Object The occipital condyle has never been studied as a viable structure that could permit bone purchase by fixation devices for occipitocervical fusion. The authors propose occipital condyle screw placement as a possible alternative to conventional occipitocervical fixation techniques. Methods Six adult cadaver heads (12 total occipital condyles) were studied, and the StealthStation image-guidance system was used for preoperative planning of occipital condyle screw placement. Morphometric studies of the occipital condyle were performed. A 3.5-mm Vertex screw was then placed in the occipital condyle with image-guided assistance in 3 specimens. Operations in the remaining 3 specimens proceeded using anatomical markers and calculated degrees of angulation for screw placement with a free-hand technique. Postoperatively the cadaver heads were rescanned and reanalyzed to determine the success of screw placement and its effect on hypoglossal canal volume. Results All screws were successfully placed with no sign of lateral or medial cortical breach. Two screws had bicortical purchase. There was no change in hypoglossal canal volume in any specimen. Conclusions Occipital condyle screw placement is a safe and viable option for occipitocervical fixation and could be a preferred procedure in selected cases. However, further biomechanical studies are required to compare its reliability to other more established techniques.

In our series, we have found a consistent way to cannulate the C2 pedicle. C2 fixation serves as an integral part of cervical reconstruction. Preoperative planning, anatomic knowledge, and lateral C-arm orientation create a low morbidity method for C2 screw placement.

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Organized psychiatry has an obligation to address sexual contact with patients and other causes for medical board discipline. This obligation may be addressable through enhanced residency training, recertification exams, and other means of education.

The aim was to determine the association between frequency of alcohol use in the past 30 days and HIV-related risk behaviours among adults in an African-American community. Data were collected by trained street outreach workers, from 522 persons in 4 areas selected on the basis of 7 health and criminal justice indicators of high risk for HIV, STD and substance abuse, and drug-related arrests. A survey assessed demographics, substance use, sexual behaviour, HIV knowledge, attitudes and depression. Subjects reporting using drugs other than alcohol (n=201) were excluded from analyses to avoid the confounding influence of polysubstance use. Of the remaining 321 subjects (mean age=37.1; 58.5% were male), 43.6% reported no alcohol use in the past 30 days, with 37.4% and 19.0%, respectively, having used alcohol < =15 days and = > 16 days in the past 30 days. Alcohol use frequency (no alcohol, 1-15 days, 16-30 days in past month) was significantly associated with being male, STD history, non-use of condoms, higher perceived risk of HIV, lower condom use self-efficacy, multiple sex partners in the past 30 days, and lower HIV-related knowledge. Frequent alcohol use, in the absence of other drugs, is associated with higher levels of HIV risk behaviours. Though an underserved population with respect to HIV prevention and, given the prevalence of alcohol use, the findings suggest that programmes need to target frequent alcohol users to reduce their HIV-associated risk behaviours and enhance HIV risk-reduction knowledge and attitudes associated with the adoption of HIV prevention practices.