Maxwell E. Cooper; Luke A. Torre-Healy; Vincent J. Alentado; Samuel Cho; Michael P. Steinmetz; Edward C. Benzel; Thomas E. Mroz
Review of spine surgery literature between 2005 and 2014 to assess the reporting of patient outcomes by determining the variability of use of patient outcomes metrics in the following categories: pain and disability, patient satisfaction, readmission, and depression.
There has been a recent focus on the reporting of quality metrics associated with spine surgery outcomes. However, little consensus exists on the optimal metrics that should be used to measure spine surgery outcomes.
A PubMed search of all spine surgery manuscripts from January 2005 through December 2014 was performed. Linear regression analyses were performed on individual metrics as well as outcomes categories as a fraction of total papers reviewing surgical outcomes.
Outcomes reporting has increased significantly between January 1, 2005 and December 31, 2014 [175/2871 (6.1%) vs. 764/5603 (13.6%), respectively; P<0.001; R2=98.1%]. For the category of pain and disability reporting, Visual Analog Score demonstrated a statistically significant decrease in use from 2005 through 2014 [56/76 (73.7%) vs. 300/520 (57.7%), respectively; P<0.001], whereas Oswestry Disability Index increased significantly in use [19/76 (25.0%) vs. 182/520 (35.0%), respectively; P<0.001]. For quality of life, EuroQOL-5 Dimensions increased significantly in use between 2005 and 2014 [4/23 (17.4%) vs. 30/87 (34.5%), respectively; P<0.01]. In contrast, use of 36 Item Short Form Survey significantly decreased [19/23 (82.6%) vs. 57/87 (65.5%), respectively; P<0.01]. For depression, only the Zung Depression Scale underwent a significant increase in usage between 2005 and 2014 [0/0 (0%) vs. 7/13 (53.8%), respectively; P<0.01].
Although spine surgery outcome reporting has increased significantly over the past 10 years, there remains considerable heterogeneity in regards to individual outcomes metrics utilized. This heterogeneity makes it difficult to compare outcomes across studies and to accurately extrapolate outcomes to clinical practice.
Shalv P. Madhani; Brian J. Frankowski; Sang-Ho Ye; Greg W. Burgreen; William R. Wagner; Robert Kormos; Jonathan D’Cunha; William J. Federspiel
Antimicrobial Stewardship Practices Reported by California Hospitals Following New Legislative Requirements: Analysis of National Healthcare Safety Network Annual Survey Data, 2014-2015
Chronic posterior elbow soft tissue defects often require soft tissue reconstruction because of exposure of the underlying triceps tendon and proximal ulna. Current options for soft tissue coverage require sacrifice of a local muscle or microsurgery. The purpose of this study is to evaluate patient and surgical outcomes after reconstruction of small-sized to medium-sized (<50 cm2) posterior elbow defects with bipedicle advancement flaps. A retrospective chart review was performed for 3 patients who underwent posterior elbow reconstruction with bipedicle flaps. The etiology of the soft tissue elbow defect was chronic infected olecranon bursitis (n=2) and exposed olecranon plate after open fracture (n=1). Patient comorbidities included: diabetes, CREST (Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia) syndrome, and rheumatoid arthritis. The mean patient age at time of reconstruction was 44 years (39 to 51 y), and the mean area of soft tissue defect was 39.3 cm2 (24 to 54 cm2) after debridement of involved tissue. All patients had positive intraoperative cultures and were treated with culture-directed long-term intravenous antibiotics. There were no surgical complications or flap loss. All patients had reepithelialization of the donor site by postoperative week 8 and stable soft tissue coverage of the elbow after surgery at final follow-up with full preoperative elbow range of motion. This technique offers a simple, reliable solution for soft tissue coverage of the posterior elbow using excess local tissue for primary closure of posterior elbow wounds with minimal donor-site morbidity.
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We have a used X7 35mm Lens available for sale. This lens was used by a close partner (production company) for about a week before they decided to purchase the full lens kit (which was unavailable at the time they purchased).
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Michael Treacy: The Discipline of Market Leaders: Choose Your Customers, Narrow Your Focus, Dominate Your Market
Read this and then determine your institution's current "value discipline" -- and what it actually should be. Be honest! (*****)
November 29, 2013 in Affordability of Access, Capacity for Access, Conveneince of Access, Expense Accountability, From the Press, Learning Accountability, Links, Program Accountability, Revenue / Cost Pressure | Permalink | Comments (0)
The UNESCO-based International Association of Universities will convene its 14th General Conference on November 27, 2012 in San Juan, Puerto Rico. The conference is titled "Higher Education and the Global Agenda: Alternatives Paths to the Future." IAU has framed the conference with three important and timely thematic questions:
First, I’ll answer IAU's questions immediately below. Then I'll provide a rationale for one "alternative path to the future" based on creating an open, nonprofit, nongovernmental economic governance organization for the credentialing marketplace: the global Education Leadership Commons. The purpose of the global ELC would be to scale up educational justice and educational attainment by opening up the credentialing marketplace, which would require realigning economic rights and responsibilities among credentialers and their external investors – students/families, governments, donors, employers, and suppliers.
1. Higher education has long addressed the challenges facing humanity, but not at the scale and in the timeframe now expected.
2. Today's dominant funding model compensates credit hours attempted, not credentials awarded, and is out of synch with humanity’s expanding need for higher learning at lower costs and greater returns to all invested beneficiaries. Credentialed higher learning will have to become more affordable to both the expanding economic demographic of low-and middle-income students and to the governments and institutions that help financially support them.
3. Higher education will be internationalized, not so much by institutions attracting students from abroad, building campuses abroad, and offering study-abroad programs, as by adapting the technology-enabled “flattening” models for partnering and externally sourcing described a few years ago in Thomas Friedman’s “flat-world” account of globalization. New cross-boundary partnerships will emerge among educational institutions, governments, nongovernmental organizations, employers, and commercial suppliers.
On November 28, my dinner presentation to conference attendees will address all three IAU themes in more depth by drawing on arguments from my 2012 paper, "Is Education's Past Its 2050 Prologue?" The paper was published in conjunction with the 80th anniversary celebration of the University of North Carolina's School of Information and Library Science. The celebration concluded with an "Information Professionals 2050 Summit and Conference" on June 4-5, 2012. At the invitation of Dean Gary Marchionini, I wrote about and then discussed "education in 2050” during the June event.
Neither Dean Marchionini nor I would presume to predict the nature of education in 2050. We nevertheless agree that education is already under pressure to credential more people to higher levels of learning attainment. This pressure reflects the primary policy strategy in many modern nations for focusing education’s attention on preparing students to help advance and sustain social, economic, and environmental justice.
Many colleges and universities today still set their sights solely on becoming (or remaining) among the best in the world. Competition is desirable, but can be limiting at a time when humanity’s habitat and socioeconomic flash points evidence a collective need to focus higher education's attention on becoming best for the world – a phrase borrowed from Sister Candace Introcaso, president of La Roche College. That's why progressive policy leaders are asking educators to scale up educational attainment: the proportion of an adult population holding a trusted, postsecondary credential (degree or certificate). For example, President Obama's attainment goal is to scale up the attainment proportion from 40% to 60% in ten years, thereby enlarging the U.S. population of credentialed adults from around 80 million to over 120 million, a tall order. Many other countries have their own attainment proportion goals and timeframes.
Scaling up attainment proportions accordingly is at the heart of IAU’s theme 1, and arguably will remain the dominant thread in education policy worldwide. We must expand the attainment pool of postsecondary credentialed people not only as a proportion of population, but also in its scientific and technical expertise and its humanistic and civic habits of mind that nurture the mutual respect and cooperation so essential to addressing humanity’s grand challenges.
The attainment challenge is not only about scale and skills, but also about the interdependencies in and among its various dimensions, which are as complex as the interdependencies intrinsic to globalization and its challenges to humanity. Consider how the globalized economy sputters here and there and threatens havoc everywhere. Global warming continues apace, while the green economy wavers. Too many people suffer from the ravages of war, hunger, and other cruel injustices. Meanwhile, well-intentioned attempts by the U.N. and other organizations to advance and sustain social, economic, and environmental justice are too often stymied by the difficulty of balancing rights and responsibilities among the negotiating parties who are typically facing a tragedy of the commons in which special interests, intentionally or not, destroy or damage the value of a common good to the detriment of all of its economic beneficiaries.
Even the Internet/World Wide Web, an obvious common good that has spawned exponential growth in economic and social wealth, is not exempt from such contentious issues. A telecommunications giant, for example, might unilaterally attempt to favor the Internet traffic of its large customers to the detriment of other organizational and consumer traffic that flows through the Internet, thereby risking a tragedy of the Internet commons. The Internet Society was created to mitigate such risks, and has succeeded by governing open internetworking standards and the open processes used to advance them. This open, consensus-building governance model has protected the seminal democratic networking principle that all Internet traffic is created equal.
Likewise the core democratic principle that all people are created equal must become more personally actionable than ever in the form of affordable access to higher learning and quality-assured credentialing. We can't risk a tragedy of the learning and credentialing commons, because it is the joint public and private investment most likely to mitigate the challenges facing humanity. We need to focus on educational justice, if we are to make higher learning more affordable to the world's expanding economic demographic of low- and middle-income people. Meanwhile, public financial aid to students is shrinking in many parts of the world, while annual per-credential operating expenditures are not decreasing at most colleges and universities. The result is a three-way affordability conundrum: how to make credentialing processes more affordable to low- and middle-income students and also to the institutions and governments that support those students.
Humanity’s Grand Challenge: Expand and sustain social, economic, environmental, and educational justice.
The credentialing marketplace has become a common good – both a public and private good. It must be advanced and sustained as the delivery mechanism for educational justice and attainment at scale, which are essential to the advancement and sustainability of social, economic, and environmental justice. We must learn how to mitigate the risk of a tragedy of the credentialing commons while globally scaling up educational justice and attainment. Two Nobel Laureates in Economics and their work come to mind: Ronald Coase (1991 prize winner) and Elinor Ostrom (2009 prize winner who died in June, 2012).
Coase’s 1937 article, The Nature of the Firm, posited that “transaction costs” and the management friction they create accounted for the burgeoning size and overhead of the firms of the times. In our times, however, the Internet/Web has seriously diminished that friction and fueled globalization. Among the results are innovative, agile business models that rely on partnering and external sourcing to flatten overhead and bureaucracy, as illustrated by Thomas Friedman’s examples in his “flat-world” book. Traditional educational institutions, in contrast, continue to operate under financial models similar to the high overhead, bureaucratic, not so agile firms of the 20th century.
Elinor Ostrom’s prize-winning work on the “economic governance of the commons” raises intriguing possibilities for the economic governance of the credentialing commons. These possibilities deserve attention from both education’s internal economic beneficiaries and external investor beneficiaries – students, families, donors, governments, employers, and suppliers. In her focus on natural resource commons, Ostrom found that an open economic governance model designed to balance economic rights and responsibilities fairly among all economic beneficiary groups is the best bet for mitigating the risk of a tragedy of the commons. Neither government nor other special public or private interests should be favored over other economic beneficiary groups.
Open economic governance is already working outside of the domain of natural resources. The Internet Society described earlier is but one of many examples. Indeed, the Internet Society has been so successful that the Internet/Web continues to empower exponential growth in social and economic wealth – exactly what progressive policy leaders hope will result from scaling up educational justice and attainment. Perhaps the biggest barrier to scaling up attainment is the three-way affordability conundrum (see above), which is an economic issue directly related to educational justice. The economics of the current credentialing marketplace are working against scaling up educational justice and attainment.
Over the past two years, I have proposed and written about an open economic governance model for the credentialing marketplace. The model is described as the nonprofit, nongovernmental Education Leadership Commons in the already cited paper, "Is Education's Past Its 2050 Prologue?"
The paper includes ideas for how the ELC might be structured (along the lines of the successful Internet Society) to rebalance rights and responsibilities among credentialers and external investors in the credentialing marketplace – especially students and governments, among others. One such idea would have government commit to needs-tested financial aid (and/or a tax credit) in an amount projected annually from tax data, starting at birth. To remain eligible for such aid, a student would further have to submit at age 14 (or thereabouts), and periodically thereafter, to a constructivist, age-appropriate evaluation of basic communication fluencies and critical thinking skills – along the lines of OECD’s PISA and AHELO evaluations or other independent evaluations. Continuing eligibility would depend on re-submitting to an evaluation on schedule, but would not depend on any percentile ranking on the evaluation.
Any institution accepting a student’s financial aid would be obligated to report some to-be-determined universal high-level accountability metrics. For example, these two annualized ratios taken together could become an annual measure of credentialing productivity in peer groupings: 1) the ratio of credentials granted annually to annual unduplicated headcount, and 2) the ratio of annual operating expenses to credentials granted annually.
Government and other research centers would have access to the aggregated, privacy-secured data from the above protocols, and students would control their personal data (“my data”). The paper includes a matrix of rights and responsibilities that further illuminates the basic idea that earned, needs-tested financial aid and earned tax credits could be an economic lever for expanding and sustaining educational justice and educational attainment.
The paper also includes examples of how the ELC might be structured and openly operated to create a more open and agile credentialing marketplace.
Most nations expect the credentialing marketplace to be neither solely a private good nor solely a (universally free) public good. The former would leave educational justice unfulfilled and, thus, educational attainment goals unmet. The latter would be financially untenable in most nations, and would be questionable policy, even if affordable.
Those who doubt my policy comment above should reflect on Kris Kristofferson's lyric from the 1960s that "freedom's just another word for nothin' left to lose." With rights must come responsibilities, and vice versa. That's why credentialing's scalability and funding models must be harmonized, if educational justice and educational attainment are to proceed forward hand in hand to help meet humanity's major challenges.
August 03, 2012 in Affordability of Access, Books, Reports & Speeches, Capacity for Access, Conveneince of Access, Expense Accountability, Learning Accountability, Program Accountability, Revenue / Cost Pressure | Permalink | Comments (0)
I recently participated as a panelist in a live chat sponsored by The Guardian in the UK. We panelists interacted with each other and a larger audience to shed some light on what higher education needs from its leaders. Here's a link to the overall chat, and below are some of my summary comments about leadership, today and tomorrow, for higher education.
2) Today's progressive policy leaders are honoring Well's warning by asking educators to scale up educational attainment: the proportion of (selected) adult populations holding a trusted, postsecondary credential (degree or certificate). For example, President Obama's attainment goal is to move the attainment needle from 40% to 60% in ten years.
3) Policy leaders, in essence, are equating attainment with the democratic principle of equal opportunity and expecting educational opportunitiesto become more open (affordably accessible) and to lead to increases in attainment proportions.
4) Policy leaders believe scalable educational attainment to be critical to advancing and sustaining social, economic, and environmental justice, thereby to improving humanity's prospects for survival.
5) Economic demographic trends broadly imply that the proportion of low- and middle-income students in the education pipeline is increasing.
6) The economic demographic dimension of scaling up attainment exacerbates an already widespread three-way affordability conundrum: the need to lower the costs of attainment not only to low- and middle-class students, but also to the institutions and governments that support them. That's why "widening participation" is shorthand in the UK for what I'm calling here "scaling attainment."
7) Educational attainment priorities for higher education are increasingly boundary-crossing, collective (macro) goals that are not institutional (micro) in nature. Institutionally improving upon student-success metrics, such as various measures of persistence that include credentialing rates, is necessary to any increase in aggregate attainment proportions, but not sufficient. Credentialing rates a priori are not the same as attainment proportions!
8) Future leaders accordingly will need not only to be effective within current higher education service and organizational models, but also to have an achievable vision for leading the way across the boundaries that have traditionally demarcated various geopolitical and education sectors. New forms of collaboration and partnerships will accordingly be required.
9) Leadership experience, both inside the academy and outside the academy, can be useful, but no combination of such experiences will be sufficient to scale up, for example, national attainment proportions in large populations. Vision and a deeper understanding of the micro/macro challenges inherent in scaling up attainment are key necessities, along with the ability to attract internal and external collaborators to a more inclusively formulated vision of individual and collective success.
10) The globalized economy and its new enabling technologies interconnect everyone and everything. New forms of collaborative leadership will be required if purposeful economic governance mechanisms are to be developed in support of scaling up and sustaining educational attainment, while managing three-way affordability challenges for of all its stakeholders - educational institutions, students/families, governments, employers, and other sources of funding and support for education.
11) Unlike education, other sectors of the globalized economy have improved productivity with innovations and service redesigns enabled by technology. Education leaders will have to come to grips with this reality in order to create sustainable educational attainment models.
12) Traditional institutional leadership models and metrics of excellence, such as those practiced at Oxford, Harvard, and other universities, will persist and remain important. Education will set and maintain the pace in H.G. Wells' "race between education and catastrophe," however, only if new forms of leadership are focused on scaling attainment, affordability, and accountability. The levers of shared digital resources, communications, and collaborations are awaiting such leadership.
May 23, 2012 in Affordability of Access, Capacity for Access, Conveneince of Access, Expense Accountability, Learning Accountability, Links, Program Accountability, Revenue / Cost Pressure | Permalink | Comments (0)
Mike Mathews (my colleague at SunGard Higher Education) has asked "What if Steve Jobs had been an educator." In his paper, Mike uses the now familiar applications based on the “Global Positioning System” (GPS) technology as a metaphor for imagining an “Educational Positioning System” (EPS) enabling a suite of integrated technologies and massively interconnected data that would help deliver many benefits that are easy to imagine in analogy to the GPS. I've been arguing that many of these same benefits would accrue to the"Education Leadership Commons" described in"Adaptive Leadership for the Completions Priority: Establishing an Education Leadership Commons." Mike, I, and others are working to create the ELC from an adaptive economic governance model to make the current completions marketplace more portable, transparent, productive, and mutually affordable and beneficial to education providers and their external investors, especially to their students. We want the completions marketplace to feature a rich set of apps and data based on a universally accessible Educational Positioning System.
October 31, 2011 in Affordability of Access, Capacity for Access, Conveneince of Access, Expense Accountability, Learning Accountability, Links, Program Accountability, Revenue / Cost Pressure, Weblogs | Permalink | Comments (0)
I'm pleased to be providing leadership for starting up the Education Leadership Commons. The ELC is currently an embryonic movement dedicated to transforming education with the end-goal of enabling the scale-up of the proportion of the population holding "completions" (accredited postsecondary degrees and certificates). There's more, however. Simultaneous with scaling up the proportion of completions, investments in completions need to become mutually affordable both to education providers as expenses and to external investors in completions -- students/families, governments, donors, employers, and suppliers. In this context, my employer, SunGard Higher Education, is a "supplier" and is supporting the ELC start-up process. The intent of the start-up process, however, is to evolve the ELC into a nonprofit, non-governmental economic governance organization that does for completions what the Internet Society has done for the Internet by enabling exponential growth both in Internet traffic and in the creation of new economic and social wealth. Like the Internet, the completions production process is a common good and, like the Internet, should be economically governed to the mutual benefit of all economic beneficiaries. Not to do so is to risk a "tragedy of the commons" in which a common good is sacrificed to become, at best, primarily a government good or primarily a private good. At worst, humanity might lose the ongoing race between education and catastrophe (to paraphrase H. G. Well's distressing thought from the 1920s about the history of humanity).
Please peruse the Prospectus for a Global Education Leadership Commons, and post your comments here. The redesign of education is long overdue, and we must find find a win-win transformational strategy, rather than a strategy that keeps education providers and their external investors at unproductive odds.
July 15, 2011 in Affordability of Access, Capacity for Access, Conveneince of Access, Expense Accountability, Learning Accountability, Program Accountability, Revenue / Cost Pressure | Permalink | Comments (0)
My latest publication, "Facing Education's Mounting Challenges with Collaboration and IT," was published as a Research Bulletin from the EDUCAUSE Center for Applied Research (ECAR) on April 12, 2011.
The paper calls for new forms of collaboration at several levels, from collaboration between the CIO and other C-level officers on campus to economic-governance collaboration among education providers and education's "external investors" (students/families, governments, donors, employers, suppliers, etc.). The need for innovative forms of collaboration is fueled by the "elephant in education's room:" the "completions priority" and its multiple, complex co-dependencies, which are discussed in the paper. The paper also posits earned, need-based, promissory grants to students as the basis (in the U.S.) for restructuring Federal funding for higher education in order to provide leverage for a new economic governance collaboration at all sectors of the education marketplace and geopolitics.
By the way, I was on the EDUCAUSE Board when ECAR was created in the 1990s and am pleased to have now published my first paper under the aegis of ECAR. Membership in ECAR is by organizational subscription, and there are several options for subscribing.
April 15, 2011 in Affordability of Access, Books, Reports & Speeches, Capacity for Access, Conveneince of Access, Expense Accountability, Learning Accountability, Links, Program Accountability, Revenue / Cost Pressure | Permalink | Comments (0)
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