bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation on the effect of coating properties on lubrication of a coated spur gear pair
Authors: Liu Huaiju , Zhu Caichao , Wang Zhanjiang , Xu Xiangyang , Tang Jinyuan
Published: June 2017

A thermal elastohydrodynamic lubrication model is proposed for a coated gear pair in which the influence coefficients for the elastic deformation and the subsurface stress components are obtained through the frequency response functions. The generalized Reynolds equation is utilized to represent the non-Newtonian effect. Energy equations of the contacting solids and the oil film are derived and solved based upon the marching method. The discrete convolute, fast Fourier transform method is used for fast calculation of the tooth surface displacement and the stress components underneath the surface. Variations of the slide-to-roll ratio, rolling speed, and the tooth load during gear meshing are considered and the film squeeze effect is taken into account. Effects of the coating thickness on the tribological performance, i.e. the film thickness, the pressure, the frictional behavior as well as the stress components are investigated under both the smooth and rough surface assumptions. Effects of the root mean square value of the tooth surface roughness on the pressure and stresses are discussed.
The buddy system: A randomized controlled experiment of the benefits and costs of dieting in pairs
Authors: Incollingo Rodriguez Angela C , Rodriguez Anthony , Callahan Lauren C , Saxbe Darby , Tomiyama A Janet
Published: June 2017

A total of 67 pairs of female roommates were randomized into a diet condition: (1) both ate normally; (2) one dieted, the other ate normally; and (3) both dieted. Adherence, weight loss, anxiety, depression, disordered eating symptoms, and stress were measured. Dieters lost more weight than non-dieters, but average loss was <1 pound. Pairs where both dieted reported higher anxiety, depression, and disordered eating than one-dieter pairs. Structural equation models revealed an interrelated network of stress, anxiety, depression, and disordered eating. This was weakest when one roommate dieted. The “buddy system” may not promote weight loss, but living with a non-dieting partner may buffer consequences.
Self-reflective talk in group counselling
Authors: Logren Aija , Ruusuvuori Johanna , Laitinen Jaana
Published: May 2017

Reflective processing is a joint social action that develops in interaction. Using conversation analysis and discursive psychology, this article focuses on self-reflective turns of talk in group counselling for adults at risk of type 2 diabetes. We show how reflective processing unfolds in patterns of interaction, wherein group members take an observing, evaluating or interpreting position towards their own actions and experiences. Self-reflective talk is neither exclusively dependent on counsellors’ actions nor limited to the niches the counselling programme structure offers. Self-reflective talk is one method of generating joint reflective processing. Such talk makes a topic available for discussion by connecting details of counselling with individuals’ experiences and enabling sharing. Self-reflective talk thus serves as a way for group members to participate in constructing a lifestyle problem, to invite or provide sharing of experiences and to display their orientation to the institutional task at hand.
Computation of dynamic stress intensity factors for cracks in three-dimensional functionally graded solids
Authors: Peyman Safa , Ghajar Rahmatollah , Irani Saeed
Published: June 2017

Dynamic stress intensity factors are important parameters in the dynamic fracture behavior of a cracked body. In this paper, an interaction integral method is utilized to compute the mixed-mode dynamic stress intensity factors of three-dimensional functionally graded material solids. Using a proper definition of actual and auxiliary fields, a new formulation and application of the interaction integral is proposed, which is independent of the derivatives of the material properties. ABAQUS finite element package is applied to analyze the functionally graded material cracked bodies. Accordingly, a user material subroutine is written for implementing the continuous variation of the material properties. Temperature was used as an additional variable to consider the variation of density. A research code is developed to compute the interaction integral. This code is then validated by solving some homogeneous and functionally graded material problems. Furthermore, the effect of the material properties on the dynamic stress intensity factors of FGM bodies with elliptical crack is investigated by taking the sigmoidal model into account. Several important fracture behavior of functionally graded material cracked bodies under dynamic loadings for different material property profiles are explored in detail.
A structured approach to uncertainty analysis of predictive models of engine-out NOx emissions
Authors: Cho Hoon , Brewbaker Thomas , Upadhyay Devesh , Fulton Brien , van Nieuwstadt Michiel
Published: June 2017

Predictive models of engine-out NOx emissions continue to be a topic of active research in the diesel powertrain community. Renewed interest in the use of in-cylinder pressure sensor has presented an opportunity for improving these models through the availability of direct information about the in-cylinder combustion process. Despite several research efforts in this domain seen in open literature, there is a significant paucity of work that reports on the uncertainty analysis of such models. These models are typically designed for real-time implementation, and the model prediction is often used for control and/or diagnostic functions. It is therefore critical to establish the expected error bounds or an error probability distribution and the model prediction for consideration during the design of relevant control and/or diagnostic algorithms.
The Connection of Study Abroad to Students’ Positive Feelings of Institutional Action
Authors: Di Maggio Lily M.
Published: June 2017

Previous empirical inquiry into study abroad has consistently shown that students who study abroad have higher graduation rates than students who do not study abroad. In the current study, it was theorized that study abroad increased students’ perceptions of the college or university that they attended. Using data from the National Survey of Student Engagement, the supportive campus environment scores of students who studied abroad were compared with students who did not study abroad. The measurement of supportive campus environment was shown to be consistent to measuring students’ perception of Tinto’s concept of institutional action. The current study controlled for race/ethnicity, gender, and major. The findings indicated that students’ feelings of institutional action were more positive if they studied abroad; however, there was some variance based on academic major and race/ethnicity. At the end of the current study, policy implications were given related to the findings, and ideas for further research were presented.
The Importance of Inclusion for Cardiovascular Health Promotion Programs in Delaware
Authors: Papas Mia A. , Stolz Nicole , Orsega-Smith Elizabeth , Sparling Eileen , Freedman Brian
Published: June 2017

Individuals with disabilities experience greater rates of cardiovascular disease than individuals without disabilities. This increase can be attributed to decreased levels of physical activity, poor eating habits, and increased levels of diabetes, smoking, and obesity. Individuals with disabilities are often excluded from surveillance, treatment, and prevention efforts. Consequently, there is little known about their participation rates in health promotion and disease prevention programs. The aims of this investigation are (1) to examine time trends in cardiovascular disease and risk factors over a 10-year period by disability status and (2) to assess the inclusiveness of health promotion programs in Delaware. The percentage of individuals with disabilities increased from 18% in 2001 to 28% in 2011. Individuals with disabilities had higher rates of cardiovascular disease (t = 80.45; degrees of freedom [df] = 198; p < .0001) and obesity (body mass index > 30 kg/m2) than individuals without disabilities (t = 33.0; df = 198; p < .0001). They also reported less physical activity (t = 44.21; df = 198; p < .0001) and worse diet quality (t = 4.70; df = 198; p < .0001). There was a consistent lack of information about inclusion and participation of individuals with disabilities in health promotion programs. Making adaptations within cardiovascular disease prevention programs in Delaware is imperative to improving the health of individuals with disabilities. Ensuring cardiovascular disease programs are accessible and provide disability-specific trained staff will reduce barriers to participation so that all individuals can benefit.
Potential for Interfraction Motion to Increase Esophageal Toxicity in Lung SBRT
Authors: Pham Anthony Hoai-Nam , Yorke Ellen , Rimner Andreas , Wu Abraham Jing-Ching
Published: June 2017

Purpose:

To characterize the effect of the relative motion of esophagus and tumor on radiation doses to the esophagus in patients treated with stereotactic body radiation therapy for central lung tumors.

Methods and Materials:

Fifty fractions of stereotactic body radiation therapy in 10 patients with lung tumors within 2.5 cm of the esophagus were reviewed. The esophagus was delineated on each treatment’s cone-beam computed tomography scan and compared to its position on the planning scan. Dose–volume histograms were calculated using the original treatment beams to determine the actual dose delivered to the esophagus for each fraction of stereotactic body radiation therapy.

Results:

Median interfraction right–left shift of the esophagus was 0.9 mm (range, −5.4 to 3.3 mm) toward the left. Median interfraction anteroposterior shift was 0.7 mm (range, −3.7 to 11.5 mm) posteriorly. The median percentage increase in dose to 1 cm3, dose to 3.5 cm3, and dose to 5 cm3 was 1.7%, 5.6%, and 6.6%, respectively. Two cases of significant late esophageal toxicity were observed, with change in esophageal position relative to the planning target volume resulting in significantly higher D5cc values than anticipated.

Conclusion:

Interfraction shifts between the internal target volume and esophagus can lead to unanticipated increases in the volume of esophagus receiving high doses when treating central lung tumors with stereotactic body radiation therapy. Certain practical steps, such as considering deep breath hold for internal target volume reduction, using a planning risk volume for esophagus, and carefully visualizing and considering esophageal position at the time of stereotactic body radiation therapy, can be taken to minimize unanticipated dose increases that could cause unexpected esophageal toxicity.
Irreversible Electroporation Ablation of an Unresectable Fibrous Sarcoma With 2 Electrodes: A Case Report
Authors: Qin Zilin , Zeng Jianying , Liu Guifeng , Long Xinan , Fang Gang , Li Zhonghai , Xu Kecheng , Niu Lizhi
Published: May 2017

Purpose:

To explore the safety and efficacy of irreversible electroporation ablation in unresectable fibrous sarcoma with 2 electrodes.

Methods:

A 74-year-old woman with unresectable retroperitoneal malignant fibrous sarcoma was treated with percutaneous irreversible electroporation. Four ablations were performed on the mass, which measured 7.3 × 7.0 × 7.5 cm, with 2 electrodes.

Results:

A contrast-enhanced computed tomography scan 2 months postoperatively showed that the tumor had reduced to 5.1 × 4.0 × 5.2 cm, without obvious enhancement. Any adverse reactions were evaluated as level 1.

Conclusion:

In the short term, the treatment with 2 electrodes for fibrous sarcoma appears to be safe and effective.
Reasons Why: Examining the Experience of Women in Games 140 Characters at a Time
Authors: Ochsner Amanda
Published: May 2017

Recent discourses around digital games and game cultures have revealed myriad challenges for female professionals in the game industry. One of these conversations began in late 2012 on the social networking platform Twitter when a user posed the question, “Why are there so few lady game creators?” Using the hashtag #1ReasonWhy, Twitter users from across the game industry and game-playing communities contributed to a discussion about what women experience in public and online game-playing spaces, at game industry events, in game industry workplaces, and in the media. This article examines the #1ReasonWhy conversation to uncover how members of the game industry and of game communities account for why so few women choose to pursue and stay in game industry careers. Better understanding, women’s experiences can aid researchers, educators, and game industry stakeholders in theorizing how to make meaningful and strategic improvements to game cultures and industry spaces.
Designing Games for Moral Learning and Knowledge Building
Authors: Schrier Karen
Published: May 2017

How can we better learn about and teach moral thinking and skills? How can we solve moral problems? One possible way is to create and use moral learning games, or games that enable players to work on moral scenarios, make moral choices, and gain relevant skills. One possible subcategory of these games is moral knowledge games, or games that aim to solve real-world moral problems and create new knowledge about morality. This article systematically analyzes relevant literature and related games and media to uncover a preliminary set of design principles for creating moral learning games and moral knowledge games. Frameworks such as the Elemental Tetrad, Mechanics, Dynamics, and Aesthetics (MDA), and Ethics Practice and Implementation Categorization Framework (EPIC) were used to analyze individual games and media. Ten different categories of principles emerged, along with 95 possible subprinciples. Implications, next steps, and limitations of this analysis were also discussed.
Confidence of IRB/REC Members in Their Assessments of Human Research Risk: A Study of IRB/REC Decision Making in Action
Authors: Grinnell Frederick , Sadler John Z. , McNamara Victoria , Senetar Kristen , Reisch Joan
Published: May 2017

Understanding how institutional review boards/research ethics committees (IRBs/RECs) perform risk/benefit assessment is important to help improve their function. In environmental ethics, uncertainty about potential outcomes and the precautionary principle play important roles in regulatory oversight but have received little attention in the context of human research ethics. We carried out an empirical study to gain insight into uncertainty by asking IRB/REC members about confidence in their risk assessments immediately after discussion of new protocols under review. Based on 12 meetings carried out by four IRBs/RECs over a 6-month period, we found a robust, inverse relationship between risk and confidence. As risk increased, confidence decreased. We detected different patterns of consensus between different IRBs/RECs and their members. Our study introduces a novel and relatively easy to implement approach to begin to understand IRB/REC decision making in real time that can be used within or across institutions.
How to Grow the Business and Encourage Innovation
Authors: Turner Ian
Published: May 2017

A key issue facing every CEO is how to achieve results and grow the business, while at the same time encouraging innovation. All too often these two can be seen to be mutually exclusive. Why is this, and how can innovation be encouraged?
Effects of different conditioning programmes on the performance of high-velocity soccer-related tasks: Systematic review and meta-analysis of controlled trials
Authors: García-Ramos Amador , Haff Guy Gregory , Feriche Belén , Jaric Slobodan
Published: May 2017

Physical performance is a key factor in most of the actions that determine success in soccer competitions. The present meta-analysis aimed to determine whether, and to what extent different conditioning programmes implemented in addition to regular soccer training are able to enhance the performance of high-velocity soccer-related tasks. Study groups were categorised according to type of performance measurement: (A) vertical jump ability, (B) linear sprint performance, (C), change of direction with ball, (D) change of direction without ball, (E) repeated sprint ability, and (F) kicking performance. Subgroup analyses were done with reference to the type of conditioning programme applied: (A) resistance training, (B) plyometric, (C) sprint and/or change of direction, and (D) combined methods. The standardised mean differences (SMD) along with 95% confidence intervals (95% CI) were calculated using the Review Manager 5.3 software. The application of a conditioning programme was associated with a significant improvement in vertical jump ability (SMD = 0.64 [95% CI: 0.50–0.77]), linear sprint (SMD = −0.79 [95% CI: −0.61 to −0.96]), change of direction with ball (SMD = −0.78 [95% CI: −0.42 to −1.15]), change of direction without ball (SMD = −0.83 [95% CI: −0.61 to −1.05]), repeated sprint ability (SMD = −0.51 [95% CI: −0.19 to −0.84]), and kicking performance (SMD = 0.78 [95% CI: 0.34–1.22]). No clear differences among the different conditioning programmes were observed. The implementation of a conditioning programme in addition to regular soccer training enhances the performance of high-velocity soccer-related tasks.
Numerical issues in modeling combustion instability by quasi-1D Euler equations
Authors: Frezzotti Maria Luisa , D’Alessandro Simone , Favini Bernardo , Nasuti Francesco
Published: May 2017

The present work is devoted to investigation of numerical issues related to combustion instability simulation through a quasi-1D Eulerian solver. The main aspects addressed are the choice of a suitable multispecies model and heat release response function formulation. Experimental data and high fidelity simulation results, available in literature, are reproduced with acceptable approximation. Main features of the flow field at limit cycle are shown. Moreover, a parametric study has been performed on time-lag response function characteristic parameters, leading to important conclusions on the pertinence of each assumption in the frame of a nonlinear tool.
Two-step approach for pressure oscillations prediction in gas turbine combustion chambers
Authors: Iurashev Dmytro , Campa Giovanni , Anisimov Vyacheslav V , Cosatto Ezio
Published: May 2017

Currently, gas turbine manufacturers frequently face the problem of strong acoustic combustion-driven oscillations inside combustion chambers. These combustion instabilities can cause extensive wear and sometimes even catastrophic damage of combustion hardware. This requires prevention of combustion instabilities, which, in turn, requires reliable and fast predictive tools. We have developed a two-step method to find a set of operating parameters under which gas turbines can be operated without going into self-excited pressure oscillations. As the first step, an unsteady Reynolds-averaged Navier–Stokes simulation with the flame speed closure model implemented in the OpenFOAM® environment is performed to obtain the flame transfer function of the combustion set-up. As the second step time-domain simulations employing low-order network model implemented in Simulink® are executed. In this work, we apply the proposed method to the Beschaufelter RingSpalt test rig developed at the Technische Universität München. The sensitivity of thermoacoustic stability to the length of a combustion chamber, flame position, gain and phase of flame transfer function and outlet reflection coefficient are studied.
Predictors of Adamkiewicz artery and anterior spinal artery detection through computerized tomographic angiography
Authors: Amato Alexandre Campos Moraes , Parga Filho Jose Rodrigues , Stolf Noedir Antonio Groppo
Published: June 2017

Background:

The detection of the Adamkiewicz artery and the anterior spinal artery has been associated with the ability to prevent adverse spinal cord outcomes after aortic surgical procedures. Yet, to our knowledge, no previous studies have attempted to use modern predictive models to identify the most important variables in determining artery detectability.

Aims:

To develop a model to predict the odds of visualizing the Adamkiewicz artery or anterior spinal artery in patients undergoing computerized tomographic angiography.

Methods:

We conducted a prospective, cross-sectional study. Outcomes of interest were the non-detection of the Adamkiewicz artery and anterior spinal artery, and their corresponding level of origin. Axial images were inspected in high definition in search of two dense spots characterizing the Adamkiewicz artery and anterior spinal artery. A multiplanar three-dimensional reconstruction was then performed using the OsiriX® software.

Results:

A total of 110 participants were part of this analysis. When evaluating risks for the Adamkiewicz artery being undetectable, significant factors could be classified into three broad categories: risk factors for arterial disease, established arterial disease, and obesity. Factors in the former category included metabolic syndrome, hypertension, and smoking status, while factors in the arterial disease included descending aortic aneurysm, mural thrombi, aortic aneurysm without a dissection, and aortic disease in general. In relation to anterior spinal artery not being detectable, significant risk factors included hypertension, smoking status, and metabolic syndrome, while those associated with arterial disease involved aortic disease and arterial thrombi. When evaluating the importance of individual clinical factors, the presence of higher body mass index was the single most important risk factor.

Conclusion:

Arterial disease, established arterial disease, and increased body mass index are risk factors in the detection of Adamkiewicz artery and anterior spinal artery. Specific diagnostic protocols should be in place for patients with these underlying conditions, thus enhancing the likelihood of detection when the Adamkiewicz artery is indeed present.
Concurrent BRAF and PTEN mutations in melanoma of unknown origin presenting as a breast mass
Authors: Agosto-Arroyo Emmanuel , Rosa Marilin , Chau Alec , Khazai Laila
Published: May 2017

Background:

Metastases represent a small percentage of the malignancies affecting the breast, and only 5% of melanomas originate from non-cutaneous sites. Multiple genetic aberrations have been associated with the development of melanocytic lesions, including BRAF V600E mutation. Mutations in PTEN gene have also been related to the pathogenesis of multiple malignancies.

Purpose/Method:

This is the case of a 28-year-old female who presented with a tender, palpable mass in the upper outer quadrant of the right breast. Ultrasound showed a 1-cm solid mass, initially diagnosed as invasive ductal carcinoma on biopsy. During pre-operative workup, a second mass was identified and biopsied. Immunohistochemical stains performed on the second mass biopsy demonstrated that the neoplastic cells were positive for cytokeratin AE1/3, pan-melanoma, tyrosinase, and SOX-10 and negative for CK7, CAM5.2, and GATA-3. Subsequent workup showed widespread metastatic disease involving the liver, lungs, bones, and brain. The brain metastasis tested positive for BRAF p.V600E and PTEN p.R130Efs*4 mutations. Thorough skin and eye examination did not reveal a primary melanoma.

Conclusion:

Only few reports have been published of melanoma presenting as a breast mass. This is an interesting case due to the clinical presentation, diagnostic challenges, and genetic mutations profile.
Lymph node transfer for refractory infectious sites caused by trauma
Authors: Mihara Makoto , Hara Hisako , Kikuchi Kazuki
Published: June 2017

Objective:

In this report, we placed focus on the immunological function of lymph nodes and performed lymph node transfer via a free flap to a site of refractory infection.

Case and Results:

Case 1 describes a 34-year-old male suffering from compound fractures with severe crush injuries and burns in the right ankle joint. A 20 × 15 cm skin defect was observed around the right malleolus medialis, along with denuded tendons with bacterial infection. After conservative treatment, we transferred a lymph-node-containing free superficial circumflex iliac artery perforator flap to the region, with minimum debridement. No recurrence of wound infection appeared. Case 2 describes a 73-year-old male patient suffering from extensive contused wound in the right crus. Despite conservative treatment, the tibia gradually became denuded with computed tomography and magnetic resonance imaging revealing degeneration of the tibial cortex. We performed a free superficial circumflex iliac artery perforator flap containing lymph nodes to the chronic infection area. The wound area healed successfully.

Conclusion:

In conclusion, lymph node transfer has a potential of treatment infection sites.
Exacerbation of alopecia areata: A possible complication of sodium tetradecyl sulphate foam sclerotherapy treatment for varicose veins
Authors: Whiteley Mark S , Smith Victoria C
Published: June 2017

A 40-year-old woman with a history of alopecia areata related to stress or hormonal changes was treated for bilateral primary symptomatic varicose veins (CEAP clinical score C2S) of pelvic origin, using a staged procedure. Her first procedure entailed pelvic vein embolisation of three pelvic veins using 14 coils and including foam sclerotherapy of the tributaries, using 3% sodium tetradecyl sulphate. Following this procedure, she had an exacerbation of alopecia areata with some moderate shedding of hair. Subsequently, she underwent endovenous laser ablation under local anaesthetic without incident. Seven months after the pelvic vein embolisation, she underwent foam sclerotherapy of leg and labial varicose veins using sodium tetradecyl sulphate. Two days following this procedure, she had a severe exacerbation of alopecia areata with gross shedding of hair. These two episodes of exacerbation of alopecia areata appear to be associated with sodium tetradecyl sulphate foam sclerotherapy of veins.
Psychophysiological Responses to Kawaii Pictures With or Without Baby Schema
Authors: Nittono Hiroshi , Ihara Namiha
Published: May 2017

Baby schema has been considered a key stimulus that triggers feelings and thoughts of cuteness. Kawaii is a Japanese word that roughly translates to cute in English, but its meaning appears to be broader than cute. Specifically, cuteness is often regarded as synonymous with infant physical attractiveness, whereas kawaii is used not only for babies but also for noninfantile objects. In this study, psychophysiological responses were compared between two types of kawaii pictures: human babies and animals ( kawaii with baby schema) or objects such as desserts and dress accessories ( kawaii without baby schema). Twenty female university students were asked to view various pictures twice. Both types of kawaii pictures were rated to be more pleasant than neutral pictures, elicited a greater activation of the zygomaticus major muscles associated with smiling, and were viewed for a longer period when the same pictures were presented again. The effect of baby schema appeared in the zygomaticus major muscle activity, which was greater for pictures with baby schema. The findings suggest that the word kawaii expresses positive feelings that are more generic than infant attractiveness and that are associated with a motivation to approach a preferable object.
The Role of PTSD, Depression, and Alcohol Misuse Symptom Severity in Linking Deployment Stressor Exposure and Post-Military Work and Family Outcomes in Male and Female Veterans
Authors: Smith Brian N. , Taverna Emily C. , Fox Annie B. , Schnurr Paula P. , Matteo Rebecca A. , Vogt Dawne
Published: May 2017

Exposure to stressors during military deployment puts veterans at risk for reduced post-military quality of life. Stress-related mental health problems may lead to decreased well-being within work and family domains, yet few studies have explored associations in the context of gender. We examined relationships between deployment stressors and post-military functioning and satisfaction in the domains of work and family, with a focus on posttraumatic stress disorder (PTSD), depression, and alcohol misuse symptomatology as potential mediators. Participants included 522 male and female Iraq and Afghanistan war veterans assessed longitudinally. Structural equation models supported several direct and indirect pathways linking deployment stressors to work and family outcomes for both men and women. PTSD had an important role in these associations. Depression also played a significant role, particularly for women. These findings build on prior research by elucidating potential gender-specific risk, which may be applied to better tailor services to veterans’ unique needs.
A Levering Technique Using Small Parallel Rods for Open Reduction of High-Grade Thoracolumbar Dislocation
Authors: Hadgaonkar Shailesh , Shah Kunal , Khurjekar Ketan , Krishnan Vibhu , Shyam Ashok , Sancheti Parag
Published: May 2017

Study Design:

Technical report.

Objective:

Dorsolumbar vertebral dislocations, with or without associated fractures, occur secondary to very high velocity trauma. The reduction procedures and techniques, which may be adopted in these situations, have been multifariously discussed in the literature. Our objective was to assess the outcome of a novel reduction maneuver, using parallel rods which we have employed in reduction of high-grade thoracolumbar fractures to achieve precise sagittal balance as well as accurate vertebral alignment with minimal soft tissue damage.

Methods:

The study included a total of 11 cases of thoracolumbar dislocations, who had presented to our emergency spine services following high-velocity trauma. After appropriate systemic stabilization and necessary investigations, all patients were surgically treated using the described technique.

Results:

There were no surgical complications at 2-year follow-up. Radiographs showed good reduction and maintained sagittal balance.

Conclusion:

We believe that this technique is an excellent means of achieving safer, easier, and accurate reduction for restoration of sagittal/coronal balance and alignment in high-grade thoracolumbar dislocations. It is easily reproducible and predictable.
The Indian Diaspora in America as Reflected in Jhumpa Lahiri’s Fiction
Authors: Chandorkar Leena
Published: June 2017

Over the last 20 years, the Indian diaspora in the USA has suddenly come of age, numerically as well as economically. This growing confidence can be seen in the literature written by writers of Indian origin settled in the USA. Shunning sentimentality and overt nostalgia, this latter-day diasporic writing is laced with humour and a critical though affectionate tone directed towards their Indianness. Foremost among these voices is Jhumpa Lahiri. Pulitzer Prize winner Lahiri is the author of two novels and two short story collections. Deeply attached to her Indian heritage, yet wanting desperately to assimilate into the cultural melting pot of American society, Lahiri’s fiction is suffused with a complex biculturalism. With Jhumpa Lahiri’s fiction at the centre, my article will focus on this tug-of-war of alienation and assimilation that is at the heart of every immigrant experience.
Book Review: Rajshree Chandra (ed.), The Cunning of Rights: Law, Life, Biocultural
Authors: Premananda Hidam
Published: May 2017

Rajshree Chandra (ed.), The Cunning of Rights: Law, Life, Biocultural. New Delhi: Oxford University Press. 2015. 244 pages. ₹850.
Cardiomyopathy Related to a Weight Loss Supplement: A Case Report and Review of Literature
Authors: Murtaza Ghulam , Adhikari Sujeen , Siddiqui Irfan , Lu Hannah , Kuruvilla Aneesh
Published: June 2017

There are various etiologies of dilated cardiomyopathy. However, in young patients without a strong family history of cardiovascular disease, alcohol or drug abuse, viral infections, and absence of endocrine and metabolic abnormalities, ischemia is an unlikely cause. We present an interesting case of a young female without traditional risk factors who developed dilated cardiomyopathy following administration of a weight loss supplement xenadrine and had resolution of symptoms after discontinuation of the supplement.
Outcome & Survival Analysis of Conventional Measured Resection, Neutral Alignment Attune TKA vs CAS Anatomic Tibia, Balanced Femur, Constitutional Alignment Attune TKA
Authors: Clatworthy Mark
Published: May 2017

Objectives:

Arthroplasty knee surgeons have traditionally performed a measured resection technique with a neutral mechanical axis. We have recently developed a new total knee arthroplasty technique whereby the tibia is cut anatomically and the femoral component position is determined using a balanced approach utilizing a computer assisted ligament tension device with aim of restoring constitutional alignment. This study compares the Oxford scores and survival of these two techniques for Attune TKA’s.

Method:

The New Zealand Joint Registry has requested Oxford Knee Scores at six months on all Attune Total Knee Replacements performed. 1088 scores have been returned. 716 have been performed using a conventional measured resection technique aiming for a neutral mechanical axis. 362 have been performed using the CAS anatomic tibia, balanced femur (ATBF) technique aiming for constitutional alignment. Oxford scores are compared alone and with a multivariate analysis including age, sex, surgeon level, fixed vs mobile, public vs private, operative time and cruciate retaining vs cruciate substituting

Results:

Mean Oxford Conventional TKA univariate Oxford Score is 38.1 Mean Oxford CAS ATBF TKA univariate Oxford Score is 40.7 p=<0.001 Mean Oxford Conventional TKA multivariate Oxford Score is 36.9 Mean Oxford CAS ATBF TKA multivariate Oxford Score is 39.1 p=<0.001 The CAS ATBF had 10% less poor and fair scores and 15% more excellent scores Non infection conventional TKA has 0.71 failures per 100 component years Non infection CAS ATBF TKA has 0.25 failures per 100 component years.

Conclusion:

The CAS assisted anatomic tibia balanced femur TKA has a significantly higher Oxford score with a three times lower non infection failure rate at three years
Intra-operative Analysis of Different Patellar Implant Designs in Total Knee Replacement: A Prospective Randomised Comparative Trial
Authors: MacDessi Samuel , Chen Darren , Gharaibeh Monther
Published: May 2017

Objectives:

Present scientific literature supports patellar resurfacing with regards to reduced re-operation risk and improved long term patient satisfaction in total knee arthroplasty (Schindler 2012). Two basic techniques are present for resurfacing the patella (Lachiewicz 2003); onlay and round inset (IN). Onlay designs are either symmetrical (round) (OR) or oval shaped with an asymmetric ridge (OO). When using a round patellar implant, a lateral facetectomy is often performed to avoid lateral compression syndrome and enhance patellar tracking (Zhang, Zhang et al. 2012). However, none of these implants have been found to be superior to the other. This study will compare three different types of patellar implant designs commonly used for resurfacing in TKA and report on intra-operative outcomes. We hypothesise that OO design offers improved bone coverage with less need to perform facetectomy when compared to round designs.

Methods:

A prospective, randomised trial was performed on patients undergoing unilateral TKA by 2 surgeons. Patients who agreed to participate were allocated to one of the three patellar design groups (IN, OR, OO). Patients were blinded to the implant assigned to them. The prostheses were implanted with the aim to restore pre-resection thickness, uniform facet thickness, with maximal bone coverage and medialisation of the median ridge to enhance tracking. Groups were compared in terms of implant size, percentage bone coverage, lateral facet underhang and requirement for facetectomy. Paired t-tests and ANOVA were used to compare continuous outcome measures with chi-squared test for categorical variables.

Results:

86 patients were initially assessed for inclusion. Eight patients refused to participate and a further 18 did not meet the study inclusion criteria. A total of 60 patients were included in the final analysis. There were no differences between the 3 groups with regards to mean age, sex, pre-resection patellar thickness, patellar dimensions or pre-operative Kujala score. The asymmetrical onlay design resulted in a statistically significant larger button size (mean size 25.3 mm IN, 32.7 mm OR, 34.6 mm OO; p<0.001), reduced lateral underhang (mean 11.1mmm IN, 7.7 mm OR, 1.2 mm OO; p<0.001), and reduced need for facetectomy (85% IN, 85% OR, 0% OO). Percentage of surface bone coverage was 49%, 63.8%, 89.6% for IN, OR, OO implants respectively (p< 0.001).

Conclusion:

Oval onlay design demonstrates better surface bone coverage than round onlay or inlay implants. There were no cases in the oval group that required lateral facetectomy. Future analysis of this study group will aim to determine whether radiographic, patellar vascular and functional outcomes vary amongst the designs.
NZ ACL Registry 2016 Annual Report
Authors: Love Hamish
Published: May 2017

Objectives:

Presentation of the cumulative results of the first 2 years of the New Zealand ACL registry.

Methods:

The NZ ACL registry aims to collect relevant data for all patients undergoing ACL reconstruction in New Zealand. Injury and demographic data is collected. Marx activity and KOOS scores are recorded pre-operatively, and at 6,12 and 24 months postoperatively. Operative data is including chondral and meniscal injuries, implant choice, graft choice and diameter and concomitant procedures are recorded.

Results:

Demographic data. Patterns of technique and implant utilization. Outcome scores, complication and failure rates for the 2,500 patients currently enrolled in the registry will be presented.

Conclusion:

This report will contain the cumulative results of the NZ ACL Registry for the first full two years of it’s operation.
The hybrid anterior cruciate ligament reconstruction surgical technique does permit an accelerated early functional recovery and return to sport.
Authors: Annear Peter , Jay Ebert
Published: May 2017

Objectives:

A major reason for undergoing anterior cruciate ligament reconstruction (ACLR) for patients is to return to high demand activity and sport. Published literature supports a return to sport (RTS) at 6-12 months, though the recovery of lower limb strength and functional symmetry is critical and is linked with a patient’s ability to RTS, as well as reducing the incidence of secondary re-tear. This study aimed to compare clinical outcomes and RTS between patients undergoing ACLR utilizing a hamstring graft and those undergoing a hybrid technique which augments the hamstring graft with a synthetic LARS ligament.

Methods:

A non-randomized study design was used to compare clinical outcomes at 10-12 months post-surgery, in 82 patients undergoing conventional ACLR via a hamstring graft (HG) and 35 patients undergoing a hybrid hamstring/LARS graft (HLG). All patients were assessed using a range of patient-reported outcome (PRO) scores (IKDC, KOOS, Cinncinati, Lysholm, SF-36, Tegner, Noyes, Global Rating of Change – GRC). Limb symmetry indices (LSIs) presenting the operated limb as a percentage of the unaffected limb were calculated for several strength/functional assessments (peak isokinetic quadriceps and hamstring strength, the single, triple and triple crossover hop for distance, and the 6 m timed hop).

Results:

There were no group differences (p>0.05) in patient demographics and the majority of PROs. The HLG group perceived themselves to be significantly ‘more recovered’ (p=0.046) on the GRC scale (HLG = 3.2, HG = 2.2), and also reported a significantly greater (p=0.004) Tegner score (HLG = 7.2, HG = 5.9). For the HG group, 62% of patients had returned to Noyes Level 1 or 2 activities, versus 80% of the HLG group. For the Tegner score, 57% of patients reported a score >6, versus 77% of the HLG group. There were no significant differences (p>0.05) in LSIs between groups for the strength and functional hop tests. However, the HLG group demonstrated a mean LSI above 90% for all four hop tests, while all four were below 90% in the HG group. Both groups demonstrated mean hamstring strength LSIs above 90%, while the quadriceps strength LSI was 81.9% and 85.8% for the HG and HLG groups, respectively.

Conclusion:

Patients in the HLG group perceived themselves to be more recovered, and had returned to a higher level of activity/sport, compared with the HG group. While not significant, the HLG group did demonstrate more favorable functional hop and quadriceps strength LSIs, which has been linked with the ability to RTS and the incidence of ACL re-tear. A larger patient cohort and follow-up is required to observe long-term outcomes.
5 Year Survival of Endoscopic ACL Reconstruction with Live Donor Hamstring Tendon Allograft in Juveniles and Adolescents
Authors: Roe Justin , Fitzgibbon Emma , Salmon Lucy , Cooper Robert , Pinczewski Leo
Published: May 2017

Introduction:

ACL reconstruction with autografts in the young is associated a higher incidence of repeat injury when compared to adults. This led the authors to consider alternative graft material for the ACL deficient young population. This study was performed to assess the survival of ACL reconstruction with a living related hamstring tendon autograft in a large series of juveniles and adolescents.

Aim:

To determine the survival of the ACL graft and the contralateral ACL (CACL) after primary ACL reconstruction with living donor allograft in patients aged < 18 years and to identify the factors that increase the odds of subsequent ACL injuries.

Methods:

Patients having undergone primary ACL reconstruction with a living donor hamstring tendon allograft at age <18 years between 2005 and 2014 included in a prospective database were considered for this study. Patients completed a subjective survey involving the International Knee Documentation Committee (IKDC) questionnaire in addition to questions regarding current symptoms, further ACL injuries, family history of ACL injury, and current level of activity.

Results:

A total of 218 adolescents (mean age 14.7, age range, 8-17 years) met the inclusion criteria and were reviewed at a mean of 48 months after surgery. Of these, there were 51 ACL graft ruptures (23%) and 26 contralateral ACL ruptures (12%). The 1, 2 and 5 year survival of the ACL graft was 88%, 80% and 74%. The 1, 2 and 5 year survival of the contralateral ACL was 99%, 93% and 85%. Survival of the ACL graft was more favorable in those with open growth plates (93, 90, 85 at 1,2 and 5 survival) compared to closed growth plates (86, 75, 68 at 1,2 and 5 year survival), odds ratio 2.3 (95% CI 1.1 to 4.8, p=0.03). A return to preinjury level of activity was reported by 79%, and the mean IKDC score was 92 of a possible 100. A positive family history of ACL injury was present in 35%.

Conclusion:

Further injury after ACL reconstruction in the young presents a challenging problem. ACL reconstruction using a living related donor allograft is associated with high rates of return to sport and good subjective outcomes. This technique may be considered a viable option for ACL reconstruction in the young patient with open growth plates, but does not appear to reduce further injury in older adolescents.
One year follow-up of a case series using the iBalance medial opening wedge HTO system and an accelerated rehabilitation program
Authors: Hazratwala Kaushik
Published: May 2017

Objectives:

To investigate the clinical outcome and postoperative alignment changes changes to following computer navigated medial opening wedge HTO using the iBalance HTO system

Methods:

We performed a prospective observational series at a single centre of 20 consecutive patients undergoing computer navigated high tibial osteotomy by a single surgeon. The surgical device used to maintain the osteotomy was the Arthrex iBalance® HTO system. We compared preoperative and postoperative ROM, WOMAC, Lysholm, IKDC, alignment and the inferred tibial slope. We also measured the tibiofemoral angle on long leg weight bearing plain radiographs at 2 weeks, 6 weeks, 3 months and 1 year and calculated any change from the initial correction measured at 2 weeks to asses any loss of correction over 1-year time frame. We also correlated clinical outcome with loss of correction.

Results:

Regarding intraoperative results, the mean navigated correction to HKA was 5.4°±1.3°. No significant change was found to the knee sagittal angle posteroperatively (pre op mean 0.1°±4.4°, post op mean 0.81°±5.1°; p> 0.05). No significant change was found to the post operative ROM (pre op mean 125.4°±41.5°, post op mean 123.9°±34.4°; p> 0.05). The IKDC, Lysholm and WOMAC scores showed a significant difference, between 6 week to 3 months and 3 months to 6 months follow-up. After this time point scores did not show and statistical significant difference. The IKDC, Lysholm and WOMAC scores all demonstrate a general improvement over 12 months. One patient had to be removed from the study, as he had a lateral cortex breach at three months, and was converted to a TKR. There was a significant loss of correction between 2 weeks and 6 weeks, and again a significant loss of correction between 6 weeks and 3 months. However, the average loss of correction was measured radiographically to be 1.6°±1.7°, between 2 week and 12 month postoperative follow-up. Though this may be statistically significant, it is not clinically significant when compared to PROMs. We divided the loss of correction into greater than 1.5° and less than 1.5° and compared them to measured PROMs at all time points. We found no significant correlation between increased loss of correction and poorer PROM scores.

Conclusion:

Computer assisted iBalance medial opening wedge HTO with accelerated rehabilitation program does radiographically show loss of correction over 12 months. However it is not clinically significant when compared to PROMs. ROM and inferred tibial slope is preserved.
Medial meniscal root repair with the lasso technique
Authors: Lawrie Steven , Hopkins Nathan
Published: May 2017

Objectives:

To describe a new technique for repair of root tears of the medial meniscus. To determine that this technique is not inferior to other pull out repair techniques as described in the current literature.

Methods:

This paper reports on an observational series of an operative technique for repair of root tears of the medial meniscus. Twenty-five sequential patients presenting with root tears of the medial meniscus are described. The technique describes a simple method for repairing the root of the medial meniscus using a trans-tibial tunnel, suture loop, Fast-Fix meniscal sutures and a modified ACL jig as a prototype device.

Results:

Two objective failures have occurred in 25 sequential patients. 13 patients presented with significant medial femoral condyle oedema on MRI scan, all resolved on 6 months post operative MRI. Patients showed marked improvement in outcome measures with an average increase in the following scores;Tegner Lysholm of 50.8, KOOS of 46.9, IKDC 43, Oxford Knee Score 22.6, WOMAC 49.3.Time from injury to surgery appears to be a predictor of failure.

Conclusion:

The described technique compares reasonably to similar case series in the current literature. A successful outcome results in significant improvement in patient reported outcomes. Delay to surgery is a risk factor for failure.
Customer Value Management
Authors: Kotler Philip
Published: June 2017

A company’s job is to create superior customer value in the mind of the customer. Be aware that the customer’s sense of value may differ from the company’s sense of value. A customer is interested in more than the physical product. The customer also pays attention to the service level, guaranties and warranties, financing arrangements, return policies — all making up the total product. The challenge is to help the customer perceive more total value than the total cost of acquisition and usage.