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Statement To The Press After The Issg Meeting
No full textStatement To The Press After The Issg Meetin
Remote Plasma Nitridation of In-Situ Steam Generated (ISSG) Oxide
No full textABSTRACTElectrical performance of in-situ steam generated (ISSG) oxide nitrided using remote plasma nitridation (RPN) has been evaluated. An equivalent oxide thickness (EOT) of 1.6 nm with gate leakage current around 5×10−3 A/cm2 (at −1.5V) has been achieved. The leakage current of remote plasma nitrided ISSG oxide is lower than that of ISSG only, where more than one order of magnitude leakage current reduction (at the same EOT) has been achieved for some RPN conditions. Moreover, it is observed that the extent to which the RPN process conditions modify device parameters such as EOT, flatband voltage (VFB), and time-to-breakdown (tbd) increases with decreasing ISSG thickness. The thinner ISSG oxides appear to be more susceptible to plasma damage and accumulation of positively charged nitrogen atoms at the oxide/Si interface. Therefore, RPN processes that use lower temperature and shorter time are preferred for very thin oxides. The nitrogen content and profile in the samples evaluated using SIMS analysis, indicate that RPN offers higher nitrogen content and better nitrogen profile compared to conventional nitrogen incorporation methods such as NO annealing [1].</jats:p
Inter- and Intra-rater Reliability of the Hart-ISSG Proximal Junctional Failure Severity Scale.
No full textStudy designReliability/external validation study.ObjectiveInvestigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF).Summary of background dataThe Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed.MethodsSixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients.ResultsAll intraclass correlation coefficients demonstrated "almost perfect"' (0.817-0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated "substantial" agreement' (0.692). Five of six categories had "almost perfect" mean intrarater reliability (0.805-0.981), while "instrumentation issue" demonstrated "substantial" mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was "almost perfect" during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43 ± 0.90) versus cases recommended for observation (P ConclusionThe ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.Level of evidence3
The 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
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The ISSG-AO Complication Intervention Score, but Not Major/Minor Designation, is Correlated With Length of Stay Following Adult Spinal Deformity Surgery.
Get PDFSTUDY DESIGN: Retrospective review. OBJECTIVES: The International Spine Study Group-AO (ISSG-AO) Adult Spinal Deformity (ASD) Complication Classification System was developed to improve classification, reporting, and study of complications among patients undergoing ASD surgery. The ISSG-AO system classifies interventions to address complications by level of invasiveness: grade zero (none); grade 1, mild (e.g., medication change); grade 2, moderate (e.g., ICU admission); grade 3, severe (e.g., reoperation related to surgery of interest). To evaluate the efficacy of the ISSG-AO ASD Complication Classification System, we aimed to compare correlations between postoperative length of stay (LOS) and complication severity as classified by the ISSG-AO ASD and traditional major/minor complication classification systems. METHODS: Patients age ≥18 in a multicenter ASD database who sustained in-hospital complications were identified. Complications were classified with the major/minor and ISSG-AO systems and correlated with LOS using an ensemble-based machine learning algorithm (conditional random forest) and a generalized linear mixed model. RESULTS: 490 patients at 19 sites were included. 64.9% of complications were major, and 35.1% were minor. By ISSG-AO classification, 20.4%, 66.1%, 6.7%, and 6.7% were grades 0-3, respectively. ISSG-AO complication grading demonstrated significant correlation with LOS, whereas major/minor complication classification demonstrated inverse correlation with LOS. In conditional random forest analysis, ISSG-AO classification had the greatest relative importance when assessing correlations across multiple variables with LOS. CONCLUSIONS: The ISSG-AO system may help identify specific complications associated with prolonged LOS. Targeted interventions to avoid or reduce these complications may improve ASD surgical quality and resource utilization
The ISSG-AO Complication Intervention Score, but Not Major/Minor Designation, is Correlated With Length of Stay Following Adult Spinal Deformity Surgery.
No full textSTUDY DESIGN: Retrospective review.
OBJECTIVES: The International Spine Study Group-AO (ISSG-AO) Adult Spinal Deformity (ASD) Complication Classification System was developed to improve classification, reporting, and study of complications among patients undergoing ASD surgery. The ISSG-AO system classifies interventions to address complications by level of invasiveness: grade zero (none); grade 1, mild (e.g., medication change); grade 2, moderate (e.g., ICU admission); grade 3, severe (e.g., reoperation related to surgery of interest). To evaluate the efficacy of the ISSG-AO ASD Complication Classification System, we aimed to compare correlations between postoperative length of stay (LOS) and complication severity as classified by the ISSG-AO ASD and traditional major/minor complication classification systems.
METHODS: Patients age =18 in a multicenter ASD database who sustained in-hospital complications were identified. Complications were classified with the major/minor and ISSG-AO systems and correlated with LOS using an ensemble-based machine learning algorithm (conditional random forest) and a generalized linear mixed model.
RESULTS: 490 patients at 19 sites were included. 64.9% of complications were major, and 35.1% were minor. By ISSG-AO classification, 20.4%, 66.1%, 6.7%, and 6.7% were grades 0-3, respectively. ISSG-AO complication grading demonstrated significant correlation with LOS, whereas major/minor complication classification demonstrated inverse correlation with LOS. In conditional random forest analysis, ISSG-AO classification had the greatest relative importance when assessing correlations across multiple variables with LOS.
CONCLUSIONS: The ISSG-AO system may help identify specific complications associated with prolonged LOS. Targeted interventions to avoid or reduce these complications may improve ASD surgical quality and resource utilization
Impact of Complications on DRG Assignment for Adult Spinal Deformity Surgery Using the ISSG-AO Classification System.
No full textSTUDY DESIGN: Retrospective cohort.
OBJECTIVE: The ISSG-AO Spinal Deformity Complication Classification System (SDCCS) predicts Diagnosis Related Group (DRG) coding and cost.
BACKGROUND: Inconsistent definitions of complications contribute to variation in reported surgical complication rates. Incorrect complication reporting can lead to over or under DRG reimbursement. The ISSG-AO SDCCS provides improved complication reporting reproducibility and may help predict complication costs.
METHODS: ASD patients were grouped into: DRG without complication or comorbidity (CC) or Major CC (MCC) (DRGs 455 & 458), with CC (DRGs 454 & 457), and with MCC (DRGs 453 & 456). Complications were graded by intervention severity per ISSG-AO system: grade 0 (none), 1 (mild-e.g., med change), 2 (moderate-e.g., ICU), 3 (severe-e.g., reoperation). Cost were based on Medicare inpatient prospective payment system (IPSS, Medicare Allowable rate). A multinomial logistic model identified key predictors of DRG assignment by complication grades.
RESULTS: Of the 675 patients, 14% were in DRGs without CC/MCC, 71% in DRGs with CC, and 15% were DRGs with MCC. Patients with complications requiring intervention mostly fell into the higher DRG categories (97%). Patients who received an intervention are approximately 6.75 (2.01-22.75, P\u3c .0021) times more likely to be classified under DRG with CC and 15.72 (95% CI, 4.23-58.45, P\u3c .0001) times more likely to be classified with DRG with MCC compared to those who did not receive an intervention. Each unit increase in Edmonton Frailty Score raises the odds of being in DRG with MCC by 1.24 (95% CI 1.04-1.48, P 0.017). Similar trends were seen for OR time and LOS. Reimbursement showed incremental increase from 56K to $70K across DRG categories.
CONCLUSIONS: Patients with elevated ISSG-AO scores are more likely to be categorized into higher DRGs, experience extended lengths of stay and generate greater healthcare expenditures. The ISSG-AO SDCCS predicts DRG thereby helping standardize complication reporting
Inter- and Intra-rater Reliability of the Hart-ISSG Proximal Junctional Failure Severity Scale.
No full textSTUDY DESIGN: Reliability/external validation study.
OBJECTIVE: Investigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF).
SUMMARY OF BACKGROUND DATA: The Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed.
METHODS: Sixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients.
RESULTS: All intraclass correlation coefficients demonstrated almost perfect \u27 (0.817-0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated substantial agreement\u27 (0.692). Five of six categories had almost perfect mean intrarater reliability (0.805-0.981), while instrumentation issue demonstrated substantial mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was almost perfect during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43 ± 0.90) versus cases recommended for observation (P \u3c 0.0001).
CONCLUSION: The ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.
LEVEL OF EVIDENCE: 3
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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