bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved multi-wavelet denoising with neighboring coefficients of cutting force for application in the load spectrum of computer numerical control lathe
Authors: He Jialong , Yang Zhaojun , Chen Chuanhai , Li Guofa , Li Zhen , Jia Yuhui
Published: February 2018

To obtain accurate computer numerical control lathe cutting force signals and improve the precision of load stress cycle statistic, an improved multi-wavelet denoising with neighboring coefficients method is proposed. First, statistical variance smoothing is applied to remove the singular points in the original signal. The processed signal is then denoised with the multi-wavelet with neighboring coefficients method. Second, based on the change laws of the correlation dimension and the values of Brock, Dechert, Scheinkman statistic of load signal, reasonable decomposition levels of the multi-wavelet and the length of neighboring coefficients are used. Third, four synthetic signals with different signal-to-noise ratios are denoised with the wavelet threshold denoising method and improved multi-wavelet denoising with neighboring coefficients. Then, the difference between the values of correlation dimension and Brock, Dechert, Scheinkman statistic in the original and denoised signals is analyzed. Meanwhile, its validity is further verified with the signal-to-noise ratio and mean square error. The results show that the improved multi-wavelet denoising with neighboring coefficients is better than wavelet threshold. Finally, turning force signals are denoised by wavelet threshold and improved multi-wavelet denoising with neighboring coefficients. Comparison result shows that the improved multi-wavelet denoising with neighboring coefficients can not only remain largely low-frequency signal energy and suppress high-frequency noise signals effectively but also improve the accuracy of load stress cycle statistic.
Design, analysis, and experimental validation of a novel seamless automatic transmission for electric vehicle
Authors: Yu Jie , Yao Ligang , Ren Chengcheng , Yan Xiaolei , Lin Li
Published: February 2018

The transmission system has an important influence on the dynamic performance, endurance mileage, and energy saving in an all-electric vehicle. This article proposes an innovative two-speed seamless dry-friction automatic transmission system to improve the dynamic performance and endurance mileage of an all-electric vehicle with the existing battery technology. The proposed system consists of two-stage epicyclical gear sets without outer ring gears, a dry-friction clutch, and a brake band, realizes a seamless shifting between any two speeds in an electric vehicle. Based on the working principle and dynamic modeling of the proposed seamless dry-friction automatic transmission system, the ratio optimization was carried out to improve the dynamic performance and the power consumption at the same time, and the combination of the weight ratio method and the multi-island genetic algorithm method was introduced to solve the optimization problem. It is shown both theoretically and experimentally that the proposed seamless dry-friction automatic transmission method demonstrates a better dynamic performance and shifting comfort when compared to the automated manual transmission with same transmission ratio.
A decade of the Clinical Trials Transformation Initiative: What have we accomplished? What have we learned?
Authors: Tenaerts P , Madre L , Landray M
Published: February 2018

The Clinical Trials Transformation Initiative reflects on 10 years of working to improve the quality and efficiency of clinical trials. This article highlights many of the Clinical Trials Transformation Initiative’s accomplishments and offers examples of the impact that the Clinical Trials Transformation Initiative has had on the clinical trials enterprise. After conducting more than 25 projects and issuing recommendations for specific strategies to improve the design and execution of clinical trials, some common themes and lessons learned have emerged. Lessons include the importance of engaging many stakeholders, advanced planning to address critical issues, discontinuation of non-value added practices, and new opportunities presented by technology. Through its work, the Clinical Trials Transformation Initiative has also derived some operational best practices for conducting collaborative, multi-stakeholder projects covering project selection, project team dynamics and execution, and multi-stakeholder meetings and team discussions. Through these initiatives, the Clinical Trials Transformation Initiative has helped move the needle toward needed change in the clinical trials enterprise that has directly impacted stakeholders and patients alike.
The Clinical Trials Transformation Initiative: Methodology supporting the mission
Authors: Corneli Amy , Hallinan Zachary , Hamre Gerrit , Perry Brian , Goldsack Jennifer C , Calvert Sara B , Forrest Annemarie
Published: February 2018

The mission of the Clinical Trials Transformation Initiative, a public–private partnership co-founded by the U.S. Food and Drug Administration and Duke University, is to develop and drive adoption of practices that will increase the quality and efficiency of clinical trials. The Clinical Trials Transformation Initiative works collaboratively with key stakeholders, implements “fit-for-purpose” evidence-gathering projects, and develops actionable recommendations and tools to address the challenges faced by the clinical trials enterprise. In pursuit of its mission, The Clinical Trials Transformation Initiative follows an innovative and collaborative, five-step methodology: (1) state the problem and identify impediments to research, (2) gather evidence to identify gaps and barriers, (3) explore results by analyzing and interpreting findings, (4) finalize solutions by developing recommendations and tools, and (5) drive adoption through disseminating and implementing recommendations and tools. This article describes each step of the Clinical Trials Transformation Initiative's methodology, with a specific focus on describing the evidence-gathering activities.
Patient engagement in clinical trials: The Clinical Trials Transformation Initiative’s leadership from theory to practical implementation
Authors: Patrick-Lake Bray
Published: February 2018

Patient engagement is an increasingly important aspect of successful clinical trials. Over the past decade, as patient group involvement in clinical trials has continued to increase and diversify, the Clinical Trials Transformation Initiative has not only recognized the crucial role patients play in improving the clinical trial enterprise but also made a deep commitment to help grow and shape the emerging field of patient engagement. This article describes the evolution of patient engagement including the origins of the patient engagement movement; barriers to successful engagement and remaining challenges to full and valuable collaboration between patient groups and trial sponsors; and Clinical Trials Transformation Initiative’s role in influencing the field through organizational practices, formal project work and resulting recommendations, and external advocacy efforts.
The evolution of clinical trials: Can we address the challenges of the future?
Authors: Eichler Hans-Georg , Sweeney Fergus
Published: February 2018

The authors describe key challenges facing the clinical trials community and propose solutions to these issues, including the role the Clinical Trials Transformation Initiative can play in addressing these issues. Specifically, the authors reflect on clinical trial globalization and the harmonization of frameworks and requirements across regions; the challenges associated with balancing the desire for external validity, pragmatic trials, and precision medicine; clinical trial transparency; and operational complexity and the expense of clinical trials. By addressing these challenges, future clinical trials will be more feasible, relevant, and credible, and support both the continuing altruistic contributions of patients and the collection of more meaningful data.
Lifetime estimation of nitrile butadiene rubber O-rings under storage conditions using time-varying copula
Authors: Pan Jun , Bai Guanghan , Chen Wenhua
Published: February 2018

With several attractive properties, nitrile butadiene rubber O-rings have been widely used as compression seal components in various critical engineering systems. Therefore, it is important to obtain an accurate lifetime estimation of the nitrile butadiene rubber O-ring. In this study, aiming to estimate the lifetime of a nitrile butadiene rubber O-ring under storage conditions, a reliability model is developed by considering two performance characters, namely, compression set and compressive stress relaxation. With a long lifetime in storage, a constant-stress accelerated degradation testing is conducted to obtain the degradation model for each performance character. In addition, the statistical dependency between the two performance characters is considered, and a bivariate time-varying copula model is used to capture this relationship. An efficient two-stage approach is proposed to construct a suitable time-varying copula function. By comparing with previously reported time-varying copulas, it can be proved that the time-varying copula constructed using the proposed approach achieves a better goodness of fit.
A Markov decision process framework for optimal operation of monitored multi-state systems
Authors: Compare Michele , Marelli Paolo , Baraldi Piero , Zio Enrico
Published: February 2018

We develop a decision support framework based on Markov decision processes to maximize the profit from the operation of a multi-state system. This framework enables a comprehensive management of the multi-state system, which considers the maintenance decisions together with those on the multi-state system operation setting, that is, its loading condition and configuration. The decisions are informed by a condition monitoring system, which estimates the health state of the multi-state system components. The approach is shown with reference to a mechanical system made up of components affected by fatigue.
What Does the Evidence Say Is Best for Your Student? CLUE #3: Appraise
Authors: Maughan Erin D. , Yonkaitis Catherine F.
Published: February 2018

School nurses are often faced with various requests from parents, teachers, and even healthcare providers. How do you know what requests should be honored? What does the current evidence indicate? This article is the third in a series of articles outlining the steps of evidence-based practice. The article explains and provides tips for accomplishing the third step: Appraise the evidence. Appraising the evidence means better understanding what the literature says and how strong the evidence is. This is an important step in evidence-based school nursing practice.
An Eye on Vision: 20 Questions About Vision Screening and Eye Health
Authors: Nottingham Chaplin P. Kay , Baldonado Kira , Bradford Geoffrey E. , Cotter Susan , Moore Bruce
Published: February 2018

Current evidence-based and best practice vision screening and eye health approaches, tools, and procedures are the result of revised national guidelines in the past 3 years and advances in research during the last 16 years. To help the busy school nurse with little time to keep up with changes in children’s vision practices and a growing body of literature, the National Center for Children’s Vision and Eye Health at Prevent Blindness is providing answers to 20 questions received most often from the field. Question topics are: (1) arranging the screening environment, (2) occluders to cover the eyes during vision screening, (3) optotype-based screening at distance, (4) optotype-based screening at near, (5) instrument-based screening, (6) muscle imbalance screening, (7) referrals, and (8) vision screening certification.
The search for new antithrombotic mechanisms and therapies that may spare hemostasis
Authors: Plow Edward F. , Wang Yunmei , Simon Daniel I.
Published: February 2018

Current antithrombotic drugs, including widely used antiplatelet agents and anticoagulants, are associated with significant bleeding risk. Emerging experimental evidence suggests that the molecular and cellular mechanisms of hemostasis and thrombosis can be separated, thereby increasing the possibility of new antithrombotic therapeutic targets with reduced bleeding risk. We review new coagulation and platelet targets and highlight the interaction between integrin αMβ2 (Mac-1, CD11b/CD18) on leukocytes and GPIbα on platelets that seems to distinguish thrombosis from hemostasis.
OMNIgene.SPUTUM suppresses contaminants while maintainingMycobacterium tuberculosisviability and obviates cold-chain transport
Authors: Azam Khalide , Cadir Nureisha , Madeira Carla , Gillespie Stephen H. , Sabiiti Wilber
Published: February 2018

Tuberculosis (TB) diagnostics are centralised, requiring long-distance transportation of specimens in most resource-limited settings. We evaluated the ability of OMNIgene.SPUTUM (OM-S) to obviate cold-chain transport of TB specimens.

A two-arm (same-day and after 5 days sample processing) study was conducted to assess contamination rates andMycobacterium tuberculosisviability in OM-S-treated samples against the standard decontamination procedure (SDP) in Mozambique, using Lowenstein Jensen (LJ) and mycobacterial growth indicator tube (MGIT) culture and molecular bacterial load assay.

270 specimens were processed using OM-S and SDP in same-day and 5-day arms. Contamination was lower in OM-S-treated than SDP-treated cultures: 12%versus15% and 2%versus27% in the same-day and 5-day arms, respectively.M. tuberculosisrecovery in OM-S-treated LJ cultures was 10% and 56% higher in the same-day and 5-day arms, respectively, than SDP-treated cultures, but lower in MGIT (52% and 28% lower in the same-day and 5-day arms, respectively).M. tuberculosisviable count was 1log estimated CFU·mL−1lower in 5-day OM-S-treated sputa. OM-S was more effective at liquefying sputum with a shorter sample processing time: 22 min for culture.

OM-S is simple to use and has demonstrated a high potency to suppress contaminants, maintenance of viability at ambient temperatures and higherM. tuberculosisrecovery, particularly in the solid LJ cultures. Optimisation of OM-S to achieve higher MGIT culture positivity and shorter time to result will increase its application and utility in the clinical management of TB.
The clinical utility of lung clearance index in early cystic fibrosis lung disease is not impacted by the number of multiple-breath washout trials
Authors: Foong Rachel E. , Harper Alana J. , Skoric Billy , King Louise , Turkovic Lidija , Davis Miriam , Clem Charles C. , Rosenow Tim , Davis Stephanie D. , Ranganathan Sarath , Hall Graham L. , Ramsey Kathryn A.
Published: February 2018

The lung clearance index (LCI) from the multiple-breath washout (MBW) test is a promising surveillance tool for pre-school children with cystic fibrosis (CF). Current guidelines for MBW testing recommend that three acceptable trials are required. However, success rates to achieve these criteria are low in children aged <7 years and feasibility may improve with modified pre-school criteria that accepts tests with two acceptable trials. This study aimed to determine if relationships between LCI and clinical outcomes of CF lung disease differ when only two acceptable MBW trials are assessed.

Healthy children and children with CF aged 3–6 years were recruited for MBW testing. Children with CF also underwent bronchoalveolar lavage fluid collection and a chest computed tomography scan.

MBW feasibility increased from 46% to 75% when tests with two trials were deemed acceptable compared with tests where three acceptable trials were required. Relationships between MBW outcomes and markers of pulmonary inflammation, infection and structural lung disease were not different between tests with three acceptable trials compared with tests with two acceptable trials.

This study indicates that pre-school MBW data from two acceptable trials may provide sufficient information on ventilation distribution if three acceptable trials are not possible.
Integrated respiratory and palliative care may improve outcomes in advanced lung disease
Authors: Smallwood Natasha , Thompson Michelle , Warrender-Sparkes Matthew , Eastman Peter , Le Brian , Irving Louis , Philip Jennifer
Published: February 2018

The unaddressed palliative care needs of patients with advanced, nonmalignant, lung disease highlight the urgent requirement for new models of care. This study describes a new integrated respiratory and palliative care service and examines outcomes from this service.

The Advanced Lung Disease Service (ALDS) is a long-term, multidisciplinary, integrated service. In this single-group cohort study, demographic and prospective outcome data were collected over 4 years, with retrospective evaluation of unscheduled healthcare usage.

Of 171 patients included, 97 (56.7%) were male with mean age 75.9 years and 142 (83.0%) had chronic obstructive pulmonary disease. ALDS patients had severely reduced pulmonary function (median (interquartile range (IQR)) forced expiratory volume in 1 s 0.8 (0.6–1.1) L and diffusing capacity of the lung for carbon monoxide 37.5 (29.0–48.0) % pred) and severe breathlessness. All patients received nonpharmacological breathlessness management education and 74 (43.3%) were prescribed morphine for breathlessness (median dose 9 mg·day−1). There was a 52.4% reduction in the mean number of emergency department respiratory presentations in the year after ALDS care commenced (p=0.007). 145 patients (84.8%) discussed and/or completed an advance care plan. 61 patients died, of whom only 15 (24.6%) died in an acute hospital bed.

While this was a single-group cohort study, integrated respiratory and palliative care was associated with improved end-of-life care and reduced unscheduled healthcare usage.
COPD: time to improve its taxonomy?
Authors: Celli Bartolomé R. , Agustí Alvar
Published: February 2018

Due to well-conducted epidemiological studies and advances in genetics, molecular biology, translational research, the advent of computed tomography of the lungs and bioinformatics, the diagnosis of chronic obstructive pulmonary disease (COPD) as a single entity caused by susceptibility to cigarette smoke is no longer tenable. Furthermore, the once-accepted concept that COPD results from a rapid and progressive loss of lung function over time is not true for a sizeable proportion of adults with the disease. Now we know that some genetic predisposition and/or different environmental interactions (nutritional, infectious, pollution and immunological) may negatively modulate post-natal lung development and lead to poorly reversible airflow limitation later in life, consistent with COPD. We believe it is time to rethink the taxonomy of this disease based on the evidence at hand. To do so, we have followed the principles outlined in the 1980s by J.D. Scadding who proposed that diseases can be defined by four key characteristics: 1) clinical description (syndrome), 2) disorder of structure (morbid anatomy), 3) disorder of function (pathophysiology) and 4) causation (aetiology). Here, we propose a pragmatic approach to the taxonomy of COPD based on different processes that result in a similar syndromic presentation. It can accommodate changes over time, as the pathobiology that may lead to COPD expands. We hope that stakeholders in the field may find it useful to better define the patients now boxed into one single entity, so that specific studies can be designed and conducted for each type of COPDs.
Prevalence of Staphylococcus spp. nasal colonization among doctors of podiatric medicine and associated risk factors in Spain
Authors: de Benito Sheila , Alou Luis , Becerro-de-Bengoa-Vallejo Ricardo , Losa-Iglesias Marta Elena , Gómez-Lus María Luisa , Collado Luis , Sevillano David
Published: February 2018

Background

This study aimed to estimate the prevalence of methicillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE) nasopharyngeal carriage among Doctors of Podiatric Medicine (Podiatrists) and to determine the potential risk factors.

Methods

A cross-sectional study was carried out in 2016–2017 among 239 podiatrists in Spain. The presence of MSSA, MRSA, and MRSE was determined by microbiological analysis of nasal exudate and antimicrobial susceptibility was determined. Each podiatrist completed a questionnaire. The questionnaire comprised various parameters such as sex, age, podiatry experience duration, underlying diseases, prior antibiotic treatment, hospitalization during the last year, and use of a protective mask, an aspiration system, or gloves.

Results

The prevalence of MSSA, MRSA, and MRSE was 23.0%, 1.3%, and 23.8%, respectively. The MSSA prevalence was higher among podiatrists who did not use an aspiration system (32.3%) compared to those who did (19.3%; p = 0.0305), and among podiatrists with respiratory diseases (36.8%) compared to those without (20.8%; p = 0.0272). The MRSE prevalence was higher among men (33.7%) compared to women (8.6%; p = 0.0089), podiatrists aged ≥50 (38.5%) compared to ≤35 (17.8%; p = 0.0101), and podiatrists with ≥15 (39.3%) compared to ≤5 years of podiatry experience (12.5%; p = 0.0015). Among the S. aureus strains, 84.5% were resistant to penicillin, 22.4% to erythromycin, 20.7% to clindamycin, and 12.7% to mupirocin. The MRSE strains were resistant to penicillin (93.0%), erythromycin (78.9%), and mupirocin (73.7%).

Conclusions

The prevalence of S. aureus and S. epidermidis nasal carriage is low among Spanish podiatrists compared to other health professionals.
Nutritional risk in outpatients of a geriatric neuropsychiatry clinic
Authors: Fernandez-Filha Amparo Hurtado , Silva Gisele Wendeborn M. , Cipolli Gabriela , Ribeiro Sandra Maria Lima
Published: February 2018

Background

There are few published studies investigating the nutritional status of elderly individuals with psychiatric disorders. This study aims to describe the nutritional status of elderly patients from a neuropsychiatry outpatient clinic, investigating their nutritional status according to the type of psychiatric diagnostic, specifically Alzheimer’s disease (AD), depression (DEP), and other types of dementia (OTD).

Methods

Elderly individuals from two outpatient clinics (n = 217) were evaluated for nutritional risk (using a validated tool) and for some anthropometric and biochemical measurements.

Results

We found a high prevalence of nutritional risk in the sample (about 60%). The major dietary problems found were low daily meal frequency and the low daily intake of water. Biochemical analyses indicated blood glucose and total cholesterol to be above the reference values, while hemoglobin and vitamin D were below the reference values. Anthropometric measurements did not differ between the groups with different psychiatric diagnostics, except for calf circumference, which showed to be lower in the OTD group (p = 0.006).

Conclusions

Although we found a high prevalence of nutritional risk, the differences between the diagnostic groups were very subtle. The nutritional risk is certainly associated with inadequate eating habits. It is necessary to seek strategies to improve the diet and other lifestyle factors in geriatric neuropsychiatry, in order to mitigate the negative outcomes brought about by the diseases.
H3K9 demethylase KDM4E is an epigenetic regulator for bovine embryonic development and a defective factor for nuclear reprogramming
Authors: Liu Xin , Wang Yizhi , Gao Yuanpeng , Su Jianmin , Zhang Jingcheng , Xing Xupeng , Zhou Chuan , Yao Kezhen , An Quanli , Zhang Yong
Published: February 2018

Aberrant epigenetic reprogramming often results in developmental defects in somatic cell nuclear transfer (SCNT) embryos during embryonic genome activation (EGA). Bovine eight-cell SCNT embryos exhibit global hypermethylation of histone H3 lysine 9 tri- and di-methylation (H3K9me3/2), but the intrinsic reason for this remains elusive. Here, we provide evidence that two H3K9 demethylase genes, lysine-specific demethylase 4D (KDM4D) and 4E (KDM4E), are related to active H3K9me3/2 demethylation in in vitro fertilized (IVF) embryos and are deficiently expressed in cloned embryos at the time of EGA. Moreover, KDM4E plays a more crucial role in IVF and SCNT embryonic development, and overexpression of KDM4E can restore the global transcriptome, improve blastocyst formation and increase the cloning efficiency of SCNT embryos. Our results thereby indicate that KDM4E can function as a crucial epigenetic regulator of EGA and as an internal defective factor responsible for persistent H3K9me3/2 barriers to SCNT-mediated reprogramming. Furthermore, we show that interactions between RNA and KDM4E are essential for H3K9 demethylation during EGA. These observations advance the understanding of incomplete nuclear reprogramming and are of great importance for transgenic cattle procreation.
Approaches to Automating the Collection and Presentation of Data to Monitor the Implementation of Strategic Planning Documents
Authors: Липина С. , Lipina S. , Беляевская-Плотник Л. , Belyaevskaya-Plotnik L. , Сорокина Наталья , Sorokina Natalia
Published: February 2018

The article substantiates and presents the directions for automating the data necessary for conducting operational monitoring and control over the implementation of strategic planning documents. The urgency of work caused by the need to optimize the process of forming and reporting on the implementation of strategic planning documents at the federal level using the capabilities of the State Automated System “Management”. The transfer of functions for the generation and provision of reporting data through an automated platform is included in the activities for the digitization of the economy, which is an urgent and modern priority for national development. A special attention in the article given to the development of approaches to monitoring the implementation of the Strategy for the Social and Economic Development of the Russian Federation, currently under development, with a view to visualizing its results with the help of info graphic tools.
POST-OPERATIVE STUDY OF VITALLIUM MOULD ARTHROPLASTY OF THE HIP JOINT
Authors: Law W. Alexander
Published: February 2018

1. In this series of 150 cases of arthritis of the hip joint treated by vitallium mould arthroplasty (182 arthroplasties), 80 per cent. of late results are satisfactory to both patient and surgeon.

2. Striking features are the relative painlessness, smooth hip joint movement, progressive improvement in function, and reformation of the joint lines as seen radiographically in the post-operative period.

3. Function after arthroplasty for traumatic and degenerative arthritis approaches the normal hip joint much more closely than in cases of infective and rheumatoid arthritis.

4. There is a complete absence of low back symptoms or postural difficulties, and there is no difficulty in preventing stiffness of the knee joint.

5. Different technical procedures are indicated according to the degree of absorption of the femoral head or neck, and the stability of the mould in the acetabulum.

6. The operative mortality rate in this series was nil, and during the six-year follow-up period only one case died as the result of a complication of the arthroplasty.

7. In addition to meticulous operative technique and the use of special instruments, the importance of careful and prolonged after-treatment must be stressed.

8. It must also be emphasised that secondary operative revisions are often necessary, particularly in cases of infective and rheumatoid arthritis.
PLANTAR DIGITAL NEURITIS Morton's Metatarsalgia
Authors: Nissen K. I.
Published: February 2018

1. A series of cases of Morton's metatarsalgia is reported in which twenty-seven selected patients have had thirty-five operations on the sole of the foot.

2. At operation, degeneration of the plantar digital artery to the cleft between the third and fourth toes has now been found to precede the fibrous thickening of the nerve described by Betts in 1940. Similar changes rarely occur in neighbouring clefts.

3. Local resection of the nerve almost always gives complete relief from pain, and the plantar scar gives rise to no trouble.

4. Histological findings show that the nerve lesion is ischaemic in nature.

5. Acute pain arising as a new event in cases of the deformity of "anterior flat foot" may prove to be due to this condition.

6. Morton's metatarsalgia is a distinct clinical and pathological entity which can best be described as a plantar digital neuritis.
ISCHAEMIC NECROSIS OF THE ANTERIOR TIBIAL MUSCLES DUE TO FATIGUE
Authors: Hughes J. Rowland
Published: February 2018

1. Three cases are reported of ischaemic necrosis of the anterior tibial muscles which were not due to injury. In two, ischaemia was the result of strenuous or unaccustomed exercise in young adults; in the third it was an incident in a systemic disturbance. All three cases were probably the result of spasm of a large segment of the anterior tibial artery.

2. The clinical features during the first few hours resemble those of tenosynovitis of the tibialis anterior; and after twelve to twenty-four hours those of cellulitis of the leg. Later there is "drop foot" due to muscle weakness, contracture limiting plantar-flexion movement, and woody hardness of the muscles in the middle third.

3. The morbid histology is similar to that of Volkmann's ischaemic contracture.

4. The possible explanationsâprimary arterial disease, arterial occlusion by pressure of the interosseous membrane, occlusion by tension within the fascial space, intraluminary occlusion by embolism or thrombosis, and fatigue arterial spasm, are discussed.

5. The vascular pattern of the anterior tibial muscles has been studied by experimental injections in cadavers.

6. It is concluded that the most likely cause is spasm of the anterior tibial artery due to muscle fatigue, aggravated by increased tension within the anterior fascial compartment due to reaction after strenuous exercise.

7. Treatment is outlined. Exploration of the anterior tibial artery within the first twelve hours is warranted, but late exploration may be dangerous.

8. Although not previously recognised, evidence is shown that regeneration of necrotic muscle is possible in the human being.
THE TREATMENT OF TROCHANTERIC FRACTURES OF THE FEMUR
Authors: Evans E. Mervyn
Published: February 2018

1. Trochanteric fractures are classified, with special emphasis on the stability or instability of the fracture. The importance of the cortical buttress of bone on the inner side of the femoral neck and shaft is stressed.

2. Three series of cases are presented: a) one hundred and one cases treated conservatively in hospital; b) twenty-five cases sent home by reason of lack of hospital beds; c) twenty-two cases treated by fixation with a Capener-Neufeld nail-plate.

3. From consideration of these three series, and from study of similar series of cases reported in the literature, it is suggested that routine operative treatment of trochanteric fractures has the advantages of greater comfort and mobility of the patient, lowered mortality, and economy of hospital beds.

4. Certain features of the operation of internal fixation by the Capener-Neufeld nail-plate are discussed. A director, for more efficient insertion of the nail-plate, is described.

5. The importance of early mobility after operation is emphasized. Only a small proportion of Patients can be allowed early weight-bearing but almost all can be got up in a chair, and most can be taught to get about with crutches, without weight-bearing on the fractured limb, within a few days of operation.
ATLANTO-AXIAL FRACTURE-DISLOCATION
Authors: Colsen Kurt
Published: February 2018

1. A case of fracture-dislocation of the atlas on the axis is presented in which the neck had been manipulated under anaesthesia for "rheumatism."

2. Despite marked displacement there were no important neurological complications.

3. One-stage reduction by traction was carried out very slowly and with radiographic control. It is believed that this is less distressing to the patient, and safer, than gradual reduction by prolonged traction.

4. Because of the instability of the atlanto-axial joint after reduction surgical fusion of the upper cervical spine to the occipital bone is advisable.

5. In the case now reported recovery was complete.
ANOMALOUS INNERVATION OF THE HAND MUSCLES
Authors: Rowntree Tom
Published: February 2018

1 . Voluntary activity of any given muscle in the hand is not an absolute indication of the state of the nerve which usually supplies it.

2. Significant variations in the standard pattern of innervation have been found in 20 per cent of 226 cases studied.

3. The pattern of innervation described in standard text-books occurred in only 33 per cent. of cases.

4. A striking variation is the supply of every thenar muscle by the ulnar nerve. In other cases the first dorsal interosseous muscle may be supplied by the median nerve.

5. In order to arrive at an accurate diagnosis when anomalous innervation is suspected, nerve blocks at appropriate levels are required.

6. Great care must be taken during operations to avoid damage to connections between the ulnar and the median nerves, especially in patients with anomalous innervation of the hand muscles.
PROTRUSIONS OF THE LUMBAR INTERVERTEBRAL DISCS
Authors: O'Connell John E. A.
Published: February 2018

1. Excision of a lumbar intervertebral disc protrusion is required in only a small proportion of patients with this lesion.

2. A careful clinical and radiological examination of cases of lumbago and pain in the lower limb provides good evidence not only of the presence of a lumbar intervertebral disc protrusion but also of its anatomical level, size and relationships. Such examination is essential for the selection of the patients requiring surgical treatment.

3. In most of these selected cases, a carefully performed operation designed to relieve the affected nerve fibres from forces which stretch and compress them will give satisfying relief of symptoms. In the series reported, 92 per cent of patients were either completely free from symptoms or very greatly improved after operation.

4. The spinal and tension signs present before operation largely disappeared after it. Persistence of a pre-operative neurological deficit after operation is, however, relatively frequent, though seldom disabling.

5. The incidence of post-operative recurrence of symptoms of such severity as to indicate re-operation in the series was 2 per cent.
CANCER AS A SEQUEL TO WAR WOUNDS
Authors: Gillis Leon , Lee Stanley
Published: February 2018

A patient with a chronic discharging sinus or an extensive adherent scar is never safe from the risk of malignant change. Examples are still occurring more than thirty years after the end of the first world war. The possibility should be kept in mind by those concerned with the long-term treatment of wounds of this kind. Reasonable prophylactic measures would be: excision of adherent or unstable scars with, if necessary, their replacement by suitable pedicle flaps having a good blood supply; and earlier amputation if a osteomyelitic sinus persists for several years and does not yield to treatment. Supervision of doubtful cases should be frequent and should not be relaxed with the passage of the years. Warty changes or indolent ulceration of scars should be regarded with grave suspicion and investigated by biopsy. Any increase in pain or discharge in association with a sinus should receive prompt attention. Finally, if malignant change supervenes, treatment should be as speedy and as radical as with any other cancer. At least thirteen of our twenty-four patients have died of cancer.
ADVANCED ACTINOMYCOSIS OF THE SPINE TREATED WITH PENICILLIN AND STREPTOMYCIN
Authors: Brett M. S.
Published: February 2018

A case of extensive spinal actinomycosis, undiagnosed for nearly five years, responded dramatically to large doses of penicillin, which was later supplemented by streptomycin.
SOLITARY TUMOURS OF PERIPHERAL NERVE TRUNKS
Authors: Jenkins S. Aubrey
Published: February 2018

1. Three solitary tumours of the peripheral nerve trunks are reported. None of the patients showed evidence of von Recklinghausen's disease.

2. The origin of these tumours is discussed; the evidence suggests that they develop from the Schwann cells of the nerve sheaths, and they should therefore be called neurilemmomas.

3. A solitary tumour of a peripheral nerve trunk is usually a neurilemmoma and not a neurofibroma.

4. These tumours are often mistaken for neurofibromas, from which they are wholly distinct. They are uncommon, but probably occur more often than is generally appreciated.

5. A neurilemmoma is a benign tumour which can be distinguished from a neurofibroma on clinical and operative grounds. It must be enucleated with preservation of its parent nerve. There is negligible risk of recurrence and no risk of malignant change after operation.

6. Neurilemmomas are liable to cystic degeneration, especially in situations where they are subjected to pressure or injury. This cystic change may later destroy the usual cellular structure of the tumour and convert it into a simple cyst.
POSTERIOR DISLOCATION OF THE SHOULDER
Authors: Taylor R. G. , Wright P. R.
Published: February 2018

1. Six cases of posterior dislocation of the shoulder are described.

2. In four cases the diagnosis was made on clinical grounds.

3. The important clinical signs are the adducted and medially rotated position of the arm, a hard mass posteriorly below the acromion representing the displaced humeral head, and limitation of movement, especially abduction and lateral rotation.

4. In two cases the dislocation was not recognised at the first examination. This confirms the statement of previous authors that posterior dislocation is easily missed.

5. The value of the vertical projection in the radiography of suspected posterior dislocation is emphasised.

6. Reduction was accomplished without difficulty in five cases and the subsequent progress of these was uneventful. In the remaining case reduction was difficult and unstable, and the final recovery incomplete. It is considered that this patient would have been better treated by early open reduction.
FAMILIAL HYPERPLASTIC CALLUS FORMATION
Authors: Hilton Gwen
Published: February 2018

In osteogenesis imperfecta the formation of callus is usually plentiful and sometimes rather excessive but the excess is absorbed in the normal way as consolidation occurs. In hyperplastic callus formation the amount of callus formed is large, or even enormous; and, once its limits are defined and ossification has occurred, some part of the original swelling remains as a thickening of the bone. "Callus" may form with or without injury and with or without fracture. The interest of the present case lies partly in the fact that there is no history of multiple fractures to indicate classical osteogenesis imperfecta, and partly in the familial incidence which has also been noted in other records. It is important to recognise the true nature of the condition in order to avoid the tragedy of unnecessary amputation. In one of Brailsford's cases the lesion is said to have become malignant but there is no other evidence in the literature that the condition has any relationship to malignancy. The clinical appearance can easily give rise to the suspicion of malignancy, and on histological examination the highly cellular and rapidly growing callus can be confused with a malignant condition. In fact, for the short time in which the bone formation runs riot the behaviour of a malignant neoplasm is closely simulated.

It is thought that the present account may be of interest because of the invariable relief of pain after x-ray treatment of each new lesion, the length of time over which the case has been followed and the resemblance between the radiographic appearances in the patient now and those of her aunt taken twenty years ago.
THE USE OF CANCELLOUS BONE GRAFTS IN THE TREATMENT OF SUBACUTE AND CHRONIC OSTEOMYELITIS
Authors: Hazlett J. W.
Published: February 2018

1. One hundred and one cases of cancellous chip bone grafting operations for filling of infected bone defects are reviewed.

2. Short-term follow-up showed primary or delayed primary healing in 87 per cent of the cases.

3. Observation after five years revealed a recurrence rate of 20 per cent. The recurrences were successfully overcome by minor procedures except in five patients, who suffer from repeated flare-ups of infection.

4. At the present time, 91 per cent of the lesions are satisfactorily healed with a partial or complete bone graft intact. There have been ten failures.

5. The criteria for successful cancellous chip bone grafting of osteomyelitic cavities are discussed.
WEDGE RESECTION FOR SCOLIOSIS
Authors: Roaf Robert
Published: February 2018

"Wedge excision" of the apex of the curve is the rational way of correcting a scoliosis. It is a straightforward procedure which is successful in practice.
MALIGNANT TUMOUR AT SITE OF BONE PLATING
Authors: McDougall A.
Published: February 2018

1. A case is described in which a malignant tumour developed in the soft tissues at the site of a bone-plating operation performed thirty years before.

2. The plate and screws were found to be composed of dissimilar metals and a difference of potential existed between them.

3. A careful consideration of the history and clinical course indicates that the tumour arose because of the presence of the metals.
THE PREHENSILE MOVEMENTS OF THE HUMAN HAND
Authors: Napier J. R.
Published: February 2018

1. The prehensile movements of the hand as a whole are analysed from both an anatomical anda functional viewpoint.

2. It is shown that movements of the hand consist of two basic patterns of movements which are termed precision grip and power grip.

3. In precision grip the object is pinched between the flexor aspects of the fingers and that of the opposing thumb.

4. In power grip the object is held as in a clamp between the flexed fingers and the palm, counter pressure being applied by the thumb lying more or less in the plane of the palm.

5. These two patterns appear to cover the whole range of prehensile activity of the human hand.
FRACTURE-DISLOCATIONS OF THE CERVICAL SPINE
Authors: Durbin F. C.
Published: February 2018

1. Seventy-five injuries of the cervical spine are reported. Fifty-three were dislocations and fracture-dislocations involving the third to the seventh segments.

2. The importance of careful examination in all neck injuries is stressed.

3. The injuries are divided into stable and unstable types and the causation of the instability is discussed.

4. Plaster immobilisation for more than six months failed in some patients to prevent recurrence of dislocation.

5. Operative treatment was advised in all cases of dislocation, the spine being wired and grafted with iliac bone. This prevents recurrence and shortens the period of convalescence.
OSTEOCHONDRITIS DISSECANS OF THE HIP
Authors: Guilleminet M. , Barrier J. M.
Published: February 2018

1. The pathological anatomy of osteochondritis dissecans of the hip is described, and its causation is discussed.

2. Eight new cases are reported.

3. The problems of treatment are considered.
STUDIES OF THE VASCULARISATION OF BONE GRAFTS
Authors: Stringa Gabriele
Published: February 2018

1. The rates of vascularisation in 119 autogenous, homogenous and heterogenous bone grafts, placed in the femoral medullary cavity and under the renal capsule of rabbits, were studied.

2. Substantial differences have been found in the speed of vascular penetration and arrangement among autografts, homografts and heterografts : penetration of the heterogenous implant was six or more times slower. Moreover, large areas of the homografts and heterografts were often totally excluded from the circulation for as long as the research was continued (up to three months). Revascularisation of the cortical bone was slower and less profuse than in cancellous bone, keeping always the same respective proportion between the three types of bone we have described. The results on the kidney were much less constant, and I attribute this to the vascular peculiarities of the bed.

3. Vascular patterns peculiar to the time of implantation and type of graft are described.

4. Suggestive, even if not totally convincing, evidence was found of recanalisation of old vessels inside the graft by advancing vessels from the bed.

5. There is striking correlation between the rate of vascular penetration of the bone implants and their ultimate "take" or incorporation in the bed.
THE EFFECT OF BONE BANK PRESERVATION ON THE CALCIFYING MECHANISM
Authors: Lavine Leroy S. , Burger Martin , Sobel Albert E.
Published: February 2018

1. The influence of various methods of preserving bone on the calcifying mechanism of the tibial epiphysial cartilage of rachitic rats was studied. An in vitro calcification technique was employed.

2. Preservation by deep freezing, aqueous merthiolate, boiling, or acetone inactivated the calcifying mechanism.

3. The inactivation was reversed with calcium ions, most readily in the deep-frozen bones, less readily in the merthiolate treated bones, still less readily in the acetone stored bones, and least in boiled bones.

4. Exposure to calcium ions before preservation in the deep-freeze chest prevented inactivation.

5. The inactivation, reactivation and survival of the calcifying mechanism were confirmed by metachromasia studies.

6. The theory of the mode of action of calcium chloride on reactivation and survival of the calcifying mechanism is presented.
MUSCLE ACTION, BONE RAREFACTION AND BONE FORMATION
Authors: Geiser Max , Trueta Joseph
Published: February 2018

1. In five series of experiments in eighty-two rabbits we succeeded in causing rarefaction of the calcaneum of all the animals soon after it was relieved from muscular compressing forces; new bone was generated when the calcaneum was subjected again to the stresses and strains of muscle contraction.

2. We found evidence that during muscle action pressure forces are transmitted through the bone, and that the presence or absence of these pressure forces conditions the balance between bone formation and bone removal.

3. In the calcaneum of the rabbit lack of muscular action seems to be the most important factor inducing osteoporosis. It is possible that the origin of post-traumatic osteoporosis has the same basis.

4. In our experiments bone rarefaction was characterised by a great increase in the vascularity of the bone; this increase ceased when the bone reached its final precarious bone density. Thus, vascular over-activity accompanied the removal of bone; but bone reconstruction was also seen to be accompanied by a more localised increase in vascularity.

5. From our experiments we cannot suggest that the inhibition of muscle contraction accompanying Sudeck's syndrome is responsible for this disorder, because we were unable in our animals to cause any of the other signs characteristic of Sudeck's bone atrophy. But the constancy with which we caused bone atrophy by the removal of muscle action may possibly help to explain the mechanism of bone absorption accompanying Sudeck's disease.