Management interventions for amputation stump neuromas : evidence based review and cost-benefit analysis

Amputation is a common military and civilian surgery with high morbidity. Patients without prostheses due to neuroma pain lose productivity and lifelong contributions, which is often underestimated. The surgical and non-surgical treatment of painful stump neuromas is controversial. An evidence-based assessment and cost-benefit analysis of painful stump neuroma management modalities emphasizes institutional awareness and disruptive technologies. An Oxford Centre for Evidence Based Methodology critical appraisal and structured literature review were used in the research. We found 154 records using a reproducible literature search strategy that included electronic databases and references. A full review of 27 manuscripts after exclusion criteria yielded data for analysis. Surgical, injectable, and electromagnetic spectrum methods were used. Surgical interventions had longer follow-up times than injection and radiofrequency treatments, which affected outcomes. CEBM level 4 evidence dominated primary literature, indicating low quality. No therapy was superior, but the risks varied. Injection therapies like sclerosing alcohol had limited success and side effects. Despite limited evidence, electromagnetic spectrum modalities showed potential. Including direct and indirect costs, amputation stump refitting costs millions annually. Compared to outpatient non-surgical interventions, laser therapy could save a lot of money. According to the study, surgical interventions are common but expensive and have limited functional success. Low-risk non-surgical methods like co-ablation, pulsed radiofrequency, and transcutaneous laser therapy have mixed results. The short follow-up of all non-surgical studies seems to limit them. Follow-up duration is crucial to outcome assessment. Long-term, low-risk laser-induced thermotherapy is promising for future research. This study emphasizes the need for more research and the economic benefits of disruptive technologies in treating painful stump neuromas.peer-reviewe

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Dynamic capabilities in a sixth generation family firm: entrepreneurship and the Bibby Line

In this paper we draw on the theory of dynamic capabilities to examine development of the only surviving family-owned Liverpool shipping company. The Bibby Line was founded in 1807 to take advantage of the growing sea-trade based in Liverpool. The company remained in shipping until the mid-1960s, when a series of external crises led the owner, Derek Bibby, to begin a process of diversification. In the last 50 years, the Bibby Line has grown into a £1bn business with interests in retail, distribution and financial services as well as a continuing commitment to shipping. Our intention is to demonstrate how multigenerational ownership contributes to the creation of dynamic capabilities in family firms. The distinctive nature of Bibby as a long-standing family business is related to unique assets such as patient capital, flexible governance structures as well as the ability to mobilise social and human capital

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least 4 m. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the 6.5 m James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 yr, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit