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.

Tristate

"This work forms part of a much larger collaborative album project in progress between Tim Bruniges, Julian Knowles and David Trumpmanis which explores the intersections between traditional rock instrumentation and analogue and digital media. All of the creative team are performers, composers and producers. The material for the album was thus generated by a series of in studio improvisations and performances with each collaborator assuming a range of different and alternating roles – guitars, electronics, drums, percussion, bass, keyboards production. Thematically the work explores the intersection of instrumental (post) rock, ambient music, and historical electro-acoustic tape composition traditions. Over the past 10 years, musical practice has become increasingly hybrid, with the traditional boundaries between genre becoming progressively eroded. At the same time, digital tools have replaced many of the major analogue technologies that dominated music production and performance in the 20th century. The disappearance of analogue media in mainstream musical practice has had a profound effect on the sonic characteristics of contemporary music and the gestural basis for its production. Despite the increasing power of digital technologies, a small but dedicated group of practitioners has continued to prize and use analogue technology for its unique sounds and the non-linearity of the media, aestheticising its inherent limitations and flaws. At the most radical end of this spectrum lie glitch and lo-fi musical forms, seen in part as reactions to the clinical nature of digital media and the perceived lack of character associated with its transparency. Such developments have also problematised the traditional relationships between media and genre, where specific techniques and their associated sounds have become genre markers. Tristate is an investigation into this emerging set of dialogues between analogue and digital media across composition, production and performance. It employs analogue tape loops in performance, where a tape machine ‘performer’ records and hand manipulates loops of an electric guitar performer on ‘destroyed’ tape stock (intentionally damaged tape), processing the output of this analogue system in the digital domain with contemporary sound processors. In doing so it investigates how the most extreme sonic signatures of analogue media – tape dropout and noise – can be employed alongside contemporary digital sound gestures in both compositional and performance contexts and how the extremes of the two media signatures can brought together both compositionally and performatively. In respect of genre, the work established strategies for merging compositional techniques from the early musique concrete tradition of the 1940s with late 60s popular music experimentalism and the laptop glitch electronica movement of the early 2000s. Lastly, the work explores how analogue recording studio technologies can be used as performance tools, thus illuminating and foregrounding the performative/gestural dimensions of traditional analogue studio tools in use."

SWIRLnet : portable anemometer network for wind speed measurements of land-falling tropical cyclones

Wind speed measurement systems are sparse in the tropical regions of Australia. Tropical cyclone wind speeds impacting communities are often ‘guestimated’ from analyzing damaged structures. A re-locatable anemometer system is required to enable measurements of wind speeds. This paper discusses design criteria of the tripods and tie down system, proposed deployment of the anemometers, instrumentation, and data logging. Preliminary assessment of the anemometer response indicates a reliable system for 1 second response, however, it is noted that the Australian building code and wind loading standard uses a moving average time of approximately 0.2 seconds for its wind speed design criteria.

Wind speed measurements of land-falling tropical cyclones using SWIRLnet, a portable anemometer network

Wind speed measurement systems are sparse in the tropical regions of Australia. Given this, tropical cyclone wind speeds impacting communities are seldom measured and often only ‘guestimated’ by analysing the extent of damage to structures. In an attempt to overcome this dearth of data, a re-locatable network of anemometers to be deployed prior to tropical cyclone landfall is currently being developed. This paper discusses design criteria of the network’s tripods and tie down system, proposed deployment of the anemometers, instrumentation and data logging. Preliminary assessment of the anemometer response indicates a reliable system for measuring the spectral component of wind with frequencies of approximately 1 Hz. This system limitation highlights an important difference between the capabilities of modern instrumentation and that of the Dines anemometer (around 0.2 seconds) that was used to develop much of the design criteria within the Australian building code and wind loading standard.

In-memory business process management

In-memory databases have become a mainstay of enterprise computing offering significant performance and scalability boosts for online analytical and (to a lesser extent) transactional processing as well as improved prospects for integration across different applications through an efficient shared database layer. Significant research and development has been undertaken over several years concerning data management considerations of in-memory databases. However, limited insights are available on the impacts of applications and their supportive middleware platforms and how they need to evolve to fully function through, and leverage, in-memory database capabilities. This paper provides a first, comprehensive exposition into how in-memory databases impact Business Pro- cess Management, as a mission-critical and exemplary model-driven integration and orchestration middleware. Through it, we argue that in-memory databases will render some prevalent uses of legacy BPM middleware obsolete, but also open up exciting possibilities for tighter application integration, better process automation performance and some entirely new BPM capabilities such as process-based application customization. To validate the feasibility of an in-memory BPM, we develop a surprisingly simple BPM runtime embedded into SAP HANA and providing for BPMN-based process automation capabilities.

Multimedia super corridor, Malaysia: Knowledge-based urban development lessons from an emerging economy

Purpose Knowledge-based urban development (KBUD) has been an effective strategy and an opportunity for emerging economies for catching up with the developed economies. The paper aims to investigate and provide insights on KBUD in the context of emerging economies. Design/methodology/approach The paper scrutinizes the Multimedia Super Corridor of Malaysia (MSC) by focusing on the planning, development and orchestration of the knowledge corridor. Findings The paper reveals a number of lessons and insights drawn from the development of MSC as the largest manifestation of KBUD initiative in Malaysia. Originality/value The paper provides lessons and recommendations on the planning, development and management of KBUD for emerging economies that are seeking a prosperous development.

Characteristics of on-road driving by persons with central vision loss: Learning to drive with a bioptic telescope

There is limited research on the driving performance and safety of bioptic drivers and even less regarding the driving skills that are most challenging for those learning to drive with bioptic telescopes. This research consisted of case studies of five trainee bioptic drivers whose driving skills were compared with those of a group of licensed bioptic drivers (n = 23) while they drove along city, suburban, and controlled-access highways in an instrumented dual-brake vehicle. A certified driver rehabilitation specialist was positioned in the front passenger seat to monitor safety and two backseat evaluators independently rated driving using a standardized scoring system. Other aspects of performance were assessed through vehicle instrumentation and video recordings. Results demonstrate that while sign recognition, lane keeping, steering steadiness, gap judgments and speed choices were significantly worse in trainees, some driving behaviors and skills, including pedestrian detection and traffic light recognition were not significantly different to those of the licensed drivers. These data provide useful insights into the skill challenges encountered by a small sample of trainee bioptic drivers which, while not generalizable because of the small sample size, provide valuable insights beyond that of previous studies and can be used as a basis to guide training strategies.

Ethyl 1-(2-cyanoethyl)-3,5-dimethyl-1H-indole-2-carboxylate

The title compound, C16H18N2O2, is an important precursor in the synthesis of 1,2,3,4-tetrahydropyrazinoindoles, which show excellent antihistamine, antihypertensive and central nervous system depressant properties. The carbethoxy group attached to C2 and the planar cyanoethyl group attached to N1 make dihedral angles of 11.0(4) and 75.0(3)degrees, respectively, with the mean plane of the indole ring, The C-C=N chain is linear with a bond angle of 179.3 (4)degrees.

Evidence of clustering in an aqueous electrolyte solution: a small-angle X-ray scattering study

The work reported hen was motivated by a desire to verify the existence of structure - specifically MP-rich clusters induced by sodium bromide (NaBr) in the ternary liquid mixture 3-methylpyridine (Mf) + water(W) + NaBr. We present small-angle X-ray scattering (SAXS) measurements in this mixture. These measurements were obtained at room temperature (similar to 298 K) in the one-phase region (below the relevant lower consolute points, T(L)s) at different values of X (i.e., X = 0.02 - 0.17), where X is the weight fraction of NaBr in the mixture. Cluster-size distribution, estimated on the assumption that the clusters are spherical, shows systematic behaviour in that the peak of the distribution shifts rewards larger values of cluster radius as X increases. The largest spatial extent of the clusters (similar to 4.5 nm) is seen at X = 0.17. Data analysis assuming arbitrary shapes and sizes of clusters gives a limiting value of cluster size (- 4.5 nm) that is not very sensitive to X. It is suggested that the cluster size determined may not be the same as the usual critical-point fluctuations far removed from the critical point (T-L). The influence of the additional length scale due to clustering is discussed from the standpoint of crossover from Ising to mean-field critical behaviour, when moving away from the T-L.

Study of the processes occurring when sputtering YBa2Cu3O7-x in pure oxygen

The sputter deposition of YBa2Cu3O7-x in a de-diode was performed in pure oxygen medium and an optical spectroscopic study of the resultant discharge revealed strong emissions from both metal atoms and oxygen ions. Emission intensities were studied in pressure range from 0.5 to 3 mbar, with substrate temperatures from 150 to 850 degrees C. Raising the substrate temperature to 850 degrees C increased the number of positive ions and excited neutral atoms. Raising the pressure decreased the emission intensities of excited neutral and ionic species. The results have been compared with those obtained from Langmuir probe measurements. The rise in emission intensities of excited neutrals and ions with temperature suggested the possibility of chemically enhanced physical sputtering of YBa2Cu3O7-x. The effect of process conditions on film composition and quality is also discussed.

Anomalous thermal dynamics of Bragg gratings inscribed in germanosilicate optical fiber

An interesting, periodic appearance of a new peak has been observed in the reflected spectrum of a Fiber Bragg Grating (FBG) inscribed in a germanosilicate fiber during thermal treatment. The new peak occurs on the longer wavelength side of the spectrum during heating and on the shorter wavelength side during cooling, following an identical reverse dynamics. Comparison with a commercial grating with 99.9% reflectivity shows a similar decay dynamics. It is proposed that the distortion due to simultaneous erasure and thermal expansion of the index modulation profile may be responsible for the observed anomaly. The reported results help us in understanding the thermal behavior of FBGs and provide additional insights into the mechanisms responsible for the photosensitivity in germanosilicate fibers.

Field imperfection induced axial secular frequency shifts in nonlinear ion traps

This article develops a simple analytical expression that relates ion axial secular frequency to field aberration in ion trap mass spectrometers. Hexapole and octopole aberrations have been considered in the present computations. The equation of motion of the ions in a pseudopotential well with these superpositions has the form of a Duffing-like equation and a perturbation method has been used to obtain the expression for ion secular frequency as a function of field imperfections. The expression indicates that the frequency shift is sensitive to the sign of the octopole superposition and insensitive to the sign of the hexapole superposition. Further, for weak multipole superposition of the same magnitude, octopole superposition causes a larger frequency shift in comparison to hexapole superposition.

Studies on the target conditioning for deposition of $LiCoO_{2}$ films

Deposition of good quality thin films of Lithium Cobalt Oxide (LiCoO2), by sputtering is preceded by target conditioning, which dictates the surface composition, morphology and electrochemical performance of the deposited film. Sputtering from a Virgin target surface, results in films with excess of the more reactive elements. The concentration of these reactive elements in the films decreases until the system reaches a steady state after sufficient sputtering from the target. This paper discusses the deposition kinetics in terms of target conditioning of LiCoO2. The composition, morphology and texturing of deposited film during various hours of sputtering were analyzed using X-ray photoelectron Spectroscopy (XPS) and Field Emission Scanning electron microscopy (FESEM). The compositional stability is not observed in the films formed during the initial hours or Sputtering from the fresh target, which becomes stable after several hours of sputtering. The Li and Co concentration in the Films deposited subsequently is found to be varying and possible causes are discussed. After the compositional stability is reached, electrochemical analysis of LiCoO2 thin films was performed, which shows a discharge capacity of 129 mu Ah/cm(2).

Defect-selective photothermal imaging: a sensitive tool for damage mapping in optical coatings

A defect-selective photothermal imaging system for the diagnostics of optical coatings is demonstrated. The instrument has been optimized for pump and probe parameters, detector performance, and signal processing algorithm. The imager is capable of mapping purely optical or thermal defects efficiently in coatings of low damage threshold and low absorbance. Detailed mapping of minor inhomogeneities at low pump power has been achieved through the simultaneous action of a low-noise fiber optic photothermal beam defection sensor and a common-mode-rejection demodulation (CMRD) technique. The linearity and sensitivity of the sensor have been examined theoretically and experimentally, and the signal to noise ratio improvement factor is found to be about 110 compared to a conventional bicell photodiode. The scanner is so designed that mapping of static or shock sensitive samples is possible. In the case of a sample with absolute absorptance of 3.8 x 10(-4), a change in absorptance of about 0.005 x 10(-4) has been detected without ambiguity, ensuring a contrast parameter of 760. This is about 1085% improvement over the conventional approach containing a bicell photodiode, at the same pump power. The merits of the system have been demonstrated by mapping two intentionally created damage sites in a MgF2 coating on fused silica at different excitation powers. Amplitude and phase maps were recorded for thermally thin and thick cases, and the results are compared to demonstrate a case which, in conventional imaging, would lead to a deceptive conclusion regarding the type and location of the damage. Also, a residual damage profile created by long term irradiation with high pump power density has been depicted.

Some studies on TiO2 films deposited by sol-gel technique

TiO2 films are extensively used in various applications including optical multi-layers, sensors, photo catalysis, environmental purification, and solar cells etc. These are prepared by both vacuum and non-vacuum methods. In this paper, we present the results on TiO2 thin films prepared by a sol-gel spin coating process in non-aqueous solvent. Titanium isopropoxide is used as TiO2 precursor. The films were annealed at different temperatures up to 3000 C for 5 hours in air. The influence of the various deposition parameters like spinning speed, spinning time and annealing temperature on the thickness of the TiO2 films has been studied. The variation of film thickness with time in ambient atmosphere was also studied. The optical, structural and morphological characteristics were investigated by optical transmittance-reflectance measurements, X-ray diffraction (XRD) and scanning electron microscopy (SEM) respectively. The refractive index and extinction coefficient of the films were determined by envelope technique and spectroscopic ellipsometry. TiO2 films exhibited high transparency (92%) in the visible region with a refractive index of 2.04 at 650 nm. The extinction coefficient was found to be negligibly small. The X-ray diffraction analysis showed that the TiO2 film deposited on glass substrate changes from amorphous to crystalline (anatase) phase with annealing temperature above 2500 C. SEM results show that the deposited films are uniform and crack free.