Beyond COVID-19: Five commentaries on reimagining governance for future crises and resilience.

Several Canadian and international scholars offer commentaries on the implications of the COVID-19 pandemic for governments and public service institutions, and fruitful directions for public administration research and practice. This second suite of commentaries considers the challenges confronting governments as a result of the COVID-19 pandemic and in the decades to come with an increasingly broad lens: the need to understand and rethink the architecture of the state given recent and future challenges awaiting governments; the need to rethink government-civil society relations and policies to deliver services for increasingly diverse citizens and communities; the need for new repertoires and sensibilities on the part of governments for recognizing, anticipating, and engaging on governance risks despite imperfect expert knowledge and public skepticism; how the COVID-19 crisis has caused us to reconceive international and sub-national borders where new "borders" are being drawn; and the need to anticipate a steady stream of crises similar to the COVID-19 pandemic arising from climate change and related challenges, and develop new national and international governance strategies for fostering population and community resilience.

Plusieurs universitaires canadiens et internationaux ont offert des suggestions sur les implications de la pandémie du COVID­19 pour les gouvernements et les institutions de la fonction publique, ainsi que des orientations futures pour la recherche et la pratique en administration publique. Cette deuxième série de commentaires examine les défis que devront affronter les gouvernements en raison de la pandémie de COVID­19 et dans les décennies à venir, dans une optique large. Cette série souligne le besoin de comprendre et de repenser l'architecture de l'État, de revoir les relations entre le gouvernement et la société civile pour fournir des services à des citoyens et des communautés de plus en plus divers, d'élaborer de nouvelles façons d'identifier et d'anticiper les risques, et de s'engager malgré l'imperfection des connaissances d'experts et le scepticisme du public, de repenser les frontières, tout ceci en tenant compte des crises et défis à venir, de façon à promouvoir la résilience de la population et des communautés.

Body shape and performance on the US Army Combat Fitness Test: Insights from a 3D body image scanner.

OBJECTIVE: To identify relationships between body shape, body composition, sex and performance on the new US Army Combat Fitness Test (ACFT). METHODS: Two hundred and thirty-nine United States Military Academy cadets took the ACFT between February and April of 2021. The cadets were imaged with a Styku 3D scanner that measured circumferences at 20 locations on the body. A correlation analysis was conducted between body site measurements and ACFT event performance and evaluated using Pearson correlation coefficients and p-values. A k-means cluster analysis was performed over the circumference data and ACFT performance were evaluated between clusters using t-tests with a Holm-Bonferroni correction. RESULTS: The cluster analysis resulted in 5 groups: 1. "V" shaped males, 2. larger males, 3. inverted "V" shaped males and females, 4. "V" shaped smaller males and females, and 5. smallest males and females. ACFT performance was the highest in Clusters 1 and 2 on all events except the 2-mile run. Clusters 3 and 4 had no statistically significant differences in performance but both clusters performed better than Cluster 5. CONCLUSIONS: The association between ACFT performance and body shape is more detailed and informative than considering performance solely by sex (males and females). These associations may provide novel ways to design training programs from baseline shape measurements.

Excessive complications of open intramedullary nailing of midshaft clavicle fractures with the Rockwood Clavicle Pin.

BACKGROUND: Intramedullary clavicle fixation is a potential alternative to plate fixation. Previous studies documenting the complication rates of intramedullary clavicle fixation have demonstrated variable rates of soft tissue complications and fracture healing. QUESTIONS/PURPOSES: We asked the following questions: (1) Does use of the Rockwood Clavicle Pin (DePuy Orthopaedics Inc, Warsaw, IN) predispose patients to soft tissue complications requiring additional surgery or a high infection risk? (2) Does the Rockwood Clavicle Pin provide a truly minimally invasive insertion technique and reliable fracture fixation? PATIENTS AND METHODS: We retrospectively evaluated 18 patients (mean age, 31 years) who sustained a closed midshaft fracture of the clavicle treated with open intramedullary nailing with a Rockwood Clavicle Pin. We determined the incidence of complications and rate of fracture healing. RESULTS: Fourteen complications occurred in 10 patients. Five patients experienced a complication with fracture healing, including three nonunions. Nine patients experienced complications relating to soft tissue, including infection, skin necrosis, or posterior pain from pin prominence. CONCLUSIONS: The Rockwood Clavicle Pin remains a historically relevant method of clavicle fixation. However, due to an unacceptably high rate of nonunion, repeat operation, and soft tissue complications, we do not recommend this device for treating middiaphyseal clavicle fractures. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

An in vitro biomechanical investigation: variable positioning of leopard carbon fiber interbody cages.

STUDY DESIGN: This study is a biomechanical analysis of intervertebral cage placement, using a biomechanical model that has the appropriate matching geometry of the lumbar spine at the level of L4-L5 based upon prior morphometric studies. OBJECTIVE: The goal of this in vitro biomechanical analysis of interbody cages is to determine the effect of interbody cage position on the mechanics of posterior spinal instrumentation. This biomechanical analysis can potentially be used to guide surgical technique for placement of interbody cage devices. SUMMARY OF BACKGROUND DATA: Lumbar interbody spinal fusion cages are increasingly being used to promote spinal fusion and improve sagittal alignment in patients with degenerative disk disease. The transforaminal approach for placement of these cages has become popular, although the actual position of the cage that will provide optimal mechanical support in the intervertebral space is not known. MATERIALS AND METHODS: Leopard carbon fiber interbody cages (DepuySpine, Raynham, MA) were placed in a spinal fusion model simulating the L4-L5 disk space in one of 3 positions-anterior, middle, or anterolateral. We tested 5 constructs in each of the 3 positions, applying cyclic axial loads of 500 N at a rate of 4 Hz for 100,000 cycles. Strain on the posterior instrumentation and displacement of the cages was measured at periodic intervals. Load to failure of each construct was tested after 100,000 cycles were complete. RESULTS: Statistical analysis of biomechanical indicators show more strain in the anterolateral position as compared with the anterior position (P=0.002) and middle position (P=0.02). No difference was noted between anterior and middle positions (P=1.00). Interval analysis reveals differences in strain at 500 cycles in anterior versus anterolateral (P=0.01) and middle versus anterolateral (P=0.02). At 10,000 cycles, anterolateral strain was significantly higher (P=0.02) than anterior. No significant difference in strain was noted at 50,000 or 100,000 cycles between any of the positions. No significant differences were noted in displacement of the cages between each of the positions. Ultimate load to failure was lower (nonsignificant) in the anterolateral versus anterior position (P=0.06), but no difference was noted between anterior versus middle (P=0.57) or anterolateral versus middle (P=0.69) positions. Linear regression analysis of load-displacement curves shows significance at 500 cycles (P=0.02), approaching significance at 10,000 cycles (P=0.07), and no significant difference at 50,000 (P=0.28) or 100,000 (P=0.28) cycles. CONCLUSIONS: Positioning of interbody cages in an offset position shows higher strain upon posterior instrumentation than a central position, and quicker load to failure than an anteriorly placed cage. Biomechanical studies using shear loading, and testing of adjacent spinal levels, are necessary to further elucidate the biomechanical consequences of variable positioning of interbody cages.

The role of debridement and antibiotics in gunshot wounds to the spine.

BACKGROUND: The number of spinal cord injuries due to gunshot wounds continues to rise each year, and they currently rank third behind motor vehicle collisions and falls. Spine and wound infections pose difficult problems for transgastrointestinal gunshot wounds to the spine. METHODS: A retrospective review of 114 patients with low-velocity gunshot wounds to the spine was performed. Attention was paid to associated gastrointestinal (GI) tract injuries, antibiotic coverage, surgical intervention, and the development of spine and wound infections. RESULTS: Of 114 patients with gunshot wounds to the spine, 27 (23.7%) sustained a concomitant GI tract injury and 87 (76.3%) did not. Four spine infections (4/114, 3.5%) and 23 wound infections (23/114, 20.2%) developed in our patient population. Spine infection (chi = 13.36, p < 0.001) and wound infection (chi = 12.94, p < 0.001) rates were significantly higher in transgastrointestinal gunshot wounds to the spine. Surgical treatment of the spine in patients with transgastrointestinal gunshot wounds showed a significantly higher rate of spinal infection than did nonsurgical treatment of the spine (p = 0.013, Cramer's V = 0.61). No significant difference in spine infection rate was seen with adequate versus inadequate antibiotic coverage in the trans- gastrointestinal subset (p = 1.00), or in the development of wound infections with spine surgery (p = 0.628) or varying antibiotic coverage (p = 1.00). CONCLUSIONS: There is a significantly higher rate of spine and wound infections with trans-gastrointestinal gunshot wounds to the spine. These injuries, particularly those that involve the colon, put patients at risk for the development of spine infections after spinal surgery. Randomized controlled trials are necessary for the development of a specific protocol for intravenous antibiotic therapy in the setting of transgastrointestinal gunshot wounds to the spine.

Cervical degenerative cyst located within the body of C2: a case report and review of the literature.

STUDY DESIGN: A case report and review of the literature are presented. OBJECTIVES: To describe the clinical course and treatment of a patient with an unusual intraosseous degenerative cyst within the body of the axis, as well as review the literature regarding these lesions. SUMMARY OF BACKGROUND DATA: Intraosseous degenerative cysts of the cervical spine are extremely rare. To our knowledge, only 4 prior case studies have described these lesions, 2 of which were seen in the body of C2. METHODS: A case report of a 58-year-old patient with neck pain and an intraosseous cyst within the axis is presented with a review of the pertinent literature. RESULTS: History, examination, radiographic evaluation, and histology revealed this lesion to be an intraosseous degenerative cyst within the body of C2. The patient was treated with anterior surgical biopsy/curettage and posterior stabilization with structural graft enhancement. CONCLUSION: Although rare, intraosseous cervical degenerative cysts should be present in any differential diagnosis of cystic lesions seen in the cervical spine.