Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Imbrication for Patellar Instability Due to Trochlear Dysplasia.

BackgroundThe treatment of patellar instability in the setting of trochlear dysplasia is challenging.Purpose/hypothesisThe purpose of this study was to evaluate outcomes for the treatment of recurrent patellar dislocations due to trochlear dysplasia using anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament (MPFL) imbrication. We hypothesized that the treatment of patellar instability with tibial tubercle osteotomy and MPFL imbrication would result in improved patient satisfaction and decrease patellar instability events in patients with prior instability and trochlear dysplasia.Study designCase series; Level of evidence, 4.MethodsWe performed a retrospective analysis of patients who underwent MPFL imbrication and concomitant anteromedialization tibial tubercle osteotomy for recurrent patellofemoral instability at a single institution. The minimum follow-up was 1 year. Patient demographic information including age at the time of surgery, sex, body mass index (BMI), tibial tubercle-trochlear groove (TT-TG) distance, and grade of trochlear dysplasia was collected along with relevant operative data. Postoperatively, recurrent dislocation events as well as Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores were collected, and satisfaction was ascertained by asking patients whether they would undergo the procedure again.ResultsA total of 37 knees from 31 patients (23 female) with a mean follow-up of 3.8 years (range, 1-8.9 years) were included. The mean patient age was 28.8 years (range, 14-45 years), the mean BMI was 24 kg/m2 (range, 20-38 kg/m2), and the mean preoperative TT-TG distance was 18.9 mm (range, 8.4-32.4 mm). Two knees were classified as low-grade trochlear dysplasia (Dejour A) and 35 as high-grade trochlear dysplasia (Dejour B-D). At final follow-up, patients reported mean KOOS subscale scores of 86.5 (Pain), 79.8 (Symptoms), 93.9 (Activities of Daily Living), 74.3 (Sports/Recreation), and 61.9 (Quality of Life), as well as a mean Kujala score of 81.3. Mean patient satisfaction was 8.3 of 10. The majority of knees (86.5%; 32/37) remained stable without recurrent instability after this procedure, while 13.5% (5 knees) suffered a recurrent dislocation, with 2 requiring revision surgery. Eight knees (21.6%) underwent subsequent hardware removal.ConclusionAnteromedialization tibial tubercle osteotomy with MPFL imbrication can improve recurrent patellofemoral instability and provide significant clinical benefit to patients with trochlear dysplasia

GCIP water and energy budget synthesis (WEBS)

As part of the World Climate Research Program\u27s (WCRPs) Global Energy and Water-Cycle Experiment (GEWEX) Continental-scale International Project (GCIP), a preliminary water and energy budget synthesis (WEBS) was developed for the period 1996–1999 from the “best available” observations and models. Besides this summary paper, a companion CD-ROM with more extensive discussion, figures, tables, and raw data is available to the interested researcher from the GEWEX project office, the GAPP project office, or the first author. An updated online version of the CD-ROM is also available at http://ecpc.ucsd.edu/gcip/webs.htm/. Observations cannot adequately characterize or “close” budgets since too many fundamental processes are missing. Models that properly represent the many complicated atmospheric and near-surface interactions are also required. This preliminary synthesis therefore included a representative global general circulation model, regional climate model, and a macroscale hydrologic model as well as a global reanalysis and a regional analysis. By the qualitative agreement among the models and available observations, it did appear that we now qualitatively understand water and energy budgets of the Mississippi River Basin. However, there is still much quantitative uncertainty. In that regard, there did appear to be a clear advantage to using a regional analysis over a global analysis or a regional simulation over a global simulation to describe the Mississippi River Basin water and energy budgets. There also appeared to be some advantage to using a macroscale hydrologic model for at least the surface water budgets

Reunifying from behind bars: A quantitative study of the relationship between parental incarceration, service use, and foster care reunification

Incarcerated parents attempting to reunify with their children in foster care can find it difficult to complete the activities on their court-ordered case plans, such as drug treatment services and visitation with children. Although much has been written regarding the obstacles that are likely to interfere with reunification for incarcerated parents, very little quantitative research has examined the topic. This study uses secondary data to examine the incarceration experiences and reunification outcomes of a sample of 225 parents in one large urban California county. In multivariate analysis controlling for problems and demographics, incarcerated parents were less likely to reunify with their children; however, service use appeared to mediate this relationship, as the negative association between incarceration and reunification did not persist when service use was included as a variable in the model. Suggestions are made for policy and practice changes to improve reunification outcomes for this population of parents.

Salinity management options for the Colorado River. Damage estimates and control program impacts

Rivers draining arid basins increase in salinity content in the downstream area to the point where water users are often significantly damaged. The problem in some cases can be ameliorated by altering upstream water and land use practices. An economic trade off exists between the cost of such upstream efforts and the downstream benefits achieved. This report examines options for salinity management in the Colorado River Basin. The study sought to provide additional information to estimate 1) economic damages caused by various salt concentrations to agricultural and municipal water users and 2) economic costs of salinity control measures by upstream water users. Damages were estimated for high salinity levels to provide guidelines to project future conditions. Control costs were estimated with a physical model developed to predict the response of soil, water, and crop factors. Input-output models were used to estimate indirect economic impacts. Agricultural damages for each milligram per liter of salt concentration at Imperial Dam in the 900 to 1400 range were estimated to be #33,100 annually. Of the total, $28,200 are in the Imperial Valley and decreasing g amounts occur respectively in the Palo Verde, Yuma, Colorado River Indian Reservation, Sand Diego, Coachella, and Central Arizona and$11,400 for the $112,000 per mg/1. Comparable estimates were$11,200 for Central Arizona and $11,400 for the Las Vegas area. As for controlled costs, 80 percent of the initial salt load could theoretically be at an incremental cost of less than$2.20 per ton. The comparison of the reduction measures showed on-farm practices to be the last expensive alternative for reducing salinity. Based on an approximation that 1 mg/1 at Imperial Dam is equivalent to 10,000 tons of salt, the above estimated benefits of salinity reduction would be about $17 per ton. Salinity control projects at Paradox Valley and acreage retirements in the Grand and Uncompaghre Valleys were found to be economically justified but lining the Grand Valley Canal was not. The above estimates are approximations obtained from available data and can be improved by further studies to cover additional cost and benefit effects or by more comprehensive data the effects covered

The Influence of Information Sources on Inter- and Intra-Firm Diffusion: Evidence from UK Farming

We study the effect of different information sources on diffusion between and within companies. Our model of economically optimising farmers replicates results from dual process persuasion theory, and predicts that inter-firm diffusion will be primarily affected by reliable, easily accessible information while intra-firm diffusion will be influenced by technical information. The results are tested on UK farming data. Consistent with our model, information from agents, suppliers, farmers, and agricultural magazines influences inter-firm adoption, from buyers influences intra-firm adoption, and from crop consultants, academics, government, and an industry body influences both

Dynamically Integrating Knowledge in Teams: Transforming Resources into Performance

In knowledge-based environments, teams must develop a systematic approach to integrating knowledge resources throughout the course of projects in order to perform effectively. Yet, many teams fail to do so. Drawing on the resource-based view of the firm, we examine how teams can develop a knowledge-integration capability to dynamically integrate members‘ resources into higher performance. We distinguish among three sets of resources: relational, experiential, and structural, and propose that they differentially influence a team‘s knowledge-integration capability. We test our theoretical framework using data on knowledge workers in professional services, and discuss implications for research and practice