Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic

Objective: To determine the level of agreement between a telehealth and in-person assessment of a representative sample of patients with chronic musculoskeletal conditions referred to an advanced-practice physiotherapy screening clinic. Design: Repeated-measures study design. Participants: 42 patients referred to the Neurosurgical & Orthopaedic Physiotherapy Screening Clinic (Queensland, Australia) for assessment of their chronic lumbar spine, knee or shoulder condition. Intervention: Participants underwent two consecutive assessments by different physiotherapists within a single clinic session. In-person assessments were conducted as per standard clinical practice. Telehealth assessments took place remotely via videoconferencing. Six Musculoskeletal Physiotherapists were paired together to perform both assessment types. Main outcome measures: Clinical management decisions including (i) recommended management pathways, (ii) referral to allied health professions, (iii) clinical diagnostics, and (iv) requirement for further investigations were compared using reliability and agreement statistics. Results: There was substantial agreement (83.3%; 35/42 cases) between in-person and telehealth assessments for recommended management pathways. Moderate to near perfect agreement (AC1 = 0.58–0.9) was reached for referral to individual allied health professionals. Diagnostic agreement was 83.3% between the two delivery mediums, whilst there was substantial agreement (81%; AC1 = 0.74) when requesting further investigations. Overall, participants were satisfied with the telehealth assessment. Conclusion: There is a high level of agreement between telehealth and in-person assessments with respect to clinical management decisions and diagnosis of patients with chronic musculoskeletal conditions managed in an advanced-practice physiotherapy screening clinic. Telehealth can be considered as a viable and effective medium to assess those patients who are unable to attend these services in person

Matters (Un-)Becoming: Conversions in Epiphanius of Salamis

In this essay, I reconsider early Christian conversion through the writings of Epiphanius of Salamis (d. 404 C.E.). Far from the notion of conversion as an interior movement of soul (familiar from Augustine, A.D. Nock, and William James), Epiphanius shows us a variety of conversions—from lay to clergy, from orthodox to heretic, and from Jew to Christian—in the social and cultural context of empire. Epiphanius can help us reconsider late-ancient conversion not as the internal reorientation to a “new life,” but instead the exteriorized management of status and difference. As Epiphanius crafts conversion as the site of masterful intervention, he also conjures the failure of control, the blurring of boundaries, and collapse of frontiers that haunts the imperial Christian imagination

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

Background: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service. Methods: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure. Results: Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17–6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01–1.77) per 10/100 point score increase, p = 0.046). Conclusions: A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.</p

Responsible reconstruction: The architect's role

This paper investigates the role of the architect in post-disaster reconstruction and questions their ability to facilitate per- manent building solutions. There is an ever-increasing population of refugees and internally displaced persons due to disasters and conflicts who have a basic need for shelter. To date, housing solutions for such people has tended to focus on short-term, temporary shelter solutions that have been largely unsuccessful. This increasing demand for shelter has led to an emerging group of architects skilled in post-disaster reconstruction. These architects acknowledge that shelter is critical to survival, but believe architects should focus on rebuilding in a manner that is quick, durable but permanent. They believe that an architect skilled in post-disaster reconstruction can produce solutions that meet the requirement of the emergency phase, through to semi-permanent and even permanent homes, without wasting time and money on interim shelters. Case Study Research was used to examine and evaluate the assistance provided by Emergency Architects Australia (EAA) to the Kei Gold community in the Solomon Islands after the 2007 earthquake and tsunami. The results indicate that an architect’s response to a disaster must go beyond providing temporary shelter; they must create permanent building solutions that respond to the site and the culture while servicing the needs of the communi- ty. The vernacular reconstruction methods implemented by EAA in Kei Gold Village have been successful in develop- ing permanent housing solutions. Further research and development is required to gain a broader understanding of the role of the architect in disasters of varying scales and typologies

Penitential Discipline in the First Three Centuries

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Essays in Applied Microeconomics

This dissertation is composed of three chapters addressing the economics of health, discrimination, and inequality.The first chapter examines the roles of the Affordable Care Act (ACA) and employer spousal coverage made possible by same-sex marriage in increasing health insurance coverage for same-sex couples in the United States. It uses data from the American Community Survey in a difference-in-differences model on same-sex couples in ACA Medicaid expansion states to determine if people who did not have access to legal same-sex marriage at the time of the ACA had larger gains in insurance coverage post-ACA than those who already had access to marriage. I find a 1.8pp larger increase in Medicaid coverage and a 3.5pp larger increase in overall coverage in late gay marriage states. These differences are the combined effects of the initial differential response to the ACA and the subsequent direct response to same-sex marriage passage in the post period. When I directly control for same-sex marriage passage, I find a 2.8pp larger increase in Medicaid and suggestive evidence for increased crowd-out of employer coverage in late gay marriage states.The second chapter explores the link between homophobic attitudes and the wage gap between men in same-sex couples and men in opposite-sex couples in the US. I use average responses to General Social Survey questions to create a state-year level prejudice index and show that it has a positive relationship with the wage gap. An increase of one standard deviation in the homophobia index is associated with a 4% wage penalty for men in same-sex relationships.In the third chapter, we examine taxation of diapers, usually seen as an inelastic health product, and find substantial income heterogeneity in responsiveness to taxes using retail scanner data. Exploiting changes to sales tax exemptions for diapers in New York and Connecticut, we find that diaper sales rise by 5.4% in low-income areas when taxes are removed, accompanied by reduced spending on children's pain medications. These results imply that sales tax exemptions for diapers can have positive spillover effects on health and well-being

An introduction to the Old Testament in Greek

New Yorkxiii, 626 p.; 23 c