Operative versus nonoperative treatment of acute Achilles tendon ruptures: A pilot economic decision analysis

Background: The operative treatment of Achilles tendon ruptures has been associated with lower rerupture rates and better function but also a risk of surgery-related complications compared with nonoperative treatment, which may provide improved outcomes with accelerated rehabilitation protocols. However, economic decision analyses integrating the updated costs of both treatment options are limited in the literature. Purpose: To compare the cost-effectiveness of operative and nonoperative treatment of acute Achilles tendon tears. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: An economic decision model was built to assess the cost-utility ratio (CUR) of open primary repair versus nonoperative treatment for acute Achilles tendon ruptures, based on direct costs from the practices of sports medicine and foot and ankle surgeons at a single tertiary academic center, with published outcome probabilities and patient utility data. Multiway sensitivity analyses were performed to reflect the range of data. Results: Nonoperative treatment was more cost-effective in the average scenario (nonoperative CUR, US$520; operative CUR, US$1995), but crossover occurred during the sensitivity analysis (nonoperative CUR range, US$224-US$2079; operative CUR range, US$789-US$8380). Operative treatment cost an extra average marginal CUR of US$1475 compared with nonoperative treatment, assuming uneventful healing in both treatment arms. The sensitivity analysis demonstrated a decreased marginal CUR of operative treatment when the outcome utility was maximized, and rerupture rates were minimized compared with nonoperative treatment. Conclusion: Nonoperative treatment was more cost-effective in average scenarios. Crossover indicated that open primary repair would be favorable for maximized outcome utility, such as that for young athletes or heavy laborers. The treatment decision for acute Achilles tendon ruptures should be individualized. These pilot results provide inferences for further longitudinal analyses incorporating future clinical evidence

Friends, relatives, sanity, and health: The costs of politics

Political scientists have long known that political involvement exacts costs but they have typically defined these costs in relatively narrow, largely economic terms. Though anecdotal evidence suggests that the costs of politics may in fact extend beyond economics to frayed personal relationships, compromised emotional stability, and even physical problems, no systematic evidence on these broader costs exists. We construct and validate batteries of survey items that delineate the physical, social, and emotional costs of political engagement and administer these items to a demographically representative sample of U.S. adults. The results suggest that a large number of Americans believe their physical health has been harmed by their exposure to politics and even more report that politics has resulted in emotional costs and lost friendships

Friends, relatives, sanity, and health: The costs of politics

Political scientists have long known that political involvement exacts costs but they have typically defined these costs in relatively narrow, largely economic terms. Though anecdotal evidence suggests that the costs of politics may in fact extend beyond economics to frayed personal relationships, compromised emotional stability, and even physical problems, no systematic evidence on these broader costs exists. We construct and validate batteries of survey items that delineate the physical, social, and emotional costs of political engagement and administer these items to a demographically representative sample of U.S. adults. The results suggest that a large number of Americans believe their physical health has been harmed by their exposure to politics and even more report that politics has resulted in emotional costs and lost friendships

A Statistical Learning Regression Model Utilized To Determine Predictive Factors of Social Distancing During COVID-19 Pandemic

In an application of the mathematical theory of statistics, predictive regression modelling can be used to determine if there is a trend to predict the response variable of social distancing in terms of multiple predictor input “predictor” variables. In this study the social distancing is measured as the percentage reduction in average mobility by GPS records, and the mathematical results obtained are interpreted to determine what factors drive that response. This study was done on county level data from the state of Florida during the COVID-19 pandemic, and it is found that the most deterministic predictors are county population density along with median income

Lessons learned compiling data from multiple clinical sources to understand differences in post-surgical shoulder pathology in diabetics and pre-diabetics

"Diabetic patients suffer from shoulder joint pathologies at a rate five times higher than the non-diabetic population. Diabetes is an independent risk factor for postoperative complications. We sought to determine to what extent prediabetics experience shoulder surgery complications. We set out to review rotator cuff repair (RCR) procedures at the Missouri Orthopaedic Institute (MOI) from January 1st, 2015 through December 31st, 2020. There are significant roadblocks to studying our original research question: Delays associated with data requests. Unexpected source file formatting that required manual manipulation. Multiple patient identifiers used in different records systems. Less-than-expected completion of patient outcome questionnaires. We present the challenges associated with receiving, cross-referencing, and organizing patient data in order to prepare for data collection and analysis."--Introduction

A Statistical Learning Regression Model utilized to determine predictive factors of social distancing during COVID-19 pandemic

In an application of the mathematical theory of statistics, predictive regression modeling can be used to determine if there is a trend to predict the response variable of social distancing in terms of multiple predictor input variables. In this study, the social distancing was measured as the percentage reduction in average mobility by GPS records, and the mathematical results obtained are interpreted to determine what factors drive that response. This study was done with county level data obtained from the State of Florida during the COVID-19 pandemic. The predicting factors found that were most deterministic was the county population density along with median income

Stress radiography Is a reliable method to quantify posterior cruciate ligament insufficiency: A systematic review

PURPOSE: To perform a systematic review of posterior tibial stress radiography techniques and radiographic measurement methods to compare their accuracy and efficacy to aid clinicians in quantifying posterior cruciate ligament laxity. METHODS: Electronic databases, including PubMed, MEDLINE, Embase.com 1947- , Ovid Medline 1946- , Scopus 1823- , Cochrane Central Register of Controlled Trials (CENTRAL), and Clinicaltrials.gov 1997- were queried in December 2020. The abstracts of articles were reviewed by 2 authors for published studies comparing posterior tibial stress radiography techniques, describing, and comparing radiographic measurement methods, and comparing stress radiographs with instrumented knee testing. RESULTS: The systematic review included 13 studies that satisfied the inclusion and exclusion criteria. There were 3 studies comparing stress radiography with instrumented knee devices, 6 studies comparing stress radiography techniques, and 5 studies evaluating the reliability of radiographic measurements. Stress radiography was more sensitive for detecting posterior tibial translation than KT-1000 and KT-2000 and was similar to the Rolimeter knee arthrometer. The majority of studies found TELOS stress radiography to be more sensitive than gravity or hamstring contraction stress views. Kneeling stress radiographs were found to be equivalent to TELOS in one study and superior in another. All reported methods of radiographic measurement for posterior tibial translation showed good-to-excellent intraobserver and interobserver reliability, and no single technique demonstrated clear superiority. CONCLUSIONS: The results of this systematic review indicate that posterior stress radiography with TELOS and kneeling stress radiography are the most reliable methods to evaluate posterior cruciate ligament laxity. Gravity stress and hamstring contraction can be used but may underestimate posterior tibial translation. Radiographic measurement methods are reliable and no single method is clearly superior. CLINICAL RELEVANCE: This information will allow clinicians to use various radiographic methods to objectively measure posterior tibial translation to formulate a treatment plan

Hysterangium bonobo: A newly described truffle species that is eaten by bonobos in the Democratic Republic of Congo

Many animals have been shown to eat fungi and most truffle-like fungi depend on animals for spore dispersal via mycophagy. Although these interactions are widespread, they are understudied in many habitats. In this study, we show that bonobos (Pan paniscus) forage and feed on an undescribed truffle species in the rainforests of the Democratic Republic of Congo. Based on morphological and molecular assessment of collections, we show that the species eaten by bonobos is a previously undescribed taxon described here as Hysterangium bonobo. This species is known in the local Bantu language (Bongando) as simbokilo and is used for baiting traps to catch several species of small mammals. Our findings highlight the need for further research into mycophagy and systematics of sequestrate fungi in Africa