Outcomes of Fusions From the Cervical Spine to the Pelvis.

Study designRetrospective cohort study.ObjectiveDetermine the indications, complications, and clinical outcomes in patients requiring fusions from the cervical spine to the pelvis. Several investigators have examined fusions from the thoracic spine to the sacrum, but no similar study has been performed for cervical-to-pelvis fusions.MethodsPatients from 2003 to 2014 with an upper instrumented vertebrae (UIV) in the cervical spine (any level) and a lower instrumented vertebrae (LIV) in the sacrum or pelvis were included in the study. Those with infectious or acute trauma-related deformities were excluded. Patient demographics, medical history, diagnosis, operative procedure, and health-related quality of life measures were analyzed. Student's t test, Kruskal-Wallis test, and χ2 test were used as appropriate; significance was set at P < .05 for all tests.ResultsFifty-five patients met inclusion criteria for the study. Average follow-up was 2.8 years. Proximal junctional kyphosis was the most common indication for cervical-to-pelvis fusions (36%). The most common UIV was C2 (29%) followed by C7 (24%). There was an average 31° correction in maximum kyphosis and a 3.3 cm improvement in sagittal vertical axis. In adults, the rate of complication was 71.4%, with a major complication rate of 39.3% and reoperation rate of 53.6%. There was significant improvement in the Scoliosis Research Society (SRS-22r) score (3.0 to 3.5; P < .01).ConclusionProximal junctional kyphosis is the most common indication for patients requiring fusion to the cervical spine. Adult patients incur a significant risk of major complications and reoperations. However, significant improvement in SRS-22r outcomes are noted in these patients

Manual de Planificação de Evacuação por Tsunami

Este manual tem como objectivo prestar informação detalhada e acessível, bem como uma metodologia abrangente de criação de planos para a evacuação de populações devido a tsunami. Desta forma, fica facultado aos decisores integrados nas comunidades ou outros actores semelhantes um guia detalhado sobre como implementar um plano de evacuação totalmente desenvolvido em três etapas: elaboração da primeira instância válida de plano de evacuação, revisão a médio prazo e revisão e integração a longo prazo. A determinação do risco de tsunami e todas as implicações subsequentes relativas ao plano de evacuação são baseadas no conhecimento da altura de onda de tsunami expectável e no tempo de chegada previsível da primeira onda devastadora. O primeiro parâmetro permite calcular a área em risco e o segundo fornece indicações sobre o tempo disponível para a concretização da evacuação. A evacuação deve ser feita numa determinada rede de estradas ou caminhos. Neste contexto, se necessário, a metodologia prevê a inclusão de rotas de fuga adicionais a serem construídas e/ou locais seguros, de modo a produzir um plano de evacuação totalmente funcional que preencha os requisitos básicos. Os locais seguros (abrigos) são locais situados a elevada altitude, em terreno natural ou em construções artificiais, incluindo edifícios com altura superior a três pisos. A metodologia descreve ainda o modo de implementar o plano de evacuação através da marcação das rotas de fuga identificadas e dos abrigos reais, bem como o modo de disseminar a informação à população afectada. No âmbito da revisão a médio prazo, o plano de evacuação deve ser mantido de forma constante, garantindo as medidas de autoridade apropriadas. A revisão a longo prazo, de um ponto de vista final, mantém o acompanhamento de toda a informação necessária para cumprir apropriadamente o plano de evacuação: integração com sistemas de aviso prévio existentes, com outros planos de emergência e a verificação de obrigações legais. Numa perspectiva idealista, o plano de evacuação deve ser revisto conjuntamente com a população afectada, de modo a garantir a máxima aceitação possível. Neste contexto, se necessário, deverão ser feitas adaptações para garantir o bom funcionamento de todo o plano, no contexto do seu desempenho maximizado. O manual apresenta igualmente os resultados obtidos a partir de entrevistas realizadas com pessoas potencialmente afectadas (em Setúbal), terminando com as dificuldades e limitações que podem surgir durante a geração de planos de evacuação. Este trabalho foi realizado no âmbito do projecto europeu co-financiado FP6 SCHEMA (SCenarios for Hazard-induced Emergencies MAnagement, www.schemeproject.org). O anexo contém uma descrição dos propósitos e objectivos alcançados do projecto, juntamente com a lista de parceiros.JRC.DG.G.7-Traceability and vulnerability assessmen

Handbook of Tsunami Evacuation Planning - SCHEMA (Scenarios for Hazard-induced Emergencies Management), Project n° 030963, Specific Targeted Research Project, Space Priority

This handbook is dedicated to provide thorough and hands-on information in order to produce fully-comprehensive methodology of tsunami evacuation plan generation. Hence community-employed decision makers or similar stakeholders are supplied with a detailed guideline to implement a fully-fledged evacuation plan within three stages : set-up of valid first instance of evacuation plan, mid-term revision, and long-term revision and integration. Local tsunami risk assessment and all subsequent implications on evacuation planning are based on (1) knowing the to-be-expected tsunami wave height, and (2) the to-be-expected arrival time of the first devastating tsunami wave. The first parameter helps to calculate the area at risk ; the second parameter gives an indication of how fast the evacuation has to take place. Consequently, the evacuation plan instance must guarantee that a certain number of affected persons has to be brought onto safe areas within a given time limit. Safe areas (shelters) are higher located places, either on natural ground, or on artificially built-up constructions including building higher than three stores. Evacuation has to take place on a given network of suitable roads or paths. In this context, if necessary, the methodology foresees also the inclusion of additionally to be built escape routes and/or safe places in order to produce a fully working evacuation plan that fulfills the basic requirements. The methodology also explains how to implement a valid instance of evacuation plan by marking the identified escape routes and shelters in reality, and how to disseminate all information to the affected population. Within a mid-term review the evacuation plan has to be maintained constantly and appropriate authority-own measures have to be guaranteed. The long-term review, finally, keeps track of all other information needed to run the evacuation plan properly : integration with early-warning systems, integration with other emergency plans, checking of legal obligations. In addition, the whole evacuation plan must be reviewed together with the affected population and a maximum of acceptance be obtained. In this contaxt, and if necessary, adaptations should be made in order to guarantee the well-functioning of the whole plan within its best performance.JRC.DG.G.7-Traceability and vulnerability assessmen

UC-62 Machine Learning: Twitter Bots in Disguise

This project was designed to help fight against misinformation spread by bots(computers), the goal assigned to us was to find and inform Twitter users of bots that follow and are being followed by the user.Advisors(s): Dr. Reza PariziTopic(s): Artificial IntelligenceSWE 472

Outcomes of Surgical Treatment for Patients With Mild Scoliosis and Age-Appropriate Sagittal Alignment With Minimum 2-Year Follow-up

OBJECTIVE: The goal of this study was to determine if patients with mild scoliosis and age-appropriate sagittal alignment have favorable outcomes following surgical correction. METHODS: Retrospective review of a prospective, multicenter adult spinal deformity database. Inclusion criteria: operative patients age ≥18 years, and preoperative pelvic tilt, mismatch between pelvic incidence and lumbar lordosis (PI-LL), and C7 sagittal vertical axis all within established age-adjusted thresholds with minimum 2-year follow-up. Health-related quality of life (HRQoL) scores: Oswestry Disability Index (ODI), 36-item Short Form health survey (SF-36), Scoliosis Research Society-22R (SRS22R), back/leg pain Numerical Rating Scale and minimum clinically important difference (MCID)/substantial clinical benefit (SCB). Two-year and preoperative HRQoL radiographic data were compared. Patients with mild scoliosis (Mild Scoli, Max coronal Cobb 10°-30°) were compared to those with larger curves (Scoli). RESULTS: One hundred fifty-one patients included from 667 operative patients (82.8% women; average age, 56.4 ± 16.2 years). Forty-two patients (27.8%) included in Mild Scoli group. Mild Scoli group had significantly worse baseline leg pain, ODI, and physical composite scores (p \u3c 0.02). Mean 2-year maximum coronal Cobb angle was significantly improved compared to baseline (p \u3c 0.001). All 2-year HRQoL measures were significantly improved compared to (p \u3c 0.001) except mental composite score, SRS activity and SRS mental for the Mild Scoli group (p \u3e 0.05). From the mild Scoli group, 36%-74% met either MCID or SCB for the HRQoL measures. Sixty-four point three percent had minimum 1 complication, 28.6% had a major complication, 35.7% had reoperation. CONCLUSION: Mild scoliosis patients with age-appropriate sagittal alignment benefit from surgical correction, decompression, and stabilization at 2 years postoperative despite having a high complication rate

The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management

Digital interventions have emerged as a solution for time and geographical barriers, however, their potential to target other social determinants of health is largely unexplored. In this post-hoc analysis, we report the impact of social deprivation on engagement and clinical outcomes after a completely remote multimodal musculoskeletal (MSK) digital care program managed by a culturally-sensitive clinical team. Patients were stratified in five categories according to their social deprivation index, and cross-referenced with their race/ethnicity, rurality and distance to healthcare facilities. From a total of 12,062 patients from all U.S. states, 8569 completed the program. Higher social deprivation was associated with greater baseline disease burden. We observed that all categories reported pain improvements (ranging from -2.0 95%CI -2.1, -1.9 to -2.1 95%CI -2.3, -1.9, p < 0.001) without intergroup differences in mean changes or responder rates (from 59.9% (420/701) to 66.6% (780/1172), p = 0.067), alongside reduction in analgesic consumption. We observed significant improvements in mental health and productivity across all categories, with productivity and non-work-related functional recovery being greater within the most deprived group. Engagement was high but varied slightly across categories. Together these findings highlight the importance of a patient-centered digital care program as a tool to address health inequities in musculoskeletal pain management. The idea of investigating social deprivation within a digital program provides a foundation for future work in this field to identify areas of improvement.info:eu-repo/semantics/publishedVersio

Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery.

Study Design: Retrospective cohort study. Objective: Factors that predict outcomes for adult cervical spine deformity (ACSD) have not been well defined. To compare ACSD patients with best versus worst outcomes. Methods: This study was based on a prospective, multicenter observational ACSD cohort. Best versus worst outcomes were compared based on Neck Disability Index (NDI), Neck Pain Numeric Rating Scale (NP-NRS), and modified Japanese Orthopaedic Association (mJOA) scores. Results: Of 111 patients, 80 (72%) had minimum 1-year follow-up. For NDI, compared with best outcome patients (n = 28), worst outcome patients (n = 32) were more likely to have had a major complication ( Conclusions: Factors distinguishing best and worst ACSD surgery outcomes included patient, surgical, and radiographic factors. These findings suggest areas that may warrant greater awareness to optimize patient counseling and outcomes

Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study

Background: Comorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. &nbsp; Objective: The aim of this study was to assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. &nbsp; Methods: Ad hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP was performed. Three subgroups with different baseline depression severity levels were established based on responses to the Patient Health Questionnaire (PHQ-9): cluster 1 (score&lt;5: minimal depression), cluster 2 (scores 5-10: mild depression), and cluster 3 (score&ge;10: moderate depression). The mean changes in depression, anxiety, fear-avoidance beliefs, work productivity, and activity impairment and adherence between baseline and end of program (8-12 weeks) were assessed across subgroups by latent growth curve analysis. &nbsp; Results: From a total of 7785 eligible participants, 6137 (78.83%) were included in cluster 1, 1158 (14.87%) in cluster 2, and 490 (6.29%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not in cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (score of 5 and 10, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from &ndash;16.82, 95% CI &ndash;20.32 to &ndash;13.42 in cluster 1 to &ndash;20.10, 95% CI &ndash;32.64 to &ndash;7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). &nbsp; Conclusions: A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. &nbsp; Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 &nbsp; J Med Internet Res 2022;24(7):e38942</p

The number of transmission channels through a single-molecule junction

We calculate transmission eigenvalue distributions for Pt-benzene-Pt and Pt-butadiene-Pt junctions using realistic state-of-the-art many-body techniques. An effective field theory of interacting $\pi$-electrons is used to include screening and van der Waals interactions with the metal electrodes. We find that the number of dominant transmission channels in a molecular junction is equal to the degeneracy of the molecular orbital closest to the metal Fermi level.Comment: 9 pages, 8 figure

Evaluation of rate law approximations in bottom-up kinetic models of metabolism.

BackgroundThe mechanistic description of enzyme kinetics in a dynamic model of metabolism requires specifying the numerical values of a large number of kinetic parameters. The parameterization challenge is often addressed through the use of simplifying approximations to form reaction rate laws with reduced numbers of parameters. Whether such simplified models can reproduce dynamic characteristics of the full system is an important question.ResultsIn this work, we compared the local transient response properties of dynamic models constructed using rate laws with varying levels of approximation. These approximate rate laws were: 1) a Michaelis-Menten rate law with measured enzyme parameters, 2) a Michaelis-Menten rate law with approximated parameters, using the convenience kinetics convention, 3) a thermodynamic rate law resulting from a metabolite saturation assumption, and 4) a pure chemical reaction mass action rate law that removes the role of the enzyme from the reaction kinetics. We utilized in vivo data for the human red blood cell to compare the effect of rate law choices against the backdrop of physiological flux and concentration differences. We found that the Michaelis-Menten rate law with measured enzyme parameters yields an excellent approximation of the full system dynamics, while other assumptions cause greater discrepancies in system dynamic behavior. However, iteratively replacing mechanistic rate laws with approximations resulted in a model that retains a high correlation with the true model behavior. Investigating this consistency, we determined that the order of magnitude differences among fluxes and concentrations in the network were greatly influential on the network dynamics. We further identified reaction features such as thermodynamic reversibility, high substrate concentration, and lack of allosteric regulation, which make certain reactions more suitable for rate law approximations.ConclusionsOverall, our work generally supports the use of approximate rate laws when building large scale kinetic models, due to the key role that physiologically meaningful flux and concentration ranges play in determining network dynamics. However, we also showed that detailed mechanistic models show a clear benefit in prediction accuracy when data is available. The work here should help to provide guidance to future kinetic modeling efforts on the choice of rate law and parameterization approaches