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Opioid use prior to surgery is associated with worse preoperative and postoperative patient reported quality of life and decreased surgical cost effectiveness for symptomatic adult spine deformity; A matched cohort analysis.
No full textBackgroundPreoperative opioid is associated with poor postoperative outcomes for several surgical specialties, including neurosurgical, orthopedic, and general surgery. Patients with symptomatic adult spinal deformity (SASD) are among the highest patient populations reporting opioid use prior to surgery. Surgery for SASD has been demonstrated to improve patient reported quality of life, however, little medical economic data exists evaluating impact of preoperative opioid use upon surgical cost-effectiveness for SASD. The purpose of this study was to evaluate the impact that preoperative opioid use has upon SASD surgery including duration of intensive care unit (ICU) and hospital stay, postoperative complications, patient reported outcome measures (PROMs), and surgical cost-effectiveness using a propensity score matched analysis model.MethodsSurgically treated SASD patients enrolled into a prospective multi-center SASD study were assessed for preoperative opioid use, and divided into two cohorts; preoperative opioid users (OPIOID) and preoperative opioid non-users (NON). Propensity score matching (PSM) was used to control for patient age, medical comorbidities, spine deformity type and magnitude, and surgical procedures for OPIOID vs NON. Preoperative and minimum 2-year postoperative PROMs, duration of ICU and hospital stay, postoperative complications, and opioid use at one and two years postoperative were compared for OPIOID vs NON. Preoperative, one year, and minimum two-year postoperative SF6D values were calculated, and one- and two-year postoperative QALYs were calculated using SF6D change from baseline. Hospital costs at the time of index surgery were calculated and cost/QALY compared at one and two years postop for OPIOID vs NON.Results261/357 patients (mean follow-up 3.3 years) eligible for study were evaluated. Following the PSM control, OPIOID (n=97) had similar preoperative demographics, smoking and depression history, spine deformity magnitude, and surgery performed as NON (n=164; p>0.05). Preoperatively, OPIOID reported greater NRS back pain (7.7 vs 6.7) and leg pain (5.2 vs 3.9), worse ODI (50.8 vs 36.9), worse SF-36 PCS (28.8 vs 35.6), and worse SRS-22r self-image (2.3 vs 2.5) than NON, respectively (pConclusionsProspective, multi-center, matched analysis demonstrated SASD patients using opioids prior to SASD surgery reported worse preoperative and postoperative quality of life, had longer ICU and hospital stay, had less cost effectiveness of SASD surgery. Preoperative opioid users also reported lower treatment satisfaction, and reported greater postoperative opioid use than non-users. These data should be used to council patients on the negative impact preoperative opioid use can have on SASD surgery
A Structural Event Approach to the Analysis of Group Composition
No full textSince Simmel's early work on forms of association, the processes guiding group composition have commanded considerable attention in structural sociology, but have not led to a general methodology for examining compositional properties. By introducing a structural event approach, this study offers a new technique that is not restricted to analysis of dyads or triads nor post hoc analysis of those structural arrangements that are observed in a given sample. The approach is illustrated using data on 745 organizational founding teams. Structural event analysis separates choice behavior guiding team composition (with respect to ascribed and achieved characteristics of members) from structurally-induced behavior based on contact opportunities. Results suggest that the strong impact of ascriptive homophily may be tempered when functional considerations of group composition are addressed. However, many of the other arrangements that ostensibly pass as 'functional' are in fact induced by opportunity structures. © 2002 Elsevier Science B.V. All rights reserved
Weak Lensing Cosmology Analysis with Stage-III Cosmic Shear Surveys
No full textAs light travels from distant galaxies it is coherently bent by the gravitational potential of the mass distribution between the source and the observer. This weak gravitational lensing creates correlations between galaxy shapes that can be measured as a function of redshift in a tomographic cosmic shear measurement. Cosmic shear is a powerful probe of cosmological models, as different expansion scenarios for our Universe produce different weak lensing signals as a function of redshift. Comparison of cosmic shear survey data to theoretical models is a precise test of the current standard model of cosmology; CDM. The upcoming Legacy Survey of Space and Time (LSST) of the Vera C. Rubin Observatory will produce sub-percent level measurements of cosmological parameters by optically imaging billions of galaxies to unprecedented depth. In anticipation of the LSST analysis, we examine three of the most recent cosmic shear datasets: the first year data from the Dark Energy Survey (DES-Y1), the 1,000 deg dataset from the Kilo-Degree Survey (KiDS-1000), and the first year data from the Hyper Suprime-Cam Subaru Strategic Program (HSC-Y1). In this work we re-analyze the cosmic shear results from each of the previous surveys using a unified pipeline from the LSST Dark Energy Science Collaboration (DESC). We then measure each of the datasets statistical consistencies, finding each of the surveys to be in agreement. We additionally assess the robustness of the results to analysis choices, and find the cosmology constraints to be robust to two different small-scale treatment methods. Finally we produce a combined cosmology constraint from the three datasets under our unified pipeline. Our combined analysis gives a constraint on the , given different approximation methods for the cross-covariance of the overlapping HSC-Y1 and KiDS-1000 footprint. This constraint is as precise as the most recent cosmic shear survey measurement, DES-Y3. This work paves the way for a cosmology analysis with the upcoming LSST-Y1 dataset by DESC by serving as the first test of DESC pipelines on real data, and demonstrating its capabilities to reproduce Stage-III results. It additionally provides guidance to the LSST-Y1 analysis by examining the effects of prior choice and scale cuts on cosmology measurements. </p
THE MISSING TURKISH REVOLUTION: COMPARING VILLAGE-LEVEL CHANGE AND CONTINUITY IN REPUBLICAN TURKEY AND SOVIET CENTRAL ASIA, 1920–50
No full textAbstractThe Kemalist leadership of early Republican Turkey attempted to transform the country's Muslim populace with a heavy emphasis on secularism, scientific rationalism, and nationalism. Several studies have examined the effects of this effort, or the “Turkish Revolution,” at the central and more recently provincial levels. This article uses first-hand accounts and statistical data to carry the analysis to the village level. It argues that the Kemalist reforms failed to reach rural Turkey, where more than 80 percent of the population lived. A comparison with sedentary Soviet Central Asia's rural transformation in the same period reveals ideology and the availability of resources as the underlying causes of this failure. Informed by a Marxist–Leninist emphasis on the necessity of transforming the “substructure” for revolutionary change, the Soviet state undermined existing authority structures in Central Asia's villages to facilitate the introduction of communist ideals among their Muslim inhabitants. Turkey's Kemalist leadership, on the other hand, preserved existing authority structures in villages and attempted to change culture first. However, they lacked and could not create the resources to implement this change.</jats:p
Pharmacological Wnt ligand inhibition overcomes key tumor-mediated resistance pathways to anti-PD-1 immunotherapy.
No full textWhile immune checkpoint blockade is associated with prolonged responses in multiple cancers, most patients still do not benefit from this therapeutic strategy. The Wnt-β-catenin pathway is associated with diminished T cell infiltration; however, activating mutations are rare, implicating a role for autocrine/paracrine Wnt ligand-driven signaling in immune evasion. In this study, we show that proximal mediators of the Wnt signaling pathway are associated with anti-PD-1 resistance, and pharmacologic inhibition of Wnt ligand signaling supports anti-PD-1 efficacy by reversing dendritic cell tolerization and the recruitment of granulocytic myeloid-derived suppressor cells in autochthonous tumor models. We further demonstrate that the inhibition of Wnt signaling promotes the development of a tumor microenvironment that is more conducive to favorable responses to checkpoint blockade in cancer patients. These findings support a rationale for Wnt ligand-focused treatment approaches in future immunotherapy clinical trials and suggest a strategy for selecting those tumors more responsive to Wnt inhibition
Ballet Pedagogy and a “Hard Re-Set”: Perspectives on Equitable and Inclusive Teaching Practices
No full textIn her scholarship on pedagogy, Gloria Ladson-Billings describes COVID-19 as a call to re-set education using a more culturally relevant pedagogy. As ballet teachers and researchers working in higher education and pre-professional settings, we teach a form of dance often associated with the characteristics of white supremacy. Through this collaborative institutional ethnography, we generated methods for posing questions, critiquing choices, and imagining alternatives to create more equitable educational settings. We connect the process of addressing and challenging systemic exclusions in ballet with tangible steps toward creating more inclusive classes and performances that value the joy and pleasure in moving
Demographic and Socioeconomic Disparities in Life Expectancy With Hearing Impairment in the United States.
No full textObjectivesHearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired.MethodWe investigate the number of years an "average" person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n = 20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50.ResultsMen, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy.DiscussionSignificant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes
Osteoimmunology: Interactions With the Immune System in Spinal Fusion.
No full textSpinal fusion is important for the clinical success of patients undergoing surgery, and the immune system plays an increasingly recognized role. Osteoimmunology is the study of the interactions between the immune system and bone. Inflammation impacts the osteogenic, osteoconductive, and osteoinductive properties of bone grafts and substitutes and ultimately influences the success of spinal fusion. Macrophages have emerged as important cells for coordinating the immune response following spinal fusion surgery, and macrophage-derived cytokines impact each phase of bone graft healing. This review explores the cellular and molecular immune processes that regulate bone homeostasis and healing during spinal fusion
Association of Burden and Prevalence of Arthritis With Disparities in Social Risk Factors, Findings From 17 US States.
No full textIntroductionSocial risks previously have been associated with arthritis prevalence and costs. Although social risks often cluster among individuals, no studies have examined associations between multiple social risks within the same individual. Our objective was to determine the association between individual and multiple social risks and the prevalence and burden of arthritis by using a representative sample of adults in 17 US states.MethodsData are from the 2017 Behavioral Risk Factor Surveillance System. Respondents were 136,432 adults. Social risk factors were food insecurity, housing insecurity, financial insecurity, unsafe neighborhoods, and health care access hardship. Weighted χ2 and logistic regression analyses, controlling for demographic characteristics, measures of socioeconomic position, and other health conditions examined differences in arthritis prevalence and burden by social risk factor and by a social risk index created by summing the social risk factors.ResultsWe observed a gradient in the prevalence and burden of arthritis. Compared with those reporting 0 social risk factors, respondents reporting 4 or more social risk factors were more likely to have arthritis (adjusted odds ratio [AOR], 1.92; 95% CI, 1.57-2.36) and report limited usual activities (AOR, 2.97; 95% CI, 2.20-4.02), limited work (AOR, 2.72; 95% CI, 2.06-3.60), limited social activities (AOR, 3.10; 95% CI, 2.26-4.26), and severe joint pain (AOR, 1.86; 95% CI, 1.44-2.41).ConclusionIncremental increases in the number of social risk factors were independently associated with higher odds of arthritis and its burden. Intervention efforts should address the social context of US adults to improve health outcomes
Host immunity associated with spontaneous suppression of viremia in therapy-naïve young rhesus macaques following neonatal SHIV infection.
No full textWe recently found that a new pathogenic chimeric simian-human immunodeficiency virus (SHIV) elicited heterologous human immunodeficiency virus type-1 (HIV-1) neutralizing antibodies (nAbs) in therapy-naïve young rhesus macaques (RMs) following neonatal SHIV infection. Moreover, a subset of the SHIV-infected young RMs spontaneously controlled viremia. Here we evaluated humoral and cellular immunity and plasma biomarkers associated with spontaneous viremia suppression in a new model of young SHIV-infected RMs that generated heterologous HIV-1 nAbs independent of viremia control to gain insights into pediatric immunity that may be harnessed by appropriate therapies in HIV-1-infected infants and children. We determined the levels of 31 plasma analytes (cytokines, chemokines, and growth factors) in SHIV-infected RMs over the course of infection and found that six analytes with chemoattractant or pro-inflammatory activities had significantly lower levels in plasma of RMs that controlled viremia compared to non-controllers. Single-cell transcriptomics of blood-derived immune cells demonstrated that RMs with viremia control had upregulated genes associated with immune activation and cytotoxic functions, whereas non-controllers had upregulated genes associated with immune cell exhaustion and dysfunction. In addition to CD8 T and natural killer cells, monocytes with upregulation of inhibitory genes previously reported only in cytotoxic cells constituted the immunologic environment associated with viremia suppression. These data implicated a complex immunologic milieu of viremia suppression that is not fully defined in pediatric subjects. Understanding immune cell subsets that may be harnessed to control viremia will provide insights into future designs of HIV-1 therapeutic strategies. IMPORTANCE Despite the advent of highly active anti-retroviral therapy, people are still dying from HIV-related causes, many of whom are children, and a protective vaccine or cure is needed to end the HIV pandemic. Understanding the nature and activation states of immune cell subsets during infection will provide insights into the immunologic milieu associated with viremia suppression that can be harnessed via therapeutic strategies to achieve a functional cure, but these are understudied in pediatric subjects. We evaluated humoral and adaptive host immunity associated with suppression of viremia in rhesus macaques infected soon after birth with a pathogenic SHIV. The results from our study provide insights into the immune cell subsets and functions associated with viremia control in young macaques that may translate to pediatric subjects for the design of future anti-viral strategies in HIV-1-infected infants and children and contribute to an understudied area of HIV-1 pathogenesis in pediatric subjects