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AIMS: Posterior tilt of the pelvis with sitting provides biological acetabular opening. Our goal was to study the post-operative interaction of skeletal mobility and sagittal acetabular component position. MATERIALS AND METHODS: This was a radiographic study of 160 hips (151 patients) who prospectively had lateral spinopelvic hip radiographs for skeletal and implant measurements. Intra-operative acetabular component position was determined according to the pre-operative spinal mobility. Sagittal implant measurements of ante-inclination and sacral acetabular angle were used as surrogate measurements for the risk of impingement, and intra-operative acetabular component angles were compared with these. RESULTS: Post-operatively, ante-inclination and sacral acetabular angles were within normal range in 133 hips (83.1%). A total of seven hips (4.4%) had pathological imbalance and were biologically or surgically fused hips. In all, 23 of 24 hips had pre-operative dangerous spinal imbalance corrected. CONCLUSIONS: In all, 145 of 160 hips (90%) were considered safe from impingement. Patients with highest risk are those with biological or surgical spinal fusion; patients with dangerous spinal imbalance can be safe with correct acetabular component position. The clinical relevance of the study is that it correlates acetabular component position to spinal pelvic mobility which provides guidelines for total hip arthroplasty. Cite this article: Bone Joint J 2017;99-B(1 Supple A):37-45.

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OBJECTIVE: To demonstrate in a group of 26 patients with benign stenosis of the trachea the possibility to use a Palmaz stent as the method of choice. MATERIAL AND METHODS: The authors introduced since 1995 to patients with benign stenosis of the trachea 36 stents (1 Wallstent, 2 Z stents and 33 Palmaz stents). The operation was performed under general anaesthesia in an operating theatre under skiascopic and optic control. The stent was inserted along a guide. Before insertion of the stent they dilated the stenosis by means of a balloon dilatation catheter. RESULTS: Respiration improved in all patients within 6 days after introduction of the stent. Within 30 days after insertion of the stent none of the patients died. Two patients (7.7%) died four weeks (Palmaz stent) and 11 months (Wallstent) after insertion of the stent. Restenosis was observed in 9 patients (34.6%) 2-16 weeks after introduction of the stent. In 5 patients restenosis developed repeatedly. At present 19 patients (73%) are free from complaints for 1 month to 4 years after insertion of the stent (average 28 months). 5 patients (19%) had a tracheostomy and insertion of the stent in these patients did not produce so far the anticipated result. CONCLUSION: The authors assume that the use of Palmaz stent is in patients with benign stenosis of the trachea in indicated cases the method of choice.

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The authors used between October 1993 and January 1997 in 131 patients with inoperable malignant or benign stenosis of the oesophagus an expansible metal stent. In 25 patients the stenosis was in the upper third of the oesophagus, in 44 in the medium part, in 53 in the lower third of the oesophagus and in 9 patients in the area of the anastomosis. All patients suffered at the time when the stent was introduced from marked dysphagia (stage 3-4 according to the international classification). In 45 patients the authors introduced more than one stent. 112 patients suffered from malignant stenosis (67 squamous cell carcinoma, 27 adenocarcinoma, 9 pulmonary or bronchogenic carcinoma, in two instances lymphoma, in two instances leiomyosarcoma and in five patients another type of tumour). Seventeen patients suffered from benign stenosis (8 complications of reflux oesophagitis, 3 stenosis in the anastomosis, in two instances corrosion by acid, 2 cases of epidermolysis bullosa oesophagi and one post-radiation stenosis). In these patients repeatedly before introduction of the stent dilatation of the stenosis by means of a balloon dilatation catheter was attempted. In two instances the etiology of the stenosis was obscure. Complications related to the procedure proper or after insertion of the stent were recorded in 49 patients-dislocation of the stent 23x, occlusion of the stent 17x, development of a fistula 6x, ulceration 16x, haemorrhage 4x, hyperplasia of the mucosa 21x, ileus 2x, inadequate expansion of the stent 8x.

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In a one-year study, thirty-two physicians' antibiotic costs decreased significantly and were lower than those in a comparison group. The quality of patient care was not adversely affected, and the hospital's overall rate of nosocomial infection decreased. The success of the program led to its being adopted throughout the hospital. The dynamics of pharmacies' implementing cost-reduction strategies with voluntary medical staffs are discussed throughout the article.

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A case study of the proposed development of a regional children's health care system in South Texas is described. Strategic plans for the system are overviewed and the community response to plans are presented. The political, social responsibility and fiscal viability issues raised are reviewed and the research literature base relevant to the health care needs of a key (Hispanic) market is summarized.

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Demographic trends and budgetary constraints at many universities suggest that education will not be "business as usual" in the next several years. Academic programs in health care administration can enhance their ability to respond to these challenges by implementing stakeholder analysis as part of their strategic planning process. This article delineates the stakeholder groups which typically influence programs in health care administration and presents a systematic manner of analyzing their relationships to the program in terms of values and beliefs, power, cooperative potential, and likely issues. Actions to strengthen relationships with each stakeholder group are noted. Finally, the utility and limitations of stakeholder analysis are discussed.

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A large sample of patients (N = 763) with Tourette syndrome (TS) responded to a questionnaire dealing primarily with symptoms, treatment history, and associated disorders. The shrinking duration between symptom onset and diagnostic confirmation confirms that diagnostic awareness of TS is increasing. A significant proportion of the sample identified several common factors that occurred in the year before symptom onset. A significantly lower proportion of subjects whose initial symptoms included facial tics reported a positive response to haloperidol. Obsessive characteristics were associated with age and were more common in females. Patients with attention deficit disorder (ADD) had earlier age at onset of TS symptoms and were diagnosed earlier than patients without ADD. In general the data provide some support for a stress-diathesis model and also support previous suggestions about the genetics of Tourette syndrome and related conditions.

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Summer camps for juveniles with rheumatic disease are being offered increasingly as components of comprehensive treatment approaches, but the therapeutic value of these sessions is largely undetermined. This study attempted to judge the impact of a summer camping experience on two aspects of participants' psychosocial functioning, self-concept, and locus of control. Both of these constructs have been related to effective disease management. On both measures, the mean scores of 36 campers improved significantly following a week-long camp session, and these positive effects were maintained over a 6-month follow-up period. Campers who had attended previous camping sessions appeared to obtain maximal benefit, and male campers with rheumatic disease were identified as needing special attention. The study's limitations are discussed, and future research directions are outlined.

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Tourette Syndrome (TS) is an uncommon developmental disability characterized by repetitive and involuntary verbal and motor tics. A survey of all known affiliates of the Tourette Syndrome Association of Ohio was conducted to document the special problems and needs of the TS student. A total of 431 questionnaires was returned, and the types and frequency of interpersonal and academic school problems were found to be pervasive. Problems did not differ by grade level, but students medicating their TS symptoms experienced more problems. In most cases, current students described similar problems to adults, suggesting that recent attempts to provide optimal educational opportunities to all handicapped children have not been successful where TS is involved. The presence of a behavioral or learning disability diagnosis indicated that substantial percentages of respondents were in need of specialized educational services, but not all those in need were receiving them. Parents were generally satisfied with their child's education, but less satisfied when specialized education was involved. Suggestions are offered for more effectively dealing with the TS child in the classroom.

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This study examines the system dimensions of need, barriers to receiving services, and utilization within a single mental health service area. The gap between estimates of service need and service utilization is conceptualized as due to a set of specific barriers covering the access attributes of availability, accessibility, acceptability and affordability. Data from community telephone surveys (N = 2183) of mental health need are analyzed to determine the relationship between the system dimensions of need, barriers and utilization. Respondents were able to distinguish among different types of service barriers. Those in the service gap were potentially more influenced by barriers than the rest of the sample, as were, paradoxically, those who had utilized services within the past year. The implications of these findings for service provision and system design are discussed.

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Tourette Syndrome (TS) is an uncommon developmental disability characterized by repetitive and involuntary verbal and motor tics. A survey of all known affiliates of the Tourette Syndrome Association of Ohio was conducted. A total of 431 questionnaires was returned, and behavioral problems were found to be pervasive in Tourette people. Some 53.1 per cent of the sample had sought some form of counseling for these problems, but this counseling was generally not perceived as being very helpful. Medication was not reported to ameliorate behavioral problems. When compared to a normal population sample, self-ratings of mental health status were low among Tourette persons. Problems experienced by TS persons were aggregated into a Behavioral Problem Scale, which successfully discriminated between levels of need in TS persons.

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Community surveys for needs assessment purposes have gained considerable popularity in recent years, yet the prevalence estimates of psychiatric impairment or mental health need vary widely across studies. It is hypothesized that part of this variability may reflect methodological concerns, in particular the directory listing status of respondents when telephone survey methods are employed. Using data from two independent community surveys, the mental health needs of listed versus unlisted subscribers were compared on a series of mental health scales. The implications of the differences observed are discussed both for further telephone needs assessment projects, as well as for service providers.

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Presentation of a masking stimulus enhances, rather than detracts from, detectability of certain multisegment targets. Present theories of backward masking cannot account for this "backward enhancement" effect, which resembles another puzzling phenomenon, previously reported as target recovery or disinhibition. An explanation in terms of interaction between retinal excitatory and inhibitory fields is offered.

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