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Purpose: Daily disposable contact lenses offer numerous benefits in terms of ocular health and wearer convenience. The purpose of this work is to update earlier surveys by describing global trends in daily disposable lens fitting between 2000 and 2023., Method: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 265,106 daily wear soft lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of daily disposable lens fitting., Results: Overall, daily disposable lens prescribing increased over time, from 17.1 % of daily wear soft lens fits in 2000 to 46.7 % in 2023 (p < 0.0001). There were significant differences between countries in daily disposable lens prescribing (p < 0.0001), and between the percentage of males fitted with daily disposable lenses, as a proportion of all daily wear soft lenses (37.2 %), compared to females (35.2 %) (p < 0.0001). Daily disposable lens wearers are slightly younger at fitting than reusable soft lens wearers (31.0 vs 31.2 years, respectively) (p < 0.0001), although this difference is not clinically meaningful. Analysis of 50,240 daily wear soft lenses fitted recently (2019-2023) were found to be prescribed for the following replacement frequencies: daily - 47 %; monthly - 42 %; 1-2 weekly - 9 %; and ≥3 monthly - 2 %., Conclusion: There has been a substantial increase in daily disposable lens fitting throughout the first 24 years of this century. The gradual nature of this increase is commensurate with the staged introduction of daily disposable lens designs and expanded parameter ranges over the survey period., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Philip Morgan: Over the past three years Philip Morgan’s research group or he personally has received funding or honoraria from: Alcon, Clearlab CooperVision, Daysoft, Johnson & Johnson Vision, Menicon, and Visco Vision. He is a director of M-Optometry Limited; Nathan Efron: Over the past three years Nathan Efron has received honoraria from CooperVision; Craig Woods: Over the past three years Craig Woods has acted as a consultant for the Brien Holden Vision Institute and Zeiss Vision Care; Deborah Jones: Over the past three years Debbie Jones has received honoraria from Hoya, Essilor, CooperVision, Alcon and SightGlass; Lyndon Jones: Over the past three years, Lyndon Jones’ research group (CORE) or he personally has received research support or lectureship honoraria from Alcon, Azura Ophthalmics, Bausch & Lomb, CooperVision, Essilor, Hoya, iMed Pharma, Integral Biosystems, Johnson & Johnson Vision, Menicon, Novartis, Ophtecs, Ote Pharma, Santen, SightGlass Vision, SightSage, Topcon and Visioneering. Dr Jones is also a consultant and/or serves on an advisory board for Alcon, CooperVision, Johnson & Johnson Vision, Novartis and Ophtecs; Jason Nichols: Jason Nichols has nothing to report. Also, Kelly Nichols is the spouse of Jason Nichols, extending her declarations to him. In the past 12 months, Kelly Nichols has consulted for and received honoraria from: Abbvie, Alcon, Aldeyra, Azura, Bausch + Lomb, Bruder, Cavalry, Dompe, HanAll Bio, Harrow, Novartis, Novaliq, Oyster Point Pharma/Viatris, Sydnexis, Tarsus, TearSolutions, Thea, Topcon, and Trukera. She has received research funding from: Aramis, Kowa, Science Based Health, Sylentis, and TearScience., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: Rigid contact lenses have an important role in contact lens practice. The purpose of this work is to update earlier surveys by describing global trends in rigid lens fitting between 2000-2023., Method: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023. Data relating to 342,500 fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of rigid lens fitting, defined as the fitting of any design of a contact lens manufactured in a rigid material., Results: Overall, rigid lens prescribing increased slightly over time, from 14.2 % of lens fits in 2000 to 15.2 % in 2023 (p < 0.0001). However, post-hoc analysis shows that the change over time is best described as a decline between 2000 and 2012, followed by a steady increase subsequently. There were significant differences in rigid lens prescribing between countries (p < 0.0001). The difference between the percentage of males fitted with rigid lenses, as a proportion of all contact lenses (12.7 %), and females (12.0 %) is significant (p < 0.0001), although not clinically meaningful. Rigid lens wearers are older at fitting than soft lens wearers (38.7 vs 31.3 years, respectively) (p < 0.0001). Analysis of 5,994 rigid lens fits prescribed currently (2019-2023) were categorised as: corneal sphere - 30 %; scleral and corneo-scleral - 28 %; corneal myopia control/orthokeratology - 21 %; and corneal complex (including toric, multifocal and monovision) - 16 %., Conclusion: There has been a slight increase in rigid lens fitting during the second decade of this century. This increase is apparently due to a 'repurposing' of rigid lenses, with the growth of scleral/corneo-scleral and myopia control/orthokeratology lens fits essentially replacing conventional spherical corneal lens fits., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nathan Efron: Over the past three years Professor Efron has received honoraria from CooperVision. Philip B. Morgan: Over the past three years Professor Morgan’s research group or he personally has received funding or honoraria from: Alcon, Clearlab CooperVision, Daysoft, Johnson & Johnson Vision, Menicon, and Visco Vision. He is a director of M-Optometry Limited. Craig Woods: Over the past 3 years Prof Woods has acted as a consultant for the Brien Holden Vision Institute and Zeiss Vision Care. Deborah Jones: Over the past 3 years Dr Jones has received honoraria from Hoya, Essilor, CooperVision, Alcon and SIghtglass. Lyndon Jones: Over the past three years, Dr Jones’ research group (CORE) or he personally has received research support or lectureship honoraria from Alcon, Azura Ophthalmics, Bausch & Lomb, CooperVision, Essilor, Hoya, iMed Pharma, Integral Biosystems, Johnson & Johnson Vision, Menicon, Novartis, Ophtecs, Ote Pharma, Santen, SightGlass, SightSage, Topcon and Visioneering. Dr Jones is also a consultant and/or serves on an advisory board for Alcon, CooperVision, Johnson & Johnson Vision, Novartis and Ophtecs. Over the last 12 months, Jason Nichols: Dr Jason Nichols has nothing to report. Also, Dr. Kelly Nichols is the spouse of Dr. Jason Nichols, extending her declarations to him. In the past 12 months, Dr Kelly Nichols has consulted for and received honorarium from: Abbvie, Alcon, Alderya, Azura, Bausch + Lomb, Bruder, Cavalry, Dompe, HanAll Bio, Harrow, Novartis, Novaliq, Oyster Point Pharma/Viatris, Sydnexis, Tarsus, TearSolutions, Thea, Topcon, and Trukera. She has received research funding from: Aramis, Kowa, Science Based Health, Sylentis, and TearScience., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Lower extremity amputation (LEA) is a major surgical procedure with a high risk of significant morbidity and mortality. The objective of this study was to describe mortality and functionality outcomes following this procedure in a developing country., Methods: This is a retrospective study of all patients undergoing LEA for non-traumatic etiology between 2007 and 2017. Medical records were used to retrieve demographics, comorbidities, and perioperative complications of identified patients. Patients were contacted to follow-up on their medical, postoperative care, and ambulatory status. Mortality and postoperative functionality rates were analyzed., Results: The study included 78 patients. Median follow-up duration was 24 months. Hypertension (81%) and diabetes (79%) were the most common comorbidities. Mortality rates at 30 days, 1, and 5 years were 10.3, 29.2, and 65.5%, respectively. Mortality was significantly associated with age > 70 at amputation ( p  = 0.042), hypertension ( p  = 0.003), chronic kidney disease ( p  = 0.031), and perioperative sepsis ( p  = 0.01). Only 1.6% of patients were discharged into a specialized care center, and only 27% of patients were ambulatory postoperatively, although 90.5% were fitted with a prosthesis., Conclusions: Survival following major amputation in a developing country is currently comparable to more developed regions of the world. Major discrepancy seems to exist in ambulatory status following the procedure. Discharge placement policies should be properly set, and rehabilitation centers funding should be increased. Awareness may also be warranted to educate patients and families about the value and positive impact of rehabilitation centers.

The human-prosthesis interface is one of the most complicated challenges facing the field of prosthetics, despite substantive investments in research and development by researchers and clinicians around the world. The journal of the International Society for Prosthetics and Orthotics, Prosthetics and Orthotics International , has contributed substantively to the growing body of knowledge on this topic. In celebrating the 50th anniversary of the International Society for Prosthetics and Orthotics, this narrative review aims to explore how human-prosthesis interfaces have changed over the last five decades; how research has contributed to an understanding of interface mechanics; how clinical practice has been informed as a result; and what might be potential future directions. Studies reporting on comparison, design, manufacturing and evaluation of lower limb prosthetic sockets, and osseointegration were considered. This review demonstrates that, over the last 50 years, clinical research has improved our understanding of socket designs and their effects; however, high-quality research is still needed. In particular, there have been advances in the development of volume and thermal control mechanisms with a few designs having the potential for clinical application. Similarly, advances in sensing technology, soft tissue quantification techniques, computing technology, and additive manufacturing are moving towards enabling automated, data-driven manufacturing of sockets. In people who are unable to use a prosthetic socket, osseointegration provides a functional solution not available 50 years ago. Furthermore, osseointegration has the potential to facilitate neuromuscular integration. Despite these advances, further improvement in mechanical features of implants, and infection control and prevention are needed.

Purpose: To determine the extent of contact lens fitting for myopia control (MC) in children (defined as ≤ 17 years of age) worldwide and to characterize the associated demographics and fitting patterns., Methods: Survey forms were sent to contact lens fitters in 66 countries between January and March every year for eight consecutive years (2011-2018, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits performed after receiving the survey form. Data were analysed for those countries reporting ≥ 100 contact lens fits to children., Results: Data were analysed for 535 MC fits and 23,295 other (non-MC) lens fits undertaken in 31 countries reporting ≥ 100 contact lens fits to children, with 52.1% of MC fits and 12.0% of non-MC fits being with rigid lenses (p < 0.0001). Overall, MC lenses represented 2.3% of all contact lens fits to children, with significant differences between nations (p < 0.0001), ranging from no MC fits recorded in the Czech Republic, Greece, Japan, South Korea and Puerto Rico, to 24.9% in Austria. There has been an increase in contact lens fitting for MC over the survey period (p < 0.0001). MC contact lenses were fitted to younger children compared to non-MC lenses (MC, median 13 years vs. non-MC, median 15 years) (p < 0.0001). There was no sex bias in the fitting of MC lenses (p = 0.89)., Conclusions: MC lenses are currently being prescribed for younger children in equal measure in terms of soft vs. rigid lenses and males vs. females. The extent of MC fitting is low and varies between nations. The gradual increase in MC fitting throughout the survey period perhaps reflects growing concerns among practitioners over the myopia epidemic., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose This study examined the current pediatric amplification practice with an emphasis on hearing aid verification using probe microphone measurement (PMM), among audiologists in Klang Valley, Malaysia. Frequency of practice, access to PMM system, practiced protocols, barriers, and perception toward the benefits of PMM were identified through a survey. Method A questionnaire was distributed to and filled in by the audiologists who provided pediatric amplification service in Klang Valley, Malaysia. One hundred eight ( N = 108) audiologists, composed of 90.3% women and 9.7% men (age range: 23-48 years), participated in the survey. Results PMM was not a clinical routine practiced by a majority of the audiologists, despite its recognition as the best clinical practice that should be incorporated into protocols for fitting hearing aids in children. Variations in practice existed warranting further steps to improve the current practice for children with hearing impairment. The lack of access to PMM equipment was 1 major barrier for the audiologists to practice real-ear verification. Practitioners' characteristics such as time constraints, low confidence, and knowledge levels were also identified as barriers that impede the uptake of the evidence-based practice. Conclusions The implementation of PMM in clinical practice remains a challenge to the audiology profession. A knowledge-transfer approach that takes into consideration the barriers and involves effective collaboration or engagement between the knowledge providers and potential stakeholders is required to promote the clinical application of evidence-based best practice.

Purpose: The purpose of this survey was to better understand scleral lens (SL) practitioners' fitting preferences and minor SL complications and their subsequent treatments., Method: Practitioners who attended the 2017 Global Specialty Lens Symposium were asked to complete an electronic questionnaire that was created by the investigators, a survey that asked practitioners about their SL fitting experience and preferences, their patients' experience with poor SL wetting, SL fogging, ocular symptoms (redness, pain/discomfort, dryness), and blurred central and side vision, and how the practitioners treated these conditions., Results: This study analyzed data from 164 SL practitioners. The practitioners had been in practice for 16.3 ± 13.4 years, had been fitting SL for 5.5 ± 5.0 years, and fit 7.4 ± 7.1 SL/month. Practitioners preferred a SL with a final central corneal clearance of ∼200 μm and an overall diameter between 15.1 mm to 16.5 mm. Poor SL wetting (90.8% of practitioners documented condition), SL fogging (84.8%), blurred central vision (40.2%), ocular redness (34.8%), ocular dryness (24.4%), ocular pain/discomfort (20.7%), and blurred side vision (12.8%) were encountered by the practitioners. Practitioners preferred treating poor wetting and fogging with lens removal, cleaning, and reapplication, blurred central vision with a lens power change, blurred side (peripheral) vision, ocular redness, and ocular pain with a lens parameter change, and dryness with artificial tears., Conclusions: Most SL practitioners preferred a SL central corneal clearance of ∼200 μm, and they occasionally encountered SL-related complications in their practice, which they treated similarly to corneal gas permeable CLs., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To understand long-term contact lens prescribing habits of Canadian optometrists., Methods: One thousand optometrists were surveyed annually from 2000 to 2015. Information was requested on the first ten patients examined after receiving the survey., Results: Over the 16-year survey period, 1987 optometrists provided information on 19,143 patients. Mean age of the patients was 32.7±14.4years. Ratio of females to males was 2:1, the ratio of new fits to refits was 2:3. Soft contact lenses represented 94.5% of all fits. Rigid lenses were more often used as a refit compared to a new fit. Over the 16 years, market share for silicone hydrogel materials grew from 0% to 69.6%, mid-water content materials declined from 75.7% to 14.1%. The multifocal market share grew at the expense of spherical designs, with no change in toric lens fitting. Monthly soft lens replacement remained the preferred option at 48.2%, followed by daily disposable at 40.8%; two-weekly replacement declined to less than10% of patients by 2015. Extended wear was likely used to refit and only to a small proportion of wearers, representing 2.6% of SCL by 2015. The lens care system of choice throughout the period was multipurpose solutions, although the proportion for peroxide systems more than doubled by 2015 from 9.6%, to 21.1%., Conclusions: Over the 16-year period, SCL material preference changed to silicone hydrogels with monthly replacement being preferred; daily disposables replacing 2-weekly as the alternate. Lens care preference continued to be multipurpose solutions. Rigid lenses appear to be sustained for specialist fitting., (Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

From its inception as a tool for prototype development in the early 1980s, three-dimensional (3-D) printing has made inroads into almost every sector of industry, including health care. Medical applications range from extra- and intracorporeal orthopedic devices to complex, temporal reconstructions of patient-specific anatomy that allow operative planning and education. In the contemporary climate of personalized medicine, the utility of tangible 3-D models extrapolated directly from patient imaging data seems boundless. The purpose of this review is to briefly outline the development of 3-D printing, discuss its applications across the many medical and surgical specialties, and attempt to address obstacles and opportunities facing radiology as this technology continues to be integrated into patient care., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

In this article the evolution beginning with the robotics of total knee arthroplasty to CT-based and kinematic navigation and patient-specific instruments is described. Thereby it is pointed out that in the early 1990s, CT imaging solely for the planning of a knee endoprosthesis was considered as obsolete radiation exposure and this led to the widespread development of kinematical systems.Also a patient specific planning tool based on CAD built acryl harz blocs existed at the time. There is an ongoing process of implanting total knee arthroplasties in a more exact position. Nowadays the new evolution of soft tissue balancing by using a kinematic alignment has put these efforts into perspective.

Background: Ocular prosthetics make a decisive contribution to the functional, esthetic and psychosomatic rehabilitation of patients after ocular extirpation., Objectives: This article provides an overview of the fitting, daily care and complications of ocular prosthetics., Methods: The study comprised a PubMed literature review and own clinical results., Results: Ocular prosthetics made from cryolite glass or perspex can be manufactured and fitted 5-8 weeks after removal of the eye. During this period a conformer is placed within the conjunctival sac in order to prevent scar formation and shrinking of the socket. Artificial eyes can be worn continuously, only interrupted by a short but regular cleaning procedure. Artificial tears and lid hygiene improve the comfort of wearing. Glass prostheses have to be renewed every 1-2 years, while perspex prostheses need to be polished once a year. Complications, such as giant papillary conjunctivitis or blepharoconjunctivitis sicca are facilitated by poor fit, increased age and inappropriate care of the prosthetic device. In the case of socket shrinkage or anophthalmic socket syndrome, surgical interventions are needed to re-enable the use of an artificial eye., Conclusion: Adequate fitting, daily care of ocular prosthetics and therapeutic management of associated complications are mandatory for a durable functional, esthetic and psychosomatic rehabilitation after ocular extirpation.

Background and Aim: Current leg prostheses in rotationplasty typically feature a thigh cuff, which, in cycling, may cause perspiration problems and friction-related abrasions of the skin. The aim has been to develop a socket-less prosthetic device for persons with a rotationplasty to be able to engage in high-intensity cycling without contracting abrasions., Technique: The new device (Socket-Less Rotationplasty Prosthesis for Cycling) features a standard cycling shoe on the rotationplasty foot, replacing the conventional socket and thigh cuff. A reinforced 12-layer carbon fibre frame bolted to the aforementioned shoe, replacing the standard tube, connects to a prosthetic foot and a second cycling shoe. Alignment of the Socket-Less Rotationplasty Prosthesis for Cycling is done both statically and dynamically., Discussion: The Socket-Less Rotationplasty Prosthesis for Cycling is lightweight and more ventilated relative to conventional sockets. All components can be replaced easily. Most important, however, is that the current user now can cycle 135 km on end without skin abrasions., Clinical Relevance: The Socket-Less Rotationplasty Prosthesis for Cycling concept enables patients with a leg rotationplasty to engage in high-intensity cycling without contracting skin problems, thereby facilitating clients' participation., (© The International Society for Prosthetics and Orthotics 2014.)

For several decades, prosthetic use was the only option to restore function after upper extremity amputation. Recent years have seen advances in the field of prosthetics. Such advances include prosthetic design and function, activity-specific devices, improved aesthetics, and adjunctive surgical procedures to improve both form and function. Targeted reinnervation is one exciting advance that allows for more facile and more intuitive function with prosthetics following proximal amputation. Another remarkable advance that holds great promise in nearly all fields of medicine is the transplantation of composite tissue, such as hand and face transplantation. Hand transplantation holds promise as the ultimate restorative procedure that can provide form, function, and sensation. However, this procedure still comes with a substantial cost in terms of the rehabilitation and toxic immunosuppression and should be limited to carefully selected patients who have failed prosthetic reconstruction. Hand transplantation and prosthetic reconstruction should not be viewed as competing options. Rather, they are two treatment options with different risk/benefit profiles and different indications and, hence vastly different implications., (Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Scleral and corneal rigid lenses represented 100 per cent of the contact lens market immediately prior to the invention of soft lenses in the mid-1960s. In the United Kingdom today, rigid lenses comprise 2 per cent of all new lens fits. Low rates of rigid lens fitting are also apparent in 27 other countries which have recently been surveyed. Thus, the 1998 prediction of the author that rigid lenses--also referred to as 'rigid gas permeable' (RGP) lenses or 'gas permeable' (GP) lenses--would be obsolete by the year 2010 has essentially turned out to be correct. In this obituary, the author offers 10 reasons for the demise of rigid lens fitting: initial rigid lens discomfort; intractable rigid lens-induced corneal and lid pathology; extensive soft lens advertising; superior soft lens fitting logistics; lack of rigid lens training opportunities; redundancy of the rigid lens 'problem solver' function; improved soft toric and bifocal/varifocal lenses; limited uptake of orthokeratology; lack of investment in rigid lenses; and the emergence of aberration control soft lenses. Rigid lenses are now being fitted by a minority of practitioners with specialist skills/training. Certainly, rigid lenses can no longer be considered as a mainstream form of contact lens correction. May their dear souls (bulk properties) rest in peace., (Copyright (c) 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Snowboarding with a below-knee prosthesis is compromised by the limited rotation capabilities of the existing below-knee prostheses, which are designed for use in normal walking. Based on snowboarding range of motion analyses, a novel below-knee prosthesis was designed with the aim to achieve similar range of motions like able-bodied snowboarders. The new prosthesis allows for passive inversion/eversion, passive plantarflexion/dorsiflexion and additional 'voluntary' plantarflexion/dorsiflexion initiated by lateral or medial rotation of the upper leg and knee. A prototype was built and was subsequently tested on a single subject, a highly professional snowboarder and candidate for the Olympic Winter Games. The movements of the subject were recorded on video, analyzed and compared to the recorded movements of an able-bodied snowboarder, and a snowboarder with a traditional below-knee prosthesis. The results indicated an increased similarity of inversion/eversion and plantarflexion/dorsiflexion between the snowboarder with the new below-knee prosthesis and the able-bodied snowboarder, whereas the snowboarder with the traditional below-knee prosthesis and the able-bodied snowboarder differed considerably. These results indicate that snowboarding with the new prosthesis is more comparable to able-bodied snowboarding. On a subjective basis this is confirmed by the test subject who stated that: "snowboarding with the new prosthesis is like it was before the amputation!".

From the roots of cross training to the rigorous worldwide events, triathlon has become a means for physical conditioning, competition and socialization that is adaptable to everyone with a desire and commitment to participate. The novelty of athletes with limb loss competing alongside able-bodied has passed. The current expectation is that sport, including triathlon, is well within the reach of any amputee athlete with the physical ability and determination to compete. Commitment by the clinical team to the amputee athlete along with the systematic practice of prosthetic fitting, sport-specific training and accurate record keeping will not only assist today's athletes, but will establish the foundation for future amputee triathletes. This article outlines the prosthetic and training consideration for clinicians working with novice and intermediate amputee triathletes or those interested in swimming, cycling and running. In addition, prosthetic fitting and component selection and race day strategies is discussed.

Although the first silicone hydrogel contact lenses introduced onto the world contact lens market in 1999 held approval for both daily wear and extended wear use, the latter modality was promoted much more heavily by the manufacturers. The first silicone hydrogel lenses specifically promoted for daily wear were introduced in 2003. Data that we have gathered from annual contact lens fitting surveys demonstrate an immediate increase in market share whereby this lens type now represents more than one-third of soft lens fits in the United Kingdom. The success of this lens category is attributed to the health and safety benefits of silicone hydrogel materials and the positive impact of lens manufacturers by way of the effective marketing and distribution of these products.

The provision of aids and prostheses for patients with upper limb deficiencies has to be based on comprehensive knowledge in the field of orthopaedic technology. Taking into account the patient's complete background, evaluation of the possible functional benefit is mandatory in order to achieve good acceptance of a prosthesis in the long term. The extent of extremity "loss" and the remaining function of the deficient limb have an impact on the success of prosthetic fitting. Furthermore, there is a trend towards myoelectric prostheses, which seem to improve prosthetic acceptance. Bilateral congenital deficiency of the upper limbs cannot be equated with amputations. Most people affected do not push for a prosthesis, but should be provided with one, if the need arises. Decades of overuse of the deficient limbs often take their toll in terms of decreasing function as degenerative changes occur. As a consequence, artificial upper limbs may be obligatory to prevent loss of independence.

In recent years, much attention has been given to the revolution in new materials for prosthetics and the components that they have made possible. The average weight of a delivered prosthesis has decreased, currently available components offer improved function and superior symmetry of gait, and limb interfaces provide superior skin protection and comfort. The focus on the features of these components sometimes has led to neglect of the basic elements of prosthetic design--the fit and the alignment. If the fit and alignment are on the mark, an amputee can function at remarkably high levels with rudimentary components. This article discusses the basics of lower extremity prosthetic practice and addresses challenges for the future.

The Desired Sensation Level (DSL) Method was originally developed in the early 1980s to provide clinicians with a systematic, science-based approach to pediatric hearing instrument fitting that ensures audibility of amplified speech by accounting for factors that are uniquely associated with the provision of amplification to infants and young children who have hearing loss. This review identifies and describes several of the primary factors that have been considered in the development of the DSL Method. Specifically, the issues discussed relate to: (1) the definition and measurement of relevant acoustic, electroacoustic and audiometric variables; (2) how the external ear acoustics of infants and young children are accounted for in the DSL Method for both audiometric assessment and in the fitting of amplification; and (3) how the DSL Method has evolved concurrently with developments in hearing instrument and electroacoustic measurement technologies. Finally, current issues in the field are identified that have motivated the development of version 5.0 of the DSL Method for hearing instrument fitting.

10 years of experience with endovascular AAA repair has yielded important information regarding the relationship between stent-graft design and stent-graft performance. Commercially available systems differ in important ways. General conclusions regarding endovascular AAA repair need to be qualified by reference to a specific system, or systems. Nevertheless, one can draw conclusions regarding the observed effects of certain design features, some of which are common to several devices. For example: tapered, trackable delivery systems (< or =20 French in diameter) rarely fail to traverse tortuous iliac arteries: transmural barbs provide the most secure means of proximal attachment, column strength is of little value; proximal stent migration is becoming the primary late failure mode; modular stent-grafts are more versatile than unibody stent-grafts; fully-stented graft limbs are less prone to thrombosis than unstented graft limbs, iliac implantation and low porosity are associated with lower rates of aneurysm dilatation in the absence of endoleak (endotension); any movement between the angle of a stent and the overlying fabric will lead to graft erosion; unpolished (black) Nitinol is prone to fracture; and a long trunk/short limb combination is more stable than a short trunk/long limb combination.