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Introduction: The management of degenerative spine pathology continues to be a significant source of costs to the US healthcare system. Besides surgery, utilization of healthcare resources after spine surgery drives costs. The responsibility of managing costs is gradually shifting to patients and providers. Patient-centered predictors of healthcare utilization after elective spine surgery may identify targets for cost reduction and value creation. Therefore, our study aims to quantify patterns of healthcare utilization and identify risk factors that predict high healthcare utilization after elective spine surgery. Methods: A total of 623 patients who underwent elective spine surgery at a tertiary academic medical center by one of three fellowship-trained orthopedic spine surgeons between 2013 and 2018 were identified in this retrospective cohort study. Healthcare utilization was quantified including advanced spine imaging, emergency and urgent care visits, hospital readmission, reoperation, PT/OT referrals, opioid prescriptions, epidural steroid injections, and pain management referrals. Patient variables, namely, the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) classification system, were assessed as potential predictors for healthcare utilization. Results: Among all patients, a wide range of health utilization was identified. Age, body mass index, Charlson Comorbidity Index, and American Society of Anesthesiology class were identified as positive predictors of postoperative healthcare utilization including emergency department visits, spine imaging studies, opioid and nerve blocker prescriptions, inpatient rehabilitation, any referrals, and pain management referrals. Conclusions: Markers of patient health―such as CCI and ASA class―may be used to predict healthcare utilization following elective spine surgery. Identifying at-risk patients and addressing these challenges prior to surgery is an important step to deliver efficient postoperative care. Level of Evidence: 3

Biomass from microalgae is a potential feedstock for biofuels production. It poses no threat to food security as it does not compete with agricultural crops for arable land. Scenedesmus acutus was used as feedstock to produce bio-oil in a large liquefaction reactor. The influence of reaction temperature (280–360ºC), reaction atmosphere (N2 or CO2) and solvent on bio-oil yield, C-16 fatty acid yield and oil properties were investigated. Oils were characterised using gas chromatography, Fourier transform infrared (FTIR) spectroscopy and ultimate analysis. Higher bio-oil yields were obtained in a CO2 atmosphere (250 g.kg-1 dry microalgae) than in a N2 atmosphere (210 g.kg-1 dry microalgae) whilst higher C16 fatty acid concentrations (600 g.kg-1 bio-oil) were recorded in N2 atmosphere compared to oil prepared in a CO2 atmosphere (500 g.kg-1 bio-oil). The oil yield increased to a maximum at 320°C, after which there were no significant changes. Highest bio-oil yields (425 g.kg-1 dry microalgae) were obtained in ethanol as solvent. FTIR spectroscopy and ultimate analysis showed that proteins present in the feedstock were degraded by breakage of peptide linkages, and nitrogen present in the oils is peptide fragments from protein degradation. The carbon content of all produced oils was high, but the hydrogen content was low, leading to low hydrogen/carbon ratios. Energy consumption and energy efficiency calculations showed that liquefaction in both reaction atmospheres results in a net energy gain, and a CO2 atmosphere is best for high energy efficiency.

In recent years, the number of people affected by flooding caused by extreme weather events has increased considerably. In order to provide support in disaster recovery or to develop mitigation plans, accurate flood information is necessary. Particularly pluvial urban floods, characterized by high temporal and spatial variations, are not well documented. This study proposes a new, low-cost approach to determining local flood elevation and inundation depth of buildings based on user-generated flood images. It first applies close-range digital photogrammetry to generate a geo-referenced 3-D point cloud. Second, based on estimated camera orientation parameters, the flood level captured in a single flood image is mapped to the previously derived point cloud. The local flood elevation and the building inundation depth can then be derived automatically from the point cloud. The proposed method is carried out once for each of 66 different flood images showing the same building façade. An overall accuracy of 0.05 m with an uncertainty of ±0.13 m for the derived flood elevation within the area of interest as well as an accuracy of 0.13 m ± 0.10 m for the determined building inundation depth is achieved. Our results demonstrate that the proposed method can provide reliable flood information on a local scale using user-generated flood images as input. The approach can thus allow inundation depth maps to be derived even in complex urban environments with relatively high accuracies.

BACKGROUND:The primary objective of this study was to retrospectively compare short-term outcomes of intracorporeal versus extracorporeal anastomosis for minimally invasive laparoscopic and robotic-assisted right colectomies for benign and malignant disease. Recent studies suggest potential short-term outcomes advantages for the intracorporeal anastomosis technique. METHODS:This is a multicenter retrospective propensity score-matched comparison of intracorporeal and extracorporeal anastomosis techniques for laparoscopic and robotic-assisted right colectomy between January 11, 2010, and July 21, 2016. RESULTS:After propensity score-matching, there were a total of 1029 minimal invasive surgery cases for analysis-379 right colectomies (335 robotic-assisted and 44 laparoscopic) done with an intracorporeal anastomosis and 650 right colectomies (253 robotic-assisted and 397 laparoscopic) done with an extracorporeal anastomosis. There were no significant differences in any preoperative patient characteristics between groups. The minimally invasive intracorporeal anastomosis group had significantly longer operative times (p

Traditionally, bio-butanol is produced with the ABE (Acetone Butanol Ethanol) process using Clostridium species to ferment sugars from biomass. However, the route is associated with some disadvantages such as low butanol yield and by-product formation (acetone and ethanol). On the other hand, butanol can be directly produced from ethanol through aldol condensation over metal oxides/ hydroxyapatite catalysts. This paper suggests that the chemical conversion route is more preferable than the ABE process, because the reaction proceeds more quickly compared to the fermentation route and fewer steps are required to get to the product.

Single- and co-culture clostridial fermentation was conducted to obtain organic alcohols and acids from sweet sorghum juice as a low cost feedstock. Different inoculum concentrations of single cultures (3, 5, 10 v/v %) as well as different ratios of C. acetobutylicum to C. tetanomorphum (3:10, 10:3, 6.5:6.5, 3:3, and 10:10 v/v %, respectively) were utilized for the fermentation. The maximum butanol concentration of 6.49 g/L was obtained after 96 h fermentation with 10 % v/v C. acetobutylicum as a single culture. The fermentation with 10% v/v C. tetanomorphum resulted in more than 5 g/l butyric acid production. Major organic acid concentration (lactic acid) of 2.7 g/L was produced when an inoculum ratio of 6.5: 6.5 %v/v C. acetobutylicum to C. tetanomorphum was used.

Ten elementary school students in need of a positive self-image and/or a sense of appropriate social conduct took part in a monthly intergenerational visiting program at an assisted living facility. In comparison to systematic observations obtained in their classrooms, the children were observed to be significantly less anxious, more interested, and participating more during the intergenerational program. Outcomes of a focus group with five seniors revealed that they had enjoyed the program and wanted it to continue. School administrators may want to consider intergenerational visiting programs for students whose behaviors place them at risk for academic failure.

The Sources of Discomfort Scale (SODS) assesses discomfort manifestations based on source of discomfort, thus making it both distinct from and complementary to pain assessments for persons with dementia. Sources were categorized as pertaining to physical discomfort, to body position, and to environmental sources. Body position sources of discomfort were related to poor functional status and to pain. The SODS scores were not related to cognitive functioning, and sources of discomfort other than those pertaining to body position were not correlated with pain. This paper demonstrates a direct and enhanced method to detect the manifestations of discomfort separately from pain indicators in a population with advanced dementia. The determination of the source of discomfort has direct implications for intervention.

This study aimed to ascertain perceived barriers and motivators to exercise in people age 74–85 and to clarify the meaning of these barriers and motivators by examining participant characteristics that relate to them. 324 community-dwelling participants age 74–85 completed a health questionnaire that included items on barriers and motivators to exercise, as well as questions on demographic variables, health, and exercise. Selected participants then completed a physical-performance battery to measure functional performance. Barriers and motivators were related internally, as well as to many other factors including pain and depressed affect on the Geriatric Depression Scale. The findings suggest a need for individualized and comprehensive approaches to the presentation of exercise programs. Health interventions are needed that will address both physical pain and depressed affect and explain the importance of exercise even in the presence of health problems. An understanding of the context of reported barriers and motivators is necessary for correct interpretation and program development. [ABSTRACT FROM AUTHOR]

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