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Reverse total shoulder arthroplasty (RTSA) has progressively been utilized for reconstruction following wide resection of proximal humerus neoplasms. The purpose of the study is to evaluate complications, reoperation rates, range of motion (ROM), patient-reported outcomes, and postoperative radiographic data to better understand patient outcomes following oncologic associated RTSA. Twenty patients who underwent RTSA reconstruction for the treatment of an oncologic process from 2011 to 2019 were identified. Demographic, pathology, technical, categorical, and physical examination data were collected from the electronic medical record. The Henderson classification was used to categorize complications. Acromion to proximal humerus cut distance (resection length), stem tip to ulnohumeral joint distance, and working stem length were measured on most recent radiographs. Patients were contacted via phone to obtain the Musculoskeletal Tumor Society score; the Disabilities of the Arm, Shoulder, and Hand score; the American Shoulder and Elbow Surgeons score; and the Simple Shoulder Test score. Descriptive statistics were calculated for demographic data, tumor and disease characteristics, adjuvant treatment, complications, and patient-reported outcome measures (PROMs). Radiographic data, ROM, and reoperation were further analyzed with Spearman rank correlation and Mann-Whitney U testing. The overall complication rate was 35%, including 4/20 with dislocations (Henderson I), 3/20 with aseptic loosening (Henderson II), 1/20 with a periprosthetic fracture (Henderson III), 1/20 with a periprosthetic joint infection (Henderson IV), and 1/20 with a radial nerve injury. There were no cases of tumor progression (Henderson V). All patients with complications required reoperation. Measured radiographically, the mean distance from stem tip to ulnohumeral joint was 13.4 cm. A shorter stem tip to ulnohumeral joint distance was significantly associated with reoperation (10.0 ± 5.0 cm vs. 14.9 ± 5.0 cm, P =.04). At final follow-up, mean flexion and abduction were 90.4 degrees and 83.6 degrees, respectively. Of note, larger resections were negatively associated with flexion (Spearman R = −0.896, P =.003) and abduction (Spearman R = −0.761, P =.028) at final follow-up. Mean PROMs were Musculoskeletal Tumor Society score 12/30, Disabilities of the Arm, Shoulder, and Hand score 58/100, American Shoulder and Elbow Surgeons score 26/100, and Simple Shoulder Test score 3/12. This study corroborates previously published data on complication rates and ROM following oncologic RTSA, while PROMs were lower. Resection length and deltoid release correlate with functional outcomes and the risk of reoperation. The RTSA remains a viable treatment option for oncologic processes about the glenohumeral joint in appropriate patients. [ABSTRACT FROM AUTHOR]

In patients with rib fractures, adverse outcomes are associated with number of rib fractures; however, studies suggest an association with frailty. We assessed whether frailty, measured using the Canadian Study of Health and Aging clinical frailty scale, was associated with adverse outcomes in this population. Patients ≥50 years admitted for rib fractures from July 2015 to June 2020 were retrospectively scored for frailty. Demographics, comorbidities, injury information, hospital course, and complications were collected. Univariate analyses were performed to assess significant differences between the fit, prefrail, and frail groups. The association between number of rib fractures and frailty with outcomes was determined. Controlling for age, sex, Injury Severity Score, preadmission anticoagulant, injury mechanism, and comorbidities and nonchest Abbreviated Injury Scores showing significant differences, the number of rib fractures was associated with developing pneumonia (odds ratio = 1.197 [1.076–1.332]; P =.001), hospital length of stay (odds ratio = 1.066 [1.033–1.100], P <.001), mortality (odds ratio = 1.157 [1.048–1.278], P =.004), and discharge to long-term acute care facilities (odds ratio = 1.295 [1.084–1.546], P =.004). Frailty was associated with hospital length of stay (odds ratio = 1.659 [1.059–2.598], P =.027) and discharge to skilled nursing facilities (odds ratio = 5.282 [1.567–17.802], P =.007). In our population, the number of rib fractures was associated with respiratory complications and mortality. Frailty was associated with longer hospitalization and discharge to higher level of care. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jpolmod.2009.05.005 Byline: Lawrence R. Klein Keywords: New growth centers; Asia-Pacific; China Author Affiliation: Department of Economics, University of Pennsylvania, Philadelphia, PA 19104, USA

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jpolmod.2006.06.010 Byline: Lawrence R. Klein Keywords: Chronic US deficits; Twin deficits; Peace dividend; Prudent fiscal policy; Accomodating monetary policy Abstract: Policy makers do not seem to learn from past mistakes. The same fiscal problems that were generated by Vietnam War finance are present again in connection with the Iraq War. Also the deficit generating policies of the Reagan Administration did not '... get away with it ...' as suggested as justification for the present deficits. Uncertainty and attitudes towards energy policies once again are troublesome. Monetary policy alone, cannot deal with present deficit problems; there is a need for appropriate policy coordination - monetary and fiscal. Author Affiliation: Department of Economics, University of Pennsylvania, 3718 Locust Walk CR, Philadelphia, PA 19104, USA

A study on the acquisition of non-profit hospitals by the investor owned chains that prompted the state to regulate laws regarding the mergers. It has been observed that prior to regulation the investor owned chains did not earn abnormal returns form their acquisition of non-profit hospitals and earned greater interest when they purchased other investor owned and privately owned hospitals. When states adopted regulations subsequently, acquisitions slowed down and the acquirer returns became negative.

The emergence of the countries like Brazil, Russia, India and China as the new economic growth areas in the globalized economy and the objectives of these countries to sustain the growth rate are discussed.

The author generates a model which illustrates the trends in growth in information technology.

Methods to assess competency in cardiothoracic training are essential. Here, we report a system that allows us to better assess competency from the perspective of both the trainee and educator. We hypothesized that postprocedural cognitive burden measurement (by the trainee) with immediate feedback (from the educator) could aid in identifying barriers to the acquisition of skills and knowledge so that training curricula can be individualized. The National Aeronautics and Space Administration Task Load Index (NASA-TLX), a validated instrument to measure cognitive load, was administered with an online platform after bronchoscopy, esophagogastroduodenoscopy, and video-assisted thoracoscopic surgery for 11 residents. Immediate postprocedure feedback and standardized debriefing occurred for each procedure. Mean NASA-TLX scores were highest (indicating greater cognitive load) for esophagogastroduodenoscopy and video-assisted thoracoscopic surgery (P <.001). When comparing subscale measures, mental demand was significantly higher for video-assisted thoracoscopic surgery (P =.026) compared with the other procedures, whereas physical demand was highest for esophagogastroduodenoscopy (P =.018). Self-reported frustration was similar for all case types (P =.247). Cognitive burden decreased with a greater number of procedures for bronchoscopy (P =.027). Significant improvement was noted by the trainee at the end of the rotation in self-assessed procedural competency and preparedness for thoracic board topics (all P <.05). Postprocedure feedback by the attending surgeon correlated with more frequent completion of self-evaluations by the residents. Longitudinal assessment of cognitive load in combination with postprocedural feedback identified barriers to skill acquisition for both residents and educators. This information allows for individualized rotation development as a step toward a competency-based curriculum. [ABSTRACT FROM AUTHOR]