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Today the world is confronted with dual crises: creeping and acute threats unfolding at the same time—for example, the manifestation of extreme weather events such as drought and flooding and the creeping crisis of climate change. To cope with dual crises, this article develops a novel temporal perspective that offers policy actors a repertoire of interrelated strategies for enhancing the robustness of institutional efforts. The repertoire consists of five temporal strategies that policy actors can use to navigate the twin challenges of immediate and latent threats in conjunction: strategic coupling of short-term shocks and creeping crises, crafting time horizons, molding the pace of public problem-solving, mobilizing anticipatory capacity through futuring techniques, and adaptive iteration of policy decisions. We illustrate the practical application of these strategies in an exploratory case study of adaptive water management in the Netherlands. De wereld wordt geconfronteerd met duale crises: sluipende en acute dreigingen op hetzelfde moment, zoals extreme weersgebeurtenissen als droogte of watersnood tegelijkertijd met de sluipende crisis van klimaatverandering. Om te reageren op duale crises, ontwikkelt dit artikel een nieuw repertoire van vijf temporele strategieën voor beleidsmakers om de robuustheid van overheidssystemen te vergroten. Dit repertoire bestaat uit de volgende strategieën: strategische koppeling van onverwachte korte termijn schokken en sluipende crises, tijdshorizonnen creëren, het tempo aanpassen van implementatie, het mobiliseren van anticiperende capaciteit door middel van scenariotechnieken, en de adaptieve iteratie van beleidsbeslissingen. We illustreren de werking van deze vijf strategieën aan de hand van een uitgewerkt voorbeeld van adaptief watermanagement in Nederland: de invoering van het programma Ruimte voor de Rivier.

Indications for reverse total shoulder arthroplasty (RTSA) have expanded to include primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff. Limited evidence exists on RTSA in patients with primary GHOA and no posterior glenoid wear (Walch A1, A2, and B1 morphologies). The purpose of this retrospective cohort study was to determine if glenoid morphology is associated with clinical outcomes in patients undergoing RTSA for primary GHOA.A retrospective review of prospectively collected data was performed in patients undergoing primary RTSA for GHOA with a minimum of 2-year clinical follow-up. Preoperative computed tomography and magnetic resonance imaging were used to categorize glenoid morphology as described by the modified Walch classification. Pre- and postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) pain scores, and range of motion (ROM) measurements were compared across Walch glenoid subtypes. The percentage of patients that reached previously established clinically significant thresholds for minimal clinically important difference (MCID) and substantial clinical benefit (SCB) was also comparatively assessed. Multivariable analysis was used to evaluate the association between glenoid morphology and postoperative ASES score while controlling for potentially confounding variables.Of the 247 consecutive patients, 197 were available at a minimum 2-year follow-up (80%). Significant improvements were seen in ASES, VAS pain, SANE, and ROM from baseline to final postoperative follow-up in the combined patient cohort (all P.001). Most (98.0%) patients reached MCID, and 90.9% of patients reached SCB for ASES threshold. No significant differences were found among Walch subtypes in terms of preoperative to postoperative improvement in ASES (P = .39), SANE (P = .4), VAS pain (P = .49), forward elevation (P = .77), external rotation (P = .45), or internal rotation (P= 0.1). The only significant difference in postoperative outcomes between Walch glenoid subtypes was higher postoperative ASES scores among type B3 glenoids compared with type A1 glenoids (P = .03) on univariate analysis. However, no individual Walch glenoid subtype was associated with lower postoperative ASES scores on multivariable analysis (P.05).Primary RTSA provides excellent short-term outcomes in patients with glenohumeral arthritis with intact rotator cuff, regardless of the degree of preoperative glenoid deformity. Surgeons can use these data to support the use of RTSA for glenohumeral arthritis in a more standardized way.

This reflective contribution tells the story of a veteran public sector crisis management (CM) researcher’s 35-year journey with educating students and CM practitioners, It offers preliminary insights about how the pandemic experience might – and should – induce a significant rethink of how educators conceptualize the nature of crises and the challenges governments and public agencies face in coping with them.

The presence of functional somatic syndromes (chronic physical symptoms with no identifiable organic cause) in patients undergoing elective joint arthroplasty may affect the recovery experience. We explored the prevalence of functional somatic syndromes among shoulder arthroplasty patients, as well as their association with postoperative outcomes and costs.We identified 480 patients undergoing elective total shoulder arthroplasty (anatomic or reverse) between 2015 and 2018 in our institutional registry with minimum 2-year follow-up. Medical records were queried for the presence of 4 well-recognized functional somatic syndromes: fibromyalgia, irritable bowel syndrome, chronic headaches, and chronic low-back pain. Multivariable linear regression modeling was used to determine the independent association of these diagnoses with hospitalization time-driven activity-based costs and 2-year postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and pain scores.Nearly 1 in 5 patients (17%) reported at least 1 functional somatic syndrome. These patients were more likely to be women, to be chronic opioid users, to report more allergies, to have a diagnosis of anxiety, and to have shoulder pathology other than degenerative joint disease (all P ≤ .001). After multivariable adjustment, the presence of at least 1 functional somatic syndrome was independently predictive of lower 2-year ASES (-9.75 points) and SANE (-7.63 points) scores and greater residual pain (+1.13 points) (all P ≤ .001). When considered cumulatively, each additional functional disorder was linked to a stepwise decrease in ASES and SANE scores and an increase in residual pain (P.001). These patients also incurred higher hospitalization costs, with a stepwise rise in costs with an increasing number of disorders (P.001).Functional somatic syndromes are common in patients undergoing shoulder arthroplasty and correlate with suboptimal outcomes and greater resource utilization. Efforts to address the biopsychosocial determinants of health that affect the value proposition of shoulder arthroplasty should be prioritized in the redesign of care pathways and bundling initiatives.

Acromial (ASF) and scapular spine (SSF) stress fractures are well-recognized complications of reverse shoulder arthroplasty (RSA), but much of the current data are derived from single-center or single-implant studies with limited generalizability. This study from the American Shoulder and Elbow Surgeons (ASES) Complications of Reverse Shoulder Arthroplasty Multicenter Research Group determined the incidence of ASF/SSF after RSA and identified preoperative patient characteristics associated with their occurrence.Fifteen institutions including 21 ASES members across the United States participated in this study. Patients undergoing either primary or revision RSA between January 2013 and June 2019 with a minimum 3-month follow-up were included. All definitions and inclusion criteria were determined using the Delphi method, an iterative survey process involving all primary investigators. Consensus was achieved when at least 75% of investigators agreed on each aspect of the study protocol. Only symptomatic ASF/SSF diagnosed by radiograph or computed tomography were considered. Multivariable logistic regression was performed to identify factors associated with ASF/SSF development.We identified 6755 RSAs with an average follow-up of 19.8 months (range, 3-94). The total stress fracture incidence rate was 3.9% (n = 264), of which 3.0% (n = 200) were ASF and 0.9% (n = 64) were SSF. Fractures occurred at an average 8.2 months (0-64) following RSA with 21.2% (n = 56) following a trauma. Patient-related factors independently predictive of ASF were chronic dislocation (odds ratio [OR] 3.67, P = .04), massive rotator cuff tear without arthritis (OR 2.51, P.01), rotator cuff arthropathy (OR 2.14, P.01), self-reported osteoporosis (OR 2.21, P.01), inflammatory arthritis (OR 2.18, P.01), female sex (OR 1.51, P = .02), and older age (OR 1.02 per 1-year increase, P = .02). Factors independently associated with the development of SSF included osteoporosis (OR 2.63, P.01), female sex (OR 2.34, P = .01), rotator cuff arthropathy (OR 2.12, P = .03), and inflammatory arthritis (OR 2.05, P = .03).About 1 in 26 patients undergoing RSA will develop a symptomatic ASF or SSF, more frequently within the first year of surgery. Our results indicate that severe rotator cuff disease may play an important role in the occurrence of stress fractures following RSA. This information can be used to counsel patients about potential setbacks in recovery, especially among older women with suboptimal bone health. Strategies for prevention of ASF and SSF in these at-risk patients warrant further study. A follow-up study evaluating the impact of prosthetic factors on the incidence rates of ASF and SSF may prove highly valuable in the decision-making process.

Reverse shoulder arthroplasty (RSA) is increasingly being utilized for the treatment of primary osteoarthritis. However, limited data are available regarding the outcomes of RSA as compared with anatomic total shoulder arthroplasty (TSA) in the setting of osteoarthritis.We performed a retrospective matched-cohort study of patients who had undergone TSA and RSA for the treatment of primary osteoarthritis and who had a minimum of 2 years of follow-up. Patients were propensity score-matched by age, sex, body mass index (BMI), preoperative American Shoulder and Elbow Surgeons (ASES) score, preoperative active forward elevation, and Walch glenoid morphology. Baseline patient demographics and clinical outcomes, including active range of motion, ASES score, Single Assessment Numerical Evaluation (SANE), and visual analog scale (VAS) for pain, were collected. Clinical and radiographic complications were evaluated.One hundred and thirty-four patients (67 patients per group) were included; the mean duration of follow-up (and standard deviation) was 30 ± 10.7 months. No significant differences were found between the TSA and RSA groups in terms of the baseline or final VAS pain score (p = 0.99 and p = 0.99, respectively), ASES scores (p = 0.99 and p = 0.49, respectively), or SANE scores (p = 0.22 and p = 0.73, respectively). TSA was associated with significantly better postoperative active forward elevation (149° ± 13° versus 142° ± 15°; p = 0.003), external rotation (63° ± 14° versus 57° ± 18°; p = 0.02), and internal rotation (≥L3) (68.7% versus 37.3%; p0.001); however, there were only significant baseline-to-postoperative improvements in internal rotation (gain of ≥4 levels in 53.7% versus 31.3%; p = 0.009). The overall complication rate was 4.5% (6 of 134), with no significant difference between TSA and RSA (p = 0.99). Radiolucent lines were observed in association with 14.9% of TSAs, with no gross glenoid loosening. One TSA (1.5%) was revised to RSA for the treatment of a rotator cuff tear. No loosening or revision was encountered in the RSA group.When performed for the treatment of osteoarthritis, TSA and RSA resulted in similar short-term patient-reported outcomes, with better postoperative range of motion after TSA. Longer follow-up is needed to determine the ultimate value of RSA in the setting of osteoarthritis.Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

In Canada many public projects, programs, and services perform well, and many are very successful. However, these cases are consistently underexposed and commonly understudied in the public realm which, for various reasons, tends to focus on policy mistakes and learning from failures rather than successes. In fact, studies of public policy successes, as such, are rare not just in Canada, but the world over, although this has started to change. The aims of the book are to see, describe, acknowledge, and promote learning from past and present instances of highly effective and highly valued public policy-making. These aims are accomplished through detailed examination of selected case studies of policy success in different eras, governments, and policy domains in Canada.

This chapter reviews the volume’s 22 case studies of successful policies across Canada, which tracked policy histories and assessed policy outcomes over time. It seeks to generate broader lessons and themes for conceptualizing and explaining policy success. It begins by providing a summary of the success ratings arising from the case studies and considers the usefulness of the multidimensional PPPE (programmatic, process, political, endurance) framework for developing and analysing such case studies. Second, it draws on the cases to identify factors across policy domains—some common, some particular, some contingent—which contribute to the different dimensions of policy success. Third, we step back from the case studies to consider the complex influence of macro-institutions in Canada (e.g. federalism, executive-dominated parliamentary government, and the judiciary) in influencing policy success. Finally, based on lessons from the Canadian cases, future lines of research to strengthen our understanding of policy success are suggested.

Patients with limited health literacy (LHL) may have difficulty understanding and acting on medical information, placing them at risk for potential misuse of health services and adverse outcomes. The purposes of our study were to determine (1) the prevalence of LHL in patients undergoing inpatient shoulder arthroplasty, (2) the association of LHL with the degree of preoperative symptom intensity and magnitude of limitations, (3) and the effects of LHL on perioperative outcomes including postoperative length of stay (LOS), total inpatient costs, and inpatient opioid consumption.We retrospectively identified 230 patients who underwent elective inpatient reverse or anatomic shoulder arthroplasty between January 2018 and May 2021 from a prospectively maintained single-surgeon registry. The health literacy of each patient was assessed preoperatively using the validated 4-item Brief Health Literacy Screening Tool. Patients with a Brief Health Literacy Screening Tool score ≤ 17 were categorized as having LHL. The outcomes of interest were preoperative patient-reported outcome scores and range of motion, LOS, total postoperative inpatient opioid consumption, and total inpatient costs as calculated using time-driven activity-based costing methodology. Univariate analysis was performed to determine associations between LHL and patient characteristics, as well as the outcomes of interest. Multivariable linear regression modeling was used to determine the association between LHL and LOS while controlling for potentially confounding variables.Overall, 58 patients (25.2%) were classified as having LHL. Prior to surgery, these patients had significantly higher rates of opioid use (P = .002), more self-reported allergies (P = .007), and worse American Shoulder and Elbow Surgeons scores (P = .001), visual analog scale pain scores (P = .020), forward elevation (P .001), and external rotation (P = .022) but did not significantly differ in terms of any additional demographic or clinical characteristics (P .05). Patients with LHL had a significantly longer LOS (1.84 ± 0.92 days vs. 1.57 ± 0.58 days, P = .012) but did not differ in terms of total hospitalization costs (P = .65) or total inpatient opioid consumption (P = .721). On multivariable analysis, LHL was independently predictive of a significantly longer LOS (β, 0.14; 95% confidence interval, 0.02-0.42; P = .035).LHL is commonplace among patients undergoing elective shoulder arthroplasty and is associated with greater preoperative symptom severity and activity intolerance. Its association with longer hospitalizations suggests that health literacy is an important factor to consider for postoperative disposition planning.

Background Refugees in humanitarian settings commonly experience many health needs and barriers to access healthcare; health data from these settings are infrequently reported, preventing effective healthcare provision. This report describes health needs of refugees in Moria Camp on Lesvos, Greece—Europe’s largest refugee camp. Methods A set of routinely collected service data of 18 131 consultations of 11 938 patients, attending a primary care clinic in the camp over 6 months in 2019–20, was analysed retrospectively, focusing on chronic health conditions. Results The most frequent chronic conditions were musculoskeletal pain (25.1%), mental health (15.9%), cardiac (12.7%) and endocrine conditions (8.9%). In all, 70.4% of consultations were for acute health problems, with high rates of injuries and wounds (20.8%), respiratory infections (12.5%), gastroenteritis (10.7%) and skin problems (9.7%), particularly scabies. Conclusions The prevalence of acute and chronic health problems is high in this setting, with some likely attributable to the deplorable living conditions in the camp. Despite its magnitude, the interpretability of routine health data is limited. A research agenda is identified, and a framework for chronic disease management in refugee camps is proposed.

There is growing evidence that the variation in value of shoulder arthroplasty may be mediated by factors external to surgery. We sought to determine if neighborhood-level socioeconomic deprivation is associated with postoperative outcomes and cost among patients undergoing elective shoulder arthroplasty.We identified 380 patients undergoing elective total shoulder arthroplasty (anatomic or reverse) between 2015 and 2018 in our institutional registry with minimum 2-year follow-up. Each patient's home address was mapped to the area deprivation index in order to determine the level of socioeconomic disadvantage. The area deprivation index is a validated composite measure of 17 census variables encompassing income, education, employment, and housing conditions. Patients were categorized into 3 groups based on socioeconomic disadvantage (least disadvantaged [deciles 1-3], middle group [4-6], and most disadvantaged [7-10]). Bivariate analysis was performed to determine associations between the level of socioeconomic deprivation with hospitalization time-driven activity-based costs and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and pain intensity scores.Overall 19% of patients were categorized as most disadvantaged. These patients were found to have equivalent preoperative pain intensity (P = .51), SANE (P = .50), and ASES (P = .72) scores compared to the middle and least disadvantaged groups, as well as similar outcome improvement at 2 years postoperatively (ASES): least disadvantaged group [35.7-84.3], middle group [35.1-82.4], and most disadvantaged group [37.1-84.0] [P = .56]; SANE: least disadvantaged group [31.8-87.1], middle group [30.8-84.8], and most disadvantaged group [34.2-85.1] [P = .42]; and pain: least disadvantaged group [6.0-0.97], middle group [6-0.97], and most disadvantaged group [5.6-0.80] [P = .88]. No differences in hospitalization costs were noted between groups (P = .77).Patients undergoing elective shoulder arthroplasty residing in the most disadvantaged neighborhoods demonstrate equivalent preoperative and postoperative outcomes as others, without incurring higher costs. These findings support continued efforts to provide equitable access to orthopedic care across the socioeconomic spectrum.

This introductory chapter sets out the objectives, approach and methodology of this volume. The main rationale for the volume is to identify, reconstruct and narrate instances of governments in Nordic countries ‘getting it right’, and to do so in a manner that is analytically robust yet presented in easy-to-read and helpful-to-teach case-study narratives. It presents the central analytical tool that all case studies use, the PPPE assessment framework, which calls on analysts to ascertain cases against programmatic, process, political and endurance criteria. And it situates the question of individual instances of policy successes in Nordic instances in the context of the broader narrative about a ‘Nordic’ approach to politics, governance and public policy, in particular but not limited to socio-economic policies and the ethos and architecture of welfare states in Northern Europe. It concludes by offering some emerging patterns of success-enabling factors across the cases and by formulating implications for future research.

Background As health care shifts to a value-based model with bundled-payment methods, it is important to understand the costs and reimbursements of arthroplasty procedures that represent the largest expenditure of Medicare. The aim of the present study was to characterize the variation in (1) total hospital costs, (2) reimbursement, and (3) profit margin for different arthroplasty procedures. Methods The total hospital costs of total knee arthroplasty (TKA), total hip arthroplasty (THA), anatomic total shoulder arthroplasty (TSA), reverse shoulder arthroplasty (RSA), and total ankle arthroplasty (TAA) were calculated with use of time-driven activity-based costing at an orthopaedic institution from 2018 to 2020. The average reimbursement for each type of procedure was determined. Profit margin, defined as the reimbursement profit after direct costs, was calculated by deducting the average time-drive activity-based total hospital costs from the reimbursement value. Multivariate analyses were performed to evaluate the associations between costs, reimbursement, and profit margins. Results There were 13,545 arthroplasty procedures analyzed for this study, including 6,636 TKAs, 5,902 THAs, 346 TSAs, 577 RSAs, and 84 TAAs. Costs and reimbursement were highest for TAA. THA and TKA resulted in the highest profit margins, whereas RSA resulted in the lowest. The strongest associations with profit margin were private insurance (0.46547), age (-0.22732), and implant cost (-0.19240). Conclusions THA and TKA had greater profit margins overall than TAA and upper-extremity arthroplasty in general. Profit margins for RSA, TSA, and TAA were all at least 28% lower than those for TKA or THA. Lower-volume arthroplasty procedures were associated with decreased profit margins. Study findings suggest that optimizing implant costs and length of stay are important for sustaining institutional fiscal health when performing shoulder and ankle arthroplasty surgery.

The primary purpose of this study was to evaluate the clinical outcomes of patients who underwent reverse total shoulder arthroplasty performed for primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff compared with rotator cuff tear arthropathy (CTA).This was a retrospective review of prospectively collected data including consecutive patients who underwent primary reverse total shoulder arthroplasty for GHOA or CTA with a minimum of 2-year follow-up. Baseline patient demographics and clinical outcomes including active range of motion, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation, and visual analog scale for pain were collected. Univariate and multivariate regression analyses were performed to evaluate the effect of preoperative diagnosis on clinical outcomes.Patients with a preoperative diagnosis of GHOA demonstrated significantly better postoperative active forward elevation (138.6° versus 127.3°; P0.01), external rotation (54.2° versus 43.8°; P0.01), and change in internal rotation (Δ 2.1 points versus Δ 1.2 points; P0.01). Patients with GHOA demonstrated significantly better postoperative ASES (86.8 versus 76.6; P0.01), Single Assessment Numerical Evaluation (89.7 versus 78.5; P0.01), and visual analog scale scores (0.63 versus 1.2; P0.01). Minimal clinically important difference for ASES score was achieved by 97.5% of patients with GHOA compared with 86.7% of patients with CTA (P0.01), whereas substantial clinical benefit was achieved by 90.4% of patients with GHOA and 71.7% of patients with CTA (P0.01). After a multivariate linear regression analysis, postoperative ASES scores were independently associated with previous ipsilateral shoulder surgery (P = 0.042), preoperative ASES score (P = 0.01), and primary diagnosis of GHOA (P0.01).RTSA performed in patients with GHOA and an intact rotator cuff is associated with improved functional and clinical outcomes compared with those patients treated for CTA.Level III Therapeutic Study.

Flexible hybrid electronics (FHE) interface rigid electronic components with flexible sensors, circuits, and substrates. This paper reports the reliability improvement of an FHE human performance monitor (HPM), designed to monitor electrocardiography (ECG) signals. The $50.8 {\,\,\mathrm {mm}} \times 50.8 {\,\,\mathrm {mm}}$ HPM is fabricated on Kapton HN polyimide (PI) substrate with flexible gold (Au) ECG electrodes on one side of the substrate and rigid electronic components for signal processing and communication mounted on the other side of the substrate. Our previously reported HPMs demonstrated reliability issues due to: 1) cracking of the copper (Cu) circuitry and 2) thinning and lack of adhesion at the printed Au and plated Cu interface that connected printed sensors to the Cu circuitry. Both failure mechanisms resulted in electrical opens in the circuit, which caused device failure. We explored effects of different design parameters, such as PI substrate thickness (50 versus $125~\mu \text{m}$ ), Cu circuit thickness (2 versus 6 $\mu \text{m}$ ), solder reflow temperature [205 °C for Tin-Lead (Sn-Pb) versus 175 °C for Tin-Bismuth (Sn–Bi) solder], solder pad design, and optimized inkjet printing (printing on bare Cu versus Au-plated Cu) on improving FHE reliability. Test vehicles (TVs) with different combinations of these factors were fabricated and bend-tested to determine the most robust configuration. TVs with 50- $\mu \text{m}$ -thick PI substrate, 6- $\mu \text{m}$ -thick Cu circuit, Sn–Bi solder, redesigned solder pads with rounded corners, and printed Au traces on Au plated Cu pads demonstrated the best reliability results.

Favorable clinical and functional outcomes can be achieved with reverse total shoulder arthroplasty (RSA). Given the expanding utilization of RSA in the United States, understanding the factors that influence both excellent and poor outcomes is increasingly important.A single-surgeon prospective registry was used to identify patients who underwent RSA from 2015 to 2018 with a minimum of 2 years' follow-up. An excellent postoperative clinical outcome was defined as a final American Shoulder and Elbow Surgeons (ASES) score in the top quartile of ASES scores. A poor outcome was defined as an ASES score in the bottom quartile. Logistic regression was used to determine preoperative characteristics associated with both excellent and poor outcomes.A total of 338 patients with a mean age of 71.5 years (standard deviation [SD], 6.4 years) met the inclusion and exclusion criteria. The average preoperative ASES score for the entire cohort was 35.3 (SD, 16.4), which improved to 82.4 (SD, 16.1) postoperatively (P.001). Univariate analysis demonstrated that a diagnosis of primary osteoarthritis (OA), private insurance, and higher preoperative ASES scores were significantly associated with achieving excellent outcomes (P.01 for all). Variables predictive of poor outcomes were workers' compensation status (P = .03), depression (P = .02), a preoperative diagnosis of rotator cuff tear arthropathy (P .01), preoperative opioid use (P.01), a higher number of allergies (P.01), and prior ipsilateral shoulder surgery (P.01). Multivariate regression analysis demonstrated that OA (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.2-26.5; P = .03) and private insurance (OR, 2.7; 95% CI, 1.12-6.5; P = .02) correlated with excellent outcomes whereas a higher number of reported allergies (OR, 0.83; 95% CI, 0.71-0.97; P = .02), self-reported depression (OR, 0.39; 95% CI, 0.16-0.99; P =.04), a history of ipsilateral shoulder surgery (OR, 0.36; 95% CI, 0.15-0.87; P =.02), and preoperative opioid use (OR, 0.26; 95% CI, 0.09-0.76; P = .01) were predictive of poor outcomes.A preoperative diagnosis of primary OA is the strongest predictor of excellent clinical outcomes following RSA. Patients with an increasing number of reported allergies, self-reported depression, a history of ipsilateral shoulder surgery, and preoperative opioid use are significantly more likely to achieve poor outcomes after RSA. Given the increasing utilization of RSA, this information is important to appropriately counsel patients regarding postoperative expectations.

This chapter reviews the main governance challenges policymakers faced during the COVID-19 crisis. It examines how governments mobilized institutional capacity to tackle these challenges. We focus on attempts to centralize crisis decision-making and discuss whether centralization contributed to government effectiveness and legitimacy.

Communication is pivotal when a society faces a sudden, disruptive and disturbing event. People want to know what is going on, why it is happening, what is done to safeguard them and what they can to protect themselves. During COVID-19, governments were the main sources of that information, at least initially. Governments tried to shape the attitudes, emotions and behaviours of citizens in accordance with their policies. Over time, alternative crisis narratives emerged and influenced citizen behaviour. This chapter examines crisis communication in the COVID-19 crisis: how did leaders try to ‘make making’ of this unprecedented threat? How did they deal with the alternative crisis frames that emerged over time?

The COVID-19 crisis has tested public institutions, crisis leadership and societal solidarity to the core. Fault lines have come to the fore; unsuspected strengths have been noted. But will this be enough to initiate the necessary steps to prepare our societies for the future crises that will come? In this chapter, we offer the building blocks for an action agenda. We identify various pathways to enhanced resilience.

COVID-19 brought the ‘unthinkable’ to our doorstep. The pandemic caused a series of global, and interconnected, health, economic, social, institutional and political crises that are unprecedented in living memory. Political leaders struggled to contain the virus and persuade anxious, weary citizens to behave this or that way in order to overcome a giant collective action problem. This chapter is a primer for the detailed examination of political and policy responses to this impossible challenge. It describes pivotal governance challenges and the constraints operating on the crisis response.

For a crisis to be effectively governed, it must first be noticed, interpreted, understood and assessed. This chapter explores how policymakers ‘made sense’ of the emerging COVID-19 pandemic. We focus on: (1) how policymakers around the world detected the developing threat as it emerged first in China and then in Italy; (2) the prominent involvement of scientific expertise in government sense-making processes (and in narratives about those processes). We discuss the complex dynamics between experts, decision-makers and publics that ensued.

The clinical significance of rotator cuff muscle quality following reverse total shoulder arthroplasty (RTSA) remains uncertain. The purpose of this study was to evaluate the influence of rotator cuff fatty infiltration (FI) and muscle atrophy (MA) on clinical outcomes following RTSA for glenohumeral osteoarthritis (GHOA).One hundred eight shoulders with primary GHOA that underwent RTSA with a lateralized glenosphere for GHOA with a minimum of 2-year follow-up were identified from a prospectively maintained registry. Each rotator cuff muscle was assessed on preoperative magnetic resonance imaging for FI and quantitative amount of MA. Pre- and postoperative outcomes included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Single Assessment Numerical Evaluation (SANE) score, visual analog scale pain score, and range of motion (ROM) measurements.Eighty-one patients with a mean age of 70.7 ± 5.4 years (range: 57-85) were included who underwent RTSA with a mean follow-up of 2.1 years (range: 2-3.9 years). There was a significant improvement in all outcome measures postoperatively (P.01). Twenty-two patients (27.1%) had moderate to severe combined infraspinatus and teres minor FI. There was no significant difference in the postoperative external rotation or clinical outcomes compared with those patients with only mild FI (P.05). Forty-three patients (53.1%) had moderate to severe global rotator cuff FI. There was no significant difference in postoperative outcomes compared with those patients with only mild FI (P.01). Univariate analysis did not reveal any significant association between the degree of FI or MA of any individual rotator cuff muscle and postoperative clinical outcomes or ROM. The size ratio of the posterior rotator cuff to the subscapularis muscle was positively correlated with preoperative SANE scores but negatively correlated with absolute postoperative and change in preoperative to postoperative SANE scores. However, there were no significant correlations between this size ratio and the other outcome measures.Rotator cuff muscle quality as assessed by MA and FI does not impact clinical outcomes following RTSA with a lateralized glenosphere in patients with GHOA and an intact rotator cuff.