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Orthopaedic Practice Cuts Cost of Surgeries
By Josh Medore | March 18, 2019
Josh Medore
YOUNGSTOWN, Ohio – As the leaders of Orthopaedic Surgery Center considered the design for construction of a new ambulatory center in Boardman, they took a trip to Columbus to look at a similar site that recently was built.
But even though the Columbus site is just a few years old and covers many of the same areas of medicine as the practice in Boardman, the changes in the health-care field have been enough to impart crucial lessons on the Mahoning Valley doctors.
"They told us that if they had to do this again today, they'd build fewer overnight rooms," says Taylor Cera, administrator of the Orthopaedic Surgery Center.
Already, just a few years into operation, doctors at the center in Columbus have seen the number of outpatient procedures climb and the number of overnight stays dwindle. As patients and insurance companies alike seek to lower costs, ambulatory-outpatient surgical centers such as the Orthopaedic Surgery Center are proving to be successful alternatives to inpatient procedures in hospitals.
"There's a hidden cost in health care that people don't always understand. It's the site-of-service costs," says Dr. Michael Engle, president of Orthopaedic Surgery Center. "When you have a hospital-based service, the cost is significantly higher than if it's at an ambulatory center like we have or even in an office."
He points to a common ailment as an example: carpal tunnel syndrome. A corrective procedure in a hospital is roughly two to three times the cost of having it done in an ambulatory setting, he says. The biggest factors in the reduced cost are less time spent in the medical center and fewer people involved in patient care.
Reducing costs, he continues, has been a guiding principle of Orthopaedic Surgery Center since it was founded 15 years ago, but it's one that has come to the fore in the past few years.
"When we start talking about cost effectiveness, it's not just for patients. It's for insurance companies and society as a whole because the largest insurer in the United States is the United States government," Engle says. "If we can take procedures that are routinely done in a hospital inpatient setting, or even outpatient, and move them into ambulatory centers, we're helping everyone involved."
Pictured: Orthopaedic Surgery Center's new site just off Western Reserve Road in Boardman is designed to contain four operation rooms and be fully integrated to handle electronic medical records. It is expected to open in December.
For patients, adds medical director Dr. Les Schwendeman, outpatient procedures mean they're back on their feet faster.
"You have healthier patients who don't need to stay in the hospital. They can be discharged with appropriate therapy and just as well, or even better, than folks who stay longer," he says.
And with that industrywide movement, Orthopaedic Surgery Center is at capacity in its office at the Beeghly Campus of Akron Children's Hospital Mahoning Valley.
"I think we did about 110 joints last year just across our small number of physicians and we're not a metropolitan area like Cleveland or Columbus," says Schwendeman, noting the practice began just two years ago.
It's that kind of growth that's led the center to begin work on a new building in Boardman just off Western Reserve Road at 8551 Crossroads Drive. Scheduled to open in December, the $7 million, 13,000-square-foot surgery center will feature new infection-control technologies, electronic medical records and a design tailored to improve experiences for both doctors and patients.
As they fill out paperwork before their surgery, patients can use a portion of the waiting room set aside for just that, providing a greater sense of privacy and security. Before and after procedures, they have access to private suites. Large windows will help keep patients oriented to the outdoors – which can help them be more relaxed instead of being sealed off through a maze of white hallways.
"That has an effect on our staff as well. We put a lot of time into this center with eight-, nine-, 10-hour days," Cera says. "That's a long time. There'll be positives in attitude and mood that come out in our staff, which translates to our patients and their families."
Pictured: Taylor Cera, administrator of the Orthopaedic Surgery Center.
The new center will also have four operating rooms, one more than the current office as well as overnight observation rooms.
"It's a bigger facility. The rooms are bigger and we'll have more rooms," Schwendeman says. "There are points we want to include and we can do that. Here, we've had to sort of retrofit. Out there, we'll have the pre-emptive ability to add stuff."
Throughout the new surgery center – from waiting room to operating room – new technologies will be featured.
"We're going to have the opportunity to put in brand-new state of the art equipment, whether they're surgical lights, arthroscopy tools or whatever else," Cera says. "Technology has helped advance the rapid change from inpatient to outpatient. We're going to be able to capitalize on that opportunity. It's going to be better for our physicians, our patients and create more efficiency."
While there are no definitive plans for expansion after the new surgery center opens, the leadership of the practice has a few ideas circulating for the next phase of the business. With the construction site situated on several acres, there's ample room to grow.
Schwendeman points to room to expand the building itself or erect new ones, even one day maybe a full medical campus that would bring in doctors working across the health-care spectrum. Today, 29 doctors use the Orthopaedic Surgery Center as the site of their procedures.
"We're looking to expand outside that realm [of orthopedics] and welcome providers that do other types of surgery," Engle says. "There's a lot of space on that campus and we could see medical-office buildings, urgent care, imaging services and build it out as the type of one-stop shop you think of as a medical facility."
Having services in one location – especially in an outpatient setting – is key to keeping costs low.
"There aren't as many links in the chain to complete the process," Schwendeman says. "If you have a more honed-in, focused business, then you can make it more streamlined for the patient. When you do that, patient satisfaction goes up because, usually, outpatient surgery centers are a little more on time, a little faster paced."
Pictured: Dr. Les Schwendeman of the Orthopaedic Surgery Center.
Helping too are relationships with insurance companies that would prefer their policyholders to opt for lower-cost services, Cera adds. The leadership of the surgery center – all physicians – meet with insurance representatives to discuss both the business and medical sides of the center.
"It takes a lot of relationship building, with our leadership team building relationships with insurance companies and communicating that low-cost, high-quality care," Cera says. "They come in and sit in on those meetings to talk about responsible medicine and what we offer to patients."
Part of what's offered to patients, Engle continues, is the perspective of doctors at every level of the business. With the Orthopaedic Surgery Center being physician-owned and independent of larger medical systems, the practice president says the Hippocratic oath plays a role in business decisions.
"We all live with this altruistic mentality of trying to do the right thing all the time for patients," Engle says. "When you have a business owned and operated by people with that background, you inherently have different philosophies and approaches that you don't see in other health-care settings."
Pictured: Dr. Michael Engle, president of Orthopaedic Surgery Center.
Copyright 2019 The Business Journal, Youngstown, Ohio.
Published by The Business Journal, Youngstown, Ohio.
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Larger than life Disco Pete to be guest of honour at Saturday's Children's Parade
Posted On 04 May 2016 at 10:30 pm
By : Jo Wadsworth
A 20ft dancing puppet of Brighton legend Disco Pete is set to star in Saturday's Children's Parade.
Freelance artist Paul Render put the finishing touches to the effigy today, and took him for a test ride outside the Same Sky studios in Belmont Street this afternoon.
Although the puppet was originally intended to be part of one school's section of the parade, he will now be making an unaffiliated appearance.
Mr Render said: "One of the parade sections is the celebrities of Brighton and he was a suggestion and we thought that was a fantastic idea.
"The school changed its mind, but when we heard he was ill it seemed that it would be a great idea to make him after all.
"Just like the original, he'll be doing the Children's Parade just for the love of it.
"It's taken me three days over the bank holiday weekend, and he was finished today. It's been a challenge as he needs to be able to dance. He's got skis attached to the end of his feet so that when I lift my legs, he lifts his.
"It will be my pleasure to operate him – if you make it, you carry it."
Disco Pete, whose real name is Pete Turner, has been a fixture at music events throughout the summer in Brighton and Hove for many years now.
This year, it was revealed that for health reasons, the best of his dancing days may be behind him.
seasideslut 6 May 2016 at 11.07pm Reply
Mmm. I think probably nobody commemorated his participation previously was because they didn't want to approach the weird old bloke who had gatecrashed a parade meant for children.

redpajama_set_name: RedPajamaCommonCrawl


We've discussed the things you can be doing through the entire month to help your period symptoms. Be that as it may, what happens when you require help, detail? Are over the counter torment pills your lone choice? Hell no! Read on for our best characteristic home solutions to ease those bothersome torments.
The first and easiest remedy of all: apply warm to your belly and back. Painful spasms are caused by a hormone like substance called prostaglandin, which makes your uterus contract. Think about your period issues simply like some other stressed or sore muscle: applying heat, you can build blood stream to the region, which can reduce pain.
There is no need to book a session with a massage specialist (despite the fact that, if that is in your budget, certain spas do great offers) you can make some relief with a few smooth moves on your own. Laying on your back with a cushion under your knees, apply delicate yet firm strokes to your stomach area in a clockwise direction. Repeat this movement 25-30 times, and then feel free to also massage other areas that are in pain.
Your lower back and hips may welcome this love too!
It might sound counterproductive when you are in torment, however a gentle amount of pressure, when applied to painful muscles, may really help to balance out muscle contractions. Many women appreciate this technique while in labor and a similar idea applies to menstrual cramps. By applying "counter weight" to the lower guts and back, you can adequately ease a portion of the strain in those zones.
A weighted cover, or even some delicate pressure point massage can likewise help. There are acupressure points in particular may help to provide some relief. To begin with, the fleshy region between your thumb and pointer finger, when squeezed by alternate hands thumb and pointer finger for 30-60 seconds, can quiet muscles. You may likewise have a go at squeezing the spot for finger widths beneath your paunch catch. Once more, hold this spot for 30-60 second while breathing profoundly. You may backpedal and forward between these two focuses or hold each for a longer period of time.
Even though exercise may be the last thing on your list to do when you are with period cramps, a nice yoga practice could be the only thing to give some peace. Yoga can help with both the psychological and physical reactions of PMF, enabling you to clear your brain, increase circulation, gently stretch crampy muscles, and get a natural boost of vitality.
Caffeine and alcohol are two major things to maintain a distance when you are managing issues, since they can frequently aggravate indications even. However many herbal, caffeine-free teas can help to naturally relieve pain and help you curb cravings for a espresso. After some time, teas can ease menstrual issues as well as really avoid them for later on. Score!


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List of Animals That Mate for Life
Monogamy is a concept we humans are familiar with, but what about our animal friends? Is monogamy a concept they adhere to as well?
Although many might assume that all animals will mate with just about anyone from their species, that is not the case. You can indeed find animals that form lasting bonds and only mate with each other.
Below, we've compiled a list of animals that mate for life. Feel free to give it a read and learn more about the animals that choose to be monogamous.
1. Albatrosses
2. Atlantic Puffins
3. Bald Eagles
4. Barn Owls
5. Beavers
6. Black Vultures
7. California Condors
8. California Mice
9. Cardinals
10. Coyotes
11. Dik-Diks
12. French Angelfish
13. Geese
14. Gibbons
15. Gray Wolves
16. Lovebirds
17. Macaroni Penguins
18. Monk Parakeets
19. Oldfield Mice
20. Pigeons
21. Prairie Voles
22. Red Foxes
23. Sandhill Cranes
24. Scarlet Macaws
25. Seahorses
26. Shingleback Skinks
27. Swans
Leading off the complete list of animals that mate for life are the albatrosses.
Albatrosses are famous for spending much of their time soaring through the skies. They look absolutely majestic with their wings spread out and the blue sky and waters serving as their beautiful backdrop.
You can find albatrosses flying all over the place. An albatross is capable of covering millions of square kilometers over the course of its lifetime.
Interestingly enough, all that traveling does not give the albatross wandering eyes. Once albatrosses mate, they remain faithful to each other for the rest of their lives. You will see nests of albatross couples on islands that line the Antarctic Circle.
See Related: Animals That Start With V
You may not know the Atlantic puffin by name, but you will likely recognize its appearance. The Atlantic puffin is best known for having a colorful beak and a coating of feathers that resembles what a penguin has.
Speaking of the Atlantic puffin's beak, that part of its body is actually useful for attracting mates. Researchers have observed that Atlantic puffins tend to stay together, but it's not entirely clear if they are monogamous for life.
It's unclear what Atlantic puffin couples get up to during the winter. Still, researchers have noted that two puffins will meet up at their burrow once they return home.
See Related: Best Books on Endangered Species
Next up are the bald eagles. Bald eagles are commonly found in different mountainous regions throughout the United States.
The aforementioned birds are known for their stunning displays of speed and skill. They can swoop in on unsuspecting predators and snatch their prey away from them.
In terms of breeding, bald eagles are believed to remain monogamous. Pairs of bald eagles can often be seen tending to their eggs while staying in their large nests.
See Related: Important Pros and Cons of Captive Breeding
Barn owls have mating habits that are not completely similar to other animals that mate for life. That's because barn owls only become monogamous if a specific condition is met.
To be more specific, barn owls only become monogamous if they are able to produce enough offspring. If that doesn't happen, the two barn owls may seek out other mates.
Even with that tendency, most barn owls still end up remaining monogamous. National Geographic notes that 75 percent of barn owl couples stick together for the long haul.
See Related: War and Effect on Wildlife
Beavers are known for being diligent workers and they don't fool around. Or at least the Eurasian beavers don't.
Researchers have found that Eurasian beavers differ from many of their counterparts because they prefer to be monogamous. It's believed that Eurasian beavers form a strong bond with only one partner because doing so helps them gather resources more efficiently.
See Related: Animals That Start With I
Black vultures are known to stay together with their mates throughout the entire year. The changing seasons do not sever their bond.
Aside from being monogamous, black vultures also like to keep their relatives close. The family structure is a real thing for black vultures.
See Related: Why Were Animals So Big in The Past?
By Fir0002
California condors are also classified as vultures. Like the black vultures above, they dine on carrion left behind by predators. The black vultures and California condors also share similarities in terms of mating habits because they often remain with one partner.
Still, it may be more accurate to say that California condors treat mating the same way that barn owls do. Once California condors discover that they are not suitable for mating, they will not hesitate to seek out a new partner.
See Related: Endangered Species in California
By Whatiguana
Mating relationships can be remarkably complex for California mice. A tendency to become monogamous is not the only interesting aspect of their relationship dynamics.
Researchers have also found that California mice will confront one another about potential infidelity. Partners may grow angry at each other after they are separated for some time. Upon being reunited, California mice may eventually reconcile, but not before arguments ensue.
See Related: Most Endangered Amphibians in the World
Cardinals are famous for their bright red feathers. Those bright red feathers may also be cluing us into the romantic side of these birds.
The aforementioned cardinals are monogamous and they also support one another while raising a family. Male cardinals feed their partners so the incubation process is not as difficult for the latter. Even when they head out to travel, you can expect cardinal couples to stay together.
See Related: Malayan Tiger
We continue this list of animals that mate for life by turning our attention to coyotes. Coyotes double as great hunters because they move quickly and have great senses. The fact that they tend to stick together also helps them survive.
Male and female coyotes will form lifelong bonds with one another. Once the pups are born, the parents work together to provide for them.
The familial bonds between coyotes are strong. That's a big reason why coyotes have successfully adapted to the changing world around them.
See Related: Endangered Species in Florida
By Yathin sk
Many wildlife biologists have studied dik-diks over the years. Over the years, they've discovered that dik-diks don't travel like other species of antelope.
Instead of traveling in packs, dik-diks prefer to travel in pairs. Their preferred companion for the journey also happens to be their mating partner.
Most antelope are not known for being monogamous animals that mate for life. That's why dik-diks stand out from the pack in more ways than one.
See Related: Yellow-Eared Parrot
By Brian Gratwicke
Do lobsters mate for life? If you're an avid fan of the TV show "Friends", then you likely think you have the answer to that question already. Unfortunately, that famous claim is mistaken.
Per this article from Today.com, male lobsters are actually known for mating with several of their female counterparts. So, does that mean that no animals living underwater are monogamous?
That's not the case either as French angelfish are among two water-based animals that mate with only one partner. French angelfish will even stay paired together as they navigate the world beneath the waves.
See Related: Ways to Save Animals from Extinction
We humans are the only ones who pledge to stay together 'til death do us part, but that seems to be an unspoken covenant for geese. Geese go way beyond practicing monogamy to show commitment to their partners.
If their partner is injured, a goose will stay with them. The healthy goose will stay until their partner is well enough to move again. Only death will cause partner geese to part ways.
See Related: What is The Goal of Wildlife Conservation?
When it comes to gibbons, being monogamous is just one aspect of their interesting relationship dynamics. The arguably more fascinating aspect of the relationship between gibbons is the way they bond with each other.
Gibbons belt out these distinctive songs that only their partners know. Those songs help bring gibbons together and they also prevent those animals from drifting apart.
See Related: Western Lowland Gorilla
Do wolves mate for life? Monogamy is not the norm for many wolf species, but gray wolves are an exception.
The male and female wolves who lead the pack are the only ones allowed to mate. Throughout their lifetimes, the two leaders remain monogamous as they grow the pack and establish their dominance.
Gray wolves rely on a hierarchical power structure to keep the pack organized. Their mating habits are crucial to keeping that hierarchy in order.
See Related: Florida Manatee
While thinking of what animals mate for life, you probably thought of lovebirds at some point. After all, the clue is right there in the name. But could their name be misleading?
In this case, the term lovebird is appropriate for these feathery creatures. Monogamy is indeed the norm for lovebirds and the bonds they form last for a lifetime.
According to The Spruce Pets, the bonds that lovebirds form with one another are so strong that they may ignore everything else around them. Keep that in mind if you're thinking of caring for lovebirds as pets.
See Related: Do Parakeets Like Being Held?
Macaroni penguins don't just practice monogamy. They are also more than eager to show affection to their partners.
When macaroni penguins that are bonded together see one another, they will engage in a kind of song and dance routine. It's not an especially elaborate routine, but you can see the affection the two macaroni penguins have for one another.
See Related: What Is The Hunter's Role In Wildlife Conservation?
Displays of affection are also the norm for monk parakeets. These birds sometimes seem like they are in a constant state of courtship.
Even after they have bonded, it's not unusual to see monk parakeets trying to impress one another. Perhaps it's their way of keeping the romance alive. In any case, those habits are clearly working for monk parakeets because they are known to bond for the rest of their lives.
See Related: Animals That Start With X
By United States Fish and Wildlife National Digital Library
Earlier, we highlighted California mice and the unique way they handled their relationships. For this entry, let's turn our attention to Oldfield mice.
Oldfield mice make for great parents. After they mate, the parents continue to work together as they care for their offspring. They form the kind of relationship that is beneficial for all the parties involved.
See Related: Importance of Wildlife Conservation
The list of animals that mate for life would not be complete without pigeons. A lot of people don't have fond memories to take from their limited interactions with pigeons. However, those who've cared for pigeons as pets know how loyal those birds are.
Pigeons are happy to stick to one partner for the entirety of their lives. Pigeon couples also become very familiar with one another because they breed on a regular basis.
The next time you see some pigeons flying overhead, check if they're flying in pairs. You may have just encountered a pigeon couple looking for a meal to share.
See Related: Spoon-Billed Sandpiper
By Creator:Japanesetea
Finding out that so many animals practice monogamy can be somewhat surprising. Even among the animals that exhibit that kind of behavior, the prairie voles stand out.
The fact that prairie voles share parenting duties is interesting, but probably not surprising at this point. As we've seen, other animals develop those tendencies as well.
What sets prairie voles apart is how they act when their partner dies. When one of the prairie voles dies, the surviving partner does not look for a new mate. It's atypical behavior for members of the animal kingdom, but most prairie voles practice it.
See Related: Why Do Animals Like Being Pet?
Monogamy is also the norm for red foxes. Similar to other canine species we've highlighted in this article, red foxes also develop familial bonds. The older red foxes are the ones that seek out food for the pups.
Notably, red foxes don't watch out for their offspring that long. After only a few months after they're born, the young foxes are allowed to hunt for their food. The younger foxes have to figure out a way to survive without much help from their parents.
See Related: Wild Bactrian Camel
Like numerous other birds, sandhill cranes are monogamous creatures. They almost have to be given the amount of effort they put into attracting a mate.
Sandhill cranes are famous for their extravagant displays of flirtation. Couples will sing together as if they've known the lyrics to the song the whole time.
While engaged in wooing activities, some sandhill cranes will jump, run, and dance for their mate. It's an awesome display to observe. You can understand why sandhill cranes stay together after seeing the extent to which they make their affections known.
See Related: Important Pros and Cons of Culling Animals
Scarlet macaws grow very close to one another once they pair up. It goes beyond committing to one another as mating partners for life.
When scarlet macaws pair up, they bond in different ways. It's common to see relaxed scarlet macaws grooming one another. Sharing food is also a common practice for them.
You may notice that scarlet macaws change their calls when they have kids. They may do that to create clear lines of communication within their family.
Seahorses are anomalies in the animal kingdom because the males are the ones that give birth. The female seahorse will place her eggs in the male's pouch to initiate breeding. From there, the male fertilizes the eggs, carries them, and eventually releases them to hatch.
With seahorses, being monogamous is just another aspect of their unusual reproduction routine.
It's hard to deny that seahorses are fascinating creatures. By contributing to conservation efforts, we will ensure that future generations will also be able to marvel at the seahorse's reproductive cycle.
See Related: Asian Elephant
By Dcoetzee
Shingleback skinks stand out because they are the only lizards featured in this list of animals that mate for life. They are also quite different because they are solitary creatures most of the time.
Breeding season is the only time when shingleback skinks will seek out others. Even then, they will look for the same mate each time.
No one's mistaking shingleback skinks for being romantic creatures, but their commitment to being solitary and monogamous is pretty remarkable.
See Related: Black Rhino
To close out this list of all animals that mate for life, we have the swans. Swans are synonymous with beauty and elegance, but there's more to them than that.
Swans will mate with only a single partner for life. If tragedy strikes and their partner dies, the surviving swan will grieve. The practice of grieving a deceased loved one is something we share in common with them.
Monogamy is not just a learned concept, nor is it solely a practice followed by humans. For many members of the animal kingdom, monogamy is a type of behavior they willingly embrace.
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