The accuracy of intramedullary femoral alignment in total knee replacement in the prescence of ipsilateral hip replacement

Objectives: During total knee replacement (TKR) surgery, the most commonly used method for aligning the distal femur appropriately is via an intramedullary (IM) distal femoral alignment rod. The alignment of the rod itself is reliant on the isthmus which is used to most accurately place the rod in the correct anatomical axis. In the instance of something preventing the rod from entering the isthmus correctly, such as a hip replacement, then the degree of accuracy could be assumed to be even less. Mechanical-anatomical malalignment has been shown to decrease the implant (TKR) survival and so methods of increasing accuracy of alignment relative to the mechanical axis have been developed. At present the most accurate method intraoperatively is computer navigation and several studies have demonstrated improved alignment. An increasing number of patients year on year are having both knee and hip replacements and as the population ages the likelihood of having both a knee and hip replacement will also increase. We propose that the presence of a hip replacement within the isthmus of the femur may further decrease the accuracy of the IM alignment of the femur leading to incorrect implant positioning. Methods: The study was conducted on 10 cadaveric specimens (20 femurs). Computational navigation instrumentation was attached in turn to each femur and the ideal alignment data recorded in a standard fashion by a single operator (principal investigator). A standard entry port was then be made in the femur for the introduction of the IM rod. An IM rod was then inserted with the distal femoral cutting block in the accepted position recorded blindly on the computer navigation (both in terms of varus/valgus alignment to the mechanical axis and the degree of flexion). The process was then repeated at 3 levels to represent primary and revision hip lengths from the greater trochanter (replicating the changes that would occur in the presence of a hip replacement) The process was recorded three times at each level. Results: The resection angles between the cutting surface and the mechanical axis were measured and collected by means of computer navigation system. The results show that the IM alignment had mean Valgus of 0 degrees +/- 0.8 but with a hip replacement in situ this increased to 0.46 degrees +/- 1.49 (range 2.5 varus to 4.5 valgus), with a revision stem 0.825 +/- 1.68 (range 2.5 varus to 4.5 valgus)and long stemmed revision 1.325 +/- 2.09 (range 5 varus to 6.5 valgus). In terms of Flexion IM alignment had a mean flexion of 0.92 +/- 1.7 (range 3 extension to 4 flexion) but with a hip replacement in situ this increased to 1.88 degrees +/- 2.03 (range 2.5 extension to 8.5 flexion), with a revision stem 2.35 +/- 2.2 (range 2.5 extension to 8 flexion) and long stemmed revision 2.75 +/- 2.16(range 3.5 extension to 7 flexion). Conclusion: This Study concludes that the prescence of a hip replacement, in particular long stemmed prosthesis, further reduces the accuracy of IM alignment in the Femur for Total Knee Replacement. Consideration of an alternative method, such as navigation, should be considered insuch situations

Novel Antibacterial Compounds and Methods of Making and Using Same

The invention provides novel antibacterial diamide compounds, pharmaceutical compositions comprising the compounds and methods for treating or preventing an infection in a subject using the compounds

Senior Recital: Christopher Malloy, saxophone

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Performance. Mr. Malloy studies saxophone with Sam Skelton.https://digitalcommons.kennesaw.edu/musicprograms/1523/thumbnail.jp

The effectiveness and variation of acute medical units: a systematic review

Purpose: To evaluate the evidence for the effectiveness of acute medical units (AMUs) compared with other models of care and compare the components of AMU models. Data sources: Six electronic databases and grey literature sources searched between 1990 and 2014. Study selection: Studies reporting on AMUs as an intervention for unplanned medical presentations to hospital with the inclusion of all outcome measures/study designs/comparators. Data extraction: Data on study characteristics/outcomes/AMU components were extracted by one author and confirmed by a second. Data synthesis: Seventeen studies of 12 AMUs across five countries were included. The AMU model was associated with a reduction in-hospital length of stay (LOS) in all analyses ranging from 0.3 to 2.6 days; and a reduction in mortality in 12 of the 14 analyses with the change ranging from a 0.1% increase to a 8.8% reduction. Evidence relating to readmissions and patient/staff satisfaction was less conclusive. There was variation in the following components of AMUs: admission criteria, entry sources, functions and consultant work patterns. Conclusion: This review provides evidence that AMUs are associated with reductions in-hospital LOS and, less convincingly, mortality compared with other models of care when implemented in European and Australasian settings. Reported estimates may be affected by residual confounding. This review reports heterogeneity in components of the AMU model. Further work to identify what constitutes the key components of an AMU is needed to improve the quality and effectiveness of acute medical care. This is of particular importance given the escalating demand on acute services

The Effects on Milk Yield and Composition, and Animal Nitrogen and Phosphorus Status, of Offering Early-Lactation Dairy Cows Concentrate Feeds of Differing Crude Protein and Phosphorus Concentrations

Milk composition is affected by the dietary concentration of crude protein (CP) (Kung Jr and Huber 1983) and minerals such as phosphorus (P) (Wu and Satter 2000). Milk composition has consequent effects on the processing properties of milk (Dillon et al. 1997). The objective of this study was to determine the effects of offering supplementary concentrate feeds differing in CP and P concentration to lactating dairy cows in the early lactation period (Feb-May) on milk yield and composition, and on animal nitrogen (N) and P status

The acute medical unit model::a characterisation based upon the National Health Service in Scotland

<div><p>Background</p><p>Acute medical units (AMUs) receive the majority of acute medical patients presenting to hospital as an emergency in the United Kingdom (UK) and in other international settings. They have emerged as a result of local service innovation in the context of a limited evidence base. As such, the AMU model is not well characterised in terms of its boundaries, patient populations and components of care. This makes service optimisation and development through strategic resource planning, quality improvement and research challenging.</p><p>Aim</p><p>This study aims to evaluate a national set of AMUs with the intent of characterising the AMU model.</p><p>Methods</p><p>Twenty-nine AMUs in Scotland were identified. Data were collected by semi-structured interviews with multidisciplinary healthcare professionals working in each AMU. A draft report was produced for each unit and verified by a unit representative. The unit reports were then analysed to develop a conceptual framework of key components of AMUs and a service definition of the boundaries of acute medical care.</p><p>Results</p><p>Acute medical care in Scotland can be described as being delivered in “acute medical services” rather than geographically distinct AMUs. Twelve key components of AMU care were identified: care areas, functions, populations, patient flow, support services, communication, nurse care, allied healthcare professional care, non-consultant medical care, consultant care, patient assessment and specialty care.</p><p>Discussion</p><p>This empirically derived characterisation of the AMU model is likely to be of utility to practitioners, managers, policy makers and researchers: it is relevant on an operational level, will aid quality improvement and is a foundation to needed further research into how best to deliver care in AMUs. This is important given the central role AMUs play in the journey of the majority of patients presenting to hospital acutely in Scotland, the UK and internationally.</p></div

SpeX Spectroscopy of Unresolved Very Low-Mass Binaries. I. Identification of Seventeen Candidate Binaries Straddling the L Dwarf/T Dwarf Transition

We report the identification of 17 candidate brown dwarf binaries whose components straddle the L dwarf/T dwarf transition. These sources were culled from a large near-infrared spectral sample of L and T dwarfs observed with the Infrared Telescope Facility SpeX spectrograph. Candidates were selected on the basis of spectral ratios which segregate known (resolved) L dwarf/T dwarf pairs from presumably single sources. Composite templates, constructed by combining 13581 pairs of absolute flux-calibrated spectra, are shown to provide statistically superior fits to the spectra of our seventeen candidates as compared to single templates. Ten of these candidates appear to have secondary components that are significantly brighter than their primaries over the 1.0-1.3 micron band, indicative of rapid condensate depletion at the L dwarf/T dwarf transition. Our results support prior indications of enhanced multiplicity amongst early-type T dwarfs; 53+/-7% of the T0-T4 dwarfs in our spectral sample are found to be either resolved or unresolved (candidate) pairs, although this is consistent with an intrinsic (volume complete) brown dwarf binary fraction of only 15%. If verified, this sample of spectral binaries more than doubles the number of known L dwarf/T dwarf transition pairs, enabling a broader exploration of this poorly-understood phase of brown dwarf atmospheric evolution.Comment: 65 pages (11pt manuscript format), 68 figures, accepted for publication to ApJ; spectral data can be accessed at http://www.browndwarfs.org/spexpris

The Brown Dwarf Kinematics Project (BDKP) I. Proper Motions and Tangential Velocities for a Large Sample of Late-type M, L and T Dwarfs

We report proper motion measurements for 427 late-type M, L and T dwarfs, 332 of which have been measured for the first time. Combining these new proper motions with previously published measurements yields a sample of 841 M7-T8 dwarfs. We combined parallax measurements or calculated spectrophotometric distances and computed tangential velocities for the entire sample. We find that kinematics for the full and volume-limited 20 pc samples are consistent with those expected for the Galactic thin disk, with no significant differences between late-type M, L, and T dwarfs. Applying an age-velocity relation we conclude that the average kinematic age of the 20 pc sample of ultracool dwarfs is older than recent kinematic estimates and more consistent with age results calculated with population synthesis models. There is a statistically distinct population of high tangential velocity sources whose kinematics suggest an even older population of ultracool dwarfs belonging to either the Galactic thick disk or halo. We isolate subsets of the entire sample, including low surface-gravity dwarfs, unusually blue L dwarfs, and photometric outliers in J-Ks color and investigate their kinematics. We find that the spectroscopically distinct class of unusually blue L dwarfs has kinematics clearly consistent with old age, implying that high surface-gravity and/or low metallicity may be relevant to their spectral properties. The low surface-gravity dwarfs are kinematically younger than the overall population, and the kinematics of the red and blue ultracool dwarfs suggest ages that are younger and older than the full sample, respectively. We also present a reduced proper motion diagram at 2MASS Ks for the entire population and find that a limit of H_Ks > 18 excludes M dwarfs from the L and T dwarf population regardless of near-infrared color.Comment: Accepted for publication in the Astronomical Journal, 21 pages text, 12 tables, 12 figure