Analysis of the subcapital two-part humerus fracture by fluoroscopy: objective criteria for classification and decision making

Background Surgical decision making in the treatment of proximal humerus fractures (PHFx) is primarily based on fracture classification using standard radiographs. Due to the lack of objective criteria, this classification process is associated with high interobserver variation. In this study, we investigate the fluoroscopic analysis of humerus fractures through the surgical neck using a semi-quantitative determination of distinct angulation patterns of the proximal humerus as they appear in the image intensifier. Methods Using a saw bone model, defined subcapital 2-part fracture configurations were generated and assessed radiographically. Anatomical landmarks—including the greater and lesser tuberosity as well as anatomical neck—were identified using an image converter, and the exact degree of fracture displacement with 10° up to 70° (in 10° increments) of posterior, varus or combined posterior-varus angulation was compared to nondisplaced controls. From the resultant series of radiographs, the appearance of these angulations in anteroposterior (AP) and scapular Y-views were also visualized and defined. Results An angulation of 50° or more of any given 2-part fracture through the surgical neck is present when the greater tuberosity becomes the most proximal point in AP view (varus and combined posterior-varus angulation) or a bimodal form is found for the superior contour of the head with the lesser tuberosity being the most proximal point in the Y-view (posterior angulation). Conclusion The radiological appearance of various PHFx constellations can be well visualized using the saw bone shoulder model. The presence of angulation in accordance with the Neer classification for group III fractures can be adequately determined by analyzing the relative position of the greater or lesser tuberosity to the humeral head calotte. This can assist the surgeon’s decision on whether to operate or opt for a conservative approach. Level of evidence Basic Science, Anatomy Study, Imaging.

The effect of forearm rotation on radiographic measurements of the wrist: an experimental study using radiostereometric analyses on cadavers

Background Although dorsal/palmar tilt, radial inclination (RI), and ulnar variance (UV) are measurements commonly performed in wrist radiographs, the impact of forearm rotation on those measurements during the radiographic procedure is uncertain. Our aim was to determine the impact of supination and pronation on the reliability of measurements of tilt, RI, and UV. Methods Tantalum markers were inserted into the distal radius of 21 unfractured cadaver forearms. The forearms were radiographed in different degrees of supination and pronation. The exact degree of rotation was calculated with radiostereometric analyses. Tilt, RI, and UV were measured by two independent readers in a random and anonymised fashion. Association between forearm rotation and radiographic measurements was examined using linear regression. Results Forearm rotation significantly impacted the radiographically measured tilt. One degree of supination and pronation respectively increased and decreased palmar tilt with 0.68° and 0.44°, observers 1 and 2, respectively. As opposed to observer 1, observer 2 found that RI was significantly impacted by rotation with a slope of 0.08. Ulnar variance was not significantly impacted by rotation with linear regression slopes of 0.01° (95% confidence interval [CI] − 0.02–0.05, p = 0.490) and 0.02° (95% CI − 0.02–0.07; p = 0.288), observer 1 and observer 2, respectively. Conclusion In unfractured forearms, the radiographically measured tilt was significantly affected by rotation. Palmar tilt increased with supination and decreased with pronation. Rotation significantly affected radial inclination, although of a magnitude that is probably not clinically relevant. No significant impact on UV was found.

P3s and Social Infrastructure: Three Decades of Prison Reform in Victoria, Australia

Once regarded as core public sector business, Australia’s prisons were reformed during the 1990s and Australia now has the highest proportion of prisoners in privately managed prisons in the world. How could this have happened? This article presents a case study of the State of Victoria and explains how public–private partnerships (P3s) were used to create a mixed public–private prison system. Despite the difficulty of determining clear and rigorous evaluation results, we argue that lessons from the Victorian experience are possible. First, neither the extreme fears of policy critics nor the grandiose policy and technical promises of reformers were fully met. Second, short-term success was achieved in political and policy terms by the delivery of badly needed new prisons. Third, the exact degree to which the state has achieved cheaper, better, and more accountable prison services remains contested. As a consequence, there is a need to continue experimentation but with greater transparency.

Atrial Fibrillation – An Orchestra of Classic and Modern Risk Factors

Over the past years, prevention and control of risk factors has begun to play an important role in the management of patients prone to develop atrial fibrillation (AF). A considerable number of risk factors that contribute to the creation of a predisposing substrate for AF has been identified over the years. Although certain AF risk factors such as age, gender, genetic predisposition, or race are unmodifiable, controlling modifiable risk factors may represent an invaluable tool in the management of AF patients. In the recent decades, numerous studies have evaluated the mechanisms linking different risk factors to AF, but the exact degree of atrial remodeling induced by each factor remains unknown. Elucidating these mechanisms is essential for initiating personalized therapies in patients prone to develop AF. The present review aims to provide an overview of the most relevant modifiable risk factors involved in AF occurrence, with a focus on the mechanisms by which these factors lead to AF initiation and perpetuation.

Parameter Reductions of Bipolar Fuzzy Soft Sets with Their Decision-Making Algorithms

Parameter reduction is a very important technique in many fields, including pattern recognition. Many reduction techniques have been reported for fuzzy soft sets to solve decision-making problems. However, there is almost no attention to the parameter reduction of bipolar fuzzy soft sets, which take advantage of the fact that membership and non-membership degrees play a symmetric role. This methodology is of great importance in many decision-making situations. In this paper, we provide a novel theoretical approach to solve decision-making problems based on bipolar fuzzy soft sets and study four types of parameter reductions of such sets. Parameter reduction algorithms are developed and illustrated through examples. The experimental results prove that our proposed parameter reduction techniques delete the irrelevant parameters while keeping definite decision-making choices unchanged. Moreover, the reduction algorithms are compared regarding the degree of ease of computing reduction, applicability, exact degree of reduction, applied situation, and multi-use of parameter reduction. Finally, a real application is developed to describe the validity of our proposed reduction algorithms.

A Modified Winding Function Theory and Firefly Algorithm based Optimization for Diagnosis of Eccentricity in Induction Motors

In past, several analytical models has been developed to establish the occurrence of various induction motor faults. Some of the primarily occurring faults in induction motor being; bearing and stator winding faults and to a smaller extent the other types such as rotor and eccentricity. Though there has been a lot of research work done in detection and diagnosis, still the recognition of eccentricity fault in induction motors, specifically deciding the precise degree of eccentricity is a challenging task for the researchers. In this paper, a novel model-based approach has been developed for the detection of exact type and degree of eccentricity fault present in the motor. Simulation of induction motor for both healthy and eccentricity fault has been carried out using the Modified Winding Function (MWF) approach. A procedure has been developed for estimating the eccentricity fault from simulation model. Also, a metaheuristic nature inspired algorithm, viz. Firefly Algorithm (FA) has been used for the optimization of results obtained from simulation model. The results obtained from experimental investigations are close to that obtained from simulations, confirming the applicability of used model and simulation approach to find the exact degree of eccentricity defect.

Super-resolution displacement mapping of unbound single molecules reveals nanoscale heterogeneities in intracellular diffusivity

Intracellular diffusion underlies vital processes of the cell. However, it remains difficult to elucidate how an average-sized protein diffuses in the cell with good spatial resolution and sensitivity. Here we report single-molecule displacement/diffusivity mapping (SMdM), a super-resolution strategy that enables the nanoscale mapping of intracellular diffusivity through the local statistics of instantaneous displacements of freely diffusing single molecules. We thus show that diffusion in the cytoplasm and in the nucleus to both be spatially heterogeneous at the nanoscale, and such variations in local diffusivity correlate strongly with the ultrastructure of the actin cytoskeleton and the chromosome, respectively. Moreover, we identify the net charge of the diffuser as a key determinant of diffusion rate: intriguingly, the possession of positive, but not negative, net charges significantly impedes diffusion, and the exact degree of slowdown is determined by the specific subcellular environments.

A new rhynchocephalian (Reptilia: Lepidosauria) from the Late Jurassic of Solnhofen (Germany) and the origin of the marine Pleurosauridae

A new rhynchocephalian is described based on a recently discovered and well-preserved specimen from the Late Jurassic (Kimmeridgian) marine limestones of Solnhofen, Bavaria. Phylogenetic analysis recovers the new taxon as the sister group to Pleurosauridae, a small radiation of rhynchocephalians representing the oldest marine invasion of crown-clade Lepidosauria. The relatively strong evidence for this taxonomically exclusive lineage, within a generally volatile rhynchocephalian tree, places the new taxon in a position to inform the early history of the pleurosaur transition to the sea. The early steps in this transition are distributed throughout the skeleton and appear to increase hydrodynamic efficiency for both swimming and aquatic feeding. This early history may also have included a global truncation of plesiomorphic ontogenetic trajectories that left a number of skeletal features with reduced levels of ossification/fusion. The exact degree to which Vadasaurus had adopted an aquatic ecology remains unclear, but the insight it provides into the origin of the enigmatic pleurosaurs exemplifies the potential of Rhynchocephalia for generating and informing broad-based questions regarding the interplay of development, morphology, ecology and macroevolutionary patterns.

Concept of Combined Femoral and Tibial Osteotomies

Medial knee osteoarthritis is not uncommon, and high tibial osteotomy (HTO) for some surgeons is a unique treatment option for young and active patients. However, the deformity is not always located at the level of proximal part of the tibia and the overcorrection needed to achieve a lasting functional result can lead to an oblique joint line. To avoid this undesirable effect to the joint line, a double-level osteotomy (DLO), one at the distal part of the femur and another one at the proximal part of the tibia, is a viable option. The aim of this article is to present the preoperative radiological assessment, the operative procedure, the indications of HTO, distal femoral osteotomy (DFO), and DLO presenting the rationale behind the treatment options. Long-leg radiographs are mandatory to measure the hip–knee–ankle angle, and the femoral and tibial mechanical axes to plan the location of the osteotomy. The best indication for DLO is a severe varus knee deformity with femoral and tibial mechanical axes in varus. This argument can be applied to a genu valgum deformity, especially when the femur is in valgus as well as the tibia, which is not rare. Although the operative technique is demanding, the biggest challenge is not the procedure itself but rather how to reach the exact degree of overcorrection. Computer-assisted surgery is a good alternative and can improve the accuracy of the surgery.

Elementary exact calculations of degree growth and entropy for discrete equations

Second-order discrete equations are studied over the field of rational functions C ( z ) , where z is a variable not appearing in the equation. The exact degree of each iterate as a function of z can be calculated easily using the standard calculations that arise in singularity confinement analysis, even when the singularities are not confined. This produces elementary yet rigorous entropy calculations.