Participation in the Georgia Food for Health program and cardiovascular disease risk factors: A longitudinal observational study

Abstract Objective To assess the relationship between program attendance in a produce prescription program and changes in cardiovascular risk factors. Design The Georgia Food for Health (GF4H) program provided 6 monthly nutrition education sessions, 6 weekly cooking classes, and weekly produce vouchers. Participants became program graduates attending at least 4 of the 6 of both the weekly cooking classes and monthly education sessions. We used a longitudinal, single-arm approach to estimate the association between the number of monthly program visits attended and changes in health indicators. Setting GF4H was implemented in partnership with a large safety-net health system in Atlanta, GA. Participants 331 participants living with or at-risk of chronic disease and food insecurity were recruited from primary care clinics. Over three years, 282 participants graduated from the program. Results After adjusting for program site, year, participant sex, age, race & ethnicity, SNAP participation, and household size, we estimated that each additional program visit attended beyond 4 visits was associated with a 0.06 kg/m2 reduction in BMI (95% CI: -0.12, -0.01; p=0.02), a 0.37 inch reduction in waist circumference (95% CI: -0.48, -0.27; p<0.001), a 1.01 mmHg reduction in systolic blood pressure (95% CI: -1.45, -0.57; p<0.001), and a 0.43 mmHg reduction in diastolic blood pressure (95% CI: -0.69, -0.17; p=0.001). Conclusions Each additional cooking and nutrition education visit attended beyond the graduation threshold was associated with modest but significant improvements in cardiovascular disease risk factors, suggesting that increased engagement in educational components of a produce prescription program improves health outcomes

The Entomopathogenic Bacterial Endosymbionts Xenorhabdus and Photorhabdus: Convergent Lifestyles from Divergent Genomes

Members of the genus Xenorhabdus are entomopathogenic bacteria that associate with nematodes. The nematode-bacteria pair infects and kills insects, with both partners contributing to insect pathogenesis and the bacteria providing nutrition to the nematode from available insect-derived nutrients. The nematode provides the bacteria with protection from predators, access to nutrients, and a mechanism of dispersal. Members of the bacterial genus Photorhabdus also associate with nematodes to kill insects, and both genera of bacteria provide similar services to their different nematode hosts through unique physiological and metabolic mechanisms. We posited that these differences would be reflected in their respective genomes. To test this, we sequenced to completion the genomes of Xenorhabdus nematophila ATCC 19061 and Xenorhabdus bovienii SS-2004. As expected, both Xenorhabdus genomes encode many anti-insecticidal compounds, commensurate with their entomopathogenic lifestyle. Despite the similarities in lifestyle between Xenorhabdus and Photorhabdus bacteria, a comparative analysis of the Xenorhabdus, Photorhabdus luminescens, and P. asymbiotica genomes suggests genomic divergence. These findings indicate that evolutionary changes shaped by symbiotic interactions can follow different routes to achieve similar end points

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Home Versus Rehabilitation: Factors that Influence Disposition After Minimally Invasive Surgery in Adult Spinal Deformity Surgery

BACKGROUND: Minimally invasive surgery (MIS) correction for adult spinal deformity (ASD) may reduce the need the need for postoperative skilled nursing facility (SNF) or inpatient rehabilitation (IR) placement following surgery. The likelihood of requiring placement in a facility rather than home disposition may be influenced by various factors. In addition, the associations between discharge location and outcomes and complication rates have not been elucidated in these patients. In this study, we aimed to define factors predicting disposition to an SNF/IR and to elucidate the rates of complications occurring in patients sent to home versus to a facility. METHODS: A retrospective review of a multicenter ASD database, which included patients who underwent surgery between 2009 and 2014. Inclusion criteria were age \u3e18 years, MIS as part of index surgery, location of discharge, and at least 1 of the following: pelvic tilt \u3e20°, sagittal vertical axis \u3e5 cm, pelvic incidence-lumbar lordosis mismatch \u3e10, or lumbar scoliosis \u3e20°. Patients with a 2-year follow-up were included. Preoperative demographic and radiographic data, postoperative (\u3c30 \u3eday) complications, and health-related quality of life were analyzed. RESULTS: A total of 182 patients met our inclusion criteria, including 113 who were discharged to home and 69 who were discharged to an SNF/IR. Older patients (\u3e50 years) were more likely to be discharged to an SNF/IR (P = 0.043). Those aged \u3e70 years were 6-fold more likely to go to an SNF/IR. No association was identified between discharge to an SNF/IR and any radiographic parameters except preoperative pelvic tilt (odds ratio [OR], 1.11; P = 0.009). Staged cases were more likely to be discharged to an SNF/IR (OR, 3.24; 95% confidence interval, 1.11-9.46; P = 0.032); otherwise, there was no difference in levels treated, operating time, estimated blood loss, osteotomy, or length of hospital stay. Patients requiring discharge to an SNF/IR had a higher rate of complications (58% vs. 39.8%; P = 0.017), including major complications (19.5% vs. 42%; P = 0.001), perioperative complications (14.2% vs. 31.9%; P = 0.004) and infections (3.5% vs. 13%; P = 0.016). Patients discharged to an SNF/IR had a higher rate of revision (19.5% vs. 33%; P = 0.035). Health-related quality of life measures were similar regardless of disposition. CONCLUSIONS: Older patients and those undergoing staged MIS deformity correction have a higher likelihood of postoperative disposition to an SNF/IR. Complications occurred more commonly in those patients requiring transfer to an SNF/IR after hospitalization

Intermediate-term clinical and radiographic outcomes with less invasive adult spinal deformity surgery: patients with a minimum follow-up of 4 years.

BACKGROUND: Little information exists regarding longer-term outcomes with minimally invasive spine surgery (MISS), particularly regarding long-segment and deformity procedures. We aimed to evaluate intermediate-term outcomes of MISS for adult spinal deformity (ASD). METHODS: This retrospective review of a prospectively collected multicenter database examined outcomes at 4 or more years following circumferential MIS (cMIS) or hybrid (HYB) surgery for ASD. A total of 53 patients at 8 academic centers satisfied the following inclusion criteria: age \u3e 18 years and coronal Cobb \u3e 20°, pelvic incidence-lumbar lordosis (PI-LL) \u3e 10°, or sagittal vertical axis (SVA) \u3e 5 cm. RESULTS: Radiographic outcomes demonstrated improvements of PI-LL from 16.8° preoperatively to 10.8° and coronal Cobb angle from 38° preoperatively to 18.2° at 4 years. The incidence of complications over the follow-up period was 56.6%. A total of 21 (39.6%) patients underwent reoperation in the thoracolumbar spine, most commonly for adjacent level disease or proximal junctional kyphosis, which occurred in 11 (20.8%) patients. Mean Oswestry Disability Index (ODI) at baseline and years 1 through 4 were 49.9, 33.1, 30.2, 32.7, and 35.0, respectively. The percentage of patients meeting minimal clinically important difference (MCID) (defined as 12% or more from baseline) decreased over time, with leg pain reduction more durable than back pain reduction. CONCLUSIONS: Intermediate-term clinical and radiographic improvement following MISS for ASD is sustained, but extent of improvement lessens over time. Outcome variability exists within a subset of patients not meeting MCID, which increases over time after year two. Loss of improvement over time was more notable in back than leg pain. However, average ODI improvement meets MCID at 4 years after MIS ASD surgery

Analysis of complications with staged surgery for less invasive treatment of adult spinal deformity

BACKGROUND: Spinal deformity surgery is often invasive and lengthy. Staging surgery over separate operative days may reduce complications. Staging is often used in minimally invasive treatment of adult spinal deformity (ASD). OBJECTIVE: To investigate the impact of staging on complication rates between hybrid (HYB; minimally invasive interbody with open posterior screw and rod fixation) and circumferential minimally invasive surgery (cMIS; minimally invasive interbody and screw/rod placement) procedures in ASD patients. METHODS: A multicenter ASD patient database was reviewed. Patients who underwent staging (at least 3 levels) and 2 years of follow-up were analyzed. A total of 99 patients underwent staging; 53 cMIS and 46 HYB surgeries. Propensity matching for levels fused resulted in 19 patients in each group. Intra- and perioperative complications were assessed. RESULTS: Three HYB but no cMIS intraoperative complications occurred. More HYB patients had perioperative complications than cMIS patients. Neurologic complications were more frequent in HYB vs. cMIS. Other complications did not differ significantly. Thirty-day re-operations were higher with cMIS than HYB, but there was no difference in reoperation rate at long-term follow-up. cMIS patients had greater improvement in Oswestry Disability Index. There was no difference in complications between staged vs. unstaged cMIS surgeries. CONCLUSION: cMIS staged surgeries appear safer than HYB staged surgeries, and equally safe to cMIS unstaged surgeries. Perioperative complications were significantly higher for HYB staged surgeries. HYB surgeries may have better results when done in a single setting, while cMIS surgeries can be done in one or two stages depending on surgeon preference

P55. Obese patients achieve similar mental health benefit as nonobese patients after adult spinal deformity surgery

Previous research on the impact of obesity on outcomes after adult spinal deformity surgery has reported radiographic and clinical outcomes, but no analysis has compared the mental health status and outcomes in these patients. This study examines the pre- and postoperative SF 36 mental health status in obese and non-obese patients undergoing correction of adult degenerative scoliosis. Multicenter prospective analysis of adult spinal deformity database. A prospective, multicenter database of ASD patients was reviewed. Patients who had at least 2 years follow-up were analyzed. Demographic and pre- and post-operative SF-36 mental health scores were assessed. A BMI threshold of 35 was selected to more accurately reflect real-world perception of obesity. A prospective database was analyzed using paired t-test and Mann-Whitney U analysis for continuous variables and Chi-Square analysis for categorical variables. A total of 120 patients were included; 60 had a BMI 35. Patients were propensity matched on pre-operative SVA, PI-LL, and Cobb angle. There were no differences between groups in age, number of levels instrumented, pre-operative back pain, ODI, SRS-22, Sacral slope, Cobb angle or PI-LL. When comparing patients with a BMI threshold of 35, there was no difference in pre-operative mental health (42 vs 44.2; p <0.291). Post-operatively, there also was no significant difference in the overall SF-36 mental health scores (49.2 vs 48.8, p <0.827). However, although not statistically significant the absolute “change” in SF-36 scores was greater in the non-obese patients than in the obese patients (7.1 vs 4,7, p<0.223). It is possible, therefore, that obesity may negatively impact post-operative mental health and satisfaction independent of pre-operative mental health. This would be consistent with previous data demonstrating poorer outcomes in some outcome measures in obese patients following correction of ASD. In this prospective evaluation of a large database of patients undergoing correction of ASD, patients with BMI >35 were not significantly different from non-obese patients pre-operatively or post-operatively. Furthermore, they experience similar improvement in mental health scores post-operatively compared to non-obese patients. This abstract does not discuss or include any applicable devices or drugs

206. Does ACR result in greater morbidity than LLIF alone when treating adult spinal deformity?

Anterior column realignment (ACR) can be utilized for correction of adult spinal deformity (ASD), but the additional benefit over lateral lumbar interbody fusion (LLIF) alone is unclear. To evaluate the relative impact of ACR vs LLIF on clinical and radiographic outcomes, as well as complication rates, when surgically treating ASD. Prospective multicenter database review. A total of 127 patients. Oswestry Disability Index (ODI), visual analog score (VAS), SRS-22. Inclusion criteria were age ≥18 years, and one of the following: coronal cobb>20°, SVA>5cm, PT>20°, PI-LL >10°. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery, underwent LLIF (LLIF group) or ACR/LLIF (ACR group) and had 1-year minimum follow-up. A total of 127 patients met inclusion criteria, 101 underwent LLIF and 26 had ACR. Average age and BMI were 66.3/27.7 and 67.8/27.4 (p=0.654/0.957). The groups had similar rates of prior spine surgery (48.5% vs 57.7%; p=0.403), cMIS (58.7% vs 73.1%; p=0.222), posterior osteotomies (43.6% vs 34.6%; p=0.409), levels instrumented (7.8 vs 8; p=0.895), and interbody fusion levels (3.4 vs 3.6; p=0.478). Preop and postop spinopelvic parameters were similar between groups, except for postop SVA which was higher in the LLIF group (40mm vs 13mm; p = 0.028). One year PI-LL (3.8 vs 5.8; p=0.555), PT (20.6 vs 22.9;p=0.536), and SVA were normalized in both groups. Preoperative and postoperative ODI, VAS, and SRS -22 scores were similar between groups. Complication rates between groups were similar as well (57.4% LLIF vs 57.7% ACR; p=0.98), including neurologic (16.8% vs 15.4%; p=0.859) and vascular (0% for both groups) injuries. Use of ACR via lateral approach for correction of adult spinal deformity results in no increase in neurologic, vascular, or other overall complications rates, when compared to using LLIF alone, but is a more complex procedure and should be performed by highly experienced surgeons. Optimization of spino-pelvic parameters was achieved regardless of the technique employed. This abstract does not discuss or include any applicable devices or drugs