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Purpose: The purpose of this study was to assess if the use of the “endobutton” technique via an arthroscopically-assisted approach was associated with good patient reported outcome measures and low complication rates in select adolescent patients with displaced lateral third clavicle fractures. Methods: A retrospective review of displaced lateral third clavicle fractures sustained in adolescents treated operatively using the endobutton technique over a 2 year period was carried out at our institution. Four cases were identified, all sustained while involved in sporting activities and all were treated via an arthroscopically-assisted approach. Results: all 4 patients scored 0 on the Quick DASH assessment score. No hardware required removal and all patients returned to sport at the same level. Conclusions: Displaced lateral clavicle fractures in adolescents can pose a significant challenge in terms of management options. Use of the endobutton technique via an arthroscopic-assisted approach can offer a safe and effective means of treatment with excellent patient reported outcomes and low complications rates. Level of Evidence: 4 Keywords: lateral clavicle; adolescent; arthroscopicassisted

Aims: To evaluate the short term functional outcomes following a reverse total shoulder replacement for complex neck of humerus fractures. Methods: A single centre retrospective case series evaluating all patients who underwent reverse shoulder arthroplasty following a complex neck of humerus fracture. Functional shoulder movements were assessed by two orthopaedic trainees at 1 year follow-up and compared to the opposite shoulder. Subjective assessment was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Oxford Shoulder Score (OSS). Documentation of any complications was also noted. Findings: The reverse total shoulder replacement showed favourable outcomes both subjectively and objectively. Subjectively patients in this study scored a mean of 27.5 +/- 24.4 (range 0 - 57.8) in the DASH and 37.9 +/- 9.2 (range 26 - 48) in the OSS. There was a high negative linear correlation between the 2 scoring systems (r = -0.95, p Conclusion: A reverse total shoulder replacement shows favourable subjective and objective outcomes for complex neck of humerus fractures in the trauma setting.

Purpose We sought to determine to what extent the knowledge of carrying a BRCA1 or BRCA2 mutation influences the uptake of preventive surgeries in Bahamian women, including bilateral salpingo‐oophorectomy and bilateral mastectomy. Patients and methods The study population consisted of 78 female residents of the Bahamas for whom a BRCA1 or BRCA2 mutation had been detected between 2004 and 2014. The mean age of the 78 participants at the time of genetic testing was 46 years (age range 22–73 years). The mean time of follow‐up was 4.4 years. Results Of the 78 study participants, 19 women had a bilateral salpingo‐oophorectomy (24%). Seven out of 37 patients who had unilateral breast cancer chose to remove the unaffected contralateral breast (19%). Three of 13 patients with no history of breast cancer chose to have a prophylactic bilateral mastectomy (23%). Conclusion Preventive surgery is an acceptable option for a significant proportion of Bahamian women with a BRCA1 or BRCA2 mutation. It will be important to identify and reduce barriers to preventive surgery in the Bahamas in order that the benefit of getting testing can be fully realized.

Key Points Question What proportion of patients in the Caribbean who develop breast or ovarian cancer carry deleterious variants? Findings This genetic association study included 1018 adult women and men with breast and ovarian cancer, of which 144 individuals had a pathogenic variant in a moderate- to high-risk gene. This finding was consistent with high rates of premenopausal breast cancer in Black women with Caribbean ancestry. Meaning Results of this study suggest that in people with Caribbean ancestry diagnosed with breast or ovarian cancer, 1 in 7 will have an actionable pathogenic variant, which may lead to use of targeted therapies and precision prevention approaches., Importance Rates of breast and ovarian cancer are high in the Caribbean; however, to date, few published data quantify the prevalence of inherited cancer in the Caribbean population. Objective To determine whether deleterious variants in genes that characterize the hereditary breast and ovarian cancer syndrome are associated with the development of breast and ovarian cancer in the English- and Creole-speaking Caribbean populations. Design, Setting, and Participants This multisite genetic association study used data from germline genetic test results between June 2010 and June 2018 in the Bahamas, Cayman Islands, Barbados, Dominica, Jamaica, Haiti, and Trinidad and Tobago. Next-generation sequencing on a panel of 30 genes and multiplex ligation-dependent probe amplification (BRCA1 and BRCA2) were performed. Medical records were reviewed at time of study enrollment. Women and men diagnosed with breast and ovarian cancer with at least 1 grandparent born in the participating study sites were included; 1018 individuals were eligible and consented to participate in this study. Data were analyzed from November 4, 2019, to May 6, 2020. Exposures Breast and/or ovarian cancer diagnosis Main Outcomes and Measures Rate of inherited breast and ovarian cancer syndrome and spectrum and types of variants. Results Of 1018 participants, 999 (98.1%) had breast cancer (mean [SD] age, 46.6 [10.8] years) and 21 (2.1%) had ovarian cancer (mean [SD] age, 47.6 [13.5] years). Three individuals declined to have their results reported. A total of 144 of 1015 (14.2%) had a pathogenic or likely pathogenic (P/LP) variant in a hereditary breast and ovarian cancer syndrome gene. A total of 64% of variant carriers had P/LP variant in BRCA1, 23% in BRCA2, 9% in PALB2 and 4% in RAD51C, CHEK2, ATM, STK11 and NBN. The mean (SD) age of variant carriers was 40.7 (9.2) compared with 47.5 (10.7) years in noncarriers. Individuals in the Bahamas had the highest proportion of hereditary breast and ovarian cancer (23%), followed by Barbados (17.9%), Trinidad (12%), Dominica (8.8%), Haiti (6.7%), Cayman Islands (6.3%), and Jamaica (4.9%). In Caribbean-born women and men with breast cancer, having a first- or second-degree family member with breast cancer was associated with having any BRCA1 or BRCA2 germline variant (odds ratio, 1.58; 95% CI, 1.24-2.01; P, This genetic association study assesses the prevalence of pathogenic gene variants among adults with breast and ovarian cancer in 7 Caribbean nations.

Women with a mutation in BRCA1 or BRCA2 face a lifetime risk of breast cancer of approximately 80 %. Tamoxifen treatment of the first cancer has been associated with a reduction in the risk of a subsequent contralateral cancer. We studied 1,504 women with a known BRCA1 or BRCA2 mutation, 411 women with bilateral breast cancer (cases) and 1,093 women with unilateral breast cancer (controls) in a matched case-control study. Control women were of similar age and had a similar age of diagnosis of first breast cancer as the cases. For each woman who used tamoxifen, the starting and stopping dates were abstracted and the duration of tamoxifen use was calculated. Three hundred and thirty-one women had used tamoxifen (22 %); of these 84 (25 %) had completed four or more years of tamoxifen, the remainder stopped prematurely or were current users. For women with up to 1 year of tamoxifen use, the odds ratio for contralateral breast cancer was 0.37 (95 % CI 0.20-0.69; p = 0.001) compared to women with no tamoxifen use. Among women with 1-4 years of tamoxifen use the odds ratio was 0.53 (95 % CI 0.32-0.87; p = 0.01). Among women with four or more years of tamoxifen use the odds ratio was 0.83 (95 % CI 0.44-1.55; p = 0.55). Short-term use of tamoxifen for chemoprevention in BRCA1 and BRCA2 mutation carriers may be as effective as a conventional 5-year course of treatment.

The Bahamas is a group of islands in the Caribbean with a high incidence of early onset breast cancer. In isolated populations, the identification of founder mutations in cancer predisposing genes may facilitate genetic testing and counseling. To date, six distinct BRCA1 mutations have been found in patients from cancer families from the Bahamas. The frequencies of these mutant alleles have not been measured in a large series of unselected breast cancer patients from Bahamas. We studied 214 Bahamian women with invasive breast cancer, unselected for age or family history of cancer. All patients were screened for six mutations in the BRCA1 gene that have previously been reported in cancer patients from the Bahamas. A mutation was identified in 49 of the 214 breast cancer patients (23%). The mutation frequency was particularly high in women diagnosed before age 50 (33%) in women with a first-degree relative with breast or ovarian cancer (41%) and in women with bilateral breast cancer (58%). Approximately 23% of unselected cases of breast cancer in the Bahamian population are attributable to a founder mutation in the BRCA1 gene-this is the highest reported mutation prevalence for any country studied to date. Genetic testing for these mutations is advisable for all women diagnosed with breast cancer in the Bahamas.

Introduction: There are many factors that affect breast and ovarian cancer incidence. Genetics, obesity, parity, age at menarche, age at first pregnancy, and family size are all determinants of breast and ovarian cancer risk and factors that differ between well-resourced countries and low- and middle-income countries (LMIC). These factors can be subject to rapid change. In addition, there are risks that are associated with the development of breast and ovarian cancer that are associated with race and ethnic group that are less well understood. The Caribbean is home to more than 20 million women, the majority of whom are of African ancestry. The demographics of the Caribbean basin in terms of finance, diet, and exposures are rapidly changing and these factors will, no doubt, be reflected in the rates of breast and ovarian cancer diagnosis. In this article, we propose to examine the changing factors that affect the development of breast and ovarian cancer in women with breast and ovarian cancer of Afro-Caribbean origin. Methods: This prospective study was approved by the University of Miami IRB and the Ministry of Health in the Bahamas. We recruited breast and ovarian cancer patients from public and private clinics in the Bahamas between September 2008 and January 2010. Women were eligible if they had been diagnosed with breast or ovarian cancer, and if at least one parent was born in the Bahamas. Data were analyzed from 250 women from 229 families. The cohort was divided into four groups depending on the year that they were born: 1970. Data analysis was conducted using the c2 test or ANOVA with adjustment for clustered data. Results: Data analysis was conducted on the 250 patients, and the groups were broken down as follows: fifty-six patients were born before 1950, ninety-one were born between 1950-1959, seventy-one between 1960-1969, and thirty-two in or after 1970. The mean age of diagnosis of their first cancer decreased from 57 years (born before 1950) to 31 years (born in or after 1970, p Conclusions: The Bahamas has undergone a rapid change from a developing country fertility pattern in the 1950s and by 1970 to a developed country's fertility pattern, in one generation. These changes influence breast and ovarian cancer risk and are associated with younger age of onset of breast cancer. We documented that 2.8% of Bahamian women without breast or ovarian cancer who had a family history of breast cancer had a deleterious mutation in BRCA 1 or 2. 40% of the 1,857 unaffected women who were offered genetic testing had a family history; thus, the prevalence of these mutations in the population is approximately 1% overall. However, the incidence of ovarian cancer is low. The unintended consequence of TAH-BSO for birth control and menorrhagia is a decrease in expected rates of both breast cancer and ovarian cancer. Citation Format: Sophia HL George, Ana Sandoval Leon, Talia Donenberg, Raleigh Bulter, Darron Halliday, DuVaughn Curling, Theodore Turnquest, John Lunn, Mohammad R. Akbari, Steven Narod, Judith Hurley. Changing fertility factors affecting breast cancer in the Bahamas [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B81.

The social thought and outreach philosophy of the Emergent Church offers a revolutionary take on global Christian mission. In particular, according to this new paradigm, the mission of the church requires nothing short of a radical revision of today’s economic system. A review of writings by leading emergent thinkers such as McLaren and Chalke, however, raises questions about the extreme economics being proposed. There are also deep concerns from an evangelical theological perspective.

We assessed the results of the modified Eden-Hybinette operation as a salvage procedure after failure of an index Latarjet. Outcomes, complications, and evidence of arthritis of the glenohumeral joint were evaluated in 46 patients. Thirty-four (74%) were clinically and radiologically assessed at a mean of 6.8 years (range, 2-17 years). Good or excellent results were recorded in 27 of the 34 patients (79%). Four patients had another dislocation, and 2 became recurrent dislocators. One required an arthrodesis. Thirteen complained of a sensation of persistent apprehension. Twenty-three (68%) returned to their predislocation level of sport. Two gave up sports entirely. Radiographic evidence of arthritis was present in 6 (18%) before revision surgery. At final review, 10 (29%) had glenohumeral arthritis, graded as moderate or severe in 6 patients. Recurrence after an initial Latarjet procedure may be successfully treated by the modified Eden-Hybinette procedure. Patients may still experience a sensation of apprehension, but this does not appear to be clinically significant.

Isolated, atraumatic rupture of the infraspinatus (IS) with associated edema of its muscle is a previously undescribed lesion. We retrospectively identified 19 patients with MRI detected, isolated lesions of the IS tendon or musculotendinous junction with associated muscle edema. The average age at the time of presentation was 47.7 years (range, 30-66). There were 15 females and 4 males. Fourteen patients were treated nonoperatively; 5 underwent an open repair. All patients underwent clinical and MRI follow-up at an average of 50.3 months (range, 24-79) after the initial MRI. Constant scores were recorded as was a detailed physical examination. Two patients had a clear history of trauma with no preceeding shoulder problems; 17 had a history of chronic shoulder pain. We identified disruption occurring within the IS tendon in 9 patients and at the level of the musculotendinous junction in 8, while the level of disruption was inconclusive in 2. No patient had other full thickness tears. Electromyographic studies were normal, as were nerve conduction velocities in the suprascapular nerve in the 15 patients tested. There was a significant improvement in the Constant score comparing the score at presentation (53 points; range, 24-69) with the score at final follow-up (67.2 points; range, 28-95; P = .009). There was no significant benefit seen comparing the gain in the Constant score between those treated operatively and nonoperatively (P = .61). All 19 patients had progressed to stage 4 fatty infiltration of the IS muscle at latest follow-up.

For most of human history, economic systems were personal in nature—people normally interacted with people they knew personally and knew well. Today's modern market economies are impersonal—people normally interact with people they do not know personally. The historical movement from personal to impersonal systems was necessary for societies to develop the specialization of labor needed for modern production technologies. That is, the high standards of living in the developed world are due to these impersonal systems. However, the ethical systems theologians apply to modern market systems were developed for personal societies and are often inappropriate for impersonal societies. In this article, we develop the differences between personal and impersonal systems, examine the writings of a number of theologians who are very critical of market economies, and attempt to show how a different ethical approach is needed.

Objective To evaluate the relationship between use of fertility medication (i.e., selective estrogen receptor [ER] modulator, gonadotropin, or other) or infertility treatment (i.e., IVF or IUI) and the risk of ovarian cancer among women with a BRCA1 or BRCA2 mutation. Design A matched case-control study of 941 pairs of BRCA1 or BRCA2 mutation carriers with and without a diagnosis of ovarian cancer. Setting Genetic clinics. Patient(s) Detailed information regarding treatment of infertility was collected from a routinely administered questionnaire. Intervention(s) None. Main Outcome Measure(s) Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals associated with fertility treatment. Result(s) There was no significant relationship between the use of any fertility medication or IVF treatment (odds ratio, 0.66; 95% confidence interval 0.18–2.33) and the subsequent risk of ovarian cancer. Conclusion(s) Our findings suggest that treatment for infertility does not significantly increase the risk of ovarian cancer among women with a BRCA mutation.

Osteochondral transplantation requires a careful assessment of the location of donor plugs. A mismatch of cartilage thickness between the donor and recipient site may lead to abnormal stresses and poor function. The objective of this study was to characterize the recommanded donor and recipient sites with respect to cartilage thickness in younger individuals. Nineteen arthro CT (13 men, 6 women), which had been carried out in a population of less than 50 years old were studied. Recommanded donor sites have included the posterior femoral condyles, the medial and lateral aspect of the trochlea and central, medial and lateral sides of the intercondylar notch. Recipient sites were studied at four regions of interest on the medial femoral condyle usually involved in osteochondritis dissecans. Average cartilage thickness was calculated on the digital version of the reference cuts for each site and compared. The sensitivity of the precision of the measurements to observer variability was evaluated using intra- and inter-observer correlation coefficient tests. The femoral cartilage in the knee was thickest in the recipient sites (2.49 mm, SD 0.64) than in donor sites (1.79 mm, SD 0.43) (P < 0.0001). There was no differences between the different donor sites, unless for the antero lateral intercondylar notch which was significantly thinner (1.3 mm, SD 0.29) than the other sites (P < 0.05). The cartilage of the donor site was consistently thinner than the cartilage of the recipient sites. Between the different donor sites, the lateral side of the intercondylar notch was significantly thinner than the other donor sites and should not be harvested in priority.

Self-employment rates differ widely across industries and across racial and ethnic categories. The former is relatively easy for economists to explain while the latter differences are more difficult. Self-employment is rare in industries for which production is characterized by substantial economies of scale. Self-employment is more common in services than in manufacturing, although it is greatest in agriculture. There are also substantial differences in self-employment across countries, with the evidence suggesting an inverse relationship between self-employment and economic development. For the United States, self- employment rates tend to be higher in less densely populated states because self-employment rates are greater when average firm size is smaller (Lunn and Steen, 2000). According to some people, differences in self-employment rates across racial and ethnic categories are due to discrimination. Self-employment rates are higher for whites than other racial/ethnic groups, and are higher for men than for women. The numerous programs initiated by state and local governments to assist minority- and women-owned businesses usually offer discrimination against minorities and women as a rationale for the programs. However, self-employment rates often differ widely across more narrowly defined groups within broader racial or ethnic classifications. Within the United States, there is a relatively large gap between self-employment rates of Mexicans and Cubans, and a larger gap between Koreans and Laotians. Fairlie (1996) reports self-employment rates for Russians of 24.9 percent and 10.5 percent for Belgians. These differences in self-employment rates within broader classifications (Hispanics, Asians, and Europeans) suggest that discrimination may not be the primary cause. In this paper, we examine self-employment rates among various ethnic groups within the broader classification of Asian to illustrate the heterogeneity of the self-employed, and to discuss the implications of this heterogeneity.

Since the development of the Australian New Zealand Standard on Risk Management (AS/NZ 4360:1995), the philosophy and concepts have been embraced and applied in many contexts outside of the insurance industry. One of these contexts is emergency management.The reason it has been adopted as a mantra in emergency management is that it appears to make emergency management more “scientific.” There appears to be a generally held belief that the more scientific we become, through the incorporation of numbers, the more it will guarantee our successful management of emergencies and disasters.Within the standard, there is brief reference to the need for communication with all “stakeholders.” This catch-all phrase would implicitly include the community. But I contend that unless consultation with the community is explicit and specific and we start talking “with” rather than “at” the community, emergency management is treading down a path that could lead to a community perception and reputation that is currently “enjoyed” by the insurance industry.

Using data from a survey of members and elders of the Presbyterian Church (USA), we estimate relationships among religious contributions, church attendance, and theological belief. Survey respondents indicated whether they were theologically conservative or liberal, and we hypothesized that the level and the composition of giving would be affected by theological belief. We found that conservative Presbyterians gave more in total, and gave more to the local church and to non-Presbyterian religious organizations than did more liberal Presbyterians, while more liberal Presbyterians gave more to secular charities than did conservative Presbyterians.

This paper examines self-employment across industries and states in the U.S. It attempts to determine whether self-employment is due more to pull or push factors and whether one or the other model fits some industries better or fits some states better. The 1990 Public Use Microdata Samples from the U.S. Census Bureau are used in the empirical analysis. It is found that self-employment rates differ considerably across ethnic groups, and that the rate of self-employment tends to be higher for immigrants. This paper also finds that increasing urbanization tends to reduce self-employment rates while the shift from manufacturing to service industries tends to increase self-employment rates.

No abstract available.

The Christian realism of Niebuhr and others had primarily a political cast, with discussions of military or ideological conflicts at the center. Many of the issues raised today in the political arena are more related to economic questions than traditional military considerations. The European Union has entailed both economic and political integration, while numerous other agreements, such as the North American Free Trade Agreement (NAFTA), envisage increased economic but low political integration. Even in trade agreements, however, nation-states voluntarily yield some sovereignty to institutions established to monitor the agreements. Meetings of the World Trade Organization involve protesters from many organizations who are concerned about the operations of the international economic order. In this chapter, I will attempt to relate and apply the principles associated with Christian realism to the economist’s vision of how market economies operate. There will be a particular focus on international issues, including globalization.

Introduction L’œdeme musculaire a ete rapporte dans les ruptures tendino-musculaires du membre inferieur. En revanche, il n’a jamais ete decrit dans les ruptures de la coiffe des rotateurs. Materiel Nous rapportons une serie retrospective de 19 cas de rupture isolee de l’infra-epineux (tendon ou jonction tendino-musculaire) avec un important œdeme musculaire detecte sur les sequences T2 Fat Sat de l’IRM. Les femmes etaient plus nombreuses (15) que les hommes (4), l’âge moyen au moment de la decouverte des lesions etait de 47,7 ans (30-66). Quatorze patients ont ete traites medicalement et cinq ont ete operes. Tous les patients ont ete revus a avec un delai moyen de 48,3 mois (24-92) avec un examen clinique detaille, un score de Constant et une IRM de controle. Resultats Trois patients avaient eu un traumatisme net avant le debut des problemes, 16 ont eu un debut progressif avec douleur d’apparition spontanee pendant une periode moyenne de 4,3 ans. Sur l’IRM la rupture siegeait au sein du tendon infra-epineux dans 9 cas, a la jonction tendino-musculaire dans 9 cas et dans 2 cas le niveau exact etait impossible a determiner. Tous avaient un important œdeme du muscle infra-epineux. Aucun patient n’avait de rupture transfixiante du supra-epineux ou du subscapulaire. Un EMG a ete pratique 15 fois et montrait toujours une vitesse de conduction nerveuse normale dans le nerf supra-scapulaire. Le score de Constant lors de la revision clinique (67.2 points (28-95)) etait significativement ameliore, p = 0,009, par rapport au score initial (53 points (24-69)). Sur l’IRM de controle, tous les patients presentaient une infiltration graisseuse stade IV de Goutallier. Les patients operes n’ont pas eu un resultat statistiquement meilleur que les patients non operes et l’IRM montrait egalement une disparition complete du muscle. Discussion Il s’agit d’une lesion nouvelle du muscle infra-epineux avec des caracteristiques cliniques, IRM et evolutives particulieres. Le traitement conservateur ou chirurgical n’a pas empeche l’evolution ineluctable vers une infiltration graisseuse complete et irreversible du muscle avec perte totale de sa fonction. Sa pathogenie reste mysterieuse ; elle survient chez des adultes jeunes, habituellement sans traumatisme. Elle correspond sans doute au premier stade des degenerescences graisseuses isolees de l’infra-epineux avec coiffe intacte deja rapportees il y a 10 ans par Godeneche et al. Conclusion Une exploration arthroscopique ou chirurgicale precoce et systematique pourrait peut etre permettre de mieux comprendre et traiter cette lesion.

Benazepril hydrochloride is a new angiotensin-converting enzyme inhibitor. In a multicenter study, 206 patients with mild to moderate hypertension were randomized to receive benazepril at a dose of 2, 5, 10, or 20 mg, hydrochlorothiazide, 25 mg, or placebo once daily for 4 weeks. The 20 mg dosage of benazepril lowered blood pressure to a degree equal to that of 25 mg hydrochlorothiazide: -12.2/7.7 mm Hg and -13.4/-7.5 mm Hg, respectively. Hydrochlorothiazide proved to be more effective in black subjects. At lower dosage levels of benazepril (2, 5, and 10 mg), blood pressure reduction was not significantly different from that with placebo. In those patients who failed to achieve goal diastolic blood pressure of less than 90 mm Hg with monotherapy after 4 weeks, the addition of open-label hydrochlorothiazide (25 mg/day) to benazepril, hydrochlorothiazide, or placebo produced a substantial additional decrease in blood pressure over a 2-week period. No definite adverse effects on hematologic measurements, serum biochemistry test results, or urinalyses were noted. Subjective adverse experiences were common in all groups but except in three or possibly four instances were not considered causally related to the study drug.

Introduction La subluxation posterieure statique de la tete humerale dans les arthroses gleno-humerales primitives peut etre responsable d’une usure asymetrique de la glene (glene biconcave de type B2). La mise en place et la survie d’une prothese d’epaule non contrainte peuvent en etre compromises. Le but de cette etude etait d’analyser les resultats des protheses d’epaule dans cette population. Materiel et Methodes Entre 1993 et 2004, 94 protheses ont ete implantees pour arthrose primitive avec glene de type B2 biconcave. Il y avait 54 femmes, 32 hommes et 8 cas bilateraux. L’âge moyen a l’operation etait de 72 ans (54-87). L’epaule dominante etait concernee dans 59 % des cas. 88 epaules ont eu une prothese totale et 6 epaules une prothese humerale. Toutes les glenes ont ete implantees apres un fraisage asymetrique ; 10 greffes osseuses glenoidiennes et 13 plicatures de la capsule posterieure ont ete associees. Tous les patients ont ete revus en consultation avec un recul moyen de 5 ans (2-11). Les resultats ont ete analyses sous l’angle clinique (score de Constant, amplitudes articulaires), radiologique (lisere ou descellement glenoidien) et scannographique. Tous les patients avaient eu un arthroscanner preoperatoire et 53 patients ont eu un scanner de controle postoperatoire. Les scanners permettaient l’analyse de la subluxation posterieure de la tete, l’usure et la retroversion glenoidienne. Resultats Le score de Constant est passe de 45 a 94 % (p Discussion et Conclusion Le resultat des protheses dans l’omarthrose primitive avec glene biconcave de type B2 est satisfaisant sur le plan clinique mais les resultats radiographiques et scanner sont preoccupants a moyen terme. La subluxation posterieure de la tete humerale a tendance a se reproduire quels que soient les gestes associes et parait plus importante a prendre en compte que l’usure et la retroversion glenoidienne.

Providing relevant spiritual support to individuals at the end-of-life often raises ethical and practical dilemmas. A little forethought and access to guidelines already in vogue can provide useful hints to many situations commonly faced in everyday practice. The author's experiences and some guidelines are discussed here.

Using data from Louisiana's Department of Transportation and Development for the years 1985–89 and a 1990 survey of construction firms doing business in Louisiana, the authors examine whether firms owned by minorities and women faced discrimination in the awarding of contracts in the state's public highway construction program. No evidence of discrimination is shown by a regression analysis, and only weak, ambiguous evidence of discrimination is shown by a disparity ratio analysis. The authors conclude that the sampled firms did not face discrimination in the years examined.

This study attempts to identify the determinants of U.S. direct foreign investment in the E.E.C. Previous studies are examined and an alternative specification is presented. The results indicate that the size of the market, growth of the market, height of trade barriers, and lagged net plant and equipment expenditures are important. Even so, the author feels that the data is too weak to permit strong policy statements from being made, as has been done in some of the previous papers.

Effects of once-daily doses of 50 mg triamterene with 25 mg hydrochlorothiazide and 5 mg amiloride with 50 mg hydrochlorothiazide were compared in a randomized, multicenter study of 84 adult subjects with mild to moderate hypertension (diastolic blood pressure 90 to 114 mm Hg). After a 3-wk placebo lead-in period, the subjects entered a 6-wk treatment period. The two drug regimens were compared with respect to antihypertensive effects and effects on serum potassium and magnesium levels during the final week of drug therapy, with the use of the last week of placebo therapy as a covariate. Both drug regimens substantially reduced mean supine systolic and diastolic blood pressures to well within normal limits; there was no significant difference the two groups. Twenty-four of the 41 subjects receiving triamterene-hydrochlorothiazide (59%) and 29 of the 43 patients receiving amiloride-hydrochlorothiazide (67%) had diastolic blood pressure less than 90 mm Hg at week 9. Five subjects receiving amiloride-hydrochlorothiazide (12%) and two subjects receiving triamterene-hydrochlorothiazide (5%) had hypokalemia (serum potassium level less than 3.5 mEq/l) at week 9. The average decrease in serum potassium levels during amiloride-hydrochlorothiazide therapy (-0.33 +/- 0.08 mEq/l) was greater than that after triamterene-hydrochlorothiazide (- 0.08 +/- 0.07 mEq/l). Serum magnesium levels were not changed by either regimen. Weight loss was greater in the amiloride-hydrochlorothiazide group than in the triamterene-hydrochlorothiazide group.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper presents an empriical study of the determinants of firm patenting. Since industrial research and development (R&D) encompasses a variety of activities, this study distinguishes between patents on process innovations and patents on product innovations. The property rights provided by a patent may differ between process and product patents, which suggests that the determinants of process innovations and product innovations may difer as well. Several recent studies have distinguished between research directed toward process innovations and research directed toward product innovations. Scherer (1983a) included measures of process R&D spending and product R&D spending in regressions for inter-industry differences in productivity growth. Link and Lunn (1984) found that the returns to process-related R&D activity exceed the returns to product-related R&D activity. Link (1982) found inter-firm differences in the allocation of R&D spending for process innovations and product innovations. Lunn (1986) fou...

JOSEPH SCHUMPETER, in Capitalism, Socialism and Democracy, argued that competition through innovation is more important than price competition in promoting economic progress, and that competition through innovation will not occur in perfectly competitive industries.' Schumpeter's arguments stimulated a large body of research on the effects of market power on R & D activity. In summarizing the empirical portion of this literature, Scherer noted that many researchers found a positive relationship between the degree of market concentration and the intensity of research activity, but that this relationship was weakened markedly when interindustry differences in technological opportunity were included in the statistical analysis.2 That is, in industries with relatively rich technological opportunities, market concentration and R & D intensity are unrelated, while in industries with relatively poor technological opportunities, market concentration and R & D intensity are positively related. The purpose of this paper is to offer an explanation for this finding. In particular, I argue that the true source of interindustry differences in R & D intensity is interindustry differences in the ability of firms to appropriate their innovative output. Further, both technological opportunity and market concentration are proxies for the appropriability of innovative output. The paper is organized as follows. Section I presents a brief discussion

This study employs a simultaneous equations model to test the relationships among industrial R&D spending, market structure and advertising. The R&D data employed are the Line of Business data collected by the FTC and published at the three- and fourdigit SIC level. The results are, in general, complementary to several other recent studies that used data sets involving different degrees of aggregation as well as different measures of research activity.

The blood pressure-lowering effects of a calcium-entry blocker, diltiazem (240 or 360 mg/day), and a thiazide diuretic, hydrochlorothiazide (50 or 100 mg/day), were studied in 20 black hypertensive patients. Supine blood pressure decreases of -34/-18 mm Hg for diltiazem and -29/-21 mm Hg for hydrochlorothiazide were noted after 14 weeks of therapy. Differences between drugs were not significant. Blood pressures were normalized in all 4 of the monotherapy nonresponders when the 2 drugs were combined. Significant adverse effects were not noted. These data suggest that diltiazem is an effective antihypertensive agent in black patients. As monotherapy, its blood pressure-lowering effect is equivalent to hydrochlorothiazide.

The safety and efficacy of sustained-release diltiazem 120 to 180 mg, 2 times a day, were compared with hydrochlorothiazide 25 to 50 mg, 2 times a day, and the combination of diltiazem and hydrochlorothiazide in 56 patients with mild to moderate hypertension (supine diastolic blood pressure between 95 and 114 mm Hg) using a placebo-controlled, parallel-design protocol. Data from an additional 21 patients were evaluated for safety only. The data reported herein represent the preliminary experience from a larger 200-patient multicenter study. All patients received placebo for 4 weeks, followed by either hydrochlorothiazide or diltiazem titrated to achieve a diastolic blood pressure reduction of greater than or equal to 10 mm Hg to reach a goal supine diastolic blood pressure of less than 90 mm Hg. Patients not achieving the treatment goal received hydrochlorothiazide plus diltiazem. At week 14, on maintenance monotherapy, diltiazem and hydrochlorothiazide produced comparable reductions in blood pressure from placebo baseline (160.3 +/- 24.3/101.7 +/- 5.5 to 145.2 +/- 24.1/89.8 +/- 7.4 mm Hg with diltiazem, 156.0 +/- 15.6/103.7 +/- 4.7 to 134.1 +/- 12.5/89.2 +/- 9.5 mm Hg with hydrochlorothiazide, p less than 0.001 for both). Diltiazem and hydrochlorothiazide achieved goal blood pressure in 42% and 45% of patients, respectively. The effects in responders were sustained for 6 months. In patients who did not achieve the treatment goal, 63% responded to diltiazem plus hydrochlorothiazide.No clinically significant postural hypotension was observed on any regimen. Heart rate was slightly lower with diltiazem than with hydrochlorothiazide. Adverse effects were minimal with diltiazem, hydrochlorothiazide and diltiazem plus hydrochlorothiazide but more hypokalemia occurred with hydrochlorothiazide.(ABSTRACT TRUNCATED AT 250 WORDS)

The safety and efficacy of sustained-release diltiazem, 120 to 180 mg twice daily, was compared with those of hydrochlorothiazide, 25 to 50 mg twice daily, in 207 patients with mild-to-moderate hypertension (supine diastolic blood pressure [BP] 95 to 114 mm Hg) using a baseline, placebo, parallel-design study protocol. All patients received placebo for 2 to 4 weeks, followed by either study drug during the double-blind phase, titrated over 8 weeks to achieve a goal of supine diastolic BP reduction of at least 10 mm Hg and/or a diastolic BP of less than 90 mm Hg. Patients not achieving the treatment goal with either drug alone received the other drug in combination. Both drugs produced significant decreases in supine and upright BP throughout the 26-week study. The magnitude of decrease in mean supine diastolic BP was similar for both drugs as monotherapy at week 14 (-11.4 and -12.1 mm Hg, respectively). Hydrochlorothiazide produced significantly greater reductions at week 14 in mean supine systolic BP than sustained-release diltiazem (-19.5 and -12.7 mm Hg, respectively). The difference in mean supine diastolic BP reduction with the 2 drugs diminished when hydrochlorothiazide (50 mg/day) was compared with sustained-release diltiazem. The BP effects were sustained for 6 months with both drugs. The 2 drugs appeared to lower BP more in patients older than 60 years and more in black than in white patients. The combination of the 2 drugs decreased supine diastolic BP to goal levels in about 56% of the patients not achieving goal with either drug alone. Adverse effects were minimal with either drug alone and in combination, except for hypokalemia, which increased with thiazide alone and in combination.

The effects of captopril (C) in doses of up to 450 mg/day, placebo (P), and hydrochlorothiazide (H) in doses of 50 to 100 mg/day were compared in double-blind studies in 38 black patients. Mean blood pressure response to C was only slightly greater than to P (systolic response difference only). Mean blood pressure responses to H were greater than to C. Results were compared to available data on 185 white and black patients treated similarly. In white patients, response to C was greater than to P, but response to H was approximately equal to that to C. In black patients, results were of the same order as those reported here; the systolic response to C was greater than that to P and response to H was greater than that to C. These data suggest that black and white patients differ in response to certain antihypertensive drugs.

In a double-blind study the long-term effects of diuretics in uncompli cated mild and moderate essential hypertension were investigated. A total of 52 outpatients completed 24 months of treatment with either furose mide at a dose of 40 mg twice daily (26 patients) or hydrochlorothiazide at a dose of 50 mg twice daily (26 patients). Throughout the 2 years of the study, both furosemide and hydro chlorothiazide significantly lowered the mean supine blood pressure from baseline levels. The fall was less with furosemide than with hydrochloro thiazide, although the difference between the two drugs reached statistical significance at only three of the eight time points. Serum electrolytes were used as major indicators of safety. The cumulative incidence of hypokalemia of 8% for the furosemide group compared to that of 62% for the hydrochlorothiazide group. Although diuretics, alone or combined with other blood pressure-lower ing drugs, have been used for many years to treat essential hypertension, information on their continued efficacy and safety is scarce. Short-term trials had shown that furosemide (Lasix(®)) resembled the thiazides in its antihypertensive properties,1-3 despite its different mode of action on the kidney. A cooperative study in hypertensive patients was therefore under taken at three clinical centers to investigate the long-term effects of furose mide on blood pressure and on serum electrolytes, and to compare them with those of hydrochlorothiazide.