Achieving Value in Spine Surgery: 10 Major Cost Contributors.

STUDY DESIGN: Narrative Review. OBJECTIVES: The increasing cost of healthcare overall and for spine surgery, coupled with the growing burden of spine-related disease and rising demand have necessitated a shift in practice standards with a new emphasis on value-based care. Despite multiple attempts to reconcile the discrepancy between national recommendations for appropriate use and the patterns of use employed in clinical practice, resources continue to be overused-often in the absence of any demonstrable clinical benefit. The following discussion illustrates 10 areas for further research and quality improvement. METHODS: We present a narrative review of the literature regarding 10 features in spine surgery which are characterized by substantial disproportionate costs and minimal-if any-clear benefit. Discussion items were generated from a service-wide poll; topics mentioned with great frequency or emphasis were considered. Items are not listed in hierarchical order, nor is the list comprehensive. RESULTS: We describe the cost and clinical data for the following 10 items: Over-referral, Over-imaging & Overdiagnosis; Advanced Imaging for Low Back Pain; Advanced imaging for C-Spine Clearance; Advanced Imaging for Other Spinal Trauma; Neuromonitoring for Cervical Spine; Neuromonitoring for Lumbar Spine/Single-Level Surgery; Bracing & Spinal Orthotics; Biologics; Robotic Assistance; Unnecessary perioperative testing. CONCLUSIONS: In the pursuit of value in spine surgery we must define what quality is, and what costs we are willing to pay for each theoretical unit of quality. We illustrate 10 areas for future research and quality improvement initiatives, which are at present overpriced and underbeneficial

Sheldon Spectrum and the Plankton Paradox: Two Sides of the Same Coin : A trait-based plankton size-spectrum model

The Sheldon spectrum describes a remarkable regularity in aquatic ecosystems: the biomass density as a function of logarithmic body mass is approximately constant over many orders of magnitude. While size-spectrum models have explained this phenomenon for assemblages of multicellular organisms, this paper introduces a species-resolved size-spectrum model to explain the phenomenon in unicellular plankton. A Sheldon spectrum spanning the cell-size range of unicellular plankton necessarily consists of a large number of coexisting species covering a wide range of characteristic sizes. The coexistence of many phytoplankton species feeding on a small number of resources is known as the Paradox of the Plankton. Our model resolves the paradox by showing that coexistence is facilitated by the allometric scaling of four physiological rates. Two of the allometries have empirical support, the remaining two emerge from predator-prey interactions exactly when the abundances follow a Sheldon spectrum. Our plankton model is a scale-invariant trait-based size-spectrum model: it describes the abundance of phyto- and zooplankton cells as a function of both size and species trait (the maximal size before cell division). It incorporates growth due to resource consumption and predation on smaller cells, death due to predation, and a flexible cell division process. We give analytic solutions at steady state for both the within-species size distributions and the relative abundances across species

Progress and prospects for event tourism research

This paper examines event tourism as a field of study and area of professional practice updating the previous review article published in 2008. In this substantially extended review, a deeper analysis of the field’s evolution and development is presented, charting the growth of the literature, focusing both chronologically and thematically. A framework for understanding and creating knowledge about events and tourism is presented, forming the basis which signposts established research themes and concepts and outlines future directions for research. In addition, the review article focuses on constraining and propelling forces, ontological advances, contributions from key journals, and emerging themes and issues. It also presents a roadmap for research activity in event tourism

Digital Chinese Whispers: Death Threats and Rumors Inside China’s Online Marketplace of Ideas

The Chinese internet is a wonderfully raucous and interesting place. It has greatly expanded the scope of public discourse and activity, despite the party-state’s extensive censorship regime. Not surprisingly, the world’s largest cyber-community exhibits tremendous depth and diversity: progressive cyber-activists and professional agitators; navel-gazing starlets and steam-venting gamers; mundane infotainment and the banal waxing of quotidian life; and, sadly, dark corners of fear, hatred and paranoia. It’s all there; it simply depends on where one looks. Like other technologies before it, the internet is normatively neutral, and thus can be put to good, bad and anodyne uses: individuals—not tools—shape the contours of different societies and their cultures

Whose Peoples’ Games?

With the self-professed slogans of the Green Olympics, High-tech Olympics and the People’s Olympics, the Beijing Organizing Committee for the Olympic Games (BOCOG) should have anticipated criticism. It left nothing to chance in hosting the world’s athletes and spectators—gleaming stadia, smiling faces and blue skies: all as ordered. But as many Western observers noted, BOCOG forgot to invite the Chinese people—with security guards, CCTV cameras and robot-like volunteers ensuring little spontaneity or popular emotion at the so-called People’s Games. In the wake of the unprecedented media coverage of China’s global “coming out party,” few have paused to consider who and what were on display at Beijing 2008. In the pomp and pageantry of the most expensive Olympic Games in history, whose image did the organizers project before the world’s probing gaze? In promoting the Olympic Games and Olympic Movement, BOCOG promised to “organize diversified cultural and educational programs to cater to the needs of the people,” while encouraging “the widest participation of the people in the preparation of the Games” in order to “increase the cohesion and pride of the Chinese nation.” But a closer look at the preparations and staging of the Games reveals deep strains in the very fabric of the Chinese nation, not only the fraying threads of class, place, and gender, which have been often commented on, but also of ethnicity