Multipass Vector (Mpave) Technique with Nonablative Radiofrequency to Treat Facial and Neck Laxity

Background. Redundant facial and neck skin is a major feature of aging and historically has been corrected surgically. Recently, monopolar radiofrequency application has been introduced for nonablative tissue tightening of skin by volumetric heating of the deep dermis. It has been able to improve neck and cheek laxity and periorbital rhytides and to elevate eyebrows. However, questions remain as to the ideal parameters needed to optimize the use of radiofrequency.
Objective. To determine the safety and report on the efficacy of a radiofrequency application that involves a multipass vector (mpave) technique to target facial and neck skin laxity.
Methods. Twenty-five patients (skin types I to V) with mild to severe facial and neck laxity received one treatment session with monopolar radiofrequency. Treatment parameters, adverse events, and digital photographs were recorded. All patients were treated with a multipass vector technique consisting of four to five passes targeted over areas of skin that would most improve facial laxity. The multipass vector (mpave) treatment approach is described. Energy levels ranged from 62 to 91 J/cm2 per pulse.
Results. All patients experienced some immediate erythema and edema, which had completely resolved in most patients within 48 hours. No scarring or dyspigmentation was noted on follow-up at 6 and 12 weeks. Photographic analysis of pre- and post-treatment digital images revealed cosmetic improvement in facial and neck laxity in 96% of patients. The majority of patients demonstrated a moderate or better improvement. Stacked pulses in the submental region were shown to reduce fat.
Conclusions. The direct application of monopolar radiofrequency to facial and neck skin using a multipass vector (mpave) treatment approach was safely tolerated in patients of all skin types. Patient satisfaction correlated well with photographic analysis, and the technique was shown to be efficacious for most patients.     

A Process and Outcomes Evaluation of the International AIDS Conference: Who Attends? Who Benefits Most?

The objective of the study was to conduct a process and outcomes evaluation of the International AIDS Conference (IAC). Reaction evaluation data are presented from a delegate survey distributed at the 2004 IAC held in Thailand. Input and output data from the Thailand IAC are compared to data from previous IACs to ascertain attendance and reaction trends, which delegates benefit most, and host country effects. Outcomes effectiveness data were collected via a survey and intercept interviews. Data suggest that the host country may significantly affect the number and quality of basic science IAC presentations, who attends, and who benefits most. Intended and executed HIV work‐related behavior change was assessed under 9 classifications. Delegates who attended 1 previous IAC were more likely to report behavior changes than attendees who attended more than 1 previous IAC. The conference needs to be continually evaluated to elicit the required data to plan effective future IACs.     

The overlap between personality disorders and major depressive disorder (MDD).

BACKGROUND: Research studies have focused attention on the importance of the comorbidity of personality disorders and depression. METHODS: The present review examines seven potential explanations for the overlap to clarify the nature of the relationship, if any, between depression and personality disorder diagnoses. RESULTS: There may be many explanations for the potential overlap of personality disorders (PD) and major depressive disorder (MDD). For example, the distinction between states and traits may not be as clear and definitive as suggested in the DSM-IV. In some cases, depression may influence personality pathology, and may even lead to personality disorders. In other cases, personality disorders may lead to MDD. CONCLUSION: Further research may clarify the nature of the relationship, if any, between depression and personality disorder diagnoses, as well as the relationship between comorbidity and treatment response.     

Comparison of three oral sip-feed supplements in patients with cancer

This study set out to compare the long-term palatability of three oral sip-feed supplements. Sixty patients with various malignancies were randomized to receive one of three products—Build-Up, Fortimel and Fortisip. Participants were encouraged to take as much of the supplements each day for as long as they could manage. At the initial tasting, palatability and acceptability of the products was recorded and this was repeated throughout the trial period. Patients' reasons for discontinuing the trial were noted.
Build-Up was found to be the best-tolerated product of the three. It was taken for a significantly longer time than either Fortimel or Fortisip. There was an indication that Build-Up was more acceptable at the initial tasting than Fortisip but not Fortimel. A smaller proportion of patients stopped taking Build-Up due to flavour-related reasons compared to Fortisip but there was no significant difference between Build-Up and Fortimel. In all, 54% of the patients discontinued the trial for flavour-related reasons. Thirty-five per cent found that the sip-feeds they had been allotted unpalatable at the initial tasting, while 19% stopped the trial due to 'flavour fatigue'. Only 10% of the sample continued taking their allotted product for 90 days or more.     

Serodiagnosis of Crimean-Congo haemorrhagic fever.

Several methods for demonstrating antibody to Crimean-Congo haemorrhagic fever virus were compared on serum samples taken from 101 patients during the acute stage of illness and at intervals for up to 59 months thereafter, with emphasis on early detection of the immune response. The deaths of 23 patients on days 5-14 of illness were ascribed to the effects of the disease; two patients died later from other causes. Very few of the patients who died from the acute illness mounted an antibody response detectable by the methods tested. Four patients who died and 18 who recovered were treated with immune plasma collected from recovered patients. Treated patients acquired IgG antibody from the plasma, but it was possible to discern the onset of an endogenous IgM response in those individuals who survived the disease by all of the methods tested. Indirect immunofluorescence (IF) tests detected IgM and/or IgG antibodies at the earliest on day 4 of illness in about 10% of patients who survived the disease, and by day 9 all survivors had antibodies demonstrable by IF. A biotin-streptavidin IF technique offered no advantage over the standard IF test for the early detection of IgG antibody, but demonstrated higher antibody titres and detected IgM antibody earlier in about a quarter of the patients tested. An IgM-capture enzyme-linked immunoassay (ELISA) and an IgG sandwich ELISA demonstrated higher antibody titres than did IF tests, and detected antibody responses at an earlier stage of infection than did IF tests in about one-fifth of patients, but the reverse was true in a similar proportion of instances. A competition ELISA, which detected total antibody activity, produced lower titres than did the IgM and IgG ELISAs, but yielded results which were in close agreement with the findings in IF tests. It was concluded that the IF tests were most convenient for use in making a rapid serodiagnosis of the disease.     

Decomposing Area of Residence Differences in Multiple Regression Studies: The Relative Contributions of Independent Variables and Model Coefficients

When rural/urban differences are found in health status or health care use, it is often desirable to identify those factors (such as age, social structure, income, etc.) that influence such differences. To this end, researchers often test rural/urban differences in age, social structure, income, etc., for statistical significance. Also, researchers commonly perform multivariate analyses (such as multiple regressions) to examine rural-urban differences in the influence of various independent variables on the dependent variable of interest. Frequently, researchers discover: (1) statistically significant rural/urban differences in the independent variables (such as age, social structure, income, etc.) and (2) statistically significant rural/urban differences in the effects of these independent variables (i.e., statistically significant rural/urban differences in regression coefficients). The analysis typically stops here, without addressing the relative contributions of (1) and (2) to the rural/urban differences in the dependent variable. This paper argues that the relative contributions of (1) and (2) have important implications for the way policy-makers address rural health problems. This paper presents a method for assessing the relative contributions of differences in the independent variables and differences in regression coefficients to observed differences in the dependent variable, and illustrates the application of the method by analyzing rural/urban differences in the risk of institutionalization.