Effects of the green supply chain management practices on firm performance and sustainable development.

The idea of sustainable development and green supply chain management is considered at the underlying stage in the research and academic fields, particularly in the rising economies of Asia. This research investigates the persuasive force of the firm's green supply chain management practices with the mediating part of the competitiveness and investment recovery. Data was collected from the 12 ISO 9001 and ISO 14001 leather industries based in Pakistan. We distributed the 350 questionnaires at 12 leather industries, and the questionnaire was also transferred on Google Forms, and 50 questionnaire mail to different individuals who work in leather industries of other cities of Pakistan; out of 350 questionnaires, 183 were filled, and the remaining questionnaires were incomplete, and out of 50 emails, we get the response of 33 emails, and evaluated the model of this study by using the partial least square structural equation modeling PLS-SEM. We interact with the employees of leather industries and try to understand how they are following the green practices in their firms. This research uses resource dependence theory as the theoretical base. This study elaborates how the organization's behavior is affected by the external resources of the corporation. The actual outcomes uncover that green supply chain management activities positively impacting the firm's performance, where competitiveness and investment recovery play a mediating role among intra-organizational green practices.

A Review and Description of Acetabular Impaction Bone Grafting: Updating the Traditional Technique.

Restoring acetabular bone loss in revision hip arthroplasty is a major challenge for the orthopaedic surgeon. This paper discusses the traditional cemented technique of impaction bone grafting as applied to the acetabulum, as well as the evolution of the technique to employ uncemented implants. Some of the recent published literature regarding these techniques is reviewed and the personal experiences of the senior author with these techniques are also reported.

MicroRNAs in a hypertrophic heart: from foetal life to adulthood.

The heart is the first organ to form and undergoes adaptive remodelling with age. Ventricular hypertrophy is one such adaptation, which allows the heart to cope with an increase in cardiac demand. This adaptation is necessary as part of natural growth from foetal life to adulthood. It may also occur in response to resistance in blood flow due to various insults on the heart and vessels that accumulate with age. The heart can only compensate to this increase in workload to a certain extent without losing its functional architecture, ultimately resulting in heart failure. Many genes have been implicated in cardiac hypertrophy, however none have been shown conclusively to be responsible for pathological cardiac hypertrophy. MicroRNAs offer an alternative mechanism for cellular regulation by altering gene expression. Since 1993 when the function of a non-coding DNA sequence was first discovered in the model organism Caenorhabditis elegans, many microRNAs have been implicated in having a central role in numerous physiological and pathological cellular processes. The level of control these antisense oligonucleotides offer can often be exploited to manipulate the expression of target genes. Moreover, altered levels of microRNAs can serve as diagnostic biomarkers, with the prospect of diagnosing a disease process as early as during foetal life. Therefore, it is vital to ascertain and investigate the function of microRNAs that are involved in heart development and subsequent ventricular remodelling. Here we present an overview of the complicated network of microRNAs and their target genes that have previously been implicated in cardiogenesis and hypertrophy. It is interesting to note that microRNAs in both of these growth processes can be of possible remedial value to counter a similar disease pathophysiology.

Patient characteristics and risk of subsequent contralateral hip fracture after surgical management of first fracture.

BACKGROUND: Sequential hip fractures are associated with increased morbidity and mortality. Understanding of risk factors is important for secondary prevention. Although hip fractures have a multifactorial aetiology related to falls, it is unknown whether fracture management approach influences the risk of sequential hip fractures. OBJECTIVES: Our objective is to explore whether subsequent contralateral hip fractures are more common following femoral head replacement or salvage procedures for the treatment of hip fractures. METHODS: Patients older than 50, admitted to a single regional trauma unit in Worcestershire between 2010 and 2012 were identified from the national database. 700 patients matched our inclusion criteria and case notes were reviewed. The male to female ratio was 1:3.3 and the mean age was 82.8 years (standard deviation: 8.9 years). Contralateral fractures were identified from admission X-rays. Risk factors were analysed based on patient demographics and data related to first hip fracture management. RESULTS: Seventy-one patients presented with contralateral fractures, of which 19 had their first fracture during the data collection period, estimating a period prevalence of 10.1%, and incidence of 2.9%. Contralateral fracture rates were not significantly different between femoral head salvage and replacement procedures (P-value 0.683). Older institutionalised females with poorer mobility status were at greatest risk of contralateral hip fractures. Half (50.7%) of these occurred within 2 years of their first fracture. CONCLUSION: No additional risk was seen in either fixation approaches. Risk factors identified were in keeping with existing literature, which can help to identify high-risk groups for targeted prevention strategies.

Application of core biopsy in revision arthroplasty for deep infection.

A preliminary core biopsy was performed in 168 consecutive joint arthroplasties (141 hips and 27 knees) before revision for suspected deep infection. Data of the core biopsy and subsequent revision procedures were available for 159 cases. Biopsies and revisions were all performed by one surgeon, and the exchange procedures were all undertaken in an ultra clean air enclosure. Biopsy material was cultured both aerobically and anaerobically and the results compared to that of the specimens obtained at the subsequent exchange procedure. In 116 patients (70%), the culture and sensitivity results were identical in samples from core biopsy and samples obtained during revision procedure (either no growth or growth of same organisms). When compared to intraoperative specimen report, 25 biopsies (15%) gave an apparently false-positive result. In 16 instances, a false-negative result was seen, but repeat biopsy in 4 of these cases was positive. The final diagnosis of infection was made using all available clinical and investigative data. When compared to final diagnosis, the sensitivity of core biopsy was 88%, the specificity was 91%, and the accuracy was 89%. Core biopsy was successful in identifying the organisms with the sensitivities to antibiotics in 80% of the disease-positive cases, hence, offering the opportunity to add the most appropriate antibiotic to bone cement during the exchange procedure.

Use of a Dall-Miles plate and cables for the fixation of a periprosthetic humeral fracture.

Increase in the use of shoulder arthroplasty has resulted in the emergence of periprosthetic fractures of the humerus. The management of such fractures is technically demanding. We describe a case in which a displaced periprosthetic fracture at the tip of a stable humeral implant was successfully managed with the Dall-Miles plate and cables system.

Placement of vena cava filters: factors affecting technical success and immediate complications.

OBJECTIVE: The goal of this study was to evaluate factors affecting technical success and the immediate complications of placement of vena cava filters. MATERIALS AND METHODS: The medical records of 148 consecutive patients who underwent filter placement between December 1995 and February 1999 were retrospectively reviewed for cavography, technical success, complications, and operator specialty. RESULTS: The records of 143 filter placements in 142 patients were complete (one patient underwent two placements). One hundred twenty filter placements were preceded by cavography, and 23 were not. Three misplacements (2.5%) were preceded by cavography and 10 (43%) were not (p<0.0001). One hundred fourteen filter placements were performed by radiologists and 29 by surgeons. Cavography was performed before 98% of placements by radiologists but in only 28% of placements by surgeons (p<0.0001). Filter misplacement occurred in 12 placements (41%) by surgeons and in only one (0.9%) by radiologists (p<0.0001). Major complications occurred in three placements (10%) by surgeons and in none of the placements by radiologists (p<0.01). CONCLUSION: Vena cava filters were placed with greater technical success and fewer complications when preceded by cavography. Radiologists placed filters with greater technical success and fewer complications than surgeons, which may be the result of radiologists generally having more training and more familiarity with imaging-guided procedures and adhering more to cavography protocol. A credentialing requirement for physician operators and evaluation using quality improvement standards may be advisable.