Lumbar epidural steroids are not cost effective in sciatica

Background Lumbar Epidural Steroids Injections (ESI’s) have previously been shown to provide some degree of pain relief in sciatica. Number Needed To Treat (NNT) to achieve 50% pain relief has been estimated at 7 from the results of randomised controlled trials. Pain relief is temporary. They remain one of the most commonly provided procedures in the UK. It is unknown whether this pain relief represents good value for money. Methods 228 patients were randomised into a multi-centre Double Blind Randomised Controlled Trial. Subjects received up to 3 ESI’s or intra-spinous saline depending on response and fall off with the first injection. All other treatments were permitted. All received a review of analgesia, education and physical therapy. Quality of life was assessed using the SF36 at 6 points and compared using independent sample t-tests. Follow up was up to 1 yr. Missing data was imputed using last observation carried forward (LOCF). QALY’s (Quality of Life Years) were derived from preference based heath values (summary health utility score). SF-6D health state classification was derived from SF-36 raw score data. Standard gambles (SG) were calculated using Model 10. SG scores were calculated on trial results. LOCF was not used for this. Instead average SG were derived for a subset of patients with observations for all visits up to week 12. Incremental QALY’s were derived as the difference in the area between the SG curve for the active group and placebo group. Results SF36 domains showed a significant improvement in pain at week 3 but this was not sustained (mean 54 Active vs 61 Placebo P<0.05). Other domains did not show any significant gains compared with placebo. For derivation of SG the number in the sample in each period differed. In week 12, average SG scores for active and placebo converged. In other words, the health gain for the active group as measured by SG was achieved by the placebo group by week 12. The incremental QALY gained for a patient under the trial protocol compared with the standard care package was 0.0059350. This is equivalent to an additional 2.2 days of full health. The cost per QALY gained to the provider from a patient management strategy administering one epidural as suggested by results was £25 745.68. This result was derived assuming that the gain in QALY data calculated for patients under the trial protocol would approximate that under a patient management strategy based on the trial results (one ESI). This is above the threshold suggested by some as a cost effective treatment. Conclusions The transient benefit in pain relief afforded by ESI’s does not appear to be cost-effective. Further work is needed to develop more cost-effective conservative treatments for sciatica.

From words to models : a bibliometric approach to designing agent-based models in entrepreneurship

Agent-based modeling and simulation (ABMS) may fit well with entrepreneurship research and practice because the core concepts and basic premises of entrepreneurship coincide with the characteristics of ABMS. However, it is difficult to find cases where ABMS is applied to entrepreneurship research. To apply ABMS to entrepreneurship and organization studies, designing a conceptual model is important; thus to effectively design a conceptual model, various mixed method approaches are being attempted. As a new mixed method approach to ABMS, this study proposes a bibliometric approach to designing agent based models, which establishes and analyzes a domain corpus. This study presents an example on the venture creation process using the bibliometric approach. This example shows us that the results of the multi-agent simulations on the venturing process based on the bibliometric approach are close to each nation’s surveyed data on the venturing activities. In conclusion, by the bibliometric approach proposed in this study, all the agents and the agents’ behaviors related to a phenomenon can be extracted effectively, and a conceptual model for ABMS can be designed with the agents and their behaviors. This study contributes to the entrepreneurship and organization studies by promoting the application of ABMS.

Reading words into statutes : when Homer nods

The grammatical meaning of a statutory provision may not always gel with the purpose of the statute. The court may strive to give the provision an interpretation at odds with its ordinary and natural meaning to meet the purpose of the legislation. On occasion, this may involve notionally adding words to, or substituting words in, a statutory provision. This process of “reading in” words demands that close attention be paid to the boundary between statutory construction and judicial legislation, particularly where a court is invited to carve out an exception from grammatically clear words. In Jones v Wrotham Park Settled Estates [1980] AC 74, Lord Diplock identified three pre-conditions to reading words into a statute. This article analyses the utility of those conditions within the context of the modern purposive approach to statutory interpretation and evaluates whether they remain sufficient guideposts for identifying the boundary between interpretation and legislation.

Introduction - There's crime out there, but not as we know it: Rural criminology - the last frontier

The idea that crime is a predominantly urban phenomenon has been pervasive in criminology, so much so that Australian criminology textbooks do not recognise rural crime as a distinct phenomenon worthy of scholarly attention (see Chappell & Wilson, 2000; Goldsmith et al, 2003; White & Haines, 2004; White & Habibis, 2005). There are no chapters or sections in Australian texts which specifically examine rural crime, despite the inclusion of a range of topics that appear to provide a broad coverage of crime in its many temporal and spatial dimensions. Nor is there so much as an index reference to "rural" issues in criminology textbooks. The standardised syllabus for crime texts provides coverage of topics such as violent crime, public crime, delinquency, race and crime, gender and crime, and crime and social class. This canon is mirrored in international texts, most of which also fail to address the issue of rural crime, but make abundant reference to crime in various urban contexts (see Carrabine et al, 2004; Conklin, 2004). This is not to suggest that Australian texts fail to localise their subject matter.

Catching drink drivers in Queensland through Random Breath Testing : what does the last decade of data tell us

Background Random Breath Testing (RBT) has proven to be a cornerstone of enforcement attempts to deter (as well as apprehend) motorists from drink driving in Queensland (Australia) for decades. However, scant published research has examined the relationship between the frequency of implementing RBT activities and subsequent drink driving apprehension rates across time. Aim This study aimed to examine the prevalence of apprehending drink drivers in Queensland over a 12 year period. It was hypothesised that an increase in breath testing rates would result in a corresponding decrease in the frequency of drink driving apprehension rates over time, which would reflect general deterrent effects. Method The Queensland Police Service provided RBT data that was analysed. Results Between the 1st of January 2000 and 31st of December 2011, 35,082,386 random breath tests (both mobile and stationary) were conducted in Queensland, resulting in 248,173 individuals being apprehended for drink driving offences. A total of 342,801 offences were recorded during this period, representing an intercept rate of .96. Of these offences, 276,711 (80.72%) were recorded against males and 66,024 (19.28%) offences committed by females. The most common drink driving offence was between 0.05 and 0.08 BAC limit. The largest proportion of offences was detected on the weekends, with Saturdays (27.60%) proving to be the most common drink driving night followed by Sundays (21.41%). The prevalence of drink driving detection rates rose steadily across time, peaking in 2008 and 2009, before slightly declining. This decline was observed across all Queensland regions and any increase in annual figures was due to new offence types being developed. Discussion This paper will further outline the major findings of the study in regards to tailoring RBT operations to increase detection rates as well as improve the general deterrent effect of the initiative.

Having the last word? Will making and contestation in Australia

Increased longevity and the need to fund living and care expenses across late old age, greater proportions of blended and culturally diverse families and concerns about the increasing possibility of contestation of wills highlight the importance of understanding current will making practices and intentions. Yet, there is no current national data on the prevalence of wills, intended beneficiaries, the principles and practices surrounding will making and the patterns and outcomes of contestation. This project sought to address this gap. This report summarises the results of a four year program of research examining will making and will contestation in Australia. The project was funded by the Australian Research Council (LP10200891) in conjunction with seven Public Trustee Organisations across Australia. The interdisciplinary research team with expertise in social science, social work, law and social policy are from The University of Queensland, Queensland University of Technology and Victoria University. The project comprised five research studies: a national prevalence survey, a judicial case review, a review of Public Trustee files, an online survey of will drafters and in-depth interviews with key groups of interest. The report outlines key findings. On the basis of the evidence provided recommendations are presented to support the achievement of these policy goals: increasing will making in the Australian population, ensuring that the wills of those Australians who have taken this step reflect their current situation and intentions, and reducing will contestation.

Motorcyclist hazard perception research: The last 10 years

Motorcycle trauma is a serious issue in Queensland and throughout Australia; the fatality rate per 100 million kilometres travelled for motorcycle riders in Australia is nearly 30 times the rate for drivers of other vehicles (Australian Transport Safety Bureau, 2002). In 2009, the then Queensland Transport (later the Department of Transport and Main Roads or TMR) appointed CARRS-Q to provide a three-year program of Road Safety Research Services for Motorcycle Rider Safety. Funding for this research originated from the Motor Accident Insurance Commission who had the uncommon foresight to fund such a comprehensive program of research.

South Asians' cardiac medication adherence

Aim This paper is a report of a narrative review examining the current state of knowledge regarding adherence with cardiac medication among South Asian cardiac patients. Background South Asians experience higher rates of cardiovascular disease than any other ethnic group. South Asians may be less adherent with a cardiac medication regimen than Caucasians. The factors contributing to adherence are important to discover to assist South Asians to optimize their cardiac health. Data sources CINAHL, Medline (Ovid), PsychINFO, EMB Reviews-(Cochrane), and EMBASE were accessed using the key words: 'South Asian', 'Asia', 'East India', 'India', 'Pakistan', 'Bangladesh', 'Sri Lanka', 'medication compliance', 'medication noncompliance' and 'medication adherence'. English language papers published from January 1980 to January 2013 were eligible for inclusion. Review methods Abstracts were reviewed for redundancy and eligibility by the primary author. Manuscripts were then retrieved and reviewed for eligibility and validity by the first and last authors. Content analysis strategies were used for the synthesis. Results Thirteen papers were in the final data set; most were conducted in India and Pakistan. Medication side-effects, cost, forgetfulness and higher frequency of dosing contributed to non-adherence. South Asian immigrants also faced language barriers, which contributed to non-adherence. Knowledge regarding the medications prescribed was a factor that increased adherence. Conclusion South Asians' non-adherence to cardiac medications is multifaceted. How South Asians who newly immigrate to Western countries make decisions regarding their cardiac medication adherence ought to be explored in greater detail.

The last taboo: Patenting human beings

This article considers the efforts of the Australian Law Reform Commission to clarify the meaning of section 18(2) of the Australian Patents Act 1990 (Cth): ’Human beings and the biological processes for their generation are not patentable inventions.' It provides a critique of the proposals of the Commission with respect to patent law and stem cell research. The Commission has recommended that IP Australia should develop examination guidelines to explain how the criteria for patentability apply to inventions involving stem cell technologies. It has advised the Australian Government that the practice code of the United Kingdom Patent Office (UKPO) would be a good model for such guidelines, with its distinction between totipotent and pluripotent stem cells. Arguably, though, there is a need to codify this proposal in a legislative directive, and not merely in examination guidelines. The Commission has been reluctant to take account of the ethical considerations with respect to patent law and stem cell research. There could be greater scope for such considerations, by the use of expert advisory boards, opposition proceedings and the requirement of informed consent. The Commission has put forward a number of general and specific recommendations to enhance access to patented stem cell technologies. It recommends the development of a research exemption, and the modernisation of compulsory licensing and crown use provisions. It also explores the establishment of a stem cell bank and the promulgation of guidelines by funding agencies. Such proposals to promote greater public access to stem cell research are to be welcomed.

Neural correlates of semantic priming for ambiguous words: An event-related fMRI study

We investigated the neural correlates of semantic priming by using event-related fMRI to record blood oxygen level dependent (BOLD) responses while participants performed speeded lexical decisions (word/nonword) on visually presented related versus unrelated prime-target pairs. A long stimulus onset asynchrony of 1000 ms was employed, which allowed for increased controlled processing and selective frequency-based ambiguity priming. Conditions included an ambiguous word prime (e.g. bank) and a target related to its dominant (e.g. money) or subordinate meaning (e.g. river). Compared to an unrelated condition, primed dominant targets were associated with increased activity in the LIFG, the right anterior cingulate and superior temporal gyrus, suggesting postlexical semantic integrative mechanisms, while increased right supramarginal activity for the unrelated condition was consistent with expectancy based priming. Subordinate targets were not primed and were associated with reduced activity primarily in occipitotemporal regions associated with word recognition, which may be consistent with frequency-based meaning suppression. These findings provide new insights into the neural substrates of semantic priming and the functional-anatomic correlates of lexical ambiguity suppression mechanisms.

Putting an "end" to the motor cortex representations of action words

Language processing is an example of implicit learning of multiple statistical cues that provide probabilistic information regarding word structure and use. Much of the current debate about language embodiment is devoted to how action words are represented in the brain, with motor cortex activity evoked by these words assumed to selectively reflect conceptual content and/or its simulation. We investigated whether motor cortex activity evoked by manual action words (e.g., caress) might reflect sensitivity to probabilistic orthographic-phonological cues to grammatical category embedded within individual words. We first review neuroimaging data demonstrating that nonwords evoke activity much more reliably than action words along the entire motor strip, encompassing regions proposed to be action category specific. Using fMRI, we found that disyllabic words denoting manual actions evoked increased motor cortex activity compared with non-body-part-related words (e.g., canyon), activity which overlaps that evoked by observing and executing hand movements. This result is typically interpreted in support of language embodiment. Crucially, we also found that disyllabic nonwords containing endings with probabilistic cues predictive of verb status (e.g., -eve) evoked increased activity compared with nonwords with endings predictive of noun status (e.g., -age) in the identical motor area. Thus, motor cortex responses to action words cannot be assumed to selectively reflect conceptual content and/or its simulation. Our results clearly demonstrate motor cortex activity reflects implicit processing of ortho-phonological statistical regularities that help to distinguish a word's grammatical class.

No specific role for the manual motor system in processing the meanings of words related to the hand

The present study explored whether semantic and motor systems are functionally interwoven via the use of a dual-task paradigm. According to embodied language accounts that propose an automatic and necessary involvement of the motor system in conceptual processing, concurrent processing of hand-related information should interfere more with hand movements than processing of unrelated body-part (i.e., foot, mouth) information. Across three experiments, 100 right-handed participants performed left- or right-hand tapping movements while repeatedly reading action words related to different body-parts, or different body-part names, in both aloud and silent conditions. Concurrent reading of single words related to specific body-parts, or the same words embedded in sentences differing in syntactic and phonological complexity (to manipulate context-relevant processing), and reading while viewing videos of the actions and body-parts described by the target words (to elicit visuomotor associations) all interfered with right-hand but not left-hand tapping rate. However, this motor interference was not affected differentially by hand-related stimuli. Thus, the results provide no support for proposals that body-part specific resources in cortical motor systems are shared between overt manual movements and meaning-related processing of words related to the hand.

The hemispheric asymmetry of solar activity during the last century and the solar dynamo

We believe the Babcock-Leighton process of poloidal field generation to be the main source of irregularity in the solar cycle. The random nature of this process may make the poloidal field in one hemisphere stronger than that in the other hemisphere at the end of a cycle. We expect this to induce an asymmetry in the next sunspot cycle. We look for evidence of this in the observational data and then model it theoretically with our dynamo code. Since actual polar field measurements exist only from the 1970s, we use the polar faculae number data recorded by Sheeley (1991, 2008) as a proxy of the polar field and estimate the hemispheric asymmetry of the polar field in different solar minima during the major part of the twentieth century. This asymmetry is found to have a reasonable correlation with the asymmetry of the next cycle. We then run our dynamo code by feeding information about this asymmetry at the successive minima and compare the results with observational data. We find that the theoretically computed asymmetries of different cycles compare favorably with the observational data, with the correlation coefficient being 0.73. Due to the coupling between the two hemispheres, any hemispheric asymmetry tends to get attenuated with time. The hemispheric asymmetry of a cycle either from observational data or from theoretical calculations statistically tends to be less than the asymmetry in the polar field (as inferred from the faculae data) in the preceding minimum. This reduction factor turns out to be 0.43 and 0.51 respectively in observational data and theoretical simulations.

Use of personal mobility devices for first-and-last mile travel: The Macquarie-Ryde trial

Electric-motored personal mobility devices (PMDs) are appearing on Australian roads. While legal to import and own, their use is typically illegal for adult riders within the road transport system. However, these devices could provide an answer to traffic congestion by getting people out of cars for short trips (“first-and-last mile” travel). City of Ryde council, Macquarie University, and Transport for NSW examined PMD use within the road transport system. Stage 1 of the project examined PMD use within a controlled pedestrian environment on the Macquarie University campus. Three PMD categories were used: one-wheelers (an electric unicycle, the Solowheel); two-wheelers (an electric scooter, the Egret); and three-wheelers (the Qugo). The two-wheeled PMD was most effective in terms of flexibility. In contrast, the three-wheeled PMD was most effective in terms of speed. One-wheeled PMD riders were very satisfied with their device, especially at speed, but significant training and practice was required. Two-wheeled PMD riders had less difficulty navigating through pedestrian precincts and favoured the manoeuvrability of the device as the relative narrowness of the two-wheeled PMD made it easier to use on a diversity of path widths. The usability of all PMDs was compromised by the weight of the devices, difficulties in ascending steeper gradients, portability, and parking. This was a limited trial, with a small number of participants and within a unique environment. However, agreement has been reached for a Stage 2 extension into the Macquarie Park business precinct for further real-world trials within a fully functional road transport system.