Parallel-arm randomized controlled trial.
To assess the effectiveness of an enhanced video education session highlighting risks of opioid utilization on longterm opioid utilization after spine ...surgery.
Long-term opioid use occurs in more than half of patients undergoing spine surgery and strategies to reduce this use are needed.
Patients undergoing spine surgery at Brooke Army Medical Center between July 2015 and February 2017 were recruited at their preoperative appointment, receiving the singlesession interactive video education or control at that same appointment. Opioid utilization was tracked for the full year after surgery from the Pharmacy Data Transaction Service of the Military Health System Data Repository. Self-reported pain also collected weekly for 1 and at 6months.
A total of 120 participants (40 women, 33.3%) with a mean age of 45.9 ± 10.6 years were randomized 1:1 to the enhanced education and usual care control (60 per group). In the year following surgery the cohort had a mean 5.1 (standard deviation SD 5.9) unique prescription fills, mean total days' supply was 88.3 (SD 134.9), and mean cumulative morphine milligrams equivalents per participant was 4193.0 (SD 12,187.9) within the year after surgery, with no significant differences in any opioid use measures between groups. Twelve individuals in the standard care group and 13 in the enhanced education group were classified with having long-term opioid utilization.
The video education session did not influence opioid use after spine surgery compared to the usual care control. There was no significant difference in individuals classified as long-term opioid users after surgery based on the intervention group. Prior opioid use was a strong predictor of future opioid use in this cohort. Strategies to improve education engagement, understanding, and decision- making continue to be of high importance for mitigating risk of long-term opioid use after spine surgery.Level of Evidence: 1.
By contrasting the uses of image-as-evidence and documentary-as-witness, this report challenges some of the maxims of documentary film studies and exposes the ways in which different forms of ...audiovisual media construct distant conflict. More specifically, the report analyzes a purposive case selection of videos/films related to the Syrian uprising: the first set of visual data includes a montage of 13 YouTube videos claiming to show the aftereffects of the 21 August 2013 chemical weapons attack in Syria; the visual analysis in section two centers upon a selection of 15 short documentary films produced by the Syrian Abounaddara Collective. Theoretically, the study advances the value of witnessing in the re-envisioning of documentary film. My research demonstrates the relative weakness of both legalistic and journalistic approaches to depicting war that treat visual material primarily as recorded fact or evidence. In its place, the report advances a new form of documentary with a higher degree of interpretive acumen based on the "emergency cinema" model developed in Syria -- what I term "documentary-as-witness."
text
For a considerable time, the efficiency of planar antennas at high frequency has failed to reach its full potential. Since the planar antenna is an important element in an MMIC transceiver system, ...this poses a major problem. Due to the nature of the electromagnetic environment the antenna operates in, a large amount of the propagating radiation is coupled into the substrate meaning that only around forty percent efficiency is achieved, especially at millimetre wave frequencies. To improve this situation, methods to control the propagation of electromagnetic radiation from planar antennas is being sought. One method is to use a periodic dielectric structure positioned beneath the radiating antenna to act as a reflector. In this work, the periodic dielectric is a woodpile three-dimensional photonic crystal, fabricated using high resistivity silicon. The photonic crystal has a stop-band in which the resonant frequency of the antenna is contained, thus allowing no signal to pass and thereby reflecting the radiation to enhance the radiation pattern. This paper is intended to give a detailed explanation of the problem, through to the practical results obtained to date from fabrication and measurement.
