Background:
The surgical treatment of recurrent shoulder instability has evolved in recent years to include a variety of soft tissue and bone block procedures, undertaken with either an open or ...arthroscopic approach. Although the utilization of such techniques has rapidly expanded, the associated risk of complications remains poorly defined. This information is vital for clinical decision making and patient counseling.
Purpose:
To quantify the complication rate associated with all types of surgery for anterior glenohumeral joint dislocation.
Study Design:
Systematic review.
Methods:
A systematic search was undertaken of studies reporting complications from anterior shoulder stabilization surgery. Inclusion criteria were studies published in English between 2000 and 2017 with a minimum 2-year follow-up. Methodological quality of the included studies was assessed with the Methodological Index for Non-Randomized Studies criteria. Complication rates for all undesirable events contributing to the patient outcome were extracted and cumulative rates calculated.
Results:
Out of 1942 references, 56 studies were included, totaling 4362 procedures among 4336 patients. Arthroscopic soft tissue repair had a complication rate of 1.6% (n = 2805). When repair was combined with arthroscopic remplissage, the rate was 0.5% (n = 219). Open soft tissue repair had a complication rate of 6.2% (n = 219) and open labral repair with remplissage, a rate of 2.3% (n = 79). An open bone block procedure had a complication rate of 7.2% (n = 573) and an arthroscopic bone block procedure, a rate of 13.6% (n = 163).
Conclusion:
This large systematic review demonstrates the overall complication rates (not purely recurrence rates) in modern shoulder stabilization surgery. With the growing interest in bone block stabilization procedures, including those performed arthroscopically, surgeons should be aware of the 10-fold increase in complications for these procedures over soft tissue arthroscopic surgery and counsel their patients accordingly.
We study the composition of the housing stock across ownership and rental markets in a dynamic model of frictional assignment. Houses are rented or sold to heterogeneous households that sort over ...quality. Due to matching frictions and an increasing ownership surplus, wealthy households tend to own and lower value housing tends to be rented, even without financial frictions or rental supply constraints. When calibrated to match key housing market features of the average U.S. city, the model is consistent with observed empirical relationships across cities. We study the model's implications for affordability, ownership, and the impact of progressive property taxation.
Delayed response to clinical deterioration of hospital inpatients is common. Deployment of an electronic automated advisory vital signs monitoring and notification system to signal clinical ...deterioration is associated with significant improvements in clinical outcomes but there is no evidence on the cost-effectiveness compared with routine monitoring, in the National Health Service (NHS) in the United Kingdom (UK).
A decision analytic model was developed to estimate the cost-effectiveness of an electronic automated advisory notification system versus standard care, in adults admitted to a district general hospital. Analyses considered: (1) the cost-effectiveness of the technology based on secondary analysis of patient level data of 3787 inpatients in a before-and-after study; and (2) the cost-utility (cost per quality-adjusted life-year (QALY)) over a lifetime horizon, extrapolated using published data. Analysis was conducted from the perspective of the NHS. Uncertainty in the model was assessed using a range of sensitivity analyses.
The study population had a mean age of 68 years, 48% male, with a median inpatient stay of 6 days. Expected life expectancy at discharge was assumed to be 17.74 years. (1) Cost-effectiveness analysis: The automated notification system was more effective (-0.027 reduction in mean events per patient) and provided a cost saving of -£12.17 (-182.07 to 154.80) per patient admission. (2) Cost-utility analysis: Over a lifetime horizon the automated notification system was dominant, demonstrating a positive incremental QALY gain (0.0287 QALYs, equivalent to ~10 days of perfect health) and a cost saving of £55.35. At a threshold of £20,000 per QALY, the probability of automated monitoring being cost-effective in the NHS was 81%. Increased use of cableless sensors may reduce cost-savings, however, the intervention remains cost-effective at 100% usage (ICER: £3,107/QALY). Stratified cost-effectiveness analysis by age, National Early Warning Score (NEWS) on admission, and primary diagnosis indicated the automated notification system was cost-effective for most strategies and that use representative of the patient population studied was the most cost-saving strategy.
Automated notification system for adult patients admitted to general wards appears to be a cost-effective use in the NHS; adopting this technology could be good use of scarce resources with significance for patient safety.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
External border surveillance is critical to the security of every state and the challenges it poses are changing and likely to intensify. Wireless sensor networks (WSN) are a low cost technology that ...provide an intelligence-led solution to effective continuous monitoring of large, busy, and complex landscapes. The linear network topology resulting from the structure of the monitored area raises challenges that have not been adequately addressed in the literature to date. In this paper, we identify an appropriate metric to measure the quality of WSN border crossing detection. Furthermore, we propose a method to calculate the required number of sensor nodes to deploy in order to achieve a specified level of coverage according to the chosen metric in a given belt region, while maintaining radio connectivity within the network. Then, we contribute a novel cross layer routing protocol, called levels division graph (LDG), designed specifically to address the communication needs and link reliability for topologically linear WSN applications. The performance of the proposed protocol is extensively evaluated in simulations using realistic conditions and parameters. LDG simulation results show significant performance gains when compared with its best rival in the literature, dynamic source routing (DSR). Compared with DSR, LDG improves the average end-to-end delays by up to 95%, packet delivery ratio by up to 20%, and throughput by up to 60%, while maintaining comparable performance in terms of normalized routing load and energy consumption.
We develop a methodology to track and quantify the economic impacts of lockdown and reopening policies by Canadian provinces in response to the COVID‐19 pandemic, using data that is available with a ...relatively short time lag. To do so, we adapt, calibrate and implement a dynamic, seasonally adjusted, input–output model with supply constraints. Our framework allows us to quantify potential scenarios that allow for dynamic complementarities between industries, seasonal fluctuations and changes in demand composition. Taking account of the observed variation in reopening strategies across provinces, we estimate the costs of the policy response in terms of lost hours of employment and production. Among other results, we show how a more aggressive response, even though it imposes higher economic costs in the short run, can lead to lower economic costs in the long run if it means avoiding future waves of lockdowns.
Résumé
Quantification des impacts économiques des politiques associées à la COVID‐19dans les provinces canadiennes en temps réel (ou presque). On développe une méthodologie pour identifier et quantifier les impacts économiques des mesures de confinement et des politiques de déconfinement dans chacune des provinces canadiennes en réponse à la pandémie de la COVID‐19 en utilisant des données publiées avec un court décalage. Pour ce faire, on adapte, calibre et implémente un modèle d'entrées‐sorties dynamique désaisonnalisé avec des contraintes au niveau de l'offre. Notre modèle nous permet de quantifier des scénarios potentiels qui incorporent les complémentarités dynamiques entre les industries, les fluctuations saisonnières et les changements dans la composition de la demande. En prenant en compte les variations observées dans les stratégies de déconfinement de chaque province, on estime les coûts des politiques en ce qui a trait aux pertes d'heures travaillées et de production. Parmi les autres résultats observés, on démontre qu'une réponse plus agressive, quoique plus coûteuse à court terme, peut mener à des coûts économiques moins élevés à long‐terme si elle permet d’éviter des vagues de reconfinement.
The dynamics of house prices, sales, construction, and population growth in response to city-specific income shocks are characterized for 106 US cities. A dynamic model of search in the housing ...market in which construction, the entry of buyers, house prices, and sales are determined in equilibrium is then developed. The theory generates dynamics qualitatively consistent with the observations and a version calibrated to match key features of the US housing market offers a substantial quantitative improvement over models without search. In particular, variation in the time it takes to sell induces transaction prices to exhibit serially correlated growth.
Facial bristles are one of the least described feather types and have not yet been systematically studied across phylogenetically diverse avian species. Consequently, little is known about their ...form, function and evolutionary history. Here we address this knowledge gap by characterising the evolution of facial bristles for the first time. We especially focus on rictal bristle presence and their associations with foraging behaviour, diet and habitat preferences in 1022 avian species, representing 91 families in 29 orders. Results reveal that upper rictal, lower rictal and interramal bristles were likely to be present in the most recent common ancestor of this avian phylogeny, whereas narial bristles were likely to be absent. Rictal bristle presence, length and shape varied both within and between avian orders, families and genera. Rictal bristles were gained or lost multiple times throughout evolution, which suggest that the different morphologies observed within species might not be homologous. Phylogenetic relatedness is also not likely to be the only driver of rictal bristle presence and morphology. Rictal bristle presence and length were associated with species-specific ecological traits, especially nocturnality. Our findings suggest that species foraging in low-light conditions are likely to have longer rictal bristles, and that rictal bristles are likely to have evolved in early birds.
Coastal saltpans are a common supratidal human-modified wetland habitat found within many coastal landscape mosaics. Commercial salt production and aquaculture practices often result in the creation ...of exposed coastal substrates that could provide suitable breeding habitat for waterbird populations; however, few studies have quantified waterbird breeding success in these artificial wetlands.
Here we examine the nesting behavior of the Gull-billed tern (
) breeding in the Nanpu coastal saltpans of Bohai Bay, Yellow Sea, China over three consecutive nesting seasons (2017-2019) by using nest survival model in Program MARK.
The results revealed that nest survival of Gull-billed terns in coastal saltpans (0.697) was higher than previously published estimates from other regions, with an estimated daily survival rate (DSR) of 0.982 ± 0.001 (±95% CI). High nest survival was mainly attributed to low levels of human disturbances and low predation rates, while exposure to strong winds, flooding and silting were the main factors causing nest failure. Model-averaged estimates revealed that eggs laid in nests located on 'habitat islands' with feather or clam shell substrates were most likely to hatch. Initiation date, nest age, clutch size and quadratic effects of nearest-neighbor distance, nearest distance to road and nearest distance to water were all significant predictors of nest success, but the nest survival declined overall from 2017 to 2019 due to the degradation and loss of breeding habitat anthropogenically caused by rising water levels.
Coastal saltpans represent an alternative breeding habitat for the Gull-billed tern populations in Bohai Bay, but conservation management should prioritize flood prevention to improve the extent and quality of breeding habitat, concurrent with efforts to create further 'habitat islands' with suitable nesting substrate.
The dramatic rise in the ratio of Canada's average house price to average rent has led to speculation that there is a bubble in the Canadian housing market. Others have argued, however, that the ...currently high level of house prices may be rationalized by the low cost of financing, given the decline in interest rates over the last two decades. In this article, we assess these arguments through the lens of a simple asset pricing model applied to city-level data. We quantify the extent to which excess growth in Canadian house prices depends on the nature of the current regime governing real interest rates, expectations of rent growth in different cities and variations in property taxes. Au Canada, la montée dramatique du ratio du prix moyen des maisons sur le loyer moyen a suscité certaines spéculations à savoir qu'on ferait l'expérience d'une bulle de prix dans le marché canadien des maisons. D'autres, cependant, ont suggéré qu'on pourrait expliquer le fort prix des maisons pour le moment par le faible coût de financement, compte tenu du déclin des taux d'intérêt au cours des deux dernières décennies. Dans ce mémoire, on évalue ces arguments à travers la lentille d'un modèle simple du coût des actifs et à l'aide de données au niveau urbain. On quantifie l'ampleur de la croissance du prix des maisons au Canada qui est attribuable au régime en place qui gouverne les taux d'intérêt réel, aux expectatives quant à la croissance des loyers dans différentes villes, et aux variations dans les impôts fonciers.
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