International Comparison of the Sources of Productivity Slowdown 1973 1982

This paper uses an integrated model of aggregate supply to analyze the post-1973 slowdown in productivity growth in the seven major OECD economies. Factor substitution, unexpected demand changes, profitability, and inventory disequilibrium all contribute to the explanation, which is based on a three-factor nested aggregate production function, including energy, and postulating Harrod-neutral disembodied technical progress. The model is first applied separately to the seven countries assuming constant (though country-specific) rates of technical progress. This model provides empirical evidence that this rate of progress has in fact slowed down for several of the faster-growing countries, even after adjusting for factor substitution and cyclical factors. The model is therefore re-estimated, and the sources of productivity decline recalculated, on the hypothesis that rates of efficiency growth in other countries are converging to those in the United States.

Effect of Surgical Fusion on Volitional Weight-Shifting in Individuals With Adolescent Idiopathic Scoliosis

Study Design Prospective. Objectives The goals of this study were to (1) evaluate the differences in weightbearing symmetry between individuals with adolescent idiopathic scoliosis (AIS) and typically developing controls; (2) observe the effect of posterior spinal fusion and instrumentation (PSFI) on volitional weight-shifting at 1 and 2 years postoperatively; and (3) evaluate whether lowest instrumented fusion level (ie, lowest instrumented vertebra [LIV]) in PSFI has an effect on volitional weight-shifting. Summary of Background Data Previous studies have conflicting findings with regard to the effect of scoliosis on postural control tasks as well as the effect of surgery. They have also noted an inconsistent effect of PSFI at different LIVs, with more distal LIVs exhibiting greater reductions in postoperative range of motion. Methods The study was designed with an AIS group of 41 patients (8 males and 33 females) with AIS who underwent PSFI, along with a Control Group of 24 age-matched typically developing participants (12 male and 12 female). Both groups performed postural control tasks (static balance and volitional weight-shifting), with the AIS group repeating the tasks at 1 and 2 years postoperatively. Results At baseline, the AIS group showed increased weightbearing asymmetry than the Control Group (p = .01). The AIS group showed improvements in volitional weight-shifting at 2 years over baseline (p \u3c .01). There was no effect of LIV on volitional weight-shifting by the second postoperative year. Conclusions Individuals with AIS have greater weightbearing asymmetry but improved volitional weight-shifting over typically developing controls. PSFI improves volitional weight-shifting beyond preoperative baseline but does not differ significantly by LIV

Effect of Surgical Fusion on Volitional Weight-Shifting in Individuals With Adolescent Idiopathic Scoliosis

Study Design Prospective. Objectives The goals of this study were to (1) evaluate the differences in weightbearing symmetry between individuals with adolescent idiopathic scoliosis (AIS) and typically developing controls; (2) observe the effect of posterior spinal fusion and instrumentation (PSFI) on volitional weight-shifting at 1 and 2 years postoperatively; and (3) evaluate whether lowest instrumented fusion level (ie, lowest instrumented vertebra [LIV]) in PSFI has an effect on volitional weight-shifting. Summary of Background Data Previous studies have conflicting findings with regard to the effect of scoliosis on postural control tasks as well as the effect of surgery. They have also noted an inconsistent effect of PSFI at different LIVs, with more distal LIVs exhibiting greater reductions in postoperative range of motion. Methods The study was designed with an AIS group of 41 patients (8 males and 33 females) with AIS who underwent PSFI, along with a Control Group of 24 age-matched typically developing participants (12 male and 12 female). Both groups performed postural control tasks (static balance and volitional weight-shifting), with the AIS group repeating the tasks at 1 and 2 years postoperatively. Results At baseline, the AIS group showed increased weightbearing asymmetry than the Control Group (p = .01). The AIS group showed improvements in volitional weight-shifting at 2 years over baseline (p \u3c .01). There was no effect of LIV on volitional weight-shifting by the second postoperative year. Conclusions Individuals with AIS have greater weightbearing asymmetry but improved volitional weight-shifting over typically developing controls. PSFI improves volitional weight-shifting beyond preoperative baseline but does not differ significantly by LIV

Effect of Lowest Instrumented Vertebra on Trunk Mobility in Patients With Adolescent Idiopathic Scoliosis Undergoing a Posterior Spinal Fusion

Study Design Prospective. Objectives The goal of this study was to evaluate the effect of posterior spinal fusion surgery terminating at different lowest instrumented vertebrae (LIV) on trunk mobility in individuals with adolescent idiopathic scoliosis (AIS). Summary of Background Data Posterior spinal fusion with instrumentation is the standard surgical technique employed in AIS for correcting spine deformities with Cobb angles exceeding 50°. Surgical correction of curve deformity reduces trunk mobility and range of motion. However, conflicting findings from previous studies investigating the impact of different LIV levels on the reduction in trunk mobility after surgery have been reported. Methods The study was designed as a prospective study with 47 patients (7 males and 40 females) with AIS who underwent posterior spinal fusion. Patients were classified into 5 groups based on their surgical LIV level (ie, T12, L1, L2, L3, and L4). Trunk flexion-extension (sagittal plane), lateral bending (coronal plane), and axial rotation (transverse plane) kinematics were assessed during preoperative, 1 year postoperative, and 2 years postoperative evaluation visits. Results There were postoperative reductions of 41%, 51%, and 59% in trunk range of motion in the sagittal, coronal, and transverse planes, respectively (p \u3c .0001). A trend toward greater postoperative reductions in peak forward flexion at more distal LIVs was observed (p = .04). Conclusions Fusion reduces trunk mobility in the sagittal, coronal, and transverse planes. More distal LIV fusions limit peak forward flexion to a greater extent which is considered clinically significant. After fusion, the reductions seen in axial rotation, lateral bending, and backward extension do not differ significantly at more distal LIVs

Effects of Spinal Fusion for Idiopathic Scoliosis on Lower Body Kinematics During Gait

Objectives The purpose of this study was to compare gait among patients with scoliosis undergoing posterior spinal fusion and instrumentation (PSFI) to typically developing subjects and determine if the location of the lowest instrumented vertebra impacted results. Summary of Background Data PSFI is the standard of care for correcting spine deformities, allowing the preservation of body equilibrium while maintaining as many mobile spinal segments as possible. The effect of surgery on joint motion distal to the spine must also be considered. Very few studies have addressed the effect of PSFI on activities such as walking and even fewer address how surgical choice of the lowest instrumented vertebra (LIV) influences possible motion reduction. Methods Individuals with scoliosis undergoing PSFI (n = 38) completed gait analysis preoperatively and at postoperative years 1 and 2 along with a control group (n = 24). Comparisons were made with the control group at each time point and between patients fused at L2 and above (L2+) versus L3 and below (L3–). Results The kinematic results of the AIS group showed some differences when compared to the Control Group, most notably decreased range of motion (ROM) in pelvic tilt and trunk lateral bending. When comparing the LIV groups, only minor differences were observed, and the results showed decreased coronal trunk and pelvis ROM at the one-year visit and decreased hip rotation ROM at the two-year visit in the L3– group. Conclusions Patients with AIS showed decreased ROM preoperatively with further decreases postoperatively. These changes remained relatively consistent following the two-year visit, indicating that most kinematic changes occurred in the first year following surgery. Limited functional differences between the two LIV groups may be due to the lack of full ROM used during normal gait, and future work could address tasks that use greater ROM

Flexible growing rods: a biomechanical pilot study of polymer rod constructs in the stability of skeletally immature spines

Abstract Background Surgical treatments for early onset scoliosis (EOS) correct curvatures and improve respiratory function but involve many complications. A distractible, or ‘growing rod,’ implant construct that is more flexible than current metal rod systems may sufficiently correct curves in small children and reduce complications due to biomechanical factors. The purpose of this pilot study was to determine ranges of motion (ROM) after implantation of simulated growing rod constructs with a range of clinically relevant structural properties. The hypothesis was that ROM of spines instrumented with polymer rods would be greater than conventional metal rods and lower than non-instrumented controls. Methods Biomechanical tests were conducted on six thoracic spines from skeletally immature domestic swines (35–40 kg). Paired pedicle screws were used as anchors at proximal and distal levels. Specimens were tested under the following conditions: control, then dual rods of polyetheretherketone (PEEK) (diameter 6.25 mm), titanium (4 mm), and cobalt-chrome alloy (CoCr) (5 mm). Lateral bending (LB) and flexion-extension (FE) moments were applied, and vertebral rotations were measured. Differences were determined by two-tailed t-tests and Bonferroni for four primary comparisons: PEEK vs control and PEEK vs CoCr, in LB and FE (α = 0.05/4). Results In LB, ROM of spine segments after instrumenting with PEEK rods was lower than the non-instrumented control condition at each instrumented level. ROM was greater with PEEK rods than with Ti and CoCr rods at every instrumented level. Combining treated levels, in LB, ROM for PEEK rods was 35 % of control (p < 0.0001) and 270 % of CoCr rods (p < 0.01). In FE, ROM with PEEK was 27 % of control (p < 0.001) and 180 % of CoCr (p < 0.01). At proximal and distal adjacent non-instrumented levels in FE, mean ROM was lower for PEEK than for either metal. Conclusions PEEK rods increased flexibility versus metal rods, and decreased flexibility versus non-instrumented controls, both over the entire instrumented segment and at each individual level. Smaller mean increases in ROM at proximal and distal adjacent motion segments occurred with PEEK compared to metal rods, which may help decrease complications, such as junctional kyphosis. Flexible growing rods may eventually help improve treatment options for young patients with severe deformity.http://deepblue.lib.umich.edu/bitstream/2027.42/134642/1/13013_2016_Article_87.pd

Flexible growing rods: polymer rods provide stability to -skeletally immature spines

Introduction: Surgical treatments for early onset scoliosis typically require multiple operations and many complications. A more flexible growing rod construct might result in a more flexible spine with fewer complications. Polymer rods (polyetheretherketone, PEEK) are relatively flexible in bending, and therefore might allow for greater range of motion (ROM) during treatment. The purpose of this study was to determine changes in spine ROM after implantation of simulated growing rod constructs with a range of clinically relevant structural properties. Methods: Biomechanical tests were conducted on six skeletally immature porcine thoracic spines (domestic pigs, age 2–4 months, 35–40 kg, T1–T13). Paired pedicle screws were inserted into T3 and T4 proximally, and T10 and T11 distally. Specimens were tested under the following conditions: (i) control, then dual rods of (ii) PEEK (6.25 mm, n = 6), (3) titanium (4 mm, n = 6), and (4) CoCr alloy (5 mm, n = 4). Lateral bending (LB) and flexion--extension (FE) moments of ±5 Nm were applied. Vertebral rotations were measured using video analysis. ROM for the treated region was determined by averaging all maximum side-to-side rotations at each instrumented level. Differences were determined by t-tests and Bonferroni posthoc. Results: In LB, ROM of specimens with PEEK rods was lower than control at each instrumented level. ROM was greater for PEEK rods than both Ti and CoCr at every instrumented level. Mean ROM at proximal and distal uninstrumented levels was lower for PEEK than for Ti and CoCr. In FE, mean ROM at proximal and distal uninstrumented levels was lower for PEEK than for Ti and CoCr. Combining treated levels, in LB ROM for PEEK rods was 35% of control (p \u3c 0.0001) and 270% of CoCr rods (p \u3c 0.05). In FE, ROM for PEEK rods was 27% of control (p \u3c 0.005) and 180% of CoCr rods (p \u3c 0.05). Conclusions: PEEK rods provided increased flexibility versus metal rods, but also significantly greater stiffness than controls. Smaller increases in ROM at proximal and distal adjacent motion segments occurred with PEEK compared with the metal rods, which may decrease probability of junctional kyphosis. This biomechanical feasibility study of flexible polymer rod constructs showed that PEEK rods provided increased flexibility compared with CoCr and Ti rods, but also significantly greater stiffness than uninstrumented controls. Acknowledgments: Surgical technical assistanceby Max F. DeCarvalo MD; student support by Charlotte Schmidlapp Women’s Scholar Program and UC/CCHMC SURF Program

Flexible growing rods: a pilot study to determine if polymer rod constructs may provide stability to skeletally immature spines

Abstract Background Surgical treatments for early onset scoliosis (EOS), including growing rod constructs, involve many complications. Some are due to biomechanical factors. A construct that is more flexible than current instrumentation systems may reduce complications. The purpose of this preliminary study was to determine spine range of motion (ROM) after implantation of simulated growing rod constructs with a range of clinically relevant structural properties. The hypothesis was that ROM of spines instrumented with polyetheretherketone (PEEK) rods would be greater than metal rods and lower than noninstrumented controls. Further, adjacent segment motion was expected to be lower with polymer rods compared to conventional systems. Methods Biomechanical tests were conducted on 6 skeletally immature porcine thoracic spines (domestic swine, 35-40 kg). Spines were harvested after death from swine that had been utilized for other studies (IACUC approved) which had not involved the spine. Paired pedicle screws were used as anchors at proximal and distal levels. Specimens were tested under the following conditions: control, then dual rods of PEEK (6.25 mm), titanium (4 mm), and CoCr (5 mm) alloy. Lateral bending (LB) and flexion-extension (FE) moments of ±5 Nm were applied. Vertebral rotations were measured using video. Differences were determined by two-tailed t-tests and Bonferroni correction with four primary comparisons: PEEK vs control and PEEK vs CoCr, in LB and FE (α=0.05/4). Results In LB, ROM of specimens with PEEK rods was lower than control at each instrumented level. ROM was greater for PEEK rods than both Ti and CoCr at every instrumented level. Mean ROM at proximal and distal noninstrumented levels was lower for PEEK than for Ti and CoCr. In FE, mean ROM at proximal and distal noninstrumented levels was lower for PEEK than for metal. Combining treated levels, in LB, ROM for PEEK rods was 35% of control (p<0.0001) and 270% of CoCr rods (p<0.01). In FE, ROM with PEEK was 27% of control (p<0.001) and 180% of CoCr (p<0.01). Conclusions PEEK rods decreased flexibility versus noninstumented controls, and increased flexibility versus metal rods. Smaller increases in ROM at proximal and distal adjacent motion segments occurred with PEEK compared to metal rods, which may help decrease junctional kyphosis. Flexible growing rods may eventually help improve treatment options for young patients with severe deformity.http://deepblue.lib.umich.edu/bitstream/2027.42/134537/1/13013_2015_Article_967.pd

Arctic system on trajectory to new state

The Arctic system is moving toward a new state that falls outside the envelope of glacial-interglacial fluctuations that prevailed during recent Earth history. This future Arctic is likely to have dramatically less permanent ice than exists at present. At the present rate of change, a summer ice-free Arctic Ocean within a century is a real possibility, a state not witnessed for at least a million years. The change appears to be driven largely by feedback-enhanced global climate warming, and there seem to be few, if any processes or feedbacks within the Arctic system that are capable of altering the trajectory toward this “super interglacial” state