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Chile a trendy destination for astrotourism
Chile: a trendy destination for astrotourism. The booming of astrotourism.
With the ever-worsening quality of our planet's night sky due to light pollution, more and more people want to discover or rediscover it. And nothing better than to do it while you go on holiday! It has indeed become quite a trend in the past decade. Whether they go away exclusively to stargaze or just include it as part of their trip, astrotourists are setting the tone for eco-tourism and the preservation of our night sky.
Light pollution has become a worldwide problem since the rapid expansion of cities and the massive increase of the population of our planet in the recent decades. However despite this sticky situation, the world still holds extremely dark places to gaze at the night sky and they're attracting an increasing number of people for this exact reason. Among them lies Chile at the top of the list. Here's why the South American country is becoming the Mecca of astro-tourism…
Chile is a long, narrow country stretching along South America's western edge, with more than 6,000km of Pacific Ocean coastline. The eastern side of Chile is bordered in all its length by the famous Andes range. The mountains act as a shield that stops the clouds and moisture from penetrating from the west and the east, leaving a very dry and arid plateau in the middle. Now the high elevation in addition to the dryness of the air make up the perfect recipe for the space observation. That's why the biggest telescopes in the world can be found there. That's also part of the explanation as to why the astrotourism is rapidly growing in that region of the world.
Locals and scientists are trying to fight the growing light pollution of Chile thanks to the expansion of small villages and bigger cities. In spite of that, the country still holds some of the best skies in the world for stargazing. The purity and thinness of the air help produce a very clear and pinpoint sky above, which you wouldn't get at sea level. Even the pictures you take have this transparency, almost as if you were taking a shot from the International Space Station. Not only this but the dry mountains and high plateaus like Atacama in the North of the country also offer a seemingly countless amount of gorgeous foregrounds to visit and shoot from.
Catci, canyons, eroded cliffs, rivers, ponds, salars, geysirs, volcanoes, snowy plains and even wildlife, you name it! Chile has it all! After posting sequences of the milky way reflecting in bodies of water, people would not believe it was taken in what is known as the driest desert in the world: the Atacama desert. Believe it or not, there is actually a lot of water if you know where to look. It's mainly found as saltwater stagnating in salars and lagoons, in which you can also take a swim! At night, those pools transform into a vast mirror reflecting the millions stars of the firmament, as the wind usually dies after sunset. All these things also make Chile a trendy destination.
Exploring the desert and mountains in Chile is no easy task. It's not because of the weather but more because there aren't many roads and most of them are dirt lanes with sometimes very sharp rocks strewn here and there on the way. However there exists an oasis of coolness and tradition in the heart of Atacama, which is also the reason why so many tourists are drawn there. San Pedro de Atacama is a very small town perched at 2400m of altitude in the Atacama desert, at the foothills of the higher plateaus and volcanoes. If you visit the community, you will be surprised by how much this traditional town has thrived on tourism, and how easy it is to get what you are looking for in terms of hotel or food supply. It counts an impressive number of excellent restaurants, sometimes quite sophisticated!
Further south, the Elqui Valley is also a much coveted place for astrophotographers alike. It is a very long and pleasant trench going from La Serena by the ocean to Argentina deep in the mountains. There flourish a lot of vineyards and picturesque villages. Among the easy-to-access roads, you will find a lot of arid hills to observe the stars from. If you travel about an hour away from La Serena, you get rid of almost all the light pollution around. That's where you will also find a lot of different observatories that are open for the public to visit, including night visits for some.
Chile, a trendy destination: If the last paragraphs haven't convinced you yet to go stargazing in Chile though, this video certainly will: https://www.youtube.com/watch?v=vGY5sLdyajk
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From The SFX Office
By Dave Golder published 23 February 12
John Carter, The Muppets, Being Human and a cute cat – all burning hot topics in the office this week
John Carter , The Muppets , Being Human and a cute cat – all burning hot topics in the office this week
It's the calm after the storm. The post-Weekender frenzy to get another issue of SFX to be (that's a technical publishing term, not a sexual fantasy) is over. Nails and hair are safe once more from gnawing and pulling. The cleaners can finally prize the coffee mug out of editor Dave Bradley's mitts. The office is full once again of the sound of keyboards chirruping softly like a summer meadow full of crickets, rather than the sound of keyboards being pounded like machine-gun fire.
And the office will be even quieter soon, because the staff who are in will be going to a Couch Potato session this afternoon. We can't tell you the theme (it's a tradition) but there will be some young blood. And we're not talking about on the couch. Unless a fight breaks out and Jordan gets a nosebleed.
We haven't got the Weekender (or the attendant alcohol) completely out of systems, though. Adrian (in between enthusing about The Walking Dead non-stop) has trained his cat Dennis be ready for the call-and-response at the next Weekender…
[bcvideo id="1467581401001"]
Not that we've all been chained to our computers for the past week. Dave G stayed over in London on Saturday night with freelancer Jayne Nelson, so they could see John Carter on Sunday. Oddly we're under embargo, so we can't tell you how much they enjoyed it (oops), even though a load of American journos have been Tweeting about it all night after the US premiere. Strange world, PR. Dave G and Jayne were also mistaken for a couple by a Big Issue vendor in Trafalgar Square. Jayne screwed up her face in disgust and declared, "He's my boss!" To which the Big Issue guy raised an eyebrow and replied archly, "Oh, it's like that , is it?"
Jordan's feeling all warm inside. Literally. He had swish new double-glazed windows installed in his flat last week which have made his place so warm he's resorted to wearing nothing but a pair of Star Wars shorts in the evening. Unfortunately he's so taken by his windows that he has a habit of leaving his curtains open just so he can look at them, giving passers-by on the street below a bit of a fright. He also visited BBC Worldwide this week to play The Eternity Clock , the new Doctor Who game releasing on PS3 and PS Vita next month; and has been engaged in that age old debate with Russell: pancakes or omelettes? Russell thinks omelettes because "you can put cheese on omelettes". Jordan thinks Russell is mental.
The team has been giving a joint thumbs up to the new series of Being Human (UK flavour). If you're one of those grieving fans who've stopped watching because Mitchell and George have gone, you really are missing a treat. "It's feeling fresh and new," declared Rich, and he's right. Forget moping about the past. Just think of it as a new show! Hal and Tom are hilarious together. In fact Dave G's loving it so much he watched three episodes in a row the other night… the next three! And the fact he's checking BBC Previews just about every other minute of the day to leap on episode seven when it's available says something about something. (He's also convinced he's name-checked in episode six, but hey, how many Daves are there out there?)
Rich saw The Muppets last night. His review: "A lot of good moments, but very slight and not enough of the Muppets being Muppets – Sam, the Swedish Chef and Beaker are seriously underused!"
Random office quote: "I think after 45 years someone has just turned my innuendo gene on."
Whose T-shirt? (We actually can't remember if we've featured this one before! We have Swiss cheese memories. But we do recall that last week's chocolate belonged to Nick, and it was sent to him by Calum Waddell)
Razer Enki review: "A solid if unspectacular gaming chair"
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redpajama_set_name: RedPajamaCommonCrawl


text:
Actual Problems of Theory and History of Art
Partner Museum
Αbstracts of communications
Previous Emblems
Vol. 9. 2019
Actual Problems of Theory and History of Art–2018. From Antiquity to the Renaissance. Borders and Horizons
Art of the Ancient World
Byzantine and Eastern Christian Art
Medieval Russian Art
Western European Medieval Art
Art of the Renaissance
Art Critical Surveys and Reviews
Artifact. Art-Object. Argument. An Object in Fine Arts: Acquisition of New Meanings in Modern and Contemporary Eras
Western European Art of the Modern Age
Russian Art of the 18th Century
Russian Art of the 20th–21st Century
International Art of the 20th and 21st Centuries: Modernity and Contemporaneity
Material Culture, Applied Art and Design
Museum — Collection, Space, Work of Art
Publication and Study of Sources
An Object in Fine Arts: Objectives, Methods, Results
Art and Artistic Culture of the Ancient World. Archaeological Object and a Work of Art: Their Similarities and Differences
Eastern Christian Art
Western European Mediaeval Art
Mediaeval Russian Art
Cult and Artistic Culture
Old Russian Art
Western Mediaeval Art
Western Art ca. 1600 – 1900
Russian Art of the 18th and 19th centuries
World Art of the 20th Century and Contemporary Art
Russian Art of the 20th Century and Contemporary Art
Instead of an afterword
The Art of Classical Antiquity in the Mirror of the Renaissance
Russian Art of the 18th–19th Centuries. Russian View of Classical Tradition
Western European Art of the 17th–19th Centuries. Classical Tradition's Destiny: from Model to Interpretation
Art of the 20th–21st Centuries. Faces of Classical Antiquity in the Labyrinth of Modernity
Classical Antiquity and the World around Hellas
Classical Legacy in the Art of Byzantine Oikoumene and Beyond
The Harmony of Classical Antiquity under the Vaults of Old Russ
Classical Antiquity on the Ribs of European Middle Ages
Western Art from the Middle Ages to the 20th Century
Western Art of the 20th Century and Theory of Art
Russian Art of the 18th - Early 20th Century
Russian Art of the 18th–20th Centuries
Western Art of the 15th–20th Centuries
Ancient and Medieval Muslim Art
Medieval and Early Modern Western Art
Western Art of the 19th-20th Centuries and Theory of Art
Russian Art of the 19th and Early 20th Centuries
Medieval Art of the Eastern Christian World
Russian Art in the 18–20th Centuries
The East and the West, from Antiquity to the 20th Century
Theses 2015
Zuleika Murat The Compendium historiae in Genealogia Christi and its Iconographical Tradition: Legacy of Classical Antiquity in a Mediaeval Biblical Anthology
Please use this identifier to cite or link to this item: http://dx.doi.org/10.18688/aa155-4-43
Title The Compendium historiae in Genealogia Christi and its Iconographical Tradition: Legacy of Classical Antiquity in a Mediaeval Biblical Anthology
Author Zuleika Murat email zuleika.murat@unipd.it
About author Zuleika Murat — Ph. D., Postdoctoral Research Fellow. Via 8 Febbraio 2, 35122 Padova, Italy
In the section Classical Antiquity on the Ribs of European Middle Ages DOI 10.18688/aa155-4-43
Year 2015 Volume 5 Pages 404–411
Type of article RAR Index UDK 75.056 Index BBK 85.14; 8 4 ( 0 ) 4
This article aims to analyse a little known, yet extremely important, phenomenon of reception of Сlassical antiquity and its legacy in the Middle Ages. It deals with the Compendium historiae in genealogia Christi, a biblical anthology created at the end of the 12th century by Peter of Poitiers, theologian and teacher at the Cathedral school of Paris. In the prologues, Peter himself declared that the purpose of his work was to help his students to fix in memory the complex biblical material. For this reason the text was written in a simplified and resumptive way, and it was also accompanied by an 15 On this very interesting manuscript see [11, p. 165] and [16, pp. 180–183, no. 21]. unusual apparatus of images that immediately visualized the main concepts which the students should learn and remember. Peter seems to have derived the figurative system from Greek and Roman mnemonic treatises. Through selected case studies, I aim to demonstrate how Сlassical antiquity and its legacy made a contribution in the creation of that specific art system, tracing the connections between ancient theory and mediaeval practice.
Peter of Poitiers
Art of Memory
Cathedral Schools
Reference Zuleika Murat. The Compendium historiae in Genealogia Christi and its Iconographical Tradition: Legacy of Classical Antiquity in a Mediaeval Biblical Anthology. Actual Problems of Theory and History of Art: Collection of articles. Vol. 5. Eds: Svetlana V. Maltseva, Ekaterina Yu. Stanyukovich-Denisova, Anna V. Zakharova. St. Petersburg, NP-Print Publ., 2015, pp. 404–411. ISSN 2312-2129. http://dx.doi.org/10.18688/aa155-4-43
Full text version of the article Article language english
Alidori L. Il plut. 20.56 della Laurenziana. Appunti sull'iconografia dei manoscritti della Genealogia di Petrus Pictaviensis. Rivista di Storia della Miniatura, 2001–2002, no. 6–7, pp. 157–170 (in Italian).
Bolzoni L. La rete delle immagini: predicazione in volgare dalle origini a Bernardino da Siena. Torino, Einaudi Publ., 2002. 250 p. (in Italian).
Carlino L. Cronache universali in rotulo nel tardo medioevo. La storia per immagini del ms. 258 della Biblioteca Statale di Cremona. Roma, Istituto Poligrafico e Zecca dello Stato Publ., 1997, 122 p. (in Italian).
Carruthers M. The Book of Memory. A Study of Memory in Medieval Culture. New York, Cambridge University Press Publ., 2008, 519 p.
Coleman J. Ancient and Medieval Memories: The Reconstruction of the Past. Cambridge, Cambridge University Press Publ., 1992, 646 p.
Coleman J. Late Scholastic Memoria et Reminiscentia: Its Uses and Abuses. Intellectuals and Writers in Fourteenth Century Europe / London, Boydell and Brewer Publ., 1986, pp. 22–44 (23–30).
Courth K. "Petrus Pictaviensis". Lexikon des Mittelalters, VI. Stuttgart — Weimer, Metzler Publ., 1999 (in German).
Cox V.; Ward J. O. (eds.). The Rhetoric of Cicero in Its Medieval and Early Renaissance Commentary Tradition. Leiden, Brill Publ., 2006. 545 p.
Di Mauro A. Un contributo alla mnemotecnica medievale: il "Compendium historiae in Genealogia Christi" in una redazione pisana del XIII secolo. In Il codice miniato. Rapporti tra codice, testo e figurazione: III Congresso di Storia della Miniatura. Firenze, Olschki Publ., 1992, pp. 453–467 (in Italian).
Doležalová L. Obscurity and Memory in Late Medieval Latin Manuscript Culture: The Case of the 'Summarium Biblie', Krems, Medium Aevum Quotidianum Publ., 2012. 167 p.
Fossier F. Chroniques universelles en forme de rouleau à la fin du Moyen-Âge. Bulletin de la Société Nationale des Antiquaires de France, 1980–1981, pp. 163–183 (in French).
Guarnieri C. Serafino de' Serafini e il Compendium historiae in Genealogia Christi di Petrus Pictaviensis dell'Österreichiesche Nationalbibliothek di Vienna. Miniatura. Lo sguardo e la parola. Studi in onore di Giordana Mariani Canova. Cinisello Balsamo, Silvana Editoriale Publ., 2012, pp. 140–150 (in Italian).
Hilpert H. E. Geistliche Bildung und Laienbildung: Zur Überlieferung der Schulschrift "Compendium historiae in genealogia Christi" (Compendium veteri testamenti) des Petrus von Poitiers († 1205) in England. Journal of Medieval History, 1985, no. 11, pp. 315–331 (in German).
Kolmer L. Ad vocem "Petrus Pictaviensis". Biographisch-Bibliographisches Kirchenlexicon. Herzberg, T. Bautz Publ., 1994, vol. VII, pp., 374–376 (in German).
Lackner F. Katalog der Streubestände in Wien und Niederösterreich, Teil 1: Nichtarchivalische mittelalterliche Handschriften und Fragmente in Korneuburg, Mistelbach, Retz, St. Pölten, Tulln, Waidhofen an der Thaya, Weitra, Wien, Wiener Neustadt und aus Privatbesitz. Unter Mitarbeit von Alois Haidinger. Katalog- u. Registerbd. CD-ROM (Österreichische Akademie der Wissenschaften, phil.-hist. Klasse, Denkschriften 272 = Veröffentlichungen der Kommission für Schrift- und Buchwesen des Mittelalters II,5). Wien, 2000 (in German).
Lebeuf J. Dissertations sur l'histoire ecclésiastique et civile de Paris, vol. II. Paris, Lambert & Durand Publ., 1739–1743 (in French).
Monroe W. H. A Roll-Manuscript of Peter of Poitier's Compendium. The Bulletin of the Cleveland Museum of Art, 1978, no. 3, pp. 92–107.
Moore P. S. The Works of Peter of Poitiers, Master in Theology and Chancellor of Paris (1193–1205). South Bend, Notre Dame Publ., 1936. 21 p.
Panayatova S. Peter of Poitiers's Compendium in Genalogia Christi: the Early English Copies. Belief and culture in the Middle Ages: studies presented to Henry Mayr-Harting. Oxford, Oxford University Press Publ., 2001, pp. 327–341.
Peter's Stemma. Available at http://www.piggin.net/stemmahist/petercatalog.htm (Accessed May 13, 2015).
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Quintavalle A. C. (ed.). Medioevo: il tempo degli antichi. Conference proceedings: Parma, 2003. Milano, Electa Publ., 2006. 667 p. (in Italian).
Quinto R. "Teologia allegorica" e "teologia scolastica" in alcuni commenti all'Historia scholastica di Pietro Comestore. Archa Verbi, 2009, no. 6, pp. 67–101 (in Italian).
Rainini M. "Symbolica theologia". Simboli e diagrammi in Ugo di San Vittore. Ugo di San Vittore: Conference proceedings Todi 2010. Spoleto, Fondazione Centro Italiano di Studi sull'Alto Medioevo Publ., 2011, pp. 285–337 (in Italian).
Rodriguez A. D. Figurative illustrations in the Genealogia Christi by Peter of Poitiers in the Biblioteca Casanatense. Genealogia Christi. Barcelona, Moleiro Publ., 2000, pp. 69–90.
Scheffer Boichorst P. (ed.). Albrici monachi Trium Fontium, Chronica, a monacho Novi Monasterii Hoiensis interpolata. Monumenta germaniae historica. Scriptores. Hannoverae, Impensis Bibliopolii Aulici Hahniani Publ., 1874, vol. XXIII, pp. 631–950 (in Latin).
Settis S. (ed.). Memoria dell'antico nell'arte italiana, 3 vols. Torino, Einaudi Publ., 1984–1986. 477 p.; 480 p.; 539 p. (in Italian).
Smalley B. The Study of the Bible in the Middle Ages. Oxford, Blackwell Publ., 1984. 406 p.
Valenzano G. Un rotulo con la Genealogia Christi a Vicenza di metà Duecento: Venezia o Bisanzio? Miniatura. Lo sguardo e la parola. Studi in onore di Giordana Mariani Canova. Cinisello Balsamo, Silvana Editoriale Publ., 2012, pp. 76–81(in Italian).
Worm A. "Ista est Ierusalem". Intertextuality and Visual Exegesis in the Representation of Jerusalem in Peter of Poitiers's Compendium Historiae in Genealogia Christi and Werner Rovelinck's Fasciculum Temporum. Imagining Jerusalem in the Medieval West. Oxford, Oxford University Press Publ., 2012, pp. 123–161.
Worm A. Visualizing the Order of History: Hugh of Saint Victor's Chronicon and Peter of Poitiers' Compendium Historiae. Romanesque and the Past. Retrospection in the Art and Architecture of Romanesque Europe. Leeds, Maney Publ., 2013, pp. 243–264.
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Actual Problems of Theory and History of Art.
Saint Petersburg State University © 2020.


text:
Q: Does using a hotspot while connected to wifi use cellular data? I'm confused about data usage / hotspot while connected to WiFi.
I'm asking because my Windows 8 laptop cannot recognize my friend's router, as in it can't even find it, however, my iPhone 4 can. I have connected using my iPhone 4 and turned on the "Personal Hotspot" feature.
Does this use my Data Allowance from Telstra, or will all internet/network traffic flow through to the router?
If the above answer is yes, what if I took out my SIM Card? Would it not work at all, or flow through to the router?

A: You cannot use your Wi-Fi connection for Internet connectivity while other devices are using Wi-Fi for Personal Hotspot. You can share only a cellular data connection; you cannot share a Wi-Fi connection.
As seen here: http://support.apple.com/kb/ht4517

A: Yes it does use your data. Even though it says you're connected to wifi the hot spot overrides it & uses your cellular data. I finally figured this out after months of questioning my cellular company as to how it was possible I could use that much data. My son puts it on in the car for his iPad & then when we get out & go inside our home my phone connects to wifi but his iPad still leeches my hot spot from my phone.  Of course Rogers couldn't figure that out or at least they didn't want to tell me. It was only after going 4GB over my 10Gb plan & having them cut my data off completely that I was able to figure out what was going on & then called them to confirm. An expensive lesson to learn.

A: If your device are jailbreak ... Then u can do this job.  You can mywi 7 on cydia. And you can creat wifi hotspot,blutooth tether and usb tether  while you cannected wifi .

redpajama_set_name: RedPajamaStackExchange


text:
Sony Xperia S coming this month, sooner than expected
Sony Android Touch UI
The Xperia S is the first handset to come out of Sony, who bought out the Ericsson part of Sony Ericsson couple of months ago.
And as such, the device has been highly anticipated since its announcement at CES 2012. UK users will be glad to find out that the Xperia S is scheduled to be released on January 30. Initially, it was believed that the handset will be ready for customers to buy no earlier than March 9.
Currently, the Xperia S can be found on pre-order at Play.com for £450, which also happens to be the cheapest offer around. Clove and Ebuyer also have the device on pre-order.
Of course, if you are more of a contract person, the Xperia S will be offered on subsidized offers from major UK carriers, too. ThreeUK and O2 are definitely on the list, but T-Mobile UK and Orange UK are expected to join in as well.
Source | Via
Sony to announce new Xperia smartphones on February 24
Top 10 trending phones of week 2
Sony unveils Vision S concept electric car, which is jam-packed with Sony sensors, audio and more
Sony Xperia 5 Plus surfaces with a headphone jack and dual front speakers
y sony didnt include memory card slot??? it myt b dat it wanted its 1st mobile 2 b on all its own.. i mean it shudnt dpnd on ny odr company(memory cards r of odr company) lol... i jst gav my way :P
When is the Xperia ION coming to INDIA. Can anybody gues what could be the price of it ??
No, actually the S model doesn't. It's brother the Sony Xperia Ion has support for a 32GB mem card, but not the S. I don't know why they did it this way, but it wasn't a very smooth move. It's a blemish on what otherwise looks like a wonderful first ...


text:
Django ne prie pas () est un western spaghetti italo-espagnol réalisé par Mario Siciliano en 1969.

Résumé
De retour de la guerre de Sécession, après avoir traversé mille vicissitudes, Bryan Clarke retrouve sa femme assassinée. Bryan décide de mettre en œuvre sa vengeance, qui le transforme progressivement en bête humaine, malgré l'amitié de Daniel et son frère Robert.

Commentaires
 La scène de l'éclat de rire du brigand fou et de la scène de mesure du temps de relève de la garde ressemblent beaucoup aux scènes équivalentes de Et pour quelques dollars de plus.

Fiche technique
 Titre français : Django ne prie pas
 Titre italien :
 Titre espagnol :
 Réalisateur : Mario Siciliano, sous le pseudo de Marlon Sirko
 Scénario : Ernesto Gastaldi, Eduardo Manzanos Brochero, Mario Siciliano
 Musique : Manuel Parada
 Photographie : Gino Santini
 Production : Copercines, Cooperativa Cinematográfica, et Metheus Film
 Genre : Western
 Durée : 82 min
 Pays :  /
 Langue : italien
 Couleur
 Son : Mono
 Date de sortie :
  : 1969
  :
  :

Distribution
 Gianni Garko : Bryan Clarke (Django dans la vf)
 Ivan Rassimov : Daniel (sous le pseudo de Sean Todd)
 Elisa Montés : Julie
 Roberto Miali : (sous le pseudo de Jerry Wilson)
 Carla Calò : mère Douglas (sous le pseudo de Carrol Brown)
 José Jaspe
 Luciano Pigozzi : Bill Perkins (sous le pseudo de Alan Collins)
 Maria Mizar
 Manuel Galiana
 Luis Induni
 Miguel Del Castillo
 Frank Braña
 Lorenzo Robledo
 Dale Cummings
 Julio Peña
 Marco Morelli
 Gino Marturano
 Giovanni Ivan Scratuglia

Liens externes

Film italien sorti en 1969
Film espagnol sorti en 1969
Western italien
Western espagnol
Western spaghetti
Premier long métrage sorti en 1969
Film en italien
Film espagnol tourné en italien
Film se déroulant aux États-Unis
Film se déroulant dans les années 1860
Film réalisé par Mario Siciliano
Film scénarisé par Ernesto Gastaldi

redpajama_set_name: RedPajamaWikipedia


text:
The Open Orthopaedics Journal
Risk Factors for the Development of Nerve Palsy Following Primary Total Hip Arthroplasty
Shunsuke Kawano*, Motoki Sonohata, Masaru Kitajima, Masaaki Mawatari
Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
Nerve palsy following total hip arthroplasty (THA) is a complication that worsens the functional prognosis. The present study analyzed the risk factors of nerve palsy following THA.
The subjects of this study included 6,123 cases in which primary THA was performed under spinal anesthesia with cementless implants used in the posterolateral approach.
Fourteen cases (0.22%) developed nerve palsy following THA, all of which involved palsy of the entire peroneal nerve region. The diagnoses included osteoarthritis due to subluxation (n=6), complete hip dislocation (n=3), osteonecrosis of the femoral head (n=2), primary osteoarthritis (n=1), osteoarthritis due to trauma (n=1), and multiple osteochondromatosis (n=1). Recovery from nerve palsy was confirmed in 10 cases; the longest recovery period was three years. A univariate analysis revealed significant differences in the osteoarthritis due to subluxation, osteonecrosis of the femoral head, complete hip dislocation, body weight and body mass index. However, none of the factors remained significant in multivariate analysis. Peroneal (ischiadic) nerve palsy following THA occurred in patients with osteonecrosis of the femoral head, complete hip dislocation, low body weight and a low body mass index. However, there were no cases of nerve palsy after the introduction of THA combined with shortening osteotomy of the femur for complete hip dislocation. patients.
It is necessary to pay attention to direct pressure in cases of lower body weight and lower BMI because compression of the sciatic nerve during surgery and compression of the fibular head are considered to be risk factors.
Keywords: Risk factor, Total hip arthroplasty, Nerve palsy, Sciatic nerve, Complication, Clinical result.
First Page: 164
Last Page: 172
Publisher Id: TOORTHJ-12-164
Received Date: 9/2/2018
© 2018 Kawano et al.
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
* Address correspondence to this author at the Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga 849-8501, Japan; Tel: +81-952-34-2343; Fax: +81-952-34-2059; E-mail: shunsuke-kawano@hotmail.co.jp
9-2-2018 Original Manuscript Risk Factors for the Development of Nerve Palsy Following Primary Total Hip Arthroplasty
The complications associated with Total Hip Arthroplasty (THA) include dislocation, infection, looseness, blood clotting, embolisms, fracturing, vascular injury, and nerve injury (nerve palsy). In the short term, dislocation and infection may cause revision THA and the rate of revision THA due to loosening increases during the long-term follow-up [1Singh J, Politis A, Loucks L, Hedden DR, Bohm ER. Trends in revision hip and knee arthroplasty observations after implementation of a regional joint replacement registry. Can J Surg 2016; 59(5): 304-10.
[http://dx.doi.org/10.1503/cjs.002916] [PMID: 27438053] ]. While nerve palsy after THA has little effect on the long-term fixation of implants, preventive measures should be implemented against this complication because it worsens the functional prognosis.
The incidence of nerve palsy following THA is reported to range from 0.08% to 7.6%; the frequency of occurrence and the nerves that are affected vary depending on the approach [2Petis S, Howard JL, Lanting BL, Vasarhelyi EM. Surgical approach in primary total hip arthroplasty: Anatomy, technique and clinical outcomes. Can J Surg 2015; 58(2): 128-39.
[http://dx.doi.org/10.1503/cjs.007214] [PMID: 25799249] -9Eggli S, Hankemayer S, Müller ME. Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg Br 1999; 81(5): 843-5.
[http://dx.doi.org/10.1302/0301-620X.81B5.9610] [PMID: 10530847] ]. Nerve palsy occurs at sites that are under pressure from retractors during surgery, sites of direct injury during the insertion of the implant, and due to the nerve extension that occurs in association with the elongation of the leg length; however, there are also many cases in which the cause of occurrence is unclear and these represent catastrophic complications. The morphology of the nerve damage is associated with one or a combination of factors, which include compression, ischemia, extension, crushing, and tearing [3Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am 1991; 73(7): 1074-80.
[http://dx.doi.org/10.2106/00004623-199173070-00018] [PMID: 1874771] , 10Schmalziried TP, Noordin S, Amustutz HC. Update on nerve palsy associated with total hip replacement 1997.
[http://dx.doi.org/10.1097/00003086-199711000-00020] ]. Sciatic nerve palsy is the most common type of nerve damage, followed by femoral nerve palsy, and the combination of sciatic and femoral nerve palsy; paralysis of the obturator nerve is uncommon [11Satcher RL, Noss RS, Yingling CD, Ressler J, Ries M. The use of motor-evoked potentials to monitor sciatic nerve status during revision total hip arthroplasty. J Arthroplasty 2003; 18(3): 329-32.
[http://dx.doi.org/10.1054/arth.2003.50055] [PMID: 12728425] , 12Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87(12): 2619-25.
[http://dx.doi.org/10.2106/JBJS.C.01564] [PMID: 16322610] ]. In recent years, there have also been reports of lateral femoral cutaneous nerve palsy in association with the direct anterior approach [13Smith TO, Blake V, Hing CB. Minimally invasive versus conventional exposure for total hip arthroplasty: A systematic review and meta-analysis of clinical and radiological outcomes. Int Orthop 2011; 35(2): 173-84.
[http://dx.doi.org/10.1007/s00264-010-1075-8] [PMID: 20559827] ].
Several reports have been published on the risk factors for nerve palsy following the excessive elongation of the leg length, trauma and previous surgery of hip, revision THA, osteoarthritis due to subluxation, cement indentation, pressure from retractors during operation, postoperative hematoma, usage of wires in the trochanter fixation, young age, female sex, longer operation time and the posterolateral approach [3Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am 1991; 73(7): 1074-80.
[http://dx.doi.org/10.2106/00004623-199173070-00018] [PMID: 1874771] , 5Oldenburg M, Müller RT. The frequency, prognosis and significance of nerve injuries in total hip arthroplasty. Int Orthop 1997; 21(1): 1-3.
[http://dx.doi.org/10.1007/s002640050107] [PMID: 9151175] -8Nercessian OA, Piccoluga F, Eftekhar NS. Postoperative sciatic and femoral nerve palsy with reference to leg lengthening and medialization/lateralization of the hip joint following total hip arthroplasty. Clin Orthop Relat Res 1994; (304): 165-71.
[PMID: 8020209] , 10Schmalziried TP, Noordin S, Amustutz HC. Update on nerve palsy associated with total hip replacement 1997.
[http://dx.doi.org/10.1097/00003086-199711000-00020] , 12Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87(12): 2619-25.
[http://dx.doi.org/10.2106/JBJS.C.01564] [PMID: 16322610] , 14Mihalko WM, Phillips MJ, Krackow KA. Acute sciatic and femoral neuritis following total hip arthroplasty. A case report. J Bone Joint Surg Am 2001; 83-A(4): 589-92.
[http://dx.doi.org/10.2106/00004623-200104000-00017] [PMID: 11315791] -16Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 1987; (218): 136-41.
[PMID: 3568473] ]. One study on nerve palsy following THA reported that the odds ratio for the risk of nerve palsy in osteoarthritis due to subluxation is 3.7, while that for osteoarthritis due to trauma is 3.8 [12Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87(12): 2619-25.
[http://dx.doi.org/10.2106/JBJS.C.01564] [PMID: 16322610] ].
The aim of the present study was to analyze the incidence of and risk factors for nerve palsy in a consecutive series of Japanese patients who underwent cementless THA using the posterolateral approach.
The study protocol adhered to the ethical guidelines of the 1975 Declaration of Helsinki, and the institutional review board of our institution approved this study (2017-04-26).
The subjects of the study consisted of 6,123 cases from among 4,095 patients who underwent primary THA at this hospital from September 1998 to December 2013. These included 959 cases in 810 male patients and 5,164 cases in 4,085 female patients. The average age at the time of surgery was 62.1 years (range, 18–98 years). THA was performed using the posterolateral approach under spinal anesthesia with identical cementless implants (AMS-HA acetabular shell and PerFix-HA stem; Kyocera, Osaka, Japan). Three cases in which primary THA was performed using cement implants for osteopetrosis and cases of revision THA were excluded from the present study.
The number of cases of postoperative nerve palsy, the diagnosis, the amount of leg elongation and the prognosis were investigated. Two groups were created, one in which postoperative nerve palsy occurred and one in which it did not, and the risk factors for nerve palsy were analyzed. A univariate analysis was conducted to analyze the risk factors for nerve palsy, with the dependent variable being whether or not palsy occurred and the independent variables being age, gender, height, weight, body mass index (BMI), affected side, diagnosis, range of motion (ROM) before the operation, and the Japanese Orthopaedic Association (JOA) Hip Score before the operation, the operative time, operative bleeding, and leg elongation, which are considered to risk factors for the nerve palsy. The JOA hip score is used to evaluate the hip joint function. It has four categories, with a maximum total score of 100 points: pain (40 points), range of motion (20 points), walking ability (20 points), and activities of daily living (20 points). The amount of leg elongation was determined as the difference in the distance from the superior anterior iliac spine to the medial malleolus of the ankle before and after the operation. Variables that showed statistical significance in the univariate analysis were included in a multivariate analysis (regression analysis). Furthermore, nerve palsy was diagnosed with less than a Manual Muscle Test (MMT) grade 2 and sensory disorder of the proprioceptive sensation regions. In this study, complete nerve palsy was diagnosed based on an MMT grade of 0 and incomplete nerve palsy was diagnosed based on an MMT grade of 1 or 2. Furthermore, the cases involving complete hip dislocation (Crowe IV) were analyzed separately from those involving osteoarthritis due to subluxation. Eight early cases of complete hip dislocation underwent THA without femoral shortening osteotomy at the judgment of the operator, while the other cases of complete hip dislocation underwent THA with femoral shortening osteotomy.
The IBM SPSS Statistics software program (version 19 for Windows; SPSS Inc., an IBM Company, Chicago, IL, USA) was used to perform the statistical analyses. Student's t-test, the chi-square test, and a logistic regression analysis were carried out. P values of < 0.05 were considered to indicate statistical significance.
Nerve palsy occurred following primary THA in 14 out of 6,123 (0.22%) cases, all of which involved nerve palsy of the entire peroneal nerve region. The diagnoses included osteoarthritis due to subluxation (n=6), complete hip dislocation (n=3), osteonecrosis of the femoral head (n=2), primary osteoarthritis (n=1), osteoarthritis due to trauma (n=1), and multiple osteochondromatosis (n=1). The extent of nerve palsy included incomplete paralysis (n=8) and complete paralysis (n=6). The mean leg elongation of all cases was 1.33 cm (range, 0 to 6.5 cm), and the value in palsy cases was 1.96 cm (range, 0.5 to 4.5 cm) while that in no palsy cases was 1.96 cm (range, 0.5 to 4.5 cm). The mean leg elongation of complete hip dislocation cases without femoral shortening osteotomy was 4.8 cm (range, 3.0 to 6.5 cm), and the mean leg elongation of complete hip dislocation with femoral shortening osteotomy was 3.1 cm (range, 2.0-4.0 cm). Additional operations included leg shortening by stem revision (n=1) and neurolysis (n=1). The muscular strength recovered to more than an MMT score of 3 in the 8 cases of incomplete paralysis. One of the 6 cases involving complete paralysis recovered to more than an MMT score of 3 and 1 recovered to an MMT score of 2; the remaining 4 cases showed no recovery, even after three years. In the cases in which the patients recovered, a period of 1 to 36 months was required for the muscle strength to recover. In cases in which stem revision was performed as the additional operation, the diagnosis was complete hip dislocation and a leg length extension (45 mm) was performed. Incomplete paralysis occurred; however, the neurological disorder recovered by shortening the legs during stem revision. In cases in which neurolysis was performed, the pain and numbness at the distal end of the fibulae head were strong, and neurolysis of the fibulae head was performed. While the pain and numbness subsided, the motor palsy showed no improvement in the two years after the operation (Table 1).
Cases of nerve palsy in peroneal nerve reision.
In the analysis of the risk factors for nerve palsy, there were no significant differences in age, gender, affected side, ROM, JOA hip score, operation time, the bleeding of operation, and the leg elongation; however, significant differences were confirmed in the diagnosis (osteoarthritis due to subluxation, osteonecrosis of the femoral head, complete hip dislocation), weight and BMI (Table 2). None of the risk factors remained significant in the multivariate analysis (Table 3). In the cases involving osteonecrosis of the femoral head, the ROM before operation was good and the leg length discrepancy was small; however, there were many cases involving patients with a relatively low body weight and relatively low BMI (Table 4).
Subject Characteristics and results of analysis for the factors influencing nerve palsy.
Odds of the risk factors influencing nerve palsy as indicated by multivariable regression analysis.
Subject characteristics of analysis for the ION patients.
This study is a report on 6123 cases from the same institution. In all cases, THA was performed using the posterolateral approach with the same cementless implant. Furthermore, all of the subjects were Japanese and an analysis of the risk factors for nerve palsy was conducted.
In the present study, the incidence of nerve palsy following primary THA was 0.22%, with all cases of nerve palsy involving the entire peroneal nerve region. Only three cases showed factors that were considered to be associated with the occurrence of nerve palsy. The diagnosis was complete hip dislocation in each case and excessive elongation of the leg length was performed. Femoral shortening osteotomy was not performed in these cases and leg length elongation of more than 30 mm was performed during the operation. Thus, it is suspected that nerve palsy occurred due to excessive leg elongation.
Recovery from nerve palsy was observed in 10 of the 14 cases (71%) in the present study, and no recovery was observed in the four cases of complete paralysis. The average time until recovery was 10.8 months (range, 1 to 36 months). The recovery rate from nerve palsy following THA differs according to the degree of paralysis. Approximately 90% of incomplete paralysis recover. In contrast only 40–50% of complete paralysis show a complete recovery. In many cases, the period of recovery was within two years, and an incomplete nerve palsy was associated with an earlier. Sciatic nerve palsy tends to require a longer time for recovery than the other nerves, and there is one reported case in which recovery was judged to have occurred from 5 to 7 years after a THA [17Barrack RL. Neurovascular injury: Avoiding catastrophe. J Arthroplasty 2004; 19(4)(Suppl. 1): 104-7.
[http://dx.doi.org/10.1016/j.arth.2004.02.013] [PMID: 15190562] -19Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87(12): 2619-25.
[http://dx.doi.org/10.2106/JBJS.C.01564] [PMID: 16322610] ]. According to Jacob et. al., nerve palsy following THA was confirmed in 93 of 12,998 cases (0.72%), with a complete recovery occurring in 46 cases (50%). The period until recovery was less than 6 months in 17 cases (37%), 6 to12 months in 17 cases (37%), and more than 1 year in 12 cases (24%). Furthermore, 4 cases (4%) did not recover until a mean of 2.2 years after the operation [15Jacob AK, Mantilla CB, Sviggum HP, Schroeder DR, Pagnano MW, Hebl JR. Perioperative nerve injury after total hip arthroplasty: Regional anesthesia risk during a 20-year cohort study. Anesthesiology 2011; 115(6): 1172-8.
Nerve palsy after THA occurred significantly more frequently in patients with a lower body weight and a lower BMI in the present study. The sciatic nerve was present near the operative field with the posterolateral approach, and direct pressure was applied during the operation. Thus, sciatic nerve palsy may have occurred due to crushing or ischemia. In cases with a lower body weight and lower BMI, it is easy for direct pressure to be applied to the sciatic nerve, and there were probably significant differences in the incidence of nerve palsy. Furthermore, because operations were performed under spinal anesthesia in the present study, peroneal nerve palsy due to the direct pressure of the fibular head during the postoperative resting period may have developed easily in patients with a lower body weight and lower BMI. It is possible that anesthesia may cause nervous injury when using spinal anesthesia or nerve block. However, one study reported that there was no difference in the incidence of nerve disorders resulting from anesthetization in THA [15Jacob AK, Mantilla CB, Sviggum HP, Schroeder DR, Pagnano MW, Hebl JR. Perioperative nerve injury after total hip arthroplasty: Regional anesthesia risk during a 20-year cohort study. Anesthesiology 2011; 115(6): 1172-8.
The risk of nerve palsy is reported to be high in patients with osteoarthritis due to subluxation because the sciatic nerve is close to the ischium and ilium [12Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87(12): 2619-25.
[http://dx.doi.org/10.2106/JBJS.C.01564] [PMID: 16322610] , 20Liu R, Liang J, Wang K, Dang X, Bai C. Sciatic nerve course in adult patients with unilateral developmental dysplasia of the hip: Implications for hip surgery. BMC Surg 2015; 15: 14.
[http://dx.doi.org/10.1186/1471-2482-15-14] [PMID: 25638152] ]. However, the incidence of paralysis was significantly low in patients with osteoarthritis due to subluxation in the present study. This was influenced by the fact that all of the subjects were Japanese and that osteoarthritis due to subluxation was the most common diagnosis [21Nagamine S, Sonohata M, Kitajima M, et al. Seasonal trends in the incidence of hip osteoarthritis in Japanese patients. Open Orthop J 2011; 5: 134-7.
[http://dx.doi.org/10.2174/1874325001105010134] [PMID: 21584203] , 22Jingushi S, Ohfuji S, Sofue M, et al. Multiinstitutional epidemiological study regarding osteoarthritis of the hip in Japan. J Orthop Sci 2010; 15(5): 626-31.
[http://dx.doi.org/10.1007/s00776-010-1507-8] [PMID: 20953923] ]. Furthermore, the fact that that complete hip dislocation was not confused with osteoarthritis due to subluxation likely influenced this result. In contrast, nerve palsy occurred in three cases of complete hip dislocation and was significantly more common in cases of complete hip dislocation than other diagnosis. The three cases of complete hip dislocation that developed nerve palsy did not undergo femoral shortening osteotomy, and the longest leg elongation was 45 mm. Similarly to Sonohata's report, there were no cases of nerve palsy in patients with complete hip dislocation who underwent THA with femoral shortening osteotomy [23Sonohata M, Kitajima M, Kawano S, Mawatari M. Nerve Palsy after total hip arthroplasty without subtrochanteric femoral shortening osteotomy for a completely dislocated hip joint. Open Orthop J 2016; 10: 785-92.
[http://dx.doi.org/10.2174/1874325001610010785] [PMID: 28217204] , 24Sonohata M, Tajima T, Kitajima M, et al. Total hip arthroplasty combined with double-chevron subtrochanteric osteotomy. J Orthop Sci 2012; 17(4): 382-9.
[http://dx.doi.org/10.1007/s00776-012-0240-x] [PMID: 22580867] ].
The incidence of osteonecrosis of the femoral head was significantly high. The body weight and BMI were significantly lower in the osteonecrosis cases than in other diagnosis cases (Table 4). Because a lower body weight and lower BMI were found to be risk factors of nerve palsy after THA in this study, we believe that osteonecrosis of the femoral head also represents a risk factor of nerve palsy after THA.
Many studies have reported that the excessive elongation of the leg length is a risk factor for nerve palsy following THA [5Oldenburg M, Müller RT. The frequency, prognosis and significance of nerve injuries in total hip arthroplasty. Int Orthop 1997; 21(1): 1-3.
[http://dx.doi.org/10.1007/s002640050107] [PMID: 9151175] , 7Johanson NA, Pellicci PM, Tsairis P, Salvati EA. Nerve injury in total hip arthroplasty. Clin Orthop Relat Res 1983; (179): 214-22.
[PMID: 6617020] , 8Nercessian OA, Piccoluga F, Eftekhar NS. Postoperative sciatic and femoral nerve palsy with reference to leg lengthening and medialization/lateralization of the hip joint following total hip arthroplasty. Clin Orthop Relat Res 1994; (304): 165-71.
[PMID: 8020209] , 16Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 1987; (218): 136-41.
[PMID: 3568473] ]. However, determining the leg elongation length at which paralysis will not occur is difficult [19Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87(12): 2619-25.
[http://dx.doi.org/10.2106/JBJS.C.01564] [PMID: 16322610] ]. The length of leg elongation in the cases that developed nerve palsy did not exceed 20 mm except for in cases of complete hip dislocation and osteoarthritis for trauma. In the present study, nerve palsy even occurred in cases in which the length of leg elongation was small and leg elongation was not a significant factor. We consider that the nerve palsy after THA occurs by a multiple factorial.
The present clinical study was associated with some limitations. The study was a retrospective study and nerve palsy at the sciatic nerve part or nerve palsy by the fibula head could not be ruled out in cases of peroneal nerve palsy. The differentiation between palsy of the sciatic nerve and the peroneal nerve can be made by electromyography of the short head of the biceps femoris. However, this was not implemented in the present study. Another limitation is the possibility that minor nerve palsy was overlooked. Furthermore, the procedure used to measure the leg length is a simple method limited only by its inability to reflect the true bony length.
Nerve palsy occurred in 14 out of 6,123 Japanese cases (0.22%) in which primary THA was performed using the post lateral approach. In all cases the entire peroneal nerve region was affected. Recovery from nerve palsy was confirmed in 10 of the 14 cases (71.4%) with recovery requiring a maximum of 36 months. The univariate analysis revealed that complete hip dislocation, osteonecrosis of the femoral head, low body weight, and low BMI were risk factors for nerve palsy following THA. It is important to make efforts to prevent paralysis because the recovery from nerve palsy and the recovery of the leg function is delayed when nerve palsy occurs. In THA using posterolateral approach, it is necessary to pay attention to the pressure on the sciatic nerve during surgery and pressure on the fibular head before the recovery from postoperative spinal anesthesia when the operation is performed using spinal anesthesia. Furthermore, more care should be taken in cases involving patients with a low body weight and a low BMI.
BMI = Body Mass Index
JOA = Japanese Orthopaedic Association
ROM = Range of Motion
THA = Total Hip Arthroplasty
This study is approved by the Institutional Review Board (IRB) of Saga University.
HUMAN AND ANIMAL RIGHTS
All procedures were performed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1964 and later versions.
Written inform consent was obtained from all participants.
The authors declare no conflict of interest, financial or otherwise.
We wish to thank Takao Hotokebuchi MD, Yukihiko Tutumi MD, Toshimitu Koga MD, Takako Ishii MD, Masamori Shigematu MD, Kenji Ogawa MD and Hidefumi Honke MD for their assistance in patient recruitment.
[1] Singh J, Politis A, Loucks L, Hedden DR, Bohm ER. Trends in revision hip and knee arthroplasty observations after implementation of a regional joint replacement registry. Can J Surg 2016; 59(5): 304-10.
[http://dx.doi.org/10.1503/cjs.002916] [PMID: 27438053]
[2] Petis S, Howard JL, Lanting BL, Vasarhelyi EM. Surgical approach in primary total hip arthroplasty: Anatomy, technique and clinical outcomes. Can J Surg 2015; 58(2): 128-39.
[3] Schmalzried TP, Amstutz HC, Dorey FJ. Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone Joint Surg Am 1991; 73(7): 1074-80.
[http://dx.doi.org/10.2106/00004623-199173070-00018] [PMID: 1874771]
[4] Jolles BM, Bogoch ER. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Syst Rev 2006; 19(3): CD003828.
[5] Oldenburg M, Müller RT. The frequency, prognosis and significance of nerve injuries in total hip arthroplasty. Int Orthop 1997; 21(1): 1-3.
[http://dx.doi.org/10.1007/s002640050107] [PMID: 9151175]
[6] Navarro RA, Schmalzried TP, Amstutz HC, Dorey FJ. Surgical approach and nerve palsy in total hip arthroplasty. J Arthroplasty 1995; 10(1): 1-5.
[http://dx.doi.org/10.1016/S0883-5403(06)80057-4] [PMID: 7730818]
[7] Johanson NA, Pellicci PM, Tsairis P, Salvati EA. Nerve injury in total hip arthroplasty. Clin Orthop Relat Res 1983; (179): 214-22.
[PMID: 6617020]
[8] Nercessian OA, Piccoluga F, Eftekhar NS. Postoperative sciatic and femoral nerve palsy with reference to leg lengthening and medialization/lateralization of the hip joint following total hip arthroplasty. Clin Orthop Relat Res 1994; (304): 165-71.
[9] Eggli S, Hankemayer S, Müller ME. Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg Br 1999; 81(5): 843-5.
[http://dx.doi.org/10.1302/0301-620X.81B5.9610] [PMID: 10530847]
[10] Schmalziried TP, Noordin S, Amustutz HC. Update on nerve palsy associated with total hip replacement 1997.
[http://dx.doi.org/10.1097/00003086-199711000-00020]
[11] Satcher RL, Noss RS, Yingling CD, Ressler J, Ries M. The use of motor-evoked potentials to monitor sciatic nerve status during revision total hip arthroplasty. J Arthroplasty 2003; 18(3): 329-32.
[http://dx.doi.org/10.1054/arth.2003.50055] [PMID: 12728425]
[12] Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87(12): 2619-25.
[http://dx.doi.org/10.2106/JBJS.C.01564] [PMID: 16322610]
[13] Smith TO, Blake V, Hing CB. Minimally invasive versus conventional exposure for total hip arthroplasty: A systematic review and meta-analysis of clinical and radiological outcomes. Int Orthop 2011; 35(2): 173-84.
[14] Mihalko WM, Phillips MJ, Krackow KA. Acute sciatic and femoral neuritis following total hip arthroplasty. A case report. J Bone Joint Surg Am 2001; 83-A(4): 589-92.
[http://dx.doi.org/10.2106/00004623-200104000-00017] [PMID: 11315791]
[15] Jacob AK, Mantilla CB, Sviggum HP, Schroeder DR, Pagnano MW, Hebl JR. Perioperative nerve injury after total hip arthroplasty: Regional anesthesia risk during a 20-year cohort study. Anesthesiology 2011; 115(6): 1172-8.
[16] Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 1987; (218): 136-41.
[17] Barrack RL. Neurovascular injury: Avoiding catastrophe. J Arthroplasty 2004; 19(4)(Suppl. 1): 104-7.
[http://dx.doi.org/10.1016/j.arth.2004.02.013] [PMID: 15190562]
[18] Zappe B, Glauser PM, Majewski M, Stöckli HR, Ochsner PE. Long-term prognosis of nerve palsy after total hip arthroplasty: Results of two-year-follow-ups and long-term results after a mean time of 8 years. Arch Orthop Trauma Surg 2014; 134(10): 1477-82.
[20] Liu R, Liang J, Wang K, Dang X, Bai C. Sciatic nerve course in adult patients with unilateral developmental dysplasia of the hip: Implications for hip surgery. BMC Surg 2015; 15: 14.
[http://dx.doi.org/10.1186/1471-2482-15-14] [PMID: 25638152]
[21] Nagamine S, Sonohata M, Kitajima M, et al. Seasonal trends in the incidence of hip osteoarthritis in Japanese patients. Open Orthop J 2011; 5: 134-7.
[http://dx.doi.org/10.2174/1874325001105010134] [PMID: 21584203]
[22] Jingushi S, Ohfuji S, Sofue M, et al. Multiinstitutional epidemiological study regarding osteoarthritis of the hip in Japan. J Orthop Sci 2010; 15(5): 626-31.
[23] Sonohata M, Kitajima M, Kawano S, Mawatari M. Nerve Palsy after total hip arthroplasty without subtrochanteric femoral shortening osteotomy for a completely dislocated hip joint. Open Orthop J 2016; 10: 785-92.
[24] Sonohata M, Tajima T, Kitajima M, et al. Total hip arthroplasty combined with double-chevron subtrochanteric osteotomy. J Orthop Sci 2012; 17(4): 382-9.
[http://dx.doi.org/10.1007/s00776-012-0240-x] [PMID: 22580867]


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Tag: tulum
March 11, 2020 March 18, 2020 Posted in TravelTagged cenote, glamping, mexico, mexicokan, nativus tulum, quintana roo, travel, tulum, yucatanLeave a comment
The second half of our trip couldn't have been more different from the first half. Both places may speak Spanish, and it may only take an hour to get from one destination to the other, but Tulum was another world from Cuba. It's beautiful here. Like, really beautiful. I'm from Hawaii and even I was in awe of the beaches, the cenotes, and the jungle. Unfortunately, the rest of the world also knows how beautiful Tulum is, which is why it's probably one of the most touristy places I've ever visited. After interacting with locals constantly in Cuba, it was off-putting to be surrounded by so many influencers and wealthy Europeans in Tulum. Regardless, Anthony and I made the most of it and tried our best to find ways to do Tulum differently.
Gorgeous beaches!
Most tourists in Tulum stay in outrageously expensive resorts on the beach. Many of these resorts are imaginatively designed and undeniably stunning, so if you have some extra cash, you can stay at Azulik, where you pay $700/night for a villa with no roof or no WiFi. We stayed at a glamping hotel called Nativus Tulum. The hotel contains six tents tucked into their own little corners of the property, each with zippered screens to keep any bugs out, a spa-worthy outdoor bathroom (outdoor shower included!), and a backyard with a hammock and outdoor seating. We've had an outdoor shower before — in our extravagant hotel on our safari in South Africa — but it was the first time we felt that there was complete privacy, so we really enjoyed using ours here, in utter paradise. The entire property had WiFi, complimentary bike rentals, an outdoor yoga studio, and huge breakfasts every morning. The best part, however, was direct access to a cenote, where we kayaked, paddleboarded, and watched the sunset from the deck. And if we wanted to go to the beach, all we had to do was cross the street and enter through a hotel. Since our hotel was on the southern end of Tulum, this part of the beach wasn't crowded at all. This is how to do Tulum.
We stayed in Tent #5 (cinco)
Loved the design of our outdoor bathroom
Comfortable bed, with outlets, WiFi, and all the necessities
Our outdoor shower
The entrance to our hotel
Fresh eggs and quesadillas for breakfast
Breakfast, part 2
Our hammock right in front of our tent
View of the cenote from our hotel
Anthony goes paddleboarding
Watching the sunset from our deck
Of course there's a yoga area at our hotel
We were very adamant about not sitting on the beach all day, so we booked a couple of all-day tours with MexicoKan. Our first tour, Mayan Inland Expedition, was our favorite. We were driven deeper into the state of Quintana Roo to the ancient Mayan city of Cobá, which was once the most powerful in the region and is estimated to have had a population of over 50,000 at its peak. Massive pyramids and monuments have been buried in the jungle for over a thousand years, only recently discovered by archaeologists. Lush vegetation still covers most of the city, and it's exciting to see only half-excavated ruins emerging from the vines and tree roots. We biked through Cobá and climbed Ixmoja, the largest pyramid. The climb up isn't too bad, but coming down the steep, slippery steps is the hard part.
Climbing up Ixmoja
We were the first ones to the top! And wearing sandals instead of sneakers!
Climbing down was the scariest part
Our hilarious tour guide
Riding a children's bike to different ruins
After returning our bikes, we visited the stunning Punta Laguna nature reserve, where we searched for spider monkeys (it wasn't difficult, their screeching are blood-curdling), ziplined across a turquoise lake, canoed, and were blessed in a Mayan ceremony.
Mayan ceremony
After ziplining and canoeing across this lake, we took in the views
For lunch we went to the nearby village of Nuevo Durango, where we visited the house of a local family who created a project that nurtures injured or endangered animals and reintroduces them into the wild. They have all types of birds and farm animals, as well as medicinal plants and honey bees that don't have stingers. We made tortillas and had a delicious home-cooked meal there.
Making tortillas
Wanted the recipe for this soup!
Our last activity on this tour was swimming in a cenote that our group had all to ourselves. A cenote is a deep, water-filled sinkhole in limestone that is created when the roof of the underground cavern collapses. This creates a natural pool which is then filled by rain and water flowing from underground rivers. The word cenote comes from the Mayan word dzonot, which means "well." The water in these cenotes is crystal-clear, cool, calcium-rich freshwater. The calcium levels are so high, in fact, that it's hard to tread the water; I had to wear a lifejacket because my arms were getting so tired! The Yucatán Peninsula has thousands of these cenotes because the ground is primarily made up of limestone, which is porous. Cenotes were the area's main source of water and played an important role in ancient Mayan civilization, as passages to the underworld and sites for sacrificial purposes. Some cenotes are easy to access, with staircases leading down to the water, while others are a bit more tricky, with ladders. Anthony and a couple other brave souls jumped from the very top, which was 8 meters high.
Imagine stumbling across this!
Wearing a lifejacket because my arms got tired!
Enjoying the cenote with our new friends
The next day, we had another tour with the same company. The World Wonder Discovery tour was very different; instead of adventurous millennials, we were surrounded by mostly uncultural middle-aged Americans, and the pace was much slower. We started off at Chichen Itza, one of the New Wonders of the World. The iconic Temple of Kukulkan is a step pyramid of nine square terraces. The four faces of the pyramid have protruding stairways that rise at an angle of 45°. Around the spring and autumn equinoxes, the northwest corner of the pyramid casts a series of triangular shadows against the western balustrade that evokes the appearance of a serpent wriggling down the staircase. It's widespread belief that this effect was achieved on purpose to record the equinoxes.
Chichen Itza
Nearby is the Great Ball Court, the largest and best preserved ball court in ancient Mesoamerica. This sport was played throughout the Mayan civilization, but it was more than just an athletic event; it was also a sacrificial and religious event. The winning team's captain was decapitated, an honorable sacrifice to the gods. A rubber ball could be hit with the right hip, right elbow, and right knee, but no hands. The aim was to move the ball through the stone ring up high.
After Chichen Itza, we had lunch at a touristy but beautiful former mansion in Valladolid, a quiet colonial town. Then we swam in another cenote, which was even more impressive than yesterday's. It had a rope running through the middle just in case you got tired from swimming in the calcium-rich waters. On our way out, we looked at the fossils inlaid in the cenote walls — proof that the entire Yucatan used to be underwater.
Beautiful restaurant for lunch in Valladolid
Mole on chicken enchiladas
Festive Valladolid
Cenote Xux-Ha
Most of our meals in Tulum alternated between just two places (a dirt-cheap taco joint on the beach, and a mid-range vegan spot just a few steps from our hotel) because everything else by us was so overpriced, we felt like we were back in New York. Tulum caters to tourists so much that all places take USD and Euros; I sometimes forgot that I was in another country. Fortunately, we found two spots near our hotel that didn't hurt our heart or wallet too much: Charley's Vegan Tacos (a vegan spot with fun decor) and Taqueria La Eufemia (a boisterous beachfront taco shop where we saw the most locals in the entire region).
Crispy fish and grilled shrimp tacos at La Eufemia
If we had another day in Tulum, I'd try to make reservations at Hartwood, the most prestigious restaurant in Tulum that was even beloved by locals.
There are ATMs everywhere, and many of them only give out USD, which just highlights how tourist-centric this place is.
Tip restaurants 15% and tour guides $50-70 per person. 1 USD = 19 Mexican Peso.
We used a car service called eTransfers to pick us up from the airport and to take us back. I paid online, and they showed up on time and in a comfortable van.
If you only do three things in Tulum: enjoy the beach, visit a few cenotes (they're all unique, so you'll want to explore more than one), and book the Mayan Inland Expedition tour with MexicoKan. MexicoKan Tours picks you up directly from your hotel in the morning and drops you off just before sunset.
Wake up early and watch the sunrise from the beach, since it faces east.
Secluded beaches


Rarely has a new technology generated the level of enthusiasm and interest that is now associated with CRISPR/Cas-9, a simple and efficient genomic editing technique with the potential for advancing basic genetic research, gene therapy, and personalized medicine. Scientists across the world, biotech and drug companies, and university licensing officers are capitalizing on the research opportunities presented by this technology and are using this versatile system on a multitude of species.
We have done an in-depth review of sources publicly available as of this writing and discuss here: (1) the science behind this new technology, (2) several of the research groups responsible for the promising applications for this technology, and (3) the related and evolving intellectual property (IP) landscape.
CRISPR is a developing technology with a promising—and unpredictable—future. Accordingly, we will track CRISPR's progress over the coming months and will provide periodic updates.
Nearly a decade later, a group from the Universidad de Alicante, Spain recognized that these tandem repeating sequences were a common feature in microbial genomes and referred to them as TREPs.2 The characteristic feature of what is now called CRISPR thus became recognized as a series of palindromic DNA repeats of about 20-50 base pairs, separated by spacer sequences of roughly the same length.
It was not until 2005, however, that a precise function was reported for these DNA repeats. Several groups reported that the bacterial spacer sequences located between the repeating palindromic sequences were often consistent with nucleotide sequences found in phages (bacterial viruses), thus suggesting a role in bacterial innate immunity; i.e. defense.
Then, in 2007, a research team led by Rodolphe Barrangou at the food ingredient and industrial enzymes company Danisco confirmed this possibility by demonstrating that bacterial resistance to a given phage strain could be altered by modifying the bacterial spacer DNA. It was thus understood that the nucleotide sequences between the palindromic repeats (spacers) correspond to DNA sequences of phage to which bacteria had been previously exposed, and that such spacers serve as "memory" of prior infection by the phage.
But "memory" alone is not enough to protect bacteria from subsequent exposure to phage. Further research has demonstrated that, in a bacterial cell, exposure to a previously-encountered phage triggers transcription of the corresponding spacer sequence into a short guide CRISPR-RNA (crRNA). The CRISPR-associated ("Cas") enzyme known as the Cas-9 nuclease is then guided to the target phage by a two-part RNA structure that includes this crRNA and bears a short region of homology to the original phage DNA. This enables Cas-9 to identify and cleave the target phage DNA, effecting a double-stranded DNA cut at a specific site. It is this precise targeted DNA-cutting function of CRISPR/Cas9 systems that holds the most potential for use in genomic editing.
For genomic editing purposes, a researcher can simply mimic the capabilities of this two-part RNA structure by generating a single small "guide" RNA.3 This guide RNA can be programmed to correspond to any sequence of genomic DNA of interest and, when linked to a Cas-9 enzyme, constitutes an effective tool for the location and site-specific double-stranded cleavage of any target DNA.
Researchers are now able to harness the site-specificity of the CRISPR/Cas9 for genomic editing purposes. Two important advantages of the CRISPR/Cas-9 system are its remarkable versatility working in cells and directly in eggs of multiple species (e.g. primate to malaria parasite to wheat) and its ease of use, including the cheapness of production.
In addition to its use for DNA cutting, the CRISPR/Cas-9 system can be used as a DNA nickase (a version of the Cas9 enzyme which generates a single-strand DNA break [nick], instead of a double-strand DNA break), can be used to run DNA interference with a catalytically inactive Cas-9 protein, and can be used to increase the expression of a gene by fusing Cas-9 to an activator protein. Through these techniques, CRISPR/Cas-9 can act as an RNA-guided platform for sequence-specific control of gene expression.4 Such gene expression control may prove particularly useful in drug design.
In contrast with existing genomic editing tools such as Zinc Finger nucleases (ZFNs) and Transcription activator-like effector nucleases (TALENs), the CRISPR/Cas-9 sgRNA editing system does not rely on protein design. This simplicity means that use of CRISPR/Cas-9 for genomic editing research requires considerably less time and fewer resources than ZFNs or even TALENs.
Scientists at several institutions have been working hard to understand the bacterial system and CRISPR and, particularly, to improve CRISPR's functionality and harness its capabilities for ever-expanding research and biomedical applications.
Our research of publicly-available information showed there has been interest in CRISPR since at least 2007. In the following sections, we summarize work by those groups, including published papers and publicly-available patent filings. Each of these is discussed below, based on the chronological order of publications we identified.
Danisco: In 2009, Danisco began exploiting CRISPR systems to improve the innate immunity of the bacterial cultures for yogurt and cheese manufacture.
Like the technology itself, the intellectual property landscape relating to CRISPR is evolving. As we carried out our research, it became increasingly clear that, because CRISPR is such a new technology, many of the patent filings relating to CRISPR as a tool for gene editing are only just now beginning to publish.14 As of the writing of this article, there are only a few published applications relating directly to CRISPR/Cas-9 as a genomic editing platform. Additionally, however, the CRISPR IP landscape includes several published applications and issued patents which are not directed specifically to genomic editing, but may be cited as prior art15 to later-filed pending patent applications. We summarize both aspects of this IP landscape below.
The Danisco team, which published in 2007 on the functional link between spacer sequences and bacterial immunity, filed several patent applications and has issued patents relating to CRISPR and bacterial typing, bacterial modifications, and methods for enhancing bacterial resistance to phage. For example, U.S. Patent Nos. 8,361,725 and 7,919,277 claim methods of typing a particular bacterial species having a CRISPR region by amplifying and typing the nucleotide sequences comprising that region.
Published applications pending from the Danisco group include U.S. App. No. 13/722,539, which presently claims an isolated nucleic acid molecule selected from several different CRISPR-associated sequence ID numbers, and U.S. App. No. 11/990,885, which presently claims a method for modulating resistance in a cell against a target nucleic acid comprising introducing one or more Cas genes or proteins into the cell in combination with a CRISPR sequence corresponding to the target nucleic acid.
The prosecution histories for these published applications are informative regarding the types of issues applicants are likely to face in attempting to describe and craft claims to protect this very new technology. For example, enablement and written description rejections have been made in several of these cases, with examiners indicating that broad claims to "CRISPR" encompass many possible sequences and are too broad.
There is also CRISPR work by Dr. Erik Sontheimer and colleagues at Northwestern University. Northwestern filed an application on September 23, 2009 (U.S. App. No. 12/565,589) directed to "Target DNA Interference with CrRNA." This application published on March 25, 2010, before many of the filings discussed below.
Dr. Sontheimer's initial claims were broadly directed to a "method of inhibiting the function and/or presence of a target DNA sequence" comprising administration of crRNA and one or more Cas proteins to a cell. The crRNA hybridizes with the target DNA, interfering with the function of a target sequence. The claims pursued are more narrowly directed to utilizing CRISPR for treating or preventing infections.
These claims were abandoned, and there are no pending U.S. applications in that family. During prosecution, the claims were rejected for inadequate enablement and lack of sufficient written description. The early-filed published application is available for all it teaches and may well be cited against later-filed applications drawn more specifically to claiming the use of CRISPR systems for genomic editing.
The University of Georgia Research Foundation (UGRF) secured a patent, U.S. Patent No. 8,546,553, on October 1, 2013 for "Prokaryotic RNAi-like System and Methods of Use," by Terns et al. This patent includes claims directed to an isolated polynucleotide comprising at least 23 nucleotides, a psiRNA-tag (psi standing for "prokaryotic silencing") and a guide sequence.
The present CRIPSR IP landscape includes PCT17 application WO 2013/176722, filed by the Regents of the University of California in conjunction with the University of Vienna and Jennifer Doudna. This PCT application names Martin Jinik, Emmanuelle Chapentier, Jennifer Doudna and others as inventors. It was filed on March 15, 2013, published on November 28, 2013, claimed priority back to May 25, 2012, and is entitled "Methods and Compositions for RNA-Directed Target DNA Modification and for RNA-Directed Modulation of Transcription." It is an international application directed specifically to the use of the CRISPR/Cas-9 system for genomic editing (site-specific modification of a target DNA) purposes.
Several additional, recently-published PCTs describe more specific applications for the CRISPR/Cas-9 system, such as in therapeutics and more specific genomic editing strategies.
For example, on January 16, 2014, two PCTs from Sangamo Biosciences, Inc. published which describe the use of CRISPR/Cas-9 and other genomic editing platforms for specific therapeutic applications. One of these applications (PCT/US2013/032381) entitled "Methods and Compositions for the Treatment of Lysosomal Storage Diseases," describes the delivery of a transgene into a cell using nucleases (such as ZFNs, TALENs or CRISPR/Cas-9 systems), such transgene thus enabling the cell to produce a protein capable of treating monogenic diseases such as Lysosomal storage disease.
Most recently, on January 30, 2014, an application published that is owned by The Broad Institute and MIT and names Feng Zhang among several inventors. This application (PCT/US2013/051418) describes, and presently claims, non-naturally occurring or engineered TALE or CRISPR-Cas systems comprising an inducible switch for the control (activation, enhancement, termination or repression) of specific genetic expression. This appears to be the MIT/Broad Institute's first published application relating to their genomic editing work utilizing the CRISPR/Cas-9 system.
We expect the publication of additional applications relating to the CRISPR/Cas-9 system as a genomic editing tool or for specific therapeutic strategies, and we will monitor such developments.
We have also surveyed published PCT applications relating to the use of CRISPR/Cas-9 for genomic editing or therapeutic applications. Although a few of the most recent of these are described in more detail in the text above, we provide the following table as a summary of each of these international applications that relate to the use of CRISPR/Cas-9 for genomic editing or therapeutic application.
Although the technological capabilities of CRISPR/Cas-9 for genomic editing are rapidly advancing, there are still many unanswered questions about how this technology will be available to the biomedical research community from an IP perspective. Many believe that CRISPR/Cas-9 will prove itself as the platform for the next great leap forward in genetic therapeutics and personalized medicine. However, no one can predict whether (or by whom) the technology will be controlled.
Our best advice is to stay tuned. Further developments are likely just around the corner as more patent applications publish and are granted, although it may be years before the patent landscape is completely defined.
1 Ishino, Y. et al., "Nucleotide sequences of the iap gene, responsible for alkaline phosphatase isozyme conversion in Escherichia coli, and identification of the gene product," J. Bacteriology 169, 5429-5433 (1987).
2 Mojica, F.J.M. et al., "Long stretches of short tandem repeats are present in the largest replicons of the Archaea Haloferax mediterranei and Haloferax volcanii and could be involved in replicon partitioning," Mol. Microbiology 17, 85-93 (1995).
3 Jinek, M. et al., "A Programmable Dual-RNA—Guided DNA Endonuclease in Adaptive Bacterial Immunity," Science 337, 816-821 (2012).
4 Qi, L.S. et al., "Repurposing CRISPR as an RNA-Guided Platform for Sequence-Specific Control of Gene Expression," Cell 152, 1173-1183 (2013).
5 Carte, J. et al., "Cas6 is an Endoribonuclease that Generates Guide RNAs for Invader Defense in Prokaryotes," Genes & Development 22, 3489-3496 (2008).
6 Marraffini L.A. et al., "CRISPR Interference Limits Horizontal Gene Transfer in Staphylococci by Targeting DNA," Science 322, 1843-1845 (2008).
7 Jinek, M. et al., "A Programmable Dual-RNA—Guided DNA Endonuclease in Adaptive Bacterial Immunity," Science 337, 816-821 (2012).
8 Gasiunas, G. et al., "Cas9-crRNA ribonucleoprotein complex mediates specific DNA cleavage for adaptive immunity in bacteria," PNAS 109, E2579-E2586 (2012).
9 Cong L. et al., "Multiplex Genome Engineering Using CRISPR/Cas Systems," Science 339, 819-822 (2013).
10 Mali, P. et al. "RNA-Guided Human Genome Engineering via Cas9," Science 339, 823-826 (2013).
11 Wang, H. et al., "One-Step Generation of Mice Carrying Mutations in Multiple Genes by CRISPR/Cas-Mediated Genome Engineering," Cell 153, 910-918 (2013).
12 Editas press release, November 25, 2013.
13 Fu, Y. et al, "Improving CRISPR-Cas nuclease specificity using truncated guide RNAs," Nature Biotechnology advance online publication, January 26, 2014.
14 A patent application does not become public upon filing. With some limited exceptions, such as request by the applicant for an earlier publication date, an application for a patent is published after the expiration of a period of 18 months from the earliest filing date for which a benefit is sought.
15 The term "prior art" refers to information that has been made publicly available in any form before a given date that might be relevant to a patent's claims of originality. If an invention has been described in the prior art, a patent on that invention is not valid.
17 The Patent Cooperation Treaty (PCT) is an international patent law treaty that provides a unified procedure for filing patent applications to protect inventions in each of its contracting states. A patent application filed under the PCT is called an international application, or a PCT application.


Human resource management involves growth and prosperity not only of the company but also of an individual employee. The journey of human resource management is from an individual to the organization. It is important to provide the employees with their physical and emotional needs.
Importance and Functions of Human Resource Management (with diagram)!
In post-globalization era, humans are no more looked as a mere factor of production but rather they carry the capacity to bring the change at the organizational level. It is because of their distinct features such as intelligence and creativity every person in the organization carries some different skills. If the organization provides a chance to the individual to develop and sharpen their skills, that can be effectively utilized for the survival, growth, and future prospects of the company.
There comes the vital importance of managing human resources. As human resource management is a process of finding an employee (i.e., recruitment), training an employee (i.e., training and development), and retaining an employee (i.e., talent management), it has to be looked at from a much broader prospective.
More a person gets the chance to develop their career in any business, more they will become loyal to the organization. Their compensation and employment conditions should be made clear, which will provide them the emotional stability and it will result into total concentration of their work.
Human resource management is nothing but the important tool in the hands of management of any company to achieve best results and prosper through cooperation and personal development of its employees. All the functions of human resource management are focusing on the proper combination of policies on both the ends—an employee and the business.
The prominent objective of the organization is to employ the competent and skilled workforce and retain it for fulfilling the personal, operational and organizational objectives of the business. Human resource management performs different functions which start with the primary and basic processes of planning. Table 5.1 gives the idea about the functions performed by human resource management to fulfill the goals of the organization through individual employee goal achievement.
It includes framing of policies related to human resources in the business. It is a top management level function. It consists of policies from procurement, recruitment, selection, training, development, appraisal, promotion and talent retention. It is mainly intellectual function and requires immense skill.
Finalization of different processes in the business and allotment of those processes to people is the main purpose of organizing.
Formation of a team of competent employees is the basic aim of procurement of manpower. It includes recruitment of employees from internal and external sources, selection of the right people for the right job, their appointment, and induction. Promotion and transfer of an employee also form a part of procurement. It is a wide-based activity taking due care of the operational aspects of getting appropriate employees for the organization.
Providing proper instructions to the employees, fulfilling the training and development requirements, motivating them through monetary and non-monetary measures, and maintaining cordial interpersonal and industrial relations are the activities done under directing.
Human resource management executes training programmes for various categories of employees to ensure better and efficient functioning on their part. Training does the job of sharpening the skills of employees. Even managerial development programmes are organized for higher level managers. It is required to be conducted according to the changing need of time for growth and expansion of business.
Employees are to be encouraged constantly to bring out the best possible out of them. Welfare facilities, safety and security measures, proper working conditions, and worker's participation in management are some of the motivating factors for employees. The important function is maintenance of manpower. Retaining the best employees in the organization which is called talent management is the need of the hour.
Employees in any organization work either individually or in a group. To keep the morale up, to ensure sound group behaviour, and to resolve internal conflicts among employees are some of the main functions of human resource management.
Job analysis, personal career advancement, performance appraisal, cordial industrial relations and constant personnel research are the activities under controlling function.
Constant and stable appraisal of an employee leads to the better performance. The scientific evaluation techniques are to be used while assessing the performance of an employee.
Good relations between management and employees are the sign of a healthy organization. The industrial relation system should be designed accordingly and disputes between management and employees should be resolved at the earliest.
Continuous research activities are to be undertaken to formulate the effective techniques of managing human resources in the business. The research should aim at evaluation of recruitment and selection policies, handling employees' grievances, and survey of the emotional aspects of employees such as morale, satisfaction level, and attitude towards the work and other employees (Figure 5.1).


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