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.

Evaluating the use of ambient and tangible interaction approaches for personal indoor climate preferences [Extended Abstract]

In this paper we describe the preliminary results of a field study which evaluated the use of MiniOrb, a system that employs ambient and tangible interaction mechanisms to allow inhabitants of office environments to report on subjectively perceived office comfort levels. The purpose of this study was to explore the role of ubiquitous computing in the individual control of indoor climate and specifically answer the question to what extent ambient and tangible interaction mechanisms are suited for the task of capturing individual comfort preferences in a non-obtrusive manner. We outline the preliminary results of an in-situ trial of the system.

Cheating prevention in secret sharing over GF(pt)

The work investigates cheating prevention in secret sharing. It is argued that cheating is immune against cheating if the cheaters gain no advantage over honest participants by submitting invalid shares to the combiner. This work addresses the case when shares and the secret are taken from GF(pt). Two models are considered. The first one examines the case when cheaters consistently submit always invalid shares. The second modeldeal s with cheaters who submit a mixture of valid and invalid shares. For these two models, cheating immunity is defined, properties of cheating immune secret sharing are investigated and their constructions are given.

Constructions of cheating immune secret sharing

The work addresses the problem of cheating prevention in secret sharing. Two cheating scenarios are considered. In the first one, the cheaters always submit invalid shares to the combiner. In the second one, the cheaters collectively decide which shares are to be modified so the combiner gets a mixture of valid and invalid shares from the cheaters. The secret scheme is said to be k-cheating immune if any group of k cheaters has no advantage over honest participants. The paper investigates cryptographic properties of the defining function of secret sharing so the scheme is k-cheating immune. Constructions of secret sharing immune against k cheaters are given.

Proteins, drug targets and the mechanisms they control : the simple truth about complex networks

Realizing the promise of molecularly targeted inhibitors for cancer therapy will require a new level of knowledge about how a drug target is wired into the control circuitry of a complex cellular network. Here we review general homeostatic principles of cellular networks that enable the cell to be resilient in the face of molecular perturbations, while at the same time being sensitive to subtle input signals. Insights into such mechanisms may facilitate the development of combination therapies that take advantage of the cellular control circuitry, with the aim of achieving higher efficacy at a lower drug dosage and with a reduced probability of drug-resistance development.

Plasma-driven self-organization of Ni nanodot arrays on Si(100)

The results of the combined experimental and numerical study suggest that nonequilibrium plasma-driven self-organization leads to better size and positional uniformity of nickel nanodot arrays on a Si(100) surface compared with neutral gas-based processes under similar conditions. This phenomenon is explained by introducing the absorption zone patterns, whose areas relative to the small nanodot sizes become larger when the surface is charged. Our results suggest that strongly nonequilibrium and higher-complexity plasma systems can be used to improve ordering and size uniformity in nanodot arrays of various materials, a common and seemingly irresolvable problem in self-organized systems of small nanoparticles. © 2008 American Institute of Physics.

Plasma-aided nanofabrication: where is the cutting edge?

Plasma-aided nanofabrication is a rapidly expanding area of research spanning disciplines ranging from physics and chemistry of plasmas and gas discharges to solid state physics, materials science, surface science, nanoscience and nanotechnology and related engineering subjects. The current status of the research field is discussed and examples of superior performance and competitive advantage of plasma processes and techniques are given. These examples are selected to represent a range of applications of two major types of plasmas suitable for nanoscale synthesis and processing, namely thermally non-equilibrium and thermal plasmas. Major concepts and terminology used in the field are introduced. The paper also pinpoints the major challenges facing plasma-aided nanofabrication and identifies some emerging topics for future research. © 2007 IOP Publishing Ltd.

Growth kinetics of carbon nanowall-like structures in low-temperature plasmas

The results of a hybrid numerical simulation of the growth kinetics of carbon nanowall-like nanostructures in the plasma and neutral gas synthesis processes are presented. The low-temperature plasma-based process was found to have a significant advantage over the purely neutral flux deposition in providing the uniform size distribution of the nanostructures. It is shown that the nanowall width uniformity is the best (square deviations not exceeding 1.05) in high-density plasmas of 3.0× 1018 m-3, worsens in lower-density plasmas (up to 1.5 in 1.0× 1017 m-3 plasmas), and is the worst (up to 1.9) in the neutral gas-based process. This effect has been attributed to the focusing of ion fluxes by irregular electric field in the vicinity of plasma-grown nanostructures on substrate biased with -20 V potential, and differences in the two-dimensional adatom diffusion fluxes in the plasma and neutral gas-based processes. The results of our numerical simulations are consistent with the available experimental reports on the effect of the plasma process parameters on the sizes and shapes of relevant nanostructures.

Low-temperature assembly of ordered carbon nanotip arrays in low-frequency, high-density inductively coupled plasmas

High-density inductively coupled plasma (ICP)-assisted self-assembly of the ordered arrays of various carbon nanostructures (NS) for the electron field emission applications is reported. Carbon-based nano-particles, nanotips, and pyramid-like structures, with the controllable shape, ordering, and areal density are grown under remarkably low process temperatures (260-350 °C) and pressures (below 0.1 Torr), on the same Ni-based catalyst layers, in a DC bias-controlled floating temperature regime. A high degree of positional and directional ordering, elevated sp2 content, and a well-structured graphitic morphology are achieved without the use of pre-patterned or externally heated substrates.

Food safety : maximising impact by understanding the food business context

In Australia there are 5.4 million cases of food-borne illness annually which costs the community $1.2 billion per annum (Department of Health and Ageing 2006). As a co-regulator in food safety, local government has a significant interest in ensuring adherence to good food safety practices. This research project involved focus groups or interviews with food business operators and young food handlers to explore their food safety understanding, attitudes, practices and the organisational culture in which they participated. By its nature qualitative research is not intended to provide definitive generalizable findings. Rather the advantage of a small sample size qualitative study is to provide depth rather than breadth. Thus the findings here provide insight into the complexities and nuances of food safety regulation in a manner which a large scale quantitative study could not.

Strategic entry deterrence : does it constitute a misuse of market power?

A challenge for regulators and the courts has been establishing the boundary between behaviour is exclusionary and should be condemned under s 46 of the then Trade Practices Act 1974 (Cth) (TPA), now s 46 of the Competition and Consumer Act 2010 (Cth) (CCA), and behaviour that is not exclusionary and might even be pro-competitive. This boundary can be especially difficult to draw in the case of entry deterring strategies. Section 46(1) prohibits corporations with a substantial degree of market power from taking advantage of that market power for one of the statutorily proscribed purposes which include preventing the entry of a person into that or any other market. Section 45(2) separately prohibits corporations from making and giving effect to contracts arrangements and understandings that have the purpose, effect or likely effect of substantially lessening competition in a market. The latest case in which the ACCC has failed to satisfy the s 46 criteria is the decision of Greenwood J in ACCC v Cement Australia Pty Ltd [2013] FCA 909 (Cement Australia case). Final orders were published in a separate judgment, in ACCC v Cement Australia Pty Ltd [2014] FCA 148 (28 February 2014). The case concerned an entry deterring strategy, namely the pre-emptive buying of input factors in an upstream market to protect an incumbent with substantial market power in a downstream market and to prevent new entry in the downstream market. Greenwood J found that while Cement Australia Pty Ltd, formerly known as Queensland Cement Ltd (QCL), had substantial market power, its conduct in entering into the pre-emptive contracts was not a contravention of s 46, because Cement Australia had not “taken advantage” of its market power. However, since Cement Australia’s purpose in entering into the pre-emptive contracts was anti-competitive, they were held to contravene s 45(2) of the TPA. The purpose of this Note is to consider only the reasons for judgment in the Cement Australia case in relation to the “taking advantage” element. The judgment was handed down on 10 September 2013. The final hearing date was 15 July 2011, so it was long-awaited. At 714 pages, it is carefully drafted.

Development of gas sensing technology for ground and airborne applications powered by solar energy : methodology and experimental results

Monitoring gases for environmental, industrial and agricultural fields is a demanding task that requires long periods of observation, large quantity of sensors, data management, high temporal and spatial resolution, long term stability, recalibration procedures, computational resources, and energy availability. Wireless Sensor Networks (WSNs) and Unmanned Aerial Vehicles (UAVs) are currently representing the best alternative to monitor large, remote, and difficult access areas, as these technologies have the possibility of carrying specialised gas sensing systems, and offer the possibility of geo-located and time stamp samples. However, these technologies are not fully functional for scientific and commercial applications as their development and availability is limited by a number of factors: the cost of sensors required to cover large areas, their stability over long periods, their power consumption, and the weight of the system to be used on small UAVs. Energy availability is a serious challenge when WSN are deployed in remote areas with difficult access to the grid, while small UAVs are limited by the energy in their reservoir tank or batteries. Another important challenge is the management of data produced by the sensor nodes, requiring large amount of resources to be stored, analysed and displayed after long periods of operation. In response to these challenges, this research proposes the following solutions aiming to improve the availability and development of these technologies for gas sensing monitoring: first, the integration of WSNs and UAVs for environmental gas sensing in order to monitor large volumes at ground and aerial levels with a minimum of sensor nodes for an effective 3D monitoring; second, the use of solar energy as a main power source to allow continuous monitoring; and lastly, the creation of a data management platform to store, analyse and share the information with operators and external users. The principal outcomes of this research are the creation of a gas sensing system suitable for monitoring any kind of gas, which has been installed and tested on CH4 and CO2 in a sensor network (WSN) and on a UAV. The use of the same gas sensing system in a WSN and a UAV reduces significantly the complexity and cost of the application as it allows: a) the standardisation of the signal acquisition and data processing, thereby reducing the required computational resources; b) the standardisation of calibration and operational procedures, reducing systematic errors and complexity; c) the reduction of the weight and energy consumption, leading to an improved power management and weight balance in the case of UAVs; d) the simplification of the sensor node architecture, which is easily replicated in all the nodes. I evaluated two different sensor modules by laboratory, bench, and field tests: a non-dispersive infrared module (NDIR) and a metal-oxide resistive nano-sensor module (MOX nano-sensor). The tests revealed advantages and disadvantages of the two modules when used for static nodes at the ground level and mobile nodes on-board a UAV. Commercial NDIR modules for CO2 have been successfully tested and evaluated in the WSN and on board of the UAV. Their advantage is the precision and stability, but their application is limited to a few gases. The advantages of the MOX nano-sensors are the small size, low weight, low power consumption and their sensitivity to a broad range of gases. However, selectivity is still a concern that needs to be addressed with further studies. An electronic board to interface sensors in a large range of resistivity was successfully designed, created and adapted to operate on ground nodes and on-board UAV. The WSN and UAV created were powered with solar energy in order to facilitate outdoor deployment, data collection and continuous monitoring over large and remote volumes. The gas sensing, solar power, transmission and data management systems of the WSN and UAV were fully evaluated by laboratory, bench and field testing. The methodology created to design, developed, integrate and test these systems was extensively described and experimentally validated. The sampling and transmission capabilities of the WSN and UAV were successfully tested in an emulated mission involving the detection and measurement of CO2 concentrations in a field coming from a contaminant source; the data collected during the mission was transmitted in real time to a central node for data analysis and 3D mapping of the target gas. The major outcome of this research is the accomplishment of the first flight mission, never reported before in the literature, of a solar powered UAV equipped with a CO2 sensing system in conjunction with a network of ground sensor nodes for an effective 3D monitoring of the target gas. A data management platform was created using an external internet server, which manages, stores, and shares the data collected in two web pages, showing statistics and static graph images for internal and external users as requested. The system was bench tested with real data produced by the sensor nodes and the architecture of the platform was widely described and illustrated in order to provide guidance and support on how to replicate the system. In conclusion, the overall results of the project provide guidance on how to create a gas sensing system integrating WSNs and UAVs, how to power the system with solar energy and manage the data produced by the sensor nodes. This system can be used in a wide range of outdoor applications, especially in agriculture, bushfires, mining studies, zoology, and botanical studies opening the way to an ubiquitous low cost environmental monitoring, which may help to decrease our carbon footprint and to improve the health of the planet.

Review and future options for computer modelling in the sugar industry

Computer modelling has been used extensively in some processes in the sugar industry to achieve significant gains. This paper reviews the investigations carried out over approximately the last twenty five years,including the successes but also areas where problems and delays have been encountered. In that time the capability of both hardware and software have increased dramatically. For some processes such as cane cleaning, cane billet preparation, and sugar drying, the application of computer modelling towards improved equipment design and operation has been quite limited. A particular problem has been the large number of particles and particle interactions in these applications, which, if modelled individually, is computationally very intensive. Despite the problems, some attempts have already been made and knowledge gained on tackling these issues. Even if the detailed modelling is wanting, a model can provide some useful insights into the processes. Some options to attack these more intensive problems include the use of commercial software packages, which are usually very robust and allow the addition of user-supplied subroutines to adapt the software to particular problems. Suppliers of such software usually charge a fee per CPU licence, which is often problematic for large problems that require the use of many CPUs. Another option to consider is using open source software that has been developed with the capability to access large parallel resources. Such software has the added advantage of access to the full internal coding. This paper identifies and discusses the detail of software options with the potential capability to achieve improvements in the sugar industry.

Customer journey and experience canvas

A need to respond to changing legislative requirements, rising expectations from customers and shortages of suitably experienced staff are forcing non-profit organisations in the aged care sector to change. As new customer segments emerge and the existing aged care offering becomes less relevant, organisations must rethink the value they present to market, and adopt innovative strategies and approaches to care delivery in order to have a sustainable future. This paper presents a framework for unpacking a customer journey and experience, developed during a longitudinal study of a non-profit organisation redefining their core purpose and attempting to design a customer-centric business model.

A non-profit design-led innovation journey

Non-profit organisations in the aged care sector are currently under pressure from more than just a sheer increase of customers. A need to respond to changing legislative requirements, increased expectations from customers and increasing likelihood of shortage in appropriate experienced staff are also contributing to instability within the sector. This paper will present a longitudinal action research study of a non-profit organisation revisiting its core purpose of providing relevant services and attempting to build a customer-centric method for addressing the current and upcoming change drivers in an Australian aged care context. The study found Design- Led Innovation to be an effective methodology for capturing deep customer insights and conceptualising new business models which address the prevalent change drivers. This paper details a design-led approach to innovation, tailored to a non-profit organisation seeking to better understand its stakeholders and redefine its value offering.