Senior Ones Research Articles

CAD Algorithms for Solid Breast Masses Discrimination: Evaluation of the Accuracy and Interobserver Variability

For a successful computer-aided diagnosis (CAD) approach, investigating the benefit of the output for radiologist diagnosis is as important as developing the computer algorithm itself. To evaluate the accuracy and the interobserver variability of two newly developed CAD algorithms for breast mass discrimination, eight radiologists with varied experience in breast ultrasonography (US) independently reviewed the lesions according to Breast Imaging Reporting and Data System (BI-RADS)-US. They interpreted the original ultrasound images, provided a final assessment category to indicate the probability of malignancy and then made a further diagnosis using the images processed by the proposed CAD algorithms. The receiver operating characteristic (ROC) curve and Cohen's κ statistics were employed to evaluate the effect of the CAD algorithms on radiologist diagnoses. By using the proposed CAD approach, the quality of the images was improved and more information was provided to the observers. With the processed images, the areas under the ROC (Az) of each reader (0.86∼0.89) were greater than those with the original ultrasound images (0.81∼0.86) and all the radiologists improved their performance significantly ( p < 0.05) except two senior radiologists ( p > 0.05). The Az values of the junior radiologists with CAD were comparable to those of the senior radiologists. Cohen's κ statistics showed that better interobserver agreement was obtained by using the processed images. We conclude that the proposed CAD method is more helpful for the junior radiologists than for the senior ones and it also showed the advantage of decreasing interobserver variability. (E-mail: jwtian2004@yahoo.com.cn)

Teachers’ perception of adolescents violence in Anambra state secondary schools

The study which was a survey investigated teachers’ perception of adolescents’ violence in secondary schools in Awka Education zone of Anambra State. The study was guided by three research questions and two null hypotheses stated at .05 level of significance. A sample of 400 out of 1,863 teachers responded to the questionnaire items. The data generated through the questionnaire were statistically analysed using mean, standard deviation and t-test statistics. The study found out that such forms of violence as destruction of school property, fighting, kicking, bullying, pushing, breaking and destroying other students’ lockers and personal belongings, cultism, riots, beating teachers, flogging the junior students by the senior ones are prevalent in secondary schools. Again the study revealed that the degree of adolescents’ involvement in violence is relatively very high. In view of the findings of the study, recommendations of the study were highlighted.

Injury incidence rate, severity and diagnosis in male volleyball players

The aim of this study was to record the injury incidence in all age categories in male volleyball players and clarify the role of age in injury occurrence. The injury incidence rate, severity, diagnosis and the anatomical location of the injuries that occurred during practice and competition in the whole championship period were recorded prospectively during the period 2005–2006. A total of 407 Greek male volleyball players participating in all Volleyball Championships in Greece according to the Greek Volleyball Federation have been observed on a weekly basis for the period 2005–2006. The injury incidence rate was recorded as the number of injured players and also the number of injuries per player per year (total exposure time). The results revealed that injury occurrence is age related and junior volleyball players have a lower injury rate than senior ones. There were significantly more acute injuries in comparison to overuse syndrome and the ankle was the most common injured anatomical location. Finally, outside hitters, universals and setters presented different injury rates to other players and the “incorrect sprawls” and “stepping on others’ feet” were the most common injury factors. In conclusion, findings in the injury occurrence rate must be interpreted in relation to the total exposure time in order to have more realistic conclusions.

Analysis of biological networks

Analysis of biological networks

Physicians' attitudes towards knowledge transfer and sharing

PurposeThe role of medical and health organizations within their communities has been altered to include knowledge services as a basic issue facing the current era of complexities as related to health. Knowledge transfer (KT) can provide the right vehicle for transferring the needed knowledge through different means suitable to each group of receivers, including patients. This study aims to identify the management of activities that help in facilitating KT (the environment), the groups or individuals with when the respondents are communicating, the frequency and type of communications that respondents share with others, the effective forms of communications they use, and the knowledge and learning instruments which are used to transfer and share knowledge.Design/methodology/approachThe study focuses on how health organizations in the Sultanate of Oman view their corporate knowledge and utilize it to improve practices and subsequently reinforce quality standards, while sustaining the image of learning organizations. Based on that, the study attempts to gain a comprehensive picture of the process of KT to show how physicians at two hospitals look at the knowledge of its participants and to discover how participants are willing to share, transfer and receive knowledge.FindingsThe results indicate that junior physicians suffered from work overload and senior ones had negative attitudes and were unwilling to share knowledge. In addition, social activities at both places were not strong enough to encourage the communication process among physicians to share insights and reduce medical errors.Originality/valueThe paper provides a comprehensive overview of the process of KT in two hospitals.

Identifying nurses' rewards: a qualitative categorization study in Belgium

BackgroundRewards are important in attracting, motivating and retaining the most qualified employees, and nurses are no exception to this rule. This makes the establishment of an efficient reward system for nurses a true challenge for every hospital manager. A reward does not necessarily have a financial connotation: non-financial rewards may matter too, or may even be more important. Therefore, the present study examines nurses' reward perceptions, in order to identify potential reward options.MethodsTo answer the research question "What do nurses consider a reward and how can these rewards be categorized?", 20 in-depth semi-structured interviews with nurses were conducted and analysed using discourse and content analyses. In addition, the respondents received a list of 34 rewards (derived from the literature) and were asked to indicate the extent to which they perceived each of them to be rewarding.ResultsDiscourse analysis revealed three major reward categories: financial, non-financial and psychological, each containing different subcategories. In general, nurses more often mentioned financial rewards spontaneously in the interview, compared to non-financial and psychological rewards. The questionnaire results did not, however, indicate a significant difference in the rewarding potential of these three categories. Both the qualitative and quantitative data revealed that a number of psychological and non-financial rewards were important for nurses in addition to their monthly pay and other remunerations. In particular, appreciation for their work by others, compliments from others, presents from others and contact with patients were highly valued. Moreover, some demographical variables influenced the reward perceptions. Younger and less experienced nurses considered promotion possibilities as more rewarding than the older and more senior ones. The latter valued job security and working for a hospital with a good reputation higher than their younger and more junior colleagues.ConclusionWhen trying to establish an efficient reward system for nurses, hospital managers should not concentrate on the financial reward possibilities alone. They also ought to consider non-financial and psychological rewards (in combination with financial rewards), since nurses value these as well and they may lead to a more personalized reward system.

Errores clínicos y eventos adversos: percepción de los médicos de atención primaria

To evaluate how primary care physicians perceive and face clinical errors (CE) and/or adverse events (AE). Cross-sectional study (personal mail survey). SETTING. Primary care physicians from "Ambit Costa de Ponent." All doctors with tenure from this area (717). Standardized questionnaire with error and adverse event frequencies. We compared answers considering age, gender, family medicine residency, "deniers" (never make a mistake), "perceptive" (admitting a mistake in the last year), "hyper-perceptive" (28 or more errors/adverse events a year), "internal locus of control" (admitting personal reasons in errors), and "hypersecure" (>7 points out of 10 in clinical security on Likert scale). Two hundred thirty eight physicians (33.2%) with an average age of 42.6 (95% CI, 41.6-43.6) replied. The 28% were "deniers" (95% CI, 22.34-34.26), 67% "perceptive" (95% CI, 60.79-73.23), 7.4% "hyperperceptive" (95% CI, 4.41-11.44), 6% had "internal locus of control" (95% CI, 3.34-9.91), and 23.4% were "hypersecure" (95% CI, 18.14-29.22). Every doctor had on average 10.6 adverse events yearly, mainly drug side-effects (37%) (95% CI, 35.36-39.15), and diagnostic delay in oncology scenarios (33%) (95% CI, 31.16-34.85). The most common reaction to an error was to try and contact the patient (80%) (95% CI, 73.24-85.73) and to communicate the case to the team (41.4%) (95% CI, 33.97-49.22). AE and CE were recognized as frequent, but a third of doctors affirmed they never made a mistake. Young male physicians, unlike senior ones, communicate mistakes to the team. "Internal locus of control" and "hyperperceptive" professionals tended to have stronger emotional reactions after committing errors. Physicians felt less secure with ophthalmology and ENT problems; and older doctors added to these dermatology and palliative care.

General Stream Adjudications and the Environment

An article on the relationship between general stream adjudications and the environment should be a short one. There is none. The basic purpose of adjudications is to sort through the conflicting claims of users to surface water (and sometimes ground water) under the prior appropriation doctrine. The most valuable rights – the most senior ones – are often enshrouded in the mysteries of the past. Adjudications subject these claims, frequently based on oral recounting or flimsy paper records, to proof in a court of law. It is hoped at the end of the day that the adjudication court will enter a judicial decree that establishes water rights to specific quantities of water with relative priority dates. Given this central mission, it is obvious that adjudications are not designed to protect rivers by keeping water in the rivers, unless a particular state protects rivers through instream flow rights or other doctrines such as the public trust.

Dedovshchina in the Russian Army: The Problem That Won't Go Away

The problem of unsanctioned relations has a major impact on all Army units. –Major V. V. Savel'ev Of the many problems facing the Russian political and military leadership as it attempts to rebuild and reform the Russian armed forces, none is of greater concern than dedovshchina, or the harassment of junior recruits by more senior ones. It has undermined combat readiness, unit cohesion and led to an increase in suicides and desertions by recruits who cannot stand the kind of humiliation, beatings, rapes and even murders they face on a daily basis. In this regard, Vladimir Putin, Sergei Ivanov and the military high command are at a cross-roads. They have made some major, even fundamental structural changes in the way the Russian armed forces are organized and operate, but no change, not even the addition of desperately needed weapons, equipment, and financial resources or key personnel changes at the top will make the Russian Army into an effective military unless the Russian high command either gets rid of or minimizes the impact of dedovshchina. Such a step will not solve all of the Russian Army's problems, but it is a critical step on the way to making the Russian Army into a serious, cohesive, combat ready military.

Attitudes towards corporal punishment and reporting of abuse

Objectives: To assess physicians’ attitudes towards corporal punishment in childhood and their subsequent actions regarding the reporting of child abuse. Participants: 107 physicians (95 pediatricians and 12 family practitioners) who work in hospitals and community clinics in northern Israel were interviewed. Of the participants, 16% were new immigrants. Procedure: A structured interview was conducted by one of two pediatric residents. Results: Attitudes towards corporal punishment were not influenced by the physicians’ sex or specialty. Corporal punishment was approved by 58% of the physicians. A significant difference in attitudes towards corporal punishment between immigrants and Israeli born physicians was found ( p=.004). Family practitioners and especially senior ones were found significantly less tolerant towards corporal punishment than pediatricians ( p=.04). While reporting behavior was not found to be associated with parental status and the past experience of the physicians with child abuse, a significant effect of attitudes towards corporal punishment on reporting behavior was found ( p=.01). Conclusions: (1) Corporal punishment is still perceived as an acceptable disciplinary act by a significant proportion of physicians responsible for the health care of children in our area. (2) Attitudes towards corporal punishment are different between immigrants and native born Israeli trained doctors and, unexpectedly, pediatricians were more tolerant of corporal punishment than family practitioners.

Robert Wilson

Robert Wilson

A Pot Pourri of Trivia

It is a truism that medical students, junior doctors, and even some senior ones may develop symptoms that they interpret (usually falsely) as indicative of illness within their own area...

Dangerous collusion: corruption as a collective venture in contemporary China

Echoing changing social environments, corruption has grown in sophistication and complexity. This paper focuses on the phenomenon of collective corruption. Collective corruption, a distinctive form of social interaction among people dominated by individual calculations and unorganized interests, takes place when collaboration becomes a powerful, necessary weapon in pursuing private gains. The danger of collusion in corrupt ventures is that as corruption gets well planned and skillfully coordinated in its collective form, it may become less forthright and therefore more difficult to detect, or more overt and increasingly legitimized as an appropriate form of economic intercourse. The term corruption tends to carry with it an image of secrecy and furtiveness that entails the involvement of the least possible number of individuals. Corruption, on the whole, is a clandestine exchange due to its illegal nature. Corruption takes place, for example, when a financial officer embezzles public funds for personal use, a school principal arranges “back-door” admissions for his relatives or friends, or a government official accepts bribes from his subordinates in exchange for favourable treatment. These practices are either conducted by a single person who seeks to enrich him/herself in an individualized manner or occur between two parties where a patron (usually an official) grants his/her client (whoever is willing and able to pay for it) desired preferential treatment in exchange for goods or services. Corruption, in reality, is more complex than its heuristically useful definition. Echoing changing social environments, corruption grows in sophistication and complexity in terms of causes, forms and characteristics. This paper studies the phenomenon of “collective corruption”, a concept derived from the author’s research in China where recent corruption cases show an alarming tendency for party and government officials to collude with each other, as well as with people outside the government, on a massively corrupt scale. The following are just a few examples of this kind of “dangerous collusion”: • In Hebei province, a collective embezzlement case involved at least seven high-ranking government officials, including the province’s executive deputy governor, bureau chief of transportation, director of the taxation department, and the party secretary of a major city. 1 1 Hebei Ribao, 21 November, 2000. • A startling bribery case concerning the Minjiang Engineering Bureau of Fujian Province implicated 70% of its bureau-level officials, including the two most senior ones—the bureau director and the party chief. 2 2 Datequ Dangfeng (The Party Discipline in Special Economic Zones), 7 June, 1997. • More than twenty bureau and departmental chiefs were involved in a case of land leasing fraud. Each of them accepted bribes of at least hundreds of thousands RMB. 3 3 People’s Daily, 1 November, 2000. The exchange rate between US dollars and Chinese RMB is approximately $1=8 yuan. • When a major corruption case of the East China Aviation Management Bureau was disclosed, seven section directors and one deputy bureau chief were found involved. 4 4 Baokan Wenzhai (Shanghai), 10 September, 1998. • More than a dozen officials at the Public Security Bureau in Qinghai Province were found guilty of corruption, including the bureau chief, deputy chief, deputy director of the province’s legal affairs office, and deputy general manager of a company affiliated with the bureau. 5 5 Zhongguo Jiancha (Supervision in China), July 2000, p. 32. These cases, and many more like them, testify to the fact that corruption in many instances takes the form of a collective undertaking. Why do people act collectively rather than singly in what is supposedly a secret exchange? How do they come to transcend or bypass institutional and legal boundaries in their collusion? To what extent does the collectivization of corruption alter the forms and characteristics of corruption, if not its very nature? What impact does collective corruption have on the overall efforts to curb corruption? This article tries to provide answers to these questions. It treats collective corruption as a distinctive form of social interaction among people dominated by individual calculations and a pursuit of personal interests. It extends the analysis of collective behavior to corruption and argues that an aggregation of individual pursuits of self-interest can yield similar claims and behavior patterns. Collective corruption serves as a good case to study how unorganized interests generate collective behavior and how collaboration becomes a powerful weapon in seeking private gains. This article opens with a definition of collective corruption. It then discusses the socio-economic and psychological roots of collective corruption and offers interpretative remarks on how and why collective corruption rapidly spreads in China. In so doing, it portrays the characteristics of collective corruption as a distinctive form of collective behavior. The findings of this article illustrate how corruption is evolving as its actors, forms, and characteristics actively respond to social and economic changes, especially under the construct of a hybrid of state socialism and capitalism in today’s China.

Anti‐Foundationalism and Radical Orthodoxy

It has often been claimed in the history of philosophy that great thinkers have been badly served by their disciples. Plato’s genuine doctrines don’t resemble the historical construction known as “Platonism”, Aquinas is a more subtle and rigorous thinker than the Thomists, Hume more interesting than the positivists and so on. This claim is cuirendy deployed for certain thinkers who collectively bear the signifier “Postmodern”. It’s held that Derrida, Foucault, Deleuze et al., are more subtle, deep and dialectically agile than their disciples. In particular, those who regard these thinkers as philosophers maintain that the use to which they are put in other disciplines—literary theory, cultural studies, sociology, and so on, fails to convey the depth of the echt thinker.Be that as it may, it is true that philosophical ideas percolate into other disciplines and have profound general cultural impact, and this is especially true of the so-called postmodern ideas. Theologians in particular have responded with a certain degree of alacrity to the postmodern clarion (probably because modernism proved barren ground for most of them). The kind of views articulated in theology serve also as a model of the way postmodernist views have been used in general in the humanities and social sciences. It’s not unusual for theologians to latch onto the latest philosophical fashion and use it with skill and ingenuity. The medieval theologians of Paris reacted to Aristotle and developed some of the most enduring intellectual works of the western tradition. The Cartesian revolution led to sustained theological reflection—a position still appearing as a bogey for novice theologians to sharpen their dialectical teeth on, or for more senior ones to dramatically unmask in their opponents.

The effects of surface roughness and polymethylmethacrylate precoating on the radiographic and clinical results of the Iowa hip prosthesis. A study of patients less than fifty years old.

The purpose of the present study was to compare the results associated with two different surface finishes (bead-blasted and grit-blasted) for Iowa femoral components used in total hip arthroplasties performed between January 1979 and June 1991 in patients who were less than fifty years old. Between January 1979 and December 1985, thirty-six primary total hip replacements were performed in twenty-five patients with insertion of a bead-blasted Iowa femoral component (average surface roughness, 0.8 micrometer) with cement and insertion of a titanium-backed acetabular component (thirty-five hips) or non-metal-backed acetabular component (one hip) with cement. Between January 1986 and June 1991, forty-five primary total hip replacements were performed in thirty-seven patients with use of a precoated grit-blasted Iowa femoral component (average surface roughness, 2.1 micrometers) and a Harris-Galante-I porous ingrowth acetabular component (forty-one hips) or an Osteonics component (four hips). The only change in the design of the femoral component (other than the surface finish) between the two consecutive series was the addition of polymethylmethacrylate precoating to the proximal third of all forty-five grit-blasted stems and modularity of the femoral head of the last eight grit-blasted stems. No hip was lost to follow-up. The duration of radiographic follow-up of the hips treated with the bead-blasted component averaged 11.3 years (range, ten to sixteen years) postoperatively, whereas that of the hips treated with the precoated grit-blasted component averaged 8.2 years (range, five to eleven years). Two (6 percent) of the bead-blasted femoral components were revised because of aseptic loosening compared with eight (18 percent) of the precoated grit-blasted components. Four bead-blasted components (11 percent) were either radiographically loose or were revised because of loosening compared with eleven precoated grit-blasted components (24 percent). Kaplan-Meier survivorship curves evaluated with log-rank analysis revealed that the bead-blasted Iowa femoral components were revised because of aseptic loosening (p = 0.0184) and were radiographically loose (p = 0.0068) less often than the precoated grit-blasted Iowa femoral components. The findings of the present study have led the senior ones of us to resume using femoral components with a polished surface and fixed with cement.

The Golden Rule of Grading: Being Fair

Here is a typical scene. After two teaching assistants, one experienced and one new, hand back the first graded assignment in the fall, the experienced TA gets a few students coming in to ask about how they can improve their work. The students may be upset, but they usually are not angry at the grader. They ask what they can do to improve their performance next time. Meanwhile, the new TA has a line of angry students coming in to argue that the grading wasn't fair. It happens every fall, and new TAs find themselves wondering why they are dealing with such an angry crowd when the more experienced ones are not. The reason new TAs hear the complaint about unfair grading far more often than senior ones is that experienced graders tend to follow four important rules. This article may help new teaching assistants from having to learn these rules the hard way. If TAs take this advice seriously, they will find teaching and grading far more pleasant, and their students will be more satisfied as well.

Частота увеличения щитовидной железы и экскреция йода с мочой у детей Новосибирска

The aim of this study was to assess the prevalence of thyroid hyperplasia and iodine deficiency in children in the city of Novosibirsk. Children aged 7 to 10 and 13 to 16 years of both sexes were examined. The degree of thyroid hyperplasia was assessed by palpation and ultrasonic method, thyroid function was assessed clinically, and the level of urinary excretion of inorganic iodine was measured. Ultrasonography revealed enlargement of the thyroid in 20% of younger schoolchildren and in 47% of pubertal children. Slight or moderate iodine deficiency was revealed in half of all examinees; the condition was 1.5 times more frequent in younger children than in senior ones. Measurements of daily urinary excretion of iodine in children and adults indicate that iodine consumption is insufficient. The authors consider that high prevalence of thyroid hyperplasia in the children of Novosibirsk is a result of neglect of endemic goiter control in Russia and emphasize that the state program for salt iodination is to be resumed.

"There's a Footnote to History!" Memory and the History of Martin Luther King's October 1960 Arrest and Its Aftermath

Politicians possess characteristics with distinct implications for oral history. On the one hand, they tend to be gregarious and affable, are relatively at ease with the microphone and tape recorder, have been interviewed on numerous occasions, and often have a highly developed sense of historical consciousness, living in a world that they have clearly influenced. As the number of political oral history projects increases, politicians may also realize that oral history interviews come with the territory. On the other hand, politicians-especially the more senior ones -can easily develop and present an inflated sense of their own importance in the governmental process. They are also interested in the protection of their established public images and reputations. This is especially true of those still in or contemplating office, who must regularly face voters, constituents, and the media, and who have ongoing political obligations.1 Interviews with former southern politicians display their own special problematic aspects, particularly when the subject turns to race, segregation, or desegregation. Many white politicians grew up amid and defended segregation, ended up on the losing side, then adapted to new politicial realities. Understandably, they are often hesitant, cautious, or uncomfortable discussing the past, especially in the presence of interviewers from a different generation who have been raised with dramatically different values and practices concerning race. Yet oral history interviews with politicians can prove crucial in shedding new light on even the most celebrated of events. This essay explores the history and memory of an incident that looms large in the nation's recent political history: the October 1960 arrest of Martin Luther KingJr. and the subsequent intervention ofJohn F and Robert Kennedy in the affair. From Theodore White and Arthur M. Schlesinger

HÁBITOS E ATITUDES DOS ACADÊMICOS DE ODONTOLOGIA DA UNIVERSIDADE FEDERAL DE GOIÁS EM RELAÇÃO AO AÇÚCAR E À SAÚDE

O presente estudo objetivou investigar os hábitos dietéticos de um grupo de acadêmicos de Odontologia em relação ao açúcar, analisando a influência dos conhecimentos adquiridos durante o curso. Os dados foram coletados através de questionários aplicados a 140 acadêmicos recém-ingressantes e formandos da Universidade Federal de Goiás. Observou-se que o consumo de sacarose foi mais freqüente entre os recém-ingressantes (92%) do que entre os formandos (80%) (p &lt;&lt; 0,05). Sessenta por cento dos formandos relataram ter reduzido a ingestão após o ingresso no curso, e a grande maioria pretende recomendar restrição de açúcar aos próprios filhos (97,5%) e aos futuros pacientes (87%), visando uma melhor saúde bucal e geral (77%). Concluiu-se que os conhecimentos adquiridos não levam necessariamente à mudança dos hábitos dietéticos entre os acadêmicos de Odontologia, apesar de influenciarem em sua intenção de conduta junto aos futuros filhos e pacientes

Total knee replacement in young, active patients. Long-term follow-up and functional outcome.

We reviewed our experience with total knee arthroplasties performed between 1977 and 1992 in patients who were fifty-five years old or less to determine the appropriate management for younger patients who have severe osteoarthrosis. One hundred and fourteen knee replacements were performed in eighty-eight patients who were an average of fifty-one years old (range, twenty-two to fifty-five years old). All of the operations were performed by one of the two senior ones of us (J. N. I. or W. N. S.) with the use of cementing techniques. A posterior stabilized, posterior cruciate-substituting design was used for all but one replacement, for which a semiconstrained total condylar prosthesis was used. Six knees (four patients) were lost to follow-up. Follow-up data for the remaining 108 knees (eighty-four patients) were used to perform the survivorship analysis. One hundred and three unrevised knees (eighty patients) were available for clinical evaluation with the scoring systems of The Hospital for Special Surgery and the Knee Society at an average of eight years (range, three to eighteen years) postoperatively; thirty-six knees were followed for more than ten years. In addition, the activity levels of the patients were assessed with the activity score of Tegner and Lysholm. Radiographs were examined for evidence of loosening of the component. At the latest follow-up examination, the average knee score according to the system of The Hospital for Special Surgery had improved from 55 points preoperatively to 92 points. According to the system of the Knee Society, the average knee score was 94 points and the average functional score was 89 points. The result for all 103 knees was good or excellent according to the knee scores of The Hospital for Special Surgery and the Knee Society. Ninety-seven knees (94 per cent) had good or excellent function according to the functional score of the Knee Society. The average activity score of Tegner and, Lysholm improved from 1.3 points (range, 0 to 4 points) preoperatively to 3.5 points (range, 1 to 6 points) at the latest follow-up examination. All but two patients had improvement in the activity score postoperatively, and nineteen (24 per cent) of the eighty patients had an activity score of at least 5 points, indicating regular participation in activities such as tennis, skiing, bicycling, or strenuous farm or construction work. Nine (9 per cent) of the 103 knees had non-progressive tibial radiolucent lines. Two patients had a revision because of late infection, and one patient had revision of a well fixed tibial component because of wear of the polyethylene. In addition, three patellar components were revised for loosening, and one spacer was exchanged to treat instability. With failure defined as revision of either the femoral or the tibial component, the over-all rate of survival was 94 per cent at eighteen years. When the three patellar revisions were included in the failures, the survival rate was 90 per cent at eighteen years. When the exchange of the spacer was also included in the failures, the survival rate was 87 per cent at eighteen years. We consider arthroplasty with cementing of a posterior stabilized total knee prosthesis to be effective operative treatment with durable results for osteoarthrosis in younger patients when other, less invasive measures have failed. Within the average eight-year follow-up interval of this study, polyethylene wear, osteolysis, and loosening of the conforming posterior cruciate-substituting prosthesis were not major problems for these younger, active patients, although it is possible that this observation could change with an even longer duration of follow-up.