We have carried out measurements of the frequency dependence of ultrasonic attenuation in the range 0.2-1 MHz in in vitro samples of bovine cancellous bone and in vivo 0s calcis heel bones. A comparison of the results allows us to infer that the in vivo measurements are dependent on the bone mineral content of the 0s calcis. The bone mineral content has been determined in this way for three female populations and indicates that the technique allows determination of bone loss and the study of the onset and progress of osteoporosis. The technique has the great advantage of health safety over radiographic and neutron activation analysis. It may also prove to be more sensitive to small changes in bone mineral content.
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Neurogenic claudication is diagnosed from a classical history and complementary spinal imaging. The abnormal signs may be few. It should be distinguished from intermittent claudication (peripheral vascular disease), referred pain from the back or root pain that is aggravated by walking, and psychological distress. Pathologically, a developmentally small canal is usually affected by multiple levels of segmental degenerative change, with venous pooling in the cauda equina between two levels of low pressure stenosis. There is probably then a failure of arterial vasodilatation of the congested roots in response to exercise, with symptoms in the legs when walking. Once established, symptoms tend neither to improve nor deteriorate. Conservative management is reasonable. Otherwise decompression at the most significant stenotic level is probably adequate to obtain a good surgical result.
World Health Organization (WHO) recommendations and meta-analyses of controlled trials have concluded that inappropriate perinatal care and technology continue to be practiced widely throughout the world, despite the acceptance of evidence-based principles and care. The WHO Regional Office for Europe, in consultation with policy makers and reproductive health experts recently proposed ten "Principles of Perinatal Care," which have been endorsed by the reproductive health units of most member states. A comprehensive training program, based on the principles, is now being offered throughout the European region. This paper describes the development of the WHO principles and the WHO training course "Essential Antenatal, Perinatal and Postpartum Care." Together they provide an innovative model of evidence-based and psychosocially sensitive care for the future guidance of perinatal policy makers and caregivers worldwide.
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