Intraoperative imaging in hallux valgus surgery

Background: This prospective study investigates the use of intraoperative fluoroscopy in 28 consecutive cases undergoing hallux valgus surgery. To our knowledge there have been no studies validating the use of intraoperative fluoroscopy in hallux valgus surgery. Methods: We performed a prospective investigation of 28 consecutive cases undergoing hallux valgus surgery. Fluoroscopic images were examined intraoperatively and any significant unforseen findings documented. A comparison was made between the fluoroscopic images and weight bearing films taken 6 weeks postoperatively to examine whether the intraoperative images are an accurate representation of the standard films obtained post-operatively. We excluded those patients that went on to have an Akin osteotomy. Results: There were no unforeseen intraoperative events that were revealed by the use of fluoroscopy and no surgical modifications were made as a result of the intraoperative images. The intraoperative films were found to be a reliable representation of the postoperative weight bearing films but a small increase in the hallux valgus angle was noted at six weeks and this is thought to be due to stretching of the medial soft tissue repair. Conclusions: Intraoperative fluoroscopy is a reliable technique. This study was performed at a centre which performs approximately 100 hallux valgus operations per year and that should be taken into consideration when reviewing our findings. We conclude that there may be a role for fluoroscopy for surgeons in the early stages of the surgical learning curve and for those that infrequently perform hallux valgus surgery. We cannot however recommend that fluoroscopy be used routinely in hallux valgus surgery.

Post-operative CT assessment of interbody fusion two years after thoracoscopic scoliosis surgery

The relationship between radiologic union and clinical outcome in thoracoscopic scoliosis surgery is not clear, as apparent non-union of a spinal fusion does not always correspond to a poor clinical result. The aim of this study was to evaluate CT fusion rates 2yrs after thoracoscopic surgery, and to explore the relationship between fusion scores and rod diameter, graft type, fusion level, implant failure, and lateral position in the disc space. This study suggests that moderate fusion scores secure successful clinical outcomes in thoracoscopic scoliosis surgery.

Internet-enabled international entrepreneurship : a conceptual exploration of the link between a firm’s resource base, dynamic capabilities and international market performance

It has been suggested that the accumulation of valuable resources and capabilities, such as Internet application, is not enough to support a firm’s sustainable competitive advantage, especially for high technology-mediated firms; which often operate in fast changing dynamic environments. While the idea of ‘Internet-enabled resources and capabilities’ has been recognised by RBV theorists, the notion has largely been ignored in conceptual and empirical studies. Given this finding, a conceptual framework is constructed and research issues are then developed in order to focus attention on the relationship between, the Internet and a firm’s resource base, dynamic capabilities and international market performance. We postulate that successful Internet-enabled market performance arises from those international entrepreneurial-oriented firms which encompass: international vision, international business experience, Internet-international marketing capabilities and international networking capabilities. Recommendations for future theory development are presented, along with the implications for international entrepreneurial managers in Australian small and medium sized firms

Tax concessions for charities : competitive neutrality, the tax base and "public goods" choice

It is argued that concerns arise about the integrity and fairness of the taxation regime where charitable organizations, which avail themselves of the tax exemption status while undertaking commercial activities, compete directly with the for-profit sector. The appropriateness of the tax concessions granted to charitable organizations is considered in respect of income derived from commercial activities. It is principally argued that the traditional line of reasoning for imposing limitations on tax concessions focuses on an incorrect underlying inquiry. Traditionally, it is argued that limitations should be imposed because of unfair competition, lack of competitive neutrality, or an arbitrary decision relating to a lack of deserving. However, it is argued that a more appropriate question from which to base any limitations is one which considers the value attached to the integrity of the taxation regime as a whole, and the tax base specifically compared to the public good of charities. When the correct underlying question is asked, sound taxation policy ensues, as a less arbitrary approach may be adopted to limit the scope of tax concessions available to charitable organizations.

Multisensory integration weightings underlying haptic feedback laparoscopic surgery

"This letter aims to highlight the multisensory integration weighting mechanisms that may account for the results in studies investigating haptic feedback in laparoscopic surgery. The current lack of multisensory theoretical knowledge in laparoscopy is evident, and “a much better understanding of how multimodal displays in virtual environments influence human performance is required” ...publisher website

Is flapless implant surgery a viable option in posterior maxilla? : a review

This article reviews the literature on the outcome of flapless surgery for dental implants in the posterior maxilla. The literature search was carried out in using the keywords: flapless, dental implants and maxilla. A hand search and Medline search were carried out on studies published between 1971 and 2011. The authors included research involving a minimum of 15 dental implants with a followup period of 1 year, an outcome measurement of implant survival, but excluded studies involving multiple simultaneous interventions, and studies with missing data. The Cochrane approach for cohort studies and Oxford Centre for Evidence- Based Medicine were applied. Of the 56 published papers selected, 14 papers on the flapless technique showed high overall implant survival rates. The prospective studies yielded 97.01% (95% CI: 90.72–99.0) while retrospective studies or case series illustrated 95.08% (95% CI: 91.0–97.93) survival. The average of intraoperative complications was 6.55% using the flapless procedure. The limited data obtained showed that flapless surgery in posterior maxilla areas could be a viable and predictable treatment method for implant placement. Flapless surgery tends to be more applicable in this area of the mouth. Further long-term clinical controlled studies are needed.

Challenges in the construction of a lunar base

The construction of a Lunar Base is seen as achievable. The paper provides a useful summary of challenges facing pioneers of lunar base construction. It highlights important aspects of the location and use of the facility, the local environment, the human physiological adaptation process, and a principal concern for the construction industry—construction materials and methods required to erect the facility. Specific emphasis is placed on the latter two major issues. The authors believe that a lunar base will be built, operated and maintained by humans. It may be the next generation that carry out these dreams, but it is research of the type reported in this paper that will make these dreams a reality.

Design of a knowledge base to teach programming

Programming is a subject that many beginning students find difficult. This paper describes a knowledge base designed for the purpose of analyzing programs written in the PHP web development language. The aim is to use this knowledge base in an Intelligent Tutoring System that will provide effective feedback to students. The main focus of this research is that a programming exercise can have many correct solutions. This paper presents an overview of how the proposed knowledge base can be utilized to accept different solutions to a given exercise

Designing the knowledge base for a PHP tutor

Programming is a subject that many beginning students students find difficult. This paper descibes a knowledge base designed for the purpose of analyzing programs written in the PHP web development language. The aim is to use this knowledge base in an Intelligent Tutoring System. The main emphasis is on accepting alternative solutions to a given problem.

Towards determining soft tissue properties for modelling spine surgery : current progress and challenges

Current complication rates for adolescent scoliosis surgery necessitate the development of better surgical planning tools to improve outcomes. Here we present our approach to developing finite element models of the thoracolumbar spine for deformity surgery simulation, with patient-specific model anatomy based on low-dose pre-operative computed tomography scans. In a first step towards defining patient-specific tissue properties, an initial 'benchmark' set of properties were used to simulate a clinically performed pre-operative spinal flexibility assessment, the fulcrum bending radiograph. Clinical data for ten patients were compared with the simulated results for this assessment and in cases where these data differed by more than 10%, soft tissue properties for the costo-vertebral joint (CVJt) were altered to achieve better agreement. Results from these analyses showed that changing the CVJt stiffness resulted in acceptable agreement between clinical and simulated flexibility in two of the six cases. In light of these results and those of our previous studies in this area, it is suggested that spinal flexibility in the fulcrum bending test is not governed by any single soft tissue structure acting in isolation. More detailed biomechanical characterisation of the fulcrum bending test is required to provide better data for determination of patient-specific soft tissue properties.

Galah's Skull

Poem

Indications for early hip revision surgery in the UK : A re-analysis of NJR data

This study determined the rate and indication for revision between cemented, uncemented, hybrid and resurfacing groups from NJR (6 th edition) data. Data validity was determined by interrogating for episodes of misclassification. We identified 6,034 (2.7%) misclassified episodes, containing 97 (4.3%) revisions. Kaplan-Meier revision rates at 3 years were 0.9% cemented, 1.9% for uncemented, 1.2% for hybrids and 3.0% for resurfacings (significant difference across all groups, p<0.001, with identical pattern in patients <55 years). Regression analysis indicated both prosthesis group and age significantly influenced failure (p<0.001). Revision for pain, aseptic loosening, and malalignment were highest in uncemented and resurfacing arthroplasty. Revision for dislocation was highest in uncemented hips (significant difference between groups, p<0.001). Feedback to the NJR on data misclassification has been made for future analysis. © 2012 Wichtig Editore.

A computer model to simulate scoliosis surgery

Use of patient-specific computer models as a pre-operative planning tool permits predictions of the likely deformity correction and allows a more detailed investigation of the biomechanical influence of different surgical procedures on the scoliotic spinal anatomy. In this paper, patient-specific computer models are used of adolescent idiopathic scoliosis patients who underwent a single rod anterior procedure at the Mater Children’s Hospital in Brisbane, to predict deformity correction and to investigate the change in biomechanics of the scoliotic spine due to surgical compressive forces applied during implant placement.