Search

Sardines are a crucial component of Philippine capture fisheries, providing economic benefits and contributing to food security. This study aimed to provide an overview of the status, trends and challenges in the sardine fishery in the Sulu Archipelago, a major fishing ground for sardines, focusing on the traditional but less-documented small-scale commercial ringnets or locally called kulibu. The modern kulibu has an average size of about 10 gross tons and is operated by 7–15 crew members. We estimated about 500 kulibu vessels operating in the entire Sulu Archipelago, with Sulu having the most, followed by Basilan and Tawi-Tawi, respectively. The normal catch rates of a kulibu ranged from 10 to 20 tubs or banggera per night, with each banggera containing about 40 kg of fish. While some fishers reported that catches are still abundant and did not change much over the past three decades, we have identified some signs of overfishing. These include using of advanced technology and bigger boats/nets, expansion of fishing to more distant areas, the increasing frequency of low to zero catches, and a change in species composition indicative of fishing down marine foodwebs. Fishers have identified major issues and challenges confronting the fishery, such as intrusion of larger purse seiners into their fishing grounds, lack or inefficiency of post-harvest facilities, absence of a reliable market for their catches, and security risks at sea. To provide a comprehensive perspective, we adopted the Sustainable Livelihood Approach (SLA) framework, highlighting the broader implications of our findings for fishery management. Bottom of Form [ABSTRACT FROM AUTHOR]

The author indicates that mankind will continue to automate for economic reasons.

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. [ABSTRACT FROM AUTHOR]

Background: Data assessing femoral stems may be influenced by grouping together matt and polished stems, despite their differing reported survivorship. The aim of this study is to assess the difference in revision rates between commonly used cemented and cementless stems when polished tapered stems are assessed independently of matt stems.Methods: Australian Orthopaedic Association National Joint Replacement Registry data from 1999 to 2019 were used to assess difference in revision rates between the 5 most commonly implanted femoral cemented and cementless stems for osteoarthritis. Cemented matt femoral stems, stems using line-to-line cementing techniques and procedures using non-cross-linked polyethylene, large head (>32 mm) metal-on-metal bearing surfaces or exchangeable necks were excluded. Cumulative percent revision was used to help compare survivorship between stems.Results: There were 201,889 total hip replacements meeting the inclusion criteria, of which 50.0% were cemented and 50.0% cementless. Cemented stems had a lower rate of revision at all time points compared to cementless stems. This was most significant during the first 2 weeks (hazard ratio 0.48, 95% confidence interval 0.40-0.58, P < .001) compared to 2 weeks postoperatively and onwards (hazard ratio 0.85, 95% confidence interval 0.81-0.90, P < .001). A subanalysis of head size, bearing type, and surgeon volume further supported the use of a cemented stem.Conclusion: Commonly used cemented polished tapered stems have a lower revision rate when compared to commonly used cementless prostheses, and are recommended in all age groups for both low-volume and high-volume surgeons especially when head size 32 mm or smaller is used. [ABSTRACT FROM AUTHOR]

Background: In order to reduce the incidence of total hip joint replacement revision for wear, multiple advanced materials and alloys targeting hip replacement tribology have been introduced. Ion implantation of chromium-cobalt heads is thought to reduce wear due to increased surface hardness and lower friction. These advances in technology result in additional manufacturing costs. However, it is unclear whether these attributes result in a decreased rate of revision for wear and when used with modern highly crosslinked polyethylene (XLPE). The aim of this study is to compare the survivorship of stainless steel and ion-implanted chromium-cobalt femoral heads in order to determine whether ion implantation has a lower risk of revision.Methods: Data from the Australian Orthopedic Association National Joint Replacement Registry included all stainless steel and low-friction ion-treated (LFIT) femoral heads used in conjunction with a primary Exeter/Trident hip replacement combination and XLPE liners performed for osteoarthritis. Kaplan-Meier estimates of survivorship were used to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, with adjustment for age and gender, were used to compare revision rates between the 2 groups.Results: There were 40,468 total hip replacements that met the inclusion criteria. Stainless steel heads had a lower revision rate compared to LFIT chromium-cobalt heads (HR 0.87, 95% confidence interval 0.76-1.00, P = .048). The difference in the rate of revision was even greater when 32-mm heads were used (HR 0.72, 95% confidence interval 0.58-0.89, P = .002). There was no difference in revision for loosening between head alloys or when stratified by age.Conclusion: Given the increased costs associated with LFIT implants and the lower rate of revision for stainless steel heads, we recommend the use of a stainless steel heads when using an Exeter/Trident hybrid hip with an XLPE liner. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This is a paper on modularity, a mode of managing complexity by breaking up a complex system into parts that communicate with one another through standardized interfaces, showing that rights in a firm of cooperating parties do not all reside in the same hands.

Purpose: This study aimed to (1) determine whether intraoperative graft soaking with vancomycin is a cost-effective measure for preventing infection after arthroscopic anterior cruciate ligament (ACL) reconstruction and (2) provide an adaptable model for providers and institutions to determine the cost effectiveness of this strategy over a range of initial infection rates, infection-related care costs, and vancomycin costs.Methods: Baseline postoperative infection rates and the costs of antibiotics and infection-related care were gathered from the literature. The cost of treating infection was determined for 2 alternative protocols-irrigation and debridement with revision ACL reconstruction or ACL graft retention. Using a break-even economic analysis, we developed an equation to determine the absolute risk reduction (ARR) in infection rate required for the use of vancomycin graft soaking to be deemed cost-effective. To provide a widely applicable robust model, multiple simulations were performed at varying unit costs, infection rates, and ACL reconstruction postoperative infection related care costs. The number needed to treat was calculated from the ARR.Results: Intraoperative vancomycin was determined to be cost-effective if it prevents 1 infection in 550 cases (ARR = 0.182%), given costs of $24,178 and $44/1,000 mg for revision ACL reconstruction and vancomycin, respectively. If the ACL graft is retained following infection, intraoperative vancomycin was considered cost-effective if it prevents 1 infection in 146 cases (ARR = 0.685%), given costs of $6,424 and $44/1,000 mg for arthroscopic debridement and vancomycin prophylaxis, respectively. For any specific cost of treating infection and cost of vancomycin, variation in baseline infection rates did not influence the economic viability of vancomycin graft soaking. This intervention remained economically viable over a wide range of unit costs of vancomycin.Conclusions: Through break-even economic analysis, this study demonstrates that the use of intraoperative graft preparation with vancomycin is a highly cost-effective prophylactic measure for infection prevention in arthroscopic ACL reconstruction.Level Of Evidence: IV, economic analysis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the cost-effectiveness of the most commonly used type of antimicrobial silver-impregnated occlusive dressing (Aquacel Ag, ConvaTec, Oklahoma City, OK, USA) for prosthetic shoulder infection (PSI) prevention after shoulder arthroplasty. Data regarding the cost of silver-impregnated occlusive dressing, cost to treat a PSI and initial infection rates after shoulder arthroplasty were calculated from available literature. Using a break-even economic analysis, we developed an equation that incorporated these variables to determine the absolute risk reduction (ARR) in infection rate required to make the use of this dressing cost-effective. To provide a widely applicable and reusable model, multiple simulations were performed at varying unit costs, infection rates, and PSI-related care costs. At a dressing cost of $34.00 and presuming a cost of $50,230 for treating a PSI, these dressings are considered cost-effective if their use prevents at least 1 infection in 1471 TSA (ARR of 0.068% from the initial infection rate of 0.7%). The cost-effectiveness of this dressing was maintained through a realistic range of dressing and PSI treatment costs, while initial infection rate was found not to influence cost-effectiveness. Antimicrobial silver-impregnated occlusive dressings represent a cost-effective infection prevention strategy after shoulder arthroplasty. The presented model serves as a useful resource to aid in weighing the economic effects of implementing any potential prophylactic measures aimed at minimizing infections after shoulder arthroplasty. Level IV; Economic Decision Analysis [ABSTRACT FROM AUTHOR]

Background: Abnormal voiding dynamics may be a modifiable risk factor for prosthetic joint infection (PJI) after total joint arthroplasty (TJA), but the cost-effectiveness of their optimization in the perioperative setting is unknown. Using a break-even analysis, we calculated the economic viability of perioperative voiding optimization for infection prevention after TJA in patients with symptomatic benign prostatic hyperplasia (BPH).Methods: A perioperative voiding optimization algorithm was created to represent a common approach to treating symptomatic BPH before TJA. Treatment is initiated with a 6-week trial of tamsulosin (pathway 1), followed by 6 months of combination tamsulosin/finasteride therapy (pathway 2) if symptoms persist. Patients with unremitting symptoms after medical management undergo surgical correction with transurethral resection of the prostate (pathway 3). Costs associated with each pathway were derived from the literature and institutional purchasing records. A break-even economic model was constructed to calculate the absolute risk reduction (ARR) in the infection rate and number needed to treat necessary for cost-effectiveness.Results: Pathway 1 was cost-effective if it prevented 1 infection of 113 (ARR = 0.883%) TKAs or 140 (ARR = 0.714%) THAs. Pathway 2 was cost-effective if it obviated infection in 1 of 69 TKAs (ARR = 1.445%) or 86 THAs (ARR = 1.169%). Pathway 3 was only deemed cost-effective assuming a cost of $400,000 to treat a PJI (number needed to treat = 71, ARR = 1.406%). Cost-effectiveness for pathways 1 and 2 was maintained with varying voiding optimization costs, infection rates, and PJI costs.Conclusion: Perioperative medical management of symptomatic BPH is an economically justified PJI prevention strategy, whereas surgical interventions appear to be financially substantiated only when considering the long-term societal costs of a PJI. [ABSTRACT FROM AUTHOR]

Background: Recent case series have reported early failure with the use of high-viscosity cement (HVC) in total knee arthroplasty (TKA). We evaluated revision risk after TKA with HVC compared with medium-viscosity cement (MVC) in a large cohort.Methods: We conducted a cohort study using data from Kaiser Permanente's Total Joint Replacement Registry. Patients who underwent fully cemented primary TKA for osteoarthritis were identified (2001-2018). Only posterior-stabilized, fixed-mobility designs of the 3 highest-volume implant systems (DePuy PFC, Zimmer NexGen, and Zimmer Persona) were included to mitigate confounding from implant characteristics. Palacos (Zimmer/Heraeus) and Simplex (Stryker) cements comprised the HVC and MVC exposure groups, respectively. Propensity score-weighted Cox proportional hazards regression was used to evaluate risk for any revision during follow-up and risk for revision from aseptic loosening specifically.Results: The final cohort comprised 76,052 TKAs, 41.1% using MVC. The crude 14-year cumulative revision probability was 4.55% and 5.12% for TKA with MVC and HVC, respectively. In propensity score-weighted Cox models, MVC compared with HVC had a lower risk of any revision (hazard ratio = 0.82, 95% confidence interval = 0.70-0.95) while no difference was observed for revision from aseptic loosening (hazard ratio = 0.80, 95% confidence interval = 0.56-1.13).Conclusion: While we observed a lower risk for any revision with the use of Simplex MVC compared with Palacos HVC, we did not observe a difference in revision for aseptic loosening specifically. Given the widespread use of HVC, additional research to investigate other HVC and potential mechanisms for failure outside of loosening is warranted.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Prosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty that exacts a substantial economic burden on the health-care system. This study used break-even analysis to investigate whether the use of silver-impregnated occlusive dressings is a cost-effective measure for preventing PJI after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).Methods: Baseline infection rates after TKA and THA, the cost of revision arthroplasty for PJI, and the cost of a silver-impregnated occlusive dressing were determined based on institutional data and the existing literature. A break-even analysis was then conducted to calculate the minimal absolute risk reduction needed for cost-effectiveness.Results: The use of silver-impregnated occlusive dressings would be economically viable at an infection rate of 1.10%, treatment costs of $25,692 for TKA PJI, and $31,753 for THA PJI and our institutional dressing price of $38.05 if it reduces infection rates after TKA by 0.15% (the number needed to treat [NNT] = 676) and THA by 0.12% (NNT = 835). The absolute risk reduction needed to maintain cost-effectiveness did not change with varying initial infection rates and remained less than 0.40% (NNT = 263) for infection treatment costs as low as $10,000 and less than 0.80% (NNT = 129) for dressing prices as high as $200.Conclusion: The use of silver-impregnated occlusive dressings is a cost-effective measure for infection prophylaxis after TKA and THA. [ABSTRACT FROM AUTHOR]

Patients undergoing elective shoulder arthroplasty have highly variable pain experiences. We sought to characterize preoperative patient characteristics associated with fast and slow pain relief after elective total shoulder arthroplasty and evaluated whether differences in early pain recovery predicted longer term pain relief. We identified 324 patients undergoing elective primary shoulder arthroplasty, reverse and anatomic, between 2015 and 2018 from our prospective registry. Postoperative pain relief was defined as the difference in preoperative and 2-week postoperative pain intensity. Three groups were then created: fast responders (top decile), slow responders (bottom decile), and normal responders. Multinomial regression was used to identify preoperative patient factors associated with either slow or fast pain responses. Factors associated with a fast pain response included older age and being married. A slow pain response was associated with being unmarried. Pain intensity was lower in the fast responders at 6 weeks (0.60 ± 0.80 vs. 3.4 ± 2.50, P <.05) and 3 months (0.60 ± 0.90 vs. 2.60 ± 2.30, P <.05), but there was no difference at 1 year (0.30 ± 0.60 vs. 1.00 ± 1.10, P =.068) and 2 years (0.50 ± 1.30 vs. 1.40 ± 2.10, P =.183) postoperatively. The postoperative pain experience after shoulder arthroplasty seems to be influenced by patient age and marital status. Patients with marginal improvement in pain relief should be counseled that their recovery may be more prolonged, but by the 1-year mark they are likely to achieve comparably low pain levels to other patients. Level III; Retrospective Design; Prognosis Study [ABSTRACT FROM AUTHOR]

Elective total shoulder arthroplasty is highly successful, but there is a subset of patients who continue to experience pain after this procedure. The purposes of this study were to elucidate the prevalence and patient characteristics predictive of persistent pain after shoulder arthroplasty. We identified patients who had received an elective primary shoulder arthroplasty (anatomic or reverse) between 2016 and 2017 from our prospectively maintained, single-surgeon registry. Patients were stratified by the presence or absence of persistent pain at 2 years postoperatively, as defined by a Visual Analog Pain score of ≥2. This value was chosen in accordance with previously reported values for minimal clinically important differences. Multivariable logistic regression was used to identify factors associated with persistent pain. Of the 244 patients included for analysis, 46(18.9%) had persistent pain at 2 years postoperatively. The average pain score in this group was found to be significantly greater than the patients without pain (3.6 ± 1.6 vs 0.14 ± 0.35, P <.001). Patients with persistent pain had a higher incidence of preoperative opioid use (26.1% vs 13.6%, P =.038), diabetes (28.3% vs 11.6%, P =.004), number of self-reported allergies (3 ± 4.8 vs 1.9 ± 2.3, P =.03), peak postoperative inpatient pain (8.1 ± 1.9 vs 6.9 ± 2.1, P <.001), incidence of prior ipsilateral shoulder surgery (50% vs 30%, P =.011), and a higher percentage received a reverse shoulder arthroplasty (87% vs 70.7%, P =.024). The patient characteristics that were independently predictive of persistent pain were history of prior ipsilateral shoulder surgery (odds ratio 2.44; 95% confidence interval 1.21-4.91; P =.013) and greater postoperative inpatient pain intensity (odds ratio, 1.26 per 1 unit increase; 95% confidence interval 1.03-1.55; P =.024). About 1 in 5 patients report persistent pain after elective primary shoulder arthroplasty. Prompt identification of at-risk patients (eg, those with severe postoperative inpatient pain and a history of prior shoulder surgery) may prove effective in optimizing the pain experience after shoulder arthroplasty. Level III; Cohort Study with Prospective Data and Retrospective Study Design. [ABSTRACT FROM AUTHOR]

Infants have the ability to recognize repeated words in the context of fluent speech, as revealed by a study of seven-and-a-half-month old American infants. In the experiments with six-month old infants no indication of such perception was found. After exposure to repeated isolated words, the seven-and-a-half-month old infants listened longer to passages that contained the target words. They did not listen longer to passages with words differing from the target words by a single phonetic feature. The effect was also found when target words were first presented in sentential contexts rather than in isolation.

A study on the objectives motivating decisions of local leaders in China show that Chinese village leaders engage in rural industrialization due to personal profit motive and to gain independence from higher authorities. Efforts are also directed toward village welfare and preserving high agricultural productivity. The understanding of village leaders goals will assist in the formulation of incentive-based policy measures. It will also help improve the desirability of goals associated with agricultural activities.