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To examine differences in surgical practices between salaried and fee-for-service (FFS) surgeons for two common degenerative spine conditions. Surgeons may offer different treatments for similar conditions on the basis of their compensation mechanism.
The study assessed the practices of 63 spine surgeons across eight Canadian provinces (39 FFS surgeons and 24 salaried) who performed surgery for two lumbar conditions: stable spinal stenosis and degenerative spondylolisthesis. The study included a multicenter, ambispective review of consecutive spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network registry between October 2012 and July 2018. The primary outcome was the difference in type of procedures performed between the two groups. Secondary study variables included surgical characteristics, baseline patient factors, and patient-reported outcome.
For stable spinal stenosis (n = 2234), salaried surgeons performed statistically fewer uninstrumented fusion (p < 0.05) than FFS surgeons. For degenerative spondylolisthesis (n = 1292), salaried surgeons performed significantly more instrumentation plus interbody fusions (p < 0.05). There were no statistical differences in patient-reported outcomes between the two groups.
Surgeon compensation was associated with different approaches to stable lumbar spinal stenosis and degenerative lumbar spondylolisthesis. Salaried surgeons chose a more conservative approach to spinal stenosis and a more aggressive approach to degenerative spondylolisthesis, which highlights that remuneration is likely a minor determinant in the differences in practice of spinal surgery in Canada. Further research is needed to further elucidate which variables, other than patient demographics and financial incentives, influence surgical decision-making.
The evidence of funerary archaeology, historical sources and poetry has been used to define a ‘heroic warrior ethos’ across Northern Europe during the first millennium AD. In northern Britain, burials of later prehistoric to early medieval date are limited, as are historical and literary sources. There is, however, a rich sculptural corpus, to which a newly discovered monolith with an image of a warrior can now be added. Comparative analysis reveals a materialisation of a martial ideology on carved stone monuments, probably associated with elite cemeteries, highlighting a regional expression of the warrior ethos in late Roman and post-Roman Europe.
Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. In a public healthcare system, wait times to see spine specialists and eventually access surgical treatment for CSM can be substantial. The goals of this study were to determine consultation wait times (CWT) and surgical wait times (SWT), and identify predictors of wait time length. Methods: Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective and observational CSM study from March 2015 to July 2017 were included. A data-splitting technique was used to develop and internally validate multivariable models of potential predictors. Results: A CSORN query returned 264 CSM patients for CWT. The median was 46 days. There were 31% mild, 35% moderate, and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups; 207 patients underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference in SWT between mild/moderate and severe groups. Short symptom duration, less pain, lower BMI, and lower physical component score of SF-12 were predictive of shorter CWT. Only baseline pain and medication duration were predictive of SWT. Both CWT and SWT were shorter compared to a concurrent cohort of lumbar stenosis patients (p <0.001). Conclusions: Patients with shorter duration (either symptoms or medication) and less neck pain waited less to see a spine specialist in Canada and to undergo surgical treatment. This study highlights some of the obstacles to overcome in expedited care for this patient population.
The polarization characteristics of celestial radio signals are a major part of the observable nature of the radiation. Stokes polarimeters, instruments for measuring the complete polarization properties of radiation, are usually narrowband devices in order to minimise depolarization effects originating in the source or in the medium through which the radiation propagates. To measure the broadband polarization behaviour of a source, a Stokes polarimeter-spectrometer is required. Such an instrument allows the frequency dependence of each Stokes parameter to be deduced, making it possible to apply corrections to each parameter to account for known forms of polarization distortion (e.g. Faraday rotation). It is also possible to remove delay distortion from impulsive sources such as pulsars by processing the spectrometer data according to the usual de-dispersion algorithms. In some studies observation of distortion phenomena may be the major aim and a polarimeter spectrometer greatly facilitates measurements of these effects.
Previous research on the catastrophic decline of the Gyps species complex has identified diclofenac, a non-steroidal anti-inflammatory drug administered to livestock, as the primary cause. Large-scale climatic phenomena, such as ENSO-induced drought, however have not been examined. Based on time series analysis of annual count data, 1996–2005, we provide evidence that ENSO synchronised population dynamics throughout western Rajasthan. Here, we ask whether El Niño Southern Oscillation (ENSO) can also explain the population dynamics of the Critically Endangered Indian Vulture Gyps indicus. We attribute this impact largely to two La Niña events, including the major event spanning 1999. We also examine between-village variation in resident vulture populations. Our results suggest that in several villages, Indian Vulture populations may have been partially buffered from the negative effects of drought when compared to other villages in the study. Finally, we discuss potential causes of buffering in these villages.
This study follows on from previous research at Perth, Scotland, in which we dated carbonized food residues removed from the external surface of rim sherds of cooking pots of London Sandy Shellyware pottery (Museum of London Pottery Fabric Code SSW). The 15 residues that were dated produced 14C ages between 910 ± 35 and 1085 ± 40 BP. We have now carried out radiocarbon measurements on similar residues from the same fabric obtained from the Billingsgate excavations in London and the Bryggen excavations in Bergen, Norway. The London and Bergen measurements gave age ranges of 905 ± 35 to 1115 ± 35 BP and 920 ± 35 to 1055 ± 35 BP, respectively, both very similar to the Perth age range. The measurements at each site are in agreement with our Bayesian model assumption that they belong to a single phase of activity. The model estimates the introduction of London Sandy Shellyware in London to cal AD 820–1020, in Perth to cal AD 930–1020, and in Bergen to cal AD 980–1030 (95% probability). Further modeling predicts that it fell out of use in the reverse order.
The radiocarbon results (and Bayesian modeling) of 15 samples of carbonized food residues removed from the external surface of rim sherds of cooking pots indicate that shellyware pottery first appeared in Perth, Scotland, around cal AD 910–1020 (95% probability) and that it had disappeared by cal AD 1020–1140 (95% probability). Previously, it had been suggested that this pottery could not date to before AD 1150. These data, together with 14C analyses carried out on leather artifacts and a sample of wattle from a ditch lining, also demonstrate that there was occupation in Perth about 100 yr or more prior to the granting of royal burgh status to Perth in the 1120s.
Donna Cross, Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845 email@example.com or, firstname.lastname@example.org,
Margaret Hall, Centre for Public Health, School of Nursing and Public Health, Edith Cowan University, 100 Joondalup Drive, Joondalup, Western Australia 6027, email@example.com,
Greg Hamilton, Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845, firstname.lastname@example.org,
Yolanda Pintabona, School of Psychology, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845, email@example.com,
Erin Erceg, Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845, firstname.lastname@example.org
Impetus for the Friendly Schools intervention study
In Australia, approximately 1 in 6 school students reports being bullied at least once a week, and 1 in 20 reports bullying others in the past 6 months (Rigby, 1997; Zubrick et al., 1997). Slee and Rigby (1993; Slee, 1995) found that while most of these episodes of bullying last for a day or two, 17% last for 6 months or more. Australian primary-school children of both genders report being bullied more often than secondary-school students, with more boys than girls bullying others and being bullied (Rigby and Slee, 1991; Rigby, 1997; Rigby and Slee, 1998).
Despite Australian schools' increasing need systematically to address bullying, prior to 1999 no system-level, evidence-based recommendations or state curriculum materials to help to reduce bullying were available. Many school staff reported that they were unsure of the effectiveness of the strategies they utilised, and often did not know what actions could be taken at a whole-school level to reduce, or prevent, the harm from student bullying.
In response to this situation, in 1999, the Curtin University, Western Australian Centre for Health Promotion Research, applied for and received funding extensively to review and synthesise international published empirical and theoretical evidence of successful school-based strategies to reduce the harm experienced by children from being bullied or bullying others. This systematic review provided a set of ‘successful’ practice principles and exemplar case studies to develop a whole-school approach to reduce bullying.
There exists limited empirical evidence of the effectiveness of universal school-based interventions to reduce or prevent children's bullying. The Friendly Schools project was a 3-year longitudinal randomised control trial designed to determine the efficacy of a universal holistic intervention to prevent or reduce bullying among primary school children. The trial involved 1968 Western Australian children, their parents and their teachers. This paper discusses the components of the Friendly Schools program, and how empirical, theoretical and “promising” mechanisms of change (mediators) were operationalised to develop a whole-of-school approach to reduce bullying. This paper concludes that further research is needed to determine empirically: (a) which mechanisms of change mediate improvements in children's bullying behaviour and mental health status and (b) the relative contribution of the various components of a whole-of-school approach to bullying prevention and reduction in children.
The Large Magellanic Cloud (LMC) and Small Magellanic Cloud (SMC) have been searched for radio pulsars using the 64-m Parkes radiotelescope. The search has resulted in the discovery of four pulsars. Observed dispersion measures to each suggest that three lie in the Clouds (two in the LMC, one in the SMC) and that the fourth, which was found in the direction of the LMC, is a foreground object belonging to the galactic pulsar population.
From time to time one meets with the opinion, or with expressions and general phrases indicating the unavowed opinion, that “idiopathic” epilepsy results from a toxæmic state,—that is to say, that epilepsy the disease is caused by poisons circulating in the blood; or less positively that epilepsy the paroxysm is determined, the attack precipitated, by the transient presence in the blood of such poisons; and in both cases the unexpressed idea seems to be that these poisons get there, in the manner of other auto-intoxicants, by reason of the inefficient performance of the digestive function in some respect.
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