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We describe a case of a pregnant cisgender woman diagnosed with human immunodeficiency virus (HIV)-1 using the current Centers for Disease Control and Prevention diagnostic algorithm who subsequently had her diagnosis overturned after additional testing outside of the algorithm, including an HIV-1 proviral deoxyribonucleic acid test that was negative.

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Surmang Foundation's Clinic is located in Qinghai Province, Yushu Prefecture, Xiao Surmang Township, China. It is a remote, 97 percent ethnic Tibetan, mountainous region with little access to organized health care services. Surmang Foundation, a US 501(c)3 charity, has organized a cadre of local women to provide community-based care and education to women, resulting in a notable reduction in maternal mortality based on the report of community members. A festival organized to celebrate the accomplishments of the community health workers provided an opportunity for the women to demonstrate how their roles benefit themselves and their community. Both health care services and support for community empowerment are provided through the community health worker model.

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INTRODUCTION: Surmang, Qinghai Province is a rural nomadic Tibetan region in western China recently devastated by the 2010 Yushu earthquake; little information is available on access and coverage of maternal and child health services. METHODS: A cross-sectional household survey was conducted in August 2004. 402 women of reproductive age (15-50) were interviewed regarding their pregnancy history, access to and utilization of health care, and infant and child health care practices. RESULTS: Women's access to education was low at 15% for any formal schooling; adult female literacy was <20%. One third of women received any antenatal care during their last pregnancy. Institutional delivery and skilled birth attendance were <1%, and there were no reported cesarean deliveries. Birth was commonly attended by a female relative, and 8% of women delivered alone. Use of unsterilized instrument to cut the umbilical cord was nearly universal (94%), while coverage for tetanus toxoid immunization was only 14%. Traditional Tibetan healers were frequently sought for problems during pregnancy (70%), the post partum period (87%), and for childhood illnesses (74%). Western medicine (61%) was preferred over Tibetan medicine (9%) for preventive antenatal care. The average time to reach a health facility was 4.3 hours. Postpartum infectious morbidity appeared to be high, but only 3% of women with postpartum problems received western medical care. 64% of recently pregnant women reported that they were very worried about dying in childbirth. The community reported 3 maternal deaths and 103 live births in the 19 months prior to the survey. CONCLUSIONS: While China is on track to achieve national Millennium Development Goal targets for maternal and child health, women and children in Surmang suffer from substantial health inequities in access to antenatal, skilled birth and postpartum care. Institutional delivery, skilled attendance and cesarean delivery are virtually inaccessible, and consequently maternal and infant morbidity and mortality are likely high. Urgent action is needed to improve access to maternal, neonatal and child health care in these marginalized populations. The reconstruction after the recent earthquake provides a unique opportunity to link this population with the health system.

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Complexes of technetium with diphosphonate ligands are widely used for the imaging and diagnosis of bone disease and most especially metastatic bone cancer. Analogous complexes of radioactive rhenium ((186)Re) with the ligand H(4)HEDP, 1,1-hydroxyethylidenediphosphonate, have been shown to be effective palliatives for the treatment of the intense pain associated with metastatic bone cancer. We have synthesized several of these analogs using nonradioactive Re and have structurally characterized them using EXAFS (extended X-ray absorption fine structure) spectroscopy. One complex synthesized via the substitution reaction of HEDP with trans-[(py)(4)(O)(2)Re]Cl in absolute ethanol appears to be the 1:1 salt of the tris-HEDP complex anion with the starting Re cation, [(py)(4)(O)(2)Re][Re(H(2)HEDP)(3)]. Three other materials, all synthesized via reduction of perrhenate by stannous chloride in the presence of excess H(4)HEDP ligand, are quite different in structure from the material formed by substitution. The principal difference is that each of these contains Re-Re bonds and is formulated as oligomers. The material with a large excess of reductant has Re-Re bonds of ca. 2.4 Å and is best modeled as a linear tetramer of rhenium atoms bridged by HEDP ligands which also bind an equivalent number of tin atoms with additional HEDP ligands. It is formulated as Li(x)()[Re(4)(OH)(2)Sn(4)(HEDP)(12)]. The material formed with the least amount of reducing agent is best modeled as a triangular cluster of rhenium atoms bicapped by two HEDP ligands and bridged to three tin atoms by HEDP to form a complex Li(x)()[Re(3)Sn(3)(HEDP)(8)]. It also has Re-Re bonds but of a significantly longer distance, ca. 2.8 Å. A material with an intermediate amount of reducing agent, prepared in a manner most closely resembling the medically effective palliative agent, appears to contain a mixture of these, and perhaps other, oligomers.