Comparing traditional lapidus to new triplane methods for correction of hallux valgus

Hallux valgus deformity, also known as a bunion, involves lateral deviation of the hallux, medial deviation of the first metatarsal, and subluxation of the first metatarsophalangeal joint. The deformity is progressive and is treated surgically when conservative management fails.The prevalence of hallux valgus is estimated to be 23 percent among US adults aged 18 to 65 years old.The Lapidus procedure corrects hallux valgus deformity through fusion of the first tarsometatarsal joint.Current studies estimate that Lapidus arthrodesis has a 10 percent nonunion rate along with a low recurrence rate.Patient satisfaction with the Lapidus procedure has been measured between 78 to 84 percent. Recent developments in the correction of hallux valgus have centered on triplane correction (TPC) utilizing proprietary systems.These systems are effective at obtaining and maintaining correction. However, they are expensive and there is a paucity of unbiased literature comparing it to traditional methods

Vector Delivery Technique Affects Gene Transfer in the Cornea \u3cem\u3ein vivo\u3c/em\u3e

Purpose: This study tested whether controlled drying of the cornea increases vector absorption in mouse and rabbit corneas in vivo and human cornea ex vivo, and studied the effects of corneal drying on gene transfer, structure and inflammatory reaction in the mouse cornea in vivo. Methods: Female C57 black mice and New Zealand White rabbits were used for in vivo studies. Donor human corneas were used for ex vivo experiments. A hair dryer was used for drying the corneas after removing corneal epithelium by gentle scraping. The corneas received no, once, twice, thrice, or five times warm air for 10 s with a 5 s interval after each 10 s hair dryer application. Thereafter, balanced salt solution (BSS) was topically applied immediately on the cornea for 2 min using a custom-cloning cylinder. The absorbed BSS was quantified using Hamilton microsyringes. The adenoassociated virus 8 (AAV8) vector (1.1×108 genomic copies/μl) expressing marker gene was used to study the effect of corneal drying on gene transfer. Animals were sacrificed on day 14 and gene expression was analyzed using commercial staining kit. Morphological changes and infiltration of inflammatory cells were examined with H & E staining and immunocytochemistry. Results: Mice, rabbit or human corneas subjected to no or 10 s drying showed 6%–8% BSS absorption whereas 20, 30, or 50 s corneal drying showed significantly high 14%–19% (pin vivowith mild-to-moderate changes in corneal morphology. The 30 s of drying also showed significantly (pin vivowithout jeopardizing corneal morphology whereas 10 or 20 s drying showed moderate degree of gene transfer with no altered corneal morphology. Corneas that underwent 50 s drying showed high CD11b-positive cells (p Conclusions: Controlled corneal drying with hair dryer increases vector absorption significantly. The dispensing of efficacious AAV serotype into cornea with optimized minimally invasive topical application technique could provide high and targeted expression of therapeutic genes in the stroma in vivo without causing significant side effects

Climatology of Inverted Troughs Over the Gulf of Maine

Inverted troughs (ITs) over the Gulf of Maine are cool season phenomena that are responsible for unexpected high-intensity snowfall over coastal New England. An IT is a north and westward extension of relatively low atmospheric pressure that contains an easterly component of wind and cyclonic relative vorticity. These ITs have the ability to focus moisture into a low-tropospheric convergence zone, lift the air parcel into an unstable atmosphere, and produce high-intensity banded precipitation over a given region. This study creates an inceptive 25-year cool season (September–May) climatology of ITs over the Gulf of Maine from 1989 to 2013. The dynamical characteristics of the high intensity IT-influenced precipitation events are investigated via composite analyses that compare National Weather Service headlined and non-headlined ITs over the Gulf of Maine. This thesis will describe and present the roles of both quasi-geostrophic processes and mesoscale characteristics that influence IT genesis and evolution via composite cross section analyses and a case study. Results suggest that (1) north and westward extensions of quasi-geostrophic forcing for upward vertical motion removed from the sea-level pressure minimum of a parent-low pressure system can result in the genesis of ITs, (2) IT axes contain similar characteristics to frontal boundaries, and (3) the moist air along and upstream of the IT axes has potential to become unstable and produce quasi-stationary convective precipitation bands over a given region. The strong latent and sensible heat fluxes over the Gulf of Maine and cooling temperatures aloft (approaching upper-tropospheric trough) result a conditionally/symmetrically unstable environment that, given low-tropospheric forcing (frontogenesis) and middle-tropospheric forcing for upward-vertical motion, lead to a banded convective response. Operational forecasting techniques based upon the results of this study are presented in order to improve the forecasts of IT-influenced precipitation

Climatology of Inverted Troughs Over the Gulf of Maine

Inverted troughs (ITs) over the Gulf of Maine are cool season phenomena that are responsible for unexpected high-intensity snowfall over coastal New England. An IT is a north and westward extension of relatively low atmospheric pressure that contains an easterly component of wind and cyclonic relative vorticity. These ITs have the ability to focus moisture into a low-tropospheric convergence zone, lift the air parcel into an unstable atmosphere, and produce high-intensity banded precipitation over a given region. This study creates an inceptive 25-year cool season (September–May) climatology of ITs over the Gulf of Maine from 1989 to 2013. The dynamical characteristics of the high intensity IT-influenced precipitation events are investigated via composite analyses that compare National Weather Service headlined and non-headlined ITs over the Gulf of Maine. This thesis will describe and present the roles of both quasi-geostrophic processes and mesoscale characteristics that influence IT genesis and evolution via composite cross section analyses and a case study. Results suggest that (1) north and westward extensions of quasi-geostrophic forcing for upward vertical motion removed from the sea-level pressure minimum of a parent-low pressure system can result in the genesis of ITs, (2) IT axes contain similar characteristics to frontal boundaries, and (3) the moist air along and upstream of the IT axes has potential to become unstable and produce quasi-stationary convective precipitation bands over a given region. The strong latent and sensible heat fluxes over the Gulf of Maine and cooling temperatures aloft (approaching upper-tropospheric trough) result a conditionally/symmetrically unstable environment that, given low-tropospheric forcing (frontogenesis) and middle-tropospheric forcing for upward-vertical motion, lead to a banded convective response. Operational forecasting techniques based upon the results of this study are presented in order to improve the forecasts of IT-influenced precipitation

A Framework for Non-Pipeline Alternatives Analysis and Review of Existing Approaches

States are increasingly interested in gas distribution system planning and the role that demand-side resources can play in maintaining an affordable, reliable, equitable, and low-carbon energy system. In particular, public utility commissions and utilities are exploring the role of non-pipeline alternatives (NPA) – an investment or activity that defers, reduces, or avoids the need to construct or replace a pipeline – in gas distribution system planning. NPAs are an emerging cost and risk mitigation tool that can provide gas utilities with an opportunity to reduce emissions, gas system costs, and customer risk by avoiding unnecessary infrastructure spending. Rather than address system issues with more costly and long-lived traditional capital projects, utilities can leverage demand-side NPA resources such as energy efficiency and electrification as well as supply-side NPA resources to meet system needs. However, there is limited guidance on performing an NPA and even fewer lessons learned. To fill this gap, the U.S. Department of Energy funded two reports on NPAs. The first report is a literature review that focuses on four states' NPA policies. The second report offers a framework for evaluating NPAs that states can adapt to meet their policy needs