Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.

BACKGROUND: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons. MATERIALS AND METHODS: A retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA). Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients. RESULTS: SA was associated with significantly lower operative time, blood loss, total anesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR, and total duration of hospital stay, but a longer stay in the PACU. The SA group experienced one spinal hematoma, which was evacuated without any long-term neurological deficits, and neither group experienced a death. The SA group had no episodes of paraparesis or plegia, post-dural puncture headaches, or episodes of persistent postoperative paresthesia or weakness. CONCLUSION: SA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting

The Key Role of Heavy Precipitation Events in Climate Model Disagreements of Future Annual Precipitation Changes in California

Climate model simulations disagree on whether future precipitation will increase or decrease over California, which has impeded efforts to anticipate and adapt to human-induced climate change. This disagreement is explored in terms of daily precipitation frequency and intensity. It is found that divergent model projections of changes in the incidence of rare heavy (\u3e60 mm day−1) daily precipitation events explain much of the model disagreement on annual time scales, yet represent only 0.3% of precipitating days and 9% of annual precipitation volume. Of the 25 downscaled model projections examined here, 21 agree that precipitation frequency will decrease by the 2060s, with a mean reduction of 6–14 days yr−1. This reduces California\u27s mean annual precipitation by about 5.7%. Partly offsetting this, 16 of the 25 projections agree that daily precipitation intensity will increase, which accounts for a model average 5.3% increase in annual precipitation. Between these conflicting tendencies, 12 projections show drier annual conditions by the 2060s and 13 show wetter. These results are obtained from 16 global general circulation models downscaled with different combinations of dynamical methods [Weather Research and Forecasting (WRF), Regional Spectral Model (RSM), and version 3 of the Regional Climate Model (RegCM3)] and statistical methods [bias correction with spatial disaggregation (BCSD) and bias correction with constructed analogs (BCCA)], although not all downscaling methods were applied to each global model. Model disagreements in the projected change in occurrence of the heaviest precipitation days (\u3e60 mm day−1) account for the majority of disagreement in the projected change in annual precipitation, and occur preferentially over the Sierra Nevada and Northern California. When such events are excluded, nearly twice as many projections show drier future conditions

Probabilistic estimates of future changes in California temperature and precipitation usingstatistical and dynamical downscaling

Sixteen global general circulation models were used to develop probabilistic projections of temperature (T) and precipitation (P) changes over California by the 2060s. The global models were downscaled with two statistical techniques and three nested dynamical regional climate models, although not all global models were downscaled with all techniques. Both monthly and daily timescale changes in T and P are addressed, the latter being important for a range of applications in energy use, water management, and agriculture. The T changes tend to agree more across downscaling techniques than the P changes. Year-to-year natural internal climate variability is roughly of similar magnitude to the projected T changes. In the monthly average, July temperatures shift enough that that the hottest July found in any simulation over the historical period becomes a modestly cool July in the future period. Januarys as cold as any found in the historical period are still found in the 2060s, but the median and maximum monthly average temperatures increase notably. Annual and seasonal P changes are small compared to interannual or intermodel variability. However, the annual change is composed of seasonally varying changes that are themselves much larger, but tend to cancel in the annual mean. Winters show modestly wetter conditions in the North of the state, while spring and autumn show less precipitation. The dynamical downscaling techniques project increasing precipitation in the Southeastern part of the state, which is influenced by the North American monsoon, a feature that is not captured by the statistical downscaling

Accuracy of In Vivo Multimodal Optical Imaging for Detection of Oral Neoplasia

If detected early, oral cancer is eminently curable. However, survival rates for oral cancer patients remain low, largely due to late-stage diagnosis and subsequent difficulty of treatment. To improve cliniciansﾒ ability to detect early disease and to treat advanced cancers, we developed a multimodal optical imaging system (MMIS) to evaluate tissue in situ, at macroscopic and microscopic scales. The MMIS was used to measure 100 anatomic sites in 30 patients, correctly classifying 98% of pathologically confirmed normal tissue sites, and 95% of sites graded as moderate dysplasia, severe dysplasia, or cancer. When used alone, MMIS classification accuracy was 35% for sites determined by pathology as mild dysplasia. However, MMIS measurements correlated with expression of candidate molecular markers in 87% of sites with mild dysplasia. These findings support the ability of noninvasive multimodal optical imaging to accurately identify neoplastic tissue and premalignant lesions. This in turn may have considerable impact on detection and treatment of patients with oral cancer and other epithelial malignancies

High-Resolution Microendoscopy for the Detection of Cervical Neoplasia in Low-Resource Settings

Cervical cancer is the second leading cause of cancer death among women in developing countries. Developing countries often lack infrastructure, cytotechnologists, and pathologists necessary to implement current screening tools. Due to their low cost and ease of interpretation at the point-of-care, optical imaging technologies may serve as an appropriate solution for cervical cancer screening in low resource settings. We have developed a high-resolution optical imaging system, the High Resolution Microendoscope (HRME), which can be used to interrogate clinically suspicious areas with subcellular spatial resolution, revealing changes in nuclear to cytoplasmic area ratio. In this pilot study carried out at the women's clinic of Princess Marina Hospital in Botswana, 52 unique sites were imaged in 26 patients, and the results were compared to histopathology as a reference standard. Quantitative high resolution imaging achieved a sensitivity and specificity of 86% and 87%, respectively, in differentiating neoplastic (≥CIN 2) tissue from non-neoplastic tissue. These results suggest the potential promise of HRME to assist in the detection of cervical neoplasia in low-resource settings

Modular video endoscopy for in vivo cross-polarized and vital-dye fluorescence imaging of Barrett's-associated neoplasia

A modular video endoscope is developed and tested to allow imaging in different modalities. This system incorporates white light imaging (WLI), cross-polarized imaging (CPI), and vital-dye fluorescence imaging (VFI), using interchangeable filter modules. CPI and VFI are novel endoscopic modalities that probe mucosal features associated with Barrett's neoplasia. CPI enhances vasculature, while VFI enhances glandular architecture. In this pilot study, we demonstrate the integration of these modalities by imaging areas of Barrett's metaplasia and neoplasia in an esophagectomy specimen. We verify that those key image features are also observed during an in vivo surveillance procedure. CPI images demonstrate improved visualization of branching blood vessels associated with neoplasia. VFI images show glandular architecture with increased glandular effacement associated with neoplasia. Results suggests that important pathologic features seen in CPI and VFI are not visible during standard endoscopic white light imaging, and thus the modalities may be useful in future in vivo studies for discriminating neoplasia from Barrett's metaplasia. We further demonstrate that the integrated WLI/CPI/VFI endoscope is compatible with complementary high-resolution endomicroscopy techniques such as the high-resolution microendoscope, potentially enabling two-step (“red-flag” widefield plus confirmatory high-resolution imaging) protocols to be enhanced

Survey of Barbell Trajectory and Kinematics of the Snatch Lift from the 2015 World and 2017 Pan-American Weightlifting Championships

Analysis of elite performances is important to elucidate the characteristics of effective weightlifting technique contributing to the highest level of achievement. The general technique of the weightlifting movements is well established. However, it is also apparent that weightlifting technique can differ based on athlete characteristics. Thus, existing technical models may not accurately reflect current technique of top performers or be applied generically to athletes of different skill, size, sex, or ability. Therefore, the purpose of this descriptive study was to update the scientific knowledge of snatch technique of top international weightlifters. This study used video analysis to determine barbell trajectory and kinematics of 319 successful snatch attempts from two major international competitions. Relative frequencies of barbell trajectory types differed based on competition, sex, category, and ranking. No statistical differences were observed among the top-three performers for either sex for most kinematic variables, and there were no overall discernible patterns of effect size differences for individual or clusters of kinematic variables. The results of this study indicate that weightlifting success can be achieved with a variety of technique profiles

Quantitative analysis of high-resolution microendoscopic images for diagnosis of neoplasia in patients with Barrett’s esophagus

Background and Aims: Previous studies show that microendoscopic images can be interpreted visually to identify the presence of neoplasia in patients with Barrett’s esophagus (BE), but this approach is subjective and requires clinical expertise. This study describes an approach for quantitative image analysis of microendoscopic images to identify neoplastic lesions in patients with BE. Methods: Images were acquired from 230 sites from 58 patients by using a fiberoptic high-resolution microendoscope during standard endoscopic procedures. Images were analyzed by a fully automated image processing algorithm, which automatically selected a region of interest and calculated quantitative image features. Image features were used to develop an algorithm to identify the presence of neoplasia; results were compared with a histopathology diagnosis. Results: A sequential classification algorithm that used image features related to glandular and cellular morphology resulted in a sensitivity of 84% and a specificity of 85%. Applying the algorithm to an independent validation set resulted in a sensitivity of 88% and a specificity of 85%. Conclusions: This pilot study demonstrates that automated analysis of microendoscopic images can provide an objective, quantitative framework to assist clinicians in evaluating esophageal lesions from patients with BE. (Clinical trial registration number: NCT01384227 and NCT02018367.

An empirical investigation of dance addiction

Although recreational dancing is associated with increased physical and psychological well-being, little is known about the harmful effects of excessive dancing. The aim of the present study was to explore the psychopathological factors associated with dance addiction. The sample comprised 447 salsa and ballroom dancers (68% female, mean age: 32.8 years) who danced recreationally at least once a week. The Exercise Addiction Inventory (Terry, Szabo, & Griffiths, 2004) was adapted for dance (Dance Addiction Inventory, DAI). Motivation, general mental health (BSI-GSI, and Mental Health Continuum), borderline personality disorder, eating disorder symptoms, and dance motives were also assessed. Five latent classes were explored based on addiction symptoms with 11% of participants belonging to the most problematic class. DAI was positively associated with psychiatric distress, borderline personality and eating disorder symptoms. Hierarchical linear regression model indicated that Intensity (ß=0.22), borderline (ß=0.08), eating disorder (ß=0.11) symptoms, as well as Escapism (ß=0.47) and Mood Enhancement (ß=0.15) (as motivational factors) together explained 42% of DAI scores. Dance addiction as assessed with the Dance Addiction Inventory is associated with indicators of mild psychopathology and therefore warrants further research