Dislocations of the upper extremity in children

Traumatic dislocations and subluxations of the upper extremity in children have been surveyed. The elbow joint is most commonly dislocated and is dislocated more frequently in children than in adults. Severe neurovascular injury may be associated with dislocation of this joint. The most common subluxation is that of the radial head, secondary to a "pulled elbow." Otherwise dislocations and subluxations of the upper extremity are uncommon in children, apparently because of the relative weakness of the epiphyseal plate. Most of these injuries are the result of predictable indirect forces. Principles of reduction and immobilization are based on the unique anatomic structure of the joint involved and the known anatomic disruption resulting from the trauma.     

An educational strategy for occupational therapy community service

In response to the increasing trend toward community health care, a model of training that prepares students for community practice was incorporated into the occupational therapy curriculum at the University of Southern California. During academic training students are placed in a part-time community assignment where no occupational therapy services are offered. Training students for the role of community health specialist produces a dilemma for curriculum design. A balance must be achieved between providing traditional clinical content and providing the knowledge and expertise necessary for community practice. However, this training is considered necessary for maintaining the viability of the profession in a changing health system. Significantly, during the four-year period using this model, many graduates have sought employment in "nontraditional" community roles.     

Comparative analysis of experimental performance and stability of sensorless induction motor drives

This paper compares the experimental performance of three flux and speed observers for speed-sensorless induction motor drives and discusses the cause of their differences. The small signal analysis using the linearized model is carried out to analyze stability. Three methods are generally accepted to be representative candidates for high sensorless performance, namely: 1) rotor-flux model reference adaptive system (MRAS); 2) torque-current MRAS; and 3) adaptive nonlinear flux observer. Many other sensorless methods improved these methods. The paper discusses baseline conditions for the experiments and the stability analysis, which include matched load inertia, specified speed estimator dynamics, and sensorless operation within a speed control loop. For the comparison tests in the paper, the speed estimation dynamics of the methods are the same; this is important for parameter sensitivity. The paper concentrates on the low-speed performance, and all results shown are under sensorless speed control.     

Vascular endothelial growth factor (VEGF) induces rapid prourokinase (pro-uPA) activation on the surface of endothelial cells

Vascular endothelial growth factor (VEGF) is the pivotal angiogenic growth factor activating endothelial cells to migrate, proliferate, and form capillary tubes. For an ordered endothelial cell migration, tissue invasion, and degradation of the extracellular matrix, proteolytic machinery is indispensable. Such machinery, suitable for localized proteolysis, is provided by the prourokinase-urokinase-plasmin system. Prourokinase (pro-uPA), the initial component of this system, is, however, synthesized in its inactive precursor form and as such bound to its cellular receptor uPAR. Here we identify a mechanism via which VEGF(165) interacting with its receptor VEGFR-2 rapidly induces prourokinase activation that is dependent on a change in integrin affinity, activation of matrix metalloproteinase 2 (MMP-2), and pro-uPA being bound to its surface receptor uPAR. This VEGF-induced pro-uPA activation on endothelial cells is responsible for VEGF-dependent local fibrinolytic activity and might be one of the initial steps in the angiogenic process.     

Compact beam expander with linear gratings

Novel compact beam expanders that could be useful for applications such as providing light to flat panel displays are presented. They are based on a planar configuration in which three spatially linear gratings are recorded on one transparent substrate, so as to expand a narrow incoming beam in two dimensions. We present the design and recording procedures along with results, showing a relatively uniform intensity of the wide output beam. Such expanders can serve for illuminating flat panel displays.     

Effects of foam on ocean surface microwave emission inferred from radiometric observations of reproducible breaking waves

WindSat, the first satellite polarimetric microwave radiometer, and the NPOESS Conical Microwave Imager/Sounder both have as a key objective the retrieval of the ocean surface wind vector from radiometric brightness temperatures. Available observations and models to date show that the wind direction signal is only 1-3 K peak-to-peak at 19 and 37 GHz, much smaller than the wind speed signal. In order to obtain sufficient accuracy for reliable wind direction retrieval, uncertainties in geophysical modeling of the sea surface emission on the order of 0.2 K need to be removed. The surface roughness spectrum has been addressed by many studies, but the azimuthal signature of the microwave emission from breaking waves and foam has not been adequately addressed. Recently, a number of experiments have been conducted to quantify the increase in sea surface microwave emission due to foam. Measurements from the Floating Instrumentation Platform indicated that the increase in ocean surface emission due to breaking waves may depend on the incidence and azimuth angles of observation. The need to quantify this dependence motivated systematic measurement of the microwave emission from reproducible breaking waves as a function of incidence and azimuth angles. A number of empirical parameterizations of whitecap coverage with wind speed were used to estimate the increase in brightness temperatures measured by a satellite microwave radiometer due to wave breaking in the field of view. These results provide the first empirically based parameterization with wind speed of the effect of breaking waves and foam on satellite brightness temperatures at 10.8, 19, and 37 GHz.     

Rack-induced metal binding vs. flexibility: Met121His azurin crystal structures at different pH

The rack-induced bonding mechanism of metals to proteins is a useful concept for explaining the generation of metal sites in electron transfer proteins, such as the blue copper proteins, that are designed for rapid electron transfer. The trigonal pyramidal structure imposed by the protein with three strong equatorial ligands (one Cys and two His) provides a favorable geometry for both cuprous and cupric oxidation states. However, the crystal structures of the Met121His mutant of azurin from Alcaligenes denitrificans at pH 6.5 (1.89- and 1.91-A resolutions) and pH 3.5 (2.45-A resolution) show that the preformed metal binding cavity in the protein is more flexible than expected. At high pH (6.5), the Cu site retains the same three equatorial ligands as in the wild-type azurin and adds His121 as a fourth strong ligand, creating a tetrahedral copper site geometry with a green color referred to as 1.5 type. In the low pH (3.5) structure, the protonation of His121 causes a conformational change in residues 117-123, moving His121 away from the copper. The empty coordination site is occupied by an oxygen atom of a nitrate molecule of the buffer solution. This axial ligand is coordinated less strongly, generating a distorted tetrahedral copper geometry with a blue color and spectroscopic properties of a type-1 site. These crystal structures demonstrate that blue copper proteins are flexible enough to permit a range of movement of the Cu atom along the axial direction of the trigonal pyramid.     

Management of thyroid carcinoma invading the aerodigestive tract

OBJECTIVES: To evaluate approaches to thyroid carcinoma invading the aerodigestive tract, with particular attention to well-differentiated carcinomas. STUDY DESIGN: Retrospective review of experience with thyroid carcinoma invading the aerodigestive tract over a 20-year period at a tertiary referral hospital. METHODS: The medical records of all patients with a diagnosis of thyroid cancer treated at Emory University Hospital, Atlanta, Georgia, from 1977 through 1997 were reviewed. Multiple clinical variables were analyzed including treatment, development of recurrence, and survival. Survival and time to local recurrence were determined by Kaplan-Meier analysis, and statistical comparisons were made using log-rank analysis. RESULTS: Five hundred thirty-six cases were identified; 28 patients (5.2%) were identified with invasive disease involving the aerodigestive tract. Histologic findings at the time of invasion included 15 well-differentiated (WD) carcinomas and 13 poorly differentiated (PD) carcinomas. Eight of the 28 patients (5 WD, 3 PD) underwent surgical resection of some portion of the aerodigestive tract with curative intent. Ten patients (8 WD, 2 PD) underwent incomplete resection with tumor left adjacent to aerodigestive tract structures. All patients undergoing incomplete resection developed local recurrence. Six required salvage resection, as opposed to no recurrences in WD carcinomas following complete resection (P = .01). Survival at 5 years for WD carcinomas undergoing complete resection versus initial incomplete resection was 100% versus 50%, respectively (P = .27). CONCLUSION: Review of our experience shows that complete resection of thyroid carcinoma invading the aerodigestive tract can offer prolonged palliation, improved local control, and the opportunity for cure in selected patients.