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

ELECTRICITY DEREGULATION: WHAT'S IN STORE FOR THE ENVIRONMENT?

We test the: degree to which electricity consumers will trade off price and environmental attributes, effectiveness of environmental certification, and effectiveness of voluntary versus mandatory environmental disclosure. The type and consistency of information, the degree of difference in environmental attributes and the individual's characteristics all impact the choice of electricity product.Environmental Economics and Policy,

Adaptation of a Community Health Advisor Intervention to Increase Colorectal Cancer Screening Among African Americans in the Southern United States

Community health advisor (CHA) interventions increase colorectal cancer (CRC) screening rates. Focus groups and learner verification were used to adapt National Cancer Institute CRC screening educational materials for delivery by a CHA to African American community health center patients. Such academic-community collaboration improves adoption of evidence-based interventions. This short article describes the adaptation of an evidence-based cancer education intervention for implementation in an African American community

Ideal Quantum Tele-amplification up to a Selected Energy Cut-off using Linear Optics

We introduce a linear optical technique that can implement ideal quantum tele-amplification up to the $n^\mathrm{th}$ Fock state, where $n$ can be any positive integer. Here tele-amplification consists of both quantum teleportation and noiseless linear amplification (NLA). This simple protocol consists of a beam-splitter and an $(n+1)$-splitter, with $n$ ancillary photons and detection of $n$ photons. For a given target fidelity, our technique improves success probability and physical resource costs by orders of magnitude over current alternative teleportation and NLA schemes. We show how this protocol can also be used as a loss-tolerant quantum relay for entanglement distribution and distillation.Comment: 6 pages (main) + 16 pages (supplementary), 5 figures (main) + 11 figures (supplementary). Main change is the addition of a new section describing how our scheme still works well given experimental imperfections + additional success probability paragrap

Noiseless Linear Amplification and Loss-Tolerant Quantum Relay using Coherent State Superpositions

Noiseless linear amplification (NLA) is useful for a wide variety of quantum protocols. Here we propose a fully scalable amplifier which, for asymptotically large sizes, can perform perfect fidelity NLA on any quantum state. Given finite resources however, it is designed to perform perfect fidelity NLA on coherent states and their arbitrary superpositions. Our scheme is a generalisation of the multi-photon quantum scissor teleamplifier, which we implement using a coherent state superposition resource state. Furthermore, we prove our NLA is also a loss-tolerant relay for multi-ary phase-shift keyed coherent states. Finally, we demonstrate that our NLA is also useful for continuous-variable entanglement distillation, even with realistic experimental imperfections.Comment: 14 pages, 9 figure

A biophysical Raman spectroscopic model for noninvasive screening of skin cancer

Raman spectroscopy (RS) is sensitive to the molecular composition of biological tissues. Raman optical fiber- based probes have demonstrated efficacy in noninvasive cancer screening of the skin, breast, stomach, cervical, lung and brain. Currently, statistical algorithms such as principle component analysis (PCA) are the standard approaches for describing the spectral variance of the RS data and providing tissue classification. However, a PCA-based analysis does not allow for an examination of the biophysical basis of disease, such as microstructural organization of proteins and lipids. Understanding those biophysical parameters is essential to interpret the diagnostic result similar to that a pathologist is familiar reading, and develop diagnostic algorithms for fast and accurate cancer screening. Please click Additional Files below to see the full abstract

Saturating the Maximum Success Probability Bound for Noiseless Linear Amplification using Linear Optics

A noiseless linear amplifier (NLA) performs the highest quality amplification allowable under the rules of quantum physics. Unfortunately, these same rules conspire against us via the no-cloning theorem, which constrains NLA operations to the domain of probabilistic processes. Nevertheless, they are useful for a wide variety of quantum protocols, with numerous proposals assuming access to an optimal NLA device which performs with the maximum possible success probability. Here we propose the first linear optics NLA protocol which asymptotically achieves this success probability bound, by modifying the Knill-Laflamme-Milburn near-deterministic teleporter into an amplifier.Comment: 11 pages, 5 figures. Updated reference

Total knee arthroplasty using computer-assisted navigation in patients with deformities of the femur and tibia: A report of 5 cases

Anatomic aberrations of the femur and tibia secondary to trauma, congenital defects, and prior surgery present challenges for the reconstructive knee surgeon because of an altered mechanical axis and distorted anatomic landmarks. Five patients with arthritis of the knee and extra-articular femoral and/or tibial deformity, retained hardware, or intramedullary (IM) implants underwent total knee arthroplasty using a computer navigation system. The navigation system obviated the need for an IM guide, and the normal mechanical axis of the patients was restored. Extensive dissection for hardware removal or osteotomy was not necessary in these patients. In these 5 cases, a navigation system proved to be an effective tool for restoration of limb alignment in the presence of significant extra-articular deformities and/or IM hardware. Thus, it provides an alternative approach to the traditional IM instrumentation for treating these patients in an effective manner