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23 Jan 2014 

xkcd: Shoes
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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.
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22 Nov 2013 
Elevator Shoes | Increase Height | Lift - 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.

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.

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.

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02 Nov 2013 

Leg Length Discrepancy

Leg Length Discrepancy

as difference in rate of growth between two limbs:

due to abnormal physeal growth


loss from osteomyelitis or tumor resections

includes determination of whether shortening is true or apparent.

limb length discrepancy (LLD) may be due to:


o scoliosis


o pelvic fracture


o hip contracture

o knee contracture

o ankle contracture

True Shortening Apparent Shortening

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

- tapemeasure

- leveling the pelvis with blocks


- CT scans

leg standing films

does leg length inequality matter?



and/or knee osteoarthritis

study by Gross (1978) showed & recommended:

than 2.0 cm showed no difficulties

than 3.5 cm, 80% had complaints

of 3 cm was compatible with high level sports

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

options exist for limb lengthening, although are somewhat controversial:


o stapling

o epiphysiodesis

mature for discrepancy greater than 3 cm

o lengthening using frame or

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

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

o > 15 cm: prosthetic


described by Phemiser in 1933

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

difficult to undo physeal bar created if not satisfied with result

- complications include
miscalculation of timing and technical errors

Epiphyseal Stapling

by Blount in 1949

the same problems as the epiphysiodesis

may be removed and physis will usually resume growth

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

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

shortening usually preferred to tibial shortening

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

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

Growth Stimulation

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



creation of AV fistulae

of foreign bodies next to the physes

bone beneath periosteum near physes

Limb Lengthening

is generally reserved for patients with the most severe deformities

potential complications

tract infections


subluxation or dislocation


treatment times

4 to 20 cm

stable joints above and below are a prerequisite

or angular malalignment usually decreases total length attainable

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

fixators have focused interest on the biology of lengthening

of lengthening is critical

begins in IM canal as multipotential cells diffentiate into osteoblasts

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

appear to lay down in longitudinal direction of retreating bone end

allowed to fully weight bear and to do regular exercise to prevent joint

modifications on the original theme (Ilizarov)

o uniplanar frame lengthening
over an IM rod is becoming popular

decision concerning timing of removal of frame

Prosthetic Fitting

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

when predicted discrepancy at maturity exceeds 15 to 20 cm

operation vs multiple procedures and complications

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

performed when child is younger than 1 year

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

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.

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

and Menelaus (arithmetic method)

o Distal femur grows 0.9 cm/yr

o Proximal tibia grows 0.6

o Inaccurate in young children

o Uses chronological age, not

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

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

(straight-line graph method)

o Derived from Green and
Anderson data/tables

o Use more complicated straight
line tables

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

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


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.

Straight-line Graph Method

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?.

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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.

PC, Servers, Storage, Data centre, Mobile, Networking, Chips & processors, Printers

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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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