Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches

The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrodesis has been shown to increase given placement of bone graft along the weight-bearing axis. The fusion rate across the disc space is further enhanced with the placement of posterior pedicle screw–rod constructs and the application of an osteoinductive material. The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection

Clinical handover: An audit from Australia

BackgroundThe Australian National Safety and Quality Health Service (NHQHS) Standards (the “Standards”) provide external criteria for hospitals to assess their practices. Since the introduction of the Standards, no Australian hospital has published a report on how its handover practices compare to these Standards.AimsTo evaluate house medical officer (HMO) shift-to-shift handover practices against the Standards at a large regional hospital.MethodAll HMOs employed by Barwon Health were invited to participate in our qualitative and quantitative study by completing an online questionnaire and taking part in a focus group.ResultsOf the 100 HMOs, 61 completed the questionnaire and 11 HMOs participated in focus groups. Questionnaire results revealed that HMOs were concerned about the quality of shift-to-shift handovers. Fifty-three per cent reported that current shift-to-shift handover practices could be putting patients at risk of adverse events. Ninety-eight per cent indicated that the handover processes could be improved. One hundred per cent of the HMOs stated that the quality of handover varies according to the doctors involved. In the focus groups, issues were raised about current handover structure, documentation, attendance, content, and training.ConclusionHMOs in the current study identified multiple deficiencies in handover practice with regard to structure, documentation, attendance, content, and training. The primary methods to improve handover include making it more structured and standardised, and to provide HMOs with handover training

Obligations of Researchers and Managers to Respect Wetlands: Practical Solutions to Minimizing Field Monitoring Impacts

Research and field monitoring can disturb wetland integrity. Adoption of ethical field practices is needed to limit monitoring induced stressors such as trampling, non-native seed and invertebrate dispersal, and disease and fungal spread. We identify a linear pathway of deterioration highlighting stressors that can progress to cumulative impacts, consequences, and losses at the site scale. The first step to minimize disturbance is to assess and classify the current ecosystem quality. We present a tiered framework for wetland classification and link preventative measures to the wetland tier. Preventative measures are recommended at various intensities respective to the wetland tier, with higher tiered wetlands requiring more intense preventative measures. In addition, preventative measures vary by time of implementation (before, during, and after the wetland visit) to mitigate impacts at various temporal scales. The framework is designed to increase transparency of field monitoring impacts and to promote the adoption of preventative measures. Implementing preventative measures can build accountability and foster a greater appreciation for our roles as researchers and managers in protecting wetlands

Observational Constraints on Red and Blue Helium Burning Sequences

We derive the optical luminosity, colors, and ratios of the blue and red helium burning (HeB) stellar populations from archival Hubble Space Telescope observations of nineteen starburst dwarf galaxies and compare them with theoretical isochrones from Padova stellar evolution models across metallicities from Z=0.001 to 0.009. We find that the observational data and the theoretical isochrones for both blue and red HeB populations overlap in optical luminosities and colors and the observed and predicted blue to red HeB ratios agree for stars older than 50 Myr over the time bins studied. These findings confirm the usefulness of applying isochrones to interpret observations of HeB populations. However, there are significant differences, especially for the red HeB population. Specifically we find: (1) offsets in color between the observations and theoretical isochrones of order 0.15 mag (0.5 mag) for the blue (red) HeB populations brighter than M_V ~ -4 mag, which cannot be solely due to differential extinction; (2) blue HeB stars fainter than M_V ~ -3 mag are bluer than predicted; (3) the slope of the red HeB sequence is shallower than predicted by a factor of ~3; and (4) the models overpredict the ratio of the most luminous blue to red HeB stars corresponding to ages <50 Myr. Additionally, we find that for the more metal-rich galaxies in our sample (Z> 0.5 Zsolar) the red HeB stars overlap with the red giant branch stars in the color magnitude diagrams, thus reducing their usefulness as indicators of star formation for ages >100 Myr.Comment: 18 pages, 11 figures, 3 table

Re-examining High Abundance SDSS Mass-Metallicity Outliers: High N/O, Evolved Wolf-Rayet Galaxies?

We present new MMT spectroscopic observations of four dwarf galaxies representative of a larger sample observed by the Sloan Digital Sky Survey (SDSS) and identified by Peeples et al. (2008) as low-mass, high oxygen abundance outliers from the mass-metallicity relation. Peeples et al. (2008) showed that these four objects (with metallicity estimates of 8.5 =< 12 + log(O/H) =< 8.8) have oxygen abundance offsets of 0.4-0.6 dex from the M_B luminosity-metallicity relation. Our new observations extend the wavelength coverage to include the [OII] 3726,3729 doublet, which adds leverage in oxygen abundance estimates and allows measurements of N/O ratios. All four spectra are low excitation, with relatively high N/O ratios (N/O >~ 0.10), each of which tend to bias estimates based on strong emission lines toward high oxygen abundances. These spectra all fall in a regime where the "standard" strong line methods for metallicity determinations are not well calibrated either empirically or by photoionization modeling. By comparing our spectra directly to photoionization models, we estimate oxygen abundances in the range of 7.9 =< 12 + log(O/H) =< 8.4, consistent with the scatter of the mass-metallicity relation. We discuss the physical nature of these galaxies that leads to their unusual spectra (and previous classification as outliers), finding their low excitation, elevated N/O, and strong Balmer absorption are consistent with the properties expected from galaxies evolving past the "Wolf-Rayet galaxy" phase. We compare our results to the "main" sample of Peeples et al. (2008) and conclude that they are outliers primarily due to enrichment of nitrogen relative to oxygen, and not due to unusually high oxygen abundances for their masses or luminosities.Comment: 38 pages, 10 figures, accepted to Ap

Common carotid intima media thickness and ankle-brachial pressure index correlate with local but not global atheroma burden:a cross sectional study using whole body magnetic resonance angiography

Common carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) are used as surrogate marker of atherosclerosis, and have been shown to correlate with arterial stiffness, however their correlation with global atherosclerotic burden has not been previously assessed. We compare CIMT and ABPI with atheroma burden as measured by whole body magnetic resonance angiography (WB-MRA).50 patients with symptomatic peripheral arterial disease were recruited. CIMT was measured using ultrasound while rest and exercise ABPI were performed. WB-MRA was performed in a 1.5T MRI scanner using 4 volume acquisitions with a divided dose of intravenous gadolinium gadoterate meglumine (Dotarem, Guerbet, FR). The WB-MRA data was divided into 31 anatomical arterial segments with each scored according to degree of luminal narrowing: 0 = normal, 1 = <50%, 2 = 50-70%, 3 = 70-99%, 4 = vessel occlusion. The segment scores were summed and from this a standardized atheroma score was calculated.The atherosclerotic burden was high with a standardised atheroma score of 39.5±11. Common CIMT showed a positive correlation with the whole body atheroma score (β 0.32, p = 0.045), however this was due to its strong correlation with the neck and thoracic segments (β 0.42 p = 0.01) with no correlation with the rest of the body. ABPI correlated with the whole body atheroma score (β -0.39, p = 0.012), which was due to a strong correlation with the ilio-femoral vessels with no correlation with the thoracic or neck vessels. On multiple linear regression, no correlation between CIMT and global atheroma burden was present (β 0.13 p = 0.45), while the correlation between ABPI and atheroma burden persisted (β -0.45 p = 0.005).ABPI but not CIMT correlates with global atheroma burden as measured by whole body contrast enhanced magnetic resonance angiography in a population with symptomatic peripheral arterial disease. However this is primarily due to a strong correlation with ilio-femoral atheroma burden

Dirofilariasis mouse models for heartworm preclinical research

Introduction: Dirofilariasis, including heartworm disease, is a major emergent veterinary parasitic infection and a human zoonosis. Currently, experimental infections of cats and dogs are used in veterinary heartworm preclinical drug research. Methods: As a refined alternative in vivo heartworm preventative drug screen, we assessed lymphopenic mouse strains with ablation of the interleukin-2/7 common gamma chain (γc) as susceptible to the larval development phase of Dirofilaria immitis. Results: Non-obese diabetic (NOD) severe combined immunodeficiency (SCID)γc−/− (NSG and NXG) and recombination-activating gene (RAG)2−/−γc−/− mouse strains yielded viable D. immitis larvae at 2–4 weeks post-infection, including the use of different batches of D. immitis infectious larvae, different D. immitis isolates, and at different laboratories. Mice did not display any clinical signs associated with infection for up to 4 weeks. Developing larvae were found in subcutaneous and muscle fascia tissues, which is the natural site of this stage of heartworm in dogs. Compared with in vitro-propagated larvae at day 14, in vivo-derived larvae had completed the L4 molt, were significantly larger, and contained expanded Wolbachia endobacteria titres. We established an ex vivo L4 paralytic screening system whereby assays with moxidectin or levamisole highlighted discrepancies in relative drug sensitivities in comparison with in vitro-reared L4 D. immitis. We demonstrated effective depletion of Wolbachia by 70%−90% in D. immitis L4 following 2- to 7-day oral in vivo exposures of NSG- or NXG-infected mice with doxycycline or the rapid-acting investigational drug, AWZ1066S. We validated NSG and NXG D. immitis mouse models as a filaricide screen by in vivo treatments with single injections of moxidectin, which mediated a 60%−88% reduction in L4 larvae at 14–28 days. Discussion: Future adoption of these mouse models will benefit end-user laboratories conducting research and development of novel heartworm preventatives via increased access, rapid turnaround, and reduced costs and may simultaneously decrease the need for experimental cat or dog use

Steps to Develop Early Warning Systems and Future Scenarios of Storm Wave-Driven Flooding Along Coral Reef-Lined Coasts

ABSTRACT: Tropical coral reef-lined coasts are exposed to storm wave-driven flooding. In the future, flood events during storms are expected to occur more frequently and to be more severe due to sea-level rise, changes in wind and weather patterns, and the deterioration of coral reefs. Hence, disaster managers and coastal planners are in urgent need of decision-support tools. In the short-term, these tools can be applied in Early Warning Systems (EWS) that can help to prepare for and respond to impending storm-driven flood events. In the long-term, future scenarios of flooding events enable coastal communities and managers to plan and implement adequate risk-reduction strategies. Modeling tools that are used in currently available coastal flood EWS and future scenarios have been developed for open-coast sandy shorelines, which have only limited applicability for coral reef-lined shorelines. The tools need to be able to predict local sea levels, offshore waves, as well as their nearshore transformation over the reefs, and translate this information to onshore flood levels. In addition, future scenarios require long-term projections of coral reef growth, reef composition, and shoreline change. To address these challenges, we have formed the UFORiC (Understanding Flooding of Reef-lined Coasts) working group that outlines its perspectives on data and model requirements to develop EWS for storms and scenarios specific to coral reef-lined coastlines. It reviews the state-of-the-art methods that can currently be incorporated in such systems and provides an outlook on future improvements as new data sources and enhanced methods become available

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin