Effects of bracing in adolescents with idiopathic scoliosis

BACKGROUND: The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. METHODS: We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation. Patients in the bracing group were instructed to wear the brace at least 18 hours per day. The primary outcomes were curve progression to 50 degrees or more (treatment failure) and skeletal maturity without this degree of curve progression (treatment success). RESULTS: The trial was stopped early owing to the efficacy of bracing. In an analysis that included both the randomized and preference cohorts, the rate of treatment success was 72% after bracing, as compared with 48% after observation (propensity-score–adjusted odds ratio for treatment success, 1.93; 95% confidence interval [CI], 1.08 to 3.46). In the intention-to-treat analysis, the rate of treatment success was 75% among patients randomly assigned to bracing, as compared with 42% among those randomly assigned to observation (odds ratio, 4.11; 95% CI, 1.85 to 9.16). There was a significant positive association between hours of brace wear and rate of treatment success (P CONCLUSIONS: Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and others; BRAIST ClinicalTrials.gov number, NCT00448448opens in new tab.)</p

Quantifying near-field and off-fault deformation patterns of the 1992 M_w 7.3 Landers earthquake

Coseismic surface deformation in large earthquakes is typically measured using field mapping and with a range of geodetic methods (e.g., InSAR, lidar differencing, and GPS). Current methods, however, either fail to capture patterns of near-field coseismic surface deformation or lack preevent data. Consequently, the characteristics of off-fault deformation and the parameters that control it remain poorly understood. We develop a standardized method to fully measure the surface, near-field, coseismic deformation patterns at high resolution using the COSI-Corr program by correlating pairs of aerial photographs taken before and after the 1992 M_w 7.3 Landers earthquake. COSI-Corr offers the advantage of measuring displacement across the entire zone of surface deformation and over a wider aperture than that available to field geologists. For the Landers earthquake, our measured displacements are systematically larger than the field measurements, indicating the presence of off-fault deformation. We show that 46% of the total surface displacement occurred as off-fault deformation, over a mean deformation width of 154 m. The magnitude and width of off-fault deformation along the rupture is primarily controlled by the macroscopic structural complexity of the fault system, with a weak correlation with the type of near-surface materials through which the rupture propagated. Both the magnitude and width of distributed deformation are largest in stepovers, bends, and at the southern termination of the surface rupture. We find that slip along the surface rupture exhibits a consistent degree of variability at all observable length scales and that the slip distribution is self-affine fractal with dimension of 1.56

Elite male Flat jockeys display lower bone density and lower resting metabolic rate than their female counterparts: implications for athlete welfare

To test the hypothesis that daily weight-making is more problematic to health in male compared with female jockeys, we compared the bone-density and resting metabolic rate (RMR) in weight-matched male and female Flat-jockeys. RMR (kcal.kg-1 lean mass) was lower in males compared with females as well as lower bone-density Z-scores at the hip and lumbar spine. Data suggest the lifestyle of male jockeys’ compromise health more severely than females, possibly due to making-weight more frequently

Efficient, full-spectrum, long-lived, non-toxic microwave lamp for plant growth

Fusion Systems Corporation has developed a mercury-free, low infrared, efficient microwave lamp using a benign sulfur based fill optimized for visible light. Our literature search and discussions with researchers directed us to enhance the bulbs red output. We have demonstrated a photosynthetic efficacy of over 2 micro-moles per microwave joule which corresponds to over 1.3 micro-moles per joule at the power main. Recent work has shown we can make additional increases in overall system efficiency. During the next two years, we expect to demonstrate a system capable of producing more than 1.5 micro-moles/joule measured at the power main with significantly less IR than alternative lamp systems. We determined optimal plant growth light requirements via a literature search and researcher input. We surveyed candidate lamp fill materials to be used in combination with sulfur and explored several methods of increasing photosynthetic efficacy

The prognostic value of systemic inflammation in patients undergoing surgery for colon cancer: comparison of composite ratios and cumulative scores

Introduction: The systemic inflammatory response has been proven to have a prognostic value. There are two methods of assessing the systemic inflammatory response composite ratios (R) and cumulative scores (S). The aim of this study was to compare the prognostic value of ratios and scores in patients undergoing surgery for colon cancer. Methods: Patients were identified prospectively in a single surgical unit. Preoperative neutrophil (N), lymphocyte (L), monocyte (M) and platelet (P) counts, CRP (C) and albumin (A) levels were recorded. The relationship between composite ratios neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), lymphocyte–monocyte ratio (LMR), C-reactive protein albumin ratio (CAR) and the cumulative scores neutrophil– lymphocyte score (NLS), platelet–lymphocyte score (PLS), lymphocyte–monocyte score (LMS), neutrophil– platelet score (NPS), modified Glasgow prognostic score (mGPS) and clinicopathological characteristics, cancer-specific survival (CSS) and overall survival (OS), were examined. Results: A total of 801 patients were examined. When adjusted for tumour node metastasis (TNM) stage, NLR &gt;5 (p &lt; 0.001), NLS (p &lt; 0.01), PLS (p &lt; 0.001), LMR &lt;2.4 (p &lt; 0.001), LMS (p &lt; 0.001), NPS (p &lt; 0.001), CAR &gt;0.22 (p &lt; 0.001) and mGPS (p &lt; 0.001) were significantly associated with CSS. In patients undergoing elective surgery (n = 689), the majority of the composite ratios/scores correlated with age (p &lt; 0.01), BMI (p &lt; 0.01), T stage (p &lt; 0.01), venous invasion (p &lt; 0.01) and peritoneal involvement (p &lt; 0.01). When NPS (myeloid) and mGPS (liver) were directly compared, their relationship with CSS and OS was similar. Conclusions: Both composite ratios and cumulative scores had prognostic value, independent of TNM stage, in patients with colon cancer. However, cumulative scores, based on normal reference ranges, are simpler and more consistent for clinical use

Optimal management of adults with pharyngitis – a multi-criteria decision analysis

BACKGROUND: Current practice guidelines offer different management recommendations for adults presenting with a sore throat. The key issue is the extent to which the clinical likelihood of a Group A streptococcal infection should affect patient management decisions. To help resolve this issue, we conducted a multi-criteria decision analysis using the Analytic Hierarchy Process. METHODS: We defined optimal patient management using four criteria: 1) reduce symptom duration; 2) prevent infectious complications, local and systemic; 3) minimize antibiotic side effects, minor and anaphylaxis; and 4) achieve prudent use of antibiotics, avoiding both over-use and under-use. In our baseline analysis we assumed that all criteria and sub-criteria were equally important except minimizing anaphylactic side effects, which was judged very strongly more important than minimizing minor side effects. Management strategies included: a) No test, No treatment; b) Perform a rapid strep test and treat if positive; c) Perform a throat culture and treat if positive; d) Perform a rapid strep test and treat if positive; if negative obtain a throat culture and treat if positive; and e) treat without further tests. We defined four scenarios based on the likelihood of group A streptococcal infection using the Centor score, a well-validated clinical index. Published data were used to estimate the likelihoods of clinical outcomes and the test operating characteristics of the rapid strep test and throat culture for identifying group A streptococcal infections. RESULTS: Using the baseline assumptions, no testing and no treatment is preferred for patients with Centor scores of 1; two strategies – culture and treat if positive and rapid strep with culture of negative results – are equally preferable for patients with Centor scores of 2; and rapid strep with culture of negative results is the best management strategy for patients with Centor scores 3 or 4. These results are sensitive to the priorities assigned to the decision criteria, especially avoiding over-use versus under-use of antibiotics, and the population prevalence of Group A streptococcal pharyngitis. CONCLUSION: The optimal clinical management of adults with sore throat depends on both the clinical probability of a group A streptococcal infection and clinical judgments that incorporate individual patient and practice circumstances

"Contemplating the next maneuver": functional neuroimaging reveals intraoperative decision-making strategies

OBJECTIVE: To investigate differences in the quality, confidence, and consistency of intraoperative surgical decision making (DM) and using functional neuroimaging expose decision systems that operators use. SUMMARY BACKGROUND DATA: Novices are hypothesized to use conscious analysis (effortful DM) leading to activation across the dorsolateral prefrontal cortex, whereas experts are expected to use unconscious automation (habitual DM) in which decisions are recognition-primed and prefrontal cortex independent. METHODS: A total of 22 subjects (10 medical student novices, 7 residents, and 5 attendings) reviewed simulated laparoscopic cholecystectomy videos, determined the next safest operative maneuver upon video termination (10 s), and reported decision confidence. Video paradigms either declared ("primed") or withheld ("unprimed") the next operative maneuver. Simultaneously, changes in cortical oxygenated hemoglobin and deoxygenated hemoglobin inferring prefrontal activation were recorded using Optical Topography. Decision confidence, consistency (primed vs unprimed), and quality (script concordance) were assessed. RESULTS: Attendings and residents were significantly more certain (P < 0.001), and decision quality was superior (script concordance: attendings = 90%, residents = 78.3%, and novices = 53.3%). Decision consistency was significantly superior in experts (P < 0.001) and residents (P < 0.05) than novices (P = 0.183). During unprimed DM, novices showed significant activation of the dorsolateral prefrontal cortex, whereas this activation pattern was not observed among residents and attendings. During primed DM, significant activation was not observed in any group. CONCLUSIONS: Expert DM is characterized by improved quality, consistency, and confidence. The findings imply attendings use a habitual decision system, whereas novices use an effortful approach under uncertainty. In the presence of operative cues (primes), novices disengage the prefrontal cortex and seem to accept the observed operative decision as correct

Yangian symmetry of scattering amplitudes in N=4 super Yang-Mills theory

Tree-level scattering amplitudes in N=4 super Yang-Mills theory have recently been shown to transform covariantly with respect to a 'dual' superconformal symmetry algebra, thus extending the conventional superconformal symmetry algebra psu(2,2|4) of the theory. In this paper we derive the action of the dual superconformal generators in on-shell superspace and extend the dual generators suitably to leave scattering amplitudes invariant. We then study the algebra of standard and dual symmetry generators and show that the inclusion of the dual superconformal generators lifts the psu(2,2|4) symmetry algebra to a Yangian. The non-local Yangian generators acting on amplitudes turn out to be cyclically invariant due to special properties of psu(2,2|4). The representation of the Yangian generators takes the same form as in the case of local operators, suggesting that the Yangian symmetry is an intrinsic property of planar N=4 super Yang-Mills, at least at tree level.Comment: 23 pages, no figures; v2: typos corrected, references added; v3: minor changes, references adde

A comparison of the prognostic value of composite ratios and cumulative scores in patients with operable rectal cancer

The aim of this study was to directly compare the prognostic value of cumulative scores and composite ratios in patients with operable rectal cancer. Within a single surgical unit preoperative differential blood cell results including neutrophil (N), lymphocyte (L), monocyte (M) and platelet (P) counts, as well as CRP (C) and albumin (A) levels were recorded. These results were used to construct a series of composite ratios (NLR, PLR, LMR, CAR) and cumulative scores (NLS, PLS, LMS, NPS, mGPS). The relationship between composite ratios and the cumulative scores and clinicopathological characteristics, cancer specific survival (CSS) and overall survival (OS) were examined. A total of 413 patients were included. When adjusted for TNM stage, surgical approach, time of surgery and margin involvement mGPS (p &lt; 0.05) was associated with CSS. In addition, most composite ratios/scores showed correlations with neoadjuvant therapy (p &lt; 0.001). When a direct comparison between NPS (myeloid) and mGPS (liver) was carried out they showed similar associations with both CSS and OS. Therefore, both composite ratios and cumulative scores have been shown to be prognostic in patients with operable rectal cancer