Static vs. Expandable PEEK Interbody Cages: A Comparison of One-Year Clinical and Radiographic Outcomes for One-Level TLIF

Introduction: Degenerative spine disease is a disabling condition affecting many worldwide. Transoforaminal lumbar interbody fusion (TLIF) procedures help stabilize the spine, while improving back and/or leg pain. With the introduction of new implant designs and modifications, focus has shifted to optimizing spinopelvic alignment, fusion rates, and more. This study aims to explore the effect of static versus expandable polyetheretherketone (PEEK) cages on patient-reported outcomes (PROMs) and radiographic outcomes (subsidence, disk height, and alignment parameters). Materials/Methods: A retrospective cohort study was conducted using a database of patients in a single, high volume academic center. Patient outcomes were obtained from charts and radiographic outcomes were measured using standing, lateral radiographs. Data were analyzed using mean sample t-tests or categorical chi-squared tests, and multiple linear regression where appropriate. Results: Our results showed improved Oswestry Disability Index (ODI) scores perioperatively in the expandable cage group compared to the static cage group at the three-month and one-year time periods. In addition, there were a significantly greater proportion of patients that reached minimal clinically important difference (MCID) in the expandable group compared to the static cage group. There were no significant changes in subsidence or alignment parameters between the two groups at the one-year time period. Conclusion: Overall, our results show that TLIF patients treated with expandable PEEK cages had significantly greater improvement in one-year outcomes compared to patients with static cages. Expandable cages confer the advantage of more precise insertion into the intervertebral disk space, while providing a way to tailor the cage height for better distraction and spinal alignment. Further prospective studies are warranted to get a better idea of the impact of interbody design on clinical/radiographic outcomes

Assessing Indications of Riskiness in Adolescents

Adolescents are often likely to engage in perilous behaviors during their transitional years from youth to adulthood. Nearly 75% of the primary causes of death in the adolescent population are of preventable causes. In order to address the harmful issues facing this young population today, researchers at the University of Michigan developed the Rapid Assessment for Adolescent Preventive Services (RAAPS), a 21-question risk screening examination that identifies the behaviors contributing the most to adolescent morbidity, mortality, and social problems. Over the course of this study, beginning in 2015, researchers utilized the RAAPS to gather data from University of Michigan Health System (UMHS) health clinics around Southeast Michigan. Clinic patients between the ages of 11 and 21 were administered the questionnaire as part of their primary care visit. The simple yes/no structure of each question allowed for a straightforward entry of data that could be analyzed to compare different factors affecting adolescents. Data from the assessment was entered into the Statistical Package for the Social Sciences (SPSS) statistical software for an in-depth analysis by researchers through the use of the Chi-squared test for categorical variables. Results regarding the data obtained from the assessment are still pending at the time of abstract submission; however, it is predicted that significant indications of harmful behavior will be linked to factors such as sexual orientation and/or median household income-level. These findings may suggest a new direction in which physicians can address issues for adolescents who identify with certain characteristics

Got Sugar? Pharmacist Intervention to Improve A1c

AIM: Within 6 months, we aim to decrease by 10% the number of our diabetic patients with an A1c \u3e8 through Clinical Pharmacist referrals.https://jdc.jefferson.edu/patientsafetyposters/1033/thumbnail.jp

Understanding Differences in Medical Versus Surgical Patients Alerted by the Modified Early Warning Score (MEWS) at Jefferson Hospital

An Early Warning Score (EWS) is a risk-management tool to identify patients experiencing clinical deterioration early, therefore allowing timely treatment to occur. Although EWS scores are recommended for all in-patients, more data is available for patients under general medical services compared to surgical services. This study aims to understand differences between medical versus surgical in-patients who receive a red alert from the Modified Early Warning Score (MEWS) at Jefferson hospital. Patients who received a red MEWS alert during admission and discharged between June 2017 to March 2018 (N=812) were categorized as medical or surgical patients. Patient characteristics were compared using an independent samples t-test (age, alert count) or chi-square test (sex, race, admission source, insurance). Patient outcomes were compared using a binary logistic regression (in-hospital mortality, RRT, sepsis diagnosis, ICU transfer, intubation, discharge to hospice) or a Cox regression model (length of stay), controlling for age, sex, and race. Compared to medical patients, surgical patients were younger by 2.7 years (p=0.026) and more likely to have a Commercial and/or Medicare category of insurance (OR=1.568, p=0.005). Surgical patients were more likely to have ICU transfer (OR=1.487, p=0.013) and intubation post-alert (OR=2.470, p=0.006), while less likely to be discharged early (HR=0.675,

Cecal Bascule after Colonoscopy - Case Report and Review of Literature

Cecal bascule is a rare disease variant of a cecal volvulus. It consists of upward and anterior folding of the ascending colon, forming a flap valve, and occluding the bowel lumen resulting in proximal cecal dilatation. Herein, we present a case of a patient who developed persistent abdominal pain few hours after a colonoscopy. CT scan of the abdomen revealed an upward and anterior folding of the cecum. Subsequently the patient was taken to the operating room for a right hemi-colectomy. This case emphasizes the importance to consider cecal bascule as a differential diagnosis in patients with persistent abdominal pain after colonoscopy, considering the ease of diagnosis with imaging studies and emergent surgical correction

Search on a Hypercubic Lattice using a Quantum Random Walk: I. d>2

Random walks describe diffusion processes, where movement at every time step is restricted to only the neighbouring locations. We construct a quantum random walk algorithm, based on discretisation of the Dirac evolution operator inspired by staggered lattice fermions. We use it to investigate the spatial search problem, i.e. finding a marked vertex on a $d$-dimensional hypercubic lattice. The restriction on movement hardly matters for $d>2$, and scaling behaviour close to Grover's optimal algorithm (which has no restriction on movement) can be achieved. Using numerical simulations, we optimise the proportionality constants of the scaling behaviour, and demonstrate the approach to that for Grover's algorithm (equivalent to the mean field theory or the $d\to\infty$ limit). In particular, the scaling behaviour for $d=3$ is only about 25% higher than the optimal $d\to\infty$ value.Comment: 11 pages, Revtex (v2) Introduction and references expanded. Published versio

Acute Respiratory Distress Syndrome from Tick-borne Human Granulocytic Anaplasmosis Infection

Introduction Tick-borne infections were first formally recognized over a century ago, but it was only in 1990 that the first case of human granulocytic anaplasmosis (HGA), a tick-borne infection caused by Anaplasma phagocytophilum, was identified.1,2 Like other tick-borne infections, HGA presents as a nonspecific febrile illness. The most common clinical features are fever, headache, myalgia and malaise.2 This case report presents a rare but serious complication of HGA – acute respiratory distress syndrome (ARDS). CASE PRESENTATION A 49-year-old female with no past medical history presented to her local emergency department with complaints of fevers, headache, neck pain, myalgia, and malaise. She denied symptoms of upper respiratory tract infection, diarrhea, dysuria, rashes, and bleeding or bruising. She worked as an administrative assistant and lived on a farm in a rural area of Pennsylvania. She was in a monogamous relationship. She drank alcohol socially, and she was not known to use any illicit drugs. Her vital signs were temperature of 102 degrees Fahrenheit, pulse of 100 beats per minute, oxygen saturation of 98% on room air, and respiratory rate of 18 breaths per minute. On physical examination, she appeared fatigued but was alert and oriented to person, place, and time. There were no focal neurologic deficits. Her oropharynx was clear. Her neck was supple with full range of motion. Brudzinski and Kernig test were negative. Her lungs were clear to auscultation. Cardiac exam revealed tachycardia but no murmurs, rubs, or gallops. Her abdomen was soft and non-tender. There were no stigmata of liver disease. She had no rashes and no cutaneous bleeding. There were no palpable lymph nodes. Laboratory evaluation revealed a white blood cell count of 2 x109/L (normal range = 4-11 x109/L), platelet count of 43 x109/L (normal range = 140-400 x109/L), and hemoglobin of 11 g/dL (normal range = 14-17 g/dL). Her liver function panel revealed an aspartate aminotransferase (AST) of 923 U/L (normal range = 7-42 U/L) and alanine aminotransferase (ALT) of 946 U/L (normal range = 1-45 U/L). Her bilirubin and alkaline phosphatase were mildly elevated. The patient was admitted for Systemic Inflammatory Response Syndrome (SIRS). She was empirically started on vancomycin and piperacillin-tazobactam. On her first day of admission she developed hypoxemic respiratory failure. A chest x-ray showed bilateral airspace opacities without evidence of volume overload. Mechanical ventilation was initiated and doxycycline was added. She was transferred to Thomas Jefferson University Hospital for management of ARDS

Transcatheter Aortic Valve Replacement is Associated With a Higher Rate of Permanent Pacemaker Implantation Compared to Surgical Aortic Valve Replacement: A Propensity Matched Analysis (Poster).

Background Occurrence of conduction abnormalities requiring permanent pacemaker implantation (PPI) is a serious complication after both transcatheter (TAVR) & surgical (SAVR) aortic valve replacement. Methods Nationwide Inpatient Sample was queried from August 2011 to December 2012 using ICD-9 codes 35.05 & 35.06 for TAVR and 35.21 & 35.22 for SAVR. Patients undergoing other valve surgeries, bypass grafting & those with prior pacemakers or defibrillators were excluded. Propensity matching was performed (1:1) to match TAVR & SAVR cohorts on age, gender, right bundle branch block (RBBB), first degree AV block, bifascicular or trifascicular block, hospital region, teaching hospital status & hospital bed size. Logistic regression was performed to identify predictors of PPI. Differences in the two cohorts were tested using chi-square test. Results Total 2,990 patients (1,495 in TAVR group & 1,495 in SAVR group) were included, with mean age 80.2 +/- 9.0 years, 50.4% females & 83.2% Caucasians. RBBB (OR 2.3, 95% CI 1.4-4.0, p = 0.002) & bifascicular or trifascicular block (OR 6.9, 95% CI 2.8-17.0, p Conclusions PPI rates are higher after TAVR (with predominantly balloon expandable valves) compared to SAVR, after matching on demographic, EKG & hospital characteristics. This suggests greater damage to cardiac conduction system with TAVR compared to SAVR

Quantifying Patient Reported and Documented Compliance with Adjuncts to Venous Thromboembolism Prophylaxis

Objectives: 1. Measure patient compliance with pharmacologic, mechanical and ambulatory prophylactic measures. 2. Evaluate for agreement between nursing documentation and patient reported compliance with mechanical and ambulatory prophylactic measures.https://jdc.jefferson.edu/patientsafetyposters/1042/thumbnail.jp

Search on a Hypercubic Lattice through a Quantum Random Walk: II. d=2

We investigate the spatial search problem on the two-dimensional square lattice, using the Dirac evolution operator discretised according to the staggered lattice fermion formalism. $d=2$ is the critical dimension for the spatial search problem, where infrared divergence of the evolution operator leads to logarithmic factors in the scaling behaviour. As a result, the construction used in our accompanying article \cite{dgt2search} provides an $O(\sqrt{N}\log N)$ algorithm, which is not optimal. The scaling behaviour can be improved to $O(\sqrt{N\log N})$ by cleverly controlling the massless Dirac evolution operator by an ancilla qubit, as proposed by Tulsi \cite{tulsi}. We reinterpret the ancilla control as introduction of an effective mass at the marked vertex, and optimise the proportionality constants of the scaling behaviour of the algorithm by numerically tuning the parameters.Comment: Revtex4, 5 pages (v2) Introduction and references expanded. Published versio