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Winds of Change
No full textThe offshore wind industry is expected to grow in coming years, sourcing a global market for renewable energy. The waters off Morro Bay have been sanctioned by The Bureau of Ocean Energy Management (BOEM) as a viable site for offshore wind development, considering the town’s existing electrical transmission capabilities. The introduction of an offshore wind farm would have devastating effects on Morro Bay due to the town's historic reliance on the fishing industry. This project has the potential to displace fishers and cause widespread economic harm to the community. Winds of Change explores the complexities of this case, while giving underrepresented fishers a voice in the matter
Editorial. Training the next generation of spine surgeons: an orthopedic and neurosurgical collaboration with historical precedence.
No full textThe Clinical Correlation of the Hart-ISSG Proximal Junctional Kyphosis Severity Scale With Health-Related Quality-of-life Outcomes and Need for Revision Surgery.
No full textStudy designRetrospective analysis of prospective data.ObjectiveEvaluate the utility of the Hart-International Spine Study Group proximal junctional kyphosis severity scale (Hart-ISSG PJKSS).Summary of background dataProximal junctional kyphosis (PJK) and failure (PJF) are well-described complications after long-segment instrumentation. The Hart-ISSG PJKSS was recently developed and incorporates neurological deficit, pain, instrumentation issues, degree of kyphosis, presence of fracture, and level of upper-most instrumented vertebrae.MethodsAll adult spinal deformity patients with PJK or PJF were identified from two academic centers over a 7-year period. Health-related quality-of-life (HRQOL) outcomes were prospectively collected: Oswestry Disability Index (ODI), visual analogue scale (VAS) pain, SF-36 questionnaire, and SRS-30 questionnaire. Patients were retrospectively assigned Hart-ISSG PJKSS scores. Correlation between the Hart-ISSG PJKSS and outcomes was assessed with linear regression, Pearson correlation coefficients, and χ² analysis.ResultsA total of 184 cases were included; 21.2% were men and mean age was 65.0 years. Weakness and/or myelopathy were present in 11.4% of patients and 88.6% had pain. Instrumentation issues occurred in 44.0% and 64.1% had PJK-associated fractures. PJK occurred in the upper thoracic spine in 21.7% of cases. Mean PJKSS score was 5.9. The Hart-ISSG PJKSS was significantly and strongly associated with ODI (P ConclusionThe Hart-ISSG PJKSS was strongly correlated with validated functional outcomes and higher scores were associated with higher rates of revision surgery. The Hart-ISSG PJKSS may be a useful clinical tool in the treatment of patient with PJK.Level of evidence3
The Effect of Tobacco Smoking on Adverse Events Following Adult Complex Deformity Surgery: Analysis of 270 Patients From the Prospective, Multicenter Scoli-RISK-1 Study.
No full textStudy designPost-hoc analysis of a prospective, multicenter cohort study.ObjectiveTo analyze the impact of smoking on rates of postoperative adverse events (AEs) in patients undergoing high-risk adult spine deformity surgery.Summary of background dataSmoking is a known predictor of medical complications after adult deformity surgery, but the effect on complications, implant failure and other AEs has not been adequately described in prospective studies.MethodsTwenty-six patients with a history of current smoking were identified out of the 272 patients enrolled in the SCOLI-RISK-1 study who underwent complex adult spinal deformity surgery at 15 centers, with 2-year follow-up. The outcomes and incidence of AEs in these patients were compared to the nonsmoking cohort (n = 244) using univariate analysis, with additional multivariate regression to adjust for the effect of patient demographics, complexity of surgery, and other confounders.ResultsThe number of levels and complexity of surgery in both cohorts were comparable. In the univariate analysis, the rates of implant failure were almost double (odds ratio 2.28 [0.75-6.18]) in smoking group (n = 7; 26.9%)) that observed in the nonsmoking group (n = 34; 13.9%), but this was not statistically significant (P = 0.088). Surgery-related excessive bleeding (>4 L) was significantly higher in the smoking group (n = 5 vs. n = 9; 19.2% vs. 3.7%; OR 6.22[1.48 - 22.75]; P = 0.006). Wound infection rates and respiratory complications were similar in both groups. In the multivariate analysis, the smoking group demonstrated a higher incidence of any surgery-related AEs over 2 years (n = 13 vs. n = 95; 50.0% vs. 38.9%; OR 2.12 [0.88-5.09]) (P = 0.094).ConclusionIn this secondary analysis of patients from the SCOLI-RISK-1 study, a history of smoking significantly increased the risk of excessive intraoperative bleeding and nonsignificantly increased the rate of implant failure or surgery-related AEs over 2 years. The authors therefore advocate a smoking cessation program in patients undergoing complex adult spine deformity surgery.Level of evidence2
Non-Markovian Dynamics of a Qubit Due to Single-Photon Scattering in a Waveguide
No full textWe investigate the open dynamics of a qubit due to scattering of a single photon in an infinite or semi-infinite waveguide. Through an exact solution of the time-dependent multi-photon scattering problem, we find the qubitʼs dynamical map. Tools of open quantum systems theory allow us then to show the general features of this map, find the corresponding non-Linbladian master equation, and assess in a rigorous way its non-Markovian nature. The qubit dynamics has distinctive features that, in particular, do not occur in emission processes. Two fundamental sources of non-Markovianity are present: the finite width of the photon wavepacket and the time delay for propagation between the qubit and the end of the semi-infinite waveguide
Inhibition of the aryl hydrocarbon receptor/polyamine biosynthesis axis suppresses multiple myeloma
No full textOperative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up.
No full textObjectiveAdult cervical deformity (ACD) has high complication rates due to surgical complexity and patient frailty. Very few studies have focused on longer-term outcomes of operative ACD treatment. The objective of this study was to assess minimum 2-year outcomes and complications of ACD surgery.MethodsA multicenter, prospective observational study was performed at 13 centers across the United States to evaluate surgical outcomes for ACD. Demographics, complications, radiographic parameters, and patient-reported outcome measures (PROMs; Neck Disability Index, modified Japanese Orthopaedic Association, EuroQol-5D [EQ-5D], and numeric rating scale [NRS] for neck and back pain) were evaluated, and analyses focused on patients with ≥ 2-year follow-up.ResultsOf 169 patients with ACD who were eligible for the study, 102 (60.4%) had a minimum 2-year follow-up (mean 3.4 years, range 2-8.1 years). The mean age at surgery was 62 years (SD 11 years). Surgical approaches included anterior-only (22.8%), posterior-only (39.6%), and combined (37.6%). PROMs significantly improved from baseline to last follow-up, including Neck Disability Index (from 47.3 to 33.0) and modified Japanese Orthopaedic Association score (from 12.0 to 12.8; for patients with baseline score ≤ 14), neck pain NRS (from 6.8 to 3.8), back pain NRS (from 5.5 to 4.8), EQ-5D score (from 0.74 to 0.78), and EQ-5D visual analog scale score (from 59.5 to 66.6) (all p ≤ 0.04). More than half of the patients (n = 58, 56.9%) had at least one complication, with the most common complications including dysphagia, distal junctional kyphosis, instrumentation failure, and cardiopulmonary events. The patients who did not achieve 2-year follow-up (n = 67) were similar to study patients based on baseline demographics, comorbidities, and PROMs. Over the course of follow-up, 23 of the total 169 enrolled patients were reported to have died. Notably, these represent all-cause mortalities during the course of follow-up.ConclusionsThis multicenter, prospective analysis demonstrates that operative treatment for ACD provides significant improvement of health-related quality of life at a mean 3.4-year follow-up, despite high complication rates and a high rate of all-cause mortality that is reflective of the overall frailty of this patient population. To the authors' knowledge, this study represents the largest and most comprehensive prospective effort to date designed to assess the intermediate-term outcomes and complications of operative treatment for ACD
Artificial Intelligence Models Predict Operative Versus Nonoperative Management of Patients with Adult Spinal Deformity with 86% Accuracy.
No full textObjectivePatients with ASD show complex and highly variable disease. The decision to manage patients operatively is largely subjective and varies based on surgeon training and experience. We sought to develop models capable of accurately discriminating between patients receiving operative versus nonoperative treatment based only on baseline radiographic and clinical data at enrollment.MethodsThis study was a retrospective analysis of a multicenter consecutive cohort of patients with ASD. A total of 1503 patients were included, divided in a 70:30 split for training and testing. Patients receiving operative treatment were defined as those undergoing surgery up to 1 year after their baseline visit. Potential predictors included available demographics, past medical history, patient-reported outcome measures, and premeasured radiographic parameters from anteroposterior and lateral films. In total, 321 potential predictors were included. Random forest, elastic net regression, logistic regression, and support vector machines (SVMs) with radial and linear kernels were trained.ResultsOf patients in the training and testing sets, 69.0% (n = 727) and 69.1% (n = 311), respectively, received operative management. On evaluation with the testing dataset, performance for SVM linear (area under the curve =0.910), elastic net (0.913), and SVM radial (0.914) models was excellent, and the logistic regression (0.896) and random forest (0.830) models performed very well for predicting operative management of patients with ASD. The SVM linear model showed 86% accuracy.ConclusionsThis study developed models showing excellent discrimination (area under the curve >0.9) between patients receiving operative versus nonoperative management, based solely on baseline study enrollment values. Future investigations may evaluate the implementation of such models for decision support in the clinical setting
"Favorite Professors" Open Letter to the Class of 2009
No full textA reflection on the historic events of the past 22 years and of the past four years, appealing to the justice-minded activism of the graduating seniors. Also my farewell to Harvard
Synaptic Control of Dopamine as a Driver of Reward Learning
No full textVentral tegmental area dopamine (VTADA) neurons fire in a manner consistent with Reward Prediction Error, with better-than-expected and worse-than-expected outcomes correlating with bursts and pauses, respectively. Burst and pause firing dynamics are believed to be responsible for driving associative learning, yet interrogating this causality, and understanding how these firing patterns are synaptically created within endogenous neural circuits, has been technically difficult. Utilizing a novel tool, DART (drug acutely restricted by tethering), paired with a multiplexed cue-reward associative learning task and in vivo neural recordings, I explore which classes of endogenous synaptic inputs to VTADA neurons create their canonical firing dynamics, and their role in the associated reward learning behaviors. My key finding is that antagonizing GABAA receptors on VTADA neurons decreases the pauses in firing these cells exhibit, but also accelerates extinction learning in response to unexpected reward omission. In the same mice, the manipulation had no impact on conditioning to a novel cue-reward pairing, indicating that positive-valence learning was unperturbed. This dissertation work provides critical insight into the neural circuitry underlying adaptive behaviors by creating a new framework for understanding conditioning and extinction as anti-correlated behaviors, and by establishing a novel role for direct inhibitory GABAA signaling to VTADA cells in conditioned conviction.</p