Cut Out Research Articles

OFF-LOADING PRESSURE RELIEF WITH FOAM CUT OUT CUSHIONS: EXPERIENCES FROM RANCHO LOS AMIGOS NATIONAL REHABILITATION CENTER.

This paper explores the efficacy of the cushion fitting technique using foam cut out cushions for off-loading bony prominences in the sitting position, with a particular focus on reducing the high risk of developing pressure injuries among aging wheelchair users. This technique, historically employed at Rancho Los Amigos National Rehabilitation Center, has shown promising results in reducing pressure injuries for patients with spinal cord injuries. However, its widespread adoption remains limited. This manuscript aims to raise awareness about foam cut out cushions, its historical context, and its contemporary relevance by presenting customized solutions for individual patients with specific deformities. Key clinical points are highlighted, emphasizing the importance of skilled clinicians in the fitting process and the need to consider foam cut out cushions alongside other preventive measures. Case examples illustrate successful outcomes, demonstrating improved pelvic stability, posture, and off-loading of bony prominences. By promoting foam cut out cushions as a valuable cushioning option, this manuscript equips clinicians with knowledge to utilize this technique effectively.

Cut-Through versus Cut-Out: No Easy Way to Predict How Single Lag Screw Design Cephalomedullary Nails Used for Intertrochanteric Hip Fractures Will Fail?

This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism. This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year. All patients were reviewed for demographics and radiographic parameters including tip-to-apex distance (TAD), posteromedial calcar continuity, neck-shaft angle, lateral wall thickness, and others. Patients were grouped into cohorts based on the mechanism of failure, either lag screw CO or CT, and a comparison was performed. No differences in demographics, injury details, fracture classifications, or radiographic parameters were observed between CO/CT cohorts. Of note, a similar rate of post-reduction TAD>25 mm (P=0.936) was observed between groups. A higher rate of DEXA (dual energy X-ray absorptiometry) confirmed osteoporosis (25.0% vs. 60.0%) was observed in the CT group, but without significance. The mechanism of CT failure during intramedullary nail fixation of an IT fracture did not show an association with clinical data including patient demographics, reduction accuracy, or radiographic parameters. As reported in previous biomechanical studies, the main predictive factor for patients in whom early failure might occur via the CT effect mechanism may be related to bone quality; however, conduct of larger studies will be required in order to determine whether there is a difference in bone quality.

Is a Wiggling-Motion Modified Two-Step Impression Technique as Accurate as Conventional Techniques in Restorative Dentistry?

The purpose of this study was to evaluate dental impression accuracy of one-step and two-step techniques compared to a modified two-step technique. Four impression techniques were compared: (1) a one-step double mix (DM) technique, (2) a cut-out (CO) technique, in which space relief was created using a blade and a laboratory bur, (3) a membrane (ME) technique, in which space relief was created by placing a PVC membrane on top of the putty material during the primary impression, and (4) a wiggling motion (WI) technique, in which PVC membrane was placed and additional wiggling movements were performed during the first 20 s when the primary impression was seated upon the master model (MM). Impressions were poured with type IV stone. Casts were scanned with a laboratory scanner and measurements were made for each cast using three-dimensional analysis software. All groups presented differences compared to MM group, in at least one intra-abutment distance. Groups DM and ME presented the most significant differences, in three and two distances, respectively, whereas CO and WI presented one significant different distance compared to MM. There were no differences between MM and the four techniques for inter-abutment distances. WI yielded similar results with CO technique. Both performed better than the other groups.

MOREL-LAVALLÉE LESION INDUCED BY DYNAMIC HIP SCREW (DHS) CUT OUT: A CASE REPORT AND LITERATURE REVIEW

A Morel-Lavallee lesion (MLL) is a benign cystic lesion that occurs due to injury to the soft-tissue envelope's perforating vascular and lymphatic systems, resulting in a distinctive hemolymphatic fluid accumulation between the tissue layers. The MLL has the potential to make a significant impact on the treatment of orthopaedic injuries.A 79-year-old male patient community ambulatory with assisting aid (cane) known case of Diabetes mellitus, hypertension, bronchial asthma and ischemic heart disease. He was brought to the Emergency, complaining of right hip discomfort and burning sensation for the last 5 days with no history of recent trauma at all. Patient had history of right trochanteric femur fracture 3 years ago, treated with DHS in a privet service. Clinical and Radiological assessment showed that the patient mostly has acute MLL due to lag screw cut out. We offered the patient the surgical intervention, but he refused despite explaining the risks of complications if not treated and preferred to receive the conservative treatment. Compression therapy management explained to him including biker's shorts (instructed to be worn full-time a day) and regular follow up in clinic. Symptom's improvement was reported by the patient in the subsequent visits.In the polytrauma patient, a delayed diagnosis of these lesions is conceivable due to the presence of more visible injuries. It's located over the greater trochanter more commonly, but sometimes in other areas such as the lower lumbar region, the thigh, or the calf. Incorrect or delayed diagnosis and care can have unfavorable outcomes such as infection, pseudocyst development, and cosmetologically deformity. Magnetic resonance imaging (MRI) and ultrasound will aid in MLL diagnosis. However, the effectiveness of MLL therapy remains debatable.We strongly believe that the MLL caused due to tangential shear forces applied to the soft tissue leads to accumulation of the blood and/or lymph between the subcutaneous and overlying fascia and it often misdiagnosed due to other distracting injuries. Nontheless, in our case we reported MLL occur due to internal pressure on the fascia caused by cut out of DHS lag screw.

Are carbon micro-clusters in the Khufu pyramid blocks of organic origin? PIXE and PIGE reveal the construction of Giza’s pyramids

Roman concrete is well known and has lasted well. Now, it seems that the Egyptians used concrete to build at least some of their pyramids. Guy Demortier reports that PIGE and PIXE analyses have revealed the presence of carbon clusters in the material used to build the Khufu (Great) pyramid at Giza. This fits with a model of construction in which the blocks were cast in situ rather than cut out of stone and somehow moved into place. There’s always something new to be learnt!

Medicalização da educação especial: Tensões na inclusão

We bring in this article a cut out of the situation of medicalization of special education inBrazil, also named inclusive, with a spotlight to emergencies of analyzers that mark the extremebiologism and the negligence facing the complexity from subjective processes of the human being.In the neoliberal context the children are medicated with psico-pharmacological sooner each time,being the first referral to the health area made by the school, most of the time in the study. Throughthe methodological bias of cartography, strategies and narratives point to micro-political arrangementsof non-medicalizing practices as possible “scape routes” to the smashing expansion of the pharmaceuticalindustry to treat the “disorder called childhood”. Facing the pandemic emergency of COVID-19 in2020, we explore the tensions that involve this discussion and that, at this moment, have intensified.

Cemented THR In Comminuted Intertrochanteric Multi-Fragmentary Fracture Femur And Previously Failed Hip Surgery Is Really A Challenge

Comminuted intertrochanteric fracture is a common scenario in geriatric patient group. So far only DHS is the choice of implant to fix those fractures. But unfortunately we cannot allow the patient to full weight bearing mobilization before 6 weeks of surgery. And in addition of that due to osteoporotic bone many of the cases present with cut out of DHS later on. So in our center LabaidArthroplasty Center we started in trial basis cemented THR in Comminuted intertrochanteric fracture femur cases. In these cases we can allow patient to full weight bearing mobilization at minimum in 1st POD to maximum 3rd POD as pain permitted. In addition the previously failed hip surgeries also difficult to manage and cemented THA will be one of the best option in those cases. In subsequent follow up we observed better functional outcome in comparison to the cases of DHS. It is a case based study and need to be more theoretical and long term study before any conclusive decision.

3D printing materials for generators of active particles based on electrical discharges

AbstractIn this study, we focus our attention on the impact of ozone (O3) and ultraviolet radiation (UV) on materials usable for three‐dimensional (3D) printing. Specifically, we have studied the potential degradative effect on the most commonly used filaments, such as polylactic acid (PLA) and acrylonitrile–butadiene–styrene (ABS). The effect has been examined on objects printed on a 3D printer and on the materials of discharge chambers of O3 generators from which they were printed. For the purpose of adequate assessment of the actual impact of O3 and UV, samples were monitored for a period of 18‐hr of exposure. The methods of Raman spectroscopy, optical and scanning electron microscopy and Fourier‐transform infrared spectroscopy (FTIR) have been employed for an objective evaluation of potential modifications. A generator equipped with a chamber printed from a new PLA filament and an active electrode system in the form of a stripes electrode, or more precisely, in the second case, a honeycomb‐active electrode, both cut out of a thin copper foil, was used for the generation of O3 and UV radiation. The tested materials showed substantial resistance to O3 exposure under the test conditions. The result of measurements suggested that these materials could be used for chambers for the O3 as well as for active particle generation.

RETRACTED: IP1867B suppresses the insulin-like growth factor 1 receptor (IGF1R) ablating epidermal growth factor receptor inhibitor resistance in adult high grade gliomas.

This article has been retracted at the request of the Editor-in-Chief due to concerns regarding the legitimacy of images and data presented in the paper. Though a corrigendum (Can. Lett. Vol. 469, 2020, pages 524-535) was previously published to address some of these concerns, this corrigendum has also been found to contain errors and therefore cannot stand. Specific concerns are listed below. The Editor and Publisher received a letter from the University of Portsmouth alerting us to an investigation into alleged research misconduct. The University concluded their investigation with external experts and determined that misconduct did take place in relation to the research involved in this paper. Upon our separate investigation, it has been determined that the paper headline relies on showing that there was considerable reduction of IGF1R, IL6R and EGFR post treatment in all cell lines. During review, it was determined that this cannot be concluded from the presented data. For example, in SEBTA-003 the EGFR levels go up and there is no difference in IGFR1. It is apparent from Fig 4d that in the SEBTA-003 cell line the EGFR level does not go down, which is stated in the Results section on page 32, it is rather going up. The data for IGFR1 are inconclusive and there are concerns regarding the blot. The general implications would be that the effects of the drug IP1867B does not seem to be the same for all tested cell lines, and this should have been discussed in detail by the authors. Additionally, in subsequent experiments (Fig.4g and h) the SEBTA-003 cell line (no reduction of EGFR, rather increased expression) and the other 3 cell lines (reduction of EGFR) show similar responses. This is particularly evident in Fig.4g: Two cell lines are compared, SEBTA-003 (increased EGFR expression) and UP-029 (decreased EGFR expression), both behave similarly after exposure to drugs. The corrigendum (https://doi.org/10.1016/j.canlet.2019.10.002) issue is with respect to the Supplemental Figure6i EGFR, particularly panel IP1867B. The Corrigendum states that the left part is a cut out of the very right part. If so, the bands for IP1867B should show the same staining pattern - but they do not. Also, in the Corrigendum, there are incorrect mentions between day 14 in the Figureand day 19 in the Figurelegend. All authors were informed of the retraction in advance. Drs. Pritchard and Duckworth agreed to the retraction. The corresponding author, Dr Hill, did not agree to the retraction. No response had been received from Drs. Mihajluk, Simms, Reay, Madureira, Howarth, Murray, Nasser and Pilkinton at the time of the retraction being published.

Linear free vibration of micro-/nano-plates with cut-out in thermal environment via modified couple stress theory and Ritz method

This article aims to study the natural frequency of defective micro-/nano-plates because not only the existence of cut-outs in plates may be essential on the basis of their desired functionality but also the resonant frequency can be changed by cut-outs. In this study, the modified couple stress theory is combined with Kirchhoff thin plate hypothesis to incorporate size effect to classical plate theory. The Rayleigh-Ritz method is employed to derive discrete equations of motion which yields eigenvalue problem. In the ‘numerical results’ section, the effects of different boundary conditions, location of the cut-out, side-length to thickness ratio and a rise in the temperature on dimensionless fundamental frequency of polysilicon micro-plates are studied. Results demonstrate that the natural frequency of micro-plate, the cut out of which is far from the plate center is more than that of micro-plate with a square hole close to the plate center.

A Microfluidic Fluorescence Immunoassay Test Card for Rapid Detection of Heart-type Fatty Acid Binding Protein

Abstract A kind of easily assembly self-driving test card was developed for the rapid detection and quantification of heart-type fatty acid binding protein (H-FABP) utilizing time-resolved fluorescence microspheres as signal probes. It was easy to make microfluidic channel structures with double-sided adhesive and cut out of test card substrate and cover based on polymethyl methacrylate (PMMA) material by the laser cutting technique. The membrane of polystyrene containing maleic anhydride functional groups was coated on PMMA plate surface by dip-coating method. Furthermore, the capture antibody was immobilized effectively on PMMA surface by covalent binding with maleic anhydride groups. The cover was treated with plasma treatment to improve the hydrophilic ability, so that the liquid could flow smoothly in the microchannel. The whole analysis process could be completed within 10 min. There was a very good linear correlation between response and H-FABP concentration in the range of 0.5−100 ng mL−1 (R2 = 0.9966), and the detection limit was 0.1 ng mL−1 (S/N = 3). The intra-assay precision was less than 10% and the inter-assay precision was less than 15%. This detection method has the advantages such as high sensitivity, fast detection and good accuracy.

Percolation and Contaminant Transport in Road Embankments with and without Technical Safeguards to Reduce Percolation – Lysimeter Experiments

Alternative materials, like recycling materials, industrial by-products and soils already influenced by human activities (e.g. urban soils) are commonly accepted as building material in earthwork constructions. The risk of contaminant leaching from these materials can be limited by reducing the amount of percolating water. Technical safeguards are means to achieve this, but they must be adapted to the requirements of road construction. The research project aims to better knowledge of the percolation and leaching processes in road embankments constructed from alternative materials with different technical safeguards.The input and behavior of water and contaminants from re-used soils and road runoff is measured in eight field lysimeters at an urban road in an enterprise zone in Augsburg, southern Germany with about 9,700 vehicles per day. Each lysimeter contains the cut out of an embankment. The technical safeguards aim to decrease percolation and include a capillary barrier / drainage layer from geotextile and a second one from gravel, a bituminous film of 1kg/m2 and a modified mineral sealing of 10cm.A sandy gravel and a loamy soil were each used for construction of the embankment cut out in four lysimeters. The soils were spiked with a low contamination of Cd, Cu and CN- to test the efficiency of the technical safeguards. In the percolate water of the lysimeters as well as in the road runoff the pH value, electrical conductivity and the concentrations of sulphate, chloride, As, Pb, CN-, Cr, Cu, Hg, Ni, Mo, Sb, Tl, V and Zn have been analyzed in two-week composite samples since July of 2010. The amount of road runoff, lysimeter runoff and percolating water with its electrical conductivity are measured continuously. It has to be noted that measures were taken during a testing period in order to solve imperfections in the test set-up. These measures will have affected the observations presented.Results show that the unfiltered road runoff shows considerable concentrations of Zn and also elevated concentrations of Pb, as expected from former experience and literature. Up to now, all embankment types lead to a strong retention of these two substances. However, elevated Zn and Pb concentrations can be found in the percolating water during times of high chloride concentrations originating from deicing salt. Furthermore it was shown that the average contaminant leaching of each lysimeter was relatively small during the measurement period.Changes in concentrations of other parameters seem to be induced mainly by high chloride content of the infiltrating road runoff, but the time of occurrence of the changes in the effluent as well as the temporal variations depend also on the soil type, soil pH and the technical safeguards. Additionally, it seems that the soil type has a stronger influence on the percolation process compared to the different technical safeguards. Possible reasons will be discussed.

Accuracy of the surgeon's eye: Use of the tip–apex distance in clinical practice

Tip–apex distance is a well described method for assessment of screw placement in dynamic hip screw fixation of proximal femoral fracture. A distance of <25mm is associated with a significantly lower rate of cut out of the fixation device. Measurement is frequently performed retrospectively, although there has been no demonstration as to what accuracy the surgeon has of estimating tip–apex distance from image intensifier images, whilst scrubbed in theatre.Thirty-one clinicians working within orthopaedic departments were tested in their ability to identify adequacy of tip–apex distance on a series of image intensifier images. Level of seniority, awareness of the concept of tip–apex distance and use of the concept in clinical practice were each assessed.The accuracy in identifying the correct TAD was 82.5% in consultants, 83.8% in registrars and 71.1% in Senior house officers (SHO). The method was used in clinical practice by 50% of consultants, 89% of registrars and none of the SHOs.

Producing Producers: Women and Electronic/Dance Music

At the time of our meeting, Ashley lived in San Francisco's famous Haight-Ashbury district now overrun with chain stores such as The Gap and Ben and Jerry's. She lived in a large Victorian house with six roommates, which is fairly typical of twenty-something artists in this city. We walked down a long hallway, through the kitchen and down the stairs to the basement where all her belongings, including the technology she used to make electronic music, were stored in the single room she called home. Inspirational messages--some cut out of magazines and newspapers, others hand-written--adorned the walls, giving some order to the disheveled space. For the next few hours we lounged on a futon on the floor while Ashley related stories about what it was like to be a young woman with few connections to San Francisco's electronic/dance music scene while nevertheless trying to create music and have it heard. There was an experience from a live performance she had recently given that she wanted to talk about: I was setting up my equipment and I disappeared for a minute. The band had taken my power strip and started plugging their stuff into it. The sound guy took it and gave it to the band, but I was going on before the band. [It] threw off my whole vibe. I'm a firm believer in making friends with the sound guy 'cause they make you or break you. Having the power strip stolen was a huge symbol of disrespect to me 'cause if I was a guy, and I hate saying this, I hate bringing in this if-I-was-a-guy statement, but it's true. If I was a guy setting up all my gear and I went to go to the bathroom and came back I doubt he would have stolen my power strip you know. (1) With interviews as the primary source material, this article illustrates the processes by which commonplace discursive and material practices situate women outside of the production of electronic/dance music (E/DM) in San Francisco. Because women's efforts in E/DM production are in their infancy, this study is more concerned with the barriers women are experiencing than the strategies they are using to succeed. Nonetheless, our interviews with women who are in the early phases of producing E/DM suggested the importance of strategies including networking with male producers, and working to undo a lifetime of exposure to the gendered discourses that circulate in popular culture, social contexts, and educational environments. Our descriptions and commentary draw on a series of informal, open-ended interviews with twenty-one female DJs and two producers working the large E/DM scene in San Francisco. Talks with the DJs began in the summer of 2003 and continued, on and off, through spring of 2006. The principal author of this study, Farrugia, first became interested in researching women in E/DM after years of attending E/DM related events and buying E/DM. Farrugia and Swiss collaborated on this project because they were interested in bringing their differing backgrounds, ages, and disciplinary lenses to the materials and data that Farrugia had gathered. The essay is part of Farrugia's larger book-length project about women in E/ DM that first began as a dissertation. The interviews referred to throughout the essay were recorded on a mini-disc and then transcribed. Although the women interviewed are mainly DJs, the essay focuses on producing because many of the DJs interviewed believe that the next step in trying to distinguish themselves from other DJs and gain status within E/DM culture is to find the desire, invest the time, and acquire the skills necessary to produce music. Farrugia initially made contact with the DJs in 2003 via an Internet mailing list called Sisterdjs. In addition to the original twenty-one interviews, there were thirteen follow-up interviews in 2006. The ages of the women interviewed ranged from 18-40 at the time of the initial interviews; with the exception of two women who are Asian Americans, all of the DJs interviewed are white. …

DAMAGE TOLERANCE EVALUATION OF WING IN PRESENCE OF LARGE LANDING GEAR CUTOUT THROUGH STRESS ANALYSIS USING FEM

Aircraft is symbol of a high performance mechanical structure, which has the ability to fly with a very high structural safety record. Aircraft experiences variable loading in se rvice. Rarely an aircraft will fail due to a static overload during its service life. For the continued airworthiness of an aircraft duri ng its entire economic service life, fatigue and da mage tolerance design, analysis, testing and service experience correlatio n play a pivotal role. The present study includes t he stress analysis and damage tolerance evaluation of the wing through a stiffene d panel of the bottom skin with a landing gear cuto ut. Wing bottom skin experiences tensile stress field during flight. Cut outs required for fuel access and landing gear open ing and retraction in the bottom skin will introduce stress concentration. Fa tigue cracks will initiate from high tensile stress locations. An integral stiffened panel consisting a landing gear cutout is considere d for the analysis. Stress analysis will identify tmaximum tensile stress location in the panel. In a metallic structure fatigue manifests itself in the form of a crack which p ropagates. If the crack in a critical location goes unnoticed it could lead to a catastrophic failure of the airframe. A critical c ondition will occur when the stress intensity factor (SIF) at the crack tip becomes equal to fracture toughness of the material. SI F calculations will be carried out for a crack with incremental crack lengths usin g MVCCI method. Analytical evaluation of the crack arrest capability of the stiffening members ahead of the crack tip will be c arried out.

LIE. &lt;em&gt;ráižyti &lt;/em&gt;(&lt;em&gt;-o&lt;/em&gt;) „pjaustyti, karpyti į dalis“

LITH. raižyti ( -o ) “CARVE, ENGRAVE, CUT OUT” Summary The verb has probably nothing to do with rėžti (-ia) “cut” etymologically as is sometimes supposed, but it evidently contains a root reiž- / riž-, which is represented also by Lith. pa-raižti (-ia) “fill up”, Latv. riezt (-žu, -zu) “cut, slice”, riezis “boundary, bound; patch, lot”, Lith. ryžė “patch, lot, plot”, ryželis “strip, stripe”, pa-raižiuo. pa-reižiuo “in turn, in succession, in order” and others.

The clinical application of minimally invasive guider with CT-gulded in percutaneous iliosacral screw fixation

Objective To investigate the accuracy of percutaneous iliosacral screw fixation in sacroiliac joint fracture-dislocation with minimally invasive guider with CT-guided.Methods From January 2011 to May 2011,8 patients with sacroiliac joint fracture-dislocation were treated using percutaneous iliosacral screw fixation assist with minimally invasive guider in CT-guided,which included 5 males and 3 females,with the average age of 32 years (ranged from 26 to 56 years).All patients suffered with vertically unstable pelvic fractures.Bone traction was used in femoral condyle for 6 cases which displaced more than 2cm in sacroiliac joints.Patients were prone position on the CT bed.First sacroiliac joint CT-scan was performed,then marked the needle position on affected side buttocks after measure the best position and track of needle that expected on CT computer screen.According to the data of CT-scan,the angle of the devices was adjusted,which could control 3D direction of the minimally invasive guider,then insert the Kirschner wire into sacroiliac joint guided with the front end of the sleeve of the minimally invasive guider,confirmed the track of needle was excellent with CT-scan (3D),then the guider was moved out and put the hollow screw (dia 7.3 mm Synthes) into the sacroiliac joint along the Kirschner wire.Results All 8 patients were successfully insert the Kirschner wire.The operation time was from 10 to 20 min (mean,14 min).All screws were in the position expected before surgery,no cut out of bone with the CT-scan immediately after operation,the shape of sacroiliac joint was restored satisfied and the fixation was stable.No numbness and radiation-like pain appeared among the operation in the lower limb for all patients,no case had vascular and neurological complications postoperative.Conclusion The minimally invasive guider can improve the accuracy,security and simplicity of the percutaneous iliosacral screw fixation with CT-guided,and also avoid the deviation of needle insertion angle that determined by operator himself. Key words: Sacroiliac joint; Dislocations; Bone screws; Surgery, computer-assisted

The Clinical Results of Pressurized Cement-Augmented Richard Compression Hip Screw with Trochanteric Stabilizing Plate for Intertrochanteric Fracture Compared with Pressurized Cement-Augmented Richard Compression Hip Screw Only

Purpose: We analyzed the radiologic and clinical outcomes of osteosynthesis using a Richard compression hip screw (RCHS) alone or RCHS with a trochanteric stabilizing plate (TSP) in patients with an intertrochanteric fracture. Materials and Methods: From January 2006 to December 2008, 23 patients (23 cases) underwent osteosynthesis using only RCHS and 24 patients (25 cases) underwent osteosynthesis using RCHS and TSP. We evaluated the classification of fractures, the amount of collapse and shortening, and the duration of fracture union. We used a Koval classification for the evaluation of clinical outcomes. Results: The amount of collapse and shortening in the RCHS-only group was statistically greater than the amount in the RCHS-with-TSP group. The union duration of fracture was 5.3 months in the RCHS-only group and 6.6 months in the RCHS-with-TSP group. The clinical outcomes in the RCHS-with TSP-group were better than the RCHS-only group. We had one case of fixation failure in the RCHS-only group and none in the RCHS-with-TSP group. There were no perioperative systemic complications or death. Conclusion: In patients with unstable intertrochanteric fractures, we can prevent the cut out of the lag screw or screw loosening with the use of pressurized PMMA-augmented RCHS. However, we cannot prevent excessive collapse and shortening, especially in patients with severe osteoporosis, a small diameter of the femur neck, or concealed fractures. In the case of these patients, we recommend you to use RCHS with TSP for the prevention of excessive collapse and shortening.

Weathering processes, structural degradation and slope-structure stability of rock-hewn churches of Lalibela (Ethiopia)

Abstract Lalibela is located in the northern–central part of Ethiopia, c . 600 km north of Addis Ababa in Northern Wollo (Ahmara Region). The town, which has about 12 000 inhabitants, is situated at an altitude of 2500 m. In its centre a unique complex of 11 rock-hewn Christian Orthodox churches is located, cut out of the rock some 800 years ago. Their construction is attributed to King Lalibela (1167–1207). All the churches exhibit widespread evidence of structural damage and weathering processes, which are posing a serious problem for the preservation of the monuments. Preliminary geological field surveys, in situ geotechnical analyses and laboratory tests have been carried out in the area to understand the cause of weathering and the likely consequences on the structural stability of the churches. Laboratory tests on volcanic materials detected a deep alteration of rocks as a result of the widespread presence of montmorillonite. This is the primary cause of the progressive deterioration of the physical and mechanical characteristics of the slope-forming rocks in Lalibela. Major consequences are the alveolar weathering of churches' façade, the degradation of the roofs and a reduction of rock strength, which are causing a progressive structural instability in some rock-hewn monuments. Also, sliding of façades along bedding joints was detected. Understanding the weathering processes affecting the Lalibela churches allows the detection of problems and the timely implementation of medium- to long-term protection strategies for conservation of the monuments.

Diseases of poverty and lifestyle, well-being and human development.

The problems of the haves differ substantially from those of the have-nots. Individuals in developing societies have to fight mainly against infectious and communicable diseases, while in the developed world the battles are mainly against lifestyle diseases. Yet, at a very fundamental level, the problems are the same-the fight is against distress, disability, and premature death; against human exploitation and for human development and self-actualisation; against the callousness to critical concerns in regimes and scientific power centres.While there has been great progress in the treatment of individual diseases, human pathology continues to increase. Sicknesses are not decreasing in number, they are only changing in type.The primary diseases of poverty like TB, malaria, and HIV/AIDS-and the often co-morbid and ubiquitous malnutrition-take their toll on helpless populations in developing countries. Poverty is not just income deprivation but capability deprivation and optimism deprivation as well.While life expectancy may have increased in the haves, and infant and maternal mortality reduced, these gains have not necessarily ensured that well-being results. There are ever-multiplying numbers of individuals whose well-being is compromised due to lifestyle diseases. These diseases are the result of faulty lifestyles and the consequent crippling stress. But it serves no one's purpose to understand them as such. So, the prescription pad continues to prevail over lifestyle-change counselling or research.The struggle to achieve well-being and positive health, to ensure longevity, to combat lifestyle stress and professional burnout, and to reduce psychosomatic ailments continues unabated, with hardly an end in sight.We thus realise that morbidity, disability, and death assail all three societies: the ones with infectious diseases, the ones with diseases of poverty, and the ones with lifestyle diseases. If it is bacteria in their various forms that are the culprit in infectious diseases, it is poverty/deprivation in its various manifestations that is the culprit in poverty-related diseases, and it is lifestyle stress in its various avatars that is the culprit in lifestyle diseases. It is as though poverty and lifestyle stress have become the modern “bacteria” of developing and developed societies, respectively.For those societies afflicted with diseases of poverty, of course, the prime concern is to escape from the deadly grip of poverty-disease-deprivation-helplessness; but, while so doing, they must be careful not to land in the lap of lifestyle diseases. For the haves, the need is to seek well-being, positive health, and inner rootedness; to ask science not only to give them new pills for new ills, but to define and study how negative emotions hamper health and how positive ones promote it; to find out what is inner peace, what is the connection between spirituality and health, what is well-being, what is self-actualisation, what prevents disease, what leads to longevity, how simplicity impacts health, what attitudes help cope with chronic sicknesses, how sicknesses can be reversed (not just treated), etc. Studies on well-being, longevity, and simplicity need the concerted attention of researchers.The task ahead is cut out for each one of us: physician, patient, caregiver, biomedical researcher, writer/journalist, science administrator, policy maker, ethicist, man of religion, practitioner of alternate/complementary medicine, citizen of a world community, etc. Each one must do his or her bit to ensure freedom from disease and achieve well-being.Those in the developed world have the means to make life meaningful but, often, have lost the meaning of life itself; those in the developing world are fighting for survival but, often, have recipes to make life meaningful. This is especially true of a society like India, which is rapidly emerging from its underdeveloped status. It is an ancient civilization, with a philosophical outlook based on a robust mix of the temporal and the spiritual, with vibrant indigenous biomedical and related disciplines, for example, Ayurveda, Yoga, etc. It also has a burgeoning corpus of modern biomedical knowledge in active conversation with the rest of the world. It should be especially careful that, while it does not negate the fruits of economic development and scientific/biomedical advance that seem to beckon it in this century, it does not also forget the values that have added meaning and purpose to life; values that the ancients bequeathed it, drawn from their experiential knowledge down the centuries.The means that the developed have could combine with the recipes to make them meaningful that the developing have. That is the challenge ahead for mankind as it gropes its way out of poverty, disease, despair, alienation, anomie, and the ubiquitous all-devouring lifestyle stresses, and takes halting steps towards well-being and the glory of human development.