Reply

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147110/1/pmr2539.pd

Read the Paper! Re: Cheng/Ho Point/Counterpoint on Electrodiagnostic Testing Before Surgery for Spinal Stenosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147193/1/pmr2340.pd

Controlling the Midfield: Treating Patients With Chronic Pain Using Alternative Payment Models

The entire American health care system is turning upside down, except for the parts that aren’t— yet. For physiatrists who manage pain problems, the future is complex. The usual challenge of treating these devastating and costly problems that cannot be measured physiologically is compounded by the requirement to do so in a health care system that doesn’t know what it wants to be yet. Payment, regulation, and the very structure of practice are changing at a pace that is halting and unpredictable. Nonetheless, knowledge about some structures is necessary, and some themes almost certainly emerge. I propose that the role of the pain physiatrist is best understood through a soccer analogy. Whereas the casual spectator of the past might note the goals scored by surgical colleagues and shots missed by primary care partners, sophisticated health care systems of the future will learn that the pain game is won by creating a strong physiatry midfield. Physiatrists can reach to the backfield to help primary care with tough cases, send accurate referrals to surgeons, and reorganize the team when chronic pain complicates the situation. Current and emerging payment structures include insurance from government, employers, or individuals. Although the rules may change, certain trends appear to occur: Individuals will be making more choices, deductibles will increase, narrow groups of practitioners will work together, pricing will become important, and the burden on primary care colleagues will increase. Implications of each of these trends on pain medicine and specific strategy examples are addressed. A general concept emerges that, although procedure‐ and activity‐based practice is still important, pain physiatrists can best prepare for the future by leading programs that create value for their health care system.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147152/1/pmr2s248.pd

Early Cretaceous biogeographic and oceanographic synthesis of Leg 123 (off Northwestern Australia)

Biogeographic observations made by Leg 123 shipboard paleontologists for Lower Cretaceous nannofossils, foraminifers, radiolarians, belemnites, and inoceramids are combined in this chapter to evaluate the paleoceanographic history of the northwestern Australian margin and adjacent basins. Each fossil group is characterized at specific intervals of Cretaceous time and compared with data from Tethyan and Southern Hemisphere high-latitude localities. Special attention is given to the biogeographic observations made for the Falkland Plateau (DSDP Legs 36 and 71) and the Weddell Sea (ODP Leg 113). Both areas have yielded valuable Lower Cretaceous fossil records of the circumantarctic high latitudes. In general, the Neocomian fossil record from DSDP and ODP sites off northwestern Australia has important southern high-latitude affinities and weak Tethyan influence. The same is true for the pelagic lithofacies: radiolarian chert and/or nannofossil limestone, dominant in the Tethyan Lower Cretaceous, are minor lithologies in the Exmouth-Argo sites. These observations, together with the young age of the Argo crust and plate tectonic considerations, suggest that the Argo Basin was not part of the Tethys Realm. The biogeography of the Neocomian radiolarian and nannofossil assemblages suggests opening of a seaway during the Berriasian that connected the circumantarctic area with the Argo Basin, which resulted in the influx of southern high-latitude waters. This conclusion constrains the initial fit and break-up history of Gondwana. Our results favor the loose fit of the western Australian margin with southeast India by Ricou et al. (1990), which accounts for a deeper water connection with the Weddell-Mozambique basins via drowned marginal plateaus as early as the Berriasian. In fits of the du Toit-type (1937), India would remain attached to Antarctica, at least until the late Valanginian, making such a connection impossible. After the Barremian, increasing Tethyan influence is evident in all fossil groups, although southern high-latitude taxa are still present. Biogeographic domains, such as the southern extension of Nannoconus and Ticinella suggest paleolatitudes of about 50°S for the Exmouth-Argo area. Alternatively, if paleolatitudes of about 35° are accepted, these biogeographic limits were displaced northward at least 15° along Australia in comparison to the southern Atlantic. In this case, the proto-circumantarctic current was deflected northward into an eastern boundary current off Australia and carried circumantarctic cold water into the middle latitudes. Late Aptian/early Albian time is characterized by mixing of Tethyan and southern faunal elements and a significant gradient in Albian surface-water temperatures over 10° latitude along the Australian margin, as indicated by planktonic foraminifers. Both phenomena may be indicative of convergence of temperate and antarctic waters near the Australian margin. High fertility conditions, reflected by radiolarian cherts, are suggestive of coastal upwelling during that time

Chronic Pain: Cure It First, Treat It Second

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147056/1/pmr2s324.pd

Female babies and risk-aversion : causal evidence from hospital wards

Using ultrasound scan data from paediatric hospitals, and the exogenous ‘shock’ of learning the gender of an unborn baby, the paper documents the first causal evidence that offspring gender affects adult risk-aversion. On a standard Holt-Laury criterion, parents of daughters, whether unborn or recently born, become almost twice as risk-averse as parents of sons. The study demonstrates this in longitudinal and cross-sectional data, for fathers and mothers, for babies in the womb and new-born children, and in a West European nation and East European nation. These findings may eventually aid our understanding of risky health behaviors and gender inequalities