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Elbow arthritis is an uncommon condition that can cause debilitating pain, stiffness, or instability. The most common etiologies include rheumatoid arthritis, posttraumatic arthritis, and primary osteoarthritis. Treatment begins with nonsurgical modalities, including activity modification, anti-inflammatories, hand therapy, and corticosteroids. Operative intervention may be considered once nonsurgical management has failed. Surgical treatment depends on the underlying etiology, chief complaint, patient age, and functional demand. Advances in technology, especially arthroscopic techniques, have expanded the treatment options available to surgeons. The goals of treatment include pain relief and restoration of functional range of motion. The purpose of this article is to review the pertinent soft tissue and osseous anatomy, discuss the etiologies, review the principles of diagnosis and evaluation, and finally, study the treatment options for elbow arthritis. [ABSTRACT FROM AUTHOR]

Sovereign citizens are part of an extreme anti-government movement. Since they fundamentally reject the authority of the state, they repeatedly come into conflict with governmental actors. Many publications have examined ideology and strategies of sovereign citizens. However, few studies empirically address their demographics and criminogenic factors. Based on a systematic literature review, we identified only eight empirical studies, which are used as the basis for this article's assessments. The results of the systematic literature review provide information about empirical results on demographics, driving factors of radicalization, mental health issues, behaviors and offences. However, due to the predominantly descriptive analyses and the lack of generalizability, these results can only be considered as preliminary evidence for a criminology of sovereign citizens. Further empirical research is needed to better understand who sovereign citizens are, what their radicalization processes look like, and which factors can predict the use of violence. Only then can effective P/CVE measures be developed and adequately established. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the rate of short-term complications after total elbow arthroplasty (TEA) and identify predictors of readmission and reoperation. We hypothesized that TEA performed for acute elbow trauma would have higher rates of 30-day readmission and reoperation than TEA performed for osteoarthritis (OA). Using the National Surgical Quality Improvement Program for the years 2011-2017, we identified patients undergoing TEA for fracture, OA, or inflammatory arthritis. Patient demographic characteristics, comorbidities, reoperations, and readmissions within 30 days of surgery were analyzed. Potential predictors of reoperation and readmission in the model included age, sex, race, body mass index (BMI), diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, smoking, bleeding disorders, American Society of Anesthesiologists classification, wound classification, operative time, and indication for surgery. A total of 414 patients underwent TEA from 2011-2017. Of these patients, 40.6% underwent TEA for fracture; 37.0%, for OA; and 22.7%, for inflammatory arthritis. The overall rate of unplanned readmissions was 5.1% (21 patients). The rate of unplanned reoperations was 2.4% (10 patients). Infection was the most common reason for both unplanned readmissions and reoperations. The rates of reoperations and readmissions were not significantly associated with any of the 3 operative indications: fracture, OA, or inflammatory arthritis. Multiple logistic regression analysis found increased BMI to be associated with lower odds of an unplanned readmission (odds ratio [OR], 0.883; 95% confidence interval [CI], 0.798-0.963; P =.0035) and found wound classification ≥ 3 to be associated with increased odds of an unplanned reoperation (OR, 16.531; 95% CI, 1.300-167.960; P =.0144) and total local complications (OR, 17.587; 95% CI, 2.207-132.019; P =.0057). Patients who were not functionally independent were more likely to experience local complications (OR, 4.181; 95% CI, 0.983-15.664; P =.0309) than were functionally independent patients. The 30-day unplanned reoperation rate after TEA was 2.4%, and the unplanned readmission rate was 5.1%. Low BMI was predictive of readmission. Wounds classified as contaminated or dirty were predictive of reoperation. Dependent functional status and contaminated wounds were predictive of local complications. The indication for TEA (fracture vs. OA vs. inflammatory arthritis) was not found to be a risk factor for reoperation or readmission after TEA. [ABSTRACT FROM AUTHOR]

To investigate the distinguishing morphological characteristics of the upper extremities in children with Möbius syndrome. Twenty-seven involved extremities in 14 patients with a diagnosis of Möbius syndrome were identified at 2 institutions. Medical records, radiographs, and clinical photographs were evaluated. Congenital hand differences were classified according to the Oberg, Manske, and Tonkin classification, and hands with symbrachydactyly were classified by the Blauth and Gekeler classification. The presence of other congenital anomalies was catalogued. There was bilateral involvement in 93% of patients with congenital hand anomalies. Twelve patients demonstrated congenital hand anomalies and 2 patients had been diagnosed with arthrogryposis. Among the 12 patients with congenital hand anomalies, 21 hands were classifiable as symbrachydactyly by the Oberg, Manske, and Tonkin classification and could be categorized by the Blauth and Gekeler classification. Short finger type was the most common subtype of symbrachydactyly, present in 13 hands. Eleven of these 13 patients (85%) were primarily affected on the radial side of the hand. Proximal arm involvement was identified in 2 patients with symbrachydactyly, both of whom had Poland syndrome and an absent pectoralis major. Symbrachydactyly in Möbius syndrome differs from the typical presentation of symbrachydactyly. Characteristically, there is a bilateral presentation with a strong predilection for radially based brachydactyly. These described characteristics may help the hand surgeon appropriately assess patients, especially those with radial-sided symbrachydactyly. Diagnostic III. [ABSTRACT FROM AUTHOR]

In recent years, the number of counter-radicalization and deradicalization programs has steadily increased, and they belong now to the standard counterterrorism and conflict resolution repertoire of many countries. How is the personnel of these programs trained to perform its duties and what does this tell about the relationship between academic and practitioner understandings of countering radicalization and deradicalization? This article aims at answering these questions by comparing the state of the art in evidence-based radicalization and deradicalization research with a detailed analysis of primary data concerning twelve training courses for personnel in this field. It finds that training courses are significantly disconnected from research. On the other hand, training in this field indicates that the academic literature is not well-grounded in the practical realities of delivering interventions. Both findings reveal the need for a more mutually beneficial relationship that can help improve practitioner training and making (de)radicalization research more practitioner-oriented. [ABSTRACT FROM AUTHOR]

Germany experienced in recent years a resurgence of several forms of organized and unorganized extreme rightwing violence, including lone-actor attacks, pogrom-like mass violence or clandestine cells plotting and executing attacks. A new and puzzling development, according to the German authorities, is the increasing involvement of individuals with no previous ties to the extreme right-wing environment, i.e. 'ordinary citizens', in terror plots or severe acts of violence (e.g. arson and explosive attacks). To address this puzzle, this article follows the development of extreme right-wing violence and terrorism in Germany between the detection of the 'National Socialist Underground' (NSU) terrorist cell in 2011 via the so-called 'refugee crisis' of 2015 and 2016 to the data currently available in 2018. The goal is not to explore causal pathways to right-wing violence in Germany but to explain the nature of the phenomenon, using the most recent theoretical literature. It is argued that a combination of significant refugee influx, the struggle of the legal system to label severe acts of extreme right-wing violence clearly as terrorism and a subcultural change (i.e. the decreased importance of extreme right-wing political parties in favour of subcultural forms of mobilization) might in theory have resulted in lowering the threshold for contact between 'ordinary' citizens and highly radicalized extremists. In addition, this combination of factors might also have encouraged 'ordinary' citizens to engage in severe acts of extreme right-wing-motivated violence by facilitating the transmission of grievances, opportunities, and polarization. [ABSTRACT FROM AUTHOR]

Dorsal wrist-spanning plate fixation for comminuted, intra-articular distal radius fractures involves the indirect reduction of intra-articular fractures via ligamentotaxis. The reduction is maintained by application of a bridge plate from the radial diaphysis to either the second or third metacarpal. The objective of this study was to retrospectively compare radiographic outcomes between distal radius fractures managed with bridge plate fixation to the second versus third metacarpal. A single-institution retrospective review identified 50 cases of distal radius fractures that underwent dorsal wrist-spanning plate fixation, with 9 and 41 fractures undergoing fixation to the second and third metacarpals, respectively. Radiographic parameters, such as radial height, radial inclination, volar tilt, and ulnar variance, were measured at 3 time points: immediately after surgery, immediately prior to elective plate removal, and at the final follow-up. Radiographic measurements of the 2 cohorts were compared at the 3 time points. Final radiographs showed an average radial height of 8.9 mm versus 9.4 mm for the second versus third metacarpal cohorts, respectively; average radial inclination of 17.4° for both the second and third metacarpal cohorts; average volar tilt of 1.9° versus 1.7° for the second versus third metacarpal cohorts, respectively; and an average ulnar variance of +0.6 mm versus +0.1 mm for the second versus third metacarpal cohorts, respectively. Radiographic parameters of the second and third metacarpal cohorts were similar across all the time points. Additionally, evaluation of the radiographic parameters across the 3 time points (immediately after surgery, immediately prior to elective plate removal, and at the final follow-up) demonstrated little to no loss of radiographic alignment. Radiographic outcomes for distal radius fractures managed with bridge plate fixation to the second versus third metacarpal appear similar. The distal plate fixation site can likely be determined on the basis of fracture anatomy and patient-specific features. Therapeutic IV. [ABSTRACT FROM AUTHOR]

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Research on deradicalization and disengagement from terrorist groups has produced insights into factors motivating to turn to violent milieus as well as reasons for turning away from them. Less exploration has focused on the group dynamics involved when individuals leave the group. In particular, the social pressure component, including the use of retaliatory violence, has not been adequately addressed. Testing Levine and Moreland's theoretic model of group reaction to disloyalty, this article illustrates how extremist groups determine the type of social pressure, using five problem-centred interviews with former German neo-Nazis, as well as 12 cases of violent social pressure on defectors in Germany and the United States. The main argument of this article is that a group's internal negotiation process regarding the pressure is typically segmented into two phases: one emotionally-based, immediately after the defection and a second, more rational and strategic response phase later on. Important factors determining the group's reaction are: the in-group status of the defector, group specific ideology, in-group future prospects and strategies, group structure, prevention of further defection, in-group behavioural learning processes, the defection process itself, and pressure on the group from the government. [ABSTRACT FROM AUTHOR]

This article presents a first quantitative overview of the findings of a private research project, which is running since 2011. The project aims at establishing a comprehensive database of German right-wing terrorist actors (groups, individuals) since the Second World War. It assembles data on incidents in order to gather as much information as possible about respective tactics, strategies, target groups, biographical backgrounds, connections and ideological legitimizations. As a first report and analysis, this article provides a quantitative analysis of right-wing terrorism in Germany, based on data relating to average group size, main target groups, length of existence and main tactics. [ABSTRACT FROM AUTHOR]

Purpose In order to effectively improve value in health care delivery, providers must thoroughly understand cost drivers. Time-driven activity-based costing (TDABC) is a novel accounting technique that may allow for precise characterization of procedural costs. The purpose of the present study was to use TDABC to characterize costs in a high-volume, low-complexity ambulatory procedure (endoscopic vs open carpal tunnel release [CTR]), identify cost drivers, and inform opportunities for clinical improvement. Methods The costs of endoscopic and open CTR were calculated in a matched cohort investigation using TDABC. Detailed process maps including time stamps were created accounting for all clinical and administrative activities for both the endoscopic and the open treatment pathways on the day of ambulatory surgery. Personnel cost rates were calculated accounting for capacity, salary, and fringe benefits. Costs for direct consumable supplies were based on purchase price. Total costs were calculated by aggregating individual resource utilization and time data and were compared between the 2 surgical techniques. Results Total procedural cost for the endoscopic CTR was 43.9% greater than the open technique ($2,759.70 vs $1,918.06). This cost difference was primarily driven by the disposable endoscopic blade assembly ($217), direct operating room costs related to procedural duration (44.8 vs 40.5 minutes), and physician labor. Conclusions Endoscopic CTR is 44% more expensive than open CTR compared with a TDABC methodology at an academic medical center employing resident trainees. Granular cost data may be particularly valuable when comparing these 2 procedures, given the clinical equipoise of the surgical techniques. The identification of specific cost drivers with TDABC allows for targeted interventions to optimize value delivery. Type of study/level of evidence Economic Analysis II. [ABSTRACT FROM AUTHOR]

Purpose To identify the incidence and risk factors for 30-day postoperative morbidity and mortality following operative treatment of distal radius fractures in a multicenter cohort. Methods We retrospectively queried the American College of Surgeons National Surgical Quality Improvement Program database for the years 2005–2011 for cases of closed distal radius fractures treated operatively with internal fixation. Patient demographics, comorbidities, and operative characteristics were analyzed. Thirty-day postoperative complications were identified and separated into categories of major morbidity or mortality, minor morbidity, and any complication. Risk factors were identified using univariate and multivariate analyses. Results We identified 1,673 cases of closed distal radius fractures managed with internal fixation. The overall incidence of having any early complication was 3%. Major morbidity was 2.1%, which included 4 patient deaths, and minor morbidity was 1%. The most common major morbidity was a return to the operating room (16 patients). The most common minor morbidity was urinary tract infection (6 patients). The multivariate analysis demonstrated ASA class III or IV, dependent functional status, hypertension, and myocardial infarction/congestive heart failure to be significant risk factors for any early complication. There was a 10.0% complication rate in the inpatient group and a 1.3% complication rate in the outpatient group. Conclusions The incidence of early complications following internal fixation for closed distal radius fractures was low, especially in the outpatient group. In the setting of an isolated injury to the distal radius, the data presented here can provide prognostic information for patients during informed consent for what is considered to be an elective procedure. Surgeons should consider risk of morbidity and mortality when considering surgery for patients with noteworthy cardiopulmonary disease, increased ASA class, or poor functional status. Type of study/level of evidence Prognostic II. [ABSTRACT FROM AUTHOR]