Miocene calcareous nannofossil abundance and events in sediments of ODP Leg 189 sites

During Ocean Drilling Program (ODP) Leg 189, five sites were drilled in the Tasmanian Seaway with the objective to constrain the paleoceanographic implications of the separation of Australia from Antarctica and to elucidate the paleoceanographic developments throughout the Neogene (Shipboard Scientific Party, 2001a, doi:10.2973/odp.proc.ir.189.101.2001). Sediments ranged from Cretaceous to Quaternary in age and provided the opportunity to describe the paleoenvironments in the Tasman Seaway prior to, during, and after the separation of Australia and Antarctica. This study will focus on postseparation distribution of calcareous nannofossils through the Miocene. Miocene sediments were recovered at all five Leg 189 sites, and four of these sites were studied in detail to determine the calcareous nannofossil biostratigraphy. Hole 1168A, located on the western Tasmanian margin, contains a fairly continuous Miocene record and could be easily zoned using the Okada and Bukry (1980, doi:10.1016/0377-8398(80)90016-X) zonation. Analysis of sediments from Hole 1169A, located on the western South Tasman Rise, was not included in this study, as the recovered sediments were highly disturbed and unsuitable for further analysis (Shipboard Scientific Party, 2001c, doi:10.2973/odp.proc.ir.189.104.2001). Holes 1170A, 1171A, and 1171C are located on the South Tasman Rise south of the modern Subtropical Front (STF). They revealed incomplete Miocene sequences intersected by an early Miocene and late Miocene hiatus and could only be roughly zoned using the Okada and Bukry zonation. Similarly, Hole 1172A, located on the East Tasman Plateau, contains a Miocene sequence with a hiatus in the early Miocene and in the late Miocene and could only be roughly zoned using the Okada and Bukry (1980, doi:10.1016/0377-8398(80)90016-X) zonation. This study aims to improve calcareous nannofossil biostratigraphic resolution in this sector of the mid to high southern latitudes. This paper will present abundance, preservation, and stratigraphic distribution of calcareous nannofossils through the Miocene and focus mainly on biozonal assignment.

Thoracoscopic scoliosis surgery – a cheaper option? A cost analysis of 189 consecutive cases

INTRODUCTION: Increasing health care costs, limited resources and increased demand makes cost effective and cost-efficient delivery of Adolescent Idiopathic Scoliosis (AIS) management paramount. Rising implant costs in deformity correction surgery have prompted analysis of whether high implant densities are justified. The objective of this study was to analyse the costs of thoracoscopic scoliosis surgery, comparing initial learning curve costs with those of the established technique and to the costs involved in posterior instrumented fusion from the literature. METHODS: 189 consecutive cases from April 2000 to July 2011 were assessed with a minimum of 2 years follow-up. Information was gathered from a prospective database covering perioperative factors, clinical and radiological outcomes, complications and patient reported outcomes. The patients were divided into three groups to allow comparison; 1. A learning curve cohort, 2. An intermediate cohort and 3. A third cohort of patients, using our established technique. Hospital finance records and implant manufacturer figures were corrected to 2013 costs. A literature review of AIS management costs and implant density in similar curve types was performed. RESULTS: The mean pre-op Cobb angle was 53°(95%CI 0.4) and was corrected postop to mean 22.9°(CI 0.4). The overall complication rate was 20.6%, primarily in the first cohort, with a rate of 5.6% in the third cohort. The average total costs were $46,732, operating room costs of $10,301 (22.0%) and ICU costs of $4620 (9.8%). The mean number of screws placed was 7.1 (CI 0.04) with a single rod used for each case giving average implant costs of $14,004 (29.9%). Comparison of the three groups revealed higher implant costs as the technique evolved to that in use today, from $13,049 in Group 1 to $14577 in Group 3 (P<0.001). Conversely operating room costs reduced from $10,621 in Group 1 to $7573 (P<0.001) in Group 3. ICU stay was reduced from an average of 1.2 to 0 days. In-patient stay was significantly (P=0.006) lower in Groups 2 and 3 (5.4 days) than Group 1 (5.9 days) (i.e. a reduction in cost of approximately $6,140). CONCLUSIONS: The evolution of our thoracoscopic anterior scoliosis correction has resulted in an increase in the number of levels fused and reduction in complication rate. Implant costs have risen as a result, however, there has been a concurrent decrease in those costs generated by operating room use, ICU and in-patient stay with increasing experience. Literature review of equivalent curve types treated posteriorly shows similar perioperative factors but higher implant density, 69-83% compared to the 50% in this study. Thoracoscopic Scoliosis surgery presents a low density, reliable, efficient and effective option for selected curves. A cost analysis of Thoracoscopic Scoliosis Surgery using financial records and a prospectively collected database of all patients since 2000, demonstrating a clear cost advantage compared to equivalent posterior instrumentation and fusion.

Segunda avaliação orçamentária de 2010 : contingenciamento de maio : Decreto 7.189/10, Portaria Interministerial MPOG/MF 251/10

Consultoria de Orçamento e Fiscalização Financeira - Núcleo de Assuntos Econômico-Fiscais.