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"Honestly, people really don't know it's artificial," said Nelson, whose injuries three years ago included third-degree burns, a skull fracture and broken jaw. "In casual social interactions, I see much smaller cases where people stare."

The wars in Iraq and Afghanistan have brought a new kind of patient to the facial prothestics lab at the Lackland Air Force Base: wounded warriors, who have recently suffered heavy burns and multiple traumas. The lab is one of two major facial prosthetic programs in the Defense Department, and it has seen an unprecedented new stream of wounded soldiers.

Before the wars, the 26-year-old lab's patients were almost exclusively cancer and civilian trauma survivors, but "all of that prepared us for wartime, and that's really why our department is here," said lab director Dr. Joe Villalobos.

The lab doesn't track how many soldiers wounded from the war it's treated. However, before the wars began in 2001 and 2003, the facility rarely saw combat-related injuries - only an occasional Vietnam-era veteran looking for a new prostheses. Now, partly because the lab is across town from the Army's only burn center, wounded warriors make up about one-fifth of the roughly 425 patients they treat each year.

While the technology and capabilities at the lab are available in the civilian world, the Lackland lab has the expertise and resources to give soldiers the best possible care with little concern about the financial burdens that civilian trauma patients might face, he said.

"Our goal is to give them the best of the best," Villalobos said. "We're going to give them the ideal treatment."

Patients at Lackland are treated with a combination of cutting-edge technology and carefully hand-hewed prostethics.

Using specially designed computer equipment, technicians can turn an MRI into three-dimensional molds and create custom-fit pieces to replace missing jaw bones or sections of skull for implant. The lab has even done it remotely, creating a perfectly fitting replacement for one-third of a patient's skull at a hospital in Balad, Iraq, Villalobos said.

But sometimes, after patients have undergone life-saving surgeries and reconstruction work for basic functionality, aesthetics start to matter. Soldiers tire of stares and flashes of shock on the faces of people unaccustomed to severe burn injuries.

"When your face is affected, you lose your identity," said Villalobos. "We address that here."

Not everyone who loses an ear, eye or nose tip is interested in getting a new one. After the memory of what you used to look like begins to fade, "you start to accept who you are," said Nelson, a 37-year-old Army mechanic from Evergreen, Colo. And because burn patients typically undergo dozens of surgeries (Nelson is at 43 and counting), many are simply too procedure-weary to seek prosthetic ears or noses.

But Nelson said for him, "one of the things that bothered me the most aesthetically was the missing ear."

He knew getting a prosthetic right ear, sculpted to match his remaining ear on the left, wouldn't make a functional difference. If anything, the prosthetic has slightly dampened noises.

"It was for form, but I couldn't help but want some of my form back," said Nelson, who sometimes wears a hair piece to cover his burned scalp.

To create prosthetic ears, the lab uses cameras that generate 3-D images for technicians to make molds. While adhesive can be used to keep prosthetic ears in place, younger patients like Nelson often opt for titanium implants that allow the prosthetic to magnet on.

When a patient has one ear remaining, a mirror-image ear is created. Two missing ears are more difficult, said Villalobos, but the lab has created ears using family members as models.

One soldier wanted his father's ears, so the lab took images and created versions that were smaller and less wrinkly to make sure the prosthetic versions were right for the soldier's age, Villalobos said.

"It's easier to create a second ear if they have one already, but if someone comes in and says 'I want Clint Eastwood ears,' we can do that," he said, grinning.

The technicians pay close attention to detail.

Nancy Hanson, the lab's clinical anaplastologist, carefully matches skin tone using powdered pigment and tiny red and blue embroidery threads to create the visual effect of veins. Freckles are painted on, and tops of ears are pinked to mimic sun exposure. Some soldiers get "summer ears" and "winter ears" to account for skin-tone variation.

"It's a combination of a little bit of science, art and ingenuity," said Hanson. "We deal with very unique situations."

Nelson's ear took about two years to complete, in part because his caregivers had to fight growth of scar tissue that kept covering the titanium implants and creating uneven skin on the side of his head.

Nelson said he was shocked at how realistic the fake ear turned out even after going through multiple fittings and coloration sessions to match his skin tone and freckles.

"I do feel like I have the best-looking one ever made," he smiled.

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Other common problems found by researchers at the U.S. Food and Drug Administration include puncture wounds from hypodermic needles breaking off in the skin while injecting medicine or illegal drugs; infections in young children with ear tubes; and skin tears from pelvic devices used during gynecological exams in teen girls.

Malfunction and misuse are among possible reasons; the researchers are working to determine how and why the injuries occurred and also are examining the prevalence in adults. Those efforts might result in FDA device warnings, depending on what they find, said study co-author Dr. Brock Hefflin.

The most serious problems involved implanted devices such as brain shunts for kids with hydrocephalus (water on the brain); chest catheters for cancer patients receiving chemotherapy at home; and insulin pumps for diabetics. Infections and overdoses are among problems associated with these devices. Only 6 percent of patients overall had to be hospitalized.

Dr. Steven Krug, head of emergency medicine at Chicago's Children's Memorial Hospital, said the study highlights a trade-off linked with medical advances that have enabled chronically ill children to be treated at home and live more normal lives.

Home care can be challenging for families; Krug says he has seen children brought in because catheters were damaged or became infected.

"Health care providers need to be aware of these kids and their devices and how to recognize or diagnose" related problems, Krug said. He was not involved in the study.

The study appears in Pediatrics, published online Monday.

Hefflin and lead author Dr. Cunlin Wang work in the FDA's Center for Devices and Radiological Health. They note there has been recent concern about medical device safety in children, particularly since many devices intended for adults are used in children.

The researchers analyzed medical records from ER visits reported in a national injury surveillance system. Based on data from about 100 nationally representative hospitals, they estimated that 144,799 medical device-related complications occurred during 2004 and 2005, or more than 70,000 yearly.

Almost 34,000 problems were linked with contact lenses in the two-year period. The rest were scattered among 12 other categories including general medical devices such as needles and catheters, gynecology devices and heart devices.

Hefflin said the study is the first to evaluate device-related injuries in children only. It did not include device problems in already hospitalized children.

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Many people who fish or canoe in the nearby Housatonic worry that dredging to remove PCBs could disrupt recreation and spoil the natural beauty of the river.

GE is expected to recommend in October that it take a less invasive approach for the rest of the river cleanup, expected to focus on the river's first 10 miles downstream from the plant.(c) 2010
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The companies said the higher dose improved scores on a patient test that measures cognition. There was no difference on a different test that measures global function.

Approval by the Food and Drug Administration followed a study of 1,467 patients with moderate to severe Alzheimer's. It said the larger dose is recommended for patients who are already taking smaller doses daily for at least three months.

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Veterans groups long have complained that such language could bar patients from VA benefits if they were caught using medical marijuana.

The new guidance does not authorize VA doctors to begin prescribing medical marijuana, which is considered an illegal drug under federal law.

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The editor of a British journal, Lancet Oncology, issued an "expression of concern" Friday about a 2007 study by Duke's Dr. Anil Potti. It described genes that may help predict who most needs chemotherapy.

The journal says that some of Potti's co-authors contacted them this week with concerns about the report, which the medical journal is now investigating. Neither the scientist nor Duke officials could immediately be reached for comment.

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Obama and Clinton spoke in two separate prerecorded video addresses shown Friday to experts and advocates gathered in Vienna for an international AIDS conference. The next meeting is set to take place in Washington in 2012.

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.

VIENNA (AP) - The U.N.'s top investigator on torture and punishment warned Friday that overcrowded prisons are breeding grounds for AIDS.

Often, inmates are held in inhumane conditions in which the HIV virus is spread through the use of non-sterile drug injection equipment, sexual contacts, tattooing and sharing of razors, Manfred Nowak said.

"There is a global prison crisis," he told an international AIDS conference.

Nowak, who has visited detention facilities around the world, urged authorities to inform prisoners of the risk of HIV transmission and to offer them free condoms, HIV testing and counseling. He also pressed prisons to offer needle and syringe programs, opiate substitution therapies and methadone treatments.

"Science tells us exactly what we have to do, it's just a question of political will to implement it," Nowak said.

In addition, prison guards should live up to their obligation to prevent rape and other forms of coercion that thrive in packed environments.

"One of the most important measures to prevent HIV transmission would be the reduction of overcrowding," since it leads to violence and conditions that are conducive to the spread of the virus, he added.

Nowak said that, although reliable figures are hard to come by, the prevalence of HIV in prisons is generally much higher than in a country's wider population.

In Ukraine, for example, the prevalence of HIV in prison is at least 10 times that of the overall population, he said.

Dmytro Shermebey of the All-Ukrainian Network of People Living with HIV/AIDS - who was diagnosed with HIV, tuberculosis and hepatitis after spending nine years in a Ukrainian jail - stressed that inmates have a right to both treatment and protection from the disease.

"They have the right because they are human," Shermebey said.

While about 10 million people are incarcerated every year, some 30 million enter and leave prisons annually - making it a public health problem for society, according to Nowak.

"Prison health is public health," he said.

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AIDS conference: http://www.aids2010.org/ (c) 2010
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While still considered rare in North America, health officials say they want doctors to know to look for it and patients to be aware of it.

The overall risk to the public is very low, and there's no need for people to avoid going outdoors and exercising, said Julie Harris, an epidemiologist with the U.S. Centers for Disease Control and Prevention.

The fungal illness began to show up in British Columbia, Canada, in 1999, and may have spread southward, although at least one different strain has been found in the United States. Scientists don't know why the tropical illness has appeared in the Northwest but not in other northern locations.

Since 2004, there have been 43 cases in Oregon, 15 in Washington, one in California and one in Idaho, the CDC said Thursday.

Of those 60 cases, the outcome is known in 45, and 15 ended in death. The fungus caused nine of the deaths, and was believed to be a factor in the other six, officials reported.

Symptoms include a persistent cough, headache and shortness of breath. Some cases have worsened into a pneumonia- or meningitis-like illnesses.

British Columbia has counted 272 illnesses since the first cases were detected, said Dr. Eleni Galanis, an epidemiologist with the British Columbia Centre for Disease Control. Canadian officials don't have an up-to-date count of deaths, but an earlier analysis suggested a death rate of about 9 percent.

The proportion of U.S. and Canadian cases ending in death may sound alarmingly high, but it's likely others have been infected but weren't diagnosed because they didn't develop serious illness, Harris said.

Also, most of those who got sick had another condition that likely made them more susceptible to the fungal illness.

People are not the only victims. More than 50 cases in animals have been reported in the United States, including cats, dogs, ferrets, elk and porpoises.

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