Survey Background This report is part of a series titled "Discrimination in America." The series is based on a survey conducted for National Public Radio, the Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health. The survey was conducted January 26-April 9, 2017, among a nationally representative, probability-based telephone (cell and landline) sample of 3,453 adults age 18 or older. The survey included nationally representative samples of African Americans, Latinos, Asian Americans, Native Americans, whites, men, women, and LGBTQ adults. This report presents the results specifically for a nationally representative probability sample of 802 African-American U.S. adults. Future reports will analyze each other group, and the final report will discuss major highlights from the series. Discrimination is a prominent and critically important matter in American life and throughout American history. While many surveys have explored Americans' beliefs about discrimination, this survey asks people about their own personal experiences with discrimination. Summary: Personal Experiences of Discrimination Overall, African Americans report extensive experiences of discrimination, across a range of situations. In the context of institutional forms of discrimination, half or more of African Americans say they have personally been discriminated against because they are Black when interacting with police (50%), when applying to jobs (56%), and when it comes to being paid equally or considered for promotion (57%). Additionally, 60% of African Americans say they or a family member have been unfairly stopped or treated by the police because they are Black, and 45% say the court system has treated them unfairly because they are Black. Blacks living in suburban areas are more likely than those in urban areas to report being unfairly stopped or treated by police and being threatened or harassed because they are Black. 1 See for example, Fred Pincus (1996), "Discrimination Comes in Many Forms," American Behavioral Scientist 40(2):186-194, for distinctions between structural, institutional, and individual forms of discrimination. Notes on Report Language In this report, the terms "Black" and "African American" are used interchangeably. This report distinguishes between institutional and individual forms of discrimination, though discrimination comes in many forms. 1 In this report, the term "institutional discrimination" refers to forms of discrimination based on laws, policies, institutions, and the related behavior of individuals who work in or control those laws, policies, or institutions. The term "individual discrimination" refers to forms of discrimination based in individual people's prejudicial beliefs, words, and behavior. These are not necessarily mutually exclusive, but the distinction is used for organizing purposes. In this survey, people were asked whether they had ever personally experienced discrimination related to racism, sexism, andfor LGBTQ peoplehomophobia and transphobia. Questions about these...

No abstract

The societal burden of rotator cuff disease continues to increase with the aging of our population. Rotator cuff repairs have also become increasingly common over the last 2 decades. In our current cost conscious health care environment it is imperative to understand the value delivered to patients by various interventions. Value is most often equated with outcomes relative to the costs associated with care. To determine the value of different interventions, a thorough understanding of how to measure and interpret patient outcomes is crucial. In addition, calculating costs can be complex and physicians are often unaware of the costs related to their own decisions. Despite the complexities of measuring value, its benefits include heightened transparency in health care delivery, aligning stakeholders, and avoiding the trap of focussing solely on cost reductions, which may endanger effective treatment modalities.

Background Anchored transosseous equivalent suture-bridge technique (TOE) is widely used for arthroscopic rotator cuff repair. It is unknown how patient outcomes scores, ROM, and integrity of the rotator cuff after repair using this anchored technique compare with those after repair using an anchorless transosseous technique (TO). Questions/purposes (1) What are the differences in patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES] score) and shoulder ROM between TO and TOE rotator cuff repair techniques at 1 and 2 years after surgery? (2) What is the difference in repair integrity as measured by the re-tear rate, assessed ultrasonographically at 1 year, between these two techniques? (3) What is the difference in procedure duration between the two techniques when performed by a surgeon familiar with each? Methods We reviewed 331 arthroscopic rotator cuff repairs performed by one surgeon from December 2011 to July 2016 in this retrospective, matched-pair study. Of these patients, 63% (208 of 331) underwent repair with standard anchored technique (anchors placed in a double-row, TOE manner) and 37% (123 of 331) underwent anchorless TO repair, with the same indications for surgery between groups. Forty-four percent (91 of 208) of patients in the TOE group and 61% (75 of 123) of patients in the TO group met the inclusion criteria. Eighty percent (73 of 91) of patients in the TOE group and 88% (66 of 75) in the TO group had minimum 2-year follow-up. We matched each group to a cohort of 50 patients by sex, age, smoking status, and tear size (by Cofield classification: small, < 1 cm; medium, 1-3 cm; large, > 3-5 cm; or massive, > 5 cm). The resulting cohorts did not differ in mean age (TO, 62 years [range 53-65 years]; TOE, 58 years [range 53-65 years]; p = 0.79), mean BMI value (TO, 30 [range 27-33]; TOE, 29 [range 27-35]; p = 0.97), or dominant arm involvement (TO, 80%; TOE, 78%; p = 0.81). The cohorts were followed for at least 2 years (median, 3.2 years [interquartile range (IQR) 2.2-4.3] for TO and 2.9 years [IQR 2.0-3.5 years] for TOE). ASES scores and ROM were evaluated before surgery and at follow-up visits and were recorded in a longitudinally maintained institutional database. Repair integrity was assessed using ultrasonography at 1 year, as is standard in our practice. For each tear-size group, we calculated the proportion of intact tendon repairs versus the proportion of re-tears. Duration of surgery was recorded for each patient. Results At 1 year, we observed no difference in median ASES scores (90 [IQR 92-98] for TO and 88 [IQR 72-98] for TOE; p = 0.44); external rotation (50° [IQR 45°-60°) for TO and 50° [IQR: 40°-60°] for TOE; p = 0.58); forward flexion (165° [IQR 160°-170°] for both groups; p = 0.91); or abduction (100° [IQR 90°-100°] for TO and 90° [IQR 90°-100°] for TOE; p = 0.06). Fourteen percent of shoulders (seven of 50) in each treatment group had evidence of re-tear at 1 year (p > 0.99): 0 of 2 small tears in each group, 0 of 7 medium tears in each group, five of 32 large tears in each group, and two of 9 massive tears in each group (all, p > 0.99). At 2 years, we found no differences in median ASES scores (92 [IQR 74-98)] for TO and 90 [IQR 80-100] for TOE; p = 0.84); external rotation (60° [IQR 50°-60°] for both groups; p = 0.74); forward flexion (170° [IQR 160°-170°] for both groups; p = 0.69); or abduction (100° [IQR 90°-100°] for both groups; p = 0.95). We found no differences between groups in mean ± SD procedure time, which was 103 ± 20 minutes for TO repair and 99 ± 20 minutes for TOE repair (p = 0.45). Conclusions TO and TOE techniques for arthroscopic rotator cuff repair results in no differences in ROM, ASES scores, re-tear rates, and surgical time. Randomized control trials are needed to confirm these similarities or determine a superior method of repair. Future cost analyses may also help to determine the relative value of each technique. Level of Evidence Level III, therapeutic study.