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About this Event
MAINSTREET ENTERTAINMENT PRESENTS: The Petty Hearts on the Main Stage of Potbelly's starting at 9:00pm on Friday, September 14th, 2018.
Doors: 9:00pm | Show: 10:00pm | Ages 18+ Only
Tickets are $15 through Eventbrite. Tickets will also be on sale at Potbelly's and Brick House Restaurant & Bar. Contact (850) 322-2598 for Table Service Reservations.
Parking opportunities:
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- City of Tallahassee's Trolly System ( Runs between Potbelly's, Midtown, Downtown and Collegetown)
- Kleman Plaza
- College Avenue street parking
The Petty Hearts are a nationally touring Tom Petty tribute band celebrating the life and musical legacy of Tom Petty's amazing 40-year career in rock and roll.
Performing faithful renditions of Tom Petty and the Heartbreakers' extensive catalog including dozens of his best known Top 40 hits along with some deeper album cuts Petty rarely played live, this is a can't miss performance for all music lovers alike.
The Petty Hearts have performed across the country before thousands of music fans at festivals, performing arts theaters, amphitheaters and nightclubs. The band has headlined at venues affiliated with Live Nation, iHeart Radio, the Hard Rock Café, the Miami Marlins, the Miami Dolphins, state fairs and dozens of municipalities. The Petty Hearts are also the only Tom Petty tribute invited to play the national Beatle fans convention known as Abbey Road on the River.
Each band member has extensive live performance experience and recognizes the audience's desire for entertainment as much as hearing those familiar songs. As one fan put it, "Your renditions of Tom Petty's greatest hits are outstanding and one can't help but want to get up and groove given the note-for-note approach you take."
Tom Petty passed away in October of 2017 but The Petty Hearts are committed to honoring both Tom and his bandmates by recreating the live concert experience and playing the songs the world loves and appreciates.


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The opioid crisis is identified as a national emergency and epidemic in the United States. The aim of this study was to identify risk factors associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS).
The authors queried MarketScan databases to investigate the factors affecting postsurgery opioid use in patients with DS between 2000 and 2012. The outcome of interest was opioid dependence, which was defined as continued opioid use, > 10 opioid prescriptions, or diagnosis of or prescription for opioid dependence disorder in the period of 1 year before or 3–15 months after the procedure. Comparisons of outcomes were performed using nonparametric 2-group tests and generalized regression models.
A cohort of 10,708 patients was identified from the database. The median patient age was 61 years (interquartile range 54–69 years), and 65.1% were female (n = 6975). A majority of patients had decompression with fusion (n = 10,068; 94%) and underwent multilevel procedures (n = 8123; 75.9%). Of 10,708 patients, 14.85% (n = 1591) were identified as having opioid dependence within 12 months prior to the index surgical procedure and 9.90% (n = 1060) were identified as having opioid dependence within 3–15 months after the procedure. Of all the variables, prior opioid dependence (OR 16.29, 95% CI 14.10–18.81, p < 0.001) and younger age (1-year increase in age: OR 0.972, 95% CI 0.963–0.980, p < 0.001) were independent predictors of opioid dependence following surgery for DS. The use of fusion was not associated with opioid dependence following the procedure (p = 0.8396). Following surgery for DS, patients were more likely to become opioid independent than they were to become opioid dependent (8.54% vs 3.58%, p < 0.001).
The majority of patients underwent fusion for DS. Surgical decompression with fusion was not associated with increased risk of postsurgery opioid dependence in patients with DS. Overall, opioid dependence was reduced by 4.96% after surgery for DS. Prior opioid dependence is associated with increased risk and increasing age is associated with decreased risk of opioid dependence following surgery for DS.
The opioid crisis is identified as a national emergency and epidemic in the United States.1 More than 12 million people misuse prescription opioids, and prescription opioid overdose is a leading cause of drug overdose–related deaths (60.9%) in this country.23 Given the extent of this health care problem, it is imperative to understand the risk factors predictive of long-term opioid dependence and to take necessary steps in curtailing this opioid epidemic.
The aim of this study was to identify risk factors associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS), which is a frequent cause of spinal stenosis in elderly patients (male patients mean age 68 years and females mean age 71 years), affecting primarily Caucasian women (5 times higher than men) with an estimated prevalence of approximately 6%.13 The Spine Patient Outcomes Research Trial (SPORT) reported superior outcomes at the 2-year follow-up for surgical compared to nonsurgical management of patients with DS.29 However, there is a lack of consensus regarding what type of surgical procedure provides the most effective treatment for DS, and commonly used procedures include laminectomy or decompression with or without fusion. In a recent randomized controlled trial, patients with grade 1 DS treated with laminectomy and posterolateral fusion had superior physical health–related quality of life (based on responses to the SF-36) at the 4-year follow-up compared to patients treated with laminectomy alone.12 Interestingly, another randomized Swedish study showed no significant differences in outcomes at the 2- and 5-year follow-up after either decompression alone or decompression with fusion in patients with spinal stenosis with or without spondylolisthesis.11 Despite this controversy regarding choice of treatment, a majority of patients with DS in the United States are managed with decompression combined with fusion.14,19 Opioids are commonly prescribed following common spine surgeries (discectomy, decompression, lumbar posterolateral arthrodesis, or lumbar interbody arthrodesis) and this use of prescription opioids may lead to prolonged use in only a minority of patients (0.1% at 6 months),24 in particular those with prior opioid dependence or preexisting mental health disorders such as depression.4,7,20,24 A recent study using a commercial insurance database showed that re-fusion lumbar spine surgeries were associated with increased risk and anterior lumbar fusion was associated with decreased risk of opioid dependence following lumbar fusion surgeries.6 The use of minimally invasive procedures has been shown to reduce the duration of postoperative narcotic use to half (median 2 weeks vs 4 weeks) and result in shorter hospital stays compared to open procedures for DS.2,20
Recently, there has been a surge in the use of national databases to query a variety of questions aiming to increase understanding of national trends and evaluate the efficacy of treatment modalities.3,7,8,18,25 In this study we used information from available databases to investigate factors that may increase the risk of opioid dependence in patients undergoing surgical treatment for DS. To the best of our knowledge, this is the first study focusing on the risk factors associated with opioid dependence in this patient population with DS, which is a common clinical problem associated with significant health care utilization.26
Data Sources
We used the MarketScan Commercial claims and encounters, Medicare Supplemental, and Multi-State Medicaid databases to investigate the impact of surgery on opioid use in patients with DS (https://truvenhealth.com/markets/life-sciences/products/data-tools/marketscan-databases). The MarketScan databases capture patient-level data on clinical utilization, insurance enrollment, and costs linked with detailed patient, provider, and facility information. The databases include longitudinal data grouped into multiple files, including inpatient, outpatient, and prescription medication, and use an encrypted ID for each individual, which serves as a unique identifier and a linkage variable across different files.10 The information in the MarketScan databases is obtained from paid patient health insurance claims from approximately 100 data sources and is available for purchase from Truven Health Analytics–IBM Watson Health. Included are data for covered individuals and their dependents. Patient information enters the databases when patients enroll in health insurance coverage and exits when that enrollment ends; patient interactions with the health care system are captured in the MarketScan data through their claims. These data have been used extensively in comparative effectiveness research in the medical field since 1990.
Patient Selection and Inclusion/Exclusion Criteria
From the inpatient admission tables, we extracted data on patients with a primary diagnosis of acquired lumbar spondylolisthesis (ICD-9-CM [International Classification of Diseases, Ninth Revision, Clinical Modification] code 738.4) and concurrent procedures of either a decompression-only procedure or decompression with fusion. Another inclusion criterion was age 18 years or older at the time of index hospitalization. Exclusion criteria were pregnancy, intraspinal abscess, osteomyelitis, fracture, vertebral dislocation, accidents, or pelvic instrumentation during the index procedure. Also, data on patients lacking medical records for the period of 1 year presurgery to 2 years postsurgery were excluded (Fig. 1).
Calculation of Follow-Up Time
Preoperative follow-up time was calculated as the time difference between the start of enrollment and the index hospitalization admission. If the start enrollment time was not available because the enrollment started prior to our data window, the beginning of our data window—January 1, 2000—was used. Similarly, postoperative follow-up time was calculated as the difference between the index hospitalization discharge date and the end of enrollment. If the end of enrollment fell outside of the data period, we used December 31, 2012, which was the last date of our data window.
Explanatory Variables
We used baseline characteristics at the index hospitalization as the explanatory variables. These were age, sex, year of index hospitalization, preoperative follow-up months, postoperative follow-up months, insurance type (commercial, Medicaid, or Medicare), comorbidities, instrumentation, and number of spinal levels. Comorbidities were measured with the Elixhauser comorbidity score,9 computed using an adaptation to ICD-9-CM codes developed by Quan et al.21 The Elixhauser score is an index that quantifies the burden of comorbidities abstracted from medical or claims records using ICD codes. A total of 30 comorbidities are checked as being present or not (present = 1, absent = 0) and cumulated to provide a comorbidity score. To check whether instrumentation was used, we screened the CPT-4 (Current Procedural Terminology, Fourth Edition) procedure codes 22840–22847. Cases were classified as fusion involving multiple spinal levels (≥ 2 levels) if the following codes were found: ICD-9 codes 81.62, 81.63, 81.64, and/or CPT-4 codes 22585, 22632, 22614, 63035, 63044, 63048, 63057, 63103, and 22842–22847.
Postoperative Outcome Variables
The current study aimed to identify factors predictive of postsurgery opioid dependence.
Opioid Use
Our interest was to evaluate opioid dependence postsurgery (in the period from 3 to 15 months postdischarge). However, we also looked at use prior to surgery (within 12 months before admission) in order to identify new dependence. Patients were classified as having opioid dependence if they had a diagnosis of opioid use disorder (ICD-9 305.50, 305.55, 305.52, 304.00, 304.01, 304.02, 304.70, 304.71, or 304.72),6 obtained a prescription for a medication used to treat opioid use disorder (buprenorphine or naltrexone), were counseled about psychological and pharmacological treatment options for opioid addiction (CPT-4 4306F),6 or had at least 10 prescriptions7,17,22,28 of opioid drugs (buprenorphine, butorphanol, codeine phosphate, dihydrocodeine, fentanyl citrate, hydrocodone, hydromorphone, levorphanol, meperidine, methadone, morphine sulfate, nalbuphine, opium alkaloids, oxycodone, oxymorphone, pentazocine, propoxyphene, tapentadol, tramadol, or naltrexone)16 in the look-up period (12 months prior to admission for presurgery dependence and 3–15 months5,28 after discharge for postsurgery dependence).
Statistical Analysis
We summarized continuous variables using means and standard deviations, medians and interquartile ranges, and full ranges (minimum to maximum). Categorical variables were summarized using counts and percentages.
To compare the patient characteristics and outcomes among different procedure groups, we used linear regression on logged values for continuous variables and logistic regression for categorical variables.15 The models included the procedure group as well as age, sex, insurance type (commercial, Medicaid, or Medicare), Elixhauser comorbidity score, presence of instrumentation, and whether multiple levels were involved as independent variables. We used the software SAS 9.4 (SAS Institute, Inc.) for data preparation and data analysis.27
Patient Demographics
A total of 10,708 patients with a diagnosis of degenerative spondylolisthesis (DS) who underwent a surgical procedure were identified from the MarketScan databases. The median patient age was 61 years (interquartile range [IQR] 54–69 years). A majority of the patients were female (n = 6975, 65.1%). Commercial insurance was the most common insurance type (61.4%, n = 6571), followed by Medicare (35%, n = 3746). Less than half of the patients (46%, n = 4954) had an Elixhauser comorbidity score of 0, and a minority (8.07%, n = 864) had a comorbidity index of 3+. Most of the patients underwent decompression with fusion (n = 10,068, 94%), and approximately three-quarters had multilevel procedures (n = 8,123, 75.9%).
Demographic and clinical characteristics of the patients who underwent surgical treatment for DS are shown in Table 1.
Summary of patient demographic and clinical characteristics
|Combined Cohort, n = 10,708
|Postsurgery Opioid Dependence
|p Value
|No, n = 9648 (90.1%)
|Yes, n = 1060 (9.90%)
|Age, yrs
|Mean (SD)
|60.7 (11.9)
|61.1 (11.8)
|57.0 (12.1)
|Median (IQR)
|61.0 (54.0–69.0)
|61.0 (54.0–70.0)
|57.0 (49.0–65.0)
|Range, min–max
|Sex: female, n (%)
|6975 (65.1%)
|6244 (64.7%)
|731 (69.0%)
|Insurance, n (%)
|6571 (61.4%)
|5854 (60.7%)
|717 (67.6%)
|391 (3.65%)
|322 (3.34%)
|69 (6.51%)
|3746 (35.0%)
|3472 (36.0%)
|274 (25.8%)
|Elixhauser index, n (%)
|4954 (46.3%)
|4441 (46.0%)
|513 (48.4%)
|3386 (31.6%)
|3064 (31.8%)
|322 (30.4%)
|1504 (14.1%)
|1376 (14.3%)
|128 (12.1%)
|864 (8.07%)
|767 (7.95%)
|97 (9.15%)
|Surgery: decompression, n (%)
|w/o fusion
|640 (5.98%)
|597 (6.19%)
|43 (4.06%)
|w/ fusion
|10,068 (94.0%)
|9051 (93.8%)
|1017 (95.9%)
|Multilevel surgery, n (%)
|8123 (75.9%)
|7312 (75.8%)
|811 (76.5%)
Max = maximum; min = minimum; SD = standard deviation.
Boldface type indicates statistical significance.
Opioid Dependence
The incidence of postsurgery opioid dependence gradually increased from 11.67% (2001) to 16.12% (2011) among patients who were opioid dependent prior to the surgical procedure and from 6.67% (2001) to 10.81% (2011) among patients who were opioid independent prior to the surgery (Fig. 2). A total of 1591 patients (14.85%) were identified to have opioid dependence within 12 months prior to the index surgical procedure and 1060 (9.90%) were identified to have opioid dependence within 3–15 months after the procedure. A majority of patients (90.1%, n = 9648) were opioid independent following the surgical procedure. Following surgery for DS, opioid-dependent patients were 2 times more likely to become opioid independent than opioid-independent patients were likely to become opioid dependent (8.54% vs 3.58%, odds ratio [OR] 2.39, 95% confidence interval [CI] 2.12–2.69, p < 0.0001; Fig. 3).
Factors Predicting Opioid Dependence Following Surgery for DS
Comparison of demographic and clinical characteristics of patients with and without opioid dependence following surgery showed that younger age, female sex, and having commercial insurance were associated with opioid dependence following surgery (median age 57 vs 61 years, p < 0.0001; female sex 69% vs 64.7%, p = 0.0059; and commercial insurance 67.6% vs 60.7%, p < 0.0001). Comorbidity index and type of surgical procedure had no association with postsurgery opioid dependence on univariable analysis (p > 0.05, Table 1).
Of all the variables, prior opioid dependence (OR 16.29, 95% CI 14.10–18.81, p < 0.001) and younger age (1-year increase in age: OR 0.972, 95% CI 0.963–0.980, p < 0.001) were independent predictors of opioid dependence following surgery for DS. Type of surgical procedure (decompression alone or decompression with fusion) showed an association with postsurgery opioid dependence on univariable analysis (6.72% vs 10.10%, p = 0.0009; Fig. 4 and Table 2). Also, 41.9% of patients who were not opioid dependent before surgery became opioid dependent following decompression without fusion compared to 35.90% of patients who underwent decompression with fusion (p > 0.05, Fig. 5). However, on adjusted multivariable analysis, the use of fusion was not associated with opioid dependence following the procedure (OR 1.038, 95% CI 0.726–1.483, p = 0.8396). Elixhauser comorbidity score, type of insurance, and number of levels treated had no significant association with opioid dependence following surgery for DS (Table 3).
Opioid dependence before and after surgery stratified by type of surgical procedure
|Opioid Dependence Group
|Combined Cohort, n = 10,708 (100%)
|p Value
|w/o Fusion, n = 640 (5.98%)
|w/ Fusion, n = 10,068 (94.02%)
|Previously nondependent pts who remained nondependent, n (%)
|8734 (81.6%)
|560 (87.5%)
|8174 (81.2%)
|Previously nondependent pts who became dependent, n (%)
|383 (3.58%)
|18 (2.81%)
|365 (3.63%)
|Previously dependent pts who became nondependent, n (%)
|914 (8.54%)
|37 (5.78%)
|877 (8.71%)
|Previously dependent pts who remained dependent, n (%)
|677 (6.32%)
|25 (3.91%)
|652 (6.48%)
Pts = patients.
Boldface type indicates statistical significance.
The adjusted effect of patient characteristics on postoperative opioid dependence
|Postsurgery Opioid Dependence
|p Value
|Presurgery opioid dependent vs not
|16.29 (14.10–18.81)
|Age, 1-yr increment
|0.972 (0.963–0.980)
|Sex: female vs male
|1.166 (0.998–1.362)
|Medicaid vs commercial
|1.337 (0.960–1.863)
|Medicare vs commercial
|1.170 (0.929–1.474)
|Elixhauser score
|1 vs 0
|0.956 (0.808–1.131)
|2 vs 0
|0.864 (0.686–1.088)
|3+ vs 0
|1.045 (0.800–1.365)
|Decompression, w/ vs w/o fusion
|1.038 (0.726–1.483)
|Multilevel vs single-level surgery
|1.107 (0.931–1.316)
Boldface type indicates statistical significance.
Using the MarketScan databases, we found that 90.1% of all patients were opioid independent following DS surgery compared to 85.15% prior to surgery. Patients were twice as likely to become opioid independent after surgery as they were to become opioid dependent (OR 2.39, 95% CI 2.12–2.69, p < 0.001). Prior opioid dependence and young age were independent predictors of opioid dependence following surgery for DS. Type of surgical procedure had no impact on postsurgery opioid dependence.
In our study, 14.85% of patients were reported to be opioid dependent 1 year before surgery, and 9.90% were opioid dependent 3–15 months after surgery. A recent study based on commercial insurance claims reported continued narcotic utilization in 62% of patients more than 1 year following lumbar fusion surgery.18 However, the number of patients with opioid dependence prior to the surgery was not reported in that study. In contrast, we found that a majority of patients (90.1%) were opioid independent after surgery for DS. Also, patients were twice as likely to become opioid independent following surgery for DS. In a recent study, Schoenfeld et al.24 used the TRICARE insurance claim database to investigate factors predictive of opioid dependence in patients (n = 9991) undergoing spinal surgery for a variety of lumbar pathologies, including spondylolisthesis (n = 252) in opioid-naïve patients. In this study the authors reported that 1% of patients continued opioid use at 3 months and 0.1% continued use at 6 months postsurgery. They also reported that patients who underwent low-intensity surgical procedures, such as discectomy and decompression, were more likely to be opioid independent than those who underwent fusion procedures (HR 1.43 and 1.34, respectively). In our study we found that 3.58% of patients became opioid dependent after the surgical procedure for DS; 95.3% (n = 365) of these patients had decompression with fusion, and 4.7% (n = 18) had only decompression. Therefore overall, only 0.16% of patients became opioid dependent following decompression only for DS, which is in concordance with the findings of the above-mentioned study.24 Schoenfeld et al. also identified depression as a factor associated with decreased likelihood of opioid independence following spinal surgery, which was also reported by Connolly et al.7 In contrast, we did not find any association between various comorbidities and opioid dependence in our study. This difference may be attributable to the highly selective patient population in our study—patients with a diagnosis of DS who underwent surgery treatment for that condition—compared to patients undergoing lumbar fusion procedures for a variety of spinal pathologies in the studies by Schoenfeld et al.24 and Connolly et al.7
Another study based on a commercial insurance database reported that the duration of opioid use before surgery was significantly associated with an increased risk of long-term opioid dependence after lumbar fusion surgery.7 Patients using opioids for 1–22 days or more than 250 days prior to the surgery were 2.27 and 219 times, respectively, more likely to be opioid dependent after lumbar fusion surgery.7 This study also reported that anterior fusion was associated with decreased risk and 360° fusion was associated with increased risk (compared to posterior fusion) of long-term opioid dependence following the procedure. Similarly, Armaghani et al.4 reported that young age, anxiety disorder, and increased preoperative opioid use were associated with increased opioid use during the immediate postoperative period, and major surgical procedure, revision procedure, anxiety, and increased preoperative opioid use were associated with increased opioid dependence at 12 months postsurgery. In concordance, we found that patients who were opioid dependent prior to the surgery were likely to remain dependent following the surgery (relative risk [RR] 16.29, p < 0.0001). However, type of surgical procedure had no impact on opioid dependence in our study. Also, we found that patients with increasing age were less likely to be opioid dependent following surgery for DS. This difference may be due to the different patient population in our study.
Strengths and Limitations of the MarketScan Databases
The advantages of using a nationwide collection of databases such as MarketScan include a larger sample size, which provides comprehensive overview of data relevant to the research question throughout the United States. Although retrospective in nature, these databases are based on insurance claims, which mitigate the issue of selection bias while providing a large sample size. MarketScan provides longitudinal information, which includes inpatient and outpatient services, medication refills, and costs.
Apart from our study's inherent limitations of being retrospective, the reliance on data from the MarketScan databases also entails limitations. The insurance claims from which the MarketScan data were acquired were used to bill for in-hospital procedures and outpatient medicine prescriptions, which may not reflect the actual clinical decision-making process used in specific cases or potential confounding variables that affect outcomes. Thus the data may not provide an accurate representation of a problem. The clinical profile of the patients, including additional procedures or clinical diagnosis during the follow-up after the surgery, cannot be determined using this database. Also, claims databases cannot be used to determine the factors that may be associated with opioid dependence such as alcohol/tobacco dependence/abuse and socioeconomic status. However, our study is representative of real-world clinical practice. Potential coding errors and inability to obtain information about the severity and duration of the clinical problem as well as the severity of postoperative complications and quality of life at follow-up are other limitations of such a database. One of the definitions of opioid dependence was based on medication refills prescribed by the physicians for the patients enrolled in the insurance plans. The patients may not have consumed these opioid medications on the refill date, and our analysis may thus overestimate the dependence if there was a delay in actually starting the medications or if they did not consume at all; accordingly, the dependence may have been underestimated in cases in which patients consumed the medications on the same date or beyond the dose prescribed by the physician. Data regarding preoperative and postoperative consumption of morphine equivalents were not included in this database. Also, illegal procurement of opioids is not captured by this database, which may also lead to underestimation of dependence. Nevertheless, our study provides insight into the national trends and factors predictive of opioid dependence following surgical procedures for DS in the United States.
The majority of patients underwent fusion for DS. Surgical decompression with fusion was associated with decreased postsurgery opioid dependence in patients with DS. Prior opioid dependence is associated with increased risk and increasing age is associated with decreased risk of opioid dependence following surgery for DS. Patients who underwent surgery for DS were twice as likely to become opioid independent as they were to become opioid dependent.
The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Author Contributions
Conception and design: Sharma. Acquisition of data: Ugiliweneza. Analysis and interpretation of data: Sharma. Drafting the article: Sharma. Critically revising the article: Boakye, Sharma, Nuño, Drazin. Reviewed submitted version of manuscript: all authors. Statistical analysis: Ugiliweneza. Administrative/technical/material support: Boakye. Study supervision: Boakye.
- 1↑
Achenbach JWagner JBernstein LJohnson J: Trump says opioid crisis is a national emergency, pledges more money and attention. Washington Post. (https://www.washingtonpost.com/politics/trump-declares-opioid-crisis-is-a-national-emergency-pledges-more-money-and-attention/2017/08/10/5aaaae32-7dfe-11e7-83c7-5bd5460f0d7e_story.html?utm_term=.2af1101945c9) [Accessed February 8 2018]
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Adogwa OParker SLBydon ACheng JMcGirt MJ: Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech 24:479–4842011
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Ambekar SSharma MKukreja SNanda A: Complications and outcomes of surgery for spinal meningioma: a Nationwide Inpatient Sample analysis from 2003 to 2010. Clin Neurol Neurosurg 118:65–682014
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Armaghani SJLee DSBible JEArcher KRShau DNKay H: Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine (Phila Pa 1976) 39:E1524–E15302014
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Brummett CMWaljee JFGoesling JMoser SLin PEnglesbe MJ: New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 152:e1705042017
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Cepeda MSFife DMa QRyan PB: Comparison of the risks of opioid abuse or dependence between tapentadol and oxycodone: results from a cohort study. J Pain 14:1227–12412013
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Connolly J IIIJaved ZRaji MAChan WKuo YFBaillargeon J: Predictors of long-term opioid use following lumbar fusion surgery. Spine (Phila Pa 1976) 42:1405–14112017
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Deyo RAGray DTKreuter WMirza SMartin BI: United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 30:1441–14472005
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Elixhauser ASteiner CHarris DRCoffey RM: Comorbidity measures for use with administrative data. Med Care 36:8–271998
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Finucane TEChristmas CTravis K: Tube feeding in patients with advanced dementia: a review of the evidence. JAMA 282:1365–13701999
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Försth PÓlafsson GCarlsson TFrost ABorgström FFritzell P: A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374:1413–14232016
- 12↑
Ghogawala ZDziura JButler WEDai FTerrin NMagge SN: Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 374:1424–14342016
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Jacobsen SSonne-Holm SRovsing HMonrad HGebuhr P: Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976) 32:120–1252007
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Kepler CKVaccaro ARHilibrand ASAnderson DGRihn JAAlbert TJ: National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976) 39:1584–15892014
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Littell RCStroup WWFreund RJ: SAS for Linear Modelsed 4. Cary, NC: SAS Institute2002
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Logan JLiu YPaulozzi LZhang KJones C: Opioid prescribing in emergency departments: the prevalence of potentially inappropriate prescribing and misuse. Med Care 51:646–6532013
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Martin BCFan MYEdlund MJDevries ABraden JBSullivan MD: Long-term chronic opioid therapy discontinuation rates from the TROUP study. J Gen Intern Med 26:1450–14572011
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Mino DEMunterich JECastel LD: Lumbar fusion surgery for degenerative conditions is associated with significant resource and narcotic use 2 years postoperatively in the commercially insured: a medical and pharmacy claims study. J Spine Surg 3:141–1482017
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Norton RPBianco KKlifto CErrico TJBendo JA: Degenerative spondylolisthesis: an analysis of the Nationwide Inpatient Sample database. Spine (Phila Pa 1976) 40:1219–12272015
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Phan KRao PJKam ACMobbs RJ: Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J 24:1017–10302015
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Quan HSundararajan VHalfon PFong ABurnand BLuthi JC: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130–11392005
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Raebel MANewcomer SRReifler LMBoudreau DElliott TEDeBar L: Chronic use of opioid medications before and after bariatric surgery. JAMA 310:1369–13762013
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Rudd RASeth PDavid FScholl L: Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep 65:1445–14522016
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Schoenfeld AJNwosu KJiang WYau ALChaudhary MAScully RE: Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients. J Bone Joint Surg Am 99:1247–12522017
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Sharma MSonig AAmbekar SNanda A: Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003–2010. J Neurosurg Spine 20:125–1412014
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Sharma MUgiliwenezaBAljubooriZBoakye M. Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis. Neurosurg Focus 44(5):E142018
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Stokes MDavis CKoch G: Categorical Data Analysis Using the SAS Systemed 2. Cary, NC: SAS Institute2000
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Sun ECDarnall BDBaker LCMackey S: Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med 176:1286–12932016
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Weinstein JNLurie JDTosteson TDHanscom BTosteson ANBlood EA: Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–22702007


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Expressions of Interest
Manager/Managers South Island Rowing Complex,
Lake Ruataniwha, Twizel
Our valued full time Managers will be retiring in April 2020 and the Board of South Island Rowing would like to have the new manager/managers in position at the commencement of the 2019/20 rowing season, September 2019.
This is a full time position ideally suited to a two person role, the key work responsibilities being management of the course and associated facilities, catering and hospitality for volunteers and visitors, strict adherence to Health and Safety, ensuring a tidy and well presented appearance of the overall complex.
Accommodation is available on site.
A more detailed job description is available for suitable applicants by contacting the secretary:
Karl Morgan, email@example.com


text:
Ad ID: 64762 Inactive
Backpacker and Motel Business for Sale Northland
Paradise on Waterfront - Freehold Investment
Business for Sale Description
Backpacker and Motel Business for Sale NorthlandLocated on route to famous Lighthouse at Cape Reinga Elevated prime landFreehold Land & Buildings0.3465hectares land 9 unit motel Backpacker Villa with 5 rooms3 bedroom owners home
Present owners have been here for 12 years.
Future prospects only limited to your imagination.
Live the dream with safe harbour and boat ramp on your doorstep.
Possibility to subdivide and/or develop additional accommodation
Asking Price $1.7m
New lease in place returning $85,000 + gst per annum
Sole Agents:
Michael Osborne/Jenny Blain
027 242 6881/021 455 421
Ref: NL00081
Timestamp: 20180309054550


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Everyone wants to look beautiful and stay in perfect shape and to achieve this goal they try everything from healthy eating to extreme workouts. But with the advancement in technology and latest innovations and discoveries in medical science there are some really amazing treatments these days that can help you have perfect shape and enhance your beauty without any difficulty.
You will find a number of good cosmetic clinics around you that offer non surgical face lift in Dubai to provide you with younger looks and stop ageing effects. Filler treatments will help you enhance the beauty of your lips. You can get perfect sparkling smile by opting for Hollywood smile treatment. Among all these amazing cosmetic procedures that are meant to help you achieve your desired appearance and looks liposuction holds a distinctive position.
By opting to liposuction procedure you will not have to worry about crash diet programs or look for extreme physical exercises to get rid of unwanted fat from your body. In this procedure a qualified and highly experienced cosmetic surgeon removes the excessive fat from problem areas of your body using the suction technique. This treatment is equally effective for both men and women who are looking for ways to get rid of their excessive body fat to get their desired physical appearance.
If you are also considering opting for liposuction in Dubai then you should understand that liposuction is not primarily meant to help you lose weight but to help you eliminate excessive fat that you are unable to get rid of using weight loss techniques. What this means is that you will still have to maintain a healthy lifestyle to get in to the perfect shape. If you are wondering why liposuction cannot help you eliminate unwanted body fats completely to help you lose weight then you should understand that the treatment only removes superficial layers of fat from your body and do not affect the deeper layers of fat that will be still there in your body. If you believe that you need to lose more weight after liposuction treatment then you will have to have healthy food and perform weight loss exercises to get the best results.
There are those too who confuses liposuction with tummy tuck surgery. While the fact is that both the procedures are completely different than each other. For this reason, it is highly recommended for you to consult with a professional cosmetic surgeon before opting for liposuction treatment.


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What does a foster family do?
Fostering is a great way to enjoy the love and companionship of an animal without the the permanent commitment. More importantly you're giving an animal a chance to acclimate to life outside of the shelter and giving us more time to find the animal a forever home.
How long does it take to adopt out an animal?
The answer is variable. Some animals take only days, while others may take several weeks to months. The more active our foster families are in helping to promote our animals, the quicker they find forever homes.
Can I choose the animal I foster?
Absolutely! Our goal is to match you with an animal that will thrive in your care, whether that's a 5-lbs kitten or a 120-lbs German shepherd.
What if I become too attached?
This is an extremely common worry among prospective foster parents. We know exactly how you feel, after all we've been fostering animals for a long time now. You will doubtlessly bond with your foster animal, but seeing the development of the bond between the new adoption family and the pet is even more rewarding. There is tremendous satisfaction is seeing the joy your hard work has brought to another family.
If it's not working, what do I do?
If the fit isn't right, we'll always take the animal back and try you with a new one. Every animal is different, and sometimes finding the right fit is tough!
Do I have to pay for anything?
We do our best to cover all food and veterinary costs, unless you'd like to do so yourself. Supplies that you purchase for your foster animals are likely tax-deductible, but always check with your tax advisor.
What if I already have animals in my home?
The more the merrier! So long as your current pets tolerate a foster we're happy to place our animals into families with pets.
What if I have children?
Also not a problem. Although, if you have toddlers we will have to be extra picky about foster placements into your home.
How does the animal find a permanent home?
We advertise all of our available pets online and also ask that our foster families make the pets available on weekends for adoption events. Often our foster animals get adopted by acquaintances of their foster families!
What if I need to leave town while I'm fostering?
Since there's no permanent commitment we will always take the animal back into our care whenever the need arises. The animal will be ready for you on your return!


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Easter Egg Hunt
April 11, 2009
My husbands unit had their Easter party today, inside a hanger! They had bouncy houses, which are usually Monkey's favorite things, once she's in, there's no getting her out. Today though, she is fighting a rather nasty cold and feeling blah, so she only bounced for a bit. They had a helicopter opened up for the kids to walk through and play with. Only in the military! I was hoping to get pictures of Monkey hunting eggs, but when it came time for her age group, she just stood there and cried. I don't know what was up with that! My husbands company was responsible for the cake walk, I finally convinced Monkey to participate and she won! She picked out cupcakes, pink ones of course! They are now sitting on the bar taunting me! I was surprised that she sat with the bunny and I was glad I took the picture when I did because after I snapped it, she started to cry! Oh, I hope she feels better soon! Kendal was less than impressed by the whole thing. She slept through most of it!
Entry Filed under: Army Life,Kendal,Monkey
One Comment Add your own
1.| April 11, 2009 at 8:38 pm
Darling pictures for Easter!


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Guidelines on Picking the Most Suitable Auto Transport Firm
Nowadays transportation has resulted to be very mandatory in our everyday living. People have attempted to uncover some obliging techniques to transport their automobiles with them without having challenges.Auto transportation is the movement of cars from one destination to another.There is a huge number of auto transport organizations accessible for you when you have to transport your auto or truck or whatever transportation vehicle that you have. These auto transport organizations aids in securely moving your vehicles without realizing any mischief or further obliteration to your auto.Additionally they provide impeccable services at a reduced rate or at a cost that is affordable.
Irrespective of the huge number of companies open you should take into account some factors so as to make certain that you get services that are of quality and affordable. When you perceive what and which to scan for, by then no doubt you will end up getting a firm which you can rely on and feel safe transporting your auto. The following are tips on choosing a dependable and great quality auto transport organization.
A trustworthy auto transport firm must equip themselves with employees that are experienced in managing safe transportation of the auto. Also, they ought to have the comprehensive know-how of diverse cars and the security measures that fit the auto when transporting them. Verify that the autos are passed on safely and securely in order to keep their appearances looking faultless, and also the engines and other inside parts are in extraordinary condition.the main way to guaranteeing that your vehicles are taken great care of is to get some information about the aptitudes of their representatives and their preparation also.
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Looking On The Bright Side of Cars
Why Shipping Aren't As Bad As You Think


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If you are on the hunt for custom AR-15 parts, you've likely run into 6061 and 7075 aluminum references. And before getting too far into your search, it's very important to know and understand the difference between the two.
For starters, most AR-15 parts are either 6061 or 7075 aluminum, popular for its malleability, strength and resistance to corrosion. The question is normally what do the numbers mean and why does it matter.
Crunching the Numbers
Aluminum is given numerical values based on the properties of the metal. The number refers to the amount of alloy agents present in the aluminum, which can make a huge difference in the strength and performance of the aluminum. The composition of each aluminum type includes the same list of alloys, but the amounts are quite different. Below are the alloys you will find in both 6061 and 7075 aluminum:
- Magnesium
- Silicon
- Iron
- Copper
- Zinc
- Titanium
- Manganese
- Chromium
- Additional Metals
The Aerospace Specification Metals website offers additional information on the exact percentages of alloys in both the 6061 aluminum as well as the 7075 aluminum.
Getting to the Difference
The varying percentages of the alloys present in each type of aluminum give each different characteristics, but both are considered ideal for use in a variety of AR parts. 6061 aluminum is corrosion resistant and has great weldability with medium to high strength. The 7075 aluminum offers similar qualities, but it adds a significant layer of additional strength and improved stress-corrosion resistance. Below are the mechanical properties for both the 6061 and the 7075:
6061 – Mechanical Properties
- Ultimate Tensile Strength 45000 psi
- Tensile Yield Strength 40000 psi
- Fatigue Strength 14000 psi
- Shear Strength 30000 psi
- Hardness, Rockwell 40
- Machinability 50%
7075 – Mechanical Properties
- Ultimate Tensile Strength 83000 psi
- Tensile Yield Strength 73000 psi
- Fatigue Strength 23000 psi
- Shear Strength 48000 psi
- Hardness, Rockwell 53.5
- Machinability 70%
Making the Decision
Although some may argue for parts constructed with 7075 because of the added strength, the value of AR parts made with 6061 aluminum should not be discounted. Both aluminums offer quality and reliability, and ultimately it comes down to personal preference. When making your decision, consider what matters most to you. Ask yourself the following questions:
- How will you use the AR
- How much stress do you intend to place on the part
- What budget would you prefer to stick to
Both aluminum options are extremely viable, and while the 6061 aluminum may seem subpar, that is certainly not the case. The added strength isn't a necessity, rather it is simply a bonus that some customers just prefer to have. There have been thousands of AR builders who have gone with the 6061 aluminum without any problems at all.
Aside from only thinking about the qualities of the 6061 and the 7075, it is arguably more important to pay closer attention to the manufacturer. If you are purchasing your AR parts from a reliable seller, you are more likely to receive quality materials whether you choose the 6061 or the 7075. And when you shop with us, we stand behind every one of our products. The most important part of your decision is that you are comfortable and satisfied, and as a reliable retailer, we wouldn't want anything less!
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text:
San Clemente Coach Mark McElroy wandered around the field, almost in a daze.
"I'm in tears," McElroy said. "I can't believe it."
Reality was a few feet away. The Tritons were in wild celebration following their 23-17 upset of top-ranked Mater Dei Friday at San Clemente.
The ramifications were immediate and far reaching. The victory left the Tritons tied for second place with the Monarchs, one game behind Capistrano Valley in the South Coast League race. It snapped the Monarchs' 21-game winning streak and might have been the most important San Clemente victory in 15 years.
"We kept believing," defensive back Reagan West said. "We had speeches before the game and speeches at halftime. But the big thing was we believed."


text:
"That's all they are. You lost, but you get trophies."
"Don't worry about what happened yesterday baby, I forgive youAnd as for what Liz Morrison caught you doing with Kayla, don't worry I'm not angry about that either. It turned me on hakr much.
After Mom left I asked her what the lady had said.
I guess a few had hoped for a fuck ,and a part of me agreed. Last year, they decided that we should be in school and enrolled us in the local high school which caters to both our grades. Sean excused himself and ran to the kitchen quickly grabbing the dish soap from the kitchen and returned to the small boy lying naked on the dining room table.
We're covered in cum. We pulled into our driveway no more than five minutes later and practically ran in the house.


text:
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text: On Fri, Nov 18, 2011 at 09:05:20AM -0500, Brian J. Murrell wrote: > > If mplayer dvb://120 (or mplayer stream.dump after above) does not show video, > > your problem is likely that PMT is missing from channels.conf. > > Channel "120" in my channels.conf.atsc is: > > 120:585000000:QAM_256:0:5842:11 I have no idea how ATSC is supposed to work, but MPlayer at the very least seems to ignore the last number (11), whatever that stands for. You might try changing 5842 to 5842+11 to test. Generally I actually use 8192 to test, that will get all data on that transponder, at least with DVB-T (as a positive side effect it also allows very fast channel switching for programs on the same transponder).


text:
Atkins Chat
Name: Tom
weight: 218/200/180
age: 29
BirthDay: March 14, 1971
Sex: Male
Location: Reno, NV
Hobbies: I enjoy just about anything outdoors, golf, camping, fishing, etc.(geez, that sounds like a personal ad)
Occupation: Consultant
Fav. Quote/Joke: Less is More
Comments: What to say... I started this WOE and I think I've actually grown addicted to it. I love eating all this food and still losing weight, although I am a little stalled right now. I have a wonderful girlfriend who is my biggest supporter in this WOL even though she isn't doing it herself. I highly recomend having support for yourself. This web site helps a lot also.


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Name: New software technologies in 2012
File size: 731mb
Language: English
Rating: 2/10
Emerging technologies are those technical innovations which represent progressive .. Software-defined radio, Development, commercialization, Traditional, .. New Scientist. .. Archived from the original (PDF) on 22 March Retrieved. 1 Dec By next year, using Life Technologies' Ion Proton machine, it will take less Labs across the world are going digital, and Labguru is a new product After trying other software and electronic lab notebooks to organize activity. 28 May Social networking technologies, web mashups, multicore and hybrid found in popular consumer social software, such as Facebook and MySpace, as model (80 percent) for the creation of new enterprise applications.
ARCHIVE · WHAT'S NEW · CN HOME · HOME · CLOUD · BIG DATA · MOBILE · NETWORKING · SECURITY · SOFTWARE · INSIGHTS · CAREERS · STARTUPS . And for an updated look at some new mothers of technology and their impact on tech Called the Queen of Software by some and Grandma COBOL by others, . of computing"; and in , she was inducted into the National Inventors Hall of. 8 Dec For the United States Air Force, installing a new software system has on the latest from Silicon Valley and the technology industry, plus exclusive A version of this article appears in print on December 9, , on Page.
25 Jun An array of surveillance software now exists to let parents keep tabs on their children's Tools to Control a Child's Technology JUNE 25, The Technology Radar is our thoughts on emerging technology trends in the industry. complexity always accompanies building real solutions with these new pieces. Security remains of paramount concern for virtually all software development. . Download. October. English. ePUB,Mobi,PDF. March. by Jessica Leber; November 28, Sensors, software, and new data interfaces could help industry operate more efficiently. General Electric has a new. 4 Jul You buy an iPad in order to be on the cutting edge of technology and I salute Apple for having created a whole new paradigm of computing. Recently published articles from Information and Software Technology. Spectrum-based fault localization in software product lines. August Aitor Arrieta.
Special issues published in Information and Software Technology. from "Asia- Pacific Software Engineering Conference (APSEC), " and " Software Product Line . Perspectives on Information System Technology in the New Millennium. UIST (ACM Symposium on User Interface Software and Technology) is the premier augmented reality, multimedia, new input & output devices, and CSCW . 22 Mar Support for Intel Active Management Technology (AMT) Once you are satisfied with the new client software in pre-production, you can. Become a Microsoft Technology Associate. Find out how MTA certification validates your core technical knowledge and enhances your technical credibility.


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text:
Harry the Bastard is a minor character portrayed by Brian Croucher, and appears in the episode "Parade." He runs the local pawnbrokers and on the day of the 3.30 at Chepstow is faced with an influx of customers wanting to trade in their junk for some good hard cash. Harry's exchange rates however are extortionate and overwhelmingly in his favour, evident when he offers Eddie £1.50 for a priceless carved wooden leg. An argument ensues, during which Harry reveals his name is actually Ted. Harry/Ted is receptive to blackmail, and finally buys the leg from Eddie for £500.
- Harry the Bastard was a character in The Young Ones, however was played in that series by Alexei Sayle.
- The character's actual name in the episode is open to interpretation; in dialogue he is referred to as Harry The Bastard, and corrects Eddie by telling him his name is Ted. The credits give his full name as Ted Nugent. The real Ted Nugent is of course a famous American rockstar.


text:
When you're trying to recover from a serious work injury, the last thing you want to receive in the mail is a "Notice of Intention to Discontinue Workers' Compensation Benefits," or NOID.
Injured at work? Complain your head off!
Do you have a tendency to minimize your complaints when you're sick or injured?
The 'going and coming' rule and workers' compensation benefits
Are you aware of the "going and coming" rule that applies to workers' compensation benefits?
First aid tips for chemical exposure in the workplace
Workplace chemicals are a constant hazard in some occupations -- and even if you're following all the safety regulations, it's still possible you or a co-worker could end up accidentally exposed.
Why are 'Waddell's signs' important to back injury victims?
Something called "Waddell's signs" may be the most important thing you've never heard of -- if you happen to be the victim of a low back injury and seeking workers' compensation benefits.
On workers' compensation? Beware the case manager's interventions
The big focus among workers' comp insurers today is reducing the expenses tied to "runaway" claims. However, they may now be targeting injured workers for "helpful" interventions by case managers whenever they decide a worker's attitude isn't conducive to healing.
Can undocumented immigrants file for workers' compensation?
Undocumented immigrants in the United States are having a rough time these days. The working conditions many of them face don't make it any easier.


text:
City officials are warning residents to be cautious about another utility billing scam that several people have reported in Loveland.
Three residents have filed reports about being called and asked for money over the phone by a person who either claimed to be a city employee or a utility company employee. In all cases, the person on the phone told the resident that his or her electric service would be suspended if a payment wasn't made immediately.
In one of the cases, the resident said she gave the caller her credit card information, according to a news release.
The city's Utility Billing Customer Supervisor Debbie Emery said her office will mail two notices to customers who have delinquent accounts before even considering cutting off service, the release stated.
While residents may be contacted by phone before having service shut off, city officials ask that residents who question a call's validity hang up and call 970-962-2111.
Scam artists nationwide have been preying on utility customers, according to the release, demanding specific payments or threatening to shut off service.
For more information on the city of Loveland's Utility Billing Department, go to cityofloveland.org/utilitybilling.
Saja Hindi: 970-669-5050 ext. 521, firstname.lastname@example.com, twitter.com/SajaHindiRH.


text:
Raheem Sterling's Gun Tattoo Fuels U.K. Tabloid Outrage
LONDON — He has said he has the kind of face that people just don't like — "the 'I don'tRead more
LONDON — He has said he has the kind of face that people just don't like — "the 'I don'tRead more
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