Cervical fusion rates increased in the U.S. exponentially 1990–2014, but trends leading up to/during the COVID-19 pandemic have not been fully evaluated by patient socioeconomic status (SES). Here, ...we provide the most recent, comprehensive characterization of demographic and SES trends in cervical fusions, including during the pandemic.
We collected the following variables on adults undergoing cervical fusions, 1/1/2004–3/31/2021, in Optum's Clinformatics Data Mart: age, Charlson Comorbidity Index, provider's practicing state, gender, race, education, and net worth. We performed multivariate linear and logistic regression to evaluate associations of cervical fusion rates with SES variables.
Cervical fusion rates increased 2004–2016, then decreased 2016–2020. Proportions of Asian, Black, and Hispanic patients undergoing cervical fusions increased (OR = 1.001,1.001,1.004, P < 0.01), with a corresponding decrease in White patients (OR = 0.996, P < 0.001) over time. There were increases in cervical fusions in higher education groups (OR = 1.006, 1.002, P < 0.001) and lowest net worth group (OR = 1.012, P < 0.001). During the pandemic, proportions of White (OR = 1.015, P < 0.01) and wealthier patients (OR ≥ 1.015, P < 0.01) undergoing cervical fusions increased.
We present the first documented decrease in annual cervical surgery rates in the U.S. Our data reveal a bimodal distribution for cervical fusion patients, with racial-minority, lower-net-worth, and highly-educated patients receiving increasing proportions of surgical interventions. White and wealthier patients were more likely to undergo cervical fusions during the COVID-19 pandemic, which has been reported in other areas of medicine but not yet in spine surgery. There is still considerable work needed to improve equitable access to spine care for the entire U.S. population.
Whenever we peruse through the works of Abu Tammam, we would find him being subjected to criticism or disparagement at times or being spoken about and praised at others by a multitude of critics be ...they prominent or not. Abu Tammam al-Ta'i poetry receded into history, is of a contemporaneous soul; his language, ever so scintillating, dazzles the discerner with pearls that fascinate the spirit before so the thought or sight. On this premise, this study was done based on the idea of observing how Al-Ta’i was influenced by previous poets. Thus, this study aims at observing previous poets' influence over Abu Tammam, which is considered an imprinted characteristic in his poetry- according to Al-Amedi's accusation, when he considered him as following in the path of the modernists. Furthermore, this study aims to elucidate these poetical aesthetics in the meanings that were evoked by Abu Tammam from the poetry of those who came before him, as well as to discuss the views of critics who critically dealt with the poetry of Abu Tammam, especially Al-Amedi in "Al-Mwazanah", and Al-Marzabani in "Al-Muwashah". To prove the two-way poetical influence, this study adopts a methodology that relies on the historical approach. Furthermore, it capitalizes on intertextuality to reveal how Abu Tammam was influenced by previous poets, resorting to analysis as an important procedural tool to get a sense of the aesthetics of Abu Tammam's poetry and that aforementioned influence.
Smartphone activity data recorded through high-fidelity accelerometry can provide accurate postoperative assessments of patient mobility. The "big data" available through smartphones allows for ...advanced analyses, yielding insight into patient well-being. This study compared rate of change in functional activity data between lumbar fusion (LF) and lumbar decompression (LD) patients to determine preoperative and postoperative course differences.
Twenty-three LF and 18 LD patients were retrospectively included. Activity data (steps per day) recorded in Apple Health, encompassing over 70 000 perioperative data points, was classified into 6 temporal epochs representing distinct functional states, including acute preoperative decline, immediate postoperative recovery, and postoperative decline. The daily rate of change of each patient's step counts was calculated for each perioperative epoch.
Patients undergoing LF demonstrated steeper preoperative declines than LD patients based on the first derivative of step count data (P = .045). In the surgical recovery phase, LF patients had slower recoveries (P = .041), and LF patients experienced steeper postoperative secondary declines than LD patients did (P = .010). The rate of change of steps per day demonstrated varying perioperative trajectories that were not explained by differences in age, comorbidities, or levels operated.
Patients undergoing LF and LD have distinct perioperative activity profiles characterized by the rate of change in the patient daily steps. Daily steps and their rate of change is thus a valuable metric in phenotyping patients and understanding their postsurgical outcomes. Prospective studies are needed to expand upon these data and establish causal links between preoperative patient mobility, patient characteristics, and postoperative functional outcomes.
Spine surgery outcomes assessment currently relies on patient-reported outcome measures, which satisfy established reliability and validity criteria, but are limited by the inherently subjective and ...discrete nature of data collection. Physical activity measured from smartphones offers a new data source to assess postoperative functional outcomes in a more objective and continuous manner.
To present a methodology to characterize preoperative mobility and gauge the impact of surgical intervention using objective activity data garnered from smartphone-based accelerometers.
Smartphone mobility data from 14 patients who underwent elective lumbar decompressive surgery were obtained. A time series analysis was conducted on the number of steps per day across a 2-year perioperative period. Five distinct clinical stages were identified using a data-driven approach and were validated with clinical documentation.
Preoperative presentation was correctly classified as either a chronic or acute mobility decline in 92% of patients, with a mean onset of acute decline of 11.8 ± 2.9 weeks before surgery. Postoperative recovery duration demonstrated wide variability, ranging from 5.6 to 29.4 weeks (mean: 20.6 ± 4.9 weeks). Seventy-nine percentage of patients ultimately achieved a full recovery, associated with an 80% ± 33% improvement in daily steps compared with each patient's preoperative baseline (P = .002). Two patients subsequently experienced a secondary decline in mobility, which was consistent with clinical history.
The perioperative clinical course of patients undergoing spine surgery was systematically classified using smartphone-based mobility data. Our findings highlight the potential utility of such data in a novel quantitative and longitudinal surgical outcome measure.
Hypereosinophilia (HE) is defined by the presence of >1.5 × 109/L eosinophils in the peripheral blood. Paraneoplastic HE has been reported in a number of solid and hematologic malignancies including ...ovarian cancer. We present a case with paraneoplastic HE in the setting of underlying endometrioid ovarian carcinoma.
An 88-year-old woman presented with cough, dyspnea and 20-pound unintentional weight loss of one month duration. Evaluation revealed peripheral hypereosinophilia (HE) with absolute eosinophil count of 15.38 × 109/L (53.8%) and an elevated exhaled nitric oxide at 172 parts per billion (normal < 39 PPB). Given the HE and unintentional weight loss, computed tomography (CT) scan was obtained and showed a pelvic mass. The patient underwent bilateral salpingo-ophorectomy with pathology consistent with endometrioid ovarian carcinoma. The patient experienced complete resolution of her cough, dyspnea, and peripheral eosinophilia following surgical resection.
This case highlights that solid malignancy should be considered in patients with marked HE.
Lumbar interbody fusion (LIF) techniques have seen impressive innovation in recent years, leading to an expansion of the LIF lexicon. This study systematically analyzes LIF nomenclature in ...contemporary literature and proposes a standardized classification system for reporting LIF terminology.
A search query was conducted through the PubMed database using “lumbar fusion OR lumbar interbody fusion.” A total of 1455 articles were identified, and 605 references to LIF were recorded. Following a systematic review of the terminology, we developed a LIF reporting guidelines that capture the existing LIF nomenclature while avoiding redundant or ambiguous terminology.
The most referenced anatomical approaches were transforaminal (43.0%), followed by posterior (25.0%), lateral (19.7%), and anterior (10.9%). Overall, there were 72 unique ways to describe LIF. Unique prefixes were recorded by approach (posterior: 26; lateral: 13; anterior: 3). Forty unique prefixes/suffixes overlapped in their usage. “MI” (14.4%), “MIS” (38.1%), and “MISS” (0.6%) all referenced a minimally invasive approach. “O” (12.5%), “CO” (1.3%), and “TO” (1.3%) all described open techniques. “Endo” (0.6%), “Endoscopic-assisted” (1.3%), and “PE” (1.9%) all referenced endoscopic-assisted procedures.
The current LIF nomenclature contains many unique LIF terms that were found to be inconsistently defined, redundant, or ambiguous. We propose the standardization of a 4-part naming system which highlights the crucial parts of LIF: (1) intraoperative repositioning, (2) patient position, (3) anatomical approach, and (4) orientation of the surgical corridor to the psoas muscles.
The internet of things (IoT) is prone to various types of denial of service (DoS) attacks due to their resource-constrained nature. Extensive research efforts have been dedicated to securing these ...systems, but various vulnerabilities remain. Notably, it is challenging to maintain the confidentiality, integrity, and availability of mobile ad hoc networks due to limited connectivity and dynamic topology. As critical infrastructure including smart grids, industrial control, and intelligent transportation systems is reliant on WSNs and IoT, research efforts that forensically investigate and analyze the cybercrimes in IoT and WSNs are imperative. When a security failure occurs, the causes, vulnerabilities, and facts behind the failure need to be revealed and examined to improve the security of these systems. This research forensically investigates the performance of the ad hoc IoT networks using the ad hoc on-demand distance vector (AODV) routing protocol under the blackhole attack, which is a type of denial of service attack detrimental to IoT networks. This work also examines the traffic patterns in the network and nodes to assess the attack damage and conducts vulnerability analysis of the protocol to carry out digital forensic (DF) investigations. It further reconstructs the networks under different modes and parameters to verify the analysis and provide suggestions to design roubust routing protocols.
Introduction
Blastomycosis is an uncommon; potentially life-threatening granulomatous fungal infection. The aim of this study is to report hospital and intensive care unit (ICU) outcomes of patients ...admitted with blastomycosis.
Methods
All patients admitted for treatment of blastomycosis at the Mayo Clinic-Rochester, Minnesota between 01/01/2006 and 09/30/2019 were included. Demographics, comorbidities, clinical presentation, ICU admission, and outcomes were reviewed.
Results
A total of 84 Patients were identified with 90 unique hospitalizations primarily for blastomycosis. The median age at diagnosis was 49 (IQR 28.1–65, range: 6–85) years and 56 (66.7%) were male. The most frequent comorbidities included hypertension (
n
= 28, 33.3%); immunosuppressed state (
n
= 25, 29.8%), and diabetes mellitus (
n
= 21, 25%). The lungs were the only organ involved in 56 (66.7%) cases and the infection was disseminated in 19 (22.6%) cases.
A total of 29 patients (34.5%) underwent ICU admission due to complications of blastomycosis. ICU related events included mechanical ventilation (
n
= 20, 23.8%), acute respiratory distress syndrome (ARDS) (
n
= 13, 15.5%), tracheostomy (
n
= 9, 10.7%), renal replacement therapy (
n
= 8, 9.5%), and extracorporeal membrane oxygenation (ECMO) (
n
= 4, 4.8%). A total of 12 patients (14.3%) died in the hospital; all of whom had undergone ICU admission. In-hospital mortality was associated with renal replacement therapy (RRT) (
P
= 0.0255).
Conclusion
Blastomycosis is a serious, potentially life-threatening infection that results in significant morbidity and mortality with a 34.5% ICU admission rate. RRT was associated with in-hospital mortality.
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