Surgical technique: Tscherne-Johnson extensile approach for tibial plateau fractures.

BackgroundThe standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy's tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy's tubercle.Description of techniqueThe approach entails a partial tenotomy of the anterior half of the IT band leaving the posterior IT band insertion attached to Gerdy's tubercle. Fracture lines around Gerdy's tubercle are completed or the tubercle was osteotomized and externally rotated and the joint overdistracted, allowing direct visualization of the joint depression. Joint elevation, grafting, and internal fixation are performed through this window.MethodsWe retrospectively reviewed 76 patients (two groups), Schatzker Types I to II and IV to VI fractures (66 patients), between 1989 and 2005, and 10 patients, with 10 bicondylar posterior plateau fractures, from 2002 to 2010. All patients were followed a minimum of 12 months (average, 3.9 years; range, 12 months to 10 years). Ten patients, with posterior plateau fractures, received anterolateral plateau intraarticular osteotomy for exposure of centroposterior and posterolateral articular depression.ResultsAverage knee ROM was 2° of flexion (range, -3° to 5°) to greater than 120° of flexion (range, 100°-145°). In 66 patients, average articular depression improved from 7.4 mm to 1 mm (range, 0-5 mm) and, in 10 posterior fractures, from 18 mm to 1 mm (range, 0-4.5 mm). Infection occurred in one of the 76 patients; acute débridement and intravenous antibiotics resulted in control of the infection.ConclusionsThis approach reliably increases direct visualization of the lateral plateau articular fractures and maintains IT band insertion. Articular osteotomy of the anterolateral plateau provides access to extensive posterior plateau fractures

Uncertain Risk, Science Experiments, and the Courts

Legal scholarship has looked at problems of uncertainty- unknown unknowns -in a variety of contexts, from financial regulation to national security. This Article, however, focuses on uncertain risk in what may be its most challenging arena: experimental scientific research. Notably, this context imposes a key conceptual hurdle. In other arenas, law and regulation can work to lessen uncertainty. But with science-experiment risk, uncertainty cannot be sidestepped, since going beyond the current state of human knowledge is the whole point of experimental research. Moreover, scienceexperiment risk involves the highest possible stakes, since future experiments could plausibly lead to global catastrophe, even human extinction. As a case study, this Article explores an extreme science-gone-wrong scenario: a part icle-collider-spawned black hole that grows to devour our planet. No credible source considers such a disaster likely, but scientific uncertainty has made the possibility of such a mishap frustratingly difficult to exclude. Thus, the black hole case provides a sharp example of how the classical mode of quantitative risk assessment breaks down under the weight of unknown unknowns. Proceeding from this example, this Article attempts to answer questions such as: How can the courts make good decisions about the reasonableness of risk where safety depends on understanding laws of nature the experiment itself is designed to uncover? And how can the courts keep the masses safe from science while keeping science safe from the masses? The answers revolve around the insight that courts can conduct a qualitative meta-analysis, looking at such factors as the existence of conflicts of interest, the influence of institutional pressures, and the extent to which safety rationales rely on untested assumptions. With this test suite, courts can guard the rule of law while leaving the scientific frontier open for exploration

Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006-2016).

BackgroundEosinophilic lung disease is a poorly understood inflammatory airway disease that results in substantial morbidity.ObjectiveTo describe clinical findings in dogs with eosinophilic lung disease defined on the basis of radiographic, bronchoscopic, and bronchoalveolar lavage fluid (BAL) analysis. Categories included eosinophilic bronchitis (EB), eosinophilic granuloma (EG), and eosinophilic bronchopneumopathy (EBP).AnimalsSeventy-five client owned dogs.MethodsMedical records were retrospectively reviewed for dogs with idiopathic BAL fluid eosinophilia. Information abstracted included duration and nature of clinical signs, bronchoscopic findings, and laboratory data. Thoracic radiographs were evaluated for the pattern of infiltrate, bronchiectasis, and lymphadenomegaly.ResultsThoracic radiographs were normal or demonstrated a bronchial pattern in 31 dogs assigned a diagnosis of EB. Nine dogs had intraluminal mass lesions and were bronchoscopically diagnosed with EG. The remaining 35 dogs were categorized as having EBP based on radiographic changes, yellow green mucus in the airways, mucosal changes, and airway collapse. Age and duration of cough did not differ among groups. Dogs with EB were less likely to have bronchiectasis or peripheral eosinophilia, had lower total nucleated cell count in BAL fluid, and lower percentage of eosinophils in BAL fluid compared to dogs in the other 2 groups. In contrast to previous reports, prolonged survival (>55 months) was documented in dogs with EG.Conclusions and clinical importanceDogs with eosinophilic lung disease can be categorized based on imaging, bronchoscopic and BAL fluid cytologic findings. Further studies are needed to establish response to treatment in these groups

REPRESENTATIONS OF MULTI-ATTRIBUTE GRAIN QUALITY

Grain quality is typically measured via several attributes. As these attributes vary across shipments and time, grain quality can be described using multivariate probability or frequency distributions. These distributions are important in modeling blending opportunities inherent in various grain shipments. For computational reasons, it is usually necessary to represent these distributions with a small set of discrete points and probabilities. In this analysis, we suggest a representation method based on Gaussian quadrature. This approach maintains the blending opportunities available by preserving moments of the distribution. The Gaussian quadrature method is compared to a more commonly used representation in a barley blending model.Crop Production/Industries,

A New Family of Discontinuous Galerkin Schemes for Diffusion Problems

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143057/1/6.2017-3444.pd