A low-cost solution for the restoration of femoral head centre during total hip arthroplasty

Restoration of joint centre during total hip arthroplasty is critical. While computer-aided navigation can improve accuracy during total hip arthroplasty, its expense makes it inaccessible to the majority of surgeons. This article evaluates the use, in the laboratory, of a calliper with a simple computer application to measure changes in femoral head centres during total hip arthroplasty. The computer application was designed using Microsoft Excel and used calliper measurements taken pre- and post-femoral head resection to predict the change in head centre in terms of offset and vertical height between the femoral head and newly inserted prosthesis. Its accuracy was assessed using a coordinate measuring machine to compare changes in preoperative and post-operative head centre when simulating stem insertion on 10 sawbone femurs. A femoral stem with a modular neck was used, which meant nine possible head centre configurations were available for each femur, giving 90 results. The results show that using this technique during a simulated total hip arthroplasty, it was possible to restore femoral head centre to within 6?mm for offset (mean 1.67?±?1.16?mm) and vertical height (mean 2.14?±?1.51?mm). It is intended that this low-cost technique be extended to inform the surgeon of a best-fit solution in terms of neck length and neck type for a specific prosthesis.

Mafic Plinian volcanism and ignimbrite emplacement at Tofua volcano, Tonga

Tofua Island is the largest emergent mafic volcano within the Tofua arc, Tonga, southwest Pacific. The volcano is dominated by a distinctive caldera averaging 4 km in diameter, containing a freshwater lake in the south and east. The latest paroxysmal (VEI 5-6) explosive volcanism includes two phases of activity, each emplacing a high-grade ignimbrite. The products are basaltic andesites with between 52 wt.% and 57 wt.% SiO(2). The first and largest eruption caused the inward collapse of a stratovolcano and produced the 'Tofua' ignimbrite and a sub-circular caldera located slightly northwest of the island's centre. This ignimbrite was deposited in a radial fashion over the entire island, with associated Plinian fall deposits up to 0.5 m thick on islands > 40 km away. Common sub-rounded and frequently cauliform scoria bombs throughout the ignimbrite attest to a small degree of marginal magma-water interaction. The common intense welding of the coarse-grained eruptive products, however, suggests that the majority of the erupted magma was hot, water-undersaturated and supplied at high rates with moderately low fragmentation efficiency and low levels of interaction with external water. We propose that the development of a water-saturated dacite body at shallow (<6 km) depth resulted in failure of the chamber roof to cause sudden evacuation of material, producing a Plinian eruption column. Following a brief period of quiescence, largescale faulting in the southeast of the island produced a second explosive phase believed to result from recharge of a chemically distinct magma depleted in incompatible elements. This similar, but smaller eruption, emplaced the 'Hokula' Ignimbrite sheet in the northeast of the island. A maximum total volume of 8 km(3) of juvenile material was erupted by these events. The main eruption column is estimated to have reached a height of similar to 12 km, and to have produced a major atmospheric injection of gas, and tephra recorded in the widespread series of fall deposits found on coral islands 40-80 km to the east (in the direction of regional upper-tropospheric winds). Radiocarbon dating of charcoal below the Tofua ignimbrite and organic material below the related fall units imply this eruption sequence occurred post 1,000 years BP. We estimate an eruption magnitude of 2.24x10(13) kg, sulphur release of 12 Tg and tentatively assign this eruption to the AD 1030 volcanic sulphate spike recorded in Antarctic ice sheet records.

Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: A safe and effective technique in risk-reducing and therapeutic mastectomy

Introduction: Immediate reconstruction following mastectomy for breast cancer has been shown to be oncologically safe and associated with improved psychosocial outcomes for patients. Bostwick described a technique for one-stage implant based reconstruction, combining skin-sparing mastectomy with concurrent reduction of the skin envelope. This report reviews the experience of a single centre using skin-reducing mastectomy and one-stage implant reconstruction in both early stage breast cancer and risk-reducing mastectomy, with specific reference to frequency of complications, implant loss and oncological outcomes.

Methods and results: A retrospective review was undertaken to identify women who had undergone skin-reducing mastectomy and one-stage implant reconstruction using a de-epithelialised dermal flap, between October 2008 and October 2012. One hundred and four consecutive mastectomies, with reconstruction, were performed by two surgeons on 64 patients. No complications were seen in 43.8% of patients. At three months, four implants were lost (3.8% of breast reconstructions, 6.3% of patients), due to either peri-implant infection or mastectomy skin flap necrosis. One patient required unplanned return to theatre for evacuation of a haematoma. Minor mastectomy skin flap necrosis was seen in 10 breasts (9.6% of reconstructed breasts) and superficial wound infection in 8 breasts (7.7% of reconstructed breasts). All of these complications were managed conservatively and none required operative intervention. At a median follow up of 35 months (4-53 months) there had been one episode of ipsilateral axillary nodal recurrence.

Conclusion: One-stage implant reconstruction using a myo-dermal flap technique following skin-reducing mastectomy is safe and should be considered in selected patients. Most complications are minor and will resolve with conservative management. Major complications such as implant failure or immediate reoperation, were relatively uncommon (6.3% patients, 3.8% of reconstructed breasts). Early follow-up suggests that oncological outcomes are satisfactory, but longer follow-up is required to substantiate this. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Streets for people, or why we should reuse buildings in the city centre

Cities are constantly changing, and city centres are the pinnacle of that change. In the last hundred years these changes have been dramatic, transforming city centres from a complex combination of uses into exclusively retail and leisure areas. Meanwhile, most residents of city centres fled to the suburbs, removing much of the livelihood of central areas. These transformations has been stronger in Northern Europe and especially in English speaking countries, where zoning policies were instrumental in urban development since the 1960s. This process along with the rise of shopping malls left many city centre streets lifeless, which in turn caused the dereliction and demolition of significant heritage areas and buildings. Belfast is no exception, where the broad process of suburbanization and zoning since the 1970s produced a city centre for either retail or dereliction, where much built heritage has been lost or is at risk of being lost.

New technology and new workplaces: call centre careers – a growing reality?

Research to date suggests that career advancement in call centres (CCs) is relatively uncommon with employees often viewing such employment as a stopgap measure before moving on to something better. This study set out to determine whether such scenarios have changed over time since CCs have become more established in their work organisation, information and communication technology (ICT) and management processes. This study particularly focused on training and development initiatives, how employees access training and development, and whether CCs support career development. Using both qualitative and quantitative methods, these issues are examined within 10 Australian CCs of varying size from various sectors. Two-thirds of respondents stated that they intended to develop a career in the industry and 7 in 10 reported that they believed there were promotional opportunities emerging in their current organisation. Despite these findings, the evidence also suggests that more needs to be done both to create coherent career paths and to establish structured, accredited training programmes for CC employees.

Off-Centre Localisation Performance of Ambisonics and HOA For Large and Small Loudspeaker Array Radii

Ambisonics and Higher Order Ambisonics (HOA) are scalable spatial audio techniques that attempt to present a sound scene to listeners over as large an area as possible. A localisation experiment was carried out to investigate the performance of a first and third order system at three listening positions - one in the centre and two off-centre - using a 5 m radius loudspeaker array. The results are briefly presented and compared to those of an earlier experiment on a 2.2 m loudspeaker array. In both experiments the off-centre listeners were placed such that the ratio of distance from the centre to the array radius was constant in both experiments. The test used a reverse target-pointer adjustment method to determine the error, both signed and absolute, for each combination of listening position and system. The results for both arrays were found to be very similar, suggesting that the relative amplitude of the loudspeakers, which were the same in both cases, was more dominant for localisation than the arrival time differences, which differed between array sizes.