Arthroscopic transosseous rotator cuff repair: A prospective study on cost savings, surgical time, and outcomes

Objectives: Health expenditures in the United States are outpacing national income, and affordability has become a major policy issue. Over 500,000 rotator cuff repairs (RCR) are performed annually in the United States making RCR a potential source of cost savings. Arthroscopic trans-osseous equivalent (TOE) repair using a double row of anchors has shown superior biomechanical strength compared to other techniques, but at a higher cost. The arthroscopic transosseous (TO) repair is a novel technique allowing arthroscopic rotator cuff repair to be performed without suture anchors. Arthroscopic TO repair may be a means to provide similarly excellent patient outcomes while lowering the cost of care. The primary purpose is to compare the price differential and time of surgery for an arthroscopic rotator cuff repair using anchorless TO repair verses an anchor trans-osseous equivalent (TOE) repair. A secondary purpose of the study was to evaluate outcomes at 6 months postoperatively. Methods: A prospective, case-controlled study evaluating arthroscopic rotator cuff repair using two techniques was performed. The study group consisting of 21 patients undergoing TO repair was compared to a control group consisting of 22 patients undergoing TOE repair. The groups were controlled for size of tear, biceps treatment, acromioplasty, distal clavicle excision, and labral pathology. The primary outcome measures were surgical time as well as total cost of implants and equipment for each surgery, determined by an independent third party, Atlanticare Hospital. Secondary outcomes were changes in the SST, VAS, and SANE scores. Results: Mean total surgical implant/equipment cost per procedure for TOE repair was $2348.03 (SD 490.30) and for TO repair was$1204.97 (SD 330.69; p\u3c0.0001). Mean cut to close time for TOE repair was 85 minutes (95% CI is 77-90) verses 74 (95% CI = 71-98) for TO repair. A log rank test revealed no difference in time (p =0.95). A linear regression model was developed to evaluate the change in SST, VAS, and SANE scores from pre-op to 6 months follow-up. Our study was underpowered but no difference in outcome was observed. Conclusion: Arthroscopic TO rotator cuff repair is a cost savings and time neutral technique compared to TOE repair. A mean of $1100 can be saved in surgical cost per case. In a country that performs over 500,000 RCRs annually, utilizing a TO repair technique can provide substantial cost savings to the healthcare system. © The Author(s) 2015

LGBTQ Training for Aquatic Employees: Impact on Attitudes and Professional Competencies

This study examined the impact of a LGBTQ diversity training on the attitudes and professional competencies of aquatic employees within a campus recreational sports setting. While diversity training is often discussed as a key component of inclusive aquatic programming, little empirical research examining the outcomes associated with such trainings exists. As such, members of the research team developed, implemented, and evaluated a four-month long training program consisting of one in-person training session and monthly inclusion handouts discussing issues related to the inclusion of LGBTQ participants. A comparative quantitative research design was used to measure employee’s attitudes towards the LGBTQ population and inclusive-recreational sports aquatic professional competencies for both individuals who underwent the training and a control group of employees who did not participate in the training. Results indicate initial support for this training initiative with those who attended the training scoring higher on average in both attitudinal and competency-based measures

We Just Treat Everyone the Same : LGBTQ Aquatic Management Strategies, Barriers and Implementation

This study examined the management of aquatic venues in a number of areas (facilities, programming, human resource management, marketing, policies) as it pertains to LGBTQ participants and participation. The study utilized in-depth semi-structured interviews with 16 aquatic managers to examine steps that are currently being taken (or lack thereof) when it comes to creating environments that are perceived to be open, or closed, to LGBTQ participants. A grounded theory-based process of data collection and analysis resulted in emergent themes. These themes included: (a) gendered spaces, (b) non-aquatic initiatives, (c) staff knowledgeability, (d) departmental and organizational mission, (e) aquatic-specific programming and regulations and (f) barriers to inclusion. Management strategies around these emergent themes are discussed, with implications for aquatic managers regarding the creating of inclusive environments for LGBTQ participant populations

A 2-terminal perovskite/silicon multijunction solar cell enabled by a silicon tunnel junction

With the advent of efficient high-bandgap metal-halide perovskite photovoltaics, an opportunity exists to make perovskite/silicon tandem solar cells. We fabricate a monolithic tandem by developing a silicon-based interband tunnel junction that facilitates majority-carrier charge recombination between the perovskite and silicon sub-cells. We demonstrate a 1 cm[superscript 2] 2-terminal monolithic perovskite/silicon multijunction solar cell with a V [subscript OC] as high as 1.65 V. We achieve a stable 13.7% power conversion efficiency with the perovskite as the current-limiting sub-cell, and identify key challenges for this device architecture to reach efficiencies over 25%.Bay Area Photovoltaic Consortium (Contract DE-EE0004946)United States. Dept. of Energy (Contract DE-EE0006707

Novel early life risk factors for adult pulmonary hypertension

The role of perinatal insults in the development of adult onset pulmonary hypertension (PH) is unclear. We surveyed patients with and without PH for a history of early life risk factors, and identified prematurity, oxygen use, and respiratory illness each as risk predictors for development of adult PH

Abnormal Trafficking of Endogenously Expressed BMPR2 Mutant Allelic Products in Patients with Heritable Pulmonary Arterial Hypertension

More than 200 heterozygous mutations in the type 2 BMP receptor gene, BMPR2, have been identified in patients with Heritable Pulmonary Arterial Hypertension (HPAH). More severe clinical outcomes occur in patients with BMPR2 mutations by-passing nonsense-mediated mRNA decay (NMD negative mutations). These comprise 40% of HPAH mutations and are predicted to express BMPR2 mutant products. However expression of endogenous NMD negative BMPR2 mutant products and their effect on protein trafficking and signaling function have never been described. Here, we characterize the expression and trafficking of an HPAH-associated NMD negative BMPR2 mutation that results in an in-frame deletion of BMPR2 EXON2 (BMPR2ΔEx2) in HPAH patient-derived lymphocytes and in pulmonary endothelial cells (PECs) from mice carrying the same in-frame deletion of Exon 2 (Bmpr2 (ΔEx2/+) mice). The endogenous BMPR2ΔEx2 mutant product does not reach the cell surface and is retained in the endoplasmic reticulum. Moreover, chemical chaperones 4-PBA and TUDCA partially restore cell surface expression of Bmpr2ΔEx2 in PECs, suggesting that the mutant product is mis-folded. We also show that PECs from Bmpr2 (ΔEx2/+) mice have defects in the BMP-induced Smad1/5/8 and Id1 signaling axis, and that addition of chemical chaperones restores expression of the Smad1/5/8 target Id1. These data indicate that the endogenous NMD negative BMPRΔEx2 mutant product is expressed but has a folding defect resulting in ER retention. Partial correction of this folding defect and restoration of defective BMP signaling using chemical chaperones suggests that protein-folding agents could be used therapeutically in patients with these NMD negative BMPR2 mutations

The Role of the Radial Orbit Instability in Dark Matter Halo Formation and Structure

For a decade, N-body simulations have revealed a nearly universal dark matter density profile, which appears to be robust to changes in the overall density of the universe and the underlying power spectrum. Despite its universality, the physical origin of this profile has not yet been well understood. Semi--analytic models by Barnes et al. (2005) have suggested that the density structure of dark matter halos is determined by the onset of the radial orbit instability (ROI). We have tested this hypothesis using N-body simulations of collapsing dark matter halos with a variety of initial conditions. For dynamically cold initial conditions, the resulting halo structures are triaxial in shape, due to the mild aspect of the instability. We examine how variations in initial velocity dispersion affect the onset of the instability, and find that an isotropic velocity dispersion can suppress the ROI entirely, while a purely radial dispersion does not. The quantity sigma^2/vc^2 is a criterion for instability, where regions with sigma^2/vc^2 <~1 become triaxial due to the ROI or other perturbations. We also find that the radial orbit instability sets a scale length at which the velocity dispersion changes rapidly from isotropic to radially anisotropic. This scale length is proportional to the radius at which the density profile changes shape, as is the case in the semi--analytic models; however, the coefficient of proportionality is different by a factor of ~2.5. We conclude that the radial orbit instability is likely to be a key physical mechanism responsible for the nearly universal profiles of simulated dark matter halos.Comment: 13 pages, 12 figures, accepted to Ap

The Effect of the Crow Hop on Elbow Stress During an Interval Throwing Program

BACKGROUND: Postoperative rehabilitation protocols after ulnar collateral ligament (UCL) reconstruction typically involve a structured interval throwing program. In an effort to minimize torque placed on the UCL, athletes are often instructed to throw with a crow hop, even at short throwing distances. However, the effect of the crow hop on medial elbow stress is unknown. PURPOSE/HYPOTHESIS: The purpose was to determine whether elbow stress differs with and without a crow hop across the throwing distances of a typical interval throwing program. We hypothesized that crow hop throws would generate lower torque on the elbow than standing throws at each distance of the interval throwing program. STUDY DESIGN: Controlled laboratory study. METHODS: Healthy high school and collegiate pitchers and position players were recruited from the surrounding area. Each player was outfitted with a wearable athletic sleeve and device that recorded elbow torque (Newton-meters), arm slot (degrees), arm speed (revolutions per minute), and shoulder rotation (degrees). Ball velocity (miles per hour) was measured using a radar gun. Players were instructed to perform 3 crow hop throws and 3 standing throws at distances of 30, 45, 60, 90, 120, 150, and 180 feet. A repeated measures analysis of variance was used to compare ball velocity, elbow torque, arm slot, arm speed, and shoulder rotation between crow hop and standing throws at each throwing distance. RESULTS: Twenty athletes participated in this study (average age, 17.8 years; range, 15-25 years). The average medial elbow torque increased at each distance for both crow hop and standing throws at distances of 30, 45, 60, and 90 feet (P \u3c .05), after which there were no significant increases in elbow torque (P \u3e .05). The average torque was higher for crow hop throws than standing throws at distances of 30 feet (13.9 N·m vs 12.0 N·m; P = .002), 45 feet (21.8 N·m vs 19.3 N·m; P = .005), and 60 feet (28.0 N·m vs 24.5 N·m; P = .02). CONCLUSION: Crow hop throws generated greater medial elbow torque than standing throws at distances up to 60 feet; however, there were no differences in elbow torque at distances greater than 60 feet between the 2 throw types. For both crow hop and standing throws, elbow stress increased at each distance interval up to 90 feet before plateauing at distances greater than 90 feet. The crow hop throwing technique does not reduce medial elbow stress during a simulated interval throwing program, and it may actually increase torque at shorter throwing distances. CLINICAL RELEVANCE: The results of our study indicate that it would be prudent for players to initially perform standing throws at shorter distances and only later be allowed to employ a natural crow hop at greater distances to minimize torque placed on the medial elbow during UCL rehabilitation protocols

Estrogen metabolites in a small cohort of patients with idiopathic pulmonary arterial hypertension.

Increased risk and severity of idiopathic pulmonary arterial hypertension (iPAH) is associated with elevated estradiol in men and postmenopausal women. Pulmonary arteries synthesise estradiol via aromatase and metabolise it via CYP1B1 to mitogenic metabolites; SNPs in aromatase and CYP1B1 have been associated with PAH. This suggests that estradiol metabolism could be altered in iPAH. This proof-of-concept study profiles estradiol and several metabolites of estradiol simultaneously in serum from iPAH patients and controls. We show that the estradiol and metabolite profile is altered in iPAH and that 16-hydroxyestrone and 16-hydroxyestradiol accumulate in iPAH patients with 16-hydroxyestrone levels relating to disease severity