Desired End Result Research Articles

Managers: When Do We Get More Engineers?

From the figures presented, it has been demonstrated that engineers will be in short supply for the next twenty years. The effects on industry have been shown to be threefold: (1) a shortage of development engineers; (2) a shortage of engineers to serve a necessary function of management; and, (3) a far reaching effect on the military preparedness program. The possible solutions to this problem have been widely discussed in the literature. They are not as clearly presented as is the statement of the problem. At least, we have compiled the first phase of an engineering solution to a tough problem: a statement of the problem. We are now searching for possible solutions. If we proceed with the engineering approach, we will next choose one of these solutions and develop it to its fullest extent. At the end of this development period, we wil be ready to apply the solution to an industrial situation to achieve the desired end result.

DEFORMITIES OF THE HAND INCIDENTAL TO PATHOLOGICAL CHANGES OF THE EXTENSOR AND INTRINSIC MUSCLE MECHANISMS

1. Metacarpophalangeal joints in extreme hyperextension of long duration in conjunction with absent intrinsic muscles may he treated expediently by joint fusion. 2. Metacarpophalangeal joints with less severe hyperextension and with functioning intrinsic muscle mechanism can be improved by the adequate excision of collateral ligaments, freeing of all dorsal tissues, and stripping of the volar plate. The heavy deep dorsal fascia in particular must be excised. 3. When the intrinsic strength of the index finger is being restored in the absence of contractures, it is advisable to replace weak lumbrical and volar interosseus muscles, as well as a weak first. dorsal interosseus. This strengthens volar abduction and gives a strong pinch. 4. If the dorsal hood is destroyed and the joint is affected, fibrous ankylosis or osseous fusion gives a desirable end result. 5. If the dorsal hood is intact and the extensor tendons are destroyed, it is desirable to correct the extension contracture by adequate excision of scar tissue and collateral ligaments, followed by the replacement of the extensor tendons. 6. In burns, a fixed button-hole deformity can be changed to a mallet deformity for better flexion,—that. is, for a golfer, if other reconstructive measures cannot be done. In old burns, it is important occasionally to maintain a slight button-hole deformity if this position is consistent with a specific occupation,—that is, for a piano player. 7. Fusion of the middle or distal interphalangeal joints is a useful procedure for irreparable flexion or extension deformities. 8. The intrinsic-plus hand, due to contracture of the intrinsic muscle mechanism, can be improved by advancing the intrinsic muscles in the metacarpal region or by sectioning the lateral bands opposite the proximal interphalangeal joints. 9. It is necessary to differentiate a contracture of the intrinsic muscles and fascia, contracture of the lateral bands in the digit only, contracture of both the extensor mechanism and lateral hands, and changes in the digits due to pathological joint changes resulting in hyperextension.

TUBERCULOSIS OF THE SACRO-ILIAC JOINT

Because this series consisted of only seventy-five cases, undue significance should not be attached to the facts presented. However, some of the data in this review, when added to those of other authors, may serve to depict certain features regarding the nature, treatment, and outcome of the disease. The following characteristics of tuberculosis of the sacro-iliac joint have been demonstrated: 1. The disease occurred in young adults, usually between the ages of twenty and forty years (79 per cent.). 2. It was commonly associated with tuberculosis in other parts of the body (83 per cent.). 3. Pain was the most common initial symptom (83 per cent.). 4. Abscess formation occurred frequently (79 per cent.), usually followed by the formation of a draining sinus. 5. The usual roentgenographic appearance late in the disease was bony ankylosis (in 94 per cent. of cases followed three years or more). 6. The mortality was higher when there was a draining sinus (44 per cent.). 7. The data suggest, but do not prove, that operative fusion of the involved sacroiliac joint is of value in hastening the desired end result.