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As part of a program evaluation of the New York City Test & Trace program (T2)-one of the largest such programs in the USA-we conducted a study to assess how implementing organizations (NYC Health + Hospitals, government agencies, CBOs) communicated information about the T2 program on Twitter. Study aims were as follows: (1) quantify user engagement of posts ("tweets") about T2 by NYC organizations on Twitter and (2) examine the emotional tone of social media users' T2-related tweets in our sample of 1987 T2-related tweets. Celebrities and CBOs generated more user engagement (0.26% and 0.07%, respectively) compared to government agencies (e.g., Mayor's Office, 0.0019%), reinforcing the value of collaborating with celebrities and CBOs in social media public health campaigns. Sentiment analysis revealed that positive tweets (46.5%) had higher user engagement than negative tweets (number of likes: R 2  = .095, p < .01), underscoring the importance of positively framing messages for effective public health campaigns., (© 2024. The New York Academy of Medicine.)

The COVID-19 pandemic highlighted the importance of addressing social needs in a crisis context. Some US jurisdictions integrated a social service component into case investigation and contact tracing (CI/CT) programs, including the New York City (NYC) Test & Trace (T2) Program; the Take Care initiative referred NYC residents who tested positive or were exposed to COVID-19 to services to support isolation and quarantine and meet basic needs. More research is needed to determine effective implementation strategies for integrating social needs provision into CI/CT programs. To identify barriers and facilitators to the implementation of the Take Care initiative, we conducted key informant interviews with program staff, community-based organization partners, and cases and contacts as part of a larger evaluation of the T2 program. Interviews were recorded, transcribed, and analyzed using rapid qualitative methods. Key facilitators to implementation included utilizing a case management software system, employing strategies to encourage service uptake, leveraging cross-agency collaborations, and partnering with community-based organizations for resource navigation. Barriers identified included external management of the software system, challenges reaching and engaging the public, administrative complications due to shifting collaborations, and management of CBO partners' structure and hiring. Based on our findings, we provide recommendations to support effective planning and implementation of social needs service provision in a crisis context. Future research should focus on testing promising implementation strategies highlighted in this study and applying them to varied contexts and crisis situations., (© 2024. The New York Academy of Medicine.)

Background: Traditional management of moderate to severe stable slipped capital femoral epiphysis (SCFE) has been in situ fixation followed by reconstructive surgery if symptoms arise. This delayed approach may lead to irreversible intra-articular damage of the hip over time. The purpose of this study was to compare radiographic and clinical outcomes of the modified Dunn procedure (MDP) versus in situ fixation followed by delayed Imhauser osteotomy (DIO)., Methods: This was a retrospective study from a single institution between 2001 and 2021. Among 250 patients diagnosed with SCFE, a total of 18 (18 hips) treated with MDP and 16 (18 hips) treated with DIO for moderate to severe stable SCFE were included. Most patients who underwent DIO either had concomitant (11/18 hips) or subsequent (2/18 hips) open osteochondroplasty. Mean follow up was 4.7 years (range: 1 to 12.8 y). Radiographs were reviewed to measure Southwick angle, anteroposterior and lateral alpha (α) angles, and femoral head-neck offset ratio preoperatively and at latest follow up. Charts were reviewed for demographics, subsequent surgeries, complications, and Heyman-Herndon clinical outcomes., Results: The amount of deformity correction was greater in the MDP than DIO group based on anteroposterior α angles (mean: 22.3 vs. 11.9 degrees, P =0.046) and femoral head-neck offset ratios (mean: 0.26 vs. 0.12, P =0.001). There was no significant difference in Heyman-Herndon scores (both 16/18, 88.9% good to excellent outcomes, P >0.999). Less reoperations were performed in the MDP than DIO group (2/18, 11.1% vs. 9/18, 50%; P =0.004). AVN occurred in 2/18 hips (11.1%) in the MDP group with both surgeries performed early in the series and underwent prior in situ screw fixation compared with 0/18 hips (0%) in the DIO group ( P =0.486). One patient in the DIO group was later diagnosed with osteoarthritis., Conclusions: MDP resulted in more anatomic coronal and sagittal plane deformity correction, less reoperations, and similar Heyman-Herndon clinical outcomes compared with DIO. AVN occurred in the MDP group whereas osteoarthritis occurred in the DIO group. These complications must be weighed against improved long-term clinical results for patients who would otherwise be at risk for premature degenerative joint disease due to residual proximal femoral deformity., Level of Evidence: Level III-retrospective comparative study., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The monolithic misrepresentation of Asian American (AsAm) populations has maintained assumptions that AsAm people are not burdened by health disparities and social and economic inequities. However, the story is more nuanced. We critically review AsAm health research to present knowledge of AsAm health profiles from the past two decades and present findings and opportunities across three topical domains: ( a ) general descriptive knowledge, ( b ) factors affecting health care uptake, and ( c ) effective interventions. Much of the literature emphasized underutilization of health care services; low knowledge and awareness among AsAms about health-related risk factors, prevention, diagnosis, and treatment; inadequate efforts by health systems to improve language access, provider-patient communication, and trust; and the critical roles of community- and faith-based organizations and leaders in health promotion initiatives. Future opportunities for AsAm health research will require adoption of and significant investment in community-engaged research infrastructure to increase representation, funding, and research innovation for AsAm communities.

Background: The gluteus minimus (GMin) and gluteus medius (GMed) are important dynamic stabilizers of the hip, but quantitative data on their biomechanical roles in stabilizing the hip are currently lacking., Purpose: To (1) establish a reproducible biomechanical cadaveric model of the hip abductor complex and (2) characterize the effects of loading the GMin and GMed on extraneous femoral rotation and distraction., Study Design: Controlled laboratory study., Methods: A total of 10 hemipelvises were tested in 4 muscle loading states: (1) unloaded, (2) the GMin loaded, (3) the GMed loaded, and (4) both the GMin and GMed loaded. Muscle loads were applied via cables, pulleys, and weights attached to the tendons to replicate the anatomic lines of action. Specimens were tested under internal rotation; external rotation; and axial traction forces at 0°, 15°, 30°, 60°, and 90° of hip flexion., Results: When loaded together, the GMin and GMed reduced internal rotation motion at all hip flexion angles ( P < .05) except 60° and reduced external rotation motion at all hip flexion angles ( P < .05) except 0°. Likewise, when both the GMin and GMed were loaded, femoral distraction was decreased at all angles of hip flexion ( P < .05)., Conclusion: The results of this study demonstrated that the GMin and GMed provide stability against rotational torques and distractive forces and that the amount of contribution depends on the degree of hip flexion., Clinical Relevance: Improved understanding of the roles of the GMin and GMed in preventing rotational and distractive instability of the hip will better guide treatment of hip pathologies and optimize nonoperative and operative therapies., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: D.P.L. has received grant support from DJO and Arthrex; education payments from ImpactOrtho, Arthrex, Micromed, and Smith & Nephew; and hospitality payments from Stryker. L.E.L. has received grant support from DJO and Arthrex, education payments from Arthrex and Smith & Nephew, and hospitality payments from Stryker. J.F.K. has received grant support from Arthrex; education payments from Micromed, Smith & Nephew, and Arthrex; and nonconsulting fees from Smith & Nephew. M.B.B. has received education payments from Arthrex and Micromed; consulting fees from Smith & Nephew, Vericel, and Stryker; nonconsulting fees from Smith & Nephew, Arthrex, and Vericel; and honoraria from Vericel. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

New York City experienced a high COVID-19 burden and striking disparities among racial and ethnic minoritized groups. The New York Community Engagement Alliance Against COVID-19 Disparities (NYCEAL) collaborated with health agencies and clinical providers to increase and facilitate COVID-19 vaccinations across New York City. NYCEAL partners and their network of hundreds of community health workers delivered vaccine education, fostered community trust, and supported vaccine uptake among low-income, limited‒English-proficient, and racial and ethnic minoritized communities. With funding from the National Institutes of Health (NIH), the objective of NYCEAL was to reduce COVID-19 disparities by increasing vaccine uptake and promoting trust in science. ( Am J Public Health . 2024;114(S1):S92-S95. https://doi.org/10.2105/AJPH.2023.307455).

Trust is a key component in delivering quality and respectful care within health care systems. However, a growing lack of confidence in health care, particularly among specific subgroups of the population in the United States, could further widen health disparities. In this essay, we explore one approach to building trust and reaching diverse communities to promote health: engaging community-based organizations (CBOs) as trusted community messengers. We present case studies of partnerships in health promotion, community education, and outreach that showcase how CBOs' programs build and leverage trust in health care systems through their workforce, services, and engagement with the community., (© 2023 The Hastings Center.)

Background: Assessments of lower limb torsion are ubiquitous in clinical gait analysis practice as pathologic lower limb rotational deformity may contribute to gait abnormalities, anterior knee pain, as well as other debilitating conditions. Understandably, the overall utility of any torsional assessment is dependent on the measurement method's intrinsic accuracy, precision, and robustness to clinical interference factors. Recently, biplanar radiography (BPR) measurements of torsion have been shown to be both accurate and precise, but the robustness of BPR to potential interference factors is unknown., Research Question: How robust are BPR lower limb torsional assessments to six potential interference factors: amount of torsion, skeletal maturity, radiograph quality, prior osteotomy, presence of implants, and observer training background and experience?, Methods: In this retrospective cohort study, four observers of diverse backgrounds and experience generated digital 3D reconstructions of 44 lower limbs using BPR images obtained during standard of care visits (age range 7-35 years). From each reconstruction, four lower limb torsional parameters were computed: femoral torsion, femorotibial rotation, tibial torsion, and transmalleolar axis equivalent. The mean absolute deviation (MAD) of each torsional parameter - calculated across the four observers - was used as the measure of reliability and tested against all interference factors., Results: Results demonstrated that the average MAD was 2.1 degrees for femoral torsion, 3.0 degrees for transmalleolar axis equivalent, 3.8 degrees for femorotibial rotation, and 4.7 degrees for tibial torsion. None of the six potential interference factors were found to systematically influence BPR reliability across all four torsional parameters. Of the factors found to statistically influence one or more torsional parameter, none affected MAD values to a clinically meaningful extent., Significance: In addition to being accurate and precise, BPR appears to be robust to several clinical factors relevant to children and young adults with or at risk for pathological lower limb torsion., Competing Interests: Conflict of interest The authors have no conflicts of interest to disclose, (Copyright © 2022 Elsevier B.V. All rights reserved.)

Osteochondritis dissecans of the knee is a relatively rare disorder in young athletes that can lead to premature osteoarthritis. It may be caused by multiple factors, including repetitive stress, local ischemia, aberrant endochondral ossification of the subarticular physis, and hereditary disposition. Nonoperative treatment is typically attempted for patients with open physes, stable lesions, and minimal symptoms. Operative treatment is offered to patients with closed physes, unstable lesions, mechanical symptoms, and failure of nonoperative treatment. Customized rehabilitation and return to sport programs are important for successful outcomes regardless of treatment type., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Antifungal agents can have complex dosing and the potential for drug interaction, both of which can lead to subtherapeutic antifungal drug concentrations and poorer clinical outcomes for patients with haematological malignancy and haemopoietic stem cell transplant recipients. Antifungal agents can also be associated with significant toxicities when drug concentrations are too high. Suboptimal dosing can be minimised by clinical assessment, laboratory monitoring, avoidance of interacting drugs, and dose modification. Therapeutic drug monitoring (TDM) plays an increasingly important role in antifungal therapy, particularly for antifungal agents that have an established exposure-response relationship with either a narrow therapeutic window, large dose-exposure variability, cytochrome P450 gene polymorphism affecting drug metabolism, the presence of antifungal drug interactions or unexpected toxicity, and/or concerns for non-compliance or inadequate absorption of oral antifungals. These guidelines provide recommendations on antifungal drug monitoring and TDM-guided dosing adjustment for selected antifungal agents, and include suggested resources for identifying and analysing antifungal drug interactions. Recommended competencies for optimal interpretation of antifungal TDM and dose recommendations are also provided., (© 2021 Royal Australasian College of Physicians.)

➤: Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis., ➤: While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition., ➤: Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging., ➤: Treatment largely depends on skeletal maturity and lesion stability, defined by the presence or absence of articular cartilage fracture and subchondral bone separation, as determined by imaging and arthroscopy, and is typically nonoperative for stable lesions in skeletally immature patients and operative for those who have had failure of conservative management or have unstable lesions., ➤: Clinical practice guidelines have been limited by a paucity of high-level evidence, but a multicenter effort is ongoing to develop accurate and reliable classification systems and multimodal decision-making algorithms with prognostic value., Competing Interests: Disclosure: This work was partially supported by grants from the National Institutes of Health (R01 AR070020 and K01 OD021293). On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/G440)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Purpose: Supracondylar humerus (SCH) fractures are the most common elbow fracture in children; however, they rarely occur as open injuries. Open fractures are associated with higher rates of infection, neurovascular injury, compartment syndrome, and nonunion. The purpose of this study was to evaluate the treatment and outcomes of open SCH fractures in children., Methods: Between 2008 and 2015, four children (1%) had open injuries among 420 treated for SCH fractures at a single center. The mean patient age was six years (range, four to eight years). Two patients had Gustilo-Anderson grade 1 open fractures and two had grade 2 fractures. Tetanus immunization was up-to-date in all. First dose of intravenous antibiotics was given on average 3hr 7min after onset of injury (range, 1hr 38min to 8hr 15min). Time from injury to irrigation and debridement (I&D) and closed reduction and percutaneous pinning (CRPP) was on average 8hr 16min (range, 4hr 19min to 13hr 15min). All patients received 24-hour intravenous antibiotics. Pins were removed at four weeks and bony union occurred by six weeks., Results: After an average follow-up period of 12 months (range, 6 to 22 months), there were no infections, neurovascular deficits, compartment syndromes, cubitus varus deformities, or range of motion losses. All outcomes were excellent according to the Flynn criteria. Due to the unstable nature of open SCH fractures, a medial pin was used in all four cases. No loss of reduction or ulnar nerve injury occurred., Conclusion:  Open injuries occur in approximately 1% of all SCH fractures in children. The authors recommend urgent intravenous antibiotics, I&D, and CRPP involving a medial pin to treat open SCH fractures. Excellent outcomes based on the Flynn criteria were obtained in four cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Pan et al.)

Background Wound management associated with Gustilo grade IIIb open tibia fractures in children often requires muscle flaps, skin grafts, and amputations. The purpose of this study is to report the outcomes and complications of vacuum-assisted closure (VAC) treatment, as well as discuss its role in optimizing value when treating these injuries. Methods A retrospective review of medical records and imaging studies was performed from 2008-2015. Six pediatric patients with Gustilo grade IIIb fractures managed with the VAC were identified. The time to treatment, frequency of VAC changes, VAC size, and closure attempts, including muscle flaps and skin grafts, were documented. Fracture fixation methods, the incidence of delayed union or nonunion, as well as the occurrence of deep tissue infection and compartment syndrome were detailed. Results Five patients were male and one was female with an average age of 12 years (range 8-15 years). All patients sustained a Gustilo IIIb open tibia fracture and were treated with irrigation, debridement, intravenous (IV) antibiotics, fixation, and a VAC as a wound care adjunct. Three patients required both a muscle flap and a skin graft. One patient required a skin graft. There was one case of deep tissue infection. Three patients were treated successfully with the VAC alone and did not require any flap procedures. Conclusions Wound care for Gustilo grade IIIb open tibia fractures in children traditionally involved potentially painful twice-daily dressing changes with solutions such as dilute bleach or iodine. The implementation of VAC markedly reduced the frequency of dressing changes every three days. In the current study, the open wound gradually closed with only a VAC in 50% of Gustilo grade IIIb open pediatric tibia fractures. In summary, the VAC is an adjunct that increases value in the care of pediatric patients with Gustilo grade IIIb open tibia fractures (Value = Outcomes/Cost). Level of evidence Therapeutic level IV., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Mayers et al.)

Premise: Ex situ seed banking is critical for plant conservation globally, especially for threatened floras in tropical ecosystems like Hawai'i. Seed bank managers must maximize longevity, and species managers must plan restoration before seeds lose viability. Previous observations suggested some native Hawaiian seeds lost viability in frozen storage (-18°C). We investigated seed storage behavior in the Hawaiian flora to optimize storage conditions and recommend re-collection intervals (RCI) to maximize viability of stored seeds., Methods: Using 20+ years of real-time seed storage viability data, we tested freeze sensitivity for 197 species and calculated RCIs for 295 species. Using paired tests of accessions stored >2 yr at 5°C and -18°C, we developed an index of relative performance to determine freeze sensitivity. We calculated RCIs at 70% of highest germination (P70)., Results: We identified four families (Campanulaceae, Cyperaceae, Rubiaceae, and Urticaceae) and four genera with seed freeze sensitivity and six additional genera with likely freeze sensitivity. Storage longevity was variable, but 195 species had viability >70% at the most recent tests (1 to 20+ yr), 123 species had RCIs >10 yr, and 45 species had RCIs <5 yr., Conclusions: Freeze sensitive storage behavior is more widely observed in Hawai'i than any other regional flora, perhaps due to insufficient testing elsewhere. We present a new protocol to test seed freeze sensitivity, which is often not evident until 2-5 years of storage. Re-collection intervals will guide restoration practices in Hawai'i, and results inform seed conservation efforts globally, especially tropical and subtropical regions., (© 2019 The Authors. American Journal of Botany is published by Wiley Periodicals, Inc. on behalf of the Botanical Society of America.)

Objective: Social media is a potentially engaging way to support adolescents and young adults in maintaining healthy diets and learning about nutrition. This review identifies interventions that use social media to promote nutrition, examines their content and features, and evaluates the evidence for the use of such platforms among these groups., Material and Methods: We conducted a systematic search of 5 databases (PubMed, CINAHL, EMBASE, PsycINFO, and ACM Digital Library) for studies that included: 1) adolescents and/or young adults (ages 10-19; ages 18-25); 2) a nutrition education or behavior change intervention component, or outcomes related to nutrition knowledge or dietary changes; and 3) a social media component that allowed users to communicate or share information with peers., Results: 16 articles were identified that included a social media component in a nutrition-related intervention for adolescents or young adults. Interventions included features in 7 categories: social media; communication; tracking health; education; tailoring; social support; and gamification. 11 out of the 16 studies had at least one significant nutrition-related clinical or behavioral outcome., Conclusion: Social media is a promising feature for nutrition interventions for adolescents and young adults. A limited number of studies were identified that included social media. A majority of the identified studies had positive outcomes. We found that most studies utilized only basic social media features, did not evaluate the efficacy of social media components, and did not differentiate between the efficacy of social media compared to other delivery mechanisms., (Copyright © 2018 Elsevier B.V. All rights reserved.)

A randomized, placebo-controlled, efficacy trial of Carraguard was unable to demonstrate a reduction in women's risk of HIV infection, which may have been due, in part, to low adherence (gel used in 42 % of vaginal sex acts, on average). A secondary analysis was undertaken to understand baseline factors associated with high adherence (gel used in ≥85 % of sex acts). Women who reported ≥1 vaginal sex act, returned ≥1 opened applicator, and had ≥1 conclusive post-enrollment HIV test (N = 5990) were included. Adherence was estimated as the ratio of average weekly applicator insertions (based on a dye stain assay indicating vaginal insertion)/average weekly sex acts (by self-report). Multivariate logistic regression modeling indicated that coital frequency, site, contraception, and partner age difference had a significant impact on adherence. Women reporting >1 and ≤2 vaginal sex acts per week, on average, were half as likely to be adherent as those reporting 1 vaginal sex act per week or less [adjusted odds ratio (AOR): 0.48; 95 % CI 0.38-0.61]; women from the Western Cape had one-third the odds of being adherent compared to women from KZN (AOR: 0.31; 95 % CI 0.23-0.41); compared to women using injectable contraception, women using any other or no method were more likely to be adherent (AOR: 1.30; 95 % CI 1.04-1.63); and women who had a larger age gap from their partners were more likely to be adherent (AOR: 1.03; 95 % CI 1.01-1.05; p = 0.001). Despite low adherence, overall, 13 % of participants achieved nearly perfect adherence, indicating a potential niche for a coitally dependent microbicide. More research is needed on the impact of sexual patterns and HIV risk perception on product acceptability and adherence to improve counseling in ongoing trials and when products are eventually introduced.

Two species of Coprosma (Rubiaceae) J.R.Forst. & G.Forst. are described from the island of Maui of the Hawaiian Archipelago. A newly described taxon, Coprosma cordicarpa J.Cantley, Sporck-Koehler, & M.Chau, sp. nov. is locally common in medium to high elevation dry forests and shrublands of leeward East Maui. The second taxon is resurrected from the synonymy of Coprosma foliosa A.Gray as Coprosma stephanocarpa Hillebr. and occurs in mesic to wet rainforests of both East and West Maui. Both taxa are segregated from Coprosma foliosa, with which they share similar morphological characters. A conspicuous and persistent calyx of the fruit and various floral characters most easily differentiate both taxa from other Hawaiian taxa. The newly described Coprosma cordicarpa is further distinguished from Coprosma stephanocarpa by a central constriction of the fruit with a depressed apex, which gives it a characteristic heart shape. Furthermore, the taxa are largely separated phenologically, ecologically, and geographically. Descriptions, conservation status, and specimens examined for the new species are included.

Antifungal agents may be associated with significant toxicity or drug interactions leading to sub-therapeutic antifungal drug concentrations and poorer clinical outcomes for patients with haematological malignancy. These risks may be minimised by clinical assessment, laboratory monitoring, avoidance of particular drug combinations and dose modification. Specific measures, such as the optimal timing of oral drug administration in relation to meals, use of pre-hydration and electrolyte supplementation may also be required. Therapeutic drug monitoring (TDM) of antifungal agents is warranted, especially where non-compliance, non-linear pharmacokinetics, inadequate absorption, a narrow therapeutic window, suspected drug interaction or unexpected toxicity are encountered. Recommended indications for voriconazole and posaconazole TDM in the clinical management of haematology patients are provided. With emerging knowledge regarding the impact of pharmacogenomics upon metabolism of azole agents (particularly voriconazole), potential applications of pharmacogenomic evaluation to clinical practice are proposed., (© 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.)

Premise of the Study: Conserving endangered plants is a complex task, and practitioners must often use a "triage" approach, addressing only immediate needs. Ecologists can improve this process by conducting sound science upon which to base management. Marsilea villosa is an endangered, endemic Hawaiian fern with seven remaining populations in ephemerally flooding drylands. Among its uncommon traits are long-lived sporocarps, requiring flood and drought to complete its sexual life cycle, and extensive vegetative growth., Methods: We conducted a 3-yr ecological field study, measuring percent cover of M. villosa and associated species, flooding depth, and canopy cover, to identify ecological factors with the greatest impact on M. villosa growth., Key Results: Maximum flooding depth and canopy cover had strong positive relationships with M. villosa growth, and all plots with >50% threshold of either variable reached 100% cover of M. villosa by the end of the study. Interaction effects explained nuances of these relationships, including synergy between the two variables. Percent cover of nonnative functional groups (graminoids and nongraminoids) each had negative relationships with M. villosa growth, but interactions showed that nongraminoid cover was driven by particular species, and that time since flooding had greater influence on M. villosa growth than graminoid cover., Conclusions: We recommend planting reintroduced populations in flood-prone areas with moderate shade, experimental outplanting of native plants with M. villosa, and management of graminoids as a functional group, while nongraminoid management should be species-specific. These practices will promote self-sustaining populations and reduce the need for labor-intensive management.

Objective: To compare the quality of ultrasound images acquired by the new PureWave Crystal transducer with those acquired by a conventional transducer in 'difficult' obstetric subjects., Methods: A predefined list of ultrasound images were obtained from 35 'difficult' obstetric patients using both conventional and new PureWave Crystal transducers by a sonographer. All images were rated using a three-point scale by an independent assessor. Both the sonographer and assessor were experienced in obstetric ultrasound and blinded to the type of transducers being used. A higher score represented better image quality. The scores of each pair of images obtained by the two different ultrasound transducers were compared., Results: The scores for images obtained by the PureWave Crystal transducer were significant higher than those by a conventional transducer, among all 10 structures examined. The new transducer was rated to enable higher diagnostic confidence (82.9%), and produced better image quality for the near field image (94.3%), the far field image (88.6%) and overall (94.3%)., Conclusions: Ultrasound transducer incorporating the PureWave Crystal technology produces significantly better image quality for diagnostic purpose in difficult obstetric patients.

Objective: To investigate the attitudes towards termination of pregnancy (TOP) among Hong Kong Chinese women attending the prenatal diagnosis counselling (PDC) clinic under three circumstances: (1) normal fetus, (2) fetal chromosomal anomalies, and (3) fetal abnormalities diagnosed after 24 weeks of gestation, and to determine the association between the attitudes and demographic factors., Methods: One hundred and twenty-two women were interviewed using a structured questionnaire., Results: Over 50% of our women viewed it as their right to choose an abortion in early pregnancy and only 28.7% agreed that the doctor has the right to make the final decision. Approximately 90% would choose TOP for lethal chromosomal abnormalities and Down syndrome while about 50% would do so for Klinefelter or Turner syndromes. Over 80% were of the opinion that women should be given the right to choose TOP for lethal congenital malformation as well as for Down syndrome after 24 weeks of gestation. This figure dropped to 55.7% for non-lethal structural malformation that requires postnatal treatment. Religious background was a significant factor for a negative attitude towards TOP., Conclusion: Our data suggest that our women who attended the PDC clinic had an open attitude towards TOP for fetal abnormalities in general., (Copyright 2004 John Wiley and Sons, Ltd.)