. Implant was removed after 18 months.

Sarma phase in trapped unbalanced fermi gases.

We consider a trapped unbalanced Fermi gas at nonzero temperatures where the superfluid Sarma phase is stable. We determine, in particular, the phase boundaries between the superfluid, normal, and phase-separated regions of the trapped unbalanced Fermi mixture. We show that the physics of the Sarma phase is sufficient to understand the recent observations of Zwierlein et al. [Science 311, 492 (2006); Nature (London) 442, 54 (2006)] and indicate how the apparent contradictions between this experiment and the experiment of Partridge et al. [Science 311, 503 (2006)] may be resolved.

Dressed Feshbach molecules in the BEC-BCS crossover.

We present the random phase approximation (RPA) theory of the Bose-Einstein-condensation-Bardeen-Cooper-Schrieffer crossover in an atomic Fermi gas near a Feshbach resonance that includes the relevant two-body atomic physics exactly. This allows us to determine the probability for the dressed molecules in the Bose-Einstein condensate to be in the closed channel of the Feshbach resonance and to compare with the recent experiments of Partridge et al. [95, 020404 (2005)10.1103/PhysRevLett.95.020404] with , who have measured the same quantity.

Quantum phase transition in an atomic bose gas with a feshbach resonance.

We show that in an atomic Bose gas near a Feshbach resonance a quantum phase transition occurs between a phase with only a molecular Bose-Einstein condensate and a phase with both an atomic and a molecular Bose-Einstein condensate. We show that the transition is characterized by an Ising order parameter. We also determine the phase diagram of the gas as a function of magnetic field and temperature: the quantum critical point extends into a line of finite temperature Ising transitions.

Impact of managed care on obstetrician-gynecologists' practice: the providers' perspective.

The American College of Obstetricians and Gynecologists' 1998 Socioeconomic Survey of Fellows included questions, developed in collaboration with the Jacobs Institute of Women's Health, to assess the impact of managed care on respondents' practices and patients. Participation in managed care is extensive among obstetricians and gynecologists (ob/gyns), especially in commercial managed care plans. The greatest areas of dissatisfaction for physicians were administrative workload, external review of clinical decisions, and promptness of payment. More research is needed to determine the impact of administrative burdens, restrictions on access to ob/gyns, and denial of coverage on women's receipt of timely and appropriate services.

Gender and patient satisfaction in managed care plans: analysis of the 1999 HEDIS/CAHPS 2.0H Adult Survey.

This paper investigates gender differences in satisfaction, and in the variables associated with satisfaction, using the Consumer Assessment of Health Plans Study (CAHPS) adult questionnaire administered by the National Committee for Quality Assurance (NCQA) as part of HEDIS 1999. Data represent 97,873 men and women enrolled in 206 commercial managed care plans nationwide. Mean plan-level gender differences in satisfaction measures are small, with no consistent pattern of one gender being more satisfied than the other. Controlling for health plan, member, utilization, and selected HEDIS performance indicators, health plan characteristics account for the largest proportion of variance explained in satisfaction. Not-for-profit status and lower turnover of primary care providers are stronger determinants of women's than men's satisfaction. We conclude that it can be useful to analyze CAHPS scores by gender to identify areas for quality improvement in women's health care.

Delivering breast and cervical cancer screening services to underserved women: Part II. Implications for policy.

Many breast and cervical cancer screening (BCCS) programs for underserved women employ strategies to increase the use of preventive services. In Phase I of a two-phase study, strategies were identified and assessed. In Phase II, we further assess strategies previously identified and comment on policy implications. Site visits were conducted at BCCS programs that had used one successful strategy identified during Phase I, provided services to underserved women, and were located in different geographic regions. The federally funded National Breast and Cervical Cancer Early Detection Programs (NBCCEDP) were also considered for site visits. Interviews were completed and available data were reviewed. A descriptive and qualitative analysis was completed. Programs visited were found to be increasing the use of BCCS services for the defined target populations. Some programs focused on outreach and recruitment. Other programs focused on clinical preventive services with little emphasis on outreach and recruitment. Management information systems were used by most programs. We found that there continues to be a large number of women not receiving BCCS services. Some programs have had to limit outreach and recruitment because the clinical preventive services offered are at capacity. Programs need to have a balanced approach to providing services from the outset. Existing programs may need to establish partnerships to provide comprehensive BCCS services to underserved women. Because the unmet need (women who have not received BCCS services) exceeds available clinical preventive services, it is a challenge to know how to best use available resources.

Delivering breast and cervical cancer screening services to underserved women: Part I. Literature review and telephone survey.

Although breast and cervical cancer screening procedures have been shown to reduce morbidity and mortality, many women are not using these services. These women are likely to be older, of ethnic or racial minority, of low socioeconomic status, less educated, underinsured, or living in rural locations. Many breast and cervical cancer screening programs employ strategies to increase use. In order to identify and assess those strategies, we reviewed the literature and completed a telephone survey, altogether assessing 61 programs. Our study identified several strategies and found that not all strategies work for all women. Management systems directed to both patients and providers consistently are effective for most underserved women. Community-based outreach and integration of preventive services at the primary health care (PHC) site are effective strategies for both African American and Hispanic women. Use of mass media has been successful when targeted toward Hispanic women, but not when targeted toward African American women. Mobile units and integration of preventive services at PHC sites are effective strategies for elderly women. In many cases, a combination of strategies may be effective. Programs should employ strategies best suited to their target populations.

Utilization of mammography. Social and behavioral trends.

Key policy developments in the utilization of mammographic screening for the early detection of breast cancer in the U.S. since 1973 are reviewed. Recent data from the 1990 and 1992 Mammography Attitudes and Usage Studies on attitudes toward mammography and screening behaviors among U.S. women aged 40 and older are summarized. Physician screening behavior is discussed using data from the National Cancer Institute and the American Cancer Society. The author concludes that additional efforts are needed to change screening behaviors among women and physicians and summarizes key issues for future research.

Utilization of screening mammography--1990.

Although much has been accomplished in the last few years toward the early detection of breast cancer, we are far from a goal of universal acceptance of the recommended preventive health program of screening mammography. To take an analogy from the Papanicolaou smear, we are somewhere in the 1960s. Both women and physicians have more to learn, and they need to transfer that knowledge into practice.