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.

Social engineering in social networking sites : how good becomes evil

Social Engineering (ES) is now considered the great security threat to people and organizations. Ever since the existence of human beings, fraudulent and deceptive people have used social engineering tricks and tactics to trick victims into obeying them. There are a number of social engineering techniques that are used in information technology to compromise security defences and attack people or organizations such as phishing, identity theft, spamming, impersonation, and spaying. Recently, researchers have suggested that social networking sites (SNSs) are the most common source and best breeding grounds for exploiting the vulnerabilities of people and launching a variety of social engineering based attacks. However, the literature shows a lack of information about what types of social engineering threats exist on SNSs. This study is part of a project that attempts to predict a persons’ vulnerability to SE based on demographic factors. In this paper, we demonstrate the different types of social engineering based attacks that exist on SNSs, the purposes of these attacks, reasons why people fell (or did not fall) for these attacks, based on users’ opinions. A qualitative questionnaire-based survey was conducted to collect and analyse people’s experiences with social engineering tricks, deceptions, or attacks on SNSs.

Gravity-induced coronal plane joint moments in the adolescent scoliotic spine

INTRODUCTION Calculating segmental (vertebral level-by-level) torso masses in Adolescent Idiopathic Scoliosis (AIS) patients allows the gravitational loading on the scoliotic spine during relaxed standing to be estimated. METHODS Existing low dose CT scans were used to calculate vertebral level-by-level torso masses and joint moments occurring in the spine for a group of female AIS patients with right-sided thoracic curves. Image processing software, ImageJ (v1.45 NIH USA) was used to reconstruct the torso segments and subsequently measure the torso volume and mass corresponding to each vertebral level. Body segment masses for the head, neck and arms were taken from published anthropometric data. Intervertebral joint moments at each vertebral level were found by summing each of the torso segment masses above the required joint and multiplying it by the perpendicular distance to the centre of the disc. RESULTS AND DISCUSSION Twenty patients were included in this study with a mean age of 15.0±2.7 years and a mean Cobb angle 52±5.9°. The mean total trunk mass, as a percentage of total body mass, was 27.8 (SD 0.5) %. Mean segmental torso mass increased inferiorly from 0.6kg at T1 to 1.5kg at L5. The coronal plane joint moments during relaxed standing were typically 5-7Nm at the apex of the curve (Figure 1), with the highest apex joint of 7Nm. CT scans were performed in the supine position and curve magnitudes are known to be 7-10° smaller than those measured in standing [1]. Therefore joint moments produced by gravity will be greater than those calculated here. CONCLUSIONS Coronal plane joint moments as high as 7Nm can occur during relaxed standing in scoliosis patients, which may help to explain the mechanics of AIS progression. The body mass distributions calculated in this study can be used to estimate joint moments derived using other imaging modalities such as MRI and subsequently determine if a relationship exists between joint moments and progressive vertebral deformity.

Using patient specific finite element models to understand the biomechanics of paediatric spinal deformity surgery

Adolescent idiopathic scoliosis (AIS) is a spinal deformity, which may require surgical correction by attaching rods to the patient’s spine using screws inserted into the vertebrae. Complication rates for deformity correction surgery are unacceptably high. Determining an achievable correction without overloading the adjacent spinal tissues or implants requires an understanding of the mechanical interaction between these components. We have developed novel patient specific modelling software to create individualized finite element models (FEM) representing the thoracolumbar spine and ribcage of scoliosis patients. We are using these models to better understand the biomechanics of spinal deformity correction.

Understanding the value of social media in organisations : a taxonomic approach

While organizations strive to leverage the vast information generated daily from social media platforms and both decision makers and consultants are keen to identify and exploit this information’s value, there has been little research into social media in the business context. Social media are diverse, varying in scope and functionality, this diversity entailing a complex of attributes and characteristics, resulting in confusion for both researchers and organizations. Taxonomies are important precursors in emerging fields and are foundational for rigorous theory building. Though aspects of social media have been studied from various discipline perspectives, this work has been largely descriptive. Thus, while the need for a rigorous taxonomy of social media is strong, previous efforts to classify social media suffer limitations – e.g. lack of a systematic taxonomic method, overreliance on intuition, disregard for the users’ perspective, and inadequate consideration of purpose. Thus, this study was mainly initiated by the overarching question “How can social media in the business context be usefully classified?” In order to address this gap, the current paper proposes a systematic method for developing a taxonomy appropriate to study social media in organizations context, combining Nickerson et al,’s (2012) IS taxonomy building guidelines and a Repertory grid (RepGrid) approach.

Theorizing in design science research : an abstraction layers framework

For Design Science Research (DSR) to gain wide credence as a research paradigm in Information Systems (IS), it must contribute to theory. “Theory cannot be improved until we improve the theorizing process, and we cannot improve the theorizing process until we describe it more explicitly, operate it more self-consciously, and decouple it from validation more deliberately” (Weick 1989, p. 516). With the aim of improved design science theorizing, we propose a DSR abstraction-layers framework that integrates, interlates, and harmonizes key methodological notions, primary of which are: 1) the Design Science (DS), Design Research (DR), and Routine Design (RD) distinction (Winter 2008); 2) Multi Grounding in IS Design Theory (ISDT) (Goldkuhl & Lind 2010); 3) the Idealized Model for Theory Development (IM4TD) (Fischer & Gregor 2011); and 4) the DSR Theorizing Framework (Lee et al. 2011). Though theorizing, or the abstraction process, has been the subject of healthy discussion in DSR, important questions remain. With most attention to date having focused on theorizing for Design Research (DR), a key stimulus of the layered view was the realization that Design Science (DS) produces abstract knowledge at a higher level of generality. The resultant framework includes four abstraction layers: (i) Design Research (DR) 1st Abstract Layer, (ii) Design Science (DS) 2nd Abstract Layer, (iii) DSR Incubation 3rd Layer, and (iv) Routine Design 4th Layer. Differentiating and inter-relating these layers will aid DSR researchers to discover, position, and amplify their DSR contributions. Additionally, consideration of the four layers can trigger creative perspectives that suggest unplanned outputs. The first abstraction layer, including its alternative patterns of activity, is well recognized in the literature. The other layers, however, are less well recognized; and the integrated representation of layers is novel.

Firm-customer mobile digital connectedness : conceptualization, measurement and implications

Firm-customer digital connectedness for effective sensing and responding is a strategic imperative for contemporary competitive firms. This research-in-progress paper conceptualizes and operationalizes the firm-customer mobile digital connectedness of a smart-mobile customer. The empirical investigation focuses on mobile app users and the impact of mobile apps on customer expectations. Based on pilot data collected from 127 customers, we tested hypotheses pertaining to firm-customer mobile digital connectedness and customer expectations. Our test analysis using linear and non-linear postulations reveals those customers raise their expectations as they increase their digital interactions with a firm.

Antecedent factors of knowledge sharing in research supervision

Today’s economy is a knowledge-based economy in which knowledge is a crucial facilitator to individuals, as well as being an instigator of success. Due to the impact of globalisation, universities face new challenges and opportunities. Accordingly, they ought to be more innovative and have their own competitive advantages. One of the most important goals of universities is the promotion of students as professional knowledge workers. Therefore, knowledge sharing and transfer at the tertiary level between students and supervisors is vital in universities, as it decreases the budget and provides an affordable way to do research. Knowledge-sharing impact factors can be categorised in three groups, namely: organisational, individual, and technical factors. Individual barriers to knowledge sharing include: the lack of time and trust and the lack of communication skills and social networks. IT systems such as elearning, blogs and portals can increase the knowledge-sharing capability. However, it must be stated that IT systems are only tools and not solutions. Individuals are still responsible for sharing information and knowledge. This paper proposes a new research model to examine the effect of individual factors, organisational factors (learning strategy, trust culture, supervisory support) and technological factors on knowledge sharing in the research supervision process.

Enterprise systems lifecycle-wide innovation readiness

Enterprise Systems have been touted as a key driver of delivering benefits through innovation in corporate Information Systems. The advent of such systems expects to deliver best practices that improve organizational performance. Yet, most Enterprise System installations struggle to see lifecycle-wide value of it. Considering that Enterprise Systems deliver lifecycle-wide innovation; we observe organizational readiness for lifecycle-wide Enterprise Systems innovation. The A VICTORY apriori model compares contributions of eight constructs for organizational readiness for continuous Enterprise Systems innovation. The model is tested responses of both client and implementation partner. Results indicate that six of the eight constructs of readiness make significant contributions to organizational readiness for Enterprise Systems innovation.

A typology of technological enablers of website service failure prevention

An increasing range of services are now offered via online applications and e-commerce websites. However, problems with online services still occur at times, even for the best service providers due to the technical failures, informational failures, or lack of required website functionalities. Also, the widespread and increasing implementation of web services means that service failures are both more likely to occur, and more likely to have serious consequences. In this paper we first develop a digital service value chain framework based on existing service delivery models adapted for digital services. We then review current literature on service failure prevention, and provide a typology of technolo- gies and approaches that can be used to prevent failures of different types (functional, informational, system), that can occur at different stages in the web service delivery. This makes a contribution to theory by relating specific technologies and technological approaches to the point in the value chain framework where they will have the maximum impact. Our typology can also be used to guide the planning, justification and design of robust, reliable web services.

Reconceptualizing digital service quality : a call-to-action and research approach

The nature of services and service delivery has been changing rapidly since the 1980’s when many seminal papers in services research were published. Services are increasingly digital, or have a digital component. Further, a large and heterogeneous literature, with competing and overlapping definitions, many of which are dated and inappropriate to contemporary digital services offerings is impeding progress in digital services research. In this conceptual paper, we offer a critical review of some existing conceptualizations of services and digital services. We argue that an inductive approach to understanding cognition about digital services is required to develop a taxonomy of digital services and a new vocabulary. We argue that this is a pre-requisite to theorizing about digital services, including understanding quality drivers, value propositions, and quality determinants for different digital service types. We propose a research approach for reconceptualising digital services and service quality, and outline methodological approaches and outcomes.

A simulation modeling approach to understanding information technology value cocreation

The business value of information technology (IT) is increasingly being cocreated by multiple parties, opening opportunities for new research initiatives. Previous studies on IT value cocreation mainly focus on analyzing sources of cocreated IT value, yet inadequately accommodating the influence of competition relationships in IT value cocreation activities. To fill the gap, this in-progress paper suggests an agent-based modeling (also simulation) approach to investigating potential influences of the dynamic interplay between cooperation and competition relationships in IT value cocreation settings. In particular, the research proposes a high-level conceptual framework to position general IT value cocreation processes. A relational network view is offered, aiming at decomposing and systemizing several typical cooperation and competition scenarios in practical IT value cocreation settings. The application of a simulation approach to analytical insights and to theory building is illustrated.

Towards a multiple-goal pursuit and multilevel view of continuing information technology usage : a process model integration and a research agenda

The value of information technology (IT) is often realized when continuously being used after users’ initial acceptance. However, previous research on continuing IT usage is limited for dismissing the importance of mental goals in directing users’ behaviors and for inadequately accommodating the group context of users. This in-progress paper offers a synthesis of several literature to conceptualize continuing IT usage as multilevel constructs and to view IT usage behavior as directed and energized by a set of mental goals. Drawing from the self-regulation theory in the social psychology, this paper proposes a process model, positioning continuing IT usage as multiple-goal pursuit. An agent-based modeling approach is suggested to further explore causal and analytical implications of the proposed process model.

Developing an engaging IT degree

Curriculum renewal is a constant activity in Information Technology (IT), Information Systems (IS), Information and Communication Technology (ICT) and Computer Science (CS). Guiding documents from curriculum authorities such as AIS, IEEE and ACM assist in this process, as do those from professional societies, but these are often out of date when the institution seeks to refresh its approaches to learning, and position its graduates for emerging roles and technologies. This paper describes and discusses a curriculum renewal project undertaken in response to changing government requirements,student interests and the adoption of a learner-centric, active learning paradigm utilizing new physical collaborative learning facilities. This paper presents the stimulus for change, describes the use of reference resources and discusses the resulting degree structure, its majors and learning approaches.

Using enterprise information architecture methods to model wicked problems in information systems design research

Design Science is the process of solving ‘wicked problems’ through designing, developing, instantiating, and evaluating novel solutions (Hevner, March, Park and Ram, 2004). Wicked problems are described as agent finitude in combination with problem complexity and normative constraint (Farrell and Hooker, 2013). In Information Systems Design Science, determining that problems are ‘wicked’ differentiates Design Science research from Solutions Engineering (Winter, 2008) and is a necessary part of proving the relevance to Information Systems Design Science research (Hevner, 2007; Iivari, 2007). Problem complexity is characterised as many problem components with nested, dependent and co-dependent relationships interacting through multiple feedback and feed-forward loops. Farrell and Hooker (2013) specifically state for wicked problems “it will often be impossible to disentangle the consequences of specific actions from those of other co-occurring interactions”. This paper discusses the application of an Enterprise Information Architecture modelling technique to disentangle the wicked problem complexity for one case. It proposes that such a modelling technique can be applied to other wicked problems and can lay the foundations for proving relevancy to DSR, provide solution pathways for artefact development, and aid to substantiate those elements required to produce Design Theory.