Risk Factors of Not Reaching MCID after Elective Lumbar Spine Surgery: A Case Control Study

Background The therapeutic effect of spine surgery has been traditionally evaluated by physical examination, radiographic findings, and general perception of patient’s health status. However, these assessments are often insufficient to represent surgical outcomes.Patient-reported outcomes (PROs) are tools developed to measures quality outcomes following spinal surgery. Examples include the Patient-Reported Outcomes Measurement Information System Function 4-item Short Form (PROMIS-PF), Visual Analogue Scale (VAS), ODI (Oswestry Disability Index), SF-36 (Short Form Health Survey), and EQ-5D (EuroQuol-5D). The minimum clinically important difference (MCID) is an assessment tool to note the smallest clinical difference in PROs and provides the threshold where patients experience clinical benefit that justifies treatment plans or procedures despite the cost and side effects. MCID results reflect patient-perceived functional improvement, which can be a core metric in lumbar surgery for degenerative disease. Clinical and sociodemographic risk factors may serve to identify high-risk patients via MCID assessment. This study aims to identify risk factors associated with failure of reaching MCID based on PROMIS PF after elective lumbar spine surgery and the data registry from Michigan Spine Surgery Spine Surgery Improvement Collaborative (MSSIC). The results of this study can provide opportunities to optimize medical conditions of patients in prior to any elective lumbar surgery. METHODS MSSIC is a state-wide quality-improvement initiative database including 29 hospitals and 200 orthopedic- and neurosurgeons from various settings. Member hospitals are required to perform an annual minimum of 200 spine surgeries. MSSIC reviews elective spine surgeries for degenerative disease but excludes non-degenerative and/or complex pathology (i.e., spinal cord injury, traumatic fractures, pre-existing infection, grade 3 or 4 spondylolisthesis, scoliosis greater than 25◦, congenital anomalies, or ≥ 4-level fusion). Utilizing MSSIC, 10,922 patients who had undergone elective lumbar spine surgery were selected with 90 day follow up, and 7,200 patients with 1-year follow up. Patients with missing data were excluded from the study. Patient demographics, clinical presentation, medical history, surgical procedure, details of hospital stay, postsurgical adverse events within 90 days of surgery, and patient-reported outcome after surgery were reviewed. A patient was considered to have achieved MCID if there was an increase in ≥4.5 points. RESULTS Of 10,922 patients with 90-day follow-up, 4,453 patients (40.8%) did not reach MCID. Of 7,200 patients with 1-year follow up, 2,361 patients (23.8%) did not achieve MCID. There were significant baseline differences in demographic profiles and operative characteristics for those who had follow-up at 90 days and 1 year after their surgery. At 90 days after surgery, significant factors of not reaching MCID and their relative risk included symptom duration more than 1 year (1.34), previous spine surgery (1.25), African American descent (1.25), chronic opiate use (1.23), less than high school education (1.20), morbid obesity (1.15), ASA class \u3e2 (1.15), current smoking (1.14), chronic obstructive pulmonary disease (COPD) (1.13), depression (1.09), history of DVT (1.08), scoliosis (1.06), anxiety (1.06), baseline PROMIS (1.06), and surgery invasiveness (1.02). At 1 year after surgery, significant factors of not reaching MCID and their relative risk included symptom duration more than 1 year (1.41), less than high school education (1.34), previous spine surgery (1.30), morbid obesity (1.30), chronic opiate use (1.25), age (1.21), current smoking (1.21), African American descent (1.20), ASA class \u3e2 (1.18), history of DVT (1.12), depression (1.10), chronic obstructive pulmonary disease (COPD) (1.09), and baseline PROMIS (1.06). Independent ambulatory status (0.83 and 0.88 for 90-day and 1-year follow-up, respectively) and private insurance (0.83 and 0.85 for 90-day and 1-year follow-up, respectively) were associated with higher likelihood of reaching MCID. CONCLUSION This case control study identifies relevant risk factors of not reaching MCID after elective lumbar spine surgery. The results may assist clinicians in identifying high risk patients and optimizing patients’ medical conditions prior to spinal surgery

Barcoding Bugs: DNA-Based Identification of the True Bugs (Insecta: Hemiptera: Heteroptera)

oxidase I (COI) gene, has been shown to provide an efficient method for the identification of species in a wide range of animal taxa. In order to assess the effectiveness of barcodes in the discrimination of Heteroptera, we examined 344 species belonging to 178 genera, drawn from specimens in the Canadian National Collection of Insects.Analysis of the COI gene revealed less than 2% intra-specific divergence in 90% of the taxa examined, while minimum interspecific distances exceeded 3% in 77% of congeneric species pairs. Instances where barcodes fail to distinguish species represented clusters of morphologically similar species, except one case of barcode identity between species in different genera. Several instances of deep intraspecific divergence were detected suggesting possible cryptic species.Although this analysis encompasses 0.8% of the described global fauna, our results indicate that DNA barcodes will aid the identification of Heteroptera. This advance will be useful in pest management, regulatory and environmental applications and will also reveal species that require further taxonomic research

Development of Photonic Crystal Fiber Based Gas/ Chemical Sensors

The development of highly-sensitive and miniaturized sensors that capable of real-time analytes detection is highly desirable. Nowadays, toxic or colorless gas detection, air pollution monitoring, harmful chemical, pressure, strain, humidity, and temperature sensors based on photonic crystal fiber (PCF) are increasing rapidly due to its compact structure, fast response and efficient light controlling capabilities. The propagating light through the PCF can be controlled by varying the structural parameters and core-cladding materials, as a result, evanescent field can be enhanced significantly which is the main component of the PCF based gas/chemical sensors. The aim of this chapter is to (1) describe the principle operation of PCF based gas/ chemical sensors, (2) discuss the important PCF properties for optical sensors, (3) extensively discuss the different types of microstructured optical fiber based gas/ chemical sensors, (4) study the effects of different core-cladding shapes, and fiber background materials on sensing performance, and (5) highlight the main challenges of PCF based gas/ chemical sensors and possible solutions

Analysis of Interrelated Network Improvement Alternatives

69A43551747123This project developed methods for optimizing the long-term development of road networks by developing algorithms for selecting, sequencing and scheduling interrelated improvements, which change flows through the networks. It also compared how network performance can be evaluated as a network\u2019s configuration evolves, using either a fast traffic assignment algorithm or the slower but more realistically precise microscopic simulation model INTEGRATION. The results indicate when and to what extent the traffic assignment algorithm can approximate the simulation results. They demonstrate the potential value of hybrid methods in combining initial search with traffic assignment and refined search with microscopic simulation

Parametric Analysis of Telecommuting Effects on Transportation Tax Revenues

This study explores the effects of increases in online activities (such as telecommuting and online shopping) as well as shifts toward electric vehicles on transportation revenues for the District of Columbia (DC). The analysis is based on (1) a review of the literature and state of practice regarding online activities, trends in vehicle fleet mix, experience with various forms of revenue collection, methods for estimating trends in online activities and vehicle characteristics, and methods for estimating transportation revenues; (2) a survey of DC transportation users designed to obtain information that is unavailable from existing sources; (3) the adaptation of demand and travel behavior models for quantitatively predicting online activities; (4) a model developed for estimating transportation revenues from various sources, as well as other measures of effectiveness; and (5) parametric studies of the effects of various factors, individually and in combinations, on expected transportation revenues. The results of this study should support decision-making by the DC Government regarding taxation mechanisms and other policies that may be applied to fund its transportation needs

Targeting histone lysine demethylase KDM4A in Aggressive Variant Prostate Cancer

View full abstracthttps://openworks.mdanderson.org/leading-edge/1054/thumbnail.jp

Conductive-probe atomic force microscopy characterization of silicon nanowire

The electrical conduction properties of lateral and vertical silicon nanowires (SiNWs) were investigated using a conductive-probe atomic force microscopy (AFM). Horizontal SiNWs, which were synthesized by the in-plane solid-liquid-solid technique, are randomly deployed into an undoped hydrogenated amorphous silicon layer. Local current mapping shows that the wires have internal microstructures. The local current-voltage measurements on these horizontal wires reveal a power law behavior indicating several transport regimes based on space-charge limited conduction which can be assisted by traps in the high-bias regime (> 1 V). Vertical phosphorus-doped SiNWs were grown by chemical vapor deposition using a gold catalyst-driving vapor-liquid-solid process on higly n-type silicon substrates. The effect of phosphorus doping on the local contact resistance between the AFM tip and the SiNW was put in evidence, and the SiNWs resistivity was estimated

Equitable Complete Streets: Data and Methods for Optimal Design Implementation

69A43551747123The Complete Streets concept references roads designed to accommodate: (1) diverse modes, including walking, cycling, public transit, and automobile; (2) different users, e.g. affluent and low-income individuals, people with disabilities, and senior citizens; (3) and a mix of land uses such as office, retail, businesses, and residential to ensure streets are safe, balanced and inclusively support diverse economic, cultural and environmental uses. Today most of our streets are poorly designed and do not offer safe places to walk, bike, or take public transportation. Such streets are particularly dangerous for disadvantaged segments of the population, including people of color, older adults, children, and those living in low-income communities. Successful Complete Streets projects prioritize multi-modal transport systems and have been demonstrated to be effective in fostering more livable communities, increasing equity and improving public health. This project analyzes different components of Complete Streets design and use with the goal of creating fast, low-cost, and high impact (transportation) changes in our communities. In recent years, \u201ccomplete streets\u201d has been an emerging concept in North American transportation planning and design. To be considered a \u201ccomplete street\u201d, a road should be designed to be safe for users of all traffic modes. This report presents three studies: safety evaluation on the complete streets by simulating different modes, quantify the benefits of complete streets in terms of equity and improved access across different segments of the population (especially low income) and road space allocation on the complete streets

Research on Dimensionless Unit Hydrograph and Time of Concentration for Maryland Watersheds

SHA/UM/5-04Observed data from 100 rainfall-runoff events on 54 watersheds in Maryland and Delaware were used to investigate two watershed characteristics: the dimensionless unit hydrograph (DUH) and time of concentration (Tc). Streamflow hydrograph data were obtained from US Geological Survey gaging stations. Event hyetographs were generated from US Weather Service NEXRAD Radar Stage III data (DPR) using a method developed in this study. The gamma-function form of the Natural Resources Conservation Service unit hydrograph was assumed. For each event, an optimization method was used to determine the time to peak and gamma parameter (related to the Peak Rate Factor, PRF) that give the best-fit direct runoff hydrograph when convolved with the rainfall excess hyetograph. Tc was estimated by differentiation of the unit hydrograph. Efforts to predict PRF and Tc using watershed properties, and to update an existing regression equation, were inconclusive. Future investigations will focus on improving the event baseflow separation and determination of rainfall excess