Low Probability Of Success Research Articles

Solvency Tests, Debt Capacity, and Security Design

It can be hard to explain why firms do not issue more debt. I use a simple model of a debtor firm to demonstrate the impact of legal solvency tests on a firm’s debt capacity and the debt securities it is able to issue. I assume that a firm must be solvent under two legal solvency tests – the balance sheet test and the ability to pay test – immediately after borrowing. I motivate this assumption in two ways. First, the state of insolvency effectively shifts fiduciary duties to creditor welfare, limiting the firm’s ability to act exclusively in shareholders’ interest subject to other legal obligations. Second, the state of insolvency subjects the firm’s decisions to fraudulent transfer laws that also effectively limit the firm’s freedom to operate. The model explains why firms may be unable to finance themselves more fully with debt, even if other assumed rationales against doing so (e.g., costs of financial distress) are non-binding. This may be part of the explanation – previously ignored – for why debt is not used more frequently in high growth firms where there are relatively low probabilities of success (ability to pay) even when growth options generate high asset values. It may also be part of the explanation for why we do not see more ultra-high-yield debt, by which I mean debt that promises a yield significantly in excess of the rates we currently observe in the high-yield market.

Explaining Aid Project and Program Success: Findings from Asian Development Bank Interventions

Summary This paper contributes to the aid effectiveness literature by examining the determinants of aid project and program success. Both macro (country level) and micro (project level) determinants are considered. The paper employs a variety of econometric techniques to examine evaluation data for countries in the Asia-Pacific from the Asian Development Bank (ADB) for period 1970–2010. At the macro level, the rate of per capita income growth is positively associated with aid project and program success. Aid interventions are found to have a lower probability of success in the Pacific and, surprisingly, in countries with higher levels of democracy. There is little association between project and program ratings and the level of governance. At the micro level, projects are more likely to be successful than programs, as are larger aid interventions. Interventions which received less funding than anticipated, possibly due to capacity constraints, are found to have a lower probability of success. Despite these statistically significant findings, both macro and micro variables contribute very little to the explanatory power of models explaining the variation in project and program outcomes. The paper concludes that the ADB should reconsider its performance based aid allocation model.

The determinants of failed takeovers in the banking sector: Deal or country characteristics?

Abstract The consolidation process which characterized the banking industry in the last decades has been widely analyzed, but very few studies have investigated the reasons which bring a number of announced deals to failure. We fill this gap in the literature analyzing the characteristics of failed M&A operations in a large sample, including all the major domestic and cross-border deals in the banking sector announced worldwide between 1992 and 2010. The results show that the most important factors which determine the failure of an announced operation are deal specific characteristics, in particular the hostility of the bidder and the presence of multiple potential acquirers. Moreover, lengthier negotiations have a lower probability of success. Contrary to expectations, cross-border operations are more likely to be successfully completed than domestic ones.

Direct evidence implicates feral cat predation as the primary cause of failure of a mammal reintroduction programme

SummaryAs evidence mounts that the feral Cat (Felis catus) is a significant threat to endemic Australian biodiversity and impedes reintroduction attempts, uncertainty remains about the impact a residual population of cats following control will have on a mammal reintroduction programme. Also, behavioural interactions between cats and their prey continue to be an area of interest. Within the framework of an ecosystem restoration project, we tested the hypotheses that successful reintroductions of some medium‐sized mammals are possible in locations where feral cats are controlled (but not eradicated) in the absence of European Red Fox (Vulpes vulpes), and that hare‐wallabies that dispersed from their release area are more vulnerable to cat predation compared with those that remain at the release site. We used radiotelemetry to monitor the survivorship and dispersal of 16 Rufous Hare‐wallabies (Lagorchestes hirsutus spp.) and 18 Banded Hare‐wallabies (Lagostrophus fasciatus fasciatus) reintroduced to four sites within Shark Bay, Western Australia. Nearly all foxes were removed and feral cats were subject to ongoing control that kept their indices low relative to prerelease levels. All monitored hare‐wallabies were killed by cats within eight and 10 months following release. Significant predation by feral cats was not immediate: most kills occurred in clusters, with periods of several months where no mortalities occurred. Once a hare‐wallaby was killed, however, predation continued until each population was eliminated. Animals remaining near their release site survived longer than those that dispersed. The aetiology of predation events observed offers new insights into patterns of feral cat behaviour and mammal releases. We propose a hypothesis that these intense per capita predation events may reflect a targeted hunting behaviour in individual feral cats. Even where feral cats are controlled, the outcome from consistent predation events will result in reintroduction failures. Managers considering the reintroduction of medium‐sized mammals in the presence of feral cats should, irrespective of concurrent cat control, consider the low probability of success. We advocate alternative approaches to cat‐baiting alone for the recovery of cat‐vulnerable mammals such as hare‐wallabies.

Judicialización de la política y grupos de presión en Brasil: intereses, estrategias y resultados

Después de 24 años de un orden constitucional en Brasil, ¿qué se puede aprender sobre la interacción entre los grupos de presión y el Supremo Tribunal Federal (STF)?, ¿cuáles son los actores políticos que logran los mejores resultados?, ¿qué temas se juzgan más por el STF?, ¿el Supremo Tribunal privilegia específicamente algún tema o las decisiones son tomadas teniendo en cuenta más al demandante que al tema tratado? Si es así, ¿quiénes son los privilegiados por sus decisiones? Este artículo analiza la interacción entre la sociedad civil y el Poder Judicial, con base en la observación del uso de las Acciones Directas de Inconstitucionalidad (ADI). El artículo estudia, también, las demandas judiciales de los industriales sometidas al STF a través de la Confederación Nacional de la Industria (CNI), y busca evidenciar que: (1) los grupos más poderosos tienen mayor éxito a la hora de proponer las ADI; (2) aunque tenga baja probabilidad de éxito, merece la pena judicializar el conflicto de sus intereses, y (3) la judicialización de los grupos de presión es una estrategia complementaria y articulada con el conflicto de intereses en la arena legislativa.

Entanglement generation by communication using phase-squeezed light with photon loss

In order to implement fault-tolerant quantum computation, entanglement generation with low error probability and high success probability is required. We have proposed the use of squeezed coherent light as a probe to generate entanglement between two atoms by communication, and shown that the error probability is reduced well below the threshold of fault-tolerant quantum computation [Phys. Rev. A. {\bf 88}, 022313 (2013)]. Here, we investigate the effect of photon loss mainly due to finite coupling efficiency to the cavity. The error probability with the photon loss is calculated by the beam-splitter model for homodyne measurement on probe light. Optimum condition on the amplitude of probe light to minimize the error probability is examined. It is shown that the phase-squeezed probe light yields lower error probability than coherent-light probe. A fault-tolerant quantum computation algorithm can be implemented under 0.59 dB loss by concatenating five-qubit error correction code.

An Efficient and Cost-Effective Method for Preparing Transmission Electron Microscopy Samples from Powders.

The preparation of transmission electron microcopy (TEM) samples from powders with particle sizes larger than ~100 nm poses a challenge. The existing methods are complicated and expensive, or have a low probability of success. Herein, we report a modified methodology for preparation of TEM samples from powders, which is efficient, cost-effective, and easy to perform. This method involves mixing powders with an epoxy on a piece of weighing paper, curing the powder-epoxy mixture to form a bulk material, grinding the bulk to obtain a thin foil, punching TEM discs from the foil, dimpling the discs, and ion milling the dimpled discs to electron transparency. Compared with the well established and robust grinding-dimpling-ion-milling method for TEM sample preparation for bulk materials, our modified approach for preparing TEM samples from powders only requires two additional simple steps. In this article, step-by-step procedures for our methodology are described in detail, and important strategies to ensure success are elucidated. Our methodology has been applied successfully for preparing TEM samples with large thin areas and high quality for many different mechanically milled metallic powders.

Mapping the potential success of agricultural water management interventions for smallholders: Where are the best opportunities?

From field to basin scales, there are many appropriate interventions used to manage rainfall efficiently and productively in smallholder farming systems. Yet, successful targeting and scaling-out of these approaches remains a challenge. This paper presents an innovative approach in decision support called ‘Targeting Agricultural Water Management Interventions’ (TAGMI) with application in Limpopo and Volta river basins (available at http://www.seimapping.org/tagmi/). The online open-access TAGMI uses country-scale Bayesian network models to assess the likelihood of success for outscaling various agricultural water management (AWM) interventions at sub-national level. The web tool integrates multiple sources of expertise on the enabling environment for outscaling based on key social, human, physical, financial, and natural factors. It estimates the relative probability of success of an AWM intervention across the Limpopo and Volta river basins. Here we present TAGMI as a ‘proof of concept’, areas of high, medium, and low probabilities of success for three AWM technologies common in Limpopo and Volta River Basins: the soil water conservation/in situ rainwater harvesting technologies in rain-fed systems, small-scale private irrigation and small reservoirs used for communal irrigation purposes. We then apply a climate change scenario and discuss the robustness in potential AWM, according to the TAGMI tool. Finally, we discuss the need for generic or specific information on ‘best practices of implementation’ for successful uptake of technologies in poverty-constrained smallholder farming systems.

Quantification of the In Vitro Radiosensitivity of Mung Bean Sprout Elongation to 6MV X-Ray: A Revised Target Model Study.

In this study, a revised target model for quantifying the in vitro radiosensitivity of mung bean sprout elongation to 6-MV X-rays was developed. The revised target model, which incorporated the Poisson prediction for a low probability of success, provided theoretical estimates that were highly consistent with the actual data measured in this study. The revised target model correlated different in vitro radiosensitivities to various effective target volumes and was successfully confirmed by exposing mung beans in various elongation states to various doses of 6-MV X-rays. For the experiment, 5,000 fresh mung beans were randomly distributed into 100 petri dishes, which were randomly divided into ten groups. Each group received an initial watering at a different time point prior to X-ray exposure, resulting in different effective target volumes. The bean sprouts were measured 70 hr after X-ray exposure, and the average length of the bean sprouts in each group was recorded as an index of the mung bean in vitro radiosensitivity. Mung beans that received an initial watering either six or sixteen hours before X-ray exposure had the shortest sprout length, indicating that the maximum effective target volume was formed within that specific time period. The revised target model could be also expanded to interpret the “two-hit” model of target theory, although the experimental data supported the “one-hit” model. If the “two-hit” model was sustained, theoretically, the target size would be 2.14 times larger than its original size to produce the same results.

Behavioral economic insights into physician tobacco treatment decision-making.

Physicians self-report high adherence rates for Ask and Advise behaviors of tobacco dependence treatment but are much less likely to engage in "next steps" consistent with sophisticated management of chronic illness. A variety of potential explanations have been offered, yet each lacks face validity in light of experience with other challenging medical conditions. Conduct a preliminary exploration of the behavioral economics of tobacco treatment decision-making in the face of uncertain outcomes, seeking evidence that behaviors may be explained within the framework of Prospect Theory. Four physician cohorts were polled regarding their impressions of the utility of tobacco use treatment and their estimations of "success" probabilities. Contingent valuation was estimated by asking respondents to make monetary tradeoffs relative to three common chronic conditions. Responses from all four cohorts showed a similar pattern of high utility of tobacco use treatment but low success probability when compared with the other chronic medical conditions. Following instructional methods aimed at controverting cognitive biases related to tobacco, this pattern was reversed, with success probabilities attaining higher valuation than for diabetes. Important presuppositions regarding the potential "success" of tobacco-related patient interactions are likely limiting physician engagement by favoring the most secure visit outcome despite the limited potential for health gains. Under these conditions, low engagement rates would be consistent with Prospect Theory predictions. Interventions aimed at counteracting the cognitive biases limiting estimations of success probabilities seem to effectively reverse this pattern and provide clues to improving the adoption of target clinical behaviors.

Abstract 16117: Clinical and Angiographic Scoring System to Predict the Probability of Successful First Attempt PCI in Patients With Coronary Chronic Total Occlusion

Background: Coronary chronic total occlusion (CTO) remains the lesion subtype in which angioplasty has the lowest success rate. Although many independent predictors of final procedural success have been identified, no studies have yet analyzed their combined impact on final procedural outcome. In order to obtain a scoring model to predict final CTO-PCI success, we analyzed a population of patients who underwent a percutaneous coronary intervention for a chronic total occlusion (CTO-PCI) at our institution. Methods: We included 1,657 consecutive patients who underwent a first-attempt CTO-PCI at ICPS from January 2004 to December 2013. Clinical, angiographic procedural and technical characteristics were prospectively collected. A backword stepwise logistic regression including clinical and angiographic variables was used to create a multivariable model of independent predictors of CTO-PCI success. Independent variables were then scored. Results: Overall procedural success rate was 72.5%. The backward logistic regression model showed that two clinical variables: previous CABG (OR2.28, 95%CI1.53-3.4), previous MI (1.56, 95%CI 1.19-2.0) and four angiographic variables: severe lesion calcification (OR 2.95, 95%CI 2.08-4.2), longer CTOs (≥20 mm: OR 2.04, 95%CI 1.62-2.58), non LAD location (OR 1.58, 95%CI 1.21-2-06) and blunt stump morphology (OR 1.57, 95%CI 1.24-1.99) were independent predictors of CTO-PCI failure. The OR values of these variables were used to create the Clinical and Angiographic Scoring System (CL-SCORE). CL-Score values of 0, 1-3, >3 and ≤5 and >5 indentified subgroups at high (class 0), intermediate (class 1), low (class 2), very low (class 3) probability of CTO-PCI success (80.3%, 64.2%, 49.4 and 29% respectively; p<0,0001) Figure 1. The probability of CTO-PCI failure increased significantly from class 0 to class 1 (19.7% to 35.8%, p<0.0001), from class 1 to class 2 (35.8 to 50.6 p<0.0001) and from class 2 to class 3 (50.6% to 81% p=0.001), respectively. Conclusion: This clinical and angiographic score strongly predicted the final CTO-PCI procedural outcome of our study population. Further studies are required to validate this model.

Gay Marriage and American State Legislatures

In recent years, gay marriage has become an increasingly salient topic in American politics. Despite this, political scientists have paid surprisingly little attention to the question of when and how states come to provide the right to gay marriage. The limited existing literature on pro-LGBT legislation would indicate that this question should be answered by focusing on the presence of openly gay legislators or public support for LGBT issues as catalysts for the passage of gay marriage laws. In this paper, we argue that a more effective explanation relies on incorporating the important role political parties play in the legislative process. We find evidence that the success of gay marriage bills lies largely in the presence of Democratic control of the legislature and governorship. Additionally, we argue that this finding explains the recent shift from legislative to judicial attempts at introducing gay marriage: of the states that have not yet passed gay marriage legislation, the large majority has Republican control of both the legislature and governorship, indicating a very low probability of success for the legislative path.

Protecting qubit–qutrit entanglement from amplitude damping decoherence via weak measurement and reversal

We investigate the entanglement protection of a hybrid qubit–qutrit system under amplitude damping decoherence by employing weak measurement and reversal. We examine two typical families of initially entangled qubit–qutrit states (i.e. one-parameter and two-parameter qubit–qutrit states). We find that the qubit–qutrit entanglement decays monotonically as the decoherence strength increases, and may go through a sudden death for some initial states. However, we can completely defeat amplitude damping decoherence and recover the initial entanglement perfectly for any initial states by means of the combination of prior weak measurement and subsequent optimal weak measurement reversal. The only price that we have to pay is the very low success probability.

Financing successful small business projects

Purpose – The current credit rationing strongly influences the viability of SMEs innovation projects. In this context, the practice of screening borrowers by project success probability has become a paramount consideration for both lenders and firms. The aim of this paper is to test the screening role of loan contracts that consider collateral-interest margins simultaneously. Design/methodology/approach – This paper presents an empirical analysis that uses a unique data set composed of 323 bank loans granted by 28 banks to SMEs backed by a Spanish Mutual Guarantee Institution. Findings – The results show that appropriate combinations of collateral and interest rates can distinguish between borrowers with different project success probability: low success probability borrowers finance its projects without collateral and with high interest rates, whereas high success probability borrowers accept loans with real estate collateral and low interest rates. Practical implications – This screening mechanism reduces credit rationing, thus increasing good projects' access to credit. Originality/value – This study provides the first empirical evidence on the effectiveness of collateral-interest pairs as a self-selection mechanism.

Multiple Neural Mechanisms of Decision Making and Their Competition under Changing Risk Pressure

SummarySometimes when a choice is made, the outcome is not guaranteed and there is only a probability of its occurrence. Each individual’s attitude to probability, sometimes called risk proneness or aversion, has been assumed to be static. Behavioral ecological studies, however, suggest such attitudes are dynamically modulated by the context an organism finds itself in; in some cases, it may be optimal to pursue actions with a low probability of success but which are associated with potentially large gains. We show that human subjects rapidly adapt their use of probability as a function of current resources, goals, and opportunities for further foraging. We demonstrate that dorsal anterior cingulate cortex (dACC) carries signals indexing the pressure to pursue unlikely choices and signals related to the taking of such choices. We show that dACC exerts this control over behavior when it, rather than ventromedial prefrontal cortex, interacts with posterior cingulate cortex.

Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin

ObjectiveOral progestin is an alternative to hysterectomy for women with complex atypical hyperplasia (CAH) or grade one endometrial cancer (G1EC) who wish fertility preservation. We evaluated treatment efficacy and fertility outcomes in this population. MethodsWomen <45y treated with oral progestin for CAH or G1EC were identified from two cancer centers. Data were obtained from medical records and telephone questionnaires. Time until complete response (CR), and from CR until recurrence was censored for patients without events and analyzed for associations with patient and treatment characteristics; cumulative incidence functions were used to estimate event probability over time. Results44 patients were identified, 19 (43%) with CAH and 25 (57%) with G1EC. Median age was 36.5y (26–44). 24 (55%) achieved CR (median time: 5.7months). Older age was associated with a lower likelihood of CR (HR 0.84, p=0.0003, 95% CI, 0.8–0.9). CR probability appeared to plateau after 12months of therapy. Among those with CR, 13 (54%) recurred (median time 3.5y). 24 patients (55%) underwent hysterectomy; 3 (13%) were upstaged. 11 (25%) underwent fertility treatment with the following outcomes: 6 (55%) no pregnancy, 2 (18%) at least one live infant, and 3 (27%) spontaneous abortion. One achieved a live birth without intervention. ConclusionOral progestin is an effective temporizing fertility-sparing treatment for women with CAH/G1EC. Fertility specialist involvement is recommended due to the low live birth rate without intervention. Progestin therapy should be re-evaluated at 1year in non-responders due to a low probability of success. Hysterectomy is recommended after childbearing due to a high recurrence rate.

Delivering drought tolerance to those who need it: from genetic resource to cultivar

Drought limits crop yields, and with climate change, the severity of water stress is projected to increase in many production environments. Therefore, it has never been more important to deliver the findings of drought research to farmers. The maintenance in situ, collection and characterisation of key genetic variability for stress tolerance, its introgression into agronomically adapted materials, and the subsequent deployment of improved cultivars is a continuum. This paper focuses on one segment of the pathway—the process from genetic characterisation to cultivar delivery—and possible efficiencies are discussed with emphasis on wheat, one of the world’s most important food crops. The first efficiency is to limit the initial exploitation of genetic resources to close relatives, as much of this variation remains uncharacterised, rather than attempting gene transfers from unrelated species, which is time-consuming and has a low probability of success. Synthetic wheat, developed by crossing modern tetraploid wheat to Aegilops tauschii, the donor of the D-genome, has provided new genetic diversity for stress tolerance and yield advantages under drought in excess of 30% have been reported. Synthetic wheat can also be made using Triticum dicoccum, often referred to as emmer wheat, thus introducing new variation for all three wheat genomes. The second efficiency is better coordinated, field-based phenotyping. The Australian Managed Environment Facility and similar national facilities established in India and China provide a basis for accurate field-based phenotyping and the weighting of physiological traits related to water-use efficiency on a national scale. The calculation of a water balance, careful management of site heterogeneity and judicious use of rain shelters maximise trait expression and improve the relevance of results. The third efficiency is to maximise locally the benefits of global public-good research. The global wheat improvement programs of the Consultative Group on International Agricultural Research (CGIAR) have a mandate to ‘tame’ genetic diversity and distribute these improved materials globally in nurseries targeted to specific environmental conditions such as drought. Nevertheless, the exploitation of these materials is rarely managed well at the national level. The CIMMYT Australia ICARDA Germplasm Evaluation (CAIGE) program is a nationally coordinated germplasm introduction and evaluation program. Key CGIAR nurseries are received and grown by Australian quarantine, increased at one or two locations, tested for disease resistance and subsequently grown nationally in yield trials. The data are stored on the CAIGE website and, along with all supporting data generated by the international centres, are publicly available.

Use of predictive models in CNS diseases

Today the CNS drug development poses serious challenges for developers given the low probability of success and the disproportionately high investment costs. This review demonstrates how predictive models can provide quantitative criteria for increasing the efficiency of drug development in CNS. Predictive models can be applied to characterize, understand, and predict a drug's PK and PD behavior; to quantify uncertainty of information about that behavior; to identify factors that could affect the outcomes of a clinical trial through Clinical Trial Simulation (CTS), to identify prognostic factors that could affect the disease progression, to implement optimal and adaptive clinical trial and finally to control the level of placebo response by implementing study designs that minimizes the impact of placebo on study outcomes.

Donor Attrition At The Confirmatory Typing Stage Results In Poorer Transplant Options For Patients Of All Ethnicities

IntroductionIt has been previously recognised that unrelated haematopoietic stem cell donors from certain ethnic minority groups are less likely to be available when called to give a sample for confirmatory (verification) typing (CT), prior to final donor selection. However, a direct impact of such donor attrition on donor selection has not, to date, been shown for patients of any ethnicity. MethodsWe analysed the outcome of CT requests for 303 patients managed by the Anthony Nolan Graft Identification and Advisory Service (GIAS), with the aim of assessing the impact of donor attrition on the speed of donor provision and donor suitability at CT and at transplant. Patient ethnicity was categorised as white Northern European (WNE) or non-white Northern European (non-WNE). A donor was categorised as unavailable if they were unable to return a sample for CT within the timeframe required by the transplant centre, for whatever reason. Requests cancelled by the transplant centre within this timeframe were not categorised as donor attrition. Results235 patients (77.6%) were of white Northern European (WNE) descent, and 68 (22.4%) of non-WNE descent. 43 patients (13.0%) had a high, 141 (42.5%) a medium, 127 (38.3%) a low, and 21 (6.3%) a very low probability of search success (identifying a 10/10 matched donor), based on DRB1 allele and DRB1-DQB1 haplotype frequencies. Donor attrition was more common in those donors requested for CT for non-WNE patients (38.4% vs 24.6%, p<0.001), and more non-WNE patients were affected by at least two incidences of attrition (40.2% vs 29.0%, p=0.059). Patients experiencing two or more incidences of donor attrition had a longer time from first CT request to identifying the donor eventually selected for transplant (median 26 days vs 34.5 days, p<0.001). In addition, donor attrition was associated with fewer patients with at least one 10/10 donor identified at CT (46.5% vs 65.8%, p=0.001), fewer patients with a CMV matched donor at transplant (67.6% vs 80.4%, p=0.044) and fewer patients with a donor aged 30 or less at transplant (44.9% vs 62.8%, p=0.014). When analysing WNE patients alone, similar findings were made. However, the impact of attrition on search outcomes was less for non-WNE patients. Of note, there was only a trend towards a difference in time from first CT request to identifying the donor eventually selected for transplant (29.5 vs 38.5 days, p=0.072), and no impact on number of 10/10 donors identified at CT (22.6% vs 27%, p=0.673). In addition, no impact on CMV status or donor age at transplant was noted for non-WNE patients. Since patients with less common HLA phenotypes are likely to need a greater number of CT requests (and therefore are more exposed to donor attrition), a multivariate analysis was carried out including the probability of search success. For WNE patients, 2 or more episodes of donor attrition remained significantly associated with fewer patients with a 10/10 match at CT (p=0.047), more CMV mismatches at transplant (p=0.043), and fewer donors aged 30 or under (p=0.03). ConclusionWe have shown a significant impact of donor attrition on both search times and the availability of well-matched donors. Donor attrition affects not only the provision of HLA-matched donors, but also those matched for secondary characteristics such as CMV and age. However, despite a higher proportion of non-WNE patients experiencing donor attrition, the overall impact of attrition was less when compared to WNE patients. This may be because non-WNE are already sufficiently disadvantaged by the lack of available HLA-matched donors on international registries that the impact of donor attrition is minor in comparison.Since these variables are strongly associated with survival, donor attrition must be addressed at the donor registry level in order to improve patient outcome following transplant. Disclosures:No relevant conflicts of interest to declare.

Tethering Technique for Revision of a Thoracic Spinal Cord Stimulator Paddle: A Case Report

Revision of a displaced permanent spinal cord stimulator paddle lead presents certain challenges, not least of which is how to maintain the implant in the correct position. The author recently encountered a patient whose thoracic lead, which was originally placed in the midline, migrated into the lateral gutter. As a fibrous sheath had already formed around the lead in the displaced position, simply moving it back to the midline was felt to have a low probability of success. The author was able to successfully reposition the implant and anchor it with a technique that was recently presented for use in the cervical spine ( 1. Amrani J. A novel technique for the implantation of paddle leads in the cervical spine. Neuromodulation 2013. DOI: 10.1111/ner.12022 Google Scholar ).