Journal articles: 'Multilevel proximal methods'

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Luita, A. V., S. O. Zhilina, and V. V. Semenov. "PROXIMAL ALGORITHMS FOR BI-LEVEL CONVEX OPTIMIZATION PROBLEMS." Journal of Numerical and Applied Mathematics, no. 1 (135) (2021): 145–50. http://dx.doi.org/10.17721/2706-9699.2021.1.19.

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In this paper, problems of bi-level convex minimization in a Hilbert space are considered. The bi-level convex minimization problem is to minimize the first convex function on the set of minima of the second convex function. This setting has many applications, but the implicit constraints generated by the internal problem make it difficult to obtain optimality conditions and construct algorithms. Multilevel optimization problems are formulated in a similar way, the source of which is the operation research problems (optimization according to sequentially specified criteria or lexicographic optimization). Attention is focused on problem solving using two proximal methods. The main theoretical results are theorems on the convergence of methods in various situations. The first of the methods is obtained by combining the penalty function method and the proximal method. Strong convergence is proved in the case of strong convexity of the function of the exterior problem. In the general case, only weak convergence has been proved. The second, the so-called proximal-gradient method, is a combination of one of the variants of the fast proximal-gradient algorithm with the method of penalty functions. The rates of convergence of the proximal-gradient method and its weak convergence are proved.

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Silva, Janmille Valdivino da, and Angelo Giuseppe Roncalli da Costa Oliveira. "Individual and contextual factors associated to the self-perception of oral health in Brazilian adults." Revista de Saúde Pública 52 (April 2, 2018): 29. http://dx.doi.org/10.11606/s1518-8787.2018052000361.

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OBJECTIVE: To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. METHODS: A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. RESULTS: Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. CONCLUSIONS: Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.

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Loganathan, Senthil, and U. Thiyagarajan. "Multilevel segmental femur fracture in young individuals treated by a single step - All in one intramedullary device – A prospective study." Biomedicine 40, no. 4 (January 1, 2021): 488–91. http://dx.doi.org/10.51248/.v40i4.324.

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Introduction: Multilevel femur fracture is being encountered frequently than previously thought. The literature reports the incidence anywhere between 6-11%. Management of these fractures in isolation are technically demanding, and presence of other bone or organ involvement complicates the scenario in achieving the optimal functional results. The use of a single implant provides the technically better overlapping fixation. Methods: Our study represents a prospective cohort study in a 2-year period, between 2017 till 2019. Twenty-six patients with multilevel femur fractures being treated by a single step all in one interlocked cephalomedullary nail were included. Results: In our study 16 patients (88.8%) had been treated by Antegrade cephalomedullary reconstruction nail / proximal femoral nail. Healing of all the femoral fractures was without major complications or requirement of additional surgical procedures. In our study the femur fractures, on an average healed by 18 weeks. Conclusion: For multilevel segmental femur fracture in young adults, stabilization using All-in-one device such as the intramedullary nail is recommended. Closed reduction with PFNA?long / Reconstruction nail is an effective treatment for long?segment femoral fracture with good strength in fixation, high rate of fracture union, and low rate of complications.

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Ambati, Vardhaan Sai, Neha Madugala, Noriko Anderson, Vinil Shah, Praveen V. Mummaneni, and Ann Poncelet. "450 Inflammatory Brachial Plexitis Mimics Postoperative Iatrogenic Neurological Deficits." Neurosurgery 70, Supplement_1 (April 2024): 137. http://dx.doi.org/10.1227/neu.0000000000002809_450.

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INTRODUCTION: A common cause of neurosurgical malpractice cases is the misrepresentation of idiopathic brachial neuritis (incidence: 1/1000) as an iatrogenic neurological insult caused by a surgeon. METHODS: Confirmed postprocedural brachial neuritis patients from a single quaternary care institution were identified and analyzed. RESULTS: We identified 6 (3 female) postprocedural brachial neuritis patients with mean age 63.7 (range 50-75) years. Procedures included 5 cervical spine surgeries (3 multilevel ACDFs, 2 multilevel posterior fusions with laminectomies, 1 multilevel disc arthroplasty) and 1 intrajugular central venous catheter placement. Average time to symptom onset was 1 week post-procedure (range 1 day-2.5 weeks). Initial symptom was moderate-to-severe shoulder (5), arm (4), and/or neck (1) pain. Subsequently, all developed axillary/shoulder weakness; 3 distal arm/hand weakness, 2 winged scapula, and 2 dyspnea/orthopnea. For diagnosis, two patients had confirmatory EMG, 1 had MR neurography confirming plexus inflammation, and 3 had both (positive EMG findings and inflammation on MR Neurography). Average time to accurate diagnosis was 3.1 (range 1.5-5) months. Average number of clinicians seen prior to accurate diagnosis: 5. Treatments included opioids (5), steroids (1), and/or physical therapy (6). All experienced partial pain relief by 1-8 weeks; 2 had persistent pain requiring gabapentin past 6 months. All patients continued to experience motor deficits past 6 months: (4 patients had atrophy and 2-4/5 motor strength in proximal the proximal arm, 1 had distal arm 3/5 motor strength, and 1 had scapular winging). CONCLUSIONS: Postoperative idiopathic brachial plexitis mimics iatrogenic nerve damage following neurosurgical procedures. Recognition of this entity is difficult, and 6 patients at our institution saw on average 5 providers over 3 months prior to accurate diagnosis. Brachial plexitis has a prolonged course with typically only partial recovery at 6 months.

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Shaprynskyi, V., Y. Gupalo, O. Shved, O. Nabolotnyi, and D. Shapovalov. "Treatment of critical limb ischemia in patients with multilevel arterial lesions." Reports of Vinnytsia National Medical University 22, no. 3 (September 28, 2018): 474–78. http://dx.doi.org/10.31393/reports-vnmedical-2018-22(3)-16.

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The extreme manifestation of atherosclerotic lesion of the arteries of the lower extremities is the critical ischemia of the lower extremities. The number of high amputations in such patients ranges from 120 to 500 per 1 million population in the general population annually. In order to achieve the best results in the patency of the arterial bed in the near and distant periods, revascularization of the arteries of the proximal and distal blood flow is necessary. The aim of the work was to evaluate the possibilities and effectiveness of endovascular, open and hybrid arterial interventions on the lower extremities, particularly in patients with multilevel arterial disease, by conducting a retrospective analysis of treatment of critical ischemia. The results of the preoperative ultrasound duplex scan (UDS) of the arteries of 212 patients with critical ischemia of the lower limbs (CILL) shoved, that in 78 (36.8%) were multilevel arterial lesions (MLAL). Patients were divided into two groups. The first (main group) consisted of 50 patients (64%), who have been restored to the open-end and endovascular methods of MLAL, or only endovascular. The second (control) group included 28 patients (36%) — with restoration of permeability of the proximal segment without intervention on the arteries of the distal. Installed, during the period of 16 months, postoperative observation of 78 patients with MLAL, the primary frontal area of the femoral reconstruction in the main group was 92%, and limb preservation - 96%. In the control group, the permeability of the reconstruction zone was 75%, limb preservation — 82%. Thus, it has been established that the most optimal method of recovery of inflow and outflow pathways is one-time hybrid surgical interventions performed in 88% of these patients, which allow to achieve more effectively the recurrence of ischemia and maintain limb.

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Thuany, Mabliny, Thayse Natacha Gomes, Katja Weiss, Volker Scheer, Lee Hill, Ramiro Rolim, Beat Knechtle, and Marcos André Moura dos Santos. "InTrack project ˗ Theoretical framework, design, and methods: A study protocol." PLOS ONE 18, no. 3 (March 30, 2023): e0283157. http://dx.doi.org/10.1371/journal.pone.0283157.

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Sports performance is the result of a complex interaction between individual and environmental factors. The purpose of this paper is to explain the methods used in the InTrack Project, a cross-sectional and cross-cultural project developed to investigate the variance in the performance of runners from different countries and to understand whether the differences in the performance can be explained by micro-level (athletes characteristics and proximal environment), meso-level (the distal environment that plays a relevant role on the relationships established at micro-level), and the macro-level (environmental features that shape countries characteristics). The sample will be comprised of runners, of both sexes, from four countries. Data collection will be performed in two steps: i) Individual information and ii) Country-level information. At the individual level, data will be obtained from an online survey. At the country level, characteristics data will be obtained from the secondary data available (demographic, social, and economic variables). Statistical procedures expected to be used include multilevel analysis, latent class analysis, addictive and multiplicative interaction in regression models. This wealth of information is of relevance to fill gaps regarding the existence of variables to connect different levels of information, and to provide scientific support about environmental characteristics important to predict runners’ performance within and between countries.

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Chernyavsky, A. M., M. M. Lyashenko, D. A. Syrota, D. S. Khvan, B. N. Kozlov, D. S. Panfilov, and V. L. Lukinov. "Hybrid technology in the surgical treatment of proximal aortic dissection." Russian Journal of Cardiology, no. 11 (December 6, 2018): 8–13. http://dx.doi.org/10.15829/1560-4071-2018-11-8-13.

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Aim. To assess results of Meshalkin National Research Medical Center and Tomsk National Research Medical Center in surgical treatment of DeBakey type I aortic dissection using hybrid technologies (“frozen elephant trunk”) compared with classical standard interventions.Material and methods. The study included patients operated on successively in the 20022010 timeframe with a diagnosis of acute and subacute DeBakey type I aortic dissection. A retrospective observational comparison of the surgical treatment results of patients (two groups) was performed: using standard surgical approaches (beveled anastomosis or aortic arch replacement using multibranched prosthesis) and frozen elephant trunk (FET) intervention. The groups included 70 and 31 patients, respectively. Mortality and morbidity were evaluated in the postoperative period, the frequency of aortorelated events — during the observation period.Results. Mortality and the frequency of complications between the groups in the early and late postoperative periods did not differ. Aortorelated events of the groups in the longterm period differed statistically significantly in favor of hybrid interventions (p=0,005).Conclusion. The hybrid technology of thoracic aorta reconstruction using “frozen elephant trunk” type allows to make onestep reconstruction of the aorta during its multilevel lesion. Observation of patients in the longterm period allows us to announce of a longtime, stable result of surgical treatment in the absence of additional perioperative risks.

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Moro, Bruna L. P., Tatiane F. Novaes, Laura R. A. Pontes, Thais Gimenez, Juan S. Lara, Daniela P. Raggio, Mariana M. Braga, and Fausto M. Mendes. "The Influence of Cognitive Bias on Caries Lesion Detection in Preschool Children." Caries Research 52, no. 5 (2018): 420–28. http://dx.doi.org/10.1159/000485807.

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We aimed to evaluate whether children’s caries experience exerts an influence on the performance of visual and radiographic methods in detecting nonevident proximal caries lesions in primary molars. Eighty children (3–6 years old) were selected and classified as having a lower (≤3 decayed, missing, or filled surfaces; dmf-s) or higher (> 3 dmf-s) caries experience. Two calibrated examiners then assessed 526 proximal surfaces for caries lesions using visual and radiographic methods. As a reference standard, 2 other examiners checked the surfaces after temporary separation. Noncavitated and cavitated lesion thresholds were considered and Poisson multilevel regression analyses were conducted to evaluate the influence of caries experience on the performance of diagnostic strategies. Accuracy parameters stratified by caries experience were also derived. A statistically significant influence of caries experience was observed only for visual inspection, with more false-positive results in children with a higher caries experience at the noncavitated lesion threshold, and more false results at the cavitated threshold. The detection of noncavitated caries lesions in children with a higher caries experience was overestimated (specificity = 0.696), compared to children with a lower caries experience (specificity = 0.918), probably due to confirmation bias. However, the examiners underestimated the detection of cavitated lesions in children with a higher caries experience (sensitivity = 0.143) compared to lower-caries-experience children (sensitivity = 0.222), possibly because of representativeness bias. The radiographic method was not influenced by children’s caries experience. In conclusion, children’s caries experience influences the performance of visual inspection in detecting proximal caries lesions in primary teeth, evidencing the occurrence of cognitive biases.

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Khatri, Resham B., and Yibeltal Assefa. "Drivers of the Australian Health System towards Health Care for All: A Scoping Review and Qualitative Synthesis." BioMed Research International 2023 (October 20, 2023): 1–19. http://dx.doi.org/10.1155/2023/6648138.

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Background. Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia. Methods. We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level). Results. A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users’ language, access to health facilities, providers’ behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations). Conclusion. Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.

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Kulkarni, Madhura Sujay, Milind Kulkarni, and Ruta Kulkarni. "Treatment of Infected Nonunion of Fracture of the Proximal Third of Tibia Using Ilizarov Ring Fixator: A Case Series." Journal of Limb Lengthening & Reconstruction 10, no. 1 (January 2024): 16–21. http://dx.doi.org/10.4103/jllr.jllr_2_24.

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Abstract Introduction: Nonunions (NUs) of the fractured proximal third of the tibia are challenging to manage owing to a capacious canal and scarce anterior soft-tissue cover. Infection further complicates the use of internal fixators in such patients. We present a study of 25 cases of infected NU of the proximal third of the tibia that we treated using the Ilizarov ring fixator over 10 years. Materials and Methods: Twenty-three men and two women with infected NU of the proximal tibial meta-diaphyseal junction were studied. The mean age of the patients was 39.2 years. Treatment involved thorough debridement of the NU site with freshening of the bone ends followed by the application of a 3-ring hybrid Ilizarov construct. The patients were followed at regular intervals to assess the infection control, union, limb function, and complications. Results: Successful union and eradication of infection were achieved in 21 patients. Union was not satisfactory in four cases. The average fixator time was 7.12 months. Average knee flexion of 99.2° was observed. The Association for the Study and Application of the Methods of Ilizarov score was excellent in 56% of cases and good in 28%. Six patients required soft-tissue reconstruction. One patient suffered a fracture at the distal pin site while one had a refracture 4 months after treatment completion. Three patients developed a discharging sinus which required debridement and oral antibiotics. Conclusion: The Ilizarov construct provides multilevel, multidirectional, and multiplanar stability, aiding early mobility. Appropriate case selection, sound soft-tissue reconstruction, robust infection control, and good patient compliance are important for the success of the treatment.

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Rabinovich, Emily P., M. Harrison Snyder, Jesse J. McClure, Thomas J. Buell, Justin S. Smith, Christopher I. Shaffrey, and Avery L. Buchholz. "Posterior Polyethylene Tethers Reduce Occurrence of Proximal Junctional Kyphosis After Multilevel Spinal Instrumentation for Adult Spinal Deformity: A Retrospective Analysis." Neurosurgery 89, no. 2 (May 10, 2021): 227–35. http://dx.doi.org/10.1093/neuros/nyab123.

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Abstract BACKGROUND Proximal junctional kyphosis (PJK) is a common postoperative complication after adult spinal deformity (ASD) surgery and may manifest with neurological decline, worsening spinal deformity, and spinal instability, which warrant reoperation. Rates of PJK may be as high as 69.4% after ASD surgery. OBJECTIVE To evaluate the efficacy of junctional tethers for PJK prophylaxis after multilevel instrumented surgery for ASD with minimum 2-yr follow-up. METHODS Single-center retrospective analysis of adult patients (age ≥18 yr) who underwent ASD surgery with index operations performed between November 2010 and June 2016 and achieved minimum 2-yr follow-up. Patients with ASD were subdivided into 3 treatment cohorts based on institutional protocol: no tether (NT), polyethylene tether-only (TO), and tether with crosslink (TC). PJK was defined as a proximal junctional angle (PJA) >10° and 10° greater than the corresponding preoperative measurement. Patient demographics, operative details, standard radiographic scoliosis measurements (including PJA and assessment of PJK), and complications were analyzed. RESULTS Of 184 patients, 146 (79.3%) achieved minimum 2-yr follow-up (mean = 45 mo; mean age = 67 yr; 67.8% women). PJK rates reported for the NT, TO, and TC cohorts were 60.7% (37/61), 35.7% (15/42), and 23.3% (10/43), respectively. PJK rates among TC patients were significantly lower than NT (P = .01601). CONCLUSION Junctional tethers with crosslink significantly reduced the incidence of PJK and revisions for PJK among ASD patients treated with long-segment posterior instrumented fusions who achieved minimum 2-yr follow-up.

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Vanyurkin, A. G., Yu K. Belova, A. V. Chernov, O. S. Tarasova, E. V. Verkhovskaya, A. A. Vlasovets, S. S. Suslov, and M. A. Chernyavsky. "Technical aspects of hybrid interventions for multilevel lesion of brachiocephal arteries. Literature review." Translational Medicine 10, no. 4 (October 17, 2023): 274–84. http://dx.doi.org/10.18705/2311-4495-2023-10-4-274-284.

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Carotid artery stenosis is one of the leading causes of ischemic strokes and accounts for about 20 % of all strokes. The widespread use of radiological diagnostic methods and recommendations for the carotid artery stenosis patients management led to the identification of atypical forms of damage to the brachiocephalic arteries — a combination of multi-level stenoses of extra and intracranial localization. Multilevel lesion of brachiocephalic arteries is characterized by a combination of hemodynamically significant stenosis of the internal carotid artery in combination with stenosis of the common carotid artery or brachiocephalic trunk. The prevalence of tandem lesions varies from 0.5 to 6.4 %. Despite the rarity of this pathology, the risk of ischemic complications against the background of tandem stenosis of the brachiocephalic arteries is higher than with a single-level lesion. The surgical intervention strategy should provide for the correction of both stenosis, which can be achieved in three ways: endovascular method, open prosthetics and hybrid method. The essence of the hybrid technique is the simultaneous correction of the distal and proximal zones of stenosis by one surgical team in a hybrid operating room. The aim of the study is to review the available literature data and to demonstrate the developed hybrid intervention technique with a detailed description of the technical aspects of all stages of the surgery.

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Ghailane, Soufiane, Houssam Bouloussa, Manuel Fernandes Marques, Jean-Etienne Castelain, Vincent Challier, Matthieu Campana, Clément Jacquemin, Jean-Marc Vital, and Olivier Gille. "Distal Junctional Failure: A Feared Complication of Multilevel Posterior Spinal Fusions." Journal of Clinical Medicine 13, no. 17 (August 23, 2024): 4981. http://dx.doi.org/10.3390/jcm13174981.

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Objectives: Distal junctional failure (DJF) is less commonly described than proximal junctional failure following posterior spinal fusion, and particularly adult spinal deformity (ASD) surgery. We describe a case series of patients with DJF, taking into account sagittal spinopelvic alignment, and suggest potential risk factors in light of the current literature. Methods: We performed a single-center, retrospective review of posterior spinal fusion patients with DJF who underwent subsequent revision surgery between June 2009 and January 2019. Demographics and surgical details were collected. Radiographical measurements included the following: preoperative and postoperative sagittal and coronal alignment for each index or revision surgery. The upper-instrumented vertebra (UIV), lower instrumented vertebra (LIV), and fusion length were recorded. Results: Nineteen cases (64.7 ± 13.5 years, 12 women, seven men) were included. The mean follow-up was 4.7 ± 2.4 years. The number of instrumented levels was 6.79 ± 2.97. Among the patients, 84.2% (n = 16) presented at least one known DJF risk factor. LIV was frequently L5 (n = 10) or S1 (n = 2). Six patients had an initial circumferential fusion at the distal end. Initial DJFs were vertebral fracture distal to the fusion (n = 5), screw pull-out (n = 9), spinal stenosis (n = 4), instability (n = 4), and one early DJK. The distal mechanical complications after a first revision included screw pull-out (n = 4), screw fracture (n = 3), non-union (n = 2), and an iatrogenic spondylolisthesis. Conclusions: In this case series, insufficient sagittal balance restoration, female gender, osteoporosis, L5 or S1 LIV in long constructs were associated with DJF. Restoring spinal balance and circumferentially fusing the base of constructs represent key steps to maintain correction and prevent revisions.

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Uzosike, Akachimere C., Venkata K. Byrapogu, Alim F. Ramji, Richard L. Skolasky, and Brian J. Neuman. "2447." Journal of Clinical and Translational Science 1, S1 (September 2017): 78–79. http://dx.doi.org/10.1017/cts.2017.277.

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OBJECTIVES/SPECIFIC AIMS: Cervical fusion is commonly performed for the management of degenerative disc disease, which can cause spinal stenosis and radiculopathy. Adjacent segment disease (ASD) is an adverse postsurgical outcome experienced by some patients as new radiculopathy, stenosis, or other symptomatic sequelae. We sought to assess whether fusion extension past the cervicothoracic junction reduces the risk of distal ASD after multilevel fusions ending at C7-T3. METHODS/STUDY POPULATION: We retrospectively reviewed all first-time patients undergoing instrumented cervical fusion of at least 2 spinal levels and whose distal level of fusion ranged from C7-T3, at the Johns Hopkins Medical Institutions, from 1999 to 2013. The primary outcome was reoperation for distal ASD. Using multiple logistic regression, ANOVA, and χ2 analysis, we determined the odds of ASD due to age, gender, distal level of fusion, surgical approach (anterior, posterior, or combined), smoking status, and race. RESULTS/ANTICIPATED RESULTS: Of the 158 patients who met the selection criteria, the mean age was 58.7±13.8 years, and 95 (60.1%) were female. Ten patients (6.3%) underwent reoperation for ASD. Patients whose fusions ended at C7 were significantly more likely to develop ASD and undergo reoperation (70%, p=0.007) than those whose fusions ended at T1. There were no differences in age, proximal fusion level, smoking status, BMI, gender, and patient-reported race between the reoperation and non-reoperation groups. Following a multivariable analysis, extending the distal fusion to T1 was again found to be protective against reoperation (OR=0.07, p=0.020). DISCUSSION/SIGNIFICANCE OF IMPACT: Our study shows that for multilevel instrumented cervical fusions that terminate within the cervicothoracic junction, fusion distal to the C7 vertebra is associated with decreased odds of reoperation for symptomatic ASD. Therefore, this study provides clinical evidence that may help surgeons determine the optimal distal fusion segment for multilevel fusions ending at C7-T3.

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Cappella, Elise, Sophia H. J. Hwang, Michael J. Kieffer, and Miranda Yates. "Classroom Practices and Academic Outcomes in Urban Afterschool Programs: Alleviating Social-Behavioral Risk." Journal of Emotional and Behavioral Disorders 26, no. 1 (November 8, 2017): 42–51. http://dx.doi.org/10.1177/1063426617739254.

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Given the potential of afterschool programs to support youth in urban, low-income communities, we examined the role of afterschool classroom ecology in the academic outcomes of Latino and African American youth with and without social-behavioral risk. Using multireporter methods and multilevel analysis, we find that positive classroom ecology (i.e., social dynamics, responsive instruction, and organized management) positively predicted academic skills and self-concept across 1 year. For academic skills, the association was magnified for students with social-behavioral difficulties; for academic self-concept, the association was magnified for students without social-behavioral difficulties. No significant relation was found between fall classroom ecology and spring academic engagement; yet in classrooms with more positive ecology, youth with initial social-behavioral risk were more academically engaged. Results suggest the need to consider the role of afterschool classrooms and instructors in promoting supportive interactions and advancing academic outcomes for youth facing distal and proximal risk at the transition to adolescence.

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Nowak, Lauren L., Jeremy Hall, Michael D. McKee, and Emil H. Schemitsch. "A higher reoperation rate following arthroplasty for failed fixation versus primary arthroplasty for the treatment of proximal humeral fractures." Bone & Joint Journal 101-B, no. 10 (October 2019): 1272–79. http://dx.doi.org/10.1302/0301-620x.101b10.bjj-2019-0142.r2.

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Aims To compare complication-related reoperation rates following primary arthroplasty for proximal humerus fractures (PHFs) versus secondary arthroplasty for failed open reduction and internal fixation (ORIF). Patients and Methods We identified patients aged 50 years and over, who sustained a PHF between 2004 and 2015, from linkable datasets. We used intervention codes to identify patients treated with initial ORIF or arthroplasty, and those treated with ORIF who returned for revision arthroplasty within two years. We used multilevel logistic regression to compare reoperations between groups. Results We identified 1624 patients who underwent initial arthroplasty for PHF, and 98 patients who underwent secondary arthroplasty following failed ORIF. In total, 72 patients (4.4%) in the primary arthroplasty group had a reoperation within two years following arthroplasty, compared with 19 patients (19.4%) in the revision arthroplasty group. This difference was significantly different (p < 0.001) after covariable adjustment. Conclusion The number of reoperations following arthroplasty for failed ORIF of PHF is significantly higher compared with primary arthroplasty. This suggests that primary arthroplasty may be a better choice for patients whose prognostic factors suggest a high reoperation rate following ORIF. Prospective clinical studies are required to confirm these findings. Cite this article: Bone Joint J 2019;101-B:1272–1279

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Bess, Shay, Jeffrey E. Harris, Alexander W. L. Turner, Virginie LaFage, Justin S. Smith, Christopher I. Shaffrey, Frank J. Schwab, and Regis W. Haid. "The effect of posterior polyester tethers on the biomechanics of proximal junctional kyphosis: a finite element analysis." Journal of Neurosurgery: Spine 26, no. 1 (January 2017): 125–33. http://dx.doi.org/10.3171/2016.6.spine151477.

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OBJECTIVE Proximal junctional kyphosis (PJK) remains problematic following multilevel instrumented spine surgery. Previous biomechanical studies indicate that providing less rigid fixation at the cranial aspect of a long posterior instrumented construct, via transition rods or hooks at the upper instrumented vertebra (UIV), may provide a gradual transition to normal motion and prevent PJK. The purpose of this study was to evaluate the ability of posterior anchored polyethylene tethers to distribute proximal motion segment stiffness in long instrumented spine constructs. METHODS A finite element model of a T7–L5 spine segment was created to evaluate range of motion (ROM), intradiscal pressure, pedicle screw loads, and forces in the posterior ligament complex within and adjacent to the proximal terminus of an instrumented spine construct. Six models were tested: 1) intact spine; 2) bilateral, segmental pedicle screws (PS) at all levels from T-11 through L-5; 3) bilateral pedicle screws from T-12 to L-5 and transverse process hooks (TPH) at T-11 (the UIV); 4) pedicle screws from T-11 to L5 and 1-level tethers from T-10 to T-11 (TE-UIV+1); 5) pedicle screws from T-11 to L-5 and 2-level tethers from T-9 to T-11 (TE-UIV+2); and 6) pedicle screws and 3-level tethers from T-8 to T-11 (TE-UIV+3). RESULTS Proximal-segment range of motion (ROM) for the PS construct increased from 16% at UIV−1 to 91% at UIV. Proximal-segment ROM for the TPH construct increased from 27% at UIV−1 to 92% at UIV. Posterior tether constructs distributed ROM at the UIV and cranial adjacent segments most effectively; ROM for TE-UIV+1 was 14% of the intact model at UIV−1, 76% at UIV, and 98% at UIV+1. ROM for TE-UIV+2 was 10% at UIV−1, 51% at UIV, 69% at UIV+1, and 97% at UIV+2. ROM for TE-UIV+3 was 7% at UIV−1, 33% at UIV, 45% at UIV+1, and 64% at UIV+2. Proximal segment intradiscal pressures, pedicle screw loads, and ligament forces in the posterior ligament complex were progressively reduced with increasing number of posterior tethers used. CONCLUSIONS Finite element analysis of long instrumented spine constructs demonstrated that posterior tethers created a more gradual transition in ROM and adjacent-segment stress from the instrumented to the noninstrumented spine compared with all PS and TPH constructs. Posterior tethers may limit the biomechanical risk factor for PJK; however, further clinical research is needed to evaluate clinical efficacy.

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Acquati, Chiara, Tzuan A. Chen, Isabel Martinez Leal, Shahnjayla K. Connors, Arooba A. Haq, Anastasia Rogova, Stephanie Ramirez, Lorraine R. Reitzel, and Lorna H. McNeill. "The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol." International Journal of Environmental Research and Public Health 18, no. 24 (December 11, 2021): 13084. http://dx.doi.org/10.3390/ijerph182413084.

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The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients’ quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients’ outcomes.

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Argaw, Alemayehu, Giles Hanley-Cook, Nathalie De Cock, Patrick Kolsteren, Lieven Huybregts, and Carl Lachat. "Drivers of Under-Five Stunting Trend in 14 Low- and Middle-Income Countries since the Turn of the Millennium: A Multilevel Pooled Analysis of 50 Demographic and Health Surveys." Nutrients 11, no. 10 (October 16, 2019): 2485. http://dx.doi.org/10.3390/nu11102485.

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Background: Understanding the drivers contributing to the decreasing trend in stunting is paramount to meeting the World Health Assembly’s global target of 40% stunting reduction by 2025. Methods: We pooled data from 50 Demographic and Health Surveys since 2000 in 14 countries to examine the relationships between the stunting trend and potential factors at distal, intermediate, and proximal levels. A multilevel pooled trend analysis was used to estimate the association between the change in potential drivers at a country level and stunting probability for an individual child while adjusting for time trends and child-level covariates. A four-level mixed-effects linear probability regression model was fitted, accounting for the clustering of data by sampling clusters, survey-rounds, and countries. Results: Stunting followed a decreasing trend in all countries at an average annual rate of 1.04 percentage points. Among the distal factors assessed, a decrease in the Gini coefficient, an improvement in women’s decision-making, and an increase in urbanization were significantly associated with a lower probability of stunting within a country. Improvements in households’ access to improved sanitation facilities and drinking water sources, and children’s access to basic vaccinations were the important intermediate service-related drivers, whereas improvements in early initiation of breastfeeding and a decrease in the prevalence of low birthweight were the important proximal drivers. Conclusions: The results reinforce the need for a combination of nutrition-sensitive and -specific interventions to tackle the problem of stunting. The identified drivers help to guide global efforts to further accelerate stunting reduction and monitor progress against chronic childhood undernutrition.

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Vinogradov, Andrey, Emre Fikret Kapucu, and Susanna Narkilahti. "Exploring Kainic Acid-Induced Alterations in Circular Tripartite Networks with Advanced Analysis Tools." eneuro 11, no. 7 (July 2024): ENEURO.0035–24.2024. http://dx.doi.org/10.1523/eneuro.0035-24.2024.

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Brain activity implies the orchestrated functioning of interconnected brain regions. Typical in vitro models aim to mimic the brain using single human pluripotent stem cell-derived neuronal networks. However, the field is constantly evolving to model brain functions more accurately through the use of new paradigms, e.g., brain-on-a-chip models with compartmentalized structures and integrated sensors. These methods create novel data requiring more complex analysis approaches. The previously introduced circular tripartite network concept models the connectivity between spatially diverse neuronal structures. The model consists of a microfluidic device allowing axonal connectivity between separated neuronal networks with an embedded microelectrode array to record both local and global electrophysiological activity patterns in the closed circuitry. The existing tools are suboptimal for the analysis of the data produced with this model. Here, we introduce advanced tools for synchronization and functional connectivity assessment. We used our custom-designed analysis to assess the interrelations between the kainic acid (KA)-exposed proximal compartment and its nonexposed distal neighbors before and after KA. Novel multilevel circuitry bursting patterns were detected and analyzed in parallel with the inter- and intracompartmental functional connectivity. The effect of KA on the proximal compartment was captured, and the spread of this effect to the nonexposed distal compartments was revealed. KA induced divergent changes in bursting behaviors, which may be explained by distinct baseline activity and varied intra- and intercompartmental connectivity strengths. The circular tripartite network concept combined with our developed analysis advances importantly both face and construct validity in modeling human epilepsy in vitro.

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Joaquim, Andrei F., and Alpesh A. Patel. "Diagnosis, Risk Factors, and Management of Sacral and Pelvic Fractures After Instrumented Lumbar Fusions: A Systematic Review." Global Spine Journal 9, no. 5 (June 12, 2018): 540–44. http://dx.doi.org/10.1177/2192568218779986.

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Study Design: Systematic literature review. Objectives: To evaluate risk factors, diagnosis, and management of sacral and pelvic fractures (SPFs) after instrumented fusions. Methods: A systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed using the PubMed database. Articles with patients with an SPF after a lumbar instrumented fusion were included. The articles addressing specifically proximal junctional kyphosis were excluded. Eleven small cases series (level of evidence IV) were reviewed. Results: The incidence of SPF was 1.86% in one study. The risk factors reported were elderly patients, multilevel surgery, long fusions stopping at L5 or S1 instead of the ilium, osteoporosis, obesity, and sagittal imbalance. Computed tomography scan was the preferential image modality for diagnosing. Nonsurgical treatment may be used in patients with tolerable pain and nondisplaced fracture. Persistent pain was an indication for surgery, as well as fracture displacement. The most common surgical treatment reported was an extension of the fusion to the iliac using iliac screws. Conclusion: SPFs after lumbar instrumented fusion are rare but clinically meaningful complications. The risk factors, diagnosis, and management of SPFs are described in our review.

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Baker, SK. "P.001 Transient neurapraxic radiculopathy." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, S2 (June 2017): S14. http://dx.doi.org/10.1017/cjn.2017.86.

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Background: Neurapraxia is considered to be a temporary disorder of peripheral nerve conduction due to trauma that does not cause axonopathy. However, patients with radiculopathy, confirmed by MRI, who may not have active axonal damage with evidence of spontaneous activity may still report transient give-way weaknesss. In the absence of active changes on intramuscular recording a neurophysiologic consultation may fail to substantiate any significant neurologic concern. This report documents and objectifies prone positioning-induced radicular neurapraxic weakness in an elderly man. Methods: An 83-year-old gentleman was referred for neuromuscular evaluation with regards to peripheral neuropathy. He had a history of low back pain and MRI evidence of multilevel DDD and discogenic neuroforaminal narrowing. Strength testing was performed by Biodex evaluation. Routine electrophysiologic assessments were performed. Results: On neurologic examination proximal strength iwas normal with grade 4 dorsiflexion strength. Stocking-glove loss to pinprick was absent. Preliminary objective testing of the right quadriceps revealed a peak torque of 87.1 Nm. Immediately after lying prone for 3 minutes (for paraspinal EMG), his power dropped to 33.7 Nm. Strength fully recovered by 36 hrs. Conclusions: This case documents evidence of a 61% reversible reduction in torque in the right quadriceps after prone lying. Electromyographers need to be cautious with radiculopathy patients during paraspinal testing.

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Hunter, Stephen, Andrei Rosu, Kylie D. Hesketh, Ryan E. Rhodes, Christina M. Rinaldi, Wendy Rodgers, John C. Spence, and Valerie Carson. "Objectively Measured Environmental Correlates of Toddlers’ Physical Activity and Sedentary Behavior." Pediatric Exercise Science 31, no. 4 (November 1, 2019): 480–87. http://dx.doi.org/10.1123/pes.2018-0270.

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Purpose: Examine objectively measured environmental correlates of physical activity and sedentary behavior in toddlers (12–35 mo). Methods: Participants were recruited at immunization appointments in Edmonton, Canada. Physical activity and sedentary time were objectively measured via accelerometers (n = 149). The parents reported screen time and demographic characteristics via a questionnaire (n = 249). Postal codes were used to link neighborhood data via geographic information systems. Neighborhood data included 4 environmental domains: functional (ie, walkability), safety (ie, crime), esthetic (ie, tree density), and destination (ie, cul-de-sac density, wooded area percentage, green space percentage, recreation density, park density). Weather data (temperature and precipitation) were obtained via historical weather records. Multilevel multiple linear regression models were used to account for clustering of participants within neighborhoods and adjustment of demographic variables. Results: Each additional 10°C of mean temperature was significantly associated with 5.74 (95% confidence interval, 0.96–10.50) minutes per day of higher light-intensity physical activity, though the effect size was small (f2 = 0.08). No other significant associations were observed. Conclusions: The lack of significant findings for neighborhood environment factors suggests proximal factors (eg, features of the home environment) may be more important in predicting toddlers’ physical activity and sedentary behavior. More indoor physical activity opportunities may be needed on colder days for toddlers.

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Meacock, L., N. L. Petrova, Ana Donaldson, A. Isaac, A. Briody, R. Ramnarine, M. E. Edmonds, and D. A. Elias. "Novel Semiquantitative Bone Marrow Oedema Score and Fracture Score for the Magnetic Resonance Imaging Assessment of the Active Charcot Foot in Diabetes." Journal of Diabetes Research 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/8504137.

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There are no accepted methods to grade bone marrow oedema (BMO) and fracture on magnetic resonance imaging (MRI) scans in Charcot osteoarthropathy. The aim was to devise semiquantitative BMO and fracture scores on foot and ankle MRI scans in diabetic patients with active osteoarthropathy and to assess the agreement in using these scores. Three radiologists assessed 45 scans (Siemens Avanto 1.5T, dedicated foot and ankle coil) and scored independently twenty-two bones (proximal phalanges, medial and lateral sesamoids, metatarsals, tarsals, distal tibial plafond, and medial and lateral malleoli) for BMO (0—no oedema, 1—oedema < 50% of bone volume, and 2—oedema > 50% of bone volume) and fracture (0—no fracture, 1—fracture, and 2—collapse/fragmentation). Interobserver agreement and intraobserver agreement were measured using multilevel modelling and intraclass correlation (ICC). The interobserver agreement for the total BMO and fracture scores was very good (ICC = 0.83, 95% confidence intervals (CI) 0.76, 0.91) and good (ICC = 0.62; 95% CI 0.48, 0.76), respectively. The intraobserver agreement for the total BMO and fracture scores was good (ICC = 0.78, 95% CI 0.6, 0.95) and fair to moderate (ICC = 0.44; 95% CI 0.14, 0.74), respectively. The proposed BMO and fracture scores are reliable and can be used to grade the extent of bone damage in the active Charcot foot.

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Danielsson, Olof, Björn Lindvall, Istvan Gati, and Jan Ernerudh. "Classification and Diagnostic Investigation in Inflammatory Myopathies: A Study of 99 Patients." Journal of Rheumatology 40, no. 7 (May 1, 2013): 1173–82. http://dx.doi.org/10.3899/jrheum.120804.

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Objective.Insights into the pathogenesis of inflammatory myopathies have led to new diagnostic methods. The aims of our study were (1) to evaluate the consequences of using the classification of Amato/European Neuromuscular Centre Workshop (ENMC) compared to that of Bohan and Peter; and (2) to evaluate any diagnostic benefit in using an extended pathological investigation.Methods.From a consecutive retrospective database, we evaluated 99 patients for classification. Patients with inclusion body myositis (IBM) were classified according to Griggs,et al. In addition to routine stainings and immunohistochemistry, a multilevel serial sectioning procedure was performed on paraffin-embedded material, to identify scarce pathological findings.Results.Classification according to Bohan and Peter could be performed for 83 of the 99 patients, whereas only 60 patients met the Amato/ENMC criteria, the latter resulting in the following diagnostic groups: IBM (n = 18), nonspecific myositis (n = 14), polymyositis (n = 12), dermatomyositis (n = 10), dermatomyositis sine dermatitis (n = 5), and immune-mediated necrotizing myopathy (n = 1). Most of the Amato/ENMC diagnostic groups harbored patients from several of the Bohan and Peter groups, which included a substantial group lacking proximal muscle weakness. The serial sectioning procedure was essential for classification of 9 patients (15%), and led to a more specific diagnosis for 13 patients (22%) according to Amato/ENMC.Conclusion.The classification of Amato/ENMC was more restrictive, forming groups based on clinical criteria and specified myopathological findings, which clearly differed from the groups of the Bohan and Peter classification. An extended pathological investigation increased the diagnostic yield of a muscle biopsy and highlights the quantity and specificity of certain pathological findings.

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McDaniel, JT. "Prevalence of chronic obstructive pulmonary disease: county-level risk factors based on the Social Ecological Model." Perspectives in Public Health 138, no. 4 (May 10, 2018): 200–208. http://dx.doi.org/10.1177/1757913918772598.

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Aims: Chronic obstructive pulmonary disease (COPD) was the third leading cause of death among Americans in 2014. Multiple factors, ranging from proximal (i.e. biological characteristics and behaviors) to distal (i.e. environmental characteristics and policies), have been shown to predict COPD outcomes. The Social Ecological Model (SEM), which specifies that five levels of influence (i.e. intrapersonal, interpersonal, institutional, community, and public policy factors) are implicated in the development of ill health, has not been used in epidemiological studies of COPD prevalence. A better understanding of the community-level correlates of COPD prevalence may improve community health practice. Methods: Using several sources of county-level secondary data ( n = 646), changes in COPD prevalence from 2012 to 2014 were predicted from the five levels of the SEM using ordinary least squares (OLS) hierarchical linear regression. The geographic distribution of county-level changes in COPD prevalence was analyzed with a choropleth map. Results: County-level COPD prevalence increased by 4.76% between 2012 and 2014 overall; however, the greatest increases were observed among counties within the Appalachian region (i.e. counties in West Virginia). Results showed that the SEM, with five levels of influence, was a statistically significant framework for examining changes in county-level COPD prevalence, F = 10.21, p < .001, R2 = 0.28. Statistically significant county-level predictors of changes in COPD prevalence included racial composition, ethnic composition, poverty, altitude, air pollution, and smoking policy. Conclusion: COPD prevention may be assisted by the implementation of community-based programs rooted in a multilevel approach.

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Kalinin, Roman E., Igor A. Suchkov, Nina D. Mzhavanadze, Olga Zhurina, Emma A. Klimentova, and Vladislav Povarov. "Von Willebrand factor in patients with peripheral artery disease who undergo invasive treatment." I.P. Pavlov Russian Medical Biological Herald 29, no. 3 (October 6, 2021): 389–96. http://dx.doi.org/10.17816/pavlovj79099.

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AIM: To evaluate the level and activity of von Willebrand factor (vWF) in patients with peripheral artery disease (PAD) who underwent endovascular or open bypass grafting. MATERIAL AND METHODS: The study included 115 patients with chronic lower limb ischemia due to PAD, stage IIb-IV according to A.V. PokrovskyFontaine. Fifty-five participants underwent endovascular treatment, while sixty underwent open bypass procedures using synthetic grafts. Peripheral blood samples were collected from all patients at baseline and three months after invasive treatment to determine the vWF antigen and activity. All patients were monitored every three months for a year to detect the development of unfavorable outcomes including disease progression, restenosis, graft thrombosis, oncology, myocardial infarction (MI), limb loss, stroke, and lethal outcomes. RESULTS: The highest values of vWF antigen in patients who underwent endovascular treatment were detected in patients with multilevel lesions1.25 g/mL (vs 0.2 g/mL, 95% confidence interval (CI) 0.723.21 mcg/mL p = 0.019); with a similar trend observed after a 3month follow-up. Baseline vWF antigen was higher in endovascular group patients who developed myocardial infarction (MI) within a year following the procedures as compared to those without MI: 1.15 mcg/mL (95% CI 1.051.175 mcg/mL) and 0.9 mcg/mL (95% CI 0.781.01 mcg/mL), respectively (p = 0.015). Moreover, vWF antigen was increased at the 3-month follow-up in patients with lethal outcomes1.06 mcg/mL (95% CI 0.961.18 mcg/mL, р = 0.031). vWF activity in endovascular group patients with developed MI was four times higher than those without MI (р = 0.022); a similar trend was detected in the development of lethal outcomes (р = 0.009). Those who underwent open bypass grafting presented with high activity of vWF with maximum values detected in participants with proximal iliofemoral lesions (1200%, 95% CI 640%1200%) and stage IV disease (770%, 95% CI 320%1200%, p 0.05). ROC analysis revealed that vWF activity at least 6.2 times higher in patients who underwent endovascular treatment associated with the development of lethal outcomes within one year after invasive treatments; sensitivity and specificity of the method were 83.3% and 75.5%, accordingly. CONCLUSION: Patients with PAD presented with increased vWF antigen and activity with maximum values detected in patients with multilevel lesions and critical lower limb ischemia. Increased vWF antigen and activity was associated with development of MI and lethal outcomes within one year following endovascular procedures on lower extremity arteries.

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Vaganov, Alexey G., Maxim S. Nochnoy, Dmitry A. Lisitsky, Alexey I. Ivanyuk, Elena G. Chepelenko, and Alexander V. Gavrilenko. "Outcomes of Proximal Hybrid Arterial Reconstruction in Combination with Simultaneous Amputation in Dry Atherosclerotic Gangrene of Toes." I.P. Pavlov Russian Medical Biological Herald 32, no. 3 (October 4, 2024): 389–400. http://dx.doi.org/10.17816/pavlovj627546.

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INTRODUCTION: When treating atherosclerotic gangrene of the lower limb (LL), the surgeon faces the questions about the reasonability of vascular reconstruction and the optimal timing of amputation after surgery on the LL arteries. The answer to these questions is given by assessing the state of the microvasculature of the operated limb. With sufficient development of the microvasculature and good collateral circulation, it is possible to perform a simultaneous amputation after proximal reconstruction. In this situation, a clear demarcation of the zone of necrosis and reversible ischemia is required, which can be realized by the method of ultraviolet luminescence spectroscopy. AIM: To analyze the results of hybrid reconstructions on the LL arteries with multilevel diffuse atherosclerotic lesions and dry gangrene of toes (DGT). MATERIALS AND METHODS: A prospective, controlled, non-randomized study included 29 patients suffering from critical ischemia of the lower limbs and having DGT, who were operated on in the amount of hybrid arterial reconstruction. The patients were divided into two groups: patients of group 1 (n = 14) underwent restoration of the main blood flow at the level of the iliofemoral arterial segment using a hybrid method, with simultaneous minor amputation of LL at various levels; patients of group 2 (control group, n = 15) underwent a simultaneous proximal and distal hybrid operation, providing main blood flow through at least one of the lower leg arteries, followed by a minor amputation of the lower leg at various levels over the next 4–5 days. RESULTS: There were no statistically significant differences in the groups in the degree of decrease in luminescence intensity after vascular surgery. A histological examination of intraoperative preparations of DGT revealed necrosis of the cellular microenvironment at luminescence amplitude (1.0 ± 0.05) × 105 photons at 410 nm frequency. At luminescence amplitude not exceeding this level, signs of necrobiosis were noted. Luminescence level of ≥ 1.0 × 105 photons was used as the amputation boundary. In the case of an uncomplicated vascular stage of the operation, a comparable decrease in the conventional amputation boundary was noted in the study groups. In the early postoperative period, in patients of group 1, the level of inflammation markers, average number of bed-days, and the number of thrombotic complications were lower than in the control group (p 0.05). A strong correlation was recorded between the morphological signs of the acute phase of inflammation and the intensity of chemiluminescence (r = 0.7, p 0.005). CONCLUSION: In patients with DGT, at a luminescence amplitude on the lower leg and foot not exceeding 1.0 × 105 photons at 410 nm frequency and 0.7 × 105 photons at 450 nm frequency, an effective treatment method is restoration of the main blood flow in the iliofemoral segment using a hybrid method with simultaneous minor amputation at various levels of the foot. This luminescence level is the conventional boundary between necrotic changes and reversible ischemia (necrobiosis) of the soft tissues of the LL.

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Mousavi, Zahra, Jocelyn Lai, Asal Yunusova, Alexander Rivera, Sirui Hu, Sina Labbaf, Salar Jafarlou, et al. "193 Sleep Variability and Affect Dynamics Among College Students during COVID-19 Pandemic." Sleep 44, Supplement_2 (May 1, 2021): A78. http://dx.doi.org/10.1093/sleep/zsab072.192.

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Abstract Introduction Sleep disturbance is a transdiagnostic risk factor that is so prevalent among emerging adults it is considered to be a public health epidemic. For emerging adults, who are already at greater risk for psychopathology, the COVID-19 pandemic has disrupted daily routines, potentially changing sleep patterns and heightening risk factors for the emergence of affective dysregulation, and consequently mood-related disturbances. This study aimed to determine whether variability in sleep patterns across a 3-month period was associated with next-day positive and negative affect, and affective dynamics, proximal affective predictors of depressive symptoms among young adults during the pandemic. Methods College student participants (N=20, 65% female, Mage=19.80, SDage=1.0) wore non-invasive wearable devices (the Oura ring https://ouraring.com/) continuously for a period of 3-months, measuring sleep onset latency, sleep efficiency, total sleep, and time spent in different stages of sleep (light, deep and rapid eye movement). Participants reported daily PA and NA using the Positive and Negative Affect Schedule on a 0-100 scale to report on their affective state. Results Multilevel models specifying a within-subject process of the relation between sleep and affect revealed that participants with higher sleep onset latency (b= -2.98, p<.01) and sleep duration on the prior day (b= -.35, p=.01) had lower PA the next day. Participants with longer light sleep duration had lower PA (b= -.28, p=.02), whereas participants with longer deep sleep duration had higher PA (b= .36, p=.02) the next day. On days with higher total sleep, participants experienced lower NA compared to their own average (b= -.01, p=.04). Follow-up exploratory bivariate correlations revealed significant associations between light sleep duration instability and higher instability in both PA and NA, whereas higher deep sleep duration was linked with lower instability in both PA and NA (all ps< .05). In the full-length paper these analyses will be probed using linear regressions controlling for relevant covariates (main effects of sleep, sex/age/ethnicity). Conclusion Sleep, an important transdiagnostic health outcome, may contribute to next-day PA and NA. Sleep patterns predict affect dynamics, which may be proximal predictors of mood disturbances. Affect dynamics may be one potential pathway through which sleep has implications for health disparities. Support (if any):

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Schwendicke, Falk, Soraya Leal, Peter Schlattmann, Sebastian Paris, Ana Paula Dias Ribeiro, Marta Gomes Marques, and Leandro Augusto Hilgert. "Selective carious tissue removal using subjective criteria or polymer bur: study protocol for a randomised controlled trial (SelecCT)." BMJ Open 8, no. 12 (December 2018): e022952. http://dx.doi.org/10.1136/bmjopen-2018-022952.

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IntroductionSelective (incomplete/partial) carious tissue removal is suitable for treating deep carious lesions in teeth with vital, asymptomatic pulps. In the periphery of a cavity, removal to hard dentin is performed, while in pulpo-proximal areas, leathery or soft dentin is left to avoid pulp exposure. As the decision of what contains ‘soft’ or ‘leathery’ dentin is subjective, using self-limiting burs which help to standardise the hardness of the remaining dentin, has been suggested to increase the reliability of carious tissue removal. The trial compares subjectively measured selective carious tissue removal in deep lesions in primary teeth with objectively measured selective removal with a self-limiting bur (Polybur, Komet).Methods and analysisA community-based single-blind clustered randomised controlled superiority trial nested into a larger evaluation is performed. Recruitment for this trial has been concluded. We have recruited 115 children aged 6–8 years with ≥1 vital primary molar with a deep dentin lesion. The unit of randomisation was the child, with all eligible molars per child treated identically. Treatment was performed in a mobile dental unit. Subjective and objective carious tissue removal was performed at random. Teeth were restored using glass ionomer cement (Equia Forte, GC). Our primary outcome will be the time until complications occur, evaluated via multilevel survival analysis. Secondary outcomes will be the time until extraction is needed, subjective satisfaction of the child with the treatment (measured using a Likert scale) and cost-effectiveness. Re-examination will be performed after 12, 24 and 36 months (the final examination is expected in 2020).Ethics and disseminationThis trial has been approved by the Ethics Committee of the Health Sciences of the University of Brasília (CAAE 51310415.0.0000.0030). Trial results will be published in peer-reviewed journals and presented on conferences.Trial registration numberNCT02754466.

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Kim, Seung-Kook, Seoung-woo Park, Byun-chul Lim, and Su-Chan Lee. "Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases." Journal of Neurological Surgery Part A: Central European Neurosurgery 81, no. 05 (May 3, 2020): 392–98. http://dx.doi.org/10.1055/s-0040-1709164.

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Abstract Background and Study Aim Reoperation for lumbar spinal stenosis (LSS) is technically challenging. Studies comparing preoperative risk factors and reoperation outcomes between spinal fusion and spinal decompression are limited. Thus this study compared fusion and decompression with respect to reoperation rates, preoperative factors related to re-surgery, and clinical outcomes. Patients and Methods This retrospective cohort study included prospectively collected data from patients who underwent revision surgeries for degenerative LSS between May 2001 and March 2015. The reoperation rate, risk factors (proportional hazards analysis of index surgery), surgery type, main reason for revision, and final clinical outcomes (pain, quality-of-life modification, patient satisfaction, and complication rate) were analyzed and compared between the fusion and decompression surgeries. Results Among 987 cases during 13 years, 25 cases of reoperation after fusion and 23 cases of reoperation after decompression were identified, accounting for reoperation rates of 5.88% and 4.00%, respectively. Combined comorbidities (hazard ratio [HR]: 1.98 for fusion; multilevel involvement [with fusion, HR: 2.92; decompression, HR: 1.95]) were strongly correlated with preoperative demographic risk factor for each procedure. The main reason for reoperation in fusion cases was proximal junctional kyphosis (40%) and implant failure (20%), and in decompression cases, recurrent lesions (48.8%) and incomplete surgery (17.4%) An additional fusion after initial fusion and re-decompression without fusion after initial decompression were the most common surgical procedure. Back pain and patient satisfaction after fusion were better compared with those after decompression. Conclusion The reoperation rate, preoperative risk factors, reason for revision, reoperation type, clinical outcomes, patient satisfaction, and time interval between index and re-surgery were different between the primary fusion and primary decompression. A better understanding of disease pathophysiology and surgical procedure characteristics will facilitate improvement in disease management and the development of treatment strategies.

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Biancari, Fausto, Giorgio Mastroiacovo, Mauro Rinaldi, Luisa Ferrante, Timo Mäkikallio, Tatu Juvonen, Giovanni Mariscalco, et al. "The David Versus the Bentall Procedure for Acute Type A Aortic Dissection." Journal of Cardiovascular Development and Disease 11, no. 11 (November 19, 2024): 370. http://dx.doi.org/10.3390/jcdd11110370.

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Background: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. Method: The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. Results: A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (p < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, p-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, p-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, p-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, p-value 0.954), even after propensity score matching (2.8% vs. 1.8%, p-value 0.994). Conclusions: The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique.

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Kuchay, А. А., and A. N. Lipin. "Hybrid interventions on distal sections of the main arteries in extended chronic occlusions of the superficial femoral artery in patients with critical limb ischemia." Атеросклероз и Дислипидемии, no. 2(55) (July 24, 2024): 32–40. http://dx.doi.org/10.34687/2219-8202.jad.2024.02.0004.

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AbstractBackground. Over two thirds of patients with CLI present with SFA disease, often a long CTOwith patent proximal popliteal artery and extensive occlusive lesions in the crural vessels. Westudied a series of hybrid interventions to treat this multilevel disease as an alternative to conventionalapproach.Aim. To improve the results of revascularization of the lower limb in cases of extended occlusionof the SFA in combination with crural runoff.Materials and Methods: A total of 40 patients (25% women; mean age 69.5 years), all with Rutherfordclass 5-6 disease, were included in the study. Angiography showed long (>200 mm) SFA CTOin all cases (100%) accompanied by CTO of distal popliteal artery (n=9; 22.5%); all crural arteries(n=26; 65%) or all crural arteries but the peroneal (n=7; 17.5%).We performed femoropopliteal bypass with autologous vein in all patients (100%) followed byballoon angioplasty of distal popliteal and/or crural arteries done either on the same day (n=22;55%) or 2-14 days later (n=18; 45%). Direct angiosomic revascularization was achieved in 36 patients(90%).We used a series of 46 consecutive patients who underwent femoral tibial bypass as historic control.Results. The 30-day mortality and graft failure rate were 2.5% vs 4.3% (p>0.05) and 5% vs 13%(p<0.05) after hybrid and tibial bypass interventions, respectively.At 1 year the primary patency of bypass and amputation-free survival were 77.7% (95% CI 61.7-93.7) vs 57.1% (95% CI 42.9-71.3) and 82.1% (95% CI 66.8-97.4) vs 69.6% (95% CI 56.1-83.1) afterhybrid intervention and tibial bypass, respectively (all non-significant).Conclusions. Compared to femoral tibial bypass, a hybrid intervention comprised of a bypass to apatent popliteal artery and subsequent crural angioplasty decreased the early failure rate withoutany negative effect on the long-term outcomes in CLI patients with long SFA CTO and extensiverunoff disease.

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Ingebrigtsen, Tor, Michael K. Morgan, Ken Faulder, Linda Ingebrigtsen, Trygve Sparr, and Henrik Schirmer. "Bifurcation geometry and the presence of cerebral artery aneurysms." Journal of Neurosurgery 101, no. 1 (July 2004): 108–13. http://dx.doi.org/10.3171/jns.2004.101.1.0108.

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Object. The angles of arterial bifurcations are governed by principles of work minimization (optimality principle). This determines the relationship between the angle of a bifurcation and the radii of the vessels. Nevertheless, the model is predicated on an absence of significant communication between these branches. The circle of Willis changes this relationship because the vessels proximal to the ring of vessels have additional factors that determine work minimization compared with more distal branches. This must have an impact on understanding of the relationship between shear stress and aneurysm formation. The authors hypothesized that normal bifurcations of cerebral arteries beyond the circle of Willis would follow optimality principles of minimum work and that the presence of aneurysms would be associated with deviations from optimum bifurcation geometry. Nevertheless, the vessels participating in (or immediately proximal to) the circle of Willis may not follow the geometric model as it is generally applied and this must also be investigated. Methods. One hundred seven bifurcations of the middle cerebral artery (MCA), distal internal carotid artery (ICA), and basilar artery (BA) were studied in 55 patients. The authors analyzed three-dimensional reconstructions of digital subtraction angiography images with respect to vessel radii and bifurcation angles. The junction exponent (that is, a calculated measure of the division of flow at the bifurcation) and the difference between the predicted optimal and observed branch angles were used as measures of deviation from the geometry thought best to minimize work. The mean junction exponent for MCA bifurcations was 2.9 ± 1.2 (mean ± standard deviation [SD]), which is close to the theoretical optimum of 3, but it was significantly smaller (p < 0.001; 1.7 ± 0.8, mean ± SD) for distal ICA bifurcations. In a multilevel multivariate logistic regression analysis, only the observed branch angles were significant independent predictors for the presence of an aneurysm. The odds ratio (OR) (95% confidence interval) for the presence of an aneurysm was 3.46 (1.02–11.74) between the lowest and highest tertile of the observed angle between the parent vessel and the largest branch. The corresponding OR for the smallest branch was 48.06 (9.7–238.2). Conclusions. The bifurcation beyond the circle of Willis (that is, the MCA) closely approximated optimality principles, whereas the bifurcations within the circle of Willis (that is, the distal ICA and BA) did not. This indicates that the confluence of hemodynamic forces plays an important role in the distribution of work at bifurcations within the circle of Willis. In addition, the observed branch angles were predictors for the presence of aneurysms.

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Yang, Honghao, Jixuan Huang, Yong Hai, Zhexuan Fan, Yiqi Zhang, Peng Yin, and Jincai Yang. "Is It Necessary to Cross the Cervicothoracic Junction in Posterior Cervical Decompression and Fusion for Multilevel Degenerative Cervical Spine Disease? A Systematic Review and Meta-Analysis." Journal of Clinical Medicine 12, no. 8 (April 11, 2023): 2806. http://dx.doi.org/10.3390/jcm12082806.

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Background: Posterior cervical decompression and fusion (PCF) is a common procedure for treating patients with multilevel degenerative cervical spine disease. The selection of lower instrumented vertebra (LIV) relative to the cervicothoracic junction (CTJ) remains controversial. This study aimed to compare the outcomes of PCF construct terminating at the lower cervical spine and crossing the CTJ. Methods: A comprehensive literature search was performed for relevant studies in the PubMed, EMBASE, Web of Science, and Cochrane Library database. Complications, rate of reoperation, surgical data, patient-reported outcomes (PROs), and radiographic outcomes were compared between PCF construct terminating at or above C7 (cervical group) and at or below T1 (thoracic group) in patients with multilevel degenerative cervical spine disease. A subgroup analysis based on surgical techniques and indications was performed. Results: Fifteen retrospective cohort studies comprising 2071 patients (1163 in the cervical group and 908 in the thoracic group) were included. The cervical group was associated with a lower incidence of wound-related complications (RR, 0.58; 95% CI 0.36 to 0.92, p = 0.022; 831 patients in cervical group vs. 692 patients in thoracic group), a lower reoperation rate for wound-related complications (RR, 0.55; 95% CI 0.32 to 0.96, p = 0.034; 768 vs. 624 patients), and less neck pain at the final follow-up (WMD, −0.58; 95% CI −0.93 to −0.23, p = 0.001; 327 vs. 268 patients). However the cervical group also developed a higher incidence of overall adjacent segment disease (ASD, including distal ASD and proximal ASD) (RR, 1.87; 95% CI 1.27 to 2.76, p = 0.001; 1079 vs. 860 patients), distal ASD (RR, 2.18; 95% CI 1.36 to 3.51, p = 0.001; 642 vs. 555 patients), overall hardware failure (including hardware failure of LIV and hardware failure occurring at other instrumented vertebra) (RR, 1.48; 95% CI 1.02 to 2.15, p = 0.040; 614 vs. 451 patients), and hardware failure of LIV (RR, 1.89; 95% CI 1.21 to 2.95, p = 0.005; 380 vs. 339 patients). The operating time was reasonably shorter (WMD, −43.47; 95% CI −59.42 to −27.52, p < 0.001; 611 vs. 570 patients) and the estimated blood loss was lower (WMD, −143.77; 95% CI −185.90 to −101.63, p < 0.001; 721 vs. 740 patients) when the PCF construct did not cross the CTJ. Conclusions: PCF construct crossing the CTJ was associated with a lower incidence of ASD and hardware failure but a higher incidence of wound-related complications and a small increase in qualitative neck pain, without difference in neck disability on the NDI. Based on the subgroup analysis for surgical techniques and indications, prophylactic crossing of the CTJ should be considered for patients with concurrent instability, ossification, deformity, or a combination of anterior approach surgeries as well. However, long-term follow-up outcomes and patient selection-related factors such as bone quality, frailty, and nutrition status should be addressed in further studies.

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Worku, Misganaw Gebrie, Itismita Mohanty, Zelalem Mengesha, and Theo Niyonsenga. "Risk Factors of Standalone and Coexisting Forms of Undernutrition Among Children in Sub-Saharan Africa: A Study Using Data from 26 Country-Based Demographic and Health Surveys." Nutrients 17, no. 2 (January 11, 2025): 252. https://doi.org/10.3390/nu17020252.

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Introduction: Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors. Methods: Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect. Results: The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35–34.82). Additionally, 20.49% (95% CI: 20.30–20.69) and 14.09% (95% CI: 13.92–14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother’s educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0–23-month-old children. For 24–59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition. Conclusions: Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA.

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Chen, Yong, Songtao Yu, Yizhen Wang, Ruixiong Yang, and Xu Cheng. "An Improved AC-Link Voltage Matching Control for the Multiport Modular Multilevel DC Transformer in MVDC Applications." Energies 17, no. 6 (March 12, 2024): 1346. http://dx.doi.org/10.3390/en17061346.

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In this paper, an improved AC-link voltage matching control (IVM) strategy is proposed for the multiport modular multilevel DC transformer (M3DCT), which comprises a single-phase modular multilevel converter (MMC) and a series of cascaded H-bridge units. The objective of the proposed IVM strategy is to address the AC-link voltage mismatch phenomenon. Distinct from existing control methods, such as various phase-shifting control methods and the conventional AC-link voltage matching control strategy, the proposed IVM strategy orchestrates the operation of the M3DCT in an innovative fashion. It allows the sum of inserted submodule (SM) numbers in the upper and lower arms to be flexible, no longer confined to a specific SM number per arm. Consequently, the AC-link voltage of the M3DCT is maintained proximate to the matched operating condition, regardless of the degree of mismatch in the DC side voltage of the M3DCT. This enables the enhancement of the M3DCT’s overall operational performance, particularly under conditions of light loads within medium-voltage DC (MVDC) distribution systems. The correctness and effectiveness of the proposed control strategy and the corresponding analysis are substantiated through simulation results.

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Abraham, Ivy, Garth Rauscher, Anand Ashwin Patel, William B. Pearse, Priya Rajakumar, Stephanie Berg, Ahmed Aleem, et al. "The Role of Structural Violence in Acute Myeloid Leukemia Outcomes." Blood 136, Supplement 1 (November 5, 2020): 10. http://dx.doi.org/10.1182/blood-2020-136379.

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Background: Non-Hispanic Black (NHB) and Hispanic patients with Acute Myeloid Leukemia (AML) have higher mortality rates than non-Hispanic white (NHW) patients despite lower incidence, more favorable genetics, and a younger age at presentation (Darbinyan, Blood Adv. 2017). We performed a multilevel analysis of disparities in AML patients to investigate the contribution of structural violence, specifically neighborhood SES, on racial/ethnic differences in leukemia-specific survival. Methods: Adult AML (non-APL) patients diagnosed between 2012 and 2018 at six academic cancer centers in the Chicago area were included. Census tract data was collected using the FFIEC Geocoding/Mapping System and computed tract disadvantage and tract affluence scores were categorized into distribution tertiles (low, moderate, high). Time to relapse and death from leukemia were examined, adjusting for age, gender and race/ethnicity (baseline models), and for potential mediators of racial disparities including distal (Charlson Comorbidity Index (CCI), obesity, concentrated disadvantage and affluence, health insurance status), and proximal mediators (somatic mutations, and European Leukemia Network (ELN) prognostic score categories). Results Patient characteristics are shown in Table 1 (n = 822). Significant heterogeneity in age and comorbidities at diagnosis was observed, with Hispanic patients being the youngest and with the lowest CCI. Morbid obesity was more prevalent in NHB and Hispanic (23% and 20%, respectively) compared with NHW (11%) patients. Payer source also differed significantly; private insurance was twice as frequent among NHW than NHB (51% vs. 25%) patients, while the largest uninsured population was Hispanic. ELN adverse risk disease was most prevalent in NHW subjects, NPM1 mutations were least prevalent in Hispanic patients, and p53 mutations more prevalent in NHB (26%) compared to NHW (12%) and Hispanics (9%) although due to low numbers this did not reach significance (p=0.10). NHB and Hispanic patients tended to reside in more disadvantaged and less affluent areas. Treatment data was available for 764 patients (Table 2); 75% received intensive induction therapy and choice of first-line treatment did not differ by race or tract disadvantage. Allogeneic transplant rates however differed by race, age, insurance status, tract disadvantage, and ELN score. Treatment complications of induction chemotherapy, as reflected by ICU admissions during induction, were significantly lower in NHW (25%) compared to NHB (39%) and Hispanic (42%) patients. ICU admission rates were significantly higher in patients with morbid obesity and low tract affluence. Minority (vs. NHW) ethnicity was associated with a 42% increased hazard of death from leukemia (HR=1.42, 95% CI: 1.09, 1.85), and a 36% increased hazard of death from all causes (HR=1.36, 95% CI: 1.07, 1.72), each after controlling for age, gender and study site. Adjustment for continuous tract disadvantage and affluence and their interaction lowered both the hazard of leukemia and all cause death to 1.18 (95% CI: 0.88, 1.60) and 1.14 (95% CI: 0.88, 1.49), respectively. In formal mediation analysis, neighborhood SES accounted for 37% (p=0.09) and 50% (p=0.02) of the racial disparity in death from leukemia and all causes, respectively. Discussion: This study is the first to integrate data at the individual patient level with neighborhood characteristics, using census tract level variables to examine their contribution to AML patient outcomes. To date, formal mediation methods had not been employed to disentangle race/ethnic disparities in adult AML survival. Notably, our mediation analysis shows that census tract level SES explains a substantial proportion of the disparity in hazard of leukemia death. In addition, the observed disparities in treatment complications of induction chemotherapy, as reflected by ICU admissions, and the continued disparity in allogeneic transplant utilization all warrant further study. These results draw attention to the need for deeper investigation into the social and economic barriers to successful treatment outcomes for leukemia patients and represent an important first step toward designing strategies to mitigate these persistent health inequities. Disclosures Altman: Janssen: Consultancy; Syros: Consultancy; Genentech: Research Funding; Novartis: Consultancy; Amphivena: Research Funding; Amgen: Research Funding; Aprea: Research Funding; ImmunoGen: Research Funding; Celgene: Research Funding; Boehringer Ingelheim: Research Funding; Fujifilm: Research Funding; Kartos: Research Funding; AbbVie: Other: advisory board, Research Funding; Kura Oncology: Other: Scientific Advisory Board - no payment accepted, Research Funding; BioSight: Other: No payment but was reimbursed for travel , Research Funding; Daiichi Sankyo: Other: Advisory Board - no payment but was reimbursed for travel; Agios: Other: advisory board, Research Funding; Glycomimetics: Other: Data safety and monitoring committee; Astellas: Other: Advisory Board, Speaker (no payment), Steering Committee (no payment), Research Funding; Theradex: Other: Advisory Board; Immune Pharmaceuticals: Consultancy; Bristol-Myers Squibb: Consultancy; France Foundation: Consultancy; PeerView: Consultancy; PrIME Oncology: Consultancy; ASH: Consultancy; Cancer Expert Now: Consultancy. Stock:Research to Practice: Honoraria; UpToDate: Honoraria; Adaptive Biotechnologies: Consultancy, Membership on an entity's Board of Directors or advisory committees; American Society of Hematology: Honoraria; Leukemia and Lymphoma Society: Research Funding; Novartis: Research Funding; Abbvie: Honoraria, Research Funding; Morphosys: Consultancy, Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees; Kite: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Servier: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Quigley:Alnylam: Speakers Bureau; Agios: Speakers Bureau; Amgen: Other: Advisory board. Khan:Celgene: Consultancy; Incyte: Honoraria; Takeda: Research Funding; Amgen: Consultancy.

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Mesoudi, Alex. "Pursuing Darwin’s curious parallel: Prospects for a science of cultural evolution." Proceedings of the National Academy of Sciences 114, no. 30 (July 24, 2017): 7853–60. http://dx.doi.org/10.1073/pnas.1620741114.

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In the past few decades, scholars from several disciplines have pursued the curious parallel noted by Darwin between the genetic evolution of species and the cultural evolution of beliefs, skills, knowledge, languages, institutions, and other forms of socially transmitted information. Here, I review current progress in the pursuit of an evolutionary science of culture that is grounded in both biological and evolutionary theory, but also treats culture as more than a proximate mechanism that is directly controlled by genes. Both genetic and cultural evolution can be described as systems of inherited variation that change over time in response to processes such as selection, migration, and drift. Appropriate differences between genetic and cultural change are taken seriously, such as the possibility in the latter of nonrandomly guided variation or transformation, blending inheritance, and one-to-many transmission. The foundation of cultural evolution was laid in the late 20th century with population-genetic style models of cultural microevolution, and the use of phylogenetic methods to reconstruct cultural macroevolution. Since then, there have been major efforts to understand the sociocognitive mechanisms underlying cumulative cultural evolution, the consequences of demography on cultural evolution, the empirical validity of assumed social learning biases, the relative role of transformative and selective processes, and the use of quantitative phylogenetic and multilevel selection models to understand past and present dynamics of society-level change. I conclude by highlighting the interdisciplinary challenges of studying cultural evolution, including its relation to the traditional social sciences and humanities.

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Devi Artanti, Guspri, Fidesrinur, and Meyke Garzia. "Stunting and Factors Affecting Toddlers in Indonesia." JPUD - Jurnal Pendidikan Usia Dini 16, no. 1 (April 30, 2022): 172–85. http://dx.doi.org/10.21009/jpud.161.12.

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ABSTRACT: Asia is the second region after Africa to have the tallest prevalence of stunting in the world. Indonesia is one of the countries in Southeast Asia with the fifth highest prevalence of stunting in the world at 37%, or nearly 9 million children who experience stunting. This study aims to examine the factors that influence and risk the occurrence of stunting in children in Indonesia. The research method uses a type of qualitative research with a traditional literature review. This study found that stunting is influenced by several complex factors not only at the individual level but also at the family and community levels. A comprehensive synthesis of the available evidence on the determinants of stunting in children in Indonesia outlines who is most vulnerable to stunting, which interventions are successful, and what new research is needed to fill knowledge gaps. Keywords: Indonesian toddlers, stunting factors References: Adair, L. S., & Guilkey, D. K. (1997). Age-specific Determinants of Stunting in Filipino Children. The Journal of Nutrition, 127(2), 314–320. https://doi.org/10.1093/jn/127.2.314 Akombi, B. J., Agho, K. E., Hall, J. J., Merom, D., Astell-Burt, T., & Renzaho, A. M. N. (2017). Stunting and Severe Stunting Among Children Under-5 Years in Nigeria: A Multilevel Analysis. BMC Pediatrics, 17(1), 1–16. https://doi.org/10.1186/s12887-016-0770-z Asfaw, M., Wondaferash, M., Taha, M., & Dube, L. (2015). Prevalence of Undernutrition and Associated Factors Among Children Aged Between Six to Fifty Nine Months in Bule Hora District, South Ethiopia. BMC Public Health,15(1), 41. https://doi.org/10.1186/s12889-015-1370-9 Badan Penelitian dan Pengembangan Kesehatan. (2018). Hasil Utama RISKESDAS 2018. Bardosono, S., Sastroamidjojo, S., & Lukito, W. (2007). Determinants of Child Malnutrition During the 1999 Economic Crisis in Selected Poor Areas of Indonesia. Asia Pacific Journal of Clinical Nutrition, 16(3), 512–526. Best, C. M., Sun, K., De Pee, S., Sari, M., Bloem, M. W., & Semba, R. D. (2008). Paternal Smoking and Increased Risk of Child Malnutrition Among Families in Rural Indonesia. Tobacco Control, 17(1), 38–45. https://doi.org/10.1136/tc.2007.020875 Biadgilign, S., Shumetie, A., & Yesigat, H. (2016). Does Economic Growth Reduce Childhood Undernutrition in Ethiopia? PLoS ONE, 11(8), 1–14. https://doi.org/10.1371/journal.pone.0160050 Black, R. E., Victoria, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., Onis, M. de, Ezzati, M., McGregor, S. G., Katz, J., Martorell, R., Uauy, R., & The Maternal and Child Nutrition Study Group. (2013). Maternal and Child Undernutrition and Overweight in Low-income and Middle-income Countries. The Lancet, 382, 396. Budge, S., Parker, A. H., Hutchings, P. T., & Garbutt, C. (2019). Environmental Enteric Dysfunction and Child Stunting. Nutrition Reviews, 77(4), 240–253. https://doi.org/10.1093/nutrit/nuy068 Burchi, F. (2010). Child Nutrition in Mozambique in 2003: The Role of Mother’s Schooling and Nutrition Knowledge. Economics and Human Biology, 8(3), 331–345. https://doi.org/10.1016/j.ehb.2010.05.010 Casale, D., Espi, G., & Norris, S. A. (2018). Estimating the pathways through which maternal education affects stunting: Evidence from an urban cohort in South Africa. 21(10), 1810–1818. https://doi.org/10.1017/S1368980018000125 Casanovas, M. del C., Lutter, C. K., Mangasaryan, N., Mwadime, R., Hajeebhoy, N., Aguilar, A. M., Kopp, C., Rico, L., Ibiett, G., Andia, D., & Onyango, A. W. (2013). Multi-sectoral Intervensions for Healthy Growth. Matern Child Nutrition, 2, 46–57. https://doi.org/10.1111/mcn.12082 Chirande, L., Charwe, D., Mbwana, H., Victor, R., Kimboka, S., Issaka, A. I., Baines, S. K., Dibley, M. J., & Agho, K. E. (2015). Determinants of Stunting and Severe Stunting Among Under-Fives in Tanzania: Evidence from The 2010 Cross-sectional Household Survey. BMC Pediatrics, 15(1), 1–13. https://doi.org/10.1186/s12887-015-0482-9 Creswell, J. W. (2014). A Concise Introduction to Mixed Methods Research. SAGE Publications Inc. Dao, D., Thang, V. Van, & Hoa, D. T. (2010). Malnutrition Status and Related Factors Within Ethnic Minority Children Under 5 Years Old in North Tra My District, Quang Nam Province in 2010. Journal of Science, 61. Fantay Gebru, K., Mekonnen Haileselassie, W., Haftom Temesgen, A., Oumer Seid, A., & Afework Mulugeta, B. (2019). Determinants of Stunting Among Under-Five Children in Ethiopia: A Multilevel Mixed-Effects Analysis of 2016 Ethiopian Demographic and Health Survey Data. BMC Pediatrics, 19(1), 1–13. https://doi.org/10.1186/s12887-019-1545-0 Fitri, L. (2018). Hubungan BBLR dan ASI Eksklusif Dengan Kejadian Stunting di Puskesmas Lima Puluh Pekanbaru. Jurnal Endurance, 3(1), 131–137. Goldstein, H. (2010). Multilevel Statistical Models, 4th Edition. Wiley. Handayani, F., Siagian, A., & Aritonang, E. (2017). Mother’s Education as A Determinant of Stunting among Children of Age 24 to 59 Months in North Sumatera Province of Indonesia. IOSR Journal of Humanities and Social Science, 22, 58–64. https://doi.org/10.9790/0837-2206095864 Hendraswari, C. A., Purnamaningrum, Y. E., Maryani, T., Widyastuti, Y., & Harith, S. (2021). The Determinants of Stunting for Children Aged 24-59 Months in Kulon Progo District 2019. Kesmas: Jurnal Kesehatan Masyarakat Nasional, 16(2), 71–77. https://doi.org/10.21109/kesmas.v16i2.3305 Hoddinott, J., Alderman, H., Behrman, J. R., Haddad, L., & Horton, S. (2013). The Economic Rationale For Investing In Stunting Reduction. Maternal & Child Nutrition, 9, 69–82. https://doi.org/10.1111/mcn.12080 Horrell, S., Humphries, J., & Voth, H.-J. (2001). Destined for Deprivation: Human Capital Formation and Intergenerational Poverty in Nineteenth-Century England. Explorations in Economic History, 38(3), 339–365. https://doi.org/10.1006/exeh.2000.0765 International Food Policy Research Institute. (2016). Global Nutrition Report 2016: From Premise to Impact: Ending Malnutrition by 2030. Kementerian Kesehatan Republik Indonesia. (2016). InfoDATIN: Situasi Balita Pendek. Kementerian Kesehatan Republik Indonesia. (2018). Warta KESMAS: Cegah Stunting itu Penting. Kimani-Murage, E. W., Muthuri, S. K., Oti, S. O., Mutua, M. K., Van De Vijver, S., & Kyobutungi, C. (2015). Evidence of A Double Burden of Malnutrition in Urban Poor Settings in Nairobi, Kenya. PLoS ONE, 10(6), 1–17. https://doi.org/10.1371/journal.pone.0129943 Kusumawati, E., Rahardjo, S., & Sari, H. P. (2015). Model Pengendalian Faktor Risiko Stunting pada Anak Usia di Bawah Tiga Tahun Model of Stunting Risk Factor Control among Children under Three Years. Kesmas: Jurnal Kesehatan Masyarakat Nasional, 9, 249–256. Madan, E. M., Haas, J. D., Menon, Purnima., & Gillespie, Stuart. (2018). Seasonal Variation In The Proximal Determinants Of Undernutrition During The First 1000 Days Of Life In Rural South Asia: A Comprehensive Review.Global Food Security, 19, 11–23. https://doi.org/10.1016/j.gfs.2018.08.008 McGregor, S. G., Cheung, Y. B., Cueto, S., Glewwe, P., Ritcher, L., Strupp, B., & International Child Development Steering Group. (2007). Developmental Potential in The First 5 Years for Children in Developing Countries. The Lancet, 369, 60–70. https://doi.org/10.1016/S0140-6736(07)60032-4 Mugianti, S., Mulyadi, A., Anam, A. K., & Najah, Z. L. (2018). Faktor Penyebab Anak Stunting Usia 25-60 Bulan di Kecamatan Sukorejo Kota Blitar. Jurnal Ners Dan Kebidanan (Journal of Ners and Midwifery), 5(3), 268–278. https://doi.org/10.26699/jnk.v5i3.art.p268-278 Ntenda, P. A. M., & Chuang, Y.-C. (2018). Analysis of Individual-level and Community-level Effects on Childhood Undernutrition in Malawi. Pediatr Neonatol, 59(4), 380–389. https://doi.org/10.1016/j.pedneo.2017.11.019 Oddo, V. M., Rah, J. H., Semba, R. D., Sun, K., Akhter, N., Sari, M., De Pee, S., Moench-Pfanner, R., Bloem, M., & Kraemer, K. (2012). Predictors of Maternal and Child Double Burden of Malnutrition in Rural Indonesia and Bangladesh. American Journal of Clinical Nutrition, 95(4), 951–958. https://doi.org/10.3945/ajcn.111.026070 Prado, E. L., & Dewey, K. G. (2014). Nutrition and brain development in early life. Nutrition Reviews, 72(4), 267–284. https://doi.org/10.1111/nure.12102 Prakhasita, R. C. (2019). Hubungan Pola Pemberian Makan Dengan Kejadian Stunting Pada Balita Usia 12-59 Bulan di Wilayah Kerja Puskesmas Wedi Surabaya. Universitas Airlangga. Reynaldo, Martorell., & Young, M. F. (2012). Patterns of Stunting and Wasting: Potential Explanatory Factors. Advances in Nutrition, 3(2), 227–233. https://doi.org/10.3945/an.111.001107 Rosiyati, E., Pratiwi, E. A. D., Poristinawati, I., Rahmawati, E., Nurbayani, R., Lestari, S., Wardani, P. S., & Nugroho, M. R. (2019). Determinants of Stunting Children (0-59 Months) in Some Countries in Southeast Asia. Jurnal Kesehatan Komunitas, 4(3), 88–94. https://doi.org/10.25311/keskom.vol4.iss3.262 Sari, M., De Pee, S., Bloem, M. W., Sun, K., Thorne-Lyman, A. L., Moench-Pfanner, R., Akhter, N., Kraemer, K., & Semba, R. D. (2010). Higher Household Expenditure on Animal-Source and Nongrain Foods Lowers the Risk of Stunting Among Children 0-59 Months Old in Indonesia: Implications of Rising Food Prices. Journal of Nutrition, 140(1), 195–200. https://doi.org/10.3945/jn.109.110858 Satriawan, E. (2018). Strategi Nasional Percepatan Pencegahan Stunting 2018-2024. [National Strategy for the Acceleration of Stunting Prevention] Semba, R. D., Kalm, L. M., De Pee, S., Ricks, M. O., Sari, M., & Bloem, M. W. (2007). Paternal Smoking is Associated with Increased Risk of Child Malnutrition Among Poor Urban Families in Indonesia. Public Health Nutrition, 10(1), 7–15. https://doi.org/10.1017/S136898000722292X Semba, R. D., Moench-Pfanner, R., Sun, K., De Pee, S., Akhter, N., Rah, J. H., Campbell, A. A., Badham, J., Bloem, M. W., & Kraemer, K. (2011). Consumption of Micronutrient-fortified Milk and Noodles is Associated with Lower Risk of Stunting in Preschool-Aged Children in Indonesia. Food and Nutrition Bulletin, 32(4), 347–353. https://doi.org/10.1177/156482651103200406 Shieh, S. J., Chen, H. L., Liu, F. C., Liou, C. C., Lin, Y. in H., Tseng, H. I., & Wang, R. H. (2010). The Effectiveness of Structured Discharge Education on Maternal Confidence, Caring Knowledge, and Growth of Premature Newborns. Journal of Clinical Nursing, 19(23–24), 3307–3313. https://doi.org/10.1111/j.1365-2702.2010.03382.x Stewart, C. P., Iannotti, L., Dewey, K. G., Michaelsen, K. F., & Onyango, A. W. (2013). Contextualising Complementary Feeding in a Broader Framework for Stunting Prevention. Matern Child Nutrition, 9(2), 27–45. https://doi.org/10.1111/mcn.12088 Tim Nasional Percepatan Penanggulangan Kemiskinan. (2017). 100 Kabupaten/Kota Prioritas Untuk Intervensi Anak Kerdil (Stunting). Titaley, C. R., Ariawan, I., Hapsari, D., Muasyaroh, A., & Dibley, M. J. (2013). Determinants of the Stunting of Children in Indonesia: A Multilevel Analysis of the 2013 Indonesia Basic Health Survey. Nutrients, 11, 1160. UNICEF. (2015a). UNICEF’ s Approach to Scaling Up Nutrition for Mothers and Their Children. Programme Division, February 9. UNICEF. (2015b). UNICEF’s Approach to Scalling Up Nutrition For Mothers and Their Children. UNICEF. (2018). Progress For Every Child in The SDG Era. United Nations. (2021). United Nations Sustainable Development Goal 2: Zero Hunger. https://sdgs.un.org/goals/goal2 United Nations Children’s Fund. (2013). Improving Child Nutrition: The Achievable Imperative for Global Progress. Worku, B. N., Abessa, T. G., Wondafrash, M., Vanvuchelen, M., Bruckers, L., & Kolsteren, P. (2018). The Relationship of Undernutrition/Psychosocial Factors and Developmental Outcomes of Children in Extreme Poverty in Ethiopia. BMC Pediatrics, 18(1), 1–9. http://dx.doi.org/10.1186/s12887-018-1009-y World Bank Group. (2016). World Development Report 2016: Digital Dividends. World Health Organization. (2010). Nutrition Landscape Information System (NLIS) Country Profile Indicators: Interpretation Guide. World Health Organization. (2012). The Sixty Fifth World Health Assembly: Maternal, Infant, and Young Child Nutrition. World Health Organization. (2014). Global Nutrition Targets 2025: Stunting Policy Brief (No.WHO/NMH/NHD/14.3).

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Byeon, Y. Vivian, Anna S. Lau, Teresa Lind, Alison B. Hamilton, and Lauren Brookman-Frazee. "Organizational factors associated with community therapists’ self-efficacy in EBP delivery: The interplay between sustainment leadership, sustainment climate, and psychological safety." Implementation Research and Practice 3 (January 2022): 263348952211102. http://dx.doi.org/10.1177/26334895221110263.

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Background Inner context organizational factors proximally shape therapist experiences with evidence-based practice (EBP) implementation and may influence therapist self-efficacy, which has been linked to sustained use of EBPs in community mental health settings. Research has primarily focused on constructs such as implementation leadership and climate. However, the effects of such factors may depend upon other inner context dimensions, such as psychological safety. Psychologically safe environments are conducive to taking risks, speaking up about problems, and requesting feedback and may promote therapist self-efficacy during implementation. This study examines whether organizational sustainment leadership and sustainment climate relate to therapist EBP self-efficacy only under conditions of psychological safety. Methods Data were collected from 410 clinicians in 85 programs during the sustainment phase of a system-driven implementation of multiple EBPs in children's mental health services. Therapists reported on their organization's sustainment leadership, sustainment climate, psychological safety, and their own self-efficacy in delivering specific EBPs. Multilevel regression analyses were conducted to account for nested data structure. Results Among program-level variables, sustainment leadership and psychological safety both significantly predicted therapist self-efficacy. However, there were no significant interactions between program-level sustainment climate and psychological safety. Exploratory post-hoc analyses revealed a significant interaction between program-level sustainment leadership and therapist-level perceptions of psychological safety such that that the conditional effect of psychological safety on EBP self-efficacy was significant at high levels of sustainment leadership, but not at low or average levels. Conclusion We noted independent links between sustainment leadership, organizational psychological safety and therapists feelings of confidence and mastery with EBPs. Therapists’ individual perceptions of psychological safety were linked to self-efficacy only in programs with high sustainment leadership. Thus, sustainment leadership and psychological safety may both represent implementation intervention targets, but it may not be critical to assess for perceptions of psychological safety before deploying organizational leadership strategies. Plain language abstract Therapist self-efficacy is a therapist's belief that they are capable, knowledgeable, and skilled enough to deliver evidence-based practices (EBPs), and is thought to promote improved clinical and implementation outcomes, such as therapists’ sustained use of EBPs. Conditions within community mental health organizations may influence therapists’ sense of EBP self-efficacy. Leaders’ support and expectations for EBP implementation, and collective staff perceptions about the organization's climate to support EBPs are linked to positive therapist attitudes and EBP adoption. However, less is known about how these implementation-specific organizational factors associated with therapist EBP self-efficacy in the long-term, and how this may depend on general workplace conditions. Specifically, psychologically safe environments – where therapists feel safe taking risks such as asking questions, admitting mistakes, and trying new skills – may be needed to promote self-efficacy when therapists are tasked with learning and using complex multi-component EBP innovations. The current study tested the prediction that leader-driven and program-wide focus on EBP sustainment may promote therapist EBP self-efficacy only in organizations where conditions for learning are psychologically safe. Our findings confirmed that fostering strong sustainment focused leadership and psychologically safe environments may each be important for increasing therapists’ EBP self-efficacy. The model results suggested that individual therapist perceptions of psychological safety were more strongly related to EBP self-efficacy in programs with greater implementation leadership. Findings suggest the importance of increasing EBP leadership behavior to fully potentiate other facilitating conditions for therapist learning in the sustainment phase of EBP implementation initiatives.

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Birk, Manjot, Vivien Chan, Nicholas J. Yee, Evan Dimentberg, Jessica Wenghofer, Matias Pereira Duarte, Tara Gholamian, et al. "Canadian Spine SocietyCPSS-1. Abstract ID 108. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy between radiologists’ reports and surgeons’ assessments?CPSS-2. Abstract ID 21. Pediatric posterior spinal deformity correction: 30-day postoperative infection rate and risk factorsCPSS-3. Abstract ID 17. “Ultra-low dose” computed tomography without sedation is feasible and should be considered as part of the preoperative optimization pathway in paediatric patients with neuromuscular scoliosisCPSS-4. Abstract ID 20. SeeSpine: a novel surface topography smartphone application for monitoring curve progression in adolescent idiopathic scoliosisCPSS-5. Abstract ID 78. Pilot study: a machine learning algorithm for the detection of adolescent idiopathic scoliosis from images taken with modern smartphone technologyCPSS-6. Abstract ID 101. Preoperative parameters influencing vertebral body tethering outcomes: patient characteristics play an important role in determining the outcomes at 2 years after surgeryCPSS-7. Abstract ID 63. Preoperative bending radiographs are the best predictor of scoliosis correction on the first erect radiograph in vertebral body tethering: a single-centre retrospective studyCPSS-8. Abstract ID 18. Adverse events after zoledronate infusion in medically complex patients with neuromuscular scoliosisCPSS-9. Abstract ID 5. Sequential rod rolling for surgical correction of Lenke type 2 adolescent idiopathic scoliosis: a 3D analysisCPSS-10. Abstract ID 123. A comparative study of protocols for spinal casting as a surgical delay strategy in severe early-onset scoliosisA-11. Abstract ID 50. Does the type of pelvic fixation affect pelvic incidence after adult spinal deformity surgery? A retrospective analysisA-12. Abstract ID 51. How does pelvic fixation affect the compensatory mechanisms after adult spinal deformity surgery? A retrospective analysisA-13. Abstract ID 44. Development of a biomechanical model to identify risk factors in sagittal alignment contributing to proximal junctional kyphosisA-14. Abstract ID 32. Biomechanical characterization of semirigid constructs and the potential effect on proximal junctional kyphosisA-15. Abstract ID 65. Early adjacent disc characteristics are not associated with reoperation in short-segment lumbar fusionsA-16. Abstract ID 39. Concurrent validation of a novel inertial measurement unit–based method to evaluate spinal motion in clinical settingsA-17. Abstract ID 68. Distal lordosis is associated with reoperation for adjacent segment disease in patients with degenerative lumbar fusionA-18. Abstract ID 69. Automatic extraction of spinopelvic parameters using artificial intelligence methods and a review on the effects of spine stiffness, spinal fusion and spinopelvic parameters on lower limb motion and total hip arthroplasty outcomesA-19. Abstract ID 38. Gender differences in fusion rates in the treatment of degenerative lumbar spondylolisthesis: analysis from the CSORN prospective degenerative lumbar spondylolisthesis studyA-20. Abstract ID 29. L3–4 hyperlordosis after a reduction in lower lumbar lordosis with L4–L5 fusion surgery is common in patients requiring L3–4 revision surgery for adjacent segment diseaseB-21. Abstract ID 40. Predictors of dynamic instability in the decision to fuse in degenerative lumbar spondylolisthesis: results from the Canadian Spine Outcomes and Research Network prospective degenerative lumbar spondylolisthesisstudyB-22. Abstract ID 49. Impact of preoperative insomnia on poor postoperative pain control after elective spine surgery and the Modified Calgary Postoperative Pain After Spine Surgery scoreB-23. Abstract ID 115. Influence of high pelvic incidence on operative difficulty in patients treated surgically for degenerative lumbar spondylolisthesisB-24. Abstract ID 45. Reoperation rates for adjacent segment disease in degenerative lumbar fusion surgery: a comparison between minimally invasive versus open surgical approachesB-25. Abstract ID 118. Assessment of changes in opioid utilization 1 year after elective spine surgery: a Canadian Spine Outcomes and Research Network studyB-26. Abstract ID 93. Preoperative neuroleptic and opioid use effects on postoperative pain and disability after spinal surgery for lumbar radiculopathyB-27. Abstract ID 52. The importance of lower extremity compensation mechanisms in lumbar degenerative pathology: a retrospective analysisB-28. Abstract ID 107. Persistent poor sleep is associated with worse pain and quality of life in patients with degenerative thoracolumbar conditions undergoing surgery: a retrospective cohort studyB-29. Abstract ID 126. Opioid use in low back pain is associated with increased utilization of health care services and likelihood of work absenteeismB-30. Abstract ID 53. Wait times for degenerative lumbar spine consultation and surgery: a repeated cross-sectional analysis of the Canadian Spine Outcomes and Research NetworkC-31. Abstract ID 33. Patients with radicular pain improve more than those with axial pain alone after treatment for metastatic spine diseaseC-32. Abstract ID 46. Association between nutritional status and survival in patients requiring treatment for spinal metastasesC-33. Abstract ID 47. Introduction of the new Patient Expectations in Spinal Oncology questionnaireC-34. Abstract ID 74. Medium-term follow-up outcomes in palliative transpedicular corpectomy with cement-based anterior vertebral reconstruction performed for patients with spinal metastasisC-35. Abstract ID 10. Perception of frailty in spinal metastatic disease: international survey of the AO Spine CommunityC-36. Abstract ID 73. COVID-19: Were we able to get back to the prepandemic level of spine surgery activity? An experience from a tertiary referral centre in QuebecC-37. Abstract ID 114. Provider confidence with virtual spine exams 2 years after COVID-19 lockdown restrictionsC-38. Abstract ID 76. The impact of nasal decontamination by photodisinfection in spine surgery: a feasibility pilot studyC-39. Abstract ID 116. Exploring the bacterial hypothesis of low back pain: a prospective cohort studyC-40. Abstract ID 7. Management of deep surgical site infections of the spine: a Canadian surveyD-41. Abstract ID 26. Earlier tracheostomy reduces complications in complete cervical spinal cord injury in real-world practice: analysis of a multicentre cohort of 2001 patientsD-42. Abstract ID 87. Neuroprotection after traumatic spinal cord injury through mitochondrial calcium uniporter inhibitionD-43. Abstract ID 16. The impact of specialized versus nonspecialized acute hospital care on survival among patients with acute incomplete traumatic spinal cord injuries: a population-based observational study from British Columbia, CanadaD-44. Abstract ID 59. Stem cells from human spinal cord exhibit reduced oligodendrogenesis compared with rodent stem cellsD-45. Abstract ID 122. Harnessing the endogenous stem cell response after spinal cord injuryD-46. Abstract ID 62. Comparison of age and 5-Item Modified Frailty Index as predictors of in-hospital mortality for patients with complete traumatic cervical spinal cord injuryD-47. Abstract ID 109. Unplanned readmissions after traumatic spinal cord injury: perspective from the British Columbian populationD-48. Abstract ID 9. The radiographic characteristics that lead surgeons to agree and disagree on making treatment recommendations in thoracolumbar burst fractures without neurologic deficitsD-49. Abstract ID 19. The effect of Enhanced Recovery After Surgery protocols for elective cervical and lumbar spine procedures on hospital length of stay: a systematic review and meta-analysisD-50. Abstract ID 23. Exploring end-of-life decision-making and perspectives on medical assistance in dying through the eyes of individuals living with cervical spinal cord injuries in Nova ScotiaE-51. Abstract ID 88. Neurologically intact thoracolumbar burst fractures (AO Spine A3, A4) improve on Oswestry Disability Index equally when treated surgically versus nonoperativelyE-52. Abstract ID 28. Predictive algorithm for surgery recommendation in thoracolumbar burst fractures without neurological deficitsE-53. Abstract ID 36. A randomized trial of cervical orthosis versus no orthosis after multilevel posterior cervical fusionE-54. Abstract ID 11. Deterioration after surgery for degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research NetworkE-55. Abstract ID 66. Canadian cohort of older patients with cervical spinal cord injury: Do radiologic parameters correlate with initial neurological impairment?E-56. Abstract ID 6. Surgical complications or neurologic decline? A patient discrete-choice experiment for cervical myelopathyE-57. Abstract ID 82. Laminectomy alone for cervical spondylotic myelopathy: a Canadian Spine Outcomes and Research Network StudyE-58. Abstract ID 95. The effect of surgical approach on patient outcomes of degenerative cervical myelopathy: a pooled analysis of individual patient data from 1031 casesE-59. Abstract ID 81. Occiput and upper cervical fusions: Does navigation matter? A Canadian Spine Outcomes and Research Network studyE-60. Abstract ID 89. Preoperative therapies improve postoperative disability in patients who undergo anterior cervical discectomy and fusion surgery for cervical radiculopathyF-61. Abstract ID 58. The influence of wait time on surgical outcomes in elective lumbar degenerative surgery: a Canadian Spine Outcomes and Research Network studyF-62. Abstract ID 77. A cost consequence analysis comparing spinal fusion versus decompression alone for lumbar degenerative spondylolisthesisF-63. Abstract ID 96. Economic impact of wait time in degenerative lumbar stenosis surgery: association with time away from work, chronic persistent opioid use and patient satisfactionF-64. Abstract ID 121. Optimal timing of surgery for symptomatic single-level lumbar disc herniation: a cost-effectiveness analysisF-65. Abstract ID 67. Impact of scheduled spine surgery for degenerative spinal disorders on patient health-related quality of life compared with the general Canadian populationF-66. Abstract ID 84. Decompression and decompression and fusion and the influence of spinopelvic alignment in the outcome of patients with degenerative lumbar spondylolisthesisF-67. Abstract ID 43. Association between poor postoperative pain control and surgical outcomes after elective spine surgeryF-68. Abstract ID 56. Factors associated with shorter wait times for lumbar degenerative spinal surgeryF-69. Abstract ID 25. Is navigation a game changer in single-level transforaminal lumbar interbody fusions?F-70. Abstract ID 34. Radiologic and clinical evaluation of posterolateral versus interbody fusion in degenerative lumbar spondylolisthesisG-71. Abstract ID 15. Timing of recovery after surgery for patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research NetworkG-72. Abstract ID 30. Development of a patient-centred cervical myelopathy severity index: measurement property testing, item generation and item reductionG-73. Abstract ID 75. The preoperative expectations of patients with degenerative cervical myelopathyG-74. Abstract ID 61. Satisfaction with surgical treatment for degenerative cervical myelopathy is driven by improvement in patient-reported outcomesG-75. Abstract ID 98. Identification of surgical candidates for mild degenerative cervical myelopathy: a trajectory-based analysisG-76. Abstract ID 100. The impact of surgery on pain in degenerative cervical myelopathy: a pooled analysis of 1047 patients from CSM-North America, CSM-International and CSM-Protect trialsG-77. Abstract ID 104. National adverse event rates after cervical spine surgery for degenerative disorders, and impact on patient satisfactionG-78. Abstract ID 8. The unsustainable growth of out-of-hours emergent surgery for degenerative spinal disease in Canada: a retrospective cohort study from a national registryG-79. Abstract ID 102. Effect of compensation claim status on perioperative outcomes in patients with degenerative spine conditionsG-80. Abstract ID 13. Outcomes of spinal cord stimulation for management of neuropathic pain in patients with spinal cord injuryP-81. Abstract ID 97. Meaningfulness in clinical improvements at 12 months after surgery for degenerative cervical myelopathy: comparison of 30% change versus absolute change values of minimal clinically important differenceP-82. Abstract ID 22. An exploration of the evolving perception of quality of life from the perspective of individuals living with a cervical spinal cord injury in Nova ScotiaP-83. Abstract ID 41. Delays in diagnosis of degenerative cervical myelopathy: a population-based study using the Clinical Practice Research DatalinkP-84. Abstract ID 119. Sex, drugs and spine surgery: a nationwide analysis of opioid utilization and patient-reported outcomes in males and femalesP-85. Abstract ID 117. The feasibility of a multidisciplinary transitional pain service in patients undergoing spine surgery to minimize opioid use and improve perioperative outcomes: a quality improvement studyP-86. Abstract ID 103. Predictors of poor postoperative patient satisfaction in patients undergoing elective spine surgery with pre-existing compensation claimsP-87. Abstract ID 60. The efficacy and safety of P-15 peptide enhanced bone graft in bone regeneration: a systematic reviewP-88. Abstract ID 113. The influence of preoperative back pain on patient-rated outcomes after decompression with or without fusion for degenerative lumbar spondylolisthesis: results from the Canadian Spine Outcomes and Research Network prospective degenerative lumbar spondylolisthesis studyP-89. Abstract ID 55. Publication retraction in spine surgery: a systematic reviewP-90. Abstract ID 12. The use of a standardized surgical case log to document operative exposure to procedural competencies in a spine surgery fellowship curriculum: a university-wide initiativeP-91. Abstract ID 90. Preoperative psychosocial factors affect the outcomes experienced by patients who undergo anterior cervical discectomy and fusion surgery for cervical radiculopathyP-92. Abstract ID 91. Virtual reality for patient-specific, multidisciplinary planning of complex orthopedic oncological surgery including the spineP-93. Abstract ID 35. Malposition in robotic-assisted cortical bone trajectory screw placement: analysis of 1025 consecutive screwsP-94. Abstract ID 79. Accuracy of computer-assisted spine navigation platforms: a meta-analysis of 16 040 screwsP-95. Abstract ID 86. Which is better: percutaneous or open robot-assisted spine surgery? Prospective, multicentre study of 2524 screws in 336 patientsP-96. Abstract ID 124. Opioid use in low back pain is associated with decreased quality of life, increased disability and worse treatment outcomes: a stratified propensity score analysisP-97. Abstract ID 85. Incidence and management of deep spine surgical-site infections: a systematic review and meta-analysisP-99. Abstract ID 110. Associations of preoperative analgesic use with postoperative pain and disability after spinal surgery for cervical myelopathy and radiculopathyP-100. Abstract ID 42. Cervical myelopathy and social media: a mixed-methods analysisP-101. Abstract ID 24. The use of machine learning to predict the presence of cauda equina syndrome among patients with disc herniationP-102. Abstract ID 112. A systematic review of the content and structure of composite end points in spine surgery interventional trialsP-103. Abstract ID 106. Surveying the knowledge and attitudes of moving to a high-quality, low-carbon health care systemP-104. Abstract ID 125. Variability in treatment of adult spinal deformity, a Canadian surveyP-105. Abstract ID 83. Anterior cervical hybrid constructs reduce upper adjacent segment hypermobility compared with anterior cervical discectomy and fusionP-106. Abstract ID 48. A preliminary report of robotic screw insertion in cadaveric vertebrae using the Mazor X systemP-107. Abstract ID 54. Invasive brain–computer interface for motor restoration in spinal cord injury: a systematic reviewP-108. Abstract ID 27. A new cost-effective technique to mimic pedicle screw trajectory in cadavers: a robotic validation studyP-109. Abstract ID 14. Developments and applications of augmented and virtual reality technology in spine surgery training: a systematic reviewP-110. Abstract ID 80. Comprehensive accuracy analysis of robotic models in spine surgery: a pooled analysis of 14 462 screwsP-111. Abstract ID 99. Familial chiari malformation: a systematic reviewP-112. Abstract ID 31. Ninety-day complication and revision surgery rates using navigated robotics in thoracolumbar spine surgeryP-113. Abstract ID 111. Which baseline clinical factors and clinical indications are most correlated with outcome after lumbar fusion surgery?P-114. Abstract ID 92. Characterization of the mechanical state of human mesenchymal stem cells on micro- or nano-textured Ti6Al4V surfacesP-115. Abstract ID 72. Short-term outcomes associated with the use of macro–micro–nano rough Ti6Al4V (nanoLOCK) interbody cages in patients with lumbar spine degenerative conditionsP-116. Abstract ID 127. Introduction of a novel concept to decompress foramen magnum in chiari-1 malformation without affecting stabilityP-117. Abstract ID 57. Minimally invasive tubular lumbar decompression without fusion in lumbar stenosis with underlying deformity: Friend or foe?P-118. Abstract ID 64. The role of intraoperative ultrasound in nononcological intradural lumbar spine conditions: intradural lumbar disc herniation and subdural spinal abscessP-119. Abstract ID 120. Prospective Prophylactic Antibiotics Regimen in Spine Surgery: the PPARiSS cohortP-121. Abstract ID 70. Decompression versus decompression and fusion in cauda equina syndrome secondary to massive lumbar disc herniationP-122. Abstract ID 105. Implementation of robot-assisted surgery for elective spine surgeryP-123. Abstract ID 37. Spine surgery in patients with morbid obesity: tips and tricksP98: Abstract ID 71. Pelvic incidence is associated with reoperation for adjacent segment disease in degenerative lumbar spinal fusion surgery." Canadian Journal of Surgery 66, no. 4 Suppl 1 (August 11, 2023): S1—S53. http://dx.doi.org/10.1503/cjs.006523.

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Sensoy Bahar, Ozge, Fred M. Sssewamala, Flavia Namuwonge, Meti Abdella, Samuel Kizito, Florence Namuli, and Proscovia Nabunya. "A mixed Methods Study of Multilevel Factors Influencing Sexual Risk-Taking Behaviors Among Adolescent Girls in Uganda." Journal of Adolescent Research, August 6, 2024. http://dx.doi.org/10.1177/07435584241268476.

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Sub-Saharan Africa is home to two-thirds of people living with HIV globally. Adolescent girls and young women are twice as likely to be living with HIV compared to young men. Sexual risk-taking behaviors put adolescent girls at risk for adverse health outcomes, including HIV/AIDS. In this study, we conducted semi-structured in-depth interviews to explore multi-level factors that influence decisions to engage in sexual risk-taking among 58 school-going adolescent girls in Uganda. Both protective and risk factors cut across personal, proximal, and distal contexts. At the personal level, future goals and fear of negative health outcomes were identified as the most common protective factors. Positive family relations and peers were cited most frequently as protective factors at the proximal level. At the distal level, poverty was the most common risk factor. Relatedly, families’ ability to provide for adolescent girls’ needs was a protective factor. Study results point to the need for multilevel combination interventions to reduce sexual risk-taking among adolescent girls in Uganda.

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Ladd, Bryan M., Christopher T. Martin, Jonathan N. Sembrano, Kristen E. Jones, David W. Polly, and Matthew A. Hunt. "Odontoid Fracture as Proximal Junctional Failure in Patients With Multilevel Spine Fusions." Global Spine Journal, May 11, 2021, 219256822110088. http://dx.doi.org/10.1177/21925682211008833.

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Study Design: Retrospective study. Objective: Proximal junctional failure (PJF) commonly occurs as a recognized potential outcome of fusion surgery. Here we describe a unique series of patients with multilevel spine fusion including the cervical spine, who developed PJF as an odontoid fracture. Methods: We performed a single site retrospective review of patients with prior fusion that included a cervical component, who presented with an odontoid fracture between 2012 and 2019. Radiographic measurements included C2-C7 SVA, C2-C7 lordosis, T1 slope, Occiput-C2 angle, proximal junctional kyphosis, and cervical mismatch. Associated fractures, medical comorbidities, and treatments were determined via chart review after IRB approval. Results: Nine patients met inclusion criteria. 5 reported trauma with subsequent onset of pain. All patients sustained a Type II odontoid fracture. 5 with associated C1/Jefferson fractures. In all patients, pre-injury Occiput-C2 angle was outside normative range; C2-C7 SVA was greater than 4 cm in 6 patients; T1-slope minus cervical lordosis was greater than 18.5 degrees in 6 patients. 7 patients were treated operatively with extension of fusion to C1 and 2 patients declined operative treatment. Conclusion: In this series of 9 patients with multilevel fusion with type II odontoid fractures, all patients demonstrated abnormal pre-fracture sagittal alignment parameters and a greater than normal association of C1 fractures was noted. Further study is needed to establish the role of poor sagittal alignment with compensatory occiput-C2 angulation as a predisposing factor for odontoid fracture as a proximal junctional failure mechanism.

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Muñoz-Sandoval, Cecilia, Karla Gambetta-Tessini, Juliana N. Botelho, and Rodrigo A. Giacaman. "Detection of cavitated proximal carious lesions in permanent teeth, a visual and radiographic assessment." Caries Research, May 23, 2022. http://dx.doi.org/10.1159/000525193.

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Detection of proximal carious lesion involves the combination of clinical and radiographic methods, both with inherent difficulties. The present cross-sectional study aimed at estimating the prevalence of cavitation in proximal carious lesions, based on a direct clinical assessment of previously detected radiographic lesions, in permanent molars and premolars. Proximal dental surfaces were radiographically evaluated using the ADA coding system and cavitation was determined through clinical visual examination of the surfaces after separation with elastomeric bands. One-hundred and twenty-six patients attending the dental clinics at the University of Talca were examined comprising 508 proximal surfaces with radiographic codes ranging from E1 to D3. Two examiners were trained and calibrated for radiographic and clinical detection of proximal lesions. Most participants were females (61.9%). The age mean of participants was 28.7 (0.8) years old. A total of 22.2% of the examined surfaces were cavitated. Only few lesions coded as E1 (n=4; 2.1%) and E2 (n=9; 9.8%) were cavitated. Fifty D1 (35.5%) and 22 D2 (41.5%) lesions were cavitated after separation. Most lesions coded as D3 (n=28; 84.8%) were cavitated. The multilevel binary regression model (p=0.003) demonstrated that sex, age, jaw, tooth type, surface and side were not associated with the likelihood of having proximal cavitation. Challenging conventional wisdom, most D1 and D2 lesions were not cavitated. Combining detection methods seems desirable to increase the accuracy in assessing approximal posterior lesions. The low proportion of cavitated lesions reinforces the idea of cautiously indicating invasive approaches for managing proximal carious lesions.

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Wang, Wenshan, Vincent Y. Blouin, Melissa K. Gardenghi, Georges M. Fadel, Margaret M. Wiecek, and Benjamin C. Sloop. "Cutting Plane Methods for Analytical Target Cascading With Augmented Lagrangian Coordination." Journal of Mechanical Design 135, no. 10 (August 7, 2013). http://dx.doi.org/10.1115/1.4024847.

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Analytical target cascading (ATC), a hierarchical, multilevel, multidisciplinary coordination method, has proven to be an effective decomposition approach for large-scale engineering optimization problems. In recent years, augmented Lagrangian relaxation methods have received renewed interest as dual update methods for solving ATC decomposed problems. These problems can be solved using the subgradient optimization algorithm, the application of which includes three schemes for updating dual variables. To address the convergence efficiency disadvantages of the existing dual update schemes, this paper investigates two new schemes, the linear and the proximal cutting plane methods, which are implemented in conjunction with augmented Lagrangian coordination for ATC-decomposed problems. Three nonconvex nonlinear example problems are used to show that these two cutting plane methods can significantly reduce the number of iterations and the number of function evaluations when compared to the traditional subgradient update methods. In addition, these methods are also compared to the method of multipliers and its variants, showing similar performance.

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Yu, Jiajia, Rongjie Lai, Wuchen Li, and Stanley Osher. "A fast proximal gradient method and convergence analysis for dynamic mean field planning." Mathematics of Computation, July 24, 2023. http://dx.doi.org/10.1090/mcom/3879.

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In this paper, we propose an efficient and flexible algorithm to solve dynamic mean-field planning problems based on an accelerated proximal gradient method. Besides an easy-to-implement gradient descent step in this algorithm, a crucial projection step becomes solving an elliptic equation whose solution can be obtained by conventional methods efficiently. By induction on iterations used in the algorithm, we theoretically show that the proposed discrete solution converges to the underlying continuous solution as the grid becomes finer. Furthermore, we generalize our algorithm to mean-field game problems and accelerate it using multilevel and multigrid strategies. We conduct comprehensive numerical experiments to confirm the convergence analysis of the proposed algorithm, to show its efficiency and mass preservation property by comparing it with state-of-the-art methods, and to illustrate its flexibility for handling various mean-field variational problems.

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Sarmiento, Daiana Denis, Natalia Tumas, Sofia Aynelen Pereyra, Graciela Fabiana Scruzzi, and Sonia Alejandra Pou. "Social determinants of breast cancer screening: a multilevel analysis of proximal and distal factors related to the practice of mammography." Cancer Epidemiology, Biomarkers & Prevention, October 3, 2024. http://dx.doi.org/10.1158/1055-9965.epi-24-1001.

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Abstract Background: Mammography is crucial for early breast cancer detection. In Latin America, Argentina faces a significant breast cancer burden, with varying mammography rates. The social factors influencing mammography practices remain unclear. This study aimed to identify the proximal and distal social determinants of this practice among Argentinean women using a multilevel approach. Methods: This nationwide cross-sectional study included 4,924 women aged 50-70 participating in the 2018 National Risk Factor Survey of Argentina. Two-level logistic models were used to estimate measures of association (ORs) between timely mammography practice (within the last 2 years) and selected covariates (sociodemographics, proximal environment, and distal-level variables). The intraclass correlation coefficient (ICC) and proportional change in variance (PCV) were calculated. Results: 62.8% of women underwent timely mammography. Age (OR=0.96; 95%CI 0.94-0.97), health insurance (OR=2.22; 95%CI 1.87-2.63), education (OR=2.1; 95%CI 1.74-2.64), and income (OR=1.56; 95%CI 1.23-1.97) were associated with mammography practice. Women in non-marital (OR=0.61; 95%CI 0.52-0.72) or larger households (OR=0.61; 95%CI 0.51-0.63) were less likely to have timely mammograph; living in a larger city was positively associated (OR=1.28; 95%CI 1.12-1.46). Women in provinces with higher physician density (OR=1.06; 95%CI 1.01-1.11) and lower maternal mortality ratio (OR=0.9; 95%CI 0.87-0.96) had higher chances of timely mammography. The ICC and PCV suggested that the explored healthcare indicators largely explained the macro-contextual effect. Conclusions: Multilevel factors influenced mammography practices in Argentina. The results highlight disparities linked to sociodemographic characteristics and healthcare resources. Impact: Efforts to address social inequalities in breast cancer screening must consider multilevel determinants, including in healthcare settings.

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Paula, Fátima de Lima, Geraldo Marcelo da Cunha, Iúri da Costa Leite, Rejane Sobrino Pinheiro, and Joaquim Gonçalves Valente. "Readmission of older patients after hospital discharge for hip fracture: a multilevel approach." Revista de Saúde Pública 50 (2016). http://dx.doi.org/10.1590/s1518-8787.2016050005947.

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ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases.

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Vercoulen, Timon F. G., Remco J. P. Doodkorte, Alex Roth, Rob de Bie, and Paul C. Willems. "Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies." Global Spine Journal, July 30, 2021, 219256822110345. http://dx.doi.org/10.1177/21925682211034500.

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Study Design: Systematic review. Objectives: To summarize the results of clinical studies investigating spinal instrumentation techniques aiming to reduce the postoperative incidence of proximal junctional kyphosis (PJK) and/or failure (PJF) in adult spinal deformity (ASD) patients. Methods: EMBASE and Medline® were searched for articles dating from January 2000 onward. Data was extracted by 2 independent authors and methodological quality was assessed using ROBINS-I. Results: 18 retrospective- and prospective cohort studies with a severe or critical risk of bias were included. Different techniques were applied at the upper instrumented vertebra (UIV): tethers in various configurations, 2-level prophylactic vertebroplasty (2-PVP), transverse process hooks (TPH), flexible rods (FR), sublaminar tapes (ST) and multilevel stabilization screws (MLSS). Compared to a pedicle screw (PS) group, significant differences in PJK incidence were found using tethers in various configurations (18% versus 45%, P = 0.001, 15% versus 38%, P = 0.045), 2-PVP (24% vs 36%, P = 0.020), TPH (0% vs. 30%, P = 0.023) and FR (15% versus 38%, P = 0.045). Differences in revision rates for PJK were found in studies concerning tethers (4% versus 18%, P = 0.002), 2-PVP (0% vs 13%, P = 0.031) and TPH (0% vs 7%, P = n.a.). Conclusion: Although the studies are of low quality, the most frequently studied techniques, namely 2-PVP as anterior reinforcement and (tensioned) tethers or TPH as posterior semi-rigid fixation, show promising results. To provide a reliable comparison, more controlled studies need to be performed, including the use of clinical outcome measures and a uniform definition of PJF.

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Journal articles on the topic 'Multilevel proximal methods'

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