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

Radiolarian faunal characteristics in Oligocene of the Kerguelen Plateau, Leg 183, Site 1138

Three sites from Ocean Drilling Program (ODP) Leg 183 (Kerguelen Plateau) have been analyzed to document faunal change in high-latitude radiolarians and to compare the faunal change to Eocene-Oligocene climatic deterioration. Radiolarians are not preserved in Eocene sediments. In Oligocene sediments, radiolarian preservation improves in a stepwise manner toward the Miocene. A total of 115 species were found in lower Oligocene samples from Site 1138; all are documented herein. Radiolarian preservation is presumably linked to productivity triggered by climatic cooling during the early Oligocene. Similar patterns of improving preservation through the Eocene/Oligocene boundary are documented from several Deep Sea Drilling Project and ODP sites in the Southern Ocean, indicating a general pattern. In contrast to the Southern Kerguelen Plateau, however, proxies for productivity are more divergent at Site 1138 (Central Kerguelen Plateau). Whereas carbonate dissolution, as indicated by poor preservation of foraminifers and common hiatuses, is very pronounced in the upper Eocene-lowermost Oligocene, the quality of radiolarian and diatom preservation does not significantly increase until the uppermost lower Oligocene. Multiple measures of radiolarian diversity in the Oligocene from Site 1138 closely parallel radiolarian preservation, indicating that preserved radiolarian diversity is controlled by productivity

The influence of emotional reaction on help seeking by victims of school bullying

Research has started to focus on how victims of school bullying cope, but there is still very little understanding if why pupils cope in one way and not another. This paper aimed to examine the effects of gender, school-stage, frequency of victimization and different emotions (anger, vengeance, self-pity, indifference, and helplessness) upon the choice of social support that children report using. Questionnaires were completed by 6282 Maltese schoolchildren aged between 9 and 14 years old. Analyses revealed that specific patterns of emotion and victimization predict whether pupils report using certain sources of social support. Results are discussed in relation to their relevance for possible intervention, future research needs and implications for the theoretical framework used

Outcomes of Shoulder Arthroplasty Performed for Postinfectious Arthritis.

Background: The purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis. Methods: This is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations. Results: The 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m Conclusions: Shoulder arthroplasty after septic arthritis had inconsistent functional outcomes and high complication rates but no reinfection

Microwave Spectroscopy

Contains reports on three research projects