Bojejohannessen4648

natomic and reverse shoulder arthroplasty. Further high-level studies are warranted to refine these definitions and guide management.

The adaptation of new technology in joint replacement surgery is often associated with a learning curve, as performance tends to improve with experience. The purpose of this review is to define the learning curve and its relevance to joint replacement surgery in the setting of new technological advances, and to draw analogies with the learning curve of basic surgical training.

Assessing a surgeon's learning curve for a new technology is complicated and difficult. With every learning curve, the first patients subjected to the novel technology may be at higher risk for adverse events until the learning curve is overcome and a steady state is reached. While measures of performance can be clear and direct in some professions, learning curves with new technology in total joint arthroplasty have been difficult to quantify. Most attempts measure surgical learning curves via an evaluation of the surgical process or patient outcomes. There are published results of both process (i.e., operative time, accuracy of im(i.e., complication rate, revision rate) utilized as proxy for performance during learning curves. We review the concept of the learning curve in joint replacement surgery, highlighting examples of learning curves with adaptation of new technologies, and conclude with a discussion of dilemmas and challenges.

Superior capsular reconstruction (SCR) is a surgical procedure that has been developed to provide an alternative for joint preservation in patients with massive irreparable rotator cuff tears. The purpose of this review is to assess the improvements in biomechanical properties and functional outcomes of this novel procedure.

Biomechanically, SCR decreases superior translation and subacromial contact pressure. Glenoid fixation is maximized with three anchors, while margin convergence to any remaining rotator cuff improves stability, and findings vary based on graft type. Clinically, SCR has been associated with improvement in functional outcome in the setting of an isolated procedure, or in conjunction with rotator cuff repair. Outcomes appear to be dependent upon indications. However, in select cases, SCR may even be successful in reversing pseudoparalysis. SCR seems to lead to improved biomechanics for the cuff-deficient shoulder resulting in satisfactory functional outcomes. While surgical techniques haollow-up studies are needed to continue to refine indications for SCR as a joint preservation effort in the setting of irreparable massive rotator cuff tears without arthritis.

This article aims to provide a comprehensive understanding of the evaluation, diagnosis, and management of scapular dyskinesis and its impact on the kinetic chain in tennis athletes.

Optimal glenohumeral biomechanics are intimately associated with proper scapular motion and function. The tennis serve requires the scapula to act as a force transducer in the kinetic chain to convert potential energy generated in the lower extremities to kinetic energy in the upper extremity. Any aberration within this complex kinetic chain will result in force uncoupling and increases the potential for injury through compensatory mechanisms. Specifically, scapular dyskinesis has been associated with an increased risk of shoulder pain of up to 43% in overhead athletes. These pathologies include rotator cuff disease, subacromial and posterior impingement, labral injuries, and SLAP tears. Although the direct causality of these injuries remains controversial, multiple kinematic studies have demonstrated altered scapular positioscapular dyskinesis has been associated with an increased risk of shoulder pain of up to 43% in overhead athletes. These pathologies include rotator cuff disease, subacromial and posterior impingement, labral injuries, and SLAP tears. Although the direct causality of these injuries remains controversial, multiple kinematic studies have demonstrated altered scapular positioning increasing the predilection for soft tissue pathology. The diagnosis of scapular dyskinesis is predicated upon a thorough history, physical examination, and observational analysis of key nodes in the kinetic chain during tennis activity. Conservative management remains the mainstay of treatment and consists of a graduated physical therapy regimen. Although shoulder pain in the overhead athletes is often multifactorial, early recognition and treatment of scapular dyskinesis generally carry a favorable prognosis and result in improved patient outcomes.

This review presents epidemiology, etiology, management, and surgical outcomes of rotator cuff injuries in tennis players.

Rotator cuff injuries in tennis players are usually progressive overuse injuries ranging from partial-thickness articular- or bursal-sided tears to full-thickness tears. Most injuries are partial-thickness articular-sided tears, while full-thickness tears tend to occur in older-aged players. The serve is the most energy-demanding motion in the sport, and it accounts for 45 to 60% of all strokes performed in a tennis match, putting the shoulder at increased risk of overuse injury and rotator cuff tears. Studies have shown deficits in shoulder range of motion and scapular dyskinesia to occur even acutely after a tennis match. First-line treatment for rotator cuff injuries in any overhead athlete consists of conservative non-operative management with appropriate rest, anti-inflammatory drugs, followed by a specific rehabilitation program. Operative treatment is usually reserved for olderpairs for partial tears in younger players due to potential over-constraining of the shoulder joint and decreased rates of return to sport after rotator cuff repairs.The purpose of the present study was to perform a comprehensive scientific literature review and pooled data risk factor analysis of excited delirium syndrome (ExDS) and agitated delirium (AgDS). All cases of ExDS or AgDS described individually in the literature published before April 23, 2020 were used to create a database of cases, including demographics, use of force, drug intoxication, mental illness, and survival outcome. Odds ratios were used to quantify the association between death and diagnosis (ExDS vs. AgDS) across the covariates. There were 61 articles describing 168 cases of ExDS or AgDS, of which 104 (62%) were fatal. ExDS was diagnosed in 120 (71%) cases, and AgDS in 48 (29%). Fatalities were more likely to be diagnosed as ExDS (OR 9.9, p  less then  0.0001). Aggressive restraint (i.e. manhandling, handcuffs, and hobble ties) was more common in ExDS (ORs 4.7, 14, 29.2, respectively, p  less then  0.0001) and fatal cases (ORs 7.4, 10.7, 50, respectively, p  less then  0.0001). Sedation was more common in AgDS and survived cases (OR11, 25, respectively, p  less then  0.0001). The results of the study indicate that a diagnosis of ExDS is far more likely to be associated with both aggressive restraint and death, in comparison with AgDS. There is no evidence to support ExDS as a cause of death in the absence of restraint. These findings are at odds with previously published theories indicating that ExDS-related death is due to an occult pathophysiologic process. When death has occurred in an aggressively restrained individual who fits the profile of either ExDS or AgDS, restraint-related asphyxia must be considered a likely cause of the death.Thiophanate methyl is a broad-spectrum benzimidazole fungicide extensively applied in pre- and post-harvest, for the control of a wide range of fruit and vegetable pathogens. In the current work, the residue behavior of thiophanate methyl after application on strawberries and an estimation of the consumer dietary exposure was performed. Supervised field trials were conducted in Egypt (Qaluobiya Governorate) as to investigate the residue dynamics and terminal residues at different PHIs of thiophanate methyl and its metabolite carbendazim in strawberries under Egyptian conditions. For the measurement of residues in fruits, a QuEChERS-based protocol coupled with LC-MS/MS was optimized and successfully validated at 0.01 mg kg-1. The half-life (t1/2) of thiophanate methyl in strawberries was estimated, and a dietary risk assessment was performed employing both FAO/WHO and EFSA approaches.Rapid urbanization has been recognized as the primary cause of deteriorating water quality. Thus, it is crucial to take into account urbanization in water quality forecasting. The present study aims at finding the causal relationship between urbanization and water quality, and then predicting water quality based on this causality. For this purpose, nine urbanization indicators and 12 water quality parameters from 2006 to 2018 in Nanjing were collected as urbanization and water quality indices. find more Correlation and path analyses were firstly used to identify causal relationships between urbanization and water quality indices. Based on these causal relationships, comprehensive water quality indicators and their correlated urbanization parameters were input into a back-propagation neural network (BPNN) to predict water quality. In the improved BPNN, the R2 of the training sets were all greater than 0.99, and those of the test sets were all greater than 0.76, demonstrating that the optimized model is able to predict the water quality with reasonable accuracy. It also showed that the overall water quality in Nanjing will remain good from 2019 to 2028, which means that, when undergoing future urbanization process, water quality is not necessarily negatively affected. The transfer of industrial structure can have a positive influence on water quality. After 2028, the biological water environment index remained in a good state but the volatile phenol index continued to increase, making it a potential threat to future water quality. Industrial wastewater and fertilizer usage, as the primary sources of volatile phenols, should be prioritized for continued governmental control and monitoring into the future. This study provides new insight into the relationship between urbanization and water quality, and the presented models can assist in future-proofing water management strategies.The correct equations are presented below.The coronavirus (COVID-19) pandemic is infecting the human population, killing people, and destroying livelihoods. This research sought to explore the associations of daily average temperature (AT) and air quality (PM2.5) with the daily new cases of COVID-19 in the top four regions of Spain (Castilla y Leon, Castilla-La Mancha, Catalonia, and Madrid). To this end, the authors employ Pearson correlation, Spearman correlation, and robust panel regressions to quantify the overall co-movement between temperature, air quality, and daily cases of COVID-19 from 29 February to 17 July 2020. Overall empirical results show that temperature may not be a determinant to induce COVID-19 spread in Spain, while the rising temperature may reduce the virus transmission. However, the correlation and regression findings illustrate that air quality may speed up the transmission rate of COVID-19. Our findings are contrary to the earlier studies, which show a significant impact of temperature in raising the COVID-19 spread. The conclusions of this work can serve as an input to mitigate the rapid spread of COVID-19 in Spain and reform policies accordingly.