The contemporary American rural landscape reflects a mix of ongoing economic changes in agricultural land use, population change, and built environments. The mix depends on past and recent change ...which represent landscapes of memory and silence to those experiencing economic and demographic renaissance. We develop a typology of five stages that reflect the contemporary rural scene and conduct field transects in Northwest Iowa and Central Maine. Features of the dynamics in rural America are evident in photographs of residences, land use changes, and commercial structure. The study calls for additional studies on rural settlement populations, economies, and society in different environmental settings.
Background The aim of this study is to document a single surgeon's experience performing revision reverse shoulder arthroplasty after baseplate failure. Methods Revision reverse shoulder arthroplasty ...(RSA) for mechanical failure of the glenoid baseplate after RSA was performed in 14 patients. Clinical and radiographic data were collected preoperatively, prior to baseplate failure, after baseplate failure, and at latest follow-up after revision (average, 33 months). Results When comparing the pre-operative values to post-revision, ASES, forward elevation, and abduction were significantly improved. There was no significant difference in any of the outcome measures when comparing the prefailure data to the post-revision data. The post-revision prosthesis-scapular neck angle (PSNA) showed a significant increase in inferior tilt of the baseplate when compared to pre-failure PSNA (P < .001). Two patients (14%) required a second revision RSA for glenoid baseplate failure (1) and dislocation (1); 1 additional patient developed a postoperative hematoma which resolved without surgery. Conclusion Revision RSA for the treatment of glenoid baseplate mechanical failure can restore pain relief and function to the levels gained after the index RSA. Level of evidence Level IV, Case Series, Treatment Study.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background The purpose of this study was to describe the pathoanatomy of patients diagnosed with rheumatoid arthritis and rotator cuff deficiency and report their outcomes following reverse shoulder ...arthroplasty. Methods Twenty-one shoulders were evaluated prospectively. Nine had no prior surgery, 9 had a failed rotator cuff repair, and 3 had a failed arthroplasty. Patients were followed for a minimum of 2 years (average, 36 months). All patients had preoperative radiographs and 19 shoulders had an MRI or CT available for evaluation of muscular and bony deficiency. Radiographs at most recent follow-up were evaluated for loosening and scapular notching. Results All outcome measures improved significantly: ASES scores improved from 28 preoperatively to 82 postoperatively ( P < .0001); SST scores improved from 1 to 7 ( P < .0001); VAS pain scores improved from 7 to 1 ( P < .0001); VAS function scores improved from 3 to 6 ( P = .0058); elevation improved from 52° to 126° ( P < .0001); abduction improved from 55° to 116° ( P = .0002); external rotation improved from 19° to 33° ( P = .02); and internal rotation improved from S1 to L4 ( P = .02). Twelve patients rated their outcome as excellent, 6 as good, 2 as satisfactory, and 1 as unsatisfactory. Severe glenoid erosion was seen in 10 of the shoulders and 5 of the defects required structural grafting. Three patients (14%) sustained a complication that required reoperation: 2 for infection and 1 for periprosthetic fracture. Conclusions In patients with rheumatoid arthritis and rotator cuff deficiency, reverse shoulder arthroplasty can provide improvement in function and decreased pain.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
4.
Are leaders born to lead, or are they made? Klifto, Christopher S.; Cheung, Emilie V.; Holcomb, Jason O. ...
Journal of shoulder and elbow surgery,
03/2024, Volume:
33, Issue:
3
Journal Article
Peer reviewed
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Hypothesis A retrospective analysis was conducted of 2 consecutive groups of patients undergoing total shoulder arthroplasty (TSA) for primary osteoarthritis. One group was treated with formal ...physical therapy (PT), and one group was treated with home-based, physician-guided PT. We hypothesized that patients with a formal postoperative PT protocol would have significantly better postoperative clinical outcomes than patients with no formal PT. Methods Group A (43 patients) had a standard PT program. Group B (38 patients) had a home-based, physician-guided PT program. Clinical outcomes (preoperatively, 3, 6, and 12 months and most recent follow-up) were analyzed. A minimum sample size of 31 patients gives power to detect a 10-point American Shoulder and Elbow Surgeons (ASES) score (α = 0.05, β = 0.80). Results ASES and Simple Shoulder Test (SST) scores significantly improved in both groups at all follow-up periods. Forward flexion and abduction were significantly improved in group B at all time points, whereas an initial improvement in forward flexion and abduction in group A was lost at final follow-up. There were no significant differences in final ASES or SST scores between groups at final follow-up. However, forward flexion, abduction, and the Short Form-36 physical component summary in group B were significantly better than group A at final follow-up. No significant improvements in internal rotation or SF-36 mental component summary were seen within or between the groups at final follow-up. Overall, there was no difference in patient satisfaction, with 88% satisfaction in group A and 95% satisfaction in group B (χ2 = 0.471, P = .4924). Conclusions A home-based, physician-guided therapy program may provide adequate rehabilitation after TSA, allowing for a reduction in cost for the overall procedure.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The study by Kim et al2 only found a significant decrease in abduction strength with large and massive rotator cuff tears. ...small- to medium-size tears are often completely asymptomatic, that is, ...no perceived difference in strength compared to normal shoulders. Little is known about the natural history of rotator cuff tears, but a recent evaluation of patients with rotator cuff tears revealed that asymptomatic tears were less likely to progress.3 Certainly when patients with pain and dysfunction have failed nonoperative treatment and then undergo rotator cuff repair, they generally enjoy an improvement in their pain and function.4–6 However, the results seen in patients younger than 50 years left many patients dissatisfied.7 In addition, modern retear rates after rotator cuff repair are reported as 5% to 50%.4,6,8 The sequela of a neglected rotator cuff tear can progress to cuff tear arthropathy (CTA). ...the advent of modern reverse shoulder designs, arthroplasty treatment of CTA was defined by “limited goals” and frequently resulted in the surgeon and patient being dissatisfied.9–12 As Dr Schneider reported, the annual rate of reverse shoulder arthroplasty has risen each year since being made available in the United States in 2004. ...as with most novel technologies, the reported complication rate following RSA has declined as surgeons have gained more experience.13,15 Second, many of the complications reported occurred in patients undergoing RSA for a failed surgery.13,14 While our knowledge of rotator cuff tears is constantly improving, the current literature does not support routine screening and repair of asymptomatic rotator cuff tears as a preventive measure.
Government H-2A visa data and employer surveys show that Great Plains custom harvesting operations now rely on the US public employment service (PES) and private labor agencies to hire transnational ...labor. Wheat harvest labor problems and private labor bureau abuses during the Progressive Era were a driving force in the formation and development of the local, state, and federal PES agencies that are now used to secure foreign workers. The PES addressed harvest labor problems from the late nineteenth century until the 1930s when mechanization and drought sufficiently reduced labor demand. The PES became active in the wheat harvest again during WW II and into the 1950s until mobile custom combining crews eliminated the need for the federal government's involvement. Beginning in the 1990s, domestic labor scarcity caused custom harvesting employers to hire foreign labor through the H-2A and J-1 visa programs. The PES is part and parcel of the H-2A visa program, but unlike most agricultural employers that use H-2A labor, foreign workers in custom harvesting are from South Africa, New Zealand, Australia, and numerous European and other countries rather than Latin America. Transnational custom harvesting employees that use H-2A visas occupy a niche within the program and thereby maintain Great Plains harvesting's unique place in the labor market. This article traces the concurrent evolution of Great Plains harvesting and the PES from the end of the nineteenth century to the 1950s and examines the role of the PES and private labor agencies in today's global labor market.
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BFBNIB, IZUM, KILJ, NUK, PILJ, SAZU, UL, UM, UPUK
Unlike most of the Great Plains, Texas's Edwards Plateau lies near large, rapidly growing metropolitan centers. County-to-county migration data for the period 1985-1990 were used to examine migration ...patterns in Edwards Plateau counties. Weighted standard distance and stream efficiency values were used to analyze county in-migration fields of 28 nonmetropolitan counties. A key finding was that net in-migration to counties closest to metropolitan areas was not mere "urban spillover." There were also indications that counterurban migration extended beyond metropolitan-adjacent counties to more sparsely populated destinations. Counterurbanization was occurring from central counties of the nation's largest metropolitan areas and some Texas metropolitan areas. In-migration from the Gulf Coast of Texas played an important role in the Edwards Plateau. The migration system of the Edwards Plateau appears to have functioned differently than nonmetropolitan counties in the High Plains. Continued change is supported by data from the 2000 census.
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BFBNIB, NMLJ, NUK, PNG, UL, UM, UPUK
Buried within critical infrastructure control system applications and the operating systems on which they run are hundreds of settings that affect security. It is often difficult for asset owners to ...identify and audit these settings on their control system servers and workstations. Bandolier, a Digital Bond research project funded by the U.S. Department of Energy, addresses this problem. Digital Bond works with vendors and asset owners to identify the optimal security configuration for popular control system applications, and these settings are compiled into security audit files for use in vulnerability scanning tools. Over twenty application components from ten unique vendors are involved in the project. This paper examines the process of extracting security configuration data from the control system applications, describes the function of a security audit file, and demonstrates how asset owners and application vendors are using Bandolier to help secure critical infrastructure across various sectors.
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