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Upper extremity trauma is common, however the provision of emergency call for hand trauma can be challenging for hospital systems and hand surgeons. Over the past decade, the American Society for Surgery of the Hand (ASSH) has developed the Hand Trauma Network and an Emergency Hand Care Committee to refine care for hand trauma patients. The ASSH administered surveys to members about the provision of emergency hand call in 2010 and 2019. Demographic information was collected including surgeon age, years in practice, board certification, practice setting, and ACS trauma level. Other survey questions included willingness and obligation to take call, as well as barriers to providing emergency call. Financial aspects of call were also queried. Survey responses were obtained from 672 surgeons in 2010 and 1005 surgeons in 2019. There was a decrease in surgeons with obligatory hand call from 2010 to 2019 (70% vs 50%, P <.05) and an increase in the number of surgeons not taking hand call in 2019 (34%) compared to 2010 (18%, P <.05). In both surveys, the main barrier for providing hand call was "lifestyle considerations," 39% (2010) and 47% (2019). There was no change in the percentage of surgeons working at facilities that provide 24/7 emergency hand call services or the percentage of hand surgeons paid to take call. Certain aspects of providing emergency hand surgery care have not changed substantially in the past decade, including the number of centers that provide emergency hand coverage. A greater number of surgeons are not taking any hand call. Further efforts are required to promulgate advances in hand trauma call by the ASSH. The development of the ASSH Hand Trauma Network has not yet resulted in substantive improvement in the number of facilities that provide emergency hand coverage or the number of hand surgeons providing emergency hand care. [ABSTRACT FROM AUTHOR]

The recent #MeToo movement in social media has brought the important issue of gender-based violence and harassment in the workplace to the forefront of public attention. As in other fields, gender-based discrimination and sexual harassment continue to be a problem in medicine, and gender inequalities are particularly apparent in surgical specialties. Whereas the #MeToo movement has successfully raised awareness and held some perpetrators accountable, there have been unintended backlashes, including reluctance from some male surgeons to mentor female surgeons for fear of false accusations of sexual misconduct at both the trainee and the faculty levels. Gender-based neglect is harmful to the career advancement of female surgeons and threatens to continue to promote gender inequalities in surgery. We propose systems-level strategies to promote gender equity at the academic-training level and within the field of hand surgery. [ABSTRACT FROM AUTHOR]

The role played by a principal in the professional development of a teacher is discussed. The principal should be involved in inspiring the teachers to grow professionally in their occupations and should encourage teachers to work in unison to attain the mission of the school to improve student achievement.

We separately identify two mechanisms underlying peer effects in farm households' adoption of a new crop. A farmer can follow his peers to adopt a new crop because he learns knowledge about the new crop from them (social learning) and because he wants to avoid the damage caused by the practice conflicting with theirs (externalities). Using an agent-based model, we simulate the two mechanisms on a multiplex network consisting of two types of social relationships. The simulation model is estimated using detailed data of social networks, adoption and relevant socio-economic characteristics from 10 villages in China. We find that social learning - in this case, the sharing of experiential resources - among family members and production externalities between contiguous land plots both significantly influence farmers' adoption. Furthermore, sharing of experiential resources plays a significant role in the entire diffusion process and dominates the early phase, whereas externalities only matter in the late phase. This study shows the roles peer effects play in shaping diffusion can occur through different mechanisms and can vary as the diffusion proceeds. The work also suggests that agent-based models can help disentangle the role of social interactions in promoting or hindering diffusion. [ABSTRACT FROM AUTHOR]

Background: Ballistic fractures of the carpus and hand are routinely treated in large urban centers. These injuries can be challenging due to many factors. Various treatment options exist for these complicated injuries, but there are limited data available. This report analyzes patient demographics, treatments, and outcomes at a large urban trauma center. Methods: All ballistic fractures of the hand and wrist of the patients who presented to a single center from 2011 to 2014 were retrospectively reviewed. Patient demographics, injury mechanism, treatment modalities, and outcomes were analyzed. Results: Seventy-seven patients were identified; 70 were male, and 7 were female. Average age of the patients was 29.6 years. Seventy-five injuries were low velocity, whereas 2 were high velocity. Sixty-seven patients had fractures of a metacarpal or phalanx, whereas 4 had isolated carpal injuries. Six had combined carpal and metacarpal or phalanx fractures. Thirty-six patients had concomitant tendon, nerve, or vascular injuries requiring repair. Sixty-three patients underwent operative intervention, with the most common intervention being percutaneous fixation. Sixteen patients required secondary surgery. Eighteen complications were reported. Conclusions: The majority of patients in this report underwent early operative intervention with percutaneous fixation. Antibiotics were administered in almost all cases and can usually be discontinued within 24 hours after surgery. It is important to consider concomitant nerve, vascular, or tendon injuries requiring repair. We recommend early treatment of these injuries with debridement and stabilization. Due to lack of follow-up and patient noncompliance, early definitive treatment with primary bone grafting should be considered. [ABSTRACT FROM AUTHOR]

This paper investigates how anthropogenic climate change is presented to the Irish public by three of Ireland's most important national newspapers. We argue that Irish newspapers do not report climate change in an objective and unbiased way and illustrate how through the acts of agenda setting, news framing and in how they construct public discourse they present the issue in a narrow ideological form. Evidence is provided to support the argument that ecological modernisation is used by Irish newspapers to construct the issue of climate change. Our study uses three levels of analysis: (1) we calculate the trend in the coverage of climate change between 1997 and 2012 to uncover what events are correlated with peaks in coverage; (2) we conduct an in-depth frame analysis of a large sample of articles to determine how the issue is classified and categorised; and (3) we conduct a discourse network analysis to uncover which actors are given a voice, which policy measures they favour and with whom they share policy positions. The data we find support our theoretical arguments, leading us to the conclusion that Irish newspapers produce and reproduce a narrow ideological worldview that is articulated, shared and propagated by Ireland's political and economic elites. [ABSTRACT FROM AUTHOR]

Creating a social network dataset requires us to represent a set of empirical observations according to a specific conceptual understanding. This requires a number of design decisions for the conceptual framework, which is then implemented through a data structure. In this paper, we propose a standard schema to describe these decisions. A standard schema allows us to define the conceptual framework, structure, and content of a dataset. Social network datasets may contain many features. Beyond the definition of actors and relations, network data may include: actor or relation attributes; data for multiple observation periods (dynamic data); or parallel event data. The creation of a network dataset may also involve the application of specific boundary conditions, sampling approaches or may include missing data. Our proposed schema is designed to support a scientific approach to social network analysis by making these features and assumptions transparent and easy to communicate. We believe that this will facilitate researchers through the design, creation, communication, and evaluation of social network datasets. To develop this schema, we gathered and analysed the structure, content, and metadata of over 150 publicly available social network datasets drawing from multiple disciplines, including statistics, computer science, sociology, economics, and political science. [ABSTRACT FROM AUTHOR]

Background. The Alaska Native (AN) population has endured multiple historical traumatic events. This population has poorer health outcomes on nearly all factors compared with Alaska non-Natives with more than 75% reportedly being physically assaulted in their lifetime, and child sexual abuse nearly 6 times the national average. Objective. This article describes the Pathway to Hope (PTH) program, which is an indigenous approach to ending silence and denial related to child sexual abuse and encourages multigenerational healing. Design. PTH was developed by ANs who believe that each community is unique, thus strategies for ending denial and support for healing must be woven from the historical context, cultural strengths of individual communities. Strengths-based solutions built on truth, honesty, compassion and shared responsibility for healing and protecting today's children have been profound and successful. The PTH curriculum addresses child sexual abuse from a historical perspective; that the higher rates of sexual abuse among certain Tribes, regions and communities is linked in part to years of victimisation, but may also be perpetuated by internalised oppression and lateral violence among Tribal members. Results. Data suggest that community-based dialogue and wisdom of Native elders and spiritual leaders paired with readiness of community service providers are necessary for sustained change. At all levels, this Indigenous model for learning, sharing, helping and healing brings hope for an end to denial and silence about child sexual abuse for Native people. Conclusions. The PTH program utilises the wisdom and values that have sustained Native people for generations. Ending silence and denial about child sexual abuse and building upon strengths have assisted many Indigenous communities begin the journey toward wellness. Through the PTH, communities have taken steps to accept the challenges associated with establishing safety for children, supporting child victims in healing and to holding offenders accountable. [ABSTRACT FROM AUTHOR]

Delegation models make contrasting assumptions about how political disagreement affects discretion and empirical research reports contradictory findings. The authors aim to shed new light on this puzzle by distinguishing the mechanisms that drive the effect of political disagreement on discretion. Four conditions influence the strength of each mechanism: (a) policy salience, (b) actors involved, (c) their capacity, and (d) decision rule. They explore this theoretical framework on the case of economic restructuring in the United Kingdom and show that political disagreement reduces discretion. There is no significant interaction effect between salience and political disagreement on discretion. [ABSTRACT FROM PUBLISHER]

Purpose: The use of a pedicled flexor carpi ulnaris (FCU) muscle proximal turnover flap has been described previously for soft tissue reconstruction at the posterior elbow. Whereas consistent arterial supply to the FCU has been reported, the reliability of distal flap perfusion has not been confirmed. This study evaluated the vascular perfusion of an FCU turnover flap, based on the most proximal primary vascular pedicle that would permit a proximal turnover flap reconstruction to include the olecranon tip. Methods: In 12 fresh-frozen, proximal humeral human amputation specimens, the FCU flap was elevated from distal to proximal, preserving the most proximal primary vascular pedicle to the muscle belly that would permit flap coverage of the olecranon tip. The axillary artery was injected with India ink after ligation of radial and ulnar arteries at the wrist. After injection, each specimen was sectioned transversely at 0.5-cm increments to assess vascular perfusion of the muscle using loupe magnification. Results: The distance from the olecranon tip to the distal FCU muscle belly was 25.9 cm. The primary vascular pedicle that would facilitate creation of a proximal turnover flap was, on average, 5.9 cm distal to the olecranon tip. Perfusion of FCU muscle as measured distal to this primary pedicle was present in 50% to 100% of the muscle belly at an average of 8.9 cm beyond the pedicle. Perfusion of 25% to 50% of the FCU muscle belly was present at an average of 11.1 cm beyond the pedicle. Perfusion became less consistent (<25%) within the muscle belly at an average distance of 11.6 cm. Conclusions: Use of a proximally based, pedicled FCU muscle turnover flap provides a reliable option for soft tissue reconstruction at the posterior elbow. We observed consistent arterial perfusion of the muscle flap when preserving a proximal vascular pedicle 5.9 cm distal to the olecranon tip. [ABSTRACT FROM AUTHOR]

This article analyses the interaction and intersection between an EU policy instrument - INTERREG - and bottom-up mobilisation of cross-border groups on the Irish border.The analysis involves an exploration of the interaction between the planning and negotiation of the INTERREG III programme for the border area between the Republic of Ireland and Northern Ireland, the establishment of new political institutions arising from the Good Friday Agreement and the 'bottom-up' mobilisation of new territorial actors on the border. Given that the Irish border is a contested one, it offers a useful lens to study the role of the EU in sustaining or mediating political conflict. The findings suggest that the EU, notably the Commission, plays an important role in altering the opportunity structure of domestic actors and in providing them with new policy models. However, the ability of sub-state actors to take advantage of the new political space depends on developments in domestic politics. [ABSTRACT FROM AUTHOR]

This article applies a modelling approach to examine the establishment of Regional Development Agencies (RDAs) in England. RDAs are an important part of New Labour's policy programme for regional economic development, and their implementation requires the involvement of actors at both central and local government levels. The three phases of negotiations that took place between these actors are studied using alternative models of collective decision-making, including a cooperative exchange model and a non-cooperative conflict model. Data on the key elements of the decision-making process - including the issues discussed during the negotiations, the actors' policy positions and capabilities, and the levels of salience they attached to the issues - were collected systematically and form the basis of the analysis. Application of the models allows inferences to be drawn regarding the nature of the decision-making process that took place prior to the policy outcomes. These analyses are supported by the estimates of the utility gains and losses experienced by the actors as a result of the policy outcomes that were realized. The results demonstrate that Labour has pursued a largely consensual approach based on exchange and log-rolling. [ABSTRACT FROM AUTHOR]

In 1988 the European Union reformed the allocation of its Structural Funds to effectuate broader participation of local and regional parties and institutions in the Member States. This might affect the corporative and sectoral oriented government structure in Ireland, which was chosen as a test case for this study, with decision issues for plan periods 1988–93 and 1994–99. In this paper we focus on the question whether actors with high effective power do also sustain relatively small utility losses with respect to decision outcomes. This is done in terms of a collective decision model simultaneously involving multiple actors as well as multiple issues, using linear models specifying the basic model variables of collective decision modelling. The results show that effective power does not have a direct effect in isolation, but shows strong effects in specific interaction with other factors, characterising the decision contexts as they evolve over time. [ABSTRACT FROM PUBLISHER]

We conducted a retrospective, single-center (tertiary referral center with associated level I trauma center) review to evaluate the outcome of open reduction and internal fixation (ORIF) with intramedullary (IM) clavicle pin of displaced clavicular fractures. Sixty-eight displaced midshaft clavicle fractures in 68 patients underwent ORIF with IM clavicle pins. Patients were identified through a perioperative database by searching for Current Procedural Terminology (CPT) codes. Union was the primary outcome. Secondary outcomes included time to union, pain, incidence of nonunion and delayed union, postoperative range of motion, and incidence of complications. Sixty-six fractures (97%) went on to union. Complications included painful hardware (44%), deep and superficial wound infections (10%), and hardware failure (4%), including pin breakage and extrusion. Postoperative shoulder pain was present in 10% of patients and limited shoulder range of motion in 12%. IM pin fixation can provide good outcomes, even for fractures with a significant amount of shortening and comminution.