Use of the Spine AdVerse Events Severity (SAVES) System to Categorize and Report Adverse Events in Spine Surgery.

Introduction: Analysis of adverse events (AEs) in spine surgery has historically been retrospective, utilizing hospital administrative data. Our objective was to determine the incidence, severity and effect on hospital length of stay (LOS) for AEs in spine surgery using the Spine AdVerse Events Severity (SAVES V2) system. Methods: AEs for all surgical spine patients at our institution were prospectively collected for 18 months and correlated with retrospective data from operative reports and H&Ps. Statistical analyses compared patient demographics, diagnoses, and surgical characteristics to hospital length of stay and likelihood of adverse events. Results: This system captured 75% (765/977) of surgical cases for all indications over the study period. 73% (541/743) of patients experienced at least one AE, with an average of 1.2 AEs per patient (range 0-5). The most common AEs were pain control (31%), urinary retention (9.7%), wound infection (6.3%), and incidental durotomy (5.8%). For patients experiencing at least one AE, 30% had no effect on LOS, 48% increased LOS by 1-2 days, 15% increased LOS by 3-7 days, and 7% had prolonged LOS greater than 8 days. Our system captured 25.4% more adverse events (60.0% vs. 34.6%) than hospital administrative data. Univariate analysis revealed patient age, emergent surgery, diagnostic and surgical categories, and spine region to be predictors of both AEs and LOS. Instrumentation was predictive of increased LOS but not AEs. The type of AE was strongly associated with LOS. Multivariable analysis of AE likelihood demonstrated emergent surgery to be the strongest independent predictor with an adjusted odds ratio of 8.5 versus elective surgery. Discussion: Spine surgery is associated with a high incidence of adverse events, which often prolong hospital length of stay. Better characterization of adverse events and their predictors could lead to improved management strategies that reduce patient morbidity and mortality

Management of blunt extracranial traumatic cerebrovascular injury: a multidisciplinary survey of current practice

<p>Abstract</p> <p>Background</p> <p>Extracranial traumatic cerebrovascular injury (TCVI) is present in 1-3% of all blunt force trauma patients. Although options for the management of patients with these lesions include anticoagulation, antiplatelet agents, and endovascular treatment, the optimal management strategy for patients with these lesions is not yet established.</p> <p>Objective</p> <p>Multidisciplinary survey of clinicians about current management of TCVI.</p> <p>Methods</p> <p>A six-item multiple-choice survey was sent by electronic mail to a total of 11,784 neurosurgeons, trauma surgeons, stroke neurologists, and interventional radiologists. The survey included questions about their choice of imaging, medical management, and the use of endovascular techniques. Survey responses were analyzed according to stated specialty.</p> <p>Results</p> <p>Seven hundred eighty-five (6.7%) responses were received. Overall, a total of 325 (42.8%) respondents favored anticoagulation (heparin and/or warfarin), 247 (32.5%) favored antiplatelet drugs, 130 (17.1%) preferred both anticoagulation and antiplatelet drugs, and 57 (7.5%) preferred stenting and/or embolization. Anticoagulation was the most commonly preferred treatment among vascular surgeons (56.9%), neurologists (50.2%) and neurosurgeons (40.7%), whereas antiplatelet agents were the most common preferred treatment among trauma surgeons (41.5%). Overall, 158 (20.7%) of respondents recommended treatment of asymptomatic dissections and traumatic aneurysms, 211 (27.7%) did not recommend it, and 39.4% recommended endovascular treatment only if there is worsening of the lesion on follow-up imaging.</p> <p>Conclusions</p> <p>These data demonstrate the wide variability of physicians' management of traumatic cerebrovascular injury, both on an individual basis, and between specialties. These findings underscore the need for multicenter, randomized trials in this field.</p

Thirty Years After Michael E. Porter: What Do We Know About Business Exit?

Although a business exit is an important corporate change initiative, the buyer’s side seems to be more appealing to management researchers than the seller’s because acquisitions imply growth, i.e., success. Yet from an optimistic viewpoint, business exit can effectively create value for the selling company. In this paper we attempt to bring the relevance of the seller’s side back into our consciousness by asking: What do we know about business exit? We start our exploration with Porter (1976), focusing on literature that investigates the antecedents of, barriers to, and outcomes of business exit. We also include studies from related fields such as finance and economics.1 Through this research we determine three clusters of findings: factors promoting business exit, exit barriers, and exit outcomes. Overall, it is the intention of this paper to highlight the importance of business exit for research and practice. Knowing what we know about business exits and their high financial value we should bear in mind that exit need not mean failure but a new beginning for a corporation

Natural Products Chemistry and Taxonomy of the Marine Cyanobacterium Blennothrix cantharidosmum

A Papua New Guinea field collection of the marine cyanobacterium Blennothrix cantharidosmum was investigated for its cytotoxic constituents. Bioassay-guided isolation defined the cytotoxic components as the known compounds lyngbyastatins 1 and 3. However, six new acyl proline derivatives, tumonoic acids D−I, plus the known tumonoic acid A were also isolated. Their planar structures were defined from NMR and MS data, while their stereostructures followed from a series of chiral chromatographies, degradation sequences, and synthetic approaches. The new compounds were tested in an array of assays, but showed only modest antimalarial and inhibition of quorum sensing activities. Nevertheless, these are the first natural products to be reported from this genus, and this inspired a detailed morphologic and 16S rDNA-based phylogenetic analysis of the producing organism

Quasi-probability representations of quantum theory with applications to quantum information science

This article comprises a review of both the quasi-probability representations of infinite-dimensional quantum theory (including the Wigner function) and the more recently defined quasi-probability representations of finite-dimensional quantum theory. We focus on both the characteristics and applications of these representations with an emphasis toward quantum information theory. We discuss the recently proposed unification of the set of possible quasi-probability representations via frame theory and then discuss the practical relevance of negativity in such representations as a criteria for quantumness.Comment: v3: typos fixed, references adde

Towards a global land surface climate fiducial reference measurements network

There is overwhelming evidence that the climate system has warmed since the instigation of instrumental meteorological observations. The Fifth Assessment Report of the Intergovernmental Panel on Climate Change concluded that the evidence for warming was unequivocal. However, owing to imperfect measurements and ubiquitous changes in measurement networks and techniques, there remain uncertainties in many of the details of these historical changes. These uncertainties do not call into question the trend or overall magnitude of the changes in the global climate system. Rather, they act to make the picture less clear than it could be, particularly at the local scale where many decisions regarding adaptation choices will be required, both now and in the future. A set of high-quality long-term fiducial reference measurements of essential climate variables will enable future generations to make rigorous assessments of future climate change and variability, providing society with the best possible information to support future decisions. Here we propose that by implementing and maintaining a suitably stable and metrologically well-characterized global land surface climate fiducial reference measurements network, the present-day scientific community can bequeath to future generations a better set of observations. This will aid future adaptation decisions and help us to monitor and quantify the effectiveness of internationally agreed mitigation steps. This article provides the background, rationale, metrological principles, and practical considerations regarding what would be involved in such a network, and outlines the benefits which may accrue. The challenge, of course, is how to convert such a vision to a long-term sustainable capability providing the necessary well-characterized measurement series to the benefit of global science and future generations

Impacts of economic inequality on healthcare worker safety at the onset of the COVID-19 pandemic : cross-sectional analysis of a global survey

Objectives To assess the extent to which protection of healthcare workers (HCWs) as COVID-19 emerged was associated with economic inequality among and within countries. Design Cross-sectional analysis of associations of perceptions of workplace risk acceptability and mitigation measure adequacy with indicators of respondents’ respective country’s economic income level (World Bank assessment) and degree of within-country inequality (Gini index). Setting A global self-administered online survey. Participants 4977 HCWs and healthcare delivery stakeholders from 161 countries responded to health and safety risk questions and a subset of 4076 (81.2%) answered mitigation measure questions. The majority (65%) of study participants were female. Results While the levels of risk being experienced at the pandemic’s onset were consistently deemed as unacceptable across all groupings, participants from countries with less income inequality were somewhat less likely to report unacceptable levels of risk to HCWs regarding both workplace environment (OR=0.92, p=0.012) and workplace organisational factors (OR=0.93, p=0.017) compared with counterparts in more unequal national settings. In contrast, considerable variation existed in the degree to which mitigation measures were considered adequate. Adjusting for other influences through a logistic regression analysis, respondents from lower middle-income and low-income countries were comparatively much more likely to assess both occupational health and safety (OR=10.91, p≤0.001) and infection prevention and control (IPC) (OR=6.61, p=0.001) protection measures as inadequate, despite much higher COVID-19 rates in wealthier countries at the time of the survey. Greater within-country income inequality was also associated with perceptions of less adequate IPC measures (OR=0.94, p=0.025). These associations remained significant when accounting for country-level differences in occupational and gender composition of respondents, including specifically when only female care providers, our study’s largest and most at-risk subpopulation, were examined. Conclusions Economic inequality threatens resilience of health systems that rely on health workers working safely to provide needed care during emerging pandemics

Climate, irrigation, and land cover change explain streamflow trends in countries bordering the northeast Atlantic

Attribution of trends in streamflow is complex, but essential, in identifying optimal management options for water resources. Disagreement remains on the relative role of climate change and human factors, including water abstractions and land cover change, in driving change in annual streamflow. We construct a very dense network of gauging stations (n = 1,874) from Ireland, the United Kingdom, France, Spain, and Portugal for the period of 1961–2012 to detect and then attribute changes in annual streamflow. Using regression‐based techniques, we show that climate (precipitation and atmospheric evaporative demand) explains many of the observed trends in northwest Europe, while for southwest Europe human disturbances better explain both temporal and spatial trends. For the latter, large increases in irrigated areas, agricultural intensification, and natural revegetation of marginal lands are inferred to be the dominant drivers of decreases in streamflow