The Sub-axial Cervical Spine Injury Classification System (SLIC): A Novel Approach to Recognize The Importance of Morphology, Neurology and Integrity of the Disco-ligamentous complex

Abstract Background Context Despite technological advances in spine surgery, classification of sub-axial cervical spine injuries remains largely descriptive, lacking standardization and any relationship to prognosis or clinical decision making. Purpose The primary purpose of this paper is to define a classification system for sub-axial cervical spine trauma that conveys information about injury pattern and severity as well as treatment considerations and prognosis. The proposed system is designed to be both comprehensive and easy to use. The secondary objective is to evaluate the classification system in the basic principles of classification construction, namely reliability and validity. Study Design/Setting Derivation of the classification was from a synthesis of the best cervical classification parameters gleaned from an exhaustive literature review and expert opinion of experienced spine surgeons. Multi-center reliability and validity study of a cervical classification system using previously collected CT, MRI, and plain film x-ray images of sub-axial cervical trauma. Methods Important clinical and radiographic variables encountered in sub-axial cervical trauma were identified by a working section of the Spine Trauma Study Group (STSG). Significant limitations of existing injury classification systems were defined and addressed within the new system. It was then introduced to the STSG and applied to 11 cervical trauma cases selected to represent a spectrum of subaxial injury. Six weeks later, the cases were randomly re-ordered and again scored using the novel classification system. Twenty surgeons completed both intervals. Inter-rater and intra-rater reliability and several forms of validity were assessed. For comparison, the reliability of both the Harris and the Ferguson & Allen systems were also evaluated. Results Each of three main categories (injury morphology; disco-ligamentous complex integrity; and neurological status) identified as integrally important to injury description, treatment, and prognosis was assigned an ordinal score range, weighted according to its perceived contribution to overall injury severity. A composite injury severity score was modeled by summing the scores from all three categories. Treatment options were assigned based upon threshold values of the severity score. Inter-rater agreement as assessed by ICC of the DLC, Morphology, and Neurological Status scores was 0.49, 0.57, and 0.87, respectively. Intra-rater agreement as assessed by ICC of the DLC, Morphology, and Neurological Status scores was 0.66, 0.75, and 0.90, respectively. Raters agreed with treatment recommendations of the algorithm in 93.3 % of cases, suggesting high construct validity. The reliability if the SLIC treatment algorithm compared favorably to the earlier classification systems of Harris and Ferguson & Allen. Conclusions The Sub-axial Injury Classification (SLIC) and Severity Scale provides a comprehensive classification system for sub-axial cervical trauma, incorporating pertinent characteristics for generating prognoses and courses of management. Early data on validity and reliability are encouraging. Further testing is necessary before introducing the SLIC score into clinical practice

Efficient nanoscale photonic devices and monolithic electronic-photonic subsystems in sub-100 nm SOI CMOS

We demonstrate efficient photonic devices that rely on sub-100nm features in unmodified 45nm SOI CMOS, including photonic crystals, array-antenna grating couplers, and modulators. We then show monolithically integrated electronicphotonic systems comprising millions of transistors and thousands of photonic devices, including a complete chip-to-chip photonic link

PS2-15: Coding for Obesity in a Health Plan Claims Database

Background and Aims: The Centers for Disease Control estimated the obesity rate in New Mexico for 2008 to be 25.2%. Sources estimate the following associations between obesity and type 2 diabetes (80%); cardiovascular disease (70%); hypertension (26 %). Yet obesity is infrequently coded as a secondary diagnosis among providers submitting claims. This study examines the frequency with which obesity is documented on claims forms, the relationship between age, gender, and obesity coding, and the relationship between obesity coding and healthcare utilization

PS2-15: Sex-Specific Differences in the Protective Effect of Statins on Skeletal Fractures

Background: Recent reports indicate that HMG-CoA reductase inhibitors (statins), used for prevention and treatment of dyslipidemia and CVD, might have a beneficial effect on bone metabolism. Limitations of previous studies do not allow unequivocal conclusions about bone-sparing effect of statins

Toward ultimate miniaturization of high Q silicon traveling-wave microresonators

© 2010 Optical Society of AmericaThe definitive version of this paper is available at: http://dx.doi.org/10.1364/OE.18.019541DOI: 10.1364/OE.18.019541High Q traveling-wave resonators (TWR)s are one of the key building block components for VLSI Photonics and photonic integrated circuits (PIC). However, dense VLSI integration requires small footprint resonators. While photonic crystal resonators have shown the record in simultaneous high Q (~10⁵-10⁶) and very small mode volumes; the structural simplicity of TWRs has motivated many ongoing researches on miniaturization of these resonators with maintaining Q in the same range. In this paper, we investigate the scaling issues of silicon traveling-wave microresonators down to ultimate miniaturization levels in SOI platforms. Two main constraints that are considered during this down scaling are: 1) Preservation of the intrinsic Q of the resonator at high values, and 2) Compatibility of resonator with passive (active) integration by preserving the SiO₂ BOX layer (plus a thin Si slab layer for P-N junction fabrication). Microdisk and microdonut (an intermediate design between disk and ring shape) are considered for high Q, miniaturization, and single-mode operation over a wide wavelength range (as high as the free-spectral range). Theoretical and experimental results for miniaturized resonators are demonstrated and Q's as high as ~10⁵ for resonators as small as 1.5 μm radius are achieved

Single-chip microprocessor that communicates directly using light.

Data transport across short electrical wires is limited by both bandwidth and power density, which creates a performance bottleneck for semiconductor microchips in modern computer systems--from mobile phones to large-scale data centres. These limitations can be overcome by using optical communications based on chip-scale electronic-photonic systems enabled by silicon-based nanophotonic devices. However, combining electronics and photonics on the same chip has proved challenging, owing to microchip manufacturing conflicts between electronics and photonics. Consequently, current electronic-photonic chips are limited to niche manufacturing processes and include only a few optical devices alongside simple circuits. Here we report an electronic-photonic system on a single chip integrating over 70 million transistors and 850 photonic components that work together to provide logic, memory, and interconnect functions. This system is a realization of a microprocessor that uses on-chip photonic devices to directly communicate with other chips using light. To integrate electronics and photonics at the scale of a microprocessor chip, we adopt a 'zero-change' approach to the integration of photonics. Instead of developing a custom process to enable the fabrication of photonics, which would complicate or eliminate the possibility of integration with state-of-the-art transistors at large scale and at high yield, we design optical devices using a standard microelectronics foundry process that is used for modern microprocessors. This demonstration could represent the beginning of an era of chip-scale electronic-photonic systems with the potential to transform computing system architectures, enabling more powerful computers, from network infrastructure to data centres and supercomputers