In-office diagnostic arthroscopy for knee and shoulder intra-articular injuries its potential impact on cost savings in the United States

BACKGROUND: The purpose of this analysis was to determine whether in office diagnostic needle arthroscopy (Visionscope Imaging System [VSI]) can provide for improved diagnostic assessment and; more cost effective care. METHODS: Data on arthroscopy procedures in the US for deep seated pathology in the knee and shoulder were used (Calendar Year 2012). These procedures represent approximately 25-30% of all arthroscopic procedures performed annually. Sensitivities, specificities, positive predictive, and negative predictive values for MRI analysis of this deep seated pathology from systematic reviews and meta-analyses were used in assessing for false positive and false negative MRI findings. The costs of performing diagnostic and surgical arthroscopy procedures (using 2013 Medicare reimbursement amounts); costs associated with false negative findings; and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were then assessed. RESULTS: In patients presenting with medial meniscal pathology (ICD9CM diagnosis 836.0 over 540,000 procedures in CY 2012); use of the VSI system in place of MRI assessment (standard of care) resulted in a net cost savings to the system of $151 million. In patients presenting with rotator cuff pathology (ICD9CM 840.4 over 165,000 procedures in CY2012); use of VSI in place of MRI similarly saved$59 million. These savings were realized along with more appropriate care as; fewer patients were exposed to higher risk surgical arthroscopic procedures. CONCLUSIONS: The use of an in-office arthroscopy system can: possibly save the US healthcare system money; shorten the diagnostic odyssey for patients; potentially better prepare clinicians for arthroscopic surgery (when needed) and; eliminate unnecessary outpatient arthroscopy procedures, which commonly result in surgical intervention

A Synthetic Genetic Edge Detection Program

SummaryEdge detection is a signal processing algorithm common in artificial intelligence and image recognition programs. We have constructed a genetically encoded edge detection algorithm that programs an isogenic community of E. coli to sense an image of light, communicate to identify the light-dark edges, and visually present the result of the computation. The algorithm is implemented using multiple genetic circuits. An engineered light sensor enables cells to distinguish between light and dark regions. In the dark, cells produce a diffusible chemical signal that diffuses into light regions. Genetic logic gates are used so that only cells that sense light and the diffusible signal produce a positive output. A mathematical model constructed from first principles and parameterized with experimental measurements of the component circuits predicts the performance of the complete program. Quantitatively accurate models will facilitate the engineering of more complex biological behaviors and inform bottom-up studies of natural genetic regulatory networks

Drought effects on composition and yield for corn stover, mixed grasses, and \u3ci\u3eMiscanthus\u3c/i\u3e as bioenergy feedstocks

Drought conditions in 2012 were some of the most severe in recent history. The purpose of this study is to examine the impact of drought on quality, quantity, and theoretical ethanol yield (TEY) of three bioenergy feedstocks, corn stover, mixed grasses from Conservation Reserve Program lands, and Miscanthus × giganteus. To assess drought effects on these feedstocks, samples from 2010 (minimal to no drought) and 2012 (severe drought) were compared from multiple locations in the US. In all feedstocks, drought significantly increased extractives and reduced structural sugars and lignin; subsequently, TEYs were reduced 10–15%. Biomass yields were significantly reduced for M. × giganteus and mixed grasses. When reduction in quality and quantity were combined, TEYs decreased 26–59%. Drought negatively affected biomass quality and quantity that resulted in significant TEY reductions. Such fluctuations in biomass quality and yield may have significant consequences for developing lignocellulosic biorefineries

Drought effects on composition and yield for corn stover, mixed grasses, and \u3ci\u3eMiscanthus\u3c/i\u3e as bioenergy feedstocks

Drought conditions in 2012 were some of the most severe in recent history. The purpose of this study is to examine the impact of drought on quality, quantity, and theoretical ethanol yield (TEY) of three bioenergy feedstocks, corn stover, mixed grasses from Conservation Reserve Program lands, and Miscanthus × giganteus. To assess drought effects on these feedstocks, samples from 2010 (minimal to no drought) and 2012 (severe drought) were compared from multiple locations in the US. In all feedstocks, drought significantly increased extractives and reduced structural sugars and lignin; subsequently, TEYs were reduced 10–15%. Biomass yields were significantly reduced for M. × giganteus and mixed grasses. When reduction in quality and quantity were combined, TEYs decreased 26–59%. Drought negatively affected biomass quality and quantity that resulted in significant TEY reductions. Such fluctuations in biomass quality and yield may have significant consequences for developing lignocellulosic biorefineries

Drought effects on composition and yield for corn stover, mixed grasses, and Miscanthus as bioenergy feedstocks

Drought conditions in 2012 were some of the most severe in recent history. The purpose of this study is to examine the impact of drought on quality, quantity, and theoretical ethanol yield (TEY) of three bioenergy feedstocks, corn stover, mixed grasses from Conservation Reserve Program lands, and Miscanthus ×giganteus. To assess drought effects on these feedstocks, samples from 2010 (minimal to no drought) and 2012 (severe drought) were compared from multiple locations in the US. In all feedstocks, drought significantly increased extractives and reduced structural sugars and lignin; subsequently, TEYs were reduced 10–15%. Biomass yields were significantly reduced for M. × giganteus and mixed grasses. When reduction in quality and quantity were combined, TEYs decreased 26–59%. Drought negatively affected biomass quality and quantity that resulted in significant TEY reductions. Such fluctuations in biomass quality and yield may have significant consequences for developing lignocellulosic biorefineries

Non-neutralizing Antibodies May Contribute to Suppression of SIVmac239 Viremia in Indian Rhesus Macaques

The antiviral properties of broadly neutralizing antibodies against HIV are well-documented but no vaccine is currently able to elicit protective titers of these responses in primates. While current vaccine modalities can readily induce non-neutralizing antibodies against simian immunodeficiency virus (SIV) and HIV, the ability of these responses to restrict lentivirus transmission and replication remains controversial. Here, we investigated the antiviral properties of non-neutralizing antibodies in a group of Indian rhesus macaques (RMs) that were vaccinated with vif, rev, tat, nef, and env, as part of a previous study conducted by our group. These animals manifested rapid and durable control of viral replication to below detection limits shortly after SIVmac239 infection. Although these animals had no serological neutralizing activity against SIVmac239 prior to infection, their pre-challenge titers of Env-binding antibodies correlated with control of viral replication. To assess the contribution of anti-Env humoral immune responses to virologic control in two of these animals, we transiently depleted their circulating antibodies via extracorporeal plasma immunoadsorption and inhibition of IgG recycling through antibody-mediated blockade of the neonatal Fc receptor. These procedures reduced Ig serum concentrations by up to 80% and temporarily induced SIVmac239 replication in these animals. Next, we transferred purified total Ig from the rapid controllers into six vaccinated RMs one day before intrarectal challenge with SIVmac239. Although recipients of the hyperimmune anti-SIV Ig fraction were not protected from infection, their peak and chronic phase viral loads were significantly lower than those in concurrent unvaccinated control animals. Together, our results suggest that non-neutralizing Abs may play a role in the suppression of SIVmac239 viremia