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McCarl, Bruce A., M. Edward Rister, Ruby Ward, Charles R. Long, Dean McCorkle, Houshmand Ziari, J. Richard Conner, Allen W. Sturdivant, and Troy N. Thompson. "Strategie Agribusiness Operation Realignment in the Texas Prison System." Journal of Agricultural and Applied Economics 32, no. 1 (April 2000): 145–58. http://dx.doi.org/10.1017/s1074070800027899.
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AbstractMathematical programming-based systems analysis is used to examine the consequences of alternative operation configuration for the agricultural operations within the Texas Department of Criminal Justice. Continuation versus elimination of the total operation as well as individual operating departments are considered. Methodology includes a firm systems operation model combined with capital budgeting and an integer programming based investment model. Results indicate the resources realize a positive return as a whole, but some enterprises are not using resources profitably. The integer investment model is found to be superior for investigating whether to continue multiple interrelated enterprises.
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Pal, AK, DP Baksi, and DD Baksi. "Electromyographic investigation of unstable patella before and after its realignment operation." Indian Journal of Orthopaedics 45, no. 1 (2011): 69. http://dx.doi.org/10.4103/0019-5413.73662.
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Yip, Hon Ming, John C. S. Li, Kai Xie, Xin Cui, Agrim Prasad, Qiannan Gao, Chi Chiu Leung, and Raymond H. W. Lam. "Automated Long-Term Monitoring of Parallel Microfluidic Operations Applying a Machine Vision-Assisted Positioning Method." Scientific World Journal 2014 (2014): 1–14. http://dx.doi.org/10.1155/2014/608184.
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As microfluidics has been applied extensively in many cell and biochemical applications, monitoring the related processes is an important requirement. In this work, we design and fabricate a high-throughput microfluidic device which contains 32 microchambers to perform automated parallel microfluidic operations and monitoring on an automated stage of a microscope. Images are captured at multiple spots on the device during the operations for monitoring samples in microchambers in parallel; yet the device positions may vary at different time points throughout operations as the device moves back and forth on a motorized microscopic stage. Here, we report an image-based positioning strategy to realign the chamber position before every recording of microscopic image. We fabricate alignment marks at defined locations next to the chambers in the microfluidic device as reference positions. We also develop image processing algorithms to recognize the chamber positions in real-time, followed by realigning the chambers to their preset positions in the captured images. We perform experiments to validate and characterize the device functionality and the automated realignment operation. Together, this microfluidic realignment strategy can be a platform technology to achieve precise positioning of multiple chambers for general microfluidic applications requiring long-term parallel monitoring of cell and biochemical activities.
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Guo, Yu, and Jinchuan Hou. "Realignment Operation and CCNR Criterion of Separability for States in Infinite-Dimensional Quantum Systems." Reports on Mathematical Physics 72, no. 1 (August 2013): 25–40. http://dx.doi.org/10.1016/s0034-4877(14)60002-1.
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León, S. A., X. Y. Mei, O. A. Safir, A. E. Gross, and P. R. Kuzyk. "Long-term results of fresh osteochondral allografts and realignment osteotomy for cartilage repair in the knee." Bone & Joint Journal 101-B, no. 1_Supple_A (January 2019): 46–52. http://dx.doi.org/10.1302/0301-620x.101b1.bjj-2018-0407.r1.
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Aims The aim of this study was to report the outcome of femoral condylar fresh osteochondral allografts (FOCA) with concomitant realignment osteotomy with a focus on graft survivorship, complications, reoperation, and function. Patients and Methods We identified 60 patients (16 women, 44 men) who underwent unipolar femoral condylar FOCA with concomitant realignment between 1972 and 2012. The mean age of the patients was 28.9 years (10 to 62) and the mean follow-up was 11.4 years (2 to 35). Failure was defined as conversion to total knee arthroplasty, revision allograft, or graft removal. Clinical outcome was evaluated using the modified Hospital for Special Surgery (mHSS) score. Results A total of 14 grafts (23.3%) failed at a mean of 8.6 years (1.4 to 20.1). Graft survivorship was 87.3% (95% confidence interval (CI) 79.0 to 96.6), 85.0% (95% CI 75.8 to 95.3), 74.8% (95% CI 62.2 to 90.0), 65.2% (95% CI 49.9 to 85.2), and 59.8% (95% CI 43.5 to 82.1) at five, ten, 15, 20, and 25 years, respectively. A total of 23 patients (38.3%) developed complications, and 26 (43.3%) had a further operation. Persistent postoperative malalignment occurred more frequently in failed grafts (28.6% vs 4.3%; p = 0.023), and was a risk factor for graft failure (hazard ratio 6.55; 95% CI 1.61 27.71; p = 0.009). The mean mHSS score improved from 74.1 (40 to 91) preoperatively to 89.0 (66 to 100) at final follow-up (p < 0.001). Conclusion Femoral condylar FOCA with concomitant realignment osteotomy provides excellent long-term graft survival and reliable functional improvement. Persistent malalignment may increase the risk for graft failure.
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Putra, I. Nyoman Nugraha Ardana, and Nengah Sukendri. "Peningkatan Kinerja Melalui Merger Dan Akuisisi." Guna Sewaka 1, no. 2 (August 25, 2022): 45–55. http://dx.doi.org/10.53977/jgs.v1i2.669.
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The realignment of restructuring the company`s capital structure can execute through mergers and acquisitions. This research aim is to review the importance of merger activity and investment in terms of objectives and benefits. Methods used a literature review and secondary data. The research suggests that a company merger and acquisition support operation. There is good financial synergy and diversification, achieves economy of scale and scope that leads to cost efficiency and profitability, can obtain management skills, improve market forces, and may also be tax benefits. Because of that, the merger and acquisition were selective to enhance the company`s performance.
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Buckner, Charles, Christopher Kidd, Stacey Long, Peter Varlashkin, and Jim Zhu. "Environmentally controlled sample stage for Scintag's six-position XRD sample changer." Powder Diffraction 14, no. 4 (December 1999): 296–99. http://dx.doi.org/10.1017/s0885715600010721.
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An environmentally controlled sample stage for Scintag's six-position XRD sample changer is described. Unlike the commercial environmental stages for Scintag XRD units which require removal of the sample changer, and installation and alignment of the sample stage, the stage described herein is designed to fit directly on the sample changer with no realignment. Such a stage provides for more convenient operation for an X-ray diffractometer with multiple users in both routine (ambient environment) and nonroutine (nonambient temperatures up to 250 °C and varying relative humidities) modes. In addition, the new stage uses a window made of a material that is safer to machine compared to beryllium (which is toxic).
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Zhang, Ming-Zhu, and Guang-rong Yu. "Classification and operative management of malunion after midfoot injury." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0053. http://dx.doi.org/10.1177/2473011418s00533.
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Category: Midfoot/Forefoot Introduction/Purpose: To characterize clinical treatment of the malunion after midfoot injury. Methods: 22 cases of malunion following complex midfoot injury from 2004 to 2012. They were 19 men and 3 women with mean age of 37.8. The foot deformity was categorized into 3 types and 3 subtypes, with type? indicating normal foot arch (type ?a forefoot abduction, ?b forefoot adduction and Ic forefoot normal), type? Cavus deformity (subtype is same as?), and type ? flatfoot deformity (subtype is same as?) . There were 2 cases of type?a, 4 cases of type?c, 9 cases of type?a, 4 cases of type ?a, 3 cases of type ?c in our cohort. According to the malunion typing, osteotomy, joint arthrodesis, or realignment was used to correct deformity. Clinical outcomes were evaluated by AOFAS score and VAS. Results: All the patients were followed up for average 34.7 months.The mean VAS score was 2.0 points (0-6) and mean AOFAS score was 83.9±2.3 points (73-94) at the last follow-up, giving an excellent to good rate of 81.8%. All cases obtained favorable functional outcomes without bone nonunion, except one patient who still suffered from midfoot walking discomfort 3 years after operation. Conclusion: Operative management of malunion following midfoot injury is effective and good results can only be obtained by stabilizing injured joint, realignment and recover foot arch.Our typing of the midfoot malunion is helpful in the operative treatment.
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Volker, Joye. "Changing roles, changing realities: Australian art librarians in a brave new world." Art Libraries Journal 31, no. 2 (2006): 19–28. http://dx.doi.org/10.1017/s0307472200014449.
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As we all cope with an e-everything world, libraries are moving to accommodate WOW (words on the web) as well as POP (print on paper) in their collections. This has led to a realignment in organisational structures, particularly in university contexts. This paper addressed two major issues: firstly the challenges that major institutional reorganisations in Australia have placed on universities and, in particular, on art schools; secondly the way these challenges may be met, based on actions and solutions to improve access to Australian visual arts information resources which followed from an extensive survey by the National Library of Australia in co-operation with ARLIS/ANZ. These results encourage art libraries to develop partnerships and networking with their parent institution and other libraries and cultural institutions on a national level.
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Campos, Tales. "Do Haiti ao Planalto: os militares e a relação com a ONU no primeiro ano do governo Bolsonaro." Brasiliana: Journal for Brazilian Studies 10, no. 2 (2022): 295–312. http://dx.doi.org/10.25160/bjbs/10.2.16.
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This article aims to analyze the relations between the UN and Bolsonaro government in 2019 in the scope of foreign policy –considering the importance that the United Nations Stabilization Mission in Haiti (MINUSTAH) has for the Armed Forces and the international projection of Brazil. The methodology used in this article consists of bibliographical research relating primary and secondary materials (theses, articles, and dissertations) with recent journalistic material on federal management. The result found in this article demonstrates that, despite the divergence between sectors of the federal government regarding the directions of Brazilian foreign policy, due to issues of realignment at the international level, the approximation of the viability of relations with the UN through peace missions it’s not present in the plans of the Executive and the Armed Forces, although the military has prestige for this type of operation.
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Yun, Sang-Sun, and Seok-Cheol Kee. "Voltage Reference Realignment Cell Balance to Solve Overvoltage Caused by Gradual Damage of Series-Connected Batteries." Applied Sciences 13, no. 13 (June 28, 2023): 7624. http://dx.doi.org/10.3390/app13137624.
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This paper analyzes the cause of electric vehicle battery fires. The fundamental cause is attributed to a low cell balance current, and it is proven that the variation in the battery’s internal voltage due to temperature change is the decisive reason for battery fires. In this paper, the authors studied a method of solving the problem by changing only the software of the existing Battery Management System (BMS) without changing the hardware. Batteries cannot be made with 100% capacity, resulting in voltage division. Cell balancing is performed to prevent such phenomena, but a low cell balance current prevents the proper operation of cell balancing. As a result, relatively small batteries, due to progressive degradation, have continuous voltage rise toward overvoltage. Subsequently, an additional voltage rise occurs as the chemical activity of the battery increases due to temperature rise. In this paper, a new cell balancing method is proposed to limit the aging process of cells with a relatively small capacity and peak voltage. In addition, it was validated through simulation using MATLAB R2019a.
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TSUYUGUCHI, Y., T. MURASE, N. HIDAKA, H. OHNO, and H. KAWAI. "Anterior Wedge-Shaped Bone Graft for Old Scaphoid Fractures or Non-Unions." Journal of Hand Surgery 20, no. 2 (April 1995): 194–200. http://dx.doi.org/10.1016/s0266-7681(05)80049-x.
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For appraisal of anterior wedge-shaped grafts for the humpback deformity of the scaphoid, a retrospective study of 27 cases with old scaphoid fractures or non-unions was carried out. 11 cases were treated with Herbert screw fixation and anterior wedge-shaped graft and the other cases with other methods. For the assessment of carpal alignment, radio-lunate and scapho-lunate angles were measured with peri-operative radiographs. For the clinical assessment, the scoring system of Cooney was applied. In 25 cases, primary bone union was obtained with one attempt and in two cases, with the second operation. Union was achieved in a mean of 3.4 months. The post-operative wrist score ranged from 65 to 100 with an average 81.2 points. There was a statistically significant relationship between the wrist score and the post-operative scapho-lunate angulation of the affected wrist. The humpback deformity of scaphoid non-union should be treated precisely with carpal realignment surgery or anterior wedge-shaped bone graft.
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Biswas, Mrinmoy, Md Fazal Naser, SM Mahbub Alam, Md Abul Hossain, and M. A. Awal. "Comparative Study Between Outcomes of Early Primary Endoscopic Realignment Versus Suprapubic Cystostomy With Delayed Reconstruction in the Management of Posterior Urethral Injury." Bangladesh Journal of Urology 17, no. 1 (September 14, 2020): 29–35. http://dx.doi.org/10.3329/bju.v17i1.49111.
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Objectives: To compare the outcomes of early primary endoscopic realignment and suprapubic cystostomy with the outcomes of delayed reconstruction in the management of posterior urethral injury.
Methods: This is a quasi-experimental prospective study Conducted in the Urology department Dhaka medical college and hospital from January 2009 to December 2010. Atotal of 60 consecutive patients were selected for this study and inclusion criteria, male patients and age 18years and above. Posterior urethral injury resulting in distraction defect and urethral injury with pelvic fracture. Group-A, 28 patients underwent early primary endoscopic realignment after initial suprapubic urinary diversion and Group-B, 32 patients underwent primary suprapubic urinary diversion and delayed urethral reconstruction after 3 months of injury.
Results: After procedure 21(75%) out of 28 patients in Group-A developed stricture 12(42.9%) had simple and short segment stricture and 7(32.1%) had simple and long segment stricture, while in Group-B 12(37.5%) patients developed simple and short segment stricture. All of the patients in Group-A had minimum blood loss during operation. While, majority (81.3%) of patients in Group-B had a history of maximum blood loss. None of the patients in Group-A developed incontinence throughout the observations period (from removal of catheter to 9 months), while 15.6% of the patients in Group-B had incontinence at removal of catheter after anastomotic urethroplasty and at 3 month. The incontinence further increased to 18.8% at 6 and 9 months. Complaints of impotence were significantly less in Group-A than that in Group-B throughout the period of observation (14.3% vs. 37.5%, p = 0.042; 14.3% vs. 37.5%, p = 0.042 and 14.3% vs. 37.5%, p = 0.042). At removal of urethral catheter, stricture formation was observed and statistically there was no difference in Group-A and Group-B (14.3% vs. 21.9% in Group-B, p = 0.448). At month 3, stricture formation was significantly higher in Group-A than that in Group-B (42.9% vs. 15.6%, p = 0.020). At month 6, about 18% of patients in Group-A had stricture, but none of patients in Group-B was found so (p = 0.018).
Conclusions: Early primary endoscopic realignment of traumatic posterior urethral disruption is a simple, less traumatic, safe, and rapid technique. It provides a low morbidity and less postoperative complications. Though recurrent stricture formation is higher but the strictures are simple and short and amenable to be corrected endoscopically. It may be considered as initial therapy in the management of posterior urethral distraction defect over suprapubic cystostomy with delayed reconstruction.
Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.29-35
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Nurhayati, Hasan, Andri Buang, Chairil Anwar, Fetty Herlina, Lukmannulhakim Putra, Indrayani, and Muammar Khaddafi. "RESTRUCTURING, MERGER AND ACQUISITION." International Journal of Social Science, Educational, Economics, Agriculture Research and Technology (IJSET) 2, no. 7 (June 7, 2023): 128–36. http://dx.doi.org/10.54443/ijset.v2i7.167.
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Companies need to develop an appropriate strategy in order to maintain its presence and improve its performance. One attempt to become a large company and strong is to implement the strategy of restructuring. The emergence of the free market era has an impact on increasingly fierce corporate business competition. This condition spurred business people to pay attention to the strategy pursued. In fact, the company continues to formulate and perfect its business strategy in order to win the competition. The realignment of restructuring the company`s capital structure can execute through mergers and acquisitions. This research aim is to review the importance of merger activity and investment in terms of objectives and benefits. Methods used a literature review and secondary data. The research suggests that a company merger and acquisition support operation. There is good financial synergy and diversification, achieves economy of scale and scope that leads to cost efficiency and profitability, can obtain management skills, improve market forces, and may also be tax benefits. Because of that, the merger and acquisition were selective to enhance the company`s performance.
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Fitzgerald, Amy M., Nathan Wong, Annabel V. L. Fitzgerald, David A. Jesson, Ffion Martin, Richard J. Murphy, Tim Young, Ian Hamerton, and Marco L. Longana. "Life Cycle Assessment of the High Performance Discontinuous Fibre (HiPerDiF) Technology and Its Operation in Various Countries." Sustainability 14, no. 3 (February 8, 2022): 1922. http://dx.doi.org/10.3390/su14031922.
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Composite waste is a growing issue due to the increased global demand for products manufactured from these advanced engineering materials. Current reclamation methods produce short length fibres that, if not realigned during remanufacture, result in low-value additives for non-structural applications. Consequently, to maximise the economic and functional potential, fibre realignment must occur. The High Performance Discontinuous Fibre (HiPerDiF) technology is a novel process that produces highly aligned discontinuous fibre-reinforced composites, which largely meet the structural performance of virgin fibres, but to date, the environmental performance of the machine is yet to be quantified. This study assessed the environmental impacts of the operation of the machine using life cycle assessment methodology. Electrical energy consumption accounts for the majority of the greenhouse gas emissions, with water consumption as the main contributor to ecosystem quality damage. Suggestions have been made to reduce energy demand and reuse the water in order to reduce the overall environmental impact. The hypothetical operation of the machine across different European countries was also examined to understand the impacts associated with bulk material transport and electricity from different energy sources. It was observed that the environmental impact showed an inverse correlation with the increased use of renewable sources for electricity generation due to a reduction in air pollutants from fossil fuel combustion. The analysis also revealed that significant reductions in environmental damage from material transport between the reclamation facility to the remanufacturing site should also be accounted for, and concluded that transportation routes predominantly via shipping have a lower environmental impact than road and rail haulage. This study is one of the first attempts to evaluate the environmental impact of this new technology at early conceptual development and to assess how it would operate in a European scenario.
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Fisher, Wilson A. M., Olivia E. Gilbert, Cheerag Upadhyaya, and Michael Galgano. "Surgical strategies for the treatment of deformity-associated cervical spondylotic stretch myelopathy: a case series with technically nuanced illustrative operative videos." Neurosurgical Focus 55, no. 3 (September 2023): E10. http://dx.doi.org/10.3171/2023.6.focus23279.
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OBJECTIVE The aim of this study was to elucidate the vital role of anterior-only osteotomies for rigid cervical kyphosis causing stretch myelopathy by using illustrative cases and high-definition intraoperative videos. METHODS The authors describe 4 select patients who underwent anterior-only osteotomies within a 2-year time frame and demonstrate the nuances of each case with unique operative videos. RESULTS Outcomes for each of the cases demonstrated marked improvement in cervical spine alignment relative to preoperative conditions. Postoperative CT scans and upright radiographs for case 1 at 8 months demonstrated complete reduction of the kyphotic deformity and restoration of the C2 slope. In case 2, the 2-year postoperative radiographs showed significant realignment of the cervical spine, and the patient made significant neurological improvement since the operation, specifically in hand dexterity, balance, neck pain, and the ability to comfortably achieve and maintain a horizontal gaze. For case 3, postoperative upright radiographs revealed marked improvement in the patient’s cervical sagittal alignment. The 4-month follow-up was also notable for substantial improvement in postural neck pain, bilateral upper extremity strength, and continued improvements in dexterity. Case 4 also demonstrated an excellent outcome with unkinking of the patient’s spinal cord and correction of her sagittal plane deformity, as shown on her 5-month postoperative upright radiographs. CONCLUSIONS Deformity-associated cervical spondylotic stretch myelopathy often leads to devastating neurological decline and can significantly decrease quality of life. Carefully selected cases of circumferentially rigid cervical kyphosis can be successfully corrected with anterior-only osteotomies followed by posterior fixation while avoiding back-front-back operations.
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Sankaraguruswamy, Srinivasan, and J. Scott Whisenant. "An Empirical Analysis of Voluntarily Supplied Client-Auditor Realignment Reasons." AUDITING: A Journal of Practice & Theory 23, no. 1 (March 1, 2004): 107–21. http://dx.doi.org/10.2308/aud.2004.23.1.107.
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In this paper we investigate whether voluntarily disclosed reasons for auditor-client realignments (as encouraged by the SEC) have information content for investors. After classifying realignment reasons into two types—verifiable and non-verifiable, with the latter representing disclosures about the auditor-client relationship not evident from alternative sources—we find that, as predicted by the “good news” precept of theoretical signaling models, non-verifiable realignment reasons are positively associated at the time of their announcement with abnormal returns. We also investigate whether voluntarily disclosed realignment reasons are associated with the relative size of the predecessor or successor auditor. We find that clients are more likely to cite service-related (non-verifiable) reasons when dismissing large predecessor auditors, and are more likely to cite fee-related (non-verifiable) reasons when choosing small successor auditors. These findings are consistent with auditors competing for the clients of large auditors by offering better or broader services, and with smaller auditors competing based upon price. All of our findings are robust to controlling for mandatory auditor change disclosures (auditor-client disagreements, reportable events, and goingconcern opinions), and operating, financing, and investing activities found in prior research to be associated with auditor changes.
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Colucci, Vitantonio, Giampaolo Manfrida, Barbara Mendecka, Lorenzo Talluri, and Claudio Zuffi. "LCA and Exergo-Environmental Evaluation of a Combined Heat and Power Double-Flash Geothermal Power Plant." Sustainability 13, no. 4 (February 11, 2021): 1935. http://dx.doi.org/10.3390/su13041935.
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This study deals with the life cycle assessment (LCA) and an exergo-environmental analysis (EEvA) of the geothermal Power Plant of Hellisheiði (Iceland), a combined heat and power double flash plant, with an installed power of 303.3 MW for electricity and 133 MW for hot water. LCA approach is used to evaluate and analyse the environmental performance at the power plant global level. A more in-depth study is developed, at the power plant components level, through EEvA. The analysis employs existing published data with a realignment of the inventory to the latest data resource and compares the life cycle impacts of three methods (ILCD 2011 Midpoint, ReCiPe 2016 Midpoint-Endpoint, and CML-IA Baseline) for two different scenarios. In scenario 1, any emission abatement system is considered. In scenario 2, re-injection of CO2 and H2S is accounted for. The analysis identifies some major hot spots for the environmental power plant impacts, like acidification, particulate matter formation, ecosystem, and human toxicity, mainly caused by some specific sources. Finally, an exergo-environmental analysis allows indicating the wells as significant contributors of the environmental impact rate associated with the construction, Operation & Maintenance, and end of life stages and the HP condenser as the component with the highest environmental cost rate.
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Stavrakakis, Ioannis M., Zisis Ntontis, Olga Kastritsi, Constantinos Chaniotakis, Kalliopi Alpantaki, and Grigorios Kastanis. "Distal Humerus Fracture Malunion in Adults: A Case Report and a Review of the Literature." Case Reports in Orthopedics 2022 (April 29, 2022): 1–5. http://dx.doi.org/10.1155/2022/6041577.
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Introduction. Neglected distal humerus fractures are rare injuries, which the orthopaedic surgeon will not deal many times in his career. We present a case of a young patient with such an injury, who was treated with a corrective osteotomy and fixation, resulting in a very good outcome. This case report highlights the importance of surgical intervention for distal humerus fracture malunion. A narrative review of the literature regarding this topic is presented as well. Case Report. A 42-year-old female patient presented to our department nine weeks after a displaced distal humerus fracture, which was treated conservatively in another institution. Ulnar nerve neuropathy, pain, and severe stiffness of the elbow were her main symptoms. Open correction of the deformity, anatomical reduction of the articular surface, and realignment of the metaphyseal level of the fracture were performed. Six months postoperation, a painless flexion-extension arc of 110° and a normal rotation of the forearm was achieved. Conclusion. Distal humerus fracture malunion is a challenge. The operation needed for this purpose is much more demanding, and postsurgical complications are more likely to occur as opposed to the treatment of acute fractures. If a proper surgery is performed though, a good clinical outcome can be expected.
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Raveh, Joram, Jon B. Turk, Kurt Lädrach, Rolf Seiler, Nelson Godoy, Joseph Chen, Josip Paladino, Miso Virag, and Karl Leibinger. "Extended anterior subcranial approach for skull base tumors: long-term results." Journal of Neurosurgery 82, no. 6 (June 1995): 1002–10. http://dx.doi.org/10.3171/jns.1995.82.6.1002.
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✓ The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical—otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival—sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.
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Laufer, Andrea, Adrien Frommer, Georg Gosheger, Robert Roedl, Jan Niklas Broeking, Gregor Toporowski, Anna Maria Rachbauer, and Bjoern Vogt. "Femoro-pedal distraction in staged reconstructive treatment of tibial aplasia." Bone & Joint Journal 102-B, no. 9 (September 1, 2020): 1248–55. http://dx.doi.org/10.1302/0301-620x.102b9.bjj-2019-1484.r1.
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Aims The treatment of tibial aplasia is controversial. Amputation represents the gold standard with good functional results, but is frequently refused by the families. In these patients, treatment with reconstructive limb salvage can be considered. Due to the complexity of the deformity, this remains challenging and should be staged. The present study evaluated the role of femoro-pedal distraction using a circular external fixator in reconstructive treatment of tibial aplasia. The purpose of femoro-pedal distraction is to realign the limb and achieve soft tissue lengthening to allow subsequent reconstructive surgery. Methods This was a retrospective study involving ten patients (12 limbs) with tibial aplasia, who underwent staged reconstruction. During the first operation a circular hexapod external fixator was applied and femoro-pedal distraction was undertaken over several months. Subsequent surgery included reconstruction of the knee joint and alignment of the foot. Results The mean follow-up was 7.1 years (2 to 10). The mean age of the patients at the time of the application of the fixator was 2.3 years (1.1 to 5.0). The mean time under distraction was 139.7 days (81.0 to 177.0). A mean fibular distalization of 38.7 mm (14.0 to 67.0) was achieved. Pin infections occurred in four limbs (33.3%) and osteitis in one. A femoral fracture occurred in one patient. Premature removal of the frame was not required in any patient. Sufficient realignment of the leg as well as soft tissue lengthening was achieved in all patients, allowing subsequent reconstruction. All patients were able to mobilize fully weight bearing after reconstruction. Functional outcome was limited in all limbs, and five patients (50.0%) required additional reconstructive operations. Conclusion Regarding the functional results in the treatment of tibial aplasia, amputation remains superior to limb salvage. The latter procedure should only be performed in patients whose parents refuse amputation. Femoro-pedal distraction efficiently prepares the limb by realigning the leg and soft tissue lengthening. Minor complications are frequent, but usually do not hinder the continuation of distraction. Even though a fully weight-bearing limb is achieved, the functional outcome of reconstructive treatment remains limited. Recurrent deformities frequently occur and may require further operations. Cite this article: Bone Joint J 2020;102-B(9):1248–1255.
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Sherman, Seth L., Derek W. Geeslin, Daniel W. Hogan, John W. Welsh, Joseph M. Rund, John R. Worley, Ma Richard, and Aaron Gray. "Comparison of MPFL Repair Versus MPFL Reconstruction for Refractory Patella Instability in Patients Under 18 Years Old." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0018. http://dx.doi.org/10.1177/2325967120s00189.
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Background: The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint against lateral patellar displacement. Surgery to address MPFL incompetence is the current gold standard for recurrent patellofemoral instability. In the young patient, controversy remains regarding the role of MPFL repair in the setting of recurrent patella instability. Hypothesis/Purpose: Our purpose was to investigate subjective outcomes and complication profile of consecutive cohorts under age 18 undergoing MPFL repair or MPFL reconstruction. Our hypothesis was that the MPFL reconstruction group would have higher subjective outcome scores and a lower complication profile. Methods: Following IRB approval, a retrospective review of prospectively collected data identified a consecutive cohort of patients undergoing soft tissue stabilization for recurrent patella instability. Surgery was performed by a single sports fellowship trained surgeon between 2011-2019. MPFL repair was performed on patients prior to November 2015 and MPFL reconstruction with allograft from December 2015 to present. Patients undergoing concomitant bony realignment procedures were included. Patient reported outcomes (PROs) were collected including PROMIS, KOOS, IKDC, Marx, Tegner, and SANE scores. Complications requiring re-operation (i.e., infection, stiffness, recurrent instability) were recorded. Results were analyzed statistically. Results: The cohort was comprised of 43 patients (53 knees), with 15 males (34.9%), and 28 females (65.1%). The MPFL-Repair cohort had 22 patients (24 knees) and the MPFL-Reconstruction had 25 patients (29 knees). The average age of the MPFL-Repair cohort was 14.82 (range 10.5-17.8) and the average age of the MPFL-Reconstruction group was 15.59 (13.0-17.7). At final follow-up (minimum 6 months), there were no statistically significant differences between cohorts for KOOS Pain (p=0.4126), KOOS symptoms (p=0.7990), KOOS ADL (p=0.4398), KOOS Sport Rec (p=0.3357), KOOS QOL (p=0.8707), Global Physical Health (p=0.9736), Global Mental Health (p=0.1724), Physical Function (p=0.8077), Pain Interference (p=0.9740), Mobility T-Score (p=0.0634), Marx activity score (p=0.0844), Tegner Score (p=0.0752), IKDC (p=0.2646), and SANE score (p=0.0811). Regarding complications requiring re-operation, there was 1 knee in the MPFL-Reconstruction group (3.4%) that required further surgery (1 for fracture) and 9 knees in the MPFL-Iso cohort (37.5%) that required re-operation (1 for fracture, 8 for recurrent instability). The difference in complication rate was statistically significant (p=0.0012). Conclusion: In patients under 18 years old undergoing surgery for refractory patella instability, both MPFL allograft reconstruction and MPFL primary repair demonstrated no difference in subjective outcome scores at midterm follow-up. MPFL primary repair had significantly increased rate of complication requiring re-operation, particularly recurrent patella instability requiring revision to MPFL reconstruction. Tables/Figures: [Table: see text][Table: see text][Table: see text]
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Grelsamer, Ronald P., and Drew A. Stein. "Proximal Realignment Operations of the Patella." Techniques in Knee Surgery 4, no. 1 (March 2005): 62–68. http://dx.doi.org/10.1097/01.btk.0000154849.75262.1e.
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Jeong, Jae-Jung. "Rotational Distal Chevron Osteotomy for Correction of Hallux Valgus Associated with Metatarsus Adductus and Large Distal Metatarsal Articular Angle." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0023. http://dx.doi.org/10.1177/2473011419s00232.
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Category: Bunion Introduction/Purpose: Hallux valgus treatment in the setting of associated metatarsus adductus is less common and not well described. The presence of metatarsus adductus reduces the gap between the first and second metatarsals. Consequently, it complicates the measurement of the first-second intermetatarsal angle and can limit the area available for transposition of the first metatarsal head. If distal metatarsal articular angle (DMAA) is also increased here, it is difficult to correct. We investigated the effects of rotational distal chevron metatarsal osteotomy (DCMO) on hallux valgus associated with metatarsus adductus and increased DMAA. Methods: Twelve patients, (12 female, 15 feet), of average age 59 (SD 23) with symptomatic hallux valgus associated with metatarsus adductus and increased DMAA underwent a rotation DCMO and were reviewed at an average of 12 months postoperatively. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA before and after the operation was analyzed. Results: Distal Chevron osteotomy was done in 15 cases. After DCMO, The distal fragment was translated to laterally as far as possible and rotated to reduce DMAA. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from 21.8° preoperatively to 8.5° postoperatively. The first intermetatarsal angle was decreased from 11.8° preoperatively to 6.7° postoperatively. DMAA was decreased from 15.8° preoperatively to 5.5° postoperatively. Conclusion: The rotational DCMO was an effective procedure for correcting hallux valgus associated with metatarsus adductus and increased DMAA. It allowed good realignment of the first MTP joint without the need for lesser metatarsal surgery to reduce the metatarsus adductus.
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Tan, Si Heng Sharon, Chen Xi Kasia Chua, Chintan Doshi, Keng Lin Wong, Andrew Kean Seng Lim, and James Hoipo Hui. "The Outcomes of Isolated Lateral Release in Patellofemoral Instability: A Systematic Review and Meta-Analysis." Journal of Knee Surgery 33, no. 10 (May 25, 2019): 958–65. http://dx.doi.org/10.1055/s-0039-1688961.
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AbstractThere have been conflicting reports regarding the outcomes of lateral release when used in the management of patellofemoral instability. This systematic review and meta-analysis therefore aims to evaluate the outcomes of isolated lateral release in the management of patellofemoral instability. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies that reported the outcomes of isolated lateral release for recurrent patellofemoral dislocations were included. A total of 10 publications were included, with 204 knees. All studies consistently reported a decrease in the rates of patellofemoral dislocation (odds ratio [OR] < 0.01; 95% confidence interval [CI]: <0.01–0.01) and an increase in the odds of having a good outcome (OR 0.01; 95% CI: <0.01–0.02) after lateral release. All studies also consistently reported a similar number of patients participating in sports postoperatively as compared with preinjury (OR 2.78; 95% CI: 0.53–14.68). A total of 28 (14.1%) out of 198 patients had postoperative dislocation. Of these patients, 15 required a secondary procedure for patellofemoral realignment; however, all patients who had their eventual outcomes reported still had a good outcome postoperatively. Isolated lateral release can lead to good short- to middle-term outcomes when used in the management of recurrent patellofemoral dislocations. The procedure can lead to a significantly decreased rate of recurrence of patellofemoral dislocations, a significantly increased rate of good outcomes, and a similar number of patients being able to participate in sports as compared with the number of patients participating in sports prior to having patellofemoral dislocations. An isolated lateral release could therefore potentially serve as a simple and relatively low-risk procedure that could be performed as a first-line surgical management in selected patients with patellofemoral instability, allowing them to possibly avoid a more complex and major operation. This is a Level IV study.
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Ye, Q. B., Y. P. Wang, J. Zhang, Z. H. Wu, and X. S. Weng. "A NEW SPINAL INSTRUMENTATION WITHOUT FUSION FOR THE TREATMENT OF PROGRESSIVE IDIOPATHIC SCOLIOSIS IN GROWING CHILDREN." Journal of Musculoskeletal Research 07, no. 03n04 (September 2003): 201–9. http://dx.doi.org/10.1142/s0218957703001137.
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Objective: To study on the therapeutic mechanism of an innovated instrumentation — Plate-Rod System for scoliosis (PRSS) and its effectiveness for the surgical management of idiopathic scoliosis in growing children. Method: To avoid the necessity of repeated operative instrument lengthening, a new device — Plate-rod Spinal System (PRSS) was developed in our department. It can provide and maintain desirable correction of scoliosis in growing children in an one-stage operation. The instrumentation will extend itself to keep up with the growth of the spinal column, which is helpful in preventing truncal shortening and "crankshaft phenomenon". From October 1998 to March 2001, thirty-four young children with progressive idiopathic scoliosis of average 62.8° were treated using PRSS without fusion. Results: The mean percentage of correction was 62.78%, the best being 87.2%. The average loss of correction of 8° was found in 15 cases at the time of average 28 months follow-up. The remaining cases have no loss of correction. An average of 13.5 mm spinal lengthening of the instrumental segments was achieved. When PRSS is in place, compressive stress found to exert on the convex side, while tensile stress on the concave side of the curvature, and more type X collagen mRNA to be expressed on convex side than concave side; this suggests that compressive stress leads to increase earlier cartilage degeneration of the end plate on convex side, so as to retard the growth of the end plate of this side, resulting in maximum spinal realignment. No severe complication was found in our series. Conclusion: The PRSS, which dispenses with spinal fusion and allows extension along with the children's growth, is a new effective instrumentation for correcting scoliosis, especially in case of growing children.
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Mukhopadhaya, John, Arvind Gupta, Amit K. Sinha, and Janki S. Bhadani. "Chronic patellofemoral instability and pain treated effectively by anteromedial tibial tubercle transfer (Fulkerson osteotomy) with or without medial patellofemoral ligament reconstruction." International Journal of Research in Orthopaedics 7, no. 5 (August 25, 2021): 1026. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20213163.
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<p><strong>Background</strong>-Chronic patellar instability (subluxation and dislocation) and pain is a debilitating knee condition that frequently involves young, active patients. Bony malalignment and soft tissue injury (torn or stretched MPFL) is considered as a surgical indication for distal realignment in the form of Anteromedial tibial tubercle transfer(Fulkerson osteotomy) with or without MPFL reconstruction that effectively prevents the patella from tracking laterally and thus unloads the lateral patella while making the patellofemoral joint more congruous , stable and pain free.</p><p><strong>Materials and method</strong> - It is a prospective study of 22 patients of chronic patellar instability and pain. Follow up ranged from 24 to 36(average 30) months. Preoperative assessment included clinical examination, Lysholm, IKDC score and Radiological examination (X-ray, CT scan and MRI). 18 patients with history of dislocation and pain having bony malalignment and torn MPFL were treated with Fulkerson osteotomy and MPFL reconstruction and 4 patients with history of subluxation and pain having bony malalignment only were treated with Fulkerson osteotomy alone. Patients were followed up with the help of X-rays at regular interval and the clinical outcome was measured using scoring system.</p><p><strong> </strong><strong>Results</strong>-There was a significant improvement in postoperative assessment with regards to scoring system (Lysholm and IKDC) and knee pain. Union at osteotomy site for all patients was seen. None of the patients had further episode of dislocation or subluxation. Pain at femoral site of MPFL reconstruction in 2 cases persisted for 3 months followed by resolution of their symptoms. One of our patients had profuse swelling at the site of operation postoperatively which was treated with Rest, Ice Pack, Compression and Limb elevation. Out of 22 patients undertaken infection at osteotomy site was seen in 1 patient for which implant removal was done from osteotomy site after union.</p><p> <strong>Conclusion</strong>-Anteromedial Tibial tuberosity osteotomy and MPFL reconstruction is a successful procedure to treat patellofemoral pain and instability.</p>
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Сподинюк, Н. А., and В. Б. Шепітчак. "Analysis of the cost of heat energy and the ways of it's saving for residential buildings." Scientific Bulletin of UNFU 30, no. 2 (June 4, 2020): 62–65. http://dx.doi.org/10.36930/40300211.
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The rise in gas prices causes them to switch to alternative fuels such as firewood, coal and fuel briquettes. Replacing a gas boiler with a solid fuel does not require much effort and such a solution was economically feasible given the high cost of electricity as well. However, to date, energy pricing has undergone a realignment. So the question remains how to really save energy and money of consumers. The purpose of the article was to analyze the cost of thermal energy during the heating period for individual buildings given the constant change in price and priorities for a particular fuel. Mathematical estimation of heat losses of an individual building was carried out, based on a number of assumptions and generalizations. Thanks to this technique, it is possible to estimate with sufficient accuracy for engineering calculations, consumption of natural gas, solid fuel and electricity to provide energy to the home heating system. As a result of the analysis, a number of features can be outlined. After rising gas prices, individual homeowners have made a sharp switch to solid fuel heating. In 2016, prices for alternative fuels, such as coal and fuel briquettes, were much lower than the price of gas for the population. Therefore, a solid fuel boiler unit was a good solution to the problems of Ukrainians in the fight against energy dependence. In 2020, the situation changed dramatically. The price of solid fuels has risen and it is difficult to find an alternative to gas now, taking into account the ease of operation of the gas boiler, as opposed to solid fuel. The sharp rise in the price of firewood and coal is associated with high demand and a sharp decrease in solid fuel resources. It should also be noted that the problem of ecology in Ukraine will continue to become increasingly important. Therefore, the use of solid fuel sources of heat will have to be consciously refuse in the near future. Application of local infrared heating system will allow to provide local heating of only some residential zones. Also, the installation of a two-zone or three-zone electricity meter and quality regulation of the infrared heating system will save energy.
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Maloney, Michael T., and Robert E. McCormick. "Realignment in telecommunications." Managerial and Decision Economics 16, no. 4 (July 1995): 401–25. http://dx.doi.org/10.1002/mde.4090160411.
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Song, Jaehwang, Chan Kang, Je Hyung Jeon, and Chang Uk Ham. "Effects of Supramalleolar Osteotomy on Abnormal Internal Rotation of the Talus in Varus Ankle Osteoarthritis." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0045. http://dx.doi.org/10.1177/2473011420s00452.
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Category: Ankle Arthritis; Basic Sciences/Biologics Introduction/Purpose: Varus ankle osteoarthritis, which is induced by asymmetric joint load in the ankle due to varus malalignment and characterized by a loss of cartilage in the medial talar dome or medial clear space in the ankle mortise, accounts for a large proportion of ankle osteoarthritis osteoarthritis. Realignment surgery, such as supramalleolar osteotomy (SMO) is an effective surgical procedure for treating varus ankle osteoarthritis. In previous study using weightbearing computed tomography (WBCT) by other group, the abnormal internal rotation of the talus was often seen in patients with varus ankle osteoarthritis. We used axial loading three-dimensional computed tomography (AL 3D CT) to evaluate preoperative and postoperative talocrural joints of patients who underwent SMO to treat varus ankle osteoarthritis. Methods: We performed retrospective analyses of 12 patients (14 feet) who underwent SMO and fibular osteotomy. Fibular osteotomy was performed by scarf osteotomy and the center of hinge was fixed with cortical screw. For SMO, distal tibial medial sharp spike of bone produced after the opening wedge osteotomy was resected and used for the autogenous strut bone graft in the osteotomy gap. Tibial-ankle surface angle (TAS), talar tilt angle (TT), Takakura stage, and tibial-lateral surface angle (TLS) was evaluated with weightbearing radiographs before operation and at 2-year follow-up. Talus rotation ration and presence of medial gutter contact was investigated with AL CT before operation and at 6-month follow-up (Figure A-D : preoperative, E-H : postoperative).Clinical outcomes were assessed based on the preoperative and 2-year follow-up American Orthopaedic Foot & Ankle Society (AOFAS) scale, visual analog scale (VAS) for pain, and Foot and Ankle Ability Measure (FAAM). Results: The mean 2-year follow-up TAS, TT, Takakura stage, and TLS were all significantly different relative to preoperative parameters (P < .05). The mean 6-month follow-up talus rotation ratio was significantly restored compared to preoperative value (P = .001). The mean 2-year follow-up clinical outcomes were all significantly improved relative to preoperative measurements (P = .001). The preoperative talus rotation ratio had moderately positive linear relationships with preoperative Takakura stage and preoperative anterior talar translation (P < .05). Among the variables of interest, preoperative anterior talar translation was most strongly related to the preoperative talus rotation ratio (r = 0.655, P < .05). The postoperative talus rotation ratio had moderately positive linear relationships with postoperative Takakura stage and preoperative talar tilt angle (P < .05). Conclusion: In summary, abnormal internal rotation of the talus in mild to moderate varus ankle osteoarthritis, as observed by AL CT, was significantly restored after SMO combined with fibular osteotomy. SMO yielded successful radiological and clinical outcomes. Based on these results, we believe that correction of abnormal internal rotation of the talus is an important prognostic factor in patients with varus ankle osteoarthritis, and we recommend that clinicians investigate such abnormality perioperatively.
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Kim, Jaeyoung, Jesse Seilern und Aspang, Kim Ji-Beom, Jonathan Day, Oliver Gagné, and Woo-Chun Lee. "Realignment Surgery for Failed Osteochondral Autologous Transplantation in Osteochondral Lesions of the Talus Associated With Malalignment." Foot & Ankle Orthopaedics 7, no. 2 (April 2022): 2473011421S0053. http://dx.doi.org/10.1177/2473011421s00530.
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Category: Ankle Arthritis; Sports Introduction/Purpose: While osteochondral autograft transplantation (OAT) offers favorable results in most patients with osteochondral lesions of the talus (OLT), some patients continue to experience persistent pain following the procedure. Information regarding the etiology of this pain and outcomes of revision surgery are limited. This study aimed to report results of revision surgery with realignment procedures in patients with failed OAT who demonstrated concomitant malalignment at the distal tibia or hindfoot. Methods: Eight ankles with persistent pain following OAT underwent revision surgery with realignment procedures. All patients underwent primary OAT for treatment of medial OLTs. Patients were divided into two groups based on the main location of deformity; the Supramalleolar realignment group (SRG, five ankles) and the Hindfoot realignment group (HRG, three ankles). No direct procedure was performed on the osteochondral lesion at the time of revision surgery. Ankle and hindfoot alignment were evaluated using six parameters in weightbearing radiographs. Computed tomography (CT) was used to assess for medial gutter narrowing, spur formation, and cyst volume around transplanted osteochondral plug pre-and postoperatively. Clinical outcomes were assessed using foot function index and visual analogue scale. Results: All patients had medial gutter narrowing or spur formation, which are early signs of ankle arthritis. The SRG had varus distal tibial alignment with a median medial distal tibial angle of 85.7 degrees (Interquartile range [IQR], 3.2). The HRG had valgus hindfoot alignment and a lower medial longitudinal arch with a median hindfoot moment arm of 8.4 mm (IQR, 6.1) and a median Meary angle of 11.8 degrees (IQR, 1.4). Spontaneous restoration of the osteochondral lesion was observed after realignment surgery, with cyst volume decreasing from 0.2592cm3 to 0.0873cm3 (p<0.05, Figure 1 and Figure 2). Clinical scores improved in all patients. Conclusion: The current study shows the effectiveness of realignment surgery in a selected patient group in whom OAT has failed. Our study provides evidence for the role of realignment procedures in these cases, with results suggesting improved patient-reported outcomes and spontaneous restoration of osteochondral lesions.
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Jerre, R., G. Hansson, and J. Wallin et al. "LONG-TERM RESULTS AFTER REALIGNMENT OPERATIONS FOR SLIPPED UPPER FEMORAL EPIPHYSIS." Journal of Pediatric Orthopaedics 17, no. 2 (March 1997): 274. http://dx.doi.org/10.1097/01241398-199703000-00041.
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Jerre, R., G. Hansson, and J. Wallin et al. "LONG-TERM RESULTS AFTER REALIGNMENT OPERATIONS FOR SLIPPED UPPER FEMORAL EPIPHYSIS." Journal of Pediatric Orthopaedics 17, no. 2 (March 1997): 274. http://dx.doi.org/10.1097/00004694-199703000-00041.
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Jerre, R., G. Hansson, J. Wallin, and J. Karlsson. "LONG-TERM RESULTS AFTER REALIGNMENT OPERATIONS FOR SLIPPED UPPER FEMORAL EPIPHYSIS." Journal of Bone and Joint Surgery. British volume 78-B, no. 5 (September 1996): 745–50. http://dx.doi.org/10.1302/0301-620x.78b5.0780745.
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Hysa, Eglantina, and Russell Foote. "Improving Operational- Developmental Connections: Foregrounding an Alignment- Dealignment- Realignment Perspective." International Journal of Education Economics and Development 1, no. 1 (2023): 1. http://dx.doi.org/10.1504/ijeed.2023.10043670.
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Hysa, Eglantina, and Russell Foote. "Improving operational - developmental connections: foregrounding an alignment - dealignment - realignment perspective." International Journal of Education Economics and Development 14, no. 2 (2023): 191. http://dx.doi.org/10.1504/ijeed.2023.129884.
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Prokopovich, Evgeny V., Mikhail A. Konev, Konstantin A. Afonichev, Ivan E. Prokopovich, Aleksander B. Kovzikov, Maksim S. Nikitin, Vladimir V. Selizov, and Tatyana S. Vinokurova. "Congenital radioulnar synostosis: symptom complex and surgical treatment." Pediatric Traumatology, Orthopaedics and Reconstructive Surgery 4, no. 3 (September 15, 2016): 16–25. http://dx.doi.org/10.17816/ptors4316-25.
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Background. Congenital radioulnar synostosis (CRUS) is a rare musculoskeletal disease with a wide-ranging symptom complex. Attitudes toward surgical treatment of the disease is very diverse, ranging from complete negation to acceptance. When choosing a treatment method, high recurrence and complication rates should be taken into account.Aims. To analyze the clinical implications of CRUS and to identify optimal treatment options.Materials and methods. From 2008 to 2015, 54 patients (31 boys and 23 girls; aged 1–14 years) with CRUS were examined and treated. Presenting complaints and the possible factors leading to disease development were investigated; orthopedic examination, roentgenography, electromyography, and computed tomography were performed. The treatment approach was determined on the basis of the clinicoroentgenological presentation.Results. All cases of CRUS were sporadic. In 43.7% patients, risk factors resulting in disease development were detected. Unilateral lesions were observed in 30 patients, whereas bilateral lesions were observed in 24 patients. According to the Cleary and Omer classification, the first type is the rarest; it is distinguished by the absence of bony fusion and close to average forearm positioning. In such cases, operative treatment is not necessary. For the second and third types, pronounced pronation forearm realignment requiring corrective derotational osteotomy of the radial bone is the main factor. For the fourth type, the main functional disorder is the restriction of the forearm flexion; treatment for this type involves resection of the radius head. We attempted to divide the synostosis (to achieve active movements) in five patients; however, we were unsuccessful. In three patients, synostosis recurrence occurred; and in two patients, active movements were not obtained after surgery. In four patients, radial nerve neuropathy was detected in the postoperative period after conservative therapy. In two patients, ulnar fractures occurred as a result of a fall; in one of these patients, fragment apposition was required.Conclusions. Clinicoroentgenological manifestations of CRUS determine the treatment options. The most typical and important of these manifestations is the pronation positioning of the forearm. In such cases, it is reasonable to start operative CRUS treatment after 3 years. All variants of deformation are indicators for operation, and treatment options are determined by the degree of severity of the deformation. Attempts to form the forearm bone neoarthrosis in order to get rotational movements is not effective and can result in deformation recurrence.
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Veri, J. P., S. P. Pirani, and R. Claridge. "Crescentic Proximal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus: A Mean 12.2 Year Follow-Up Study." Foot & Ankle International 22, no. 10 (October 2001): 817–22. http://dx.doi.org/10.1177/107110070102201007.
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The senior author's (R.C.) first 25 patients (37 feet) treated with a combination proximal crescentic osteotomy and distal soft-tissue reconstruction made up the patient cohort. All 25 patients were reviewed at a minimum of one year post-op (short-term follow-up) and 20/25 (31/37 feet) were reviewed again at a mean 12.2 years (range 11.4 to 13.0 yrs) post-op (long-term follow-up). This allowed for a comparison of short- and long-term results and led to a long-term follow-up rate of 84% (31/37 feet, mean 12.2 yrs). Clinical, radiographic and patient outcome measures were obtained and compared pre-op and at short- and long-term follow-up. The mean preoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were 37° and 16° respectively. The mean HVA correction was 24° and IMA correction 10° at long-term follow-up with no tendency toward recurrence. Sesamoid position and first MTP subluxation was markedly improved postoperatively and the correction was maintained at long-term follow-up. Patients were asked about their satisfaction in terms of pain, appearance and motion. At long-term follow-up, more than 90% of patients were completely satisfied with pain and motion and greater than 80% with their appearance. Ninety-four percent of patients said they would have the operation again. The AOFAS clinical rating scale for the hallux was calculated retrospectively for pre-op and short-term follow-up and prospectively for long-term follow-up. The mean pre-op score was 37/100 (16 to 60) which significantly improved to 92/100 (67 to 100) at both follow-up periods, suggesting no evidence of decrease in outcome over time. Complications included two patients (5%) that were over-corrected into varus (one symptomatic, one asymptomatic), and four patients (11%) that were undercorrected, developing asymptomatic recurrences (>10° increase HVA) at long-term follow-up. In addition, two patients (5%) developed new transfer lesions postoperatively, likely related to technical error (one varus overcorrection, one dorsiflexion malunion). In conclusion, the long-term results, with a mean follow-up of 12.2 years, of the resection realignment procedure for moderate to severe hallux valgus are generally excellent and the complication rate is low and acceptable. Attention to detail, avoiding both undercorrection, which can lead to recurrence, and overcorrection, which can cause symptomatic varus, is essential.
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Finnern, Michael, Claude Anderson, and Paul Ryan. "Occupational Outcomes Of Reconstructive Surgery For Adult Acquired Flatfoot Deformity." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000167.
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Category: Hindfoot Introduction/Purpose: Reconstruction of a symptomatic adult flatfoot is an involved operation with a long recovery period. No previous studies have looked at the occupational or functional results of athletically active patients who have undergone this surgery. In the United States military, the rates of return to unrestricted active duty are unknown. Methods: A retrospective review of all active duty military patients who underwent a reconstructive surgery for adult acquired flatfoot surgery at a single institution from January 2001-2015 was performed. Surgical, inpatient, and outpatient databases were searched via CPT and ICD9 codes. Approximately 1300 cases with potential flatfoot reconstructive surgery were identified. Only those patients with the diagnosis of flatfoot treated with both a boney procedure and a soft tissue procedure were included. Patients had to have at least one year follow-up or follow-up to the point of maximum medical benefit as defined by the operative provider. Final disposition of the patients had to have been recorded in the medical record. Three possible outcomes were utilized in the review of this cohort: patient returned to duty without restrictions, patient returned to active duty with restrictions, or patient separated from active duty due all or in part to this medical condition. Results: Fifty patients met inclusion criteria. 30/50 patients (60%) remained on active duty with permanent duty restrictions, and only two of 50 patients (4%) returned to full duty without restrictions. 20/50 (40%) underwent a Medical Evaluation Board (MEB) to separate from the military. A difference was noted in terms of the hindfoot realignment procedure performed: the probability of an MEB is higher for those patients who had a lateral column lengthening procedure than those who were treated with a medializing calcaneal osteotomy. Conclusion: The sample size is the largest study to date of patients with surgical correction for symptomatic pes planus. The results demonstrate that a service member with symptomatic pes planus requiring surgery faces a 96% chance of failure to return to pre-injury level of function. While some (60%) were able to remain on active duty with restrictions, there is a 40% chance that service members will face separation from the military due to their foot pain. Furthermore, patients treated with a lateral column lengthening had a higher probability of being medically discharged than those who had a medializing calcaneal osteotomy.
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Deckey, David G., Jens Verhey, Jack Haglin, Alicia Carlson, Todd A. Kile, and Nathaniel Hinckley. "Treatment of Moderate to Severe Hallux Valgus without Osteotomy or Arthrodesis." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0064. http://dx.doi.org/10.1177/2473011421s00648.
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Category: Bunion Introduction/Purpose: Hallux valgus is a multi-planar deformity that has historically required osteotomies to correct a soft tissue deficiency. We present a novel technique for the treatment of moderate to severe hallux valgus and subsequent radiographic results of a method to correct the intermetatarsal abnormality without utilizing osteotomies or arthrodesis. Methods: One hundred and thirty-six patients undergoing primary metatarsal re-alignment with modified McBride for moderate to severe hallux valgus were included. After each patient underwent standard distal soft tissue procedure via modified McBride bunionectomy, the first metatarsal was manually reduced and brought parallel to the second. It was then held temporarily with a K-wire and position assessed to ensure the first and second metatarsal heads are in the same transverse plane to prevent relative plantar or dorsiflexion of the first ray. A bioabsorbable screw was then placed obliquely from the base of the first into the bases of the second and third metatarsals. Patients were assessed pre-operatively, at 2 weeks, 6 weeks, and 3 months for early clinical outcome, complications, and radiographic evaluation. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were recorded and used to monitor any progression or change over time. Results: This procedure allows for significant correction of moderate and severe hallux valgus deformities with little radiographic evidence of loss of reduction in early clinical follow-up. One and two-year follow-up was included for patients where available. Pre-operative assessment of HVA and IMA were 32.3° (95% CI: 31.1-33.5) and 14.8° (95% CI: 14.2-15.3), respectively. Post- operative HVA was significantly improved at 2 weeks (10.4°), 6 weeks (11.1°), and 3 months (12.1°). IMA was improved at 2 weeks (6.0°), 6 weeks (6.8°) and 3 months (7.8°). One (48 patients) and two-year follow-up (20 patients) show maintenance of correction of both HVA (1yr: 12.7°, 2yr: 10.8°) and IMA (1yr: 7.9°, 2yr: 8.0°). Complications were few including iatrogenic hallux varus (2/136, 1.4%), peri-implant fractures at the second metatarsal base (3/136, 2.2%), and valgus relapse, which was the only complication requiring re-operation (3/136, 2.2%). Conclusion: When combined with modified McBride bunionectomy, this proximal metatarsal realignment procedure provides a simple and effective method for the treatment of moderate to severe hallux valgus deformities. Additionally, there is minimal radiographic evidence of loss of reduction over time. This procedure is simple to perform, easy to learn, and does not 'burn any bridges' with regards to future surgery.
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Dell, Robert F. "Optimizing Army Base Realignment and Closure." Interfaces 28, no. 6 (December 1998): 1–18. http://dx.doi.org/10.1287/inte.28.6.1.
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Klekamp, Jörg. "Surgery for basilar invagination with and without Chiari I malformation." Neurosurgical Focus 54, no. 3 (March 2023): E11. http://dx.doi.org/10.3171/2022.12.focus22623.
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OBJECTIVE The surgical treatment for Chiari I malformation and basilar invagination has been discussed with great controversy in recent years. This paper presents a treatment algorithm for these disorders based on radiological features, intraoperative findings, and analyses of long-term outcomes. METHODS Eight-five operations for 82 patients (mean ± SD age 40 ± 18 years; range 9–75 years) with basilar invagination were evaluated, with a mean follow-up of 57 ± 55 months. Apart from the radiological features and intraoperative findings, findings on neurological examinations before and after surgery were analyzed. Long-term outcomes were evaluated with Kaplan-Meier statistics. All 77 patients with a Chiari I malformation underwent foramen magnum decompression with arachnoid dissection and duraplasty. Patients with ventral compression by the odontoid peg were managed with posterior realignment and C1–2 fusion. Patients without ventral compression did not undergo C1–2 fusion unless radiological or clinical signs of instability were detected. RESULTS Thirty-three patients without ventral compression or instability underwent foramen magnum decompression without additional fusion, whereas 52 operations on 49 patients involved posterior fusion at C0–2 or C1–2 after realignment of ventral compression and/or treatment of C1–2 instability. Postoperatively, gait ataxia, swallowing functions, and suboccipital pain improved significantly in both treatment groups. In total, 79% and 73% of patients reported that their condition improved after foramen magnum decompression alone and after fusion with or without foramen magnum decompression, respectively. Progression-free survival rates at 10 years were 83% and 81%, respectively. CONCLUSIONS Among the patients with basilar invagination, a subgroup consisting of 40.2% of the included patients underwent successful long-term treatment with foramen magnum decompression alone and without additional fusion. This subgroup was characterized by the absence of a ventral compression and no atlantoaxial dislocation or other signs of craniocervical instability. The remainder of patients underwent C1–2 fusion with posterior realignment of ventral compression if required. In the presence of basilar invagination, Chiari I malformation should be treated with foramen magnum decompression and duraplasty.
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Cestari, Heitor, Marcelo Damas Pyles, Ana Liz Garcia Alves, Marcos Jun Watanabe, Carlos Alberto Hussni, and Celso Antonio Rodrigues. "Clinical and radiographic evolution of horses with chronic laminitis subjected to deep digital flexor tenotomy and distal phalanx realignment." Research, Society and Development 11, no. 13 (October 8, 2022): e313111335298. http://dx.doi.org/10.33448/rsd-v11i13.35298.
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Deep digital flexor (DDF) tenotomy and realignment of the distal phalanx (DP) is a therapy used for the treatment of horses with chronic laminitis that, despite the few results described in the literature, presents with promising results. In view of this knowledge gap, this study aimed to describe and compare the clinical and radiographic findings of horses subject to this treatment. To this end, 7 horses with chronic laminitis that underwent tenotomy of the DDF in the metacarpal region and realignment of the DP by means of trimming and shoeing were included in this study. Data were obtained from the moments before and after the procedure. An improvement in clinical and radiographic parameters was observed when comparing the moment before and after the procedure, and it was concluded that this therapy is a viable option for the treatment of horses with chronic laminitis refractory to other therapies.
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Scott, Timothy, and Nathara Mhunpiew. "Impact of Government Policies and International Students on UK University Economic Stability." International Education Studies 14, no. 5 (April 25, 2021): 1. http://dx.doi.org/10.5539/ies.v14n5p1.
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Numerous UK universities are experiencing financial instability; with an increasingly competitive and maturing market, reliance has grown on international students to offset institutional shortfalls. Dependency on international student tuition revenue has over-exposed the market to dramatic shifts in political policies, both domestic and internationally, that could significantly impact operational success. UK higher education institutions (HEIs) ability to promote their institutions as they are intertwined with the UK government; thus, controversial policies create a backlash, drawing HEIs into disputes as unwanted participants yet recipients of significant economic disruption. Government policies on domestic tuition caps, Brexit, and increasing geopolitical disputes with China have had a considerable impact on institutional operations. This paper recommends HEIs, principally lower-tabled universities, take a more aggressive strategic realignment to best adapt to the marketplace’s uncertainty. By reemphasising institutional specialisation, variable tuition rates for under-represented growth markets, financial support for EU students, increased distance education presence, and intense market-wide lobbying of government MPs, this paper seeks to open a discussion on how to identify existing problems and target opportunities for growth. The complexity of market conditions and the decreasing solvency of many institutions will not be solved by a single recommendation or a short-term policy but by a complete realignment and robust industry-wide initiatives. If universities cease operations or collapse under market conditions’ financial strain, it will impact the overall market’s reputation, reducing UK institutions’ overall desirability as a major exporter of education.
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Martínez-Olvera, César. "Methodology for realignment of supply-chain structural elements." International Journal of Production Economics 114, no. 2 (August 2008): 714–22. http://dx.doi.org/10.1016/j.ijpe.2008.03.008.
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Gan, Wee Yong, Lina Hartanto, Andrew Haynes, and Morteza Sayarpour. "Predicting and optimising the mature Windalia waterflood based on a capacitance-resistance model (CRM)." APPEA Journal 52, no. 2 (2012): 656. http://dx.doi.org/10.1071/aj11070.
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Waterflood development drilling of the Windalia reservoir on Barrow Island at 40-acre spacing started in 1968, using five-spot and nine-spot inverted drive flood patterns. There was a general conversion to line drive in mid-1970 with various infill and realignment projects. The field comprises more than 220 active injectors and 400 producers. The reservoir is geologically complex, with low permeability and significant heterogeneity. Historically, empirical techniques and fractional flow models were used for forecasting, but these approaches have many inherent limitations; for example, they do not provide individual well performance and they are not sensitive to changes in operating conditions. More recently, a capacitance-resistance model (CRM) that uses historical injection and production data has been used to establish long-term behaviours between water injection and oil production wells, including inter-well connectivity, delay time constants and productivity indices. The evaluation of these behaviours allows direct quantification of waterflood efficiency at well-to-well level and improves identification of opportunities for changing injection patterns and prioritisation of operations and well workovers. Optimisation and forecasting of the Windalia waterflood is performed by maximising cumulative oil production by reallocating the available field wide injection water and evaluating individual injection wells target rates. Numerous optimisation scenarios were built into the models to account for the impact of changing operating conditions such as water availability and aging of wells and processing facilities. CRM is robust and is appropriate for simultaneous optimisation of well rates in a field where water injection and oil production wells are shut-in frequently. The PowerPoint presentation is not available to APPEA.
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Ji, Xiaoyun, and John E. Mitchell. "Finding optimal realignments in sports leagues using a branch-and-cut-and-price approach." International Journal of Operational Research 1, no. 1/2 (2005): 101. http://dx.doi.org/10.1504/ijor.2005.007436.
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Luby, Christi Duette. "Promoting Military Cultural Awareness in an Off-post Community of Behavioral Health and Social Support Service Providers." Advances in Social Work 13, no. 1 (March 29, 2012): 67–82. http://dx.doi.org/10.18060/1873.
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Due to U.S. military Base Realignment and Closure (BRAC) efforts and ongoing Overseas Contingency Operations, the number of military servicemembers and veterans seeking civilian-based services has increased. As the military presence grows in previously underrepresented areas, the need for culturally competent providers will also increase both on and off military installations. The purpose of this article is to promote military cultural awareness, while suggesting ways to enhance existing community behavioral health and social support services. It builds on a review of the extant literature and findings from a community assessment to introduce civilian providers to some specific issues affecting servicemembers and their families. A framework describes ways to increase military cultural competence and build community capacity to enhance civilian-based services. In addition, two appendices list some common military terminology and multiple training resources available through military organizations and websites.
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Shaw, Paula, Sarah Rawlinson, and David Sheffield. "Exploring the Problem of Establishing Horizon Emergent Technologies within a Higher Education Institution’s Operational Framework." European Journal of Open, Distance and E-Learning 23, no. 1 (July 1, 2020): 18–31. http://dx.doi.org/10.2478/eurodl-2020-0002.
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AbstractSince the early 2000s, a plethora of web-based learning technologies has been developed, each proposing to improve the student experience. Yet, a study conducted by Martin et al. (2018) demonstrate sporadic new technology adoption in Higher Education (HE), despite wide-scale social interest and a wealth of academic publications. This paper aims to provide a framework to explore this problem from an institutional perspective, involving both educational planners and pedagogues. This framework, the Pedagogic Realignment with Organisational Priorities and Horizon Emergent Technologies Framework or PROPHET Framework, is a new three phase framework that combines two distinct research methodologies used by policy makers and pedagogues with a new dynamic multi-level diffusion of innovation (DMDI) model specifically designed to support dialogue between these stakeholders. Application of the PROPHET Framework will enable stakeholders to arrive at a common understanding about the efficacy of such new technologies and collaborative exploration of technology through these different lenses will lead to increased confidence in its value and relevance. It is hypothesised that undertaking this process will increase the adoption rate of Horizon Emergent Technologies, resulting in operational policy amendments and evidence of impact in the learning environment.
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Stratton, Roy. "Reinterpreting Fisher’s coordinated strategies: a longitudinal case study." International Journal of Operations & Production Management 38, no. 5 (May 8, 2018): 1166–87. http://dx.doi.org/10.1108/ijopm-03-2016-0163.
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Purpose Much has been written about the need to align the supply chain with the product/market but it has proved, elusive especially in response to a supply change transitions. The purpose of this paper is to review the established theoretical models before considering how the realignment process can be better supported in the light of a longitudinal study. Design/methodology/approach This paper uses a single apparel case where data were gathered over a five-year period involving multiple site visits, management interviews and archival data across three echelons of the supply chain. Repeated visits enabled the collection of contemporary evidence and the development and testing of the causal relationships. This case was part of a multi-case research project that explored the causal relationship between variation, uncertainty, performance trade-offs and buffering mechanisms (time, capacity and inventory). Findings The case analysis demonstrates how established theory and causal reasoning can be used to explain the trade-off oscillations that characterised this case. As with earlier studies, local cost considerations predominated, interspersed with strategic countermeasures. Fisher’s (1997) concept of coordinated strategies is shown to provide an effective means of clarifying the trade-off implications of the transition in support of proactive realignment. This concept is discussed in relation to other cases and literature before proposing how this could be developed and used as a basis for further research. Research limitations/implications This research was limited to a single case and although this involving several transitions the findings require further testing. Practical implications Supply chain redesign is of growing importance and with it the need to more effectively manage such transitions. This paper clarifies the need for supply chain orientation and offers means of clarifying the implications of such transitions to management. Originality/value This paper provides case evidence of the underlying operations management issues and the associated analysis.