178 research outputs found
Varus Derotation Osteotomy for the Treatment of Hip Subluxation and Dislocation in GMFCS Level III to V Patients With Unilateral Hip Involvement. Follow-up at Skeletal Maturity
No full textPurpose: Hip displacement is common in children with cerebral palsy (CP). The risk of hip displacement is related to gross motor function level as graded with the Gross Motor Function Classification System (GMFCS). Most clinicians agree that surgical treatment is indicated for progressive hip subluxation in patients with CP. However, it is unclear whether unilateral bony surgery and musculotenduous release is effective in cases in which the contralateral hip is well seated. The purpose of this study is to describe the fate of the original and the contralateral hip of severely involved patients with CP, GMFCS III to V, with unilateral hip subluxation or dislocation treated by unilateral femoral osteotomy with or without pelvic osteotomy along with unilateral or bilateral soft tissue release when the contralateral hip was well seated followed to skeletal maturity. Methods: A continuous group of GMFCS III to V CP patients with unilateral hip subluxation or dislocation who underwent soft tissue release (adductor and iliopsoas) and unilateral intertrochanteric varus, rotation and shortening osteotomy with or without pelvic osteotomy are included. All patients were clinically and radiologically followed from the time of presentation until skeletal maturity. Results: Twenty-seven children and adolescents with GMFCS level III, IV, and V met the inclusion criteria. Two patients (7.4%) were GMFCS III, 5 (18.5%) were GMFCS IV and 20 (74.1%) GMFCS V. The male: female ratio was almost 1 (13 boys and 14 girls). At the time of chart and radiograph review, the average age of this patient group was 20.4 years (range: 14 to 25y).Twelve patients (44%) required subsequent bony surgical management of the contralateral hip for subluxation or dislocation after the index procedure. Initially, in all cases there was pelvic obliquity with the operative side higher, which reversed in cases in which the contralateral hip deteriorated, and did not reverse when the contralateral hip remained stable. Nine of them were treated with femoral varus osteotomy alone and 3 underwent a combination of femoral and pelvic osteotomy. Three of these 12 (25%) patients had revision of the first hip and bony correction of the contralateral hip. Age at surgery did not seem to have a significant effect on maintaining reduction or in preventing the contralateral hip to deteriorate. Conclusions: The rates of recurrence of the original hip and contralateral hip subluxation and dislocation after unilateral bony surgery in GMFCS III to V spastic patients are higher than those of other earlier series. However, in this series patients were followed until skeletal maturity. It is prudent to warn families of the possibility of long-term subluxation or dislocation of the original hip and development of the hip dysplasia requiring surgery on the contralateral side. Consideration should be given to adductor and iliopsoas release and bony surgery on the contralateral side in a GMFCS level III to V child undergoing surgery for hip displacement, even when the hip seem radiologically normal. If unilateral bony surgery is carried out, close radiological follow-up of both hips is recommended. It also seems that unilateral hip surgery alters the forces maintaining pelvic alignment, which can lead to destabilization of the contralateral hip. Copyright © 2010 by Lippincott Williams & Wilkins
Supplemental Material - Independent Prognostic Factors Associated With Improved Patient-Reported Outcomes in the Prospective Evaluation of Elderly Deformity Surgery (PEEDS) Study
No full textSupplemental Material for Independent Prognostic Factors Associated With Improved Patient-Reported Outcomes in the Prospective Evaluation of Elderly Deformity Surgery (PEEDS) Study by Fthimnir M. Hassan, Lawrence G. Lenke, Sigurd H. Berven, Michael P. Kelly, Justin S. Smith, Christopher I. Shaffrey, Benny T. Dahl, Marinus de Kleuver, Maarten Spruit, Ferran Pellise, Kenneth M. C. Cheung, Ahmet alanay, David W. Polly Jr., Jonathan Sembrano, Yukihiro Matsuyama, Yong Qiu, Stephen J. Lewis, and AO Spine Knowledge Forum Deformity in Global Spine Journal</p
Il Sistema Informativo Lavoro della Regione Campania: stato attuale e linee di sviluppo
No full textLa costituzione dei Sistemi Informativi del Lavoro (SIL) regionali risale al D. Lgs. 469/97, che disciplina il decentramento delle funzioni del collocamento pubblica e delle politiche attive del lavoro alle Regioni ed alle Province. La legge regionale 14/98 affida all'Agenzia della Campania per il Lavoro (ARLAV) il compito di realizzare il SIL della Regione Campania e di fornire alle Province, in quanto titolari della gestione dei Centri per l'Impiego (CPI), gli strumenti necessari per il loro funzionamento. Rispetto ad altre fonti amministrative, i SIL regionali sembrano destinati a fornire una copertura parziale dei fenomeni che riguardano il mercato del lavoro. Questa osservazione non esclude la possibilità di usare i dati del SIL per trarre conclusioni sul mercato del lavoro regionale, ma evidenziano la necessità di sottoporre questi dati ad operazioni di verifica e di controllo. In questo saggio, si offre un quadro del popolamento delle banche dati regionali e si presenta un breve riassunto dei dati raccolti dai Centri per l'Impiego della Regione Campania
Unlocking the power of collaborative learning in secondary schools. A transnational comparative analysis between Italy and Malta. Liberare il potenziale dell’apprendimento collaborativo nella scuola secondaria. Un’analisi comparata tra Italia e Malta
No full textL’articolo presenta uno studio comparativo sull’utilizzo delle tecniche di apprendimento collaborativo nelle
classi della scuola secondaria di primo e secondo grado in Italia e Malta e analizza i fattori che ne impediscono
l’utilizzo. L’analisi qualitativa dei dati emersi dai questionari somministrati a 30 insegnanti precari italiani
e 50 educatori di supporto all’apprendimento maltesi al termine dei rispettivi percorsi formativi,
evidenzia una valutazione positiva delle pratiche di apprendimento collaborativo, ma anche fortemente critica
dei fattori che inibiscono l’applicazione di una filosofia centrata sullo studente. I risultati indicano che
gli insegnanti a Malta sembrano condizionati da aspetti socioculturali postcoloniali, come un sistema educativo
centralizzato ed un approccio all’apprendimento competitivo basato sul curriculum tradizionale.
Inoltre, gli insegnanti sembrano riluttanti ad implementare tali tecniche poiché le percepiscono come poco
compatibili con l’inclusione di tutti gli studenti. Per i precari italiani, sono le carenze relative al sistema di
reclutamento dei docenti a contribuire a tale esitazione. Mentre la resistenza da parte di colleghi, studenti
e genitori demotiva gli insegnanti della secondaria di secondo grado, quelli della secondaria di primo grado
sembrano vedere nella scuola il luogo ideale per sperimentare le tecniche di apprendimento collaborativo.
L'analisi tematica dei focus groups richiama l'urgenza di rivisitare il concetto di "educazione" a Malta, la
necessità per gli insegnanti italiani di una alleanza educativa multi-stakeholder e il bisogno di uno sviluppo
professionale continuo che consenta di cogliere in modo proattivo la "transizione metodologica" verso le
tecniche di apprendimento collaborativo.This paper presents a transnational comparative study on the use of Collaborative Learning (CL) techniques
in lower and upper secondary classes in Italy and in Malta as it analyses the factors which impede its use.
The qualitative analysis of open-ended questionnaire data, supplied by participating educators (30 Italian
precarious teachers and 50 Maltese Learning Support Educators) at the end of their respective training
courses, highlights an appreciation of CL practices besides strong criticism of the factors which inhibit the
application of a student-centred philosophy. Findings indicate that teachers in Malta seem to be conditioned
by postcolonial socio-cultural aspects, such as a highly centralised education system, a competitive
exam-oriented approach to learning and a traditional curriculum-driven attitude to teaching; issues which
debilitate the application of CL. Moreover, teachers are seen as reluctant to implement active learning
techniques since these are perceived as non-compatible with the inclusion of all students. In contrast, systemic-
organisational deficiencies for the recruitment of precarious Italian teachers discourage the use of
CL. While resistance from colleagues, students and parents further demotivates upper secondary school
teachers, lower secondary school teachers view schools as the ideal places for the experimentation of
these techniques. The thematic analysis of focus group data implies an urgency to revisit the understanding
of ‘education’ in Malta, the need for Italian teachers to collaborate with education stakeholders and the
necessity of continued professional development which can empower teachers to proactively embrace a
‘methodological transition’ towards CL
Supplemental Material - The Influence of Multilevel Spinal Deformity Surgery on the EuroQol 5 Dimensions’ (EQ-5D) Questionnaire and Residential Status in the Elderly: <b>A</b> Prospective, Observational, Multicenter Study
No full textSupplemental Material for The Influence of Multilevel Spinal Deformity Surgery on the EuroQol 5 Dimensions’ (EQ-5D) Questionnaire and Residential Status in the Elderly: A Prospective, Observational, Multicenter Study by Thorsten Jentzsch, Stephen J. Lewis, Colby Oitment, Anna Rienmüller, Allan R. Martin, Christopher J. Nielsen, Hananel Shear-Yashuv, Marinus de Kleuver, Yong Qiu, Yukihiro Matsuyama, Lawrence G. Lenke, Ahmet alanay, Ferran Pellisé-Urquiza, Kenneth M. C. Cheung, Maarten Spruit, David W. Polly, Jonathan N. Sembrano, Christopher I. Shaffrey, Justin S. Smith, Michael P. Kelly, Benny Dahl, Sigurd H. Berven, and AO Spine Knowledge Forum D in Global Spine Journal</p
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