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23 Jan 2014 



xkcd: Shoes
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Comics I enjoy:
Three Word Phrase,Oglaf (nsfw),SMBC,Dinosaur Comics,A Softer World,Buttersafe,Perry Bible Fellowship,Questionable Content,Buttercup Festival
Warning: this comic occasionally contains strong language (which may be unsuitable for children), unusual humor (which may be unsuitable for adults), and advanced mathematics (which may be unsuitable for liberal-arts majors).
BTC 1NfBXWqseXc9rCBc3Cbbu6HjxYssFUgkH6
We did not invent the algorithm. The algorithm consistently finds Jesus. The algorithm killed Jeeves.
The algorithm is banned in China. The algorithm is from Jersey. The algorithm constantly finds Jesus.
This is not the algorithm. This is close.
This work is licensed under aCreative Commons Attribution-NonCommercial 2.5 License.

This means you're free to copy and share these comics (but not to sell them). More details.




Admin · 217 views · Leave a comment
22 Nov 2013 
Elevator Shoes | Increase Height | Lift - IncreasingShoes.com grow taller get taller

Why you need a pair of elevator shoes

Look Taller
While this is the most obvious reason, itis also the reason why most men choose to wear elevator shoes. They are morethan just a way to get taller, the added height helps make you feel moreconfident as well. Proper elevator shoes allow a man to "grow taller" with theeffect being more subconscious in nature rather than blatantly obvious.

Better Posture
Proper elevator shoes also help correctcertain posture defects, helping a man to properly stand taller and enjoybetter weight distribution. The effect is to walk with your head held high andchest more outwards, projecting a more positive outlook while walking morecorrectly. Here, proper elevator shoes can correct poor posture and helpprevent certain back issues from developing.

Comfort
Although it may seem at first that theelevated heel would add another pressure point, in truth the very structure ofproper elevator shoes provides a better platform for the foot, allowing thefoot to ride comfortably in the shoe itself. This is because the very shape ofthe shoe's interior has been properly balanced with support that goes from thetoes up to the heel in a natural fashion.

Style
Elevator shoes have not only kept up withthe times, they can also be found in highly fashionable stores offering thelatest styles and trends. Since the purpose of the elevated platform is to besubtle and invisible in effect, many of the shoes themselves are made from thefinest materials and feature modern styles that are noticed for their quality.
Overall, elevator shoes are the choice formen who want to add a little to the height and at lot to their overallappearance.

Admin · 217 views · Leave a comment
02 Nov 2013 



Leg Length Discrepancy

Leg Length Discrepancy








Defined
as difference in rate of growth between two limbs:



-
usually
due to abnormal physeal growth



-
fracture
malunions



-
bone
loss from osteomyelitis or tumor resections







Evaluation
includes determination of whether shortening is true or apparent.







Apparent
limb length discrepancy (LLD) may be due to:



-
suprapelvic
obliquity



o scoliosis



-
intrapelvic
obliquity



o pelvic fracture



-
infrapelvic
obliquity



o hip contracture



o knee contracture



o ankle contracture






True Shortening Apparent Shortening








Assessment
of true shortening involves measuring the absolute length of the limbs
involving one of a number of methods:



- tapemeasure



- leveling the pelvis with blocks

















-
scanogram

































































- CT scans




















































-
Long
leg standing films







Why
does leg length inequality matter?



-
back
pain



-
scoliosis



-
hip
and/or knee osteoarthritis







A
study by Gross (1978) showed & recommended:



-
less
than 2.0 cm showed no difficulties



-
more
than 3.5 cm, 80% had complaints



-
LLD
of 3 cm was compatible with high level sports



-
Observation
for less than 2 cm at maturity, especially if the patient has weakness or
spasticity on the short side







Many
options exist for limb lengthening, although are somewhat controversial:



-
skeletally
immature



o stapling



o epiphysiodesis



-
skeletally
mature for discrepancy greater than 3 cm



o lengthening using frame or
IMN



o acute shortening, can fairly
easily accommodate 8 cm in femur or 3 cm in tibia



-
suggested
approaches, given a normal height range are as follows:



o 0 ? 2 cm: no treatment



o 2 ? 6 cm: chow lift,
epiphysiodesis, shortening



o 4 ? 15 cm: lengthening
procedure



o > 15 cm: prosthetic
fitting







Epiphysiodesis



-
first
described by Phemiser in 1933



-
performed
by excising a square of bone from the medial and/or lateral margin of the
growth plate and rotating it 90?



-
permanent,
difficult to undo physeal bar created if not satisfied with result



- complications include
miscalculation of timing and technical errors









Epiphyseal Stapling



-
described
by Blount in 1949



-
potentially
the same problems as the epiphysiodesis



-
staples
may be removed and physis will usually resume growth











The
goal is equal limb length at maturity, unfortunately it is often difficult to
predict future growth in a child.
Stapling may permit less precise estimations whereas epiphysiodesis is
unforgiving. Growth rates have been
extensively studied and growth tables exist to help predict the growth
remaining in a given limb at a given age. Growth is fairly constant from
chronologic ages 6 to 9 with the femur growing roughly 2.0 cm (SD 0.27 cm) and
the tibia 1.6 cm (SD 0.23 cm). During
the adolescent growth spurt, yearly increments are extremely variable. Using bone age, rather than chronological
age is a more useful and reliable gauge in predicting growth. This can be performed using standardized
books containing figures of radiographs of the hand and wrist and comparing
them to the patient. (Greulich)







Acute Shortening Procedures

-
generally
considered for patients with same amounts of LLD as those for epiphysiodesis
but who are too old for correction with physeal closure

-
femoral
shortening usually preferred to tibial shortening

-
up
to 5 cm usually well tolerated in femur (3 cm in tibia), greater resulting in
ineffective recovery of muscle-tendon units

-
involves
open shortening with plate fixation, proximal shortening with blade plate or
newer closed femoral shortening using intramedullary nail





Growth Stimulation



-
multiple
techniques for stimulation of the short extremity have been tried with
irreproducible and clinically insignificant results

o
electrical
stimulation

o
sympathectomy

o
surgical
creation of AV fistulae

o
placement
of foreign bodies next to the physes

o
packing
bone beneath periosteum near physes









Limb Lengthening



-
lengthening
is generally reserved for patients with the most severe deformities

o
multiple
potential complications

?
pin
tract infections

?
joint
contractures

?
joint
subluxation or dislocation

?
nonunion/malunion

o
prolonged
treatment times

-
usually
4 to 20 cm

-
relatively
stable joints above and below are a prerequisite

-
rotational
or angular malalignment usually decreases total length attainable

-
patient
should be emotionally mature (usually older than 8 or 9 years)

-
ring
fixators have focused interest on the biology of lengthening

o
rate
of lengthening is critical

o
osteogenesis
begins in IM canal as multipotential cells diffentiate into osteoblasts

o
bone
formation resembles intramembranous growth (vs endochondral) as no cartilage
matrix is laid down

o
cells
appear to lay down in longitudinal direction of retreating bone end

o
patients
allowed to fully weight bear and to do regular exercise to prevent joint
contractures

-
many
modifications on the original theme (Ilizarov)

o uniplanar frame lengthening
over an IM rod is becoming popular



-
difficult
decision concerning timing of removal of frame











Prosthetic Fitting



-
generally
least desirable form of treatment, but may be best choice with large
discrepancy or severe deformity

-
considered
when predicted discrepancy at maturity exceeds 15 to 20 cm

-
single
operation vs multiple procedures and complications

-
Syme
amputation follows by prosthetic fitting results in a functional BKA that
results in near-normal gait and activity level

o
best
performed when child is younger than 1 year

-
for
patient with severe proximal focal femoral deficiency, Syme with or without a
knee fusion may be the best option

o
Van
Nes rotationplasty, which reverses the ankle joint to power a modified
below-knee prosthesis is also an option (best if completed before 3 to 4 years)











Fortunately, growth disturbances are often
not purely random and unpredictable.
They are usually a progressive inequality due to growth in one extremity
being inhibited. Studies have shown
that 95% of patients with LLD have constant inhibition that is predictable over
time. Polio is one example where the
growth is usually not predictable.







Three
common methods of predicting the future difference in LLD have been described:







-
White
and Menelaus (arithmetic method)



o Distal femur grows 0.9 cm/yr



o Proximal tibia grows 0.6
cm/yr



o Inaccurate in young children



o Uses chronological age, not
skeletal



o Until maturity (15 1/4 for a
girl and 17 1/4 for a male)



o Simplistic, but a good guide
for timing of epiphysiodesis







-
Green
and Anderson (growth-remaining method)



o 100 kids from Boston (50%
with polio) had their normal leg evaluated



o correlated growth to
skeletal maturity with Greulich and Pyle bone age atlas



o accuracy improved by
plotting over 3-4 yrs to assess growth inhibition



-
Moseley
(straight-line graph method)



o Derived from Green and
Anderson data/tables



o Use more complicated straight
line tables







In
evaluating the various techniques used to assess limb-length discrepancy,
studies vary with respect to interpretation of success. General success has been reported with both
of these methods, although a recent review has reported rather disappointing
results with all three commonly used methods, suggesting further refinement is
needed.











Determining Leg Length Discrepancy:



The Arithmetic Method



Leg Length Data



(same data for all threesamples)



Sex: Female







Age (yr) Skeletalage (yr) Right leglength (cm) Left leglength (cm)



7 + 10 8 + 10 66.0 58.2



8 + 4 9 + 4 64.4 61.9



9 + 3 10 + 3 70.0 66.2







Prerequisite growth information







Distal femoral plate grows10 mm/yr. Girls stop growing at 14 years of age.



Proximal tibial plategrows 6 mm/yr. Boys stop growing at 16 years of age.







Assessment of past growth







1. Longest time interval for data



= age at last visit ? age at first







2. Years of growth remaining



= 14 (16 for boys) ? age at last visit



3. Past growth of legs



= present length ? first measured length



4. Growth rate of long leg







5. Growth inhibition























1. Longest time interval for data



= 9 yr 3 mo ? 7 yr 10 mo = 1 yr 5 mo



= 1.42yr



2. Years of growth remaining



= 14 yr ? 9 yr 3 mo = 4 yr 9 mo = 4.75 yr



3. Past growth of:



Long leg = 70 ? 60 = 10.0 cm



Short leg = 66.2 ? 58.2 = 8.0 cm



4. Growth rate of long leg



= 7.04 cm/yr



5. Inhibition



= 0.2 cm



Prediction of future growth







1. Future growth of long leg



= years remaining X growth rate



2. Future increase in discrepancy



= future growth of long leg X inhibition



3. Discrepancy at maturity



= present discrepancy + future increase















1. Future growth of long leg



= 4.75 X 7.04 = 33.4 cm



2. Future increase in discrepancy



= 33.4 X 0.2 = 6.7 cm



3. Discrepancy at maturity



= (70.0 ? 66.2) + 6.7 = 10.5 cm



Prediction of effect of surgery







Effect of epiphysiodesis



= growth rate X years remaining











Effect of epiphysiodesis



Femoral = 0.9 X 4.75 = 4.28 cm



Tibial = 0.6 X 4.75 = 2.85 cm



Both = 1.6 X 4.75 = 7.13 cm







Taken from Chapman?s Volume
4, p. 4347.











Determining Leg Length Discrepancy:



The Growth Remaining Method



Prerequisite growth information







Distal femoral plate grows10 mm/yr. Girls stop growing at 14 years of age.



Proximal tibial plategrows 6 mm/yr. Boys stop growing at 16 years of age.







Assessment of past growth







1. Growth of both legs



= present length ? first length







2. Present discrepancy



= length of long leg ? length of short leg







3. Growth inhibition



























1. Growth of long leg



= 70.0 ? 60.0 = 10.0 cm







1. Growth of short leg



= 66.2 ?58.2 = 8.0 cm







2. Present discrepancy



= 70.0 ? 66.2 = 3.8 cm



3. Growth inhibition



= 0.2



Prediction of future growth







1. Plot present length of long leg on Green-Anderson leg length graphfor appropriate sex







2. Project to right parallel to standard deviation lines until maturityto determine mature length of long leg







3. Future growth of long leg



= mature length ? present length







4. Future increase in discrepancy



= future growth long X inhibition







5. Predicted discrepancy at maturity



= present discrepancy + future increase











1.





2. Length of long leg at maturity = 81.1







3. Future growth of long leg



= 81.1 ? 70.0 = 11.1 cm







4. Discrepancy at maturity



= 3.8 + 2.2 = 6.0 cm







Prediction of effect of surgery







1. The effect of epiphysiodesis of the distal femoral and proximaltibial plates for a given sex and skeletal age can be determined by theGreen-Anderson growth = remaining graph.



2. The effect of lengthening is not affected by growth.











1. Correction from proximal tibial arrest



= 2.7 cm







Correction from distal femoral arrest



= 4.1 cm







Correction from combined arrest



= 2.7 + 4.1 = 6.8 cm















Taken from Chapman?s Volume
4, p. 4348.







Moseley
Straight-line Graph Method

























































































































Generously
donated by James Roach, M.D.







Most images and much of thegeneral information from this section were ?borrowed? from a powerpoint presentationby James Roach, M.D. Much was also?borrowed? from Chapman?s, Volume 4, Chapter 170 ?Limb-Length Discrepancyin Children?.














Admin · 215 views · Leave a comment
10 Oct 2013 



PC sales continue to slump despite signs of economic recovery

Computer Weekly is the leading provider of news, analysis, and opinion for the UK IT community.



View the latest CIO interviews, videos and guides to help you develop your IT leadership skills.

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Network hardware, Network software, VoIP, Unified communications, Wireless, Mobile, Telecoms networks and broadband communications, Datacentre networking, Network routing and switching, Network monitoring and analysis, Network security strategy, WAN performance and optimisation

Smartphone, Laptop, Tablet, Mobile software, Mobile networking

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News

The signs of economic recovery and the back-to-school period have failed to inject life into the PC sector as shipments slumped to the lowest level since the height of the recession in 2008.

Worldwide shipments of PCs fell by 8.6% in the third quarter of 2013 compared to the same period last year. Although Lenovo (2.8%), HP (1.5%), and Dell (1%) managed to increase sales, Acer and Asus both experienced just over 22% reductions.

There were 80,279,267 PC shipments worldwide in the third quarter this year, compared to 87,809,406 in the same period last year. This is the lowest level since 2008.

Mikako Kitagawa, analyst at Gartner, said despite the 'back-to-school' quarter for PC sales in North America and Europe, sales dropped to their lowest volume since 2008.

He said the arrival of lower-cost tablet devices has hastened the decline in PC sales. "Consumers' shift from PCs to tablets for daily content consumption continued to decrease the installed base of PCs both in mature as well as in emerging markets. A greater availability of inexpensive Android tablets attracted first-time consumers in emerging markets, and as supplementary devices in mature markets."

Lenovo had a 17.6% of global PC shipments in the period and HP had 17.1%.

Europe saw a sharp decline. PC shipments in EMEA were 22.4m in the quarter, which was 13.7% lower than the same period last year. It was the sixth consecutive quarter of declining PC shipments in the region.

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01 Oct 2013 
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