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AIMS: We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately. METHODS: PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures. RESULTS: A total of 18 studies corresponding to 16 non-overlapping RCTs with a total of 2,819 intracapsular hip fractures were included. Comparing contemporary cemented versus uncemented hemiarthroplasty, RRs (95% CIs) for mortality were 1.32 (0.44 to 3.99) perioperatively, 1.01 (0.48 to 2.10) at 30 days, and 0.90 (0.71 to 1.15) at one year. The use of contemporary cemented hemiarthroplasty reduced the risk of intra- and postoperative periprosthetic fracture. There were no significant differences in the risk of other complications, function, pain, and quality of life. There were no significant differences in perioperative outcomes except for increases in operating time and overall anaesthesia for contemporary cemented hemiarthroplasty with mean differences (95% CIs) of 6.67 (2.65 to 10.68) and 4.90 (2.02 to 7.78) minutes, respectively. The morbidity and mortality outcomes were not significantly different between non-contemporary cemented and uncemented hemiarthroplasty. CONCLUSION: There are no differences in the risk of mortality when comparing the use of contemporary cemented with uncemented hemiarthroplasty in the management of intracapsular hip fractures. Contemporary cemented hemiarthroplasty is associated with a substantially lower risk of intraoperative and periprosthetic fractures. Cite this article: Bone Joint J 2020;102-B(9):1113-1121.
AssuntosArtroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos , Hemiartroplastia/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Humanos , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Resultado do Tratamento
AIMS: Hip resurfacing arthroplasty (HRA) is typically indicated for young and active patients. Due to the longevity of arthroplasty, these patients are likely to undergo revision surgery during their lifetime. There is a paucity of information on the long-term outcome of revision surgeries performed after failed HRA. The aim of our study was to provide survivorship data as well as clinical scores after HRA revisions. METHODS: A total of 42 patients (43 hips) were revised after HRA at our centre to a variety of devices, including four HRA and 39 total hip arthroplasties (THAs). In addition to perioperative complications, University of California, Los Angeles (UCLA) hip scores and 12-Item Short-Form Health Survey questionnaire (SF-12) quality of life scores were collected at follow-up visits after the primary HRA and after revision surgery. RESULTS: The mean follow-up time after revision surgery was 8.3 years (0.3 to 19.1). The mean UCLA pain and function scores post-revision were comparable with the best scores achieved by the patients after the index HRA, but UCLA activity scores were lower after revision. SF-12 physical component scores were comparable between timepoints, but the mental component score decreased after revision. Six patients underwent unilateral re-revision surgery at a mean follow-up time of 7.8 years (0.3 to 13.7). Using the time to any re-revision as endpoint, the Kaplan-Meier survivorship was 85.3% at 13 years. CONCLUSION: Patients undergoing revision after HRA can expect to achieve function and quality of life similar to their best after their primary surgery, while the risk of re-revision is low. Cite this article: Bone Joint J 2020;102-B(10):1289-1296.
AssuntosArtroplastia de Quadril/métodos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Inquéritos e Questionários , Resultado do Tratamento
BACKGROUND: Pain management after the total joint arthroplasty is still challenging, but worthy of attention, because good pain management can improve the outcomes of patient. It is still controversial whether fascia iliaca compartment block (FICB) can effectively decrease the opioid consumption and pain after total hip replacement (THR) owing to the number of published investigations is small. The purpose of this present study is to assess the efficacy and safety of FICB for postoperative analgesia after THR. METHODS: This is a single center, placebo-controlled randomized trial which is performed in accordance with the SPIRIT Checklist for randomized studies. It was authorized via the Chifeng Municipal Hospital institutional review committee (H2020-19-8). 100 patients undergoing THR will be included in this study. Patients are randomly divided into 2 groups: FICB group or Non-FICB group, FICB with 5mgmL of epinephrine and 40âmL of ropivacaine 0.2%. Primary outcomes are pain score at different time point. Visual analog scale is used to assess the pain (10: the maximum possible pain and 0: absent pain). The secondary outcomes are the postoperative complications, length of hospital stay and total consumption of opioid. All the needed analyses are implemented through utilizing SPSS for Windows Version 15.0. RESULTS: Figure 1 will show the primary and secondary outcomes. CONCLUSION: This trial can provide an evidence for the use of FICB for analgesia after THR.
AssuntosArtroplastia de Quadril/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Artroplastia de Quadril/efeitos adversos , Epinefrina/administração & dosagem , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Ropivacaina/administração & dosagem
AIMS: There is evidence that prior lumbar fusion increases the risk of dislocation and revision after total hip arthroplasty (THA). The relationship between prior lumbar fusion and the effect of femoral head diameter on THA dislocation has not been investigated. We examined the relationship between prior lumbar fusion or discectomy and the risk of dislocation or revision after THA. We also examined the effect of femoral head component diameter on the risk of dislocation or revision. METHODS: Data used in this study were compiled from several Finnish national health registers, including the Finnish Arthroplasty Register (FAR) which was the primary source for prosthesis-related data. Other registers used in this study included the Finnish Health Care Register (HILMO), the Social Insurance Institutions (SII) registers, and Statistics Finland. The study was conducted as a prospective retrospective cohort study. Cox proportional hazards regression and Kaplan-Meier survival analysis were used for analysis. RESULTS: Prior lumbar fusion surgery was associated with increased risk of prosthetic dislocation (hazard ratio (HR) = 2.393, p < 0.001) and revision (HR = 1.528, p < 0.001). Head components larger than 28 mm were associated with lower dislocation rates compared to the 28 mm head (32 mm: HR = 0.712, p < 0.001; 36 mm: HR = 0.700, p < 0.001; 38 mm: HR = 0.808, p < 0.140; and 40 mm: HR = 0.421, p < 0.001). Heads of 38 mm (HR = 1.288, p < 0.001) and 40 mm (HR = 1.367, p < 0.001) had increased risk of revision compared to the 28 mm head. CONCLUSION: Lumbar fusion surgery was associated with higher rate of hip prosthesis dislocation and higher risk of revision surgery. Femoral head component of 32 mm (or larger) associates with lower risk of dislocation in patients with previous lumbar fusion. Cite this article: Bone Joint J 2020;102-B(8):1003-1009.
AssuntosArtroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Fusão Vertebral/efeitos adversos , Idoso , Artroplastia de Quadril/métodos , Estudos de Coortes , Feminino , Cabeça do Fêmur/cirurgia , Finlândia , Humanos , Estimativa de Kaplan-Meier , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fusão Vertebral/métodos , Resultado do Tratamento
AIMS: The aim of this study was to investigate whether the use of antibiotic-loaded bone cement influenced the risk of revision surgery after primary total hip arthroplasty (THA) for osteoarthritis. METHODS: The study involved data collected by the National Joint Registry (NJR) for England and Wales, Northern Ireland and the Isle of Man between 1 September 2005 and 31 August 2017. Cox proportional hazards were used to investigate the association between use of antibiotic-loaded bone cement and the risk of revision due to prosthetic joint infection (PJI), with adjustments made for the year of the initial procedure, age at the time of surgery, sex, American Society of Anesthesiologists (ASA) grade, head size, and body mass index (BMI). We looked also at the association between use of antibiotic-loaded bone cement and the risk of revision due to aseptic loosening or osteolysis. RESULTS: The cohort included 418,857 THAs of whom 397,896 had received antibiotic-loaded bone cement and 20,961 plain cement. After adjusting for putative confounding factors, the risk of revision for PJI was lower in those in whom antibiotic-loaded bone cement was used (hazard ration (HR) 0.79; 95% confidence interval (CI) 0.64 to 0.98). There was also a protective effect on the risk of revision due to aseptic loosening or osteolysis, in the period of > 4.1 years after primary THA, HR 0.57, 95% CI 0.45, 0.72. CONCLUSION: Within the limits of registry analysis, this study showed an association between the use of antibiotic-loaded bone cement and lower rates of revision due to PJI. The findings support the continued use of antibiotic-loaded bone cement in cemented THA. Cite this article: Bone Joint J 2020;102-B(8):997-1002.
AssuntosAntibacterianos/farmacologia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos/farmacologia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Adulto , Idoso , Inglaterra , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Irlanda do Norte , Osteoartrite do Quadril/cirurgia , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , País de Gales
AIMS: We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. METHODS: Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time. RESULTS: Metal ion levels were repeated in 33 patients. When comparing the results of serum metal ion levels over time, regardless of head size, there was a significant increase in both cobalt and chromium levels (p < 0.001). Two patients with larger head sizes had undergone revision arthroplasty with evidence of trunnion damage at surgery. Two patients within the 40 mm subgroup had metal ion levels above the MHRA (Medicines and Healthcare Products Regulatory Agency) threshold for detailed investigation. The increase in cobalt and chromium, when comparing the 36 mm and 40 mm groups with those of the 28 mm group, was not significant (36 mm vs 28 mm; p = 0.092/p = 0.191; 40 mm vs 28 mm; p = 0.200/p = 0.091, respectively). There was no difference, between femoral head sizes, when comparing outcome as measured by the Oxford Hip Score. CONCLUSION: This study shows an increase in cobalt and chromium levels over time for all modular femoral head sizes in patients with metal-on-polyethylene bearings, with two patients demonstrating ion levels above the MHRA threshold for failure, and a further two patients requiring revision surgery. These results may have clinical implications regarding longer term follow-up of patients and future implant choice, particularly among younger patients. Cite this article: Bone Joint J 2020;102-B(7):832-837.
AssuntosArtroplastia de Quadril/métodos , Cromo/sangue , Cobalto/sangue , Prótese de Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Humanos , Íons , Masculino , Pessoa de Meia-Idade , Polietileno , Desenho de Prótese
AIMS: Failure of irrigation and debridement (I&D) for prosthetic joint infection (PJI) is influenced by numerous host, surgical, and pathogen-related factors. We aimed to develop and validate a practical, easy-to-use tool based on machine learning that may accurately predict outcome following I&D surgery taking into account the influence of numerous factors. METHODS: This was an international, multicentre retrospective study of 1,174 revision total hip (THA) and knee arthroplasties (TKA) undergoing I&D for PJI between January 2005 and December 2017. PJI was defined using the Musculoskeletal Infection Society (MSIS) criteria. A total of 52 variables including demographics, comorbidities, and clinical and laboratory findings were evaluated using random forest machine learning analysis. The algorithm was then verified through cross-validation. RESULTS: Of the 1,174 patients that were included in the study, 405 patients (34.5%) failed treatment. Using random forest analysis, an algorithm that provides the probability for failure for each specific patient was created. By order of importance, the ten most important variables associated with failure of I&D were serum CRP levels, positive blood cultures, indication for index arthroplasty other than osteoarthritis, not exchanging the modular components, use of immunosuppressive medication, late acute (haematogenous) infections, methicillin-resistant Staphylococcus aureus infection, overlying skin infection, polymicrobial infection, and older age. The algorithm had good discriminatory capability (area under the curve = 0.74). Cross-validation showed similar probabilities comparing predicted and observed failures indicating high accuracy of the model. CONCLUSION: This is the first study in the orthopaedic literature to use machine learning as a tool for predicting outcomes following I&D surgery. The developed algorithm provides the medical profession with a tool that can be employed in clinical decision-making and improve patient care. Future studies should aid in further validating this tool on additional cohorts. Cite this article: Bone Joint J 2020;102-B(7 Supple B):11-19.
AssuntosDesbridamento , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Irrigação Terapêutica , Falha de Tratamento , Fatores Etários , Idoso , Algoritmos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Proteína C-Reativa/análise , Feminino , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Imunossupressores/efeitos adversos , Aprendizado de Máquina , Masculino , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Dermatopatias Bacterianas/complicações
AIMS: To establish whether there was a consensus among the members of the Hip Society (HS) on the role of direct anterior approach (DAA) contemporary primary total hip arthroplasty (THA). METHODS: An online survey was sent to all 112 active and senior members of the HS, to which 71 members responded. The survey was constructed to determine whether they believed that evidence-based medicine proves, in modern clinical practice, that the DAA has significant benefits compared to risks when contrasted with other approaches. In addition, they were asked if they currently used the DAA. RESULTS: While only 16.9% (12/71) of respondents had been trained in a generic anterior approach during residency, 49.3% (35/71) had used the DAA in their clinical practice in the past or were using it at the present time. Unexpectedly, 42.9% (15/35) of respondents who had used the DAA in the past had abandoned it by the time of this survey. Only 22.5% (16/71) of all respondents believed that evidence-based medicine proves that the DAA has significant benefits compared to risks in contrast to other approaches. CONCLUSION: A comprehensive literature review found only three prospective randomized clinical trials (RCT) comparing the DAA with another approach with greater than one-year follow-up. Two showed minor benefits within the early postoperative period only, and one of those showed poorer mid-term results. Most of the published comparison studies with short follow-up show longer surgical times and greater blood loss for the DAA, and many three-month comparison studies show higher complication rates for the DAA using a proprietary traction table. The complications included problems with wound healing, lateral femoral cutaneous nerve injury, femoral component loosening, and femoral fractures. Because of the lack of evidence from RCTs showing superiority of the DAA over other approaches and reports of higher complications, the opinion of a large majority (77.5%; 55/71) of HS surgeons was that the DAA lacks sufficient evidence to warrant its use. Cite this article: Bone Joint J 2020;102-B(7 Supple B):57-61.
AssuntosArtroplastia de Quadril/métodos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões , Medicina Baseada em Evidências , Humanos , Sociedades Médicas , Inquéritos e Questionários
AIMS: Earlier studies dealing with trends in the management of osteonecrosis of the femoral head (ONFH) identified an increasing rate of total hip arthroplasties (THAs) and a decreasing rate of joint-preserving procedures between 1992 and 2008. In an effort to assess new trends in the management of this condition, this study evaluated the annual trends of joint-preserving versus arthroplasties for patients aged < or > 50 years old, and the incidence of specific operative management techniques. METHODS: A total of 219,371 patients with ONFH were identified from a nationwide database between 1 January 2009 and 31 December 2015. The mean age was 54 years (18 to 90) and 105,298 (48%) were female. The diagnosis was made using International Classification of Disease, Ninth revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) procedure codes. The percentage of patients managed using each procedure during each year was calculated and compared between years. The trends in the use of the types of procedure were also evaluated. RESULTS: The rate of joint-preserving procedures was significantly higher in patients aged < 50 years compared with those aged > 50 years (4.93% vs 1.52%; p < 0.001). For the overall cohort, rates of arthroplasty were far greater than those for joint-preserving procedures. THA was the most commonly performed procedure (291,114; 94.03%), while osteotomy (3,598; 1.16%), partial arthroplasty (9,171; 2.96%), core decompression (1,200; 0.39%), and bone graft (3,026; 0.98%) were performed markedly less frequently. The annual percentage of patients managed using a THA (93.56% to 89.52%; p < 0.001), resurfacing (1.22% to 0.19%; p < 0.001), and osteotomy (1.31% to 1.05%; p < 0.001) also decreased during the study period. CONCLUSION: We found that patients with ONFH have been most commonly managed with non-joint-preserving procedures. Our findings provide valuable insight into the current management of this condition and should increase efforts being made to save the hip joint. Cite this article: Bone Joint J 2020;102-B(7 Supple B):122-128.
AssuntosNecrose da Cabeça do Fêmur/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia/estatística & dados numéricos , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Transplante Ósseo/estatística & dados numéricos , Bases de Dados Factuais , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
AIMS: During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery. METHODS: This multicentre cohort study included 340 COVID-19-negative patients versus 82 COVID-19-positive patients undergoing surgical treatment for hip fractures across nine NHS hospitals in Greater London, UK. Patients in both treatment groups were comparable for age, sex, body mass index, fracture configuration, and type of surgery performed. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariate and multivariate analysis were used to identify risk factors associated with increased risk of mortality. RESULTS: COVID-19-positive patients had increased postoperative mortality rates (30.5% (25/82) vs 10.3% (35/340) respectively, p < 0.001) compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status (hazard ratio (HR) 15.4 (95% confidence interval (CI) 4.55 to 52.2; p < 0.001) and greater than three comorbidities (HR 13.5 (95% CI 2.82 to 66.0, p < 0.001). COVID-19-positive patients had increased risk of postoperative complications (89.0% (73/82) vs 35.0% (119/340) respectively; p < 0.001), more critical care unit admissions (61.0% (50/82) vs 18.2% (62/340) respectively; p < 0.001), and increased length of hospital stay (mean 13.8 days (SD 4.6) vs 6.7 days (SD 2.5) respectively; p < 0.001), compared to COVID-19-negative patients. CONCLUSION: Hip fracture surgery in COVID-19-positive patients was associated with increased length of hospital stay, more admissions to the critical care unit, higher risk of perioperative complications, and increased mortality rates compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status and multiple (greater than three) comorbidities. Cite this article: Bone Joint J 2020;102-B(9):1136-1145.
AssuntosArtroplastia de Quadril/efeitos adversos , Infecções por Coronavirus/epidemiologia , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Artroplastia de Quadril/métodos , Causas de Morte , Estudos de Coortes , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pandemias , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/fisiopatologia , Valores de Referência , Medição de Risco , Reino Unido
Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.
AssuntosArtralgia/etiologia , Artroplastia de Quadril/métodos , Artroplastia de Quadril/psicologia , Nádegas/lesões , Músculo Esquelético/lesões , Músculo Esquelético/cirurgia , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos dos Tendões/etiologia , Artralgia/diagnóstico , Artralgia/cirurgia , Nádegas/cirurgia , Endoscopia , Humanos , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/epidemiologia , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Reoperação , Ruptura , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/epidemiologia , Traumatismos dos Tendões/terapia , Resultado do Tratamento
Notable advances in hip arthroplasty implants and techniques over the past 60 years have yielded excellent survivorship of fully cemented, hybrid, and reverse hybrid total hip replacements as demonstrated in joint registries worldwide. Major advances in noncemented implants have reduced the use of cement, particularly in North America. Noncemented implants predominate today based on procedural efficiency, concern related to thromboembolic risk, and a historic belief that cement was the primary cause of osteolysis and implant loosening. With the decline of cemented techniques, press-fit fixation has become common even in osteoporotic elderly patients. Unfortunately, there is a troubling rise in intraoperative, as well as early and late postoperative periprosthetic fractures associated with the use of noncemented implants. Despite the success of noncemented fixation, an understanding of modern cement techniques and cemented implant designs is useful to mitigate the risk of periprosthetic fractures. Cemented acetabular components can be considered in elderly patients with osteoporotic or pathologic bone. Cemented stems should be considered with abnormal proximal femoral morphology, conversion of failed hip fixation, inflammatory arthritis, patient age over 75 (especially women), osteoporotic bone (Dorr C), and in the treatment of femoral neck fractures.
AssuntosArtroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos , Fraturas do Colo Femoral/cirurgia , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/prevenção & controle , Desenho de Prótese , Idoso , Feminino , Fraturas Espontâneas/cirurgia , Humanos , Masculino , Osteoporose , Falha de Prótese
AIMS: Short, bone-conserving femoral components are increasingly used in total hip arthroplasty (THA). They are expected to allow tissue-conserving implantation and to render future revision surgery more straightforward but the long-term data on such components is limited. One such component is the global tissue-sparing (GTS) stem. Following the model for stepwise introduction of new orthopaedic implants, we evaluated early implant fixation and clinical outcome of this novel short-stem THA and compared it to that of a component with established good long-term clinical outcome. METHODS: In total, 50 consecutive patients ≤ 70 years old with end-stage symptomatic osteo-arthritis were randomized to receive THA with the GTS stem or the conventional Taperloc stem using the anterior supine intermuscular approach by two experienced hip surgeons in two hospitals in the Netherlands. Primary outcome was implant migration. Patients were followed using routine clinical examination, patient reported outcome using Harris Hip Score (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), EuroQol five-dimension questionnaire (EQ5D), and Roentgen Stereophotogrammetric Analysis (RSA) at three, six, 12, and 24 months. This study evaluated the two-year follow-up results. RESULTS: In addition to the initial migration pattern of distal migration (subsidence, Y-translation) and retroversion (Y-rotation) also exhibited by the Taperloc stem, the GTS stem showed an initial migration pattern of varization (X-translation combined with Z-rotation) and posterior translation (Z-translation). However, all components stabilized aside from one Taperloc stem which became loose secondary to malposition and was later revised. Clinical outcomes and complications were not statistically significantly different with the numbers available. CONCLUSION: A substantially different and more extensive initial migration pattern was seen for the GTS stem compared to the Taperloc stem. Although implant stabilization was achieved, excellent long-term survival similar to that of the Taperloc stem should not be inferred. Especially in the absence of clinically proven relevant improvement, widespread usage should be postponed until long-term safety has been established. Cite this article: Bone Joint J 2020;102-B(6):699-708.
AssuntosArtroplastia de Quadril/métodos , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
In the UK, tranexamic acid is recommended for all surgical procedures where expected blood loss exceeds 500 ml. However, the optimal dose, route and timing of administration are not known. This study aimed to evaluate current practice of peri-operative tranexamic acid administration. Patients undergoing primary total hip arthroplasty, total knee arthroplasty or unicompartmental knee arthroplasty during a 2-week period were eligible for inclusion in this prospective study. The primary outcome was the proportion of patients receiving tranexamic acid in the peri-operative period. Secondary outcomes included: dose, route and timing of tranexamic acid administration; prevalence of pre- and postoperative anaemia; estimated blood loss; and red blood cell transfusion rates. In total, we recruited 1701 patients from 56 NHS hospitals. Out of these, 1523 (89.5%) patients received tranexamic acid and of those, 1052 (69.1%) received a single dose of 1000 mg intravenously either pre- or intra-operatively. Out of the 1701 patients, 571 (33.6%) and 1386 (81.5%) patients were anaemic (haemoglobin < 130 g.l-1 ) in the pre- and postoperative period, respectively. Mean (SD) estimated blood loss for all included patients was 792 (453) ml and 54 patients (3.1%) received a red blood cell transfusion postoperatively. The transfusion rate for patients with pre-operative anaemia was 6.5%, compared with 1.5% in patients without anaemia. Current standard of care in the UK is to administer 1000 mg of tranexamic intravenously either pre- or intra-operatively. Approximately one-third of patients present for surgery with anaemia, although the overall red blood cell transfusion rate is low. These data provide useful comparators when assessing the efficacy of tranexamic acid and other patient blood management interventions in future studies.
AssuntosAntifibrinolíticos/uso terapêutico , Artroplastia de Substituição/métodos , Ácido Tranexâmico/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Estudos de Coortes , Transfusão de Eritrócitos , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos
AssuntosArtroplastia de Quadril/métodos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/métodos , Qualidade de Vida , Amplitude de Movimento Articular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/reabilitação , Terapia por Exercício/métodos , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Hemiartroplastia/reabilitação , Humanos , Escala de Gravidade do Ferimento , Masculino , Ontário , Medição da Dor , Cuidados Pós-Operatórios/métodos , Falha de Prótese , Medição de Risco , Resultado do Tratamento
BACKGROUND: Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA. METHODS: We retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients' previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62-73) with a median follow up of 74 months. RESULTS: Implant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22-47) vs 81 (IQR 59-90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04). CONCLUSION: A modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment.
AssuntosArtroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Desenho de Prótese/instrumentação , Idoso , Feminino , Fêmur/cirurgia , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação/métodos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
OBJECTIVES: To estimate threshold prices for computer- and robot-assisted knee and hip replacement. METHODS: A lifetime cohort Markov model provided the framework for analysis. Linked primary care and inpatient hospital records informed estimates of outcomes under current practice. Outcomes were estimated under a range of hypothetical relative improvements in quality of life if unrevised and in revision risk after computer or robot-assisted surgery. Threshold prices, a price at which the net health benefit from funding the intervention would be zero, for these improvements were estimated for a cost-effectiveness threshold of £20 000 per additional quality-adjusted life-year (QALY) gained. RESULTS: For average patient profiles under current knee and hip replacement practice, lifetime QALYs were 10.3 (9.9 to 10.7) and 11.0 (10.6 to 11.4), with costs of £6060 (£5947 to £6203) and £6506 (£6335 to £6710) for knee and hip replacement, respectively. A combined 50% relative reduction in risk of revision and 5% improvement in postoperative quality of life if unrevised would, for example, result in QALYs increasing to 10.9 (10.4 to 11.3) and 11.6 (11.2 to 12.0), and costs falling to £5880 (£5816 to £5956) and £6258 (£6149 to £6376) after knee and hip replacement, respectively. These particular improvements would have an associated threshold price of £11 182 (£10 691 to £11 721) for knee replacement and £12 134 (£11 616 to £12 701) for hip replacement. The 50% reduction in revision rate alone would have associated threshold prices of £1094 (£788 to £1488) and £1347 (£961 to £1842), and the 5% improvement in quality of life alone would have associated threshold prices of £9911 (£9476 to £10 296) and £10 578 (£10 171 to £10 982). CONCLUSIONS: At current prices, computer- and robot-assisted knee and hip replacement will likely need to lead to improvements in patient-reported outcomes in addition to any reduction in the risk revision.
AssuntosArtroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Análise Custo-Benefício , Inglaterra , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/economia , Cirurgia Assistida por Computador/economia
BACKGROUND: Femoral head avascular necrosis (FHAN) is a very common condition among elderly population. Previous studies have reported that total hip arthroplasty (THAP) can benefit patients with such condition. However, no study systematically addressed this topic. Thus, this study will systematically explore the efficacy and safety of THAP for the treatment of patients with FHAN. METHODS: We will search the following electronic bibliographic databases from inception to the February 29, 2020: MEDLINE, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Scientific Journal Database. Randomized controlled trials of THAP for the treatment of patients with FHAN will be included, which were reported in any language. All process of study selection, data collection, and study quality assessment will be performed independently by 2 authors independently. Any divergences will be solved by discussion with another author. RevMan 5.3 software will be carried out for data synthesis and analysis. RESULTS: This study will provide a detailed summary of current evidence related to the efficacy and safety of THAP for the treatment of patients with FHAN through assessing pain intensity of hip or knee joints, function and limitation of attacked femoral head, health-related quality of life, and complications. CONCLUSION: The findings of this study may provide helpful guidance of THAP for the treatment of patients with FHAN. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040067.
AssuntosArtroplastia de Quadril/métodos , Necrose da Cabeça do Fêmur/cirurgia , Artroplastia de Quadril/efeitos adversos , Humanos , Dor , Desempenho Físico Funcional , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
Background: Fibrous dysplasia (FD) results from an abnormality in lamellar bone formation and most frequently involves the proximal femur. This can lead to the development of osteoarthritis requiring total hip arthroplasty (THA). Such cases are challenging, and there is a lack of information guiding best management. As such, we devised a study assessing the outcomes and complications in patients with FD undergoing THA with modern implant technology, and we outlined our preferred surgical technique. Methods: A search of our institutional arthroplasty database was performed to identify patients who underwent THA for FD between January 2001 and July 2018 at Mount Sinai Hospital in Toronto, Canada. Data regarding implants used and the use of allograft material or metal augments or both were obtained. Complications and revision requirements were noted. Radiographic and clinical leg length discrepancies were assessed. Results: A total of 10 hips in 9 patients who underwent THA for FD were identified. Mean follow-up time was 6.0 years (range 0.5 to 10.3 yr). The majority of patients underwent THA using uncemented femoral and acetabular components with large femoral heads on highly cross-linked polyethylene liners. Most cases (80% of hips) required allograft to the proximal femur. A single complication requiring revision was noted. In 90% of hip surgeries, the patient required transfusion of packed red blood cells. Mean radiographic and clinical leg length discrepancies were 0.9 cm (range -2.4 to 2.4 cm) and 0.9 cm (range -4 to 0 cm), respectively. Conclusion: Contrary to previous reports, low complication and revision rates were observed with cementless components and routine use of allograft material. The challenging nature of such cases warrants use of an experienced arthroplasty treatment team.
AssuntosArtroplastia de Quadril/métodos , Fêmur/diagnóstico por imagem , Previsões , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Desenho de Prótese , Falha de Prótese , Radiografia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
BACKGROUND: Parkinson disease (PD) is a progressive neuromuscular disease associated with bradykinesia, tremor, and postural instability. We aimed to compare outcomes and complications of total hip arthroplasty (THA) between patients with PD and those without. METHODS: A single institution retrospective cohort from 2000 to 2018 was reviewed. PD patients were matched 1:2 with non-PD control patients for age, gender, American Society of Anesthesiologists score, and body mass index using a propensity score matching procedure. The primary outcome measures were postoperative complications and revision between PD and cohort groups. Secondary outcome measures were Harris Hip Score, hip range of motion, patient satisfaction, and surgery time. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. RESULTS: Using prospectively collated data, we identified 35 PD patients after primary THA. A control cohort of 70 primary THA patients was matched. CONCLUSION: Our hypothesis was that PD would have adverse impact on complication rates, range of movement, or improvement in functional outcome after subsequent THA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5446).


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What is SEO? Search Engine Optimization 2020 Moz. Moz. Search. Resources. Menu. icon-close. Search. Moz.
SEO stands for Search Engine Optimization, which is the practice of increasing the quantity and quality of traffic to your website through organic search engine results. What goes into SEO? To understand the true meaning of SEO, let's' break that definition down and look at the parts.:
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Get the latest information from our Webmaster Central blog. You can find information about updates to Google Search, new Search Console features, and much more. Webmaster Help Forum 57. Post questions about your sites issues and find tips to create high quality sites from the product forum for webmasters. There are many experienced contributors in the forum, including Top Contributors 58 and occasionally Googlers. Google Webmasters Twitter 59. Follow us for news and resources to help you make a great site. Google Webmasters YouTube Channel 60. Watch hundreds of helpful videos created for the webmaster community and get your questions answered by Googlers. How Search Works 61. See what happens behind the scenes as you search for something in Google Search. Youll learn some really cool facts! Get Your Business Online 62. Register a free website if you have a small business. GYBO is a partnership between Google and Homestead to help small businesses register a free website for one year. Appendix: Link URLs used in this paper. The following URLs are referenced in this paper.: Was this helpful? How can we improve it? Search Engine Optimization SEO Starter Guide. Secure your site with HTTPS. Keep a simple URL structure.
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subset: commoncrawl


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- J.R. Smith annihilates Olivia Harlan Dekker, insinuates husband uses N-bombs
- Sam Dekker's wife agrees that J.R. Smith amongst 'dumbest people on planet'
- Sam Dekker issues strong response to J.R. Smith's accusation that he supports Donald Trump
- Report: Cavs to hold pre-draft workouts for Obi Toppin, other top prospects this week
- J.R. Smith says former Cavs swingman was only teammate he couldn't 'stand' in entire NBA career
- Report: J.B. Bickerstaff reveals 'positive' conversations with Andre Drummond about future with Cavs
- Skip Bayless makes strong argument why he would take 2016 Cavs over 2020 Lakers
- LeBron James gets 'chills' rewatching Cavs' historic NBA Finals win over Warriors
- Andre Drummond hints at working towards major evolution in his game
- Video: Cavs big man seen getting schooled by WNBA star in 1-on-1 matchup
Video: Darius Garland Seen Talking Smack During Private Runs in Nashville
- Updated: May 22, 2020
Cleveland Cavaliers rookie Darius Garland has been without the game he loves for quite some time due to the novel coronavirus, and it looks like he is celebrating a return to the basketball court in style.
In a number of videos posted to social media, Garland was seen dominating on the practice court and talking quite a bit of trash in the process.
In case you didn't know, DGthePG is about his 1s. @dariusgarland @allaroundgame10 🎥: @iamMrGivens pic.twitter.com/3QOZ8EAAvf
— SLAM (@SLAMonline) May 22, 2020
He looked incredibly quick and dangerous while playing in a five-on-five scrimmage last weekend.
Garland was selected by the Cavs in last year's draft with the No. 5 overall pick. While he has shown moments of real brilliance in his rookie season, he took a bit of time before consistently producing strong outings.
So far in his rookie year, he's averaged 12.3 points, 3.9 assists and 1.9 rebounds per game.
Prior the stoppage of the 2019-20 season due to COVID-19, Garland was starting to show major improvement both as a scorer and playmaker.
Over the months of January and February, Garland was averaging 13.5 points and 5.0 assists per game. He seemed to be gaining confidence with each passing matchup.
His most recent performance came on Feb. 29, as a groin injury kept him out of the few games the Cavs did play in the month of March.
Based on the videos, Garland seems to be back to full health and as confident as ever.
Surely, when the NBA does return, the talented youngster will look to continue his trash talk on the NBA court.
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HRCG7 Bible studies: for individual or small group study, HRCV4 Christian aspects of sexuality, gender & relationships, HRCX4 Christian ministry & pastoral activity, JFSJ1 Gender studies: women
We have stock available for immediate despatch, and should this not cover your order, if more stock isn't already on the way, it will be ordered immediately to cover your order.
This typically takes 1-2 weeks, depending on availability from the publisher.
Browns Books for Students © 2014 All rights reserved [rev: 184.108.40.2063]


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Deepcool AS500 air cooler review
Leven JS600 1 TB SATA3 SSD review
ClockTuner for Ryzen v1.1 (CTR) Guide by 1USMUS
Colorful GeForce RTX 3080 iGAME VULCAN review
Corsair HS60 Haptic Headset review
Corsair K60 RGB Pro keyboard review
Deepcool Macube 110 chassis review
Leven JPR600 2 TB NVMe SSD Review
ASUS GeForce RTX 3090 STRIX OC Review
AMD Announces Ryzen 5000 processors - preview
OCZ PC3-12800 Gold 6GB Triple Channel memory kit review
by Hilbert Hagedoorn on: 11/26/2008 12:41 PM | source: | 0 comment(s)
Today will test a triple memory kit from none other than OCZ technology, renowned for their speedy part we'll take a look at their OCZ DDR3 PC3-12800 Gold Low-Voltage Triple Channel memory.
A 6GB kit, memory that is capable of 1600MHz DDR3 CL 8-8-8-24 (CAS-TRCD-TRP-TRAS) and comes with a lifetime warranty. Doesn't sound too bad eh ? Well it surely isn't. An all new 6 GB kit which we'll test on an 64-bit Windows Vista environment. Razer sharp an fast stuff for sure .. let's check it out.
You can read the review right here.
« HP intros mini-Q nettop with dual-core Atom CPU · OCZ PC3-12800 Gold 6GB Triple Channel memory kit review · BFG launches LS class PSUs »


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Teleflora's Look of Love Bouquet
Express your love with style with roses and lilies in a gorgeous hand-blown art-glass vase etched with an exquisite "rosebud" design. She'll love your taste - and you.
Red roses and white lilies accented with spiral eucalyptus are arranged in a hand-blown art-glass vase with a sculpted "rosebud" design.
Product ID T11V210B
Approximately 17" W x 20 1/2" H
What People Are Saying
October 27, 2020
Bouquet was beautiful!
October 26, 2020
My Mom always loves the flowers I order -- I usually order "florist choice "
October 21, 2020
The recipient of your floral arrangement was so cheered by the design. It brightened her hospital stay considerably. It was absolutely beautiful. Thanks so much.
Reviews Sourced from Lovingly


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KUALA LUMPUR (Nov 5): The High Court here was told that the joint venture (JV) between 1Malaysia Development Bhd (1MDB) and PetroSaudi International (PSI) in 2009 had "zero governance", yet the former persisted in partnering with the latter to preserve their "strategic relationship", a witness said.
During the 1MDB-Tanore trial yesterday, Former 1MDB chief executive officer Datuk Shahrol Azral Ibrahim Halmi denied he was part of a plot to defraud the fund, even though he had presented to his board of directors, proposals to continue partnering with PSI in 2010 — after their dubious JV a year ago.
"The proposal [to partner with PSI again], was based on the underlying fact that PSI was strategic to the country, and we need to maintain that relationship. We think that it must be given a fair hearing, given the strategic relationship, while still sought the advice of chairman of the board of adviser," Shahrol said.
Lead defense Tan Sri Muhammad Shafee Abdullah had deemed the decision to continue working with PSI as "the most bizarre thing that a management can do in terms of corporate governance" — unless the management was part of the plot to facilitate siphoning of more money from 1MDB.
"You have got a situation where your partner doesn't respect you at all, you said you tried to ask for information, you don't get it, you tried to call for a board meeting, you don't get it, and yet you still want to work with them," said the lawyer who was representing former Prime Minister Datuk Seri Najib Abdul Razak.
To recap, in the 1MDB-PSI JV in 2009, Malaysia was to inject US$1 billion cash into the JV company, while PSI was supposed to put in oilfield assets worth US$1.5 billion.
The JV fell apart months later, after US$700 million of cash siphoned from 1MDB was instead transferred to Good Star Ltd, a company linked to Low Taek Jho, that had no actual business operations with the JV.
PSI's Tarek Obaid and Patrick Mahony subsequently proposed 1MDB purchase a stake in French-based energy company GDF Suez at a 20% discount of market price.
Shahrol appeared startled when Shafee suggested 1MDB management intended to influence the fund's board of directors' decision to choose the investment into GDF Suez or opting for a further drawdown by PSI under the 8.25%-coupon rate Murabaha note.
The witness argued that the management was merely presenting options that were "low risk, low return, and high risk, high return".
However, he admitted he did not know the identity of the vendor of the GDF Suez stake, and had asked former 1MDB chief investment officer Nik Faisal Ariff Kamil — who also headed the fund's former subsidiary SRC International Sdn Bhd — but did not investigate further.
"Didn't you become suspicious?" Shafee asked.
"At that point, no," Shahrol said.
The witness added that 1MDB "had tried its very best" to hold a board meeting for the JV, but was unsuccessful.
Shafee also suggested 1MDB's board had breached their fiduciary duty by claiming all decision in the strategic fund were made by the shareholder, which was Najib as then Prime Minister and Minister of Finance.
Shahrol agreed, saying: "We were trying to align the interest of the shareholder, and the interest of the country. At that time, I saw it as being aligned."
The witness also agreed with Shafee that no matter how powerful Shahrol claimed Najib was as the premier, he was not able to overrule the decision made by 1MDB's board of directors.
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Subang, Selangor
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Toyota Roomy 2016 Cars For Sale In Pakistan
Roomy Cars in Pakistan: Toyota Roomy 2016 Cars for Sale in Pakistan. Search good condition, cheap, discounted, low price second hand new model Toyota Roomy 2016 used cars for sale in year 2020 in Pakistan Pakistan. Largest stock of genuine latest local and new Japanese model of Toyota Roomy 2016 cars for sale in Pakistan at Gari from September 2020 & October 2020 ads listings. Roomy Cars in Pakistan, Punjab, Sindh, KPK, Balochistan, Kashmir AJK, Gilgit are available at bank lease, loan installment, with or without down payment, interest or advance to buy Toyota Roomy 2016 online today near me.
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Toyota Corolla Islamabad (2087)
Toyota Vitz Islamabad (420)
Toyota AQUA Karachi (385)
Toyota Passo Peshawar (295)
Toyota Prius Multan (134)
Toyota Hilux Karachi (85)


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3328 x 3328
Set of Two Hand Printed Linen Napkins - Christmas Collection
Made By Hand Onlinehttp://www.madebyhandonline.com
A set of two fabulously festive napkins for your Christmas table! These linen napkins feature a hand printed design inspired by wreaths and classic winter foliage.
Made from 100% linen, these handmade napkins are available in Natural with a raspberry red printed design, or Red with a white print. The price is for 2 napkins of the same colour.
Hand printed in Cornwall, they measure 46cm x 46cm and are machine washable at 30 degrees.
Stockist: Helen Round at madebyhandonline.com
Original price
Converted price
Products from this company are shipped to: all countries globally and are located in: United Kingdom


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Onc. Heaven Scent 'Sweet Baby' w/ Red Eco Pot (Retail Orders)
Onc. Sharry Baby x Onc. Ruffles
Onc. Heaven Scent 'Sweet Baby'- - This is a wonderful compact hybrid off of Sharry baby, that has retained the fragrance while reducing the spike length. Available in Tight spike stage, will begin to branch soon. Will include db/multis for and additional $2, if available.
Red Eco pot included in Retail Orders


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Health promotion and protection for all citizens and health care for patients represent some of the most important policy challenges worldwide. Virtually every single area of life-professional productivity, cultural creativity, political and social participation, and citizens' quality of life-is influenced by the state of health at the individual and at the population level. But are current forms of health governance and health care services sufficient to overcome inequalities, ensure health security, harness technological developments, and cover future needs? The Governance Report 2019 focuses on health governance and the models and strategies used to make health policy an integral part of modern social policy and meet growing challenges. Health governance involves state, market, non-governmental, professional, and individual actors often working across sectors and depends on interactions at multiple levels-from local clinics to global forums. The Report traces the development of health governance institutions and actors, examines factors influencing the health-related decisions of individuals and policy-makers alike, highlights innovations both at international level and at the intersection between individuals and professionals, and offers recommendations to ensure that health care and health policy are governed to meet future challenges.
This volume in Religion and Public Life, a series on religion and public affairs, provides a wide-ranging forum for differing views on religious and ethical considerations. The contributions address the decline of social capital-those patterns of behavior which are conducive to self-governance and the spirit of self-reliance-and its relation to the demise of the civic-humanist tradition in American education. The unifying theme, is that classical studies do not merely result in individual mastery over a particular technique or body of knowledge, but also link the individual to the polity and even to the whole of the cosmic order. At the same time, American republicanism, in its exaltation of the common man from the Jeffersonian agrarian soldier to the apotheosis of Lincoln tempers the classical ideal into something less exalted, if more democratic. The effects on the contemporary state of the liberal arts curriculum are demonstrated in articles critical of the market-model university. Two essays explore the historical and philosophical significance of the discipline of rhetoric, that has suffered under the hegemony of rationalistic philosophy. A concluding contribution, invokes Giambattista Vico as an eloquent defender of the humanities. Humanities and Civic Life includes: "Rome, Florence, and Philadelphia: Using the History of the Humanities to Renew Our Civic Life" by Robert E. Proctor; "The Dark Fields of the Republic: The Persistence of Republican Thought in American History" by David Brown; "Unleashing the Humanities" by Robert Weisbuch; "Liberal Arts: Listening to Faculty" by Dennis O'Brien; "Historical Consciousness in Antiquity" by Paul Gottfried; "Taking the Measure of Relativism and the Civic Virtue of Rhetoric" by Gabriel R. Ricci; "The River: A Vichian Dialogue on Humanistic Education" by Randall E. Auxier.
It is now conventional wisdom to see the great policy challenges of the 21st century as inherently transnational, spilling across national boundaries. It is equally common to note the failures of the international institutions the world relies on to address such challenges. As the acclaimed 2013 book Gridlock argued, the world increasingly needs effective international cooperation, but multilateralism appears unable to deliver it in the face of deepening interdependence, rising multipolarity, and the growing complexity and fragmentation that characterise the global order. The Gridlock authors have now partnered with a group of leading experts to offer a trenchant - and surprisingly hopeful - reassessment of elements of the Gridlock argument. Comparing anomalies and exceptions to multilateral dysfunction across a number of spheres of world politics, Beyond Gridlock explores seven pathways through and even beyond gridlock. While multilateralism continues to fall short, countries, international organizations, civil society groups, sub-national governments, businesses, and other actors are finding ways to build or defend effective international cooperation. To be sure, gridlock persists across many realms of world politics, but Beyond Gridlock identifies systematic means through which, and the conditions under which, we possess the agency to avoid or resist these forces, or even turn them to the benefit of collective solutions. Combining critical, comparative analysis across issues with forward-looking evaluation of potential strategies, this book offers a vital new perspective on world politics as well as a practical guide for positive change in global policy.
At present, a nativist turn in Indian political theory can be observed. There is a general assumption that the indigenous thought to which researchers are supposed to be (re)turning may somehow be immediately visible by ignoring the colonization of the mind and polity. In such a conception of svaraj (which can be translated as 'authentic autonomy'), the tradition to be returned to would be that of the indigenous elites. In this book, this concept of svaraj is defined as a thick conception, which links it with exclusivist notions of spirituality, profound anti-modernity, exceptionalistic moralism, essentialistic nationalism and purism. However, post-independence India has borne witness to an alternative trajectory: a thin svaraj. The author puts forward a workable contemporary ideal of thin svaraj, i.e. political, and free of metaphysical commitment. The model proposed is inspired by B.R. Ambedkar's thoughts, as opposed to the thick conception found in the works of M.K. Gandhi, KC Bhattacharya and Ramachandra Gandhi. The author argues that political theorists of Indian politics continue to work with categories and concepts alien to the lived social and political experiences of India's common man, or everyday people. Consequently, he emphasises the need to decolonize Indian political theory, and rescue it from the grip of western theories, and fascination with western modes of historical analysis. The necessity to avoid both universalism and relativism and more importantly address the political predicaments of 'the people' is the key objective of the book, and a push for a reorientation of Indian political theory. An interesting new interpretation of a contemporary ideal of svaraj, this analysis takes into account influences from other cultures and sources as well as eschews thick conceptions that stifle imaginations and imaginaries. This book will be of interest to academics in the fields of philosophy, political science, sociology, literature and cultural studies in general and contemporary political theory, South Asian and Indian politics and political theory in particular.
We live today in the first global system of sovereign states in history, encompassing all of the world's polities, peoples, religions and civilizations. Christian Reus-Smit presents a new account of how this system came to be, one in which struggles for individual rights play a central role. The international system expanded from its original European core in five great waves, each involving the fragmentation of one or more empires into a host of successor sovereign states. In the most important, associated with the Westphalian settlement, the independence of Latin America, and post-1945 decolonization, the mobilization of new ideas about individual rights challenged imperial legitimacy, and when empires failed to recognize these new rights, subject peoples sought sovereign independence. Combining theoretical innovation with detailed historical case studies, this book advances a new understanding of human rights and world politics, with individual rights deeply implicated in the making of the global sovereign order.
This volume is designed to be an in-depth and nuanced philosophical treatment of the virtue of obedience in the context of the professional military and the broader civilian political community, including the general citizenry. The nature and components of obedience are critical factors leading to further discussions of the moral obligations related to obedience, as well as the related practical issues and implications. Pauline Shanks Kaurin seeks to address the following questions: What is obedience? Is it a virtue, and if it is, why? What are the moral grounds of obedience? Why ought military members and citizens be obedient? Are there times that one ought not be obedient? Why? How should we think about obedience in contemporary political communities? In answering these questions, the book draws on arguments and materials from a variety of disciplines including classical studies, philosophy, history, international relations, literature and military studies, with a particular focus on cases and examples to illustrate the conceptual points. While a major focus of the book is the question of obedience in the contemporary military context, many similar (although not exactly the same) issues and considerations apply to other political communities and in, particular, citizens in a nation-state.
Every American needs to understand the threat to America's safety and prosperity posed by China's reemergence as a world power. Unlike our other economic and military rivals, China is the only country big enough and with enough human resources to compete with us everywhere in the world. From the point of view of Beijing, China has a long history of dominating the world, and the past century of Western dominance is only a temporary blip. Their strategy to overtake America involves using spying, extortion, lawsuits, economic infiltration, intellectual property theft, propaganda and sabotage to weaken the United States and strengthen China. Gingrich's research will show that it is clear Chinese leaders are following this strategy to the letter, and that it is working as planned. It is possible for America to respond to the Chinese effort but doing so will require many big changes and hard choices for our leaders in government and private sector. That is why it is vital to build an understanding of the China challenge so there is consensus and political support to be what must be done. Newt Gingrich's TRUMP VS CHINA will serve as a rallying cry for the American people and a plan of action for our leaders in government and the private sector. Written in a language that every American can understand, but still rich in detail and accurate in fact, TRUMP VS CHINA will lay out China's multi-pronged attack against the United States and what we must do to combat it.
In A Global Political Morality, Michael J. Perry addresses several related questions in human rights theory, political theory and constitutional theory. He begins by explaining what the term 'human right' means and then elaborates and defends the morality of human rights, which is the first truly global morality in human history. Perry also pursues the implications of the morality of human rights for democratic governance and for the proper role of courts - especially the US Supreme Court - in protecting constitutionally entrenched human rights. The principal constitutional controversies discussed in the book are capital punishment, race-based affirmative action, same-sex marriage, physician-assisted suicide and abortion.
A comprehensive account of how the Athenian constitution was created-with lessons for contemporary constitution-building We live in an era of constitution-making. More than half of the world's constitutions have been drafted in the past half-century. Yet, one question still eludes theorists and practitioners alike: how do stable, growth-enhancing constitutional structures emerge and endure? In Creating a Constitution, Federica Carugati argues that ancient Athens offers a unique laboratory for exploring this question. Because the city-state was reasonably well-documented, smaller than most modern nations, and simpler in its institutional makeup, the case of Athens reveals key factors of successful constitution-making that are hard to flesh out in more complex settings. Carugati demonstrates that the institutional changes Athens undertook in the late fifth century BCE, after a period of war and internal strife, amounted to a de facto constitution. The constitution restored stability and allowed the democracy to flourish anew. The analysis of Athens's case reveals the importance of three factors for creating a successful constitution: first, a consensus on a set of shared values capable of commanding long-term support; second, a self-enforcing institutional structure that reflects those values; and, third, regulatory mechanisms for policymaking that enable tradeoffs of inclusion to foster growth without jeopardizing stability. Uniquely combining institutional analysis, political economy, and history, Creating a Constitution is a compelling account of how political and economic goals that we normally associate with Western developed countries were once achieved through different institutional arrangements.
In this book, Alec Stone Sweet and Jud Mathews focus on the law and politics of rights protection in democracies, and in human rights regimes in Europe, the Americas, and Africa. After introducing the basic features of modern constitutions, with their emphasis on rights and judicial review, the authors present a theory of proportionality that explains why constitutional judges embraced it. Proportionality analysis is a highly intrusive mode of judicial supervision: it permits state officials to limit rights, but only when necessary to achieve a sufficiently important public interest. Since the 1950s, virtually every powerful domestic and international court has adopted proportionality analysis as the central method for protecting rights. In doing so, judges positioned themselves to review all important legislative and administrative decisions, and to invalidate them as unconstitutional when such policies fail the proportionality test. The result has been a massive - and global - transformation of law and politics. The book explicates the concepts of 'trusteeship', the 'system of constitutional justice', the 'effectiveness' of rights adjudication, and the 'zone of proportionality'. A wide range of case studies analyse: how proportionality has spread, and variation in how it is deployed; the extent to which the U.S. Supreme Court has evolved and resisted similar doctrines; the role of proportionality in building ongoing 'constitutional dialogues' with the other branches of government; and the importance of the principle to the courts of regional human rights regimes. While there is variance in the intensity of proportionality-based dialogues, such interactions are today at the very heart of governance in the modern constitutional state and beyond.
For some while we have been witnessing a series of destructive phenomena which seem to indicate a full-fledged return to the negative on the world stage - from terrorism and armed conflict to the threat of environmental catastrophe. At the same time, politics seems increasingly impotent in the face of these threats. In this book, the leading Italian philosopher Roberto Esposito reconstructs the genealogy of the reciprocal intertwining of politics and negation. He retraces the intensification of negation in the thought of various thinkers, from Schmitt and Freud to Heidegger, and examines the negative slant of some of our fundamental political categories, such as sovereignty, property and freedom. Against the centrality of negation, Esposito proposes an affirmative philosophy that does not negate or repress negation but radically rethinks it in the positive cipher of difference, determination and opposition. The result is a rigorous and original pathway which, in the tension between affirmation and negation, recognizes the disturbing traumas of our time, as well as the harbingers of what awaits at its limits. This highly original and timely book will be of great value to students and scholars in philosophy, cultural theory and the humanities more generally, and to anyone interested in contemporary European thought.
This book makes an original and readable contribution to defining the nature of justice in the aftermath of a repressive regime. While considering transitional justice as conventionally defined, this work explores broader conceptions of justice and is distinct in approaching the subject through a discussion of the lives and works of six writers: Victor Serge in Stalinist Russia, Albert Camus in Vichy France, Jorge Semprun in Spain under Franco, Ngugi wa Thiong'o in colonial and post-colonial Kenya, Ariel Dorfman in Chile under Pinochet, and Nadine Gordimer in apartheid South Africa. Each lived under a brutal regime, was prepared to take substantial risks in order to contribute to its overthrow, and survived a transition to a new regime. Each thought deeply about the evolving situation with viewpoints derived from a combination of lived experience and intellectual and artistic creation. Each illuminated key questions with reference to a particular country, while developing wider insights.Newman demonstrates that their writings provide a valuable addition to academic analysis and external policy advice that too often fails to take sufficient account of reflective understanding, social and cultural context and the specificity of each situation. He also highlights the evolving and multi-dimensional nature of justice and injustice in political transitions.
An SPSS Companion for the Third Edition of The Fundamentals of Political Science Research offers students a chance to delve into the world of SPSS using real political science data sets and statistical analysis techniques directly from Paul M. Kellstedt and Guy D. Whitten's best-selling textbook. Built in parallel with the main text, this workbook teaches students to apply the techniques they learn in each chapter by reproducing the analyses and results from each lesson using SPSS. Students will also learn to create all of the tables and figures found in the textbook, leading to an even greater mastery of the core material. This accessible, informative, and engaging companion walks through the use of SPSS step-by-step, using command lines and screenshots to demonstrate proper use of the software. With the help of these guides, students will become comfortable creating, editing, and using data sets in SPSS to produce original statistical analyses for evaluating causal claims. End-of-chapter exercises encourage this innovation by asking students to formulate and evaluate their own hypotheses.
To limit executive power, the Founding Fathers created fixed presidential terms of four years, giving voters regular opportunities to remove their leaders. Americans also discovered more dramatic paths for disempowering--or coming razor-close to removing--chief executives: undermining the president's authority, a preemptive strike to derail a presidential candidacy, assassination, impeachment, resignation, and declaration of inability. Although the United States has gone decades without assassination or resignation, the most dramatic forms of presidential removal, getting rid of a president or a potential president is a political reality-just ask not president Hillary Clinton. How To Get Rid of a President presents the dark side of the nation's history, from the Constitutional Convention through the aftermath of the shocking 2016 election, a stew of election dramas, national tragedies and presidential exits mixed with party intrigue, political betrayal and backroom scheming. It is a briskly paced, darkly humorous voyage through historical events relevant to today's headlines, highlighting the many ways that presidents have been undermined and nearly kicked out, how each method of removal offers opportunities and dangers for the republic and the thorny ethical issues that surround the choice to resist, disobey, or eject a president.
This book focuses on the idea of a modus vivendi as a way of governing political life and addressing problems characterized by pluralism or deep-rooted diversity. The individual essays illustrate both the merits and the limitations of a political theory of modus vivendi; how it might be interpreted and developed; specific challenges entailed by articulating it in a convincing form; what its institutional implications might be; and how it relates to other seminal issues and concepts in political theory; such as legitimacy, toleration, the social contract, etc. The book makes a significant contribution to the discussion on the scope and limits of liberal political theory, and on how to deal politically with deep-rooted diversity.
A fierce critique of productivity and sovereignty in the world of labor and everyday life, Bruno Gull's Earthly Plenitudes asks, can labor exist without sovereignty and without capitalism? He introduces the concept of dignity of individuation to prompt a rethinking of categories of political ontology. Dignity of individuation stresses the notion that the dignity of each and any individual being lies in its being individuated as such; dignity is the irreducible and most essential character of any being. Singularity is a more universal quality. Gull first reviews approaches to sovereignty by philosophers as varied as Gottfried Leibniz and Georges Bataille, and then looks at concrete examples where the alliance of sovereignty and capital cracks under the potency of living labor. He examines contingent academic labor as an example of the super-exploitation of labor, which has become a global phenomenon, and as such, a clear threat to the sovereign logic of capital. Gull also looks at disability to assert that a new measure of humanity can only be found outside the schemes of sovereignty, productivity, efficiency, and independence, through care and caring for others, in solidarity and interdependence.
Shaper Nations provides illuminating perspectives on the national strategies of eight emerging and established countries that are shaping global politics in the twenty-first century. The volume's authors offer a unique viewpoint: they live and work primarily in the country about which they write, bringing an insider's feel for national debates and politics. Conventional wisdom suggests that shaper states have clear central authority, coherently connect means to ends, and focus on their geopolitical environment. These essays suggest a different conclusion. In Brazil, China, Germany, India, Israel, Russia, and Turkey, strategy is dominated by non-state threats, domestic politics, the distorting effect of national identity, economic development concerns, and the sheer difficulty, in the face of powerful internal and external constraints, of pursuing an effective national strategy. The shapers represent a new trend in the international arena with important consequences. Among them is a more uncertain world in which countries concentrate on their own development rather than on shared problems that might divert precious resources, and attend more to regional than to global order. In responding to these shaper states, the United States must understand the sources of their national strategies in determining its own role on the global stage.
The story of the intrepid young women who volunteered to help and entertain American servicemen fighting overseas, from World War I through the wars in Afghanistan and Iraq. The emotional toll of war can be as debilitating to soldiers as hunger, disease, and injury. Beginning in World War I, in an effort to boost soldiers' morale and remind them of the stakes of victory, the American military formalized a recreation program that sent respectable young women and famous entertainers overseas. Kara Dixon Vuic builds her narrative around the young women from across the United States, many of whom had never traveled far from home, who volunteered to serve in one of the nation's most brutal work environments. From the "Lassies" in France and mini-skirted coeds in Vietnam to Marlene Dietrich and Marilyn Monroe, Vuic provides a fascinating glimpse into wartime gender roles and the tensions that continue to complicate American women's involvement in the military arena. The recreation-program volunteers heightened the passions of troops but also domesticated everyday life on the bases. Their presence mobilized support for the war back home, while exporting American culture abroad. Carefully recruited and selected as symbols of conventional femininity, these adventurous young women saw in the theater of war a bridge between public service and private ambition. This story of the women who talked and listened, danced and sang, adds an intimate chapter to the history of war and its ties to life in peacetime.
First published in 1990, for more than a quarter-century this has been the premier textbook on the European Parliament. This new 9th edition - the first for five years - has been fully updated and expanded, including all the familiar features and all recent significant developments. The book systematically and clearly covers every aspect of how the Parliament is elected, its internal structures and procedures, its powers and how it relates to the other EU institutions. It is written by insiders with vast accumulated experience of how the Parliament really works, with extra input from dozens of specialists within the Parliament. "An invaluable guide to the institution's history, power and politics." (Martin Schulz, President of the European Parliament)"Explains with utmost clarity how it all works. It is an indispensable tool for anyone interested in or dealing with the European Parliament." (Jean-Claude Juncker, President of the European Commission)"This book is the authoritative guide to the European Parliament." (Donald Tusk, President of the European Council)
Factory of Strategy is the last of Antonio Negri's major political works to be translated into English. Rigorous and accessible, it is both a systematic inquiry into the development of Lenin's thought and an encapsulation of a critical shift in Negri's theoretical trajectory. Lenin is the only prominent politician of the modern era to seriously question the "withering away" and "extinction" of the state, and like Marx, he recognized the link between capitalism and modern sovereignty and the need to destroy capitalism and reconfigure the state. Negri refrains from portraying Lenin as a ferocious dictator enforcing the proletariat's reappropriation of wealth, nor does he depict him as a mere military tool of a vanguard opposed to the Ancien Regime. Negri instead champions Leninism's ability to adapt to different working-class configurations in Russia, China, Latin America, and elsewhere. He argues that Lenin developed a new political figuration in and beyond modernity and an effective organization capable of absorbing different historical conditions. He ultimately urges readers to recognize the universal application of Leninism today and its potential to institutionally-not anarchically-dismantle centralized power.
An incisive history of the changing relationship between democracy and capitalism The twentieth century witnessed the triumph of democratic capitalism in the industrialized West, with widespread popular support for both free markets and representative elections. Today, that political consensus appears to be breaking down, disrupted by polarization and income inequality, widespread dissatisfaction with democratic institutions, and insurgent populism. Tracing the history of democratic capitalism over the past two centuries, Carles Boix explains how we got here-and where we could be headed. Boix looks at three defining stages of capitalism, each originating in a distinct time and place with its unique political challenges, structure of production and employment, and relationship with democracy. He begins in nineteenth-century Manchester, where factory owners employed unskilled laborers at low wages, generating rampant inequality and a restrictive electoral franchise. He then moves to Detroit in the early 1900s, where the invention of the modern assembly line shifted labor demand to skilled blue-collar workers. Boix shows how growing wages, declining inequality, and an expanding middle class enabled democratic capitalism to flourish. Today, however, the information revolution that began in Silicon Valley in the 1970s is benefitting the highly educated at the expense of the traditional working class, jobs are going offshore, and inequality has risen sharply, making many wonder whether democracy and capitalism are still compatible. Essential reading for these uncertain times, Democratic Capitalism at the Crossroads proposes sensible policy solutions that can help harness the unruly forces of capitalism to preserve democracy and meet the challenges that lie ahead.
This accessible text offers a comprehensive analysis of the European Union (EU)-China relationship, as one of the most important in global politics today. Both are major players on the world stage, accounting for 30% of trade and nearly a quarter of the world's population. This text shows how, despite many differences in political systems and values, China and the EU have developed such a close, regular set of interactions at multiple levels: from political-strategic, to economic, and individual. The authors start with an historical overview of the domestic politics and foreign policy apparatus of each partner to show the context in which external relations are devised. From this foundation, each key dimension of the relationship is analysed, from trade and monetary policy, security, culture and society. The authors show the relative merits of different theoretical perspectives and outline what is next for this complex, ever-changing relationship. At every step, the success of each partner in persuading the other of changing their position(s) for key strategic interests is explored. What emerges is a multifaceted picture of relations between two sides that are fundamentally different kinds of actors in the international system, yet have many mutual interests and a common stake in the stability of global governance. The first major text to offer an accessible introduction to the multifaceted nature of EU-China relations, this book is an ideal companion for upper undergraduate and postgraduate students on Politics, International Relations and European Studies courses.
Priests of Prosperity explores the unsung revolutionary campaign to transform postcommunist central banks from command-economy cash cows into Western-style monetary guardians. Juliet Johnson conducted more than 160 interviews in seventeen countries with central bankers, international assistance providers, policymakers, and private-sector finance professionals over the course of fifteen years. She argues that a powerful transnational central banking community concentrated in Western Europe and North America integrated postcommunist central bankers into its network, shaped their ideas about the role of central banks, and helped them develop modern tools of central banking. Johnson's detailed comparative studies of central bank development in Hungary, the Czech Republic, Slovakia, Russia, and Kyrgyzstan take readers from the birth of the campaign in the late 1980s to the challenges faced by central bankers after the global financial crisis. As the comfortable certainties of the past collapse around them, today's central bankers in the postcommunist world and beyond find themselves torn between allegiance to their transnational community and its principles on the one hand and their increasingly complex and politicized national roles on the other. Priests of Prosperity will appeal to a diverse audience of scholars in political science, finance, economics, geography, and sociology as well as to central bankers and other policymakers interested in the future of international finance, global governance, and economic development.
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