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Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality database.
No full textObjectCurrently, few studies regarding morbidity and mortality associated with operative treatment of spinal disorders in children are available to guide the surgeon. This study provides more detailed morbidity and mortality data with an analysis of 23,918 pediatric cases reported in the multicenter, multisurgeon Scoliosis Research Society morbidity and mortality database.MethodsThe Scoliosis Research Society morbidity and mortality database was queried for the years from 2004 to 2007. The inclusion criterion was age 18 years or younger. Cases were categorized by operation type and diagnosis. Details on the surgical approach, use of neurophysiological monitoring, and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Statistical analysis was performed with chi-square testing, with a p value ResultsA total of 23,918 patients were included. The mean age was 13 ± 3.6 years (± SD). Spinal pathology included the following: scoliosis (in 19,642 patients), kyphosis (in 1455), spondylolisthesis (in 748), trauma (in 478), and other (in 1595 patients). The overall complication rate was 8.5%. Major complications included wound infections (2.7%), new neurological deficits (1.4%), implant-related complications (1.6%), and hematomas (0.4%). The most common medical complications were respiratory related (0.9%). Morbidity rates differed based on pathology, with patients undergoing treatment for kyphosis and spondylolisthesis having higher overall rates of morbidity (14.7% and 9.6%, respectively). Patients undergoing revision procedures (2034) or corrective osteotomies (2787) were more likely to suffer a complication or new neurological deficit. The majority of these deficits improved at least partially. Thirty-one deaths were reported for an overall rate of 1.3 per 1000. Respiratory complications were the most common cause of mortality (13 cases). Twenty-six of the deaths occurred in children undergoing scoliosis correction.ConclusionsSpinal surgery in children is associated with a range of complications depending on the type of operation. Mortality rates for all indications and operations were low. Patients undergoing more aggressive corrective procedures for deformity are more likely to suffer complications and new neurological deficits
Operationalizing the Duke Restore Seagrass Farm
No full textI lent support for 18 months as a volunteer project manager to support the Duke Restore Seagrass Farm’s goal of operationalizing a hub for seagrass restoration. This work entailed geospatial analysis for potential farm sites, grant writing, permit acquisition, volunteer management, and relationship building with local community groups and landowners. Using my GIS site suitability analyses, we found fifteen potential locations for the Seagrass Farm in Carteret County, North Carolina and planted 0.3 acres for preliminary research
Concurrent Diabetes Mellitus may Negatively Influence Clinical Progression and Response to Androgen Deprivation Therapy in Patients with Advanced Prostate Cancer.
No full textObjectiveTo determine if a concurrent diagnosis of diabetes mellitus is associated with worse outcomes in advanced prostate cancer (PC). The effect diabetes may have on the progression of advanced PC is poorly understood.MethodsData on 148 advanced PC patients (35 with concurrent diabetes) were collected from an institutional database to obtain diabetic status, data on treatment types and durations, and prostate-specific antigen (PSA) values before, during, and after treatment. Time to castration resistance following the onset of androgen deprivation therapy (ADT) and overall survival (OS) in patients with and without diabetes were compared using univariate Cox regression analyses as the primary endpoints. Differences in PSA response to treatments were compared using chi-squared tests as a secondary endpoint.ResultsWith a median follow-up of 29 months, time to castration resistance did not differ significantly between patients with and without diabetes who underwent ADT. However, in a subset of patients who received ADT without radiographic evidence of metastases (N = 47), those with diabetes progressed to castration-resistant disease more quickly than those without DM (hazard ratio for progression with diabetes = 4.58; 95% CI: 1.92-10.94; p = 0.0006). Also, a lower percentage of patients undergoing ADT with diabetes had PSA declines of at least 50% (p = 0.17) and reached a nadir PSA ConclusionDiabetes mellitus may have a detrimental effect on progression of advanced PC, particularly in those patients without radiographic evidence of metastases. Further study is necessary to fully elucidate the effect of diabetes on PC outcomes
The Influence of Surgical Intervention and Sagittal Alignment on Frailty in Adult Cervical Deformity.
No full textBackgroundFrailty is a relatively new area of study for patients with cervical deformity (CD). As of yet, little is known of how operative intervention influences frailty status for patients with CD.ObjectiveTo investigate drivers of postoperative frailty score and variables within the cervical deformity frailty index (CD-FI) algorithm that have the greatest capacity for change following surgery.MethodsDescriptive analysis of the cohort were performed, paired t-tests determined significant baseline to 1 yr improvements of factors comprising the CD-FI. Pearson bivariate correlations identified significant associations between postoperative changes in overall CD-FI score and CD-FI score components. Linear regression models determined the effect of successful surgical intervention on change in frailty score.ResultsA total of 138 patients were included with baseline frailty scores of 0.44. Following surgery, mean 1-yr frailty score was 0.27. Of the CD-FI variables, 13/40 (32.5%) were able to improve with surgery. Frailty improvement was found to significantly correlate with baseline to 1-yr change in CBV, PI-LL, PT, and SVA C7-S1. HRQL CD-FI components reading, feeling tired, feeling exhausted, and driving were the greatest drivers of change in frailty. Linear regression analysis determined successful surgical intervention and feeling exhausted to be the greatest significant predictors of postoperative change in overall frailty score.ConclusionComplications, correction of sagittal alignment, and improving a patient's ability to read, drive, and chronic exhaustion can significantly influence postoperative frailty. This analysis is a step towards a greater understanding of the relationship between disability, frailty, and surgery in CD
When does education increase political participation? Evidence from Senegal
No full textWe argue that education's effect on political participation in developing democracies depends on the strength of democratic institutions. Education increases awareness of, and interest in, politics, which help citizens to prevent democratic erosion through increased political participation. We examine Senegal, a stable but developing democracy where presidential over-reach threatened to weaken democracy. For causal identification, we use a difference-in-differences strategy that exploits variation in the intensity of a major school reform and citizens' ages during reform implementation. Results indicate that schooling increases interest in politics and greater support for democratic institutions- but no increased political participation in the aggregate. Education increases political participation primarily when democracy is threatened, when support for democratic institutions among educated individuals is also greater
Developing a Framework for Biodiversity Credits that Create Effective Conservation Outcomes with the World Wildlife Fund
No full textAs the devastating impact of the biodiversity crisis comes into clearer focus, there has been heightened interest in alternative means of financing critical conservation work, including how to engage on the growing momentum around “biodiversity credits.” Through work with the World Wildlife Fund for Nature (WWF), the report considers the efficacy and suitability of biodiversity credits as an economic instrument to incentivize investing in nature. The proposed financial mechanism outlined herein is designed to channel payments directly to communities acting as nature stewards in exchange for the achievement of positive, measurable conservation outcomes. The scope of this study considers how WWF intends to define biodiversity credits, as well as what monitoring techniques should be used to ensure credits are measurable and equitable, with the intention of implementing the recommendations in a pilot project in the Maya Forest of Mexico beginning in late 2023.
Ultimately, we determined that biodiversity credits can be a viable method of privately financing conservation if they are equitable, transparent, measurable and comparable across time and space. We recommend WWF pursue biodiversity credits, not biodiversity offsets, and avoid including carbon stocks when measuring a Biodiversity Unit. Finally, we found that a limited number of monitoring tools can be sufficient for ensuring transparency and reliability in most cases
Using PDSA cycles to improve oral care compliance.
No full textOral care has been shown to reduce healthcare-associated pneumonia (HAP) rates, however, compliance with this practice is suboptimal. Using quality improvement PDSA cycles over an 8-week period, we saw improvements in oral care documentation compliance through statistical process control charts; HAP rates did not significantly decrease. Infection prevention leadership should consider regularly incorporating PDSA cycles to improve compliance with evidence-based infection prevention practices
ZFP36L2 in Development and Adulthood: A Critical Regulator of Hematopoietic Stem Cell Homeostasis
No full textThe tristetraprolin (TTP) protein family of RNA-binding proteins contains three widely expressed mammalian protein members: TTP (ZFP36), ZFP36L1, and ZFP36L2, all of which can regulate gene expression by binding to specific AU-rich sequences located in the 3'-untranslated regions (3’-UTR) of mRNAs and accelerating their decay. Unique among the three, ZFP36L2 plays a pivotal role in maintaining hematopoietic stem cells (HSC) during development. ZFP36L2-deficient mice exhibit severely impaired definitive hematopoiesis and die approximately two weeks after birth due to severe anemia, thrombocytopenia, and internal hemorrhage. Recent single-cell RNA sequencing (scRNA-seq) studies have demonstrated widespread Zfp36l2 expression in HSC and the hematopoietic system during both development and adulthood. Despite the recognized importance of ZFP36L2 in maintaining HSC, there are still numerous aspects of its role that are not fully understood, hindering our understanding of hematopoietic regulation. While prior studies have provided valuable insights into the physiological function of ZFP36L2, its molecular mechanisms in HSC development and hematopoietic system maintenance remain poorly defined. To decipher its involvement in hematopoiesis, it is crucial to identify the mRNA targets and pathways regulated by ZFP36L2 and determine whether this regulation is intrinsic to HSC. Moreover, the premature death of ZFP36L2-deficient mice makes it unclear to what extent this protein governs adult HSC function. Lastly, considering the pivotal position of HSC in the hematopoietic hierarchy, it is important to investigate how ZFP36L2's activity in HSC affects the subsequent differentiation of hematopoietic lineages. Clarifying this relationship could yield valuable insights into the post-transcriptional mechanisms that govern HSC biology and potentially lead to the identification of new therapeutic targets for hematological disorders. To address the knowledge gap, we employed a detailed analysis combining flow cytometry and scRNA-seq to examine HSC and hematopoietic progenitor cells (HSPC) at several critical developmental stages. Our studies revealed that the absence of ZFP36L2 resulted in significant reductions in both HSC and immature progenitors during mouse development, primarily due to HSC-autonomous dysregulation. In addition, scRNA-seq analysis of HSC and progenitors revealed that ZFP36L2 deficiency caused abnormal upregulation of transcripts related to cell cycle regulation and lymphoid specification, leading to aberrant cell cycle progression and premature lymphoid lineage commitment. This ultimately resulted in cellular damage and HSC exhaustion at birth. These findings demonstrate that ZFP36L2 is essential for maintaining the homeostasis of HSC, and emphasizes the significance of restraining lineage commitment and excessive self-renewal during HSC development.In a related study, we investigated possible functional overlap of ZFP36L2 and TTP. We developed mice (L2KO/TTP∆ARE) that lacked Zfp36l2 but modestly overexpressed TTP throughout the body. L2KO/TTP∆ARE mice not only survived but also exhibited normal peripheral blood counts, except for residual moderate thrombocytopenia. We took advantage of this rescued ZFP36L2-deficient model and investigated the role of ZFP36L2 in adult hematopoiesis. We discovered that megakaryocyte (MK) progenitors and MK-biased HSC were decreased in bone marrow from L2KO/TTP∆ARE mice and exhibited enriched erythroid and decreased MK gene signatures. In addition, L2KO/TTP∆ARE HSC failed to reconstitute hematopoiesis upon non-competitive transplantation, and showed molecular features of stress and reduced cycling. Thus, TTP can assume some functions of ZFP36L2 in a genetic dose-dependent manner, but ZFP36L2 may be specifically required for the maintenance of megakaryopoiesis and HSC function.In summary, our studies provide novel insights into the essential role of ZFP36L2 in the maintenance of HSC throughout both developmental stages and adulthood. We demonstrate that ZFP36L2 is essential for restraining abnormal cell cycling and lymphoid commitment during HSC development, thereby ensuring proper HSC maintenance. Interestingly, our results also suggest that TTP may partially compensate for ZFP36L2 deficiency during the development of the hematopoietic system, but that ZFP36L2 may have specific functions in maintaining megakaryopoiesis and HSC function in adulthood. Overall, our research provides a strong foundation for future studies aimed at elucidating the underlying mechanisms that govern ZFP36L2's function in hematopoiesis, further advancing our understanding of the intricate regulatory paradigm of HSC biology.
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