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OBJECT Despite the complexity of cervical spine deformity (CSD) and its significant impact on patient quality of life, there exists no comprehensive classification system. The objective of this study was to develop a novel classification system based on a modified Delphi approach and to characterize the intra- and interobserver reliability of this classification. METHODS Based on an extensive literature review and a modified Delphi approach with an expert panel, a CSD classification system was generated. The classification system included a deformity descriptor and 5 modifiers that incorporated sagittal, regional, and global spinopelvic alignment and neurological status. The descriptors included: “C,” “CT,” and “T” for primary cervical kyphotic deformities with an apex in the cervical spine, cervicothoracic junction, or thoracic spine, respectively; “S” for primary coronal deformity with a coronal Cobb angle ≥ 15°; and “CVJ” for primary craniovertebral junction deformity. The modifiers included C2–7 sagittal vertical axis (SVA), horizontal gaze (chin-brow to vertical angle [CBVA]), T1 slope (TS) minus C2–7 lordosis (TS–CL), myelopathy (modified Japanese Orthopaedic Association [mJOA] scale score), and the Scoliosis Research Society (SRS)-Schwab classification for thoracolumbar deformity. Application of the classification system requires the following: 1) full-length standing posteroanterior (PA) and lateral spine radiographs that include the cervical spine and femoral heads; 2) standing PA and lateral cervical spine radiographs; 3) completed and scored mJOA questionnaire; and 4) a clinical photograph or radiograph that includes the skull for measurement of the CBVA. A series of 10 CSD cases, broadly representative of the classification system, were selected and sufficient radiographic and clinical history to enable classification were assembled. A panel of spinal deformity surgeons was queried to classify each case twice, with a minimum of 1 intervening week. Inter- and intrarater reliability measures were based on calculations of Fleiss k coefficient values. RESULTS Twenty spinal deformity surgeons participated in this study. Interrater reliability (Fleiss k coefficients) for the deformity descriptor rounds 1 and 2 were 0.489 and 0.280, respectively, and mean intrarater reliability was 0.584. For the modifiers, including the SRS-Schwab components, the interrater (round 1/round 2) and intrarater reliabilities (Fleiss k coefficients) were: C2–7 SVA (0.338/0.412, 0.584), horizontal gaze (0.779/0.430, 0.768), TS-CL (0.721/0.567, 0.720), myelopathy (0.602/0.477, 0.746), SRS-Schwab curve type (0.590/0.433, 0.564), pelvic incidence-lumbar lordosis (0.554/0.386, 0.826), pelvic tilt (0.714/0.627, 0.633), and C7-S1 SVA (0.071/0.064, 0.233), respectively. The parameter with the poorest reliability was the C7–S1 SVA, which may have resulted from differences in interpretation of positive and negative measurements. CONCLUSIONS The proposed classification provides a mechanism to assess CSD within the framework of global spinopelvic malalignment and clinically relevant parameters. The intra- and interobserver reliabilities suggest moderate agreement and serve as the basis for subsequent improvement and study of the proposed classification.

OBJECT Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined. METHODS The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22°), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11°). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1–6) or thoracolumbar (T9–L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups. RESULTS Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 ± 12.4 years (range 20–82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL measures except the MCS score. For the entire patient cohort, the improvements ranged from 57.6% for the SRS-22 pain score MCID to 24.4% for the ODI score SCB. For patients undergoing PSO or VCR, the likelihood of their outcomes reaching MCID or SCB ranged from 24.3% to 62.3% and from 16.2% to 47.8%, respectively. The SRS-22 self-image score of patients who had a UIV in the upper thoracic region reached MCID significantly more than that of patients who had a UIV in the thoracolumbar region (70.6% vs 41.9%, p = 0.0281). All other outcomes were similar for UIVs of upper thoracic and thoracolumbar regions. Comparison of patients whose spines were above or below the radiographic thresholds associated with disability indicated similar rates of meeting MCID and SCB for HRQOL at the 2-year follow-up. CONCLUSIONS Outcomes for patients having UIVs in the upper thoracic region were no more likely to meet MCID or SCB than for those having UIVs in the thoracolumbar region, except for the MCID in the SRS-22 self-image measure. The HRQOL outcomes in patients who had optimal sagittal correction according to radiographic thresholds determined preoperatively were not significantly more likely to reach MCID or SCB at the 2-year follow-up. Future work needs to determine whether the Schwab preoperative radiographic thresholds for severe disability apply in postoperative settings.

Pedicle subtraction osteotomies are being used with increasing frequency to treat the problem of sagittal imbalance caused by a variety of diseases. Here we describe a simple technique that assists in osteotomy closure and has proved effective and reliable in maintaining correction.

Subcortical band heterotopia (SBH) is a disorder of neural migration. Also called as double cortex syndrome due to its appearance. Patient presents with mental retardation and epilepsy. Usually seizures start in first decade of life and may vary between focal seizures to generalized seizures. MRI is the diagnostic investigation of choice that reveals the characteristic findings. It is a rare disorder with only a few hundred cases reported till date.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.129-130

BACKGROUND AND OBJECTIVES: Acid-suppressing medications are used extensively in term and preterm newborns despite limited efficacy data and increasing evidence for potential harm. We sought to reduce nonindicated use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) in our level III/IV NICU by developing and implementing a guideline for their use. Our specific aim was to reduce prescriptions among infants METHODS: Our outcome measures were number of nonindicated PPI/H2RA prescriptions per month, total (indicated and nonindicated) prescriptions per month and percent of patient days with PPI/H2RA therapy. We also tracked potential complications associated with PPIs/H2RAs as secondary outcomes and gastrointestinal bleed as a balancing measure. Interventions and plan-do-study-act cycles included implementation of the initial guideline, guideline revision based on staff feedback, and staff education. By using statistical process control charts and interrupted time series analysis, we compared outcomes over an 8-month baseline period and 2 postimplementation periods spanning 19 months. RESULTS: Nonindicated prescription of PPIs/H2RAs decreased from mean 7.5 per month to 0 (P = .001). Concurrently, total PPI/H2RA prescriptions decreased from mean 11.5 per month to 2.5 (P = .002). Rates of the balancing measure and potentially related complications remained stable over time. CONCLUSIONS: Implementation of an evidence-based guideline in our unit led to a significant decrease in nonindicated use of acid-suppressing medications and reduced the burden of exposure to PPIs/H2RAs. This intervention could feasibly be implemented in other similar inpatient settings.

Retrospective review of a prospectively collected database.To define a simplified singular measure of cervical deformity (CD), C2 slope (C2S), which correlates with postoperative outcomes.Sagittal malalignment of the cervical spine, defined by the cervical sagittal vertical axis (cSVA) has been associated with poor outcomes following surgical correction of the deformity. There has been a proliferation of parameters to describe CD. This added complexity can lead to confusion in classifying, treating, and assessing outcomes of CD surgery.A prospective database of CD patients was analyzed. Inclusion criteria were cervical kyphosis10°, cervical scoliosis10°, cSVA4 cm, or chin-brow vertical angle25°. Patients were categorized into two groups and compared based on whether the apex of the deformity was in the cervical (C) or the cervicothoracic (CT) region. Radiographic parameters were correlated to C2S, T1 slope (T1S) and 1-year health-related quality-of-life outcomes as measured by the EuroQol 5 Dimension questionnaire (EQ5D), modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and the Neck Disability Index (NDI).One hundred four CD patients (C = 74, CT = 30; mean age 61 yr, 56% women, 42% revisions) were included. CT patients had higher baseline cSVA and T1S (P 0.05). C2S correlated with T1 slope minus cervical lordosis (TS-CL) (r = 0.98, P 0.001) and C0-C2 angle, cSVA, CL, T1S (r = 0.37-0.65, P 0.001). Correlation of cSVA with C0-C2 was weaker (r = 0.48, P 0.001). At 1-year postoperatively, higher C2S correlated with worse EQ-5D (r = 0.28, P = 0.02); in CT patients, higher C2S correlated with worse NDI, modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and EQ5D (all r 0.5, P≤0.05). Using linear regression, moderate disability by EQ5D corresponded to C2S of 20°(r = 0.08). For CT patients, C2S = 17° corresponded to moderate disability by NDI (r = 0.4), and C2S = 20° by EQ5D (r = 0.25).C2S correlated with upper-cervical and subaxial alignment. C2S correlated strongly with TS-CL (R = 0.98, P 0.001) because C2S is a mathematical approximation of TS-CL. C2S is a useful marker of CD, linking the occipitocervical and cervico-thoracic spine. C2S defines the presence of a mismatch between cervical lordosis and thoracolumbar alignment. Worse 1-year postoperative C2 slope correlated with worse health outcomes.3.

Nanofluids are suspension of nanoparticles (less than 100 nm) in the conventional base fluids. The dispersed solid metallic or non-metallic nanoparticles change the thermal properties like thermal conductivity, viscosity, specific heat, and density of the base fluid. Past studies focused on measuring the thermal properties of nanofluids. These suspended nanoparticles effectively improve the transport properties and heat transfer characteristics of the base fluids. Recently, heat transfer augmentation using suspensions of nanometre-sized solid particles in base liquids have been investigated by various research groups across the world. This paper reviews the state-of-the-art nanofluid studies in the area of forced convection heat transfer enhancement. The results for the heat transfer characteristics in internal flow with constant heat flux and constant wall temperature boundary conditions reported by various researchers have been compiled and reviewed. Further, in heat exchangers, the real boundary conditions are different from the constant heat flux and constant wall temperature boundary conditions. Over a span of 2 decades, the literature in this field is widespread; hence, this review would be useful for researchers to have a precise screening of a wide range of investigations in this area.

Few studies have examined threshold improvements in health-related quality of life (HRQOL) by measuring minimal clinically important differences (MCIDs) in treatment of adult spinal deformity. We hypothesized that patients undergoing operative treatment would be more likely to achieve MCID threshold improvement compared with those receiving nonoperative care, although a subset of nonoperative patients may still reach threshold.We analyzed a multicenter, prospective, consecutive case series of 464 patients: 225 nonoperative and 239 operative. To be included in the study, patients had to have adult spinal deformity, be older than 18 years, and have both baseline and 1-year follow-up HRQOL measures (Oswestry Disability Index [ODI], Short Form-36 [SF-36] health survey, and Scoliosis Research Society-22 [SRS-22] questionnaire). We compared the percentages of patients achieving established MCID thresholds between operative and nonoperative groups using risk ratios (RR) with a 95% confidence interval (CI).Compared to nonoperative patients, surgical patients demonstrated significant mean improvement (P0.01) and were more likely to achieve threshold MCID improvement across all HRQOL scores (ODI RR = 7.37 [CI 4.45, 12.21], SF-36 physical component score RR = 2.96 [CI 2.11, 4.15], SRS Activity RR = 3.16 [CI 2.32, 4.31]). Furthermore, operative patients were more likely to reach threshold MCID improvement in 2 or more HRQOL measures simultaneously and were less likely to deteriorate.Patients in both the operative and nonoperative treatment groups demonstrated improvement in at least one HRQOL measure at 1 year. However, surgical treatment was more likely to result in threshold improvement and more likely to lead to simultaneous improvement across multiple measures of ODI, SF-36, and SRS-22. Although a subset of nonoperative patients achieved threshold improvement, nonoperative patients were significantly less likely to improve in multiple HRQOL measures and more likely to sustain MCID deterioration or no change.

The feasibility of using sulfate-reducing bacteria to remove heavy metals from aqueous streams such as acid mine drainage was evaluated using three anaerobic reactors: an upflow anaerobic sludge blanket (UASB) reactor, a packed filter reactor, and a filter reactor that was partially packed with floating plastic pall rings. The packed filter reactors removed more than 99% of the influent metals. The performance of the partially packed reactor was superior based on effluent metal and sludge concentrations. Although the UASB reactor reduced the concentration of dissolved iron, the effluent concentration of total suspended solids remained greater than 18 g/L. This elevated solids concentration indicated that the UASB reactor was not operating as an effective clarifier, and, as a result, UASB reactor operation was discontinued after 4 months. The packed filter reactors were operated in parallel and received influent containing a combination of heavy metals. By withdrawing sludge from the bottom of these reactors, the accumulation of solids such as metal precipitates and biomass was controlled. The effluent concentrations of most metals were low, often less than drinking water standards, with the exception of manganese.

A Wireless Sensor Network (WSN) has very specific characteristics and unique requirements. The fundamental function of a wireless sensor network is the collection of information from an area of interest. Information collected by the sensor nodes deployed in the network is processed by Base Station (BS) according to the applications. Wireless sensor networks have raised tremendous research interests in recent years because of their tremendous potential in military and civil applications. Keeping these factors in mind, in this paper we proposed a Scalable Energy Efficient Deployment Scheme (SEEDS) for homogeneous WSN. In SEEDS the deployment area is logically divided into number of regular hexagons by BS and Mobile Sensor Nodes (MSNs) are instructed to place themselves at the centers of these regular hexagons (known as preferred locations) for optimal coverage. After their random deployment, MSNs in the deployment area start moving towards the preferred locations on the instruction provided by BS with an aim to minimize average movement. The proposed scheme is compared with Connectivity Preserved Virtual force scheme (CPVF) and Floor-based scheme (FLOOR). From simulation results we observed that the proposed scheme is better in terms of average movement required to setup the network. The proposed scheme is scalable because of its distributed nature.

Multicenter, retrospective, consecutive case series.This study aims to identify demographic and radiographical characteristics that influence the decision to perform revision surgery among patients with proximal junctional failure (PJF).Revision rates after PJF remain relatively high, yet the decision criteria for performing revision surgical procedures are not uniform and vary by surgeon. A better understanding of the factors that impact the decision to perform revision surgery is important in order to improve efficiency of surgical treatment of adult spinal deformity.A cohort of 57 patients with PJF was identified retrospectively from 1218 consecutive patients with adult spinal deformity. PJF was identified on the basis of 10° postoperative increase in kyphosis between upper instrumented vertebra (UIV) and UIV +2, along with 1 or more of the following: fracture of the vertebral body of UIV or UIV +1, posterior osseoligamentous disruption, or pullout of instrumentation at the UIV. Univariate statistical analysis was performed using t tests and Fisher exact tests. Multivariate analysis was performed using logistic regression.Twenty-seven (47.4%) patients underwent revision surgery within 6 months of the index operation. Regression results revealed that patients with combined posterior/anterior approaches at index were significantly more likely to undergo revision (P = 0.001) as were patients with more extreme proximal junctional kyphosis angulation (P = 0.034). Patients sustaining trauma were also significantly more likely to undergo revision (P = 0.019). Variables approaching but not reaching significance as predictors of revision included female sex (P = 0.066) and higher sagittal vertical axis (SVA) (P = 0.090).The decision to perform revision surgery is complicated and varies by surgeon. Factors that seem to influence this decision include traumatic etiology of PJF, severity of proximal junctional kyphosis angulation, higher SVA, and female sex. Factors that were expected to influence revision but had no statistical effect included soft tissue versus bony mode of failure, age, levels fused, and upper thoracic versus thoracolumbar proximal junction.

Study design Multicenter, prospective, consecutive series. Objective To evaluate responsiveness of the Scoliosis Research Society (SRS)-Schwab adult spinal deformity (ASD) classification to changes in health-related quality of life (HRQOL) after treatment for ASD. Summary of background data Ideally, a classification system should describe and be responsive to changes in a disease state. We hypothesized that the SRS-Schwab classification is responsive to changes in HRQOL measures after treatment for ASD. Methods A multicenter, prospective, consecutive series from the International Spine Study Group. Inclusion criteria ASD, age more than 18, operative or nonoperative treatment, baseline and 1-year radiographs, and HRQOL measures (Oswestry Disability Index [ODI], SRS-22, Short Form [SF]-36). The SRS-Schwab classification includes a curve descriptor and 3 sagittal spinopelvic modifiers (sagittal vertical axis [SVA], pelvic tilt, pelvic incidence/lumbar lordosis [PI-LL] mismatch). Changes in modifiers at 1 year were assessed for impact on HRQOL from pretreatment values based on minimal clinically important differences. Results Three hundred forty-one patients met criteria (mean age = 54; 85% females; 177 operative and 164 nonoperative). Change in pelvic tilt modifier at 1-year follow-up was associated with changes in ODI and SRS-22 (total and appearance scores) (P ≤ 0.034). Change in SVA modifier at 1 year was associated with changes in ODI, SF-36 physical component score, and SRS-22 (total, activity, and appearance scores) (P ≤ 0.037). Change in PI-LL modifier at 1 year was associated with changes in SF-36 physical component score and SRS-22 (total, activity, and appearance scores) (P ≤ 0.03). Patients with improvement of pelvic tilt, SVA, or PI-LL modifiers were significantly more likely to achieve minimal clinically important difference for ODI, SF-36 physical component score (SVA and PI-LL only), SRS activity, and SRS pain (PI-LL only). Conclusion The SRS-Schwab classification provides a validated system to evaluate ASD, and the classification components correlate with HRQOL measures. This study demonstrates that the classification modifiers are responsive to changes in disease state and reflect significant changes in patient-reported outcomes. Level of evidence 3.

Formal training in health care quality and safety has become an important component of medical education at all levels, and quality and safety are core concepts within the practice-based learning and system-based practice medical education competencies. Residency and fellowship programs are rapidly attempting to incorporate quality and safety curriculum into their training programs but have encountered numerous challenges and barriers. Many program directors have questioned the feasibility and utility of quality and safety education during this stage of training. In 2010, we adopted a quality and safety educational module in our neonatal fellowship program that sought to provide a robust and practical introduction to quality improvement and patient safety through a combination of didactic and experiential activities. Our module has been successfully integrated into the fellowship program’s curriculum and has been beneficial to trainees, faculty, and our clinical services, and our experience suggests that fellowship may be particularly well suited to incorporation of quality and safety training. We describe our module and share tools and lessons learned during our experience; we believe these resources will be useful to other fellowship programs seeking to improve the quality and safety education of their trainees.

The kinetics of chloroform cometabolism in methanogenic and sulfate-reducing environments were modeled. Chloroform inhibits acetate utilization in methanogenic environments and therefore the rate of chloroform cometabolism was modeled using two terms: cometabolism due to primary substrate utilization and cometabolism due to microbial cell decay (no primary substrate utilization). The modified Haldane equation was used to model chloroform cometabolism due to primary substrate utilization and the Monod equation was used for the cometabolism due to microbial cell decay. A commercial software, SigmaPlot (Jandel Scientific Software) was used to determine the optimum parameters for the model. The model agreed very well with the experimental results. The model parameters confirmed that the sulfate-reducing culture has a very high potential for chloroform cometabolism compared to the methanogenic cultures. Also, the methanogenic culture grown on acetate is very sensitive to chloroform compared to the methanogenic culture grown on methanol.

Biotransformation of chloroform (CF) was studied in a sulfate-reducing culture utilizing acetic acid as the primary substrate. In a chemostat, CF and its biotransformation product, dichloromethane (DCM) were transformed and CF removal efficiency of more than 96% was achieved, with influent CF concentrations up to 16.74 μM. Serum bottle reactor tests were conducted using the culture from the chemostat with an average VSS concentration of 259 mg/l. These tests showed that the culture exhibited a maximum rate of CF transformation of 16.3 μM/h corresponding to an initial CF concentration of 22.6 μM. The culture degraded CF primarily by reductive dehalogenation leading to the formation of DCM which degraded at a very slow rate compared to CF. No inhibition of acetic acid utilization was observed in the culture for CF concentrations as high as 29.3 μM. Compared to no acetic acid addition, acetic acid at 50 mg/l considerably increased the rate of CF transformation but further increase in acetic acid concentration to 200 mg/l did not affect the rate of CF biotransformation. Additional acclimation of the culture for 1 yr did not affect the rate of transformation of CF. The results indicate that the sulfate-reducing culture has much higher rates of CF transformation than a methanogenic culture, also grown on acetic acid at the same concentration.

Biotransformation of chloroform (CF) was studied in a methanogenic environment utilizing acetic acid as the primary substrate. CF removal efficiency of more than 99% was achieved in a chemostat, fed constant acetic acid concentration (2510 mg/l) and different CF concentrations, up to 16.74 μM. Biological methane potential tests were conducted in serum bottles using the culture from the chemostat with an average biomass concentration of 53 mg/l. The culture exhibited a maximum rate of CF transformation of 0.26 μM/h corresponding to an initial CF concentration of 1.25 μM. At initial CF concentrations higher than 2.76 μM, the rate of CF transformation became constant at 0.06 μM/h. CF present at any concentration inhibited the utilization of acetic acid, and at CF concentrations equal to or exceeding 2.7 μM, the culture was completely inhibited and no acetic acid was utilized by the culture even after the CF was completely degraded. The culture transformed CF without the addition of acetic acid, but the addition of acetic acid considerably increased the rate of biotransformation. However, increase in acetic acid concentration beyond 50 mg/l did not increase the rate. The culture exhibited higher rates of CF biotransformation when it was acclimated with higher influent concentration of CF in a chemostat. Reductive dehalogenation was one of the pathways for the transformation of CF leading to the formation of dichloromethane which was also transformed by the culture.

We performed a meta-analysis of randomized trials that compared percutaneous transluminal coronary angioplasty (PTCA) with coronary artery bypass graft (CABG) surgery in patients with multivessel coronary artery disease. The outcomes of death, combined death, and nonfatal myocardial infarction (MI), repeat revascularization, and freedom from angina were analyzed. The overall risk of death and nonfatal MI was not different over a follow-up of 1 to 3 years (CABG:PTCA odds ratio [OR] 1.03, 95% confidence interval 0.81 to 1.32, p = 0.81). Patients randomized to CABG tended to have a higher risk of death or MI in the early, periprocedural period (OR 1.33, p = 0.091), but a lower risk in subsequent follow-up (OR 0.74, p = 0.093). CABG patients were much less likely to undergo another revascularization procedure (p < 0.00001), and were more likely to be angina free (OR 1.57, p < 0.00001). Thus, CABG and PTCA patients have similar overall risks of death and nonfatal MI at 1 to 3 years of follow-up, but relative risk differences in mortality of up to 25% cannot be excluded. CABG patients have significantly less angina and less repeat revascularization than PTCA patients.

Presently, fly ash is transporting through slurry pipeline in the thermal power plant. Aim of the present investigation is to examine the rheological behaviour of finer particle (fly ash) slurry suspension with and without addition of coarser particles (bottom ash). Mixture of fly and bottom ash is taken with proportion of 9:1, 8:2 and 7:3 (by weight). The temperature of slurry suspension is varying from 25 to 40°C at solid concentration 30 % (by weight). Rheological tests are conducted with the variation of shear rate from 100 to 300 sec-1 for all slurry samples. Addition of coarse particles of bottom ash in finer particles of fly ash slurry, leads to improve the rheological characteristics of slurry suspension. The addition of bottom ash can result substantial saving in energy consumption with reduction in relative viscosity.

Nanotechnology covers a wide range of materials and techniques With the development of semiconductors, bringing computers down to palm-size, scientists, telecommunication, medicine, biotechnology environmental energy, and universe security of which the risks and unknowns vary greatly. Nano material may pass easily into the bloodstream when inhaled or swallowed, and possibly when applied to the skin. Once inside the body, they seem to have access to most or all tissues and organs, including the brain. It is unknown whether nano materials can pass from a pregnant woman's blood circulation to the fetal circulation or through breast milk to a nursing infant. These data demonstrate that inhalation of nano-size chemical pollutants is associated with asthma attacks, heart disease, strokes, and respiratory disease. At this stage it is useful to present the arguments of the enthusiasts who project the revolutionary potential of nano science and nanotechnology and those of the skeptics who seem to question the revolutionary potential Paper describes that how nano is everywhere.

Filters play a trifling role in every electronic system. The basic serviceable need for filtering is to pass an assortment of frequencies while rejecting others. This need for filtering has a lot of technical uses in the digital signal processing (DSP) areas of data communications, imaging, digital video, and voice communications. The idea of this paper is to design Butter worth IIR filter for the signal analysis using MATLAB. By this approach we will denoise the digital signal. We also consider different parameters of Butter worth low pass filter such as Cut off frequency and order of the filter and see the variation of these parameter on noise.

A new method was developed using a flow-through cell for the measurement of oxidation-reduction potential (ORP) for anaerobic microbial cultures. The method involves passing the reactor effluent through a recycle line equipped with an ORP probe. Stable ORP values were obtained for two different anaerobic reactors, operating under steady-state conditions, for more than 2 months. One of the reactors was strictly methanogenic and the other was sulfate-reducing. A comparison of ORP measurements by this method with conventional measurement techniques showed this method minimizes uncertainty in the measurement as a result of hydrodynamic limitations, temperature changes, and oxygen contamination of the sample. It prevents fouling of the ORP probe by allowing for easy cleaning of the probe and checking for calibration before use. The method can also be used for both batch reactors and chemostats (CSTR).

Six anaerobic chemostats containing mixed microbial cultures were used to investigate the interactions between sulfate reduction and methanogenesis for three substrates: acetic acid, methanol and formic acid. Sulfate reducers outcompeted methanogens in acetate-fed chemostats while methanol was not utilized by sulfate reducers. In the formic acid-fed chemostats, competition was observed between methanogens and sulfate reducers with 62 and 24% of the substrate utilized through sulfate reduction and methanogenesis, respectively. Iron was added to the sulfate-reducing chemostats to precipitate the hydrogen sulfide produced, thus eliminating sulfide inhibition and ensuring stable chemostat operation. This study involved the measurement of the oxidation-reduction potential (ORP) of the chemostats using a novel technique. Batch spike tests were also conducted to evaluate kinetic parameters for the degradation of different substrates. Although both methanol-fed chemostats were exclusively methanogenic, scanning electron microscopy (SEM) analysis revealed the presence of two different strains of methanogens. This difference was also manifested by the ORP values and the kinetic parameters.

Sagittal spinopelvic imbalance is a major contributor to pain and disability for patients with adult spinal deformity (ASD). Preoperative planning is essential for pedicle subtraction osteotomy (PSO) candidates; however, current methods are often inaccurate because no formula to date predicts both postoperative sagittal balance and pelvic alignment. The authors of this study aimed to evaluate the accuracy of 2 novel formulas in predicting postoperative spinopelvic alignment after PSO.This study is a multicenter retrospective consecutive PSO case series. Adults with spinal deformity (21 years old) who were treated with a single-level lumbar PSO for sagittal imbalance were evaluated. All patients underwent preoperative and a minimum of 6-month postoperative radiography. Two novel formulas were used to predict the postoperative spinopelvic alignment. The results predicted by the formulas were then compared with the actual postoperative radiographic values, and the formulas' ability to identify successful (sagittal vertical axis [SVA] ≤ 50 mm and pelvic tilt [PT] ≤ 25°) and unsuccessful (SVA50 mm or PT25°) outcomes was evaluated.Ninety-nine patients met inclusion criteria. The median absolute error between the predicted and actual PT was 4.1° (interquartile range 2.0°-6.4°). The median absolute error between the predicted and actual SVA was 27 mm (interquartile range 11-47 mm). Forty-one of 54 patients with a formula that predicted a successful outcome had a successful outcome as shown by radiography (positive predictive value = 0.76). Forty-four of 45 patients with a formula that predicted an unsuccessful outcome had an unsuccessful outcome as shown by radiography (negative predictive value = 0.98).The spinopelvic alignment formulas were accurate when predicting unsuccessful outcomes but less reliable when predicting successful outcomes. The preoperative surgical plan should be altered if an unsuccessful result is predicted. However, even after obtaining a predicted successful outcome, surgeons should ensure that the predicted values are not too close to unsuccessful values and should identify other variables that may affect alignment. In the near future, it is anticipated that the use of these formulas will lead to better surgical planning and improved outcomes for patients with complex ASD.

The encephalomyocarditis virus 3C protease has been observed to undergo rapid degradation, both in vivo in mouse cells and in vitro in reticulocyte lysate. Experiments were carried out to characterize the turnover of the 30 protease in reticulocyte lysate. 3C protease prepared in reticulocyte lysate by in vitro translation and processing of a precursor polyprotein could be separated from the proteolytic activity responsible for its degradation. This implies the 3C protease is not directly involved in its own proteolysis. Active 30 protease flanked by only a few amino acids was degraded at a rate identical to that of a similar protein containing an inactivated catalytic site. This indicates that 3C protease activity is not indirectly required for the proteolytic process. Other vital proteins, including the 3D polymerase and capsid proteins, were relatively stable in the lysate. In addition, polyprotein precursors containing 3C protease with an inactive catalytic site and various flanking proteins displayed distinctly different stabilities. These results suggest that the reticulocyte proteolytic system functions in a selective manner toward the vital proteins. The effects of several proteolytic inhibitors on the lysate proteolytic system were evaluated. The results of these experiments indicate that the rapid degradation of the EMC virus 3C protease requires the hydrolysis of ATP.

Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters.In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed.Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p0.001), increased thoracic kyphosis (from 30° to 38°, p0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p0.001 and from +3° to -4°, p0.001, respectively), and decreased PT (from 31° to 23°, p0.001). More caudal PSO was correlated with greater PT reduction (r = -0.410, p0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = -0.474, p0.001), lumbar lordosis (r = 0.667, p0.001), sacral slope (r = 0.426, p0.001), and PT (r = -0.358, p0.005).The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

The purpose of this study was to describe infection control practices for influenza in mother and newborn units in United States hospitals in the context of the 2009 H1N1 pandemic. We conducted surveys of neonatal intensive care unit directors in February and November 2010 and requested information on infection control practices during the 2009 and 2010 influenza seasons. We received 111 responses to the initial survey and 48 to the follow-up survey. In 2009, 58% of respondents restricted breastfeeding by mothers with influenza-like illness; 42% did not. Ninety percent of the respondents maintained physical separation between an ill mother and her newborn infant, although the approaches to this separation varied. Eighty percent of postpartum units and 89% of neonatal intensive care units restricted access by children. In 2010, fewer hospitals restricted mother-infant contact and children visitation compared with 2009. Infection control practices for influenza in mother and newborn units vary considerably in US hospitals, particularly regarding contact between an ill mother and her newborn infant. The identification of this variation may inform best practices in this area, as well as future investigations and future guideline development.

Quantitative gene expression analysis and immunohistochemistry were used to investigate the temporal and spatial expression of bone morphogenic proteins (BMPs) and BMP antagonists in a posterolateral spine fusion model in rabbits. To identify the expression pattern of BMPs and BMP antagonists and to determine the molecular and histologic changes of the graft and surrounding tissue during fusion. There are no studies on BMP antagonists during spinal fusion. Furthermore, the reciprocal interaction between bone grafts and surrounding tissue is still unknown in fusion. Eighteen New Zealand White rabbits underwent bilateral posterolateral spine fusion with autogenous bone graft. Rabbits were killed at 1, 2, 4, or 6 weeks after arthrodesis. The spinal fusions were analyzed by radiography. On the right side, specimens were collected from the outer zone over the transverse processes, the inner zone between the transverse processes, muscle surrounding bone grafts, and the transverse process. Gene expression of BMP-2, BMP-4, and BMP-7, noggin, chordin, Sox9, and Runx2 were measured by real-time polymerase chain reaction at each time point of each sample. On the left side, molecules of interest were evaluated by immunohistochemistry on tissue sections. BMP-2, BMP-4, and BMP-7, noggin, and chordin were colocalized in rimming osteoblasts, osteoclasts, and chondrocytes. The outer zone demonstrated earlier bone maturation and faster increase in BMP gene expression than the inner zone. Muscle surrounding bone grafts showed significantly higher BMP expression and Runx2 activity at the early phase. BMP-positive cells were also noted around blood vessels. The colocalization and temporal relationship of BMPs and BMP antagonists suggests that BMP activity is tightly regulated by the antagonists during fusion. In addition, not only the decorticated transverse process, but also muscle surrounding bone grafts, is actively involved in osteogenesis during fusion.

To determine the percentage of deaths in level III neonatal intensive care unit (NICU) settings that theoretically would have been eligible for donation after cardiac death (DCD), as well as the percentage of these who would have been potential DCD candidates based on warm ischemic time.We conducted a retrospective study of all deaths in 3 Harvard Program in Neonatology NICUs between 2005 and 2007. Eligible donors were identified based on criteria developed with our transplantation surgeons and our local organ procurement organization. Potential candidates for DCD were then identified based on an acceptable warm ischemic time.Of the 192 deaths that occurred during the study period, 161 were excluded, leaving 31 theoretically eligible donors. Of these, 16 patients had a warm ischemic time of1 hour and were potential candidates for DCD of 14 livers and 18 kidneys, and 14 patients had a warm ischemic time of30 minutes and were potential candidates for DCD of 10 hearts.Eight percent of NICU mortalities were potential candidates for DCD. Based on the size of the potential donor pool, establishing an infant DCD protocol for level III NICUs should be considered.

A 45-year-old woman, a restrained passenger, was involved in a rollover motor vehicle crash. She was taken to the closest hospital and diagnosed with a severe neck injury and transferred to a tertiary referral center. She had a sensory level at C6 with 4/5 strength in biceps and deltoid only. She also had a flicker of wrist extension on the right. There was no motor or sensory function below C6 in her bilateral upper or lower extremities. Initial CT scan, and model representation is shown in (Fig. 12.1).

Infrared astronomical instruments require absorptive coatings on internal surfaces to trap scattered and stray photons. This is typically accomplished with any one of a number of black paints. Although inexpensive and simple to apply, paint has several disadvantages. Painted surfaces can be fragile, prone to shedding particles, and difficult to clean. Most importantly, the vacuum performance is poor. Recently a plasma enhanced chemical vapor deposition (PECVD) process was developed to apply thick (30 μm) diamond-like carbon (DLC) based protective coatings to the interior of oil pipelines. These DLC coatings show much promise as an infrared black for an ultra high vacuum environment. The coatings are very robust with excellent cryogenic adhesion. Their total infrared reflectivity of < 10% at normal incidence approaches that of black paints. We measured outgas rates of -12 Torr liter/sec cm 2 , comparable to bare stainless steel.

Introduction There is a lack of long-term outcomes in the existing cost-effectiveness literature. This study examines the long-term cost-effectiveness of surgical treatment of ASD with a Markov model populated by estimates from literature and observed data on hospital costs and outcomes. Using estimates from literature and observed data on costs and health-related quality-of-life (HRQOL) outcomes, we simulate costs and outcomes for surgical and nonsurgical treatment to estimate incremental cost-effectiveness ratios (ICERs) after 10- and 20-year follow-up. Material and Methods We develop a robust Markov model with parameter uncertainty, incorporating costs, and outcome distributions from published literature and observed patient data. Summary statistics on mortality rates, revision rates, and nonsurgical costs are taken from the literature, whereas statistics for surgical costs and QALYs are taken from a single-center, retrospective administrative data set and a multicenter prospective data set. Costs of surgery are measured as total hospital costs from administrative records. QALYs were calculated from the SF-6D. We projected costs and QALYs for the surgical and nonsurgical populations allowing varied readmission, cost, and QALY outcomes over 10- and 20-year follow-up. Costs for surgical and nonsurgical patients are intended to reflect the full spectrum of services incurred for surgical or nonsurgical care (e.g., physical therapy, pain management, etc.). Costs and QALYs were in 2010 dollars and discounted at 3.5%. Our results are based on 1,000 simulated patients, each proceeding through 6-month cycles over a 10- and 20-year follow-up periods. Confidence intervals are formed by repeating the simulations for 1,000 iterations. Results Discounted surgical costs averaged $170,523 over 10-year follow-up, with average discounted QALYs of 6.3. Meanwhile, nonsurgical costs averaged $40,046 over 10-year follow-up with average QALYs of 5.4. This resulted in an average ICER from surgical treatment of $144,000 (95% CI: $121,500–$177,500) per QALY gained. Over 20-year follow-up, surgical costs averaged $208,616 and QALYs averaged 9.8, whereas nonsurgical costs averaged $63,467 and QALYs averaged 8.6. Over 20-year follow-up, the ICER decreased (became more cost-effective) to $115,000 (95% CI: $88,850–$156,200) per QALY gained. Conclusion Our results illustrate the potential for surgical treatment for ASD to be cost-effective over extended follow-up compared with nonsurgical treatment. These findings argue in favor of longer follow-up in ASD studies for accurate cost-effectiveness comparison. Future research should also pursue measurement of indirect costs/benefits resulting from changes in absenteeism or productivity.

Introduction Adults with spinal deformity typically present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for ASD based on a prospective, multicenter patient population. Patients and Methods This is a multicenter, prospective analysis of consecutive patients with ASD electing for op or non-op care at enrollment. Inclusion criteria are age > 18 years and ASD. Propensity scores were used to match an op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI–LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met criteria, including 286 op and 403 non-op, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS ( p 0.11). Overall, 97 matched op–non-op pairs were identified based on propensity scores. At last follow-up, the 97 matched op patients had significant improvement in all HRQL measures assessed ( p 0.20). Paired op–non-op analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed ( p Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, non-op treatment appears to at best maintain presenting levels of pain and disability.

Introduction A high prevalence of residual cervical deformity (CD) has been identified following surgical treatment of adult spinal deformity (ASD). Development of the new onset CD is less understood and its clinical impact unclear. This study quantifies the incidence of new onset CD after ASD surgery, identifies predictors of development, and determines the impact outcomes. Materials and Methods Retrospective review of a prospective multicenter database yielded 215 patients (pts) with complete 2-year follow-up and full length X-rays including the cervical spine. CD was defined by T1S–CL > 20 degrees, C2C7 SVA > 40 mm, or C2C7 kyphosis > 10 degrees. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new CD. The impact of CD on health-related quality of life (HRQL) and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders. Results Of the 215, 88 pts with ASD did not have CD at baseline and 42 of them (47.7%) developed CD at 2 years' postoperatively. Univariate analysis revealed that pts who developed new CD in the postoperative period had a higher incidence of diabetes (14.29 vs. 2.17%, p = 0.036) increased preoperative C2C7 SVA ( p = 0.04) and C2 slope ( p = 0.038) and smaller diameter rods used at surgery ( p = 0.0328). Independent predictors of new CD at 2 years included diabetes (OR, 10.49; p = 0.046) and increased preoperative TS–CL (OR, 1.08/deg, p = 0.027). Ending instrumentation below T4 was a negative predictor of CD (OR, 0.31; p = 0.019). Pts with and without CD experienced improvements in 2-year SF-36 ( p = 0.0001), ODI ( p = 0.0001), and SRS ( p = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction ( p = 0.28). Conclusion Overall, 47.7% of pts without preoperative CD develop new postoperative CD after ASD surgery. Independent predictors of new onset CD at 2 years include diabetes, higher preoperative TS–CL, and ending instrumentation above T4. Significant improvements in HRQL scores occurred despite the development of postoperative CD.

Introduction Elderly patients with adult spinal deformity (ASD) often report worse health-related quality of life (HRQOL) than younger patients. Increasing age is associated with increased surgical morbidity. The objective of this study was to compare the outcomes of patients with ASD older than 75 years managed operatively (OP) and nonoperatively (NONOP). Materials and Methods A retrospective review of a multicenter prospective ASD database was conducted. Inclusion criteria included age ≥ 75 years, ASD. Demographics, comorbidities, radiographs, complications, and HRQOL measures collected included pain with visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and Scoliosis Research Society-22 (SRS22) at baseline, 1 and 2 years. Results A total of 32 patients met criteria (OP: 17, NONOP: 15), all had a minimum 2-year clinical and radiographic follow-up. Of the 32 patients, 13 were at least 80 years of age. There were no significant differences between OP and NONOP for age, BMI, and Charlson Comorbidity Index ( p > 0.05 for all). OP had worse baseline ODI, PCS, SRS Activity, Appearance, and Total than NONOP ( p 0.05). Of the 17 OP patients, 10 (58.8%) had at least one complication with a total of 27 complications including a 64.7% rate of PJK and a 35.3% rate of reoperation. Conclusion Elderly patients ≥ 75 years undergoing ASD surgery had significantly improved HRQOL and radiographic measures over baseline at 2 years compared with a similar nonoperative cohort, despite substantial operative morbidity. This data may be used for preoperative patient counseling in this high-risk elderly population.

Introduction Decision makers and payers are placing increasing scrutiny on the costs and outcomes associated with complex spine surgery. To justify higher cost practice patterns, there must be evidence of additional patient benefit; however, little is currently known regarding the variation in resources used and associated outcomes in complex spine surgeries. Our study examines multicenter variability in patient-level surgical resource use, including implants, biologics, and length of stay, alongside health-related quality-of-life (HRQoL) improvements following adult spinal deformity (ASD) surgery. Material and Methods This is a retrospective analysis of a multicenter prospective database of consecutive patients with ASD. HRQoL outcomes were calculated from the ODI, SRS-22, and SF-36 domain scores. Changes in HRQoL were estimated as the difference between baseline and 2-year values. Patient-level surgical resources included blood use, bone morphogenetic protein (BMP), volume (ccs), length of stay (LOS), and implants. Patients were classified by sagittal modifier and analyzed across centers. The three sagittal modifier types are defined as follows: mild (SVA 9.5 cm, PT > 30 degrees, PI–LL > 20 degrees). Statistical analysis was performed using analysis of variance (ANOVA) and multivariable regression methods comparing HRQoL outcomes and resource use across center, considering the overall patient cohort and each modifier group. Results Baseline and 2-year HRQoL data were available for 226 surgical patients with ASD, with an average age of 56 (range, 18–84 years) years who were predominantly female ( N = 189, 84%). Significant differences were found in the average 2-year change in HRQoL across centers, however, this difference becomes insignificant after controlling for patients within the same major modifier groups ( p > 0.05). Significant differences were found across centers in average resources used per surgery ( p 0.05). Significant differences were found in average BMP and screw use across all modifier groups. After accounting for clinical, demographic, and regional characteristics at the patient level, variation among centers persisted in both screw use and total BMP volume with no corresponding statistical differences in HRQoL outcomes. Conclusion The use of additional surgical resources does not appear to impact 2-year HRQoL outcomes following surgery for ASD. To improve efficiency in ASD surgery, standardization of physician practice patterns and resource use could help curb costs without negatively impacting patient HRQoL.

Introduction The sagittal plane is the primary driver of disability in patients with ASD and spinopelvic radiographic thresholds have been established for pelvic tilt (PT), pelvic incidence (PI), and lumbar lordosis mismatch (PI–LL), and C7 sagittal vertical axis (SVA) in which disability occurs based on an ODI of ≥ 40. However, the patients' age was not accounted for in determining these thresholds and ODI has been shown to vary with age. The objective was to determine new thresholds based on age. Patients and Methods This is a multicenter, prospective study of consecutive patients with ASD. Inclusion criteria included patients with ASD with the age > 18 years. Patients were stratified into the following age groups: ≤ 45, 46 to 64, 65 to 74, and ≥75 years. Multivariate linear regressions were conducted for baseline PT, PI-LL, and SVA with baseline ODI and age on all patients. On the basis of the previous studies, an ODI of 40 was used as the threshold for disability. Individual patient thresholds were calculated based on their age. The thresholds were averaged across the age groups. Results A total of 833 patients were included (396 operative and 437 nonoperative). Patients with only sagittal deformity for the age groups were the following: ≤ 45 (18.8%), 46 to 64 (19.4%), 65 to 74 (40.1%), and ≥ 75 (50%). Age alone significantly predicted ODI ( r2 = 0.17, p 2 = 0.27, p 2 = 0.27, p 2 = 0.32, p Conclusion Spinopelvic radiographic thresholds correlated to moderate-to-severe regional low back disability increase as patients age. These results suggest that preoperative surgery planning and patient counseling should consider the patients' age. Further study of Schwab–SRS sagittal modifier correction goals for individual age groups is warranted.

Introduction Adults with spinal deformity typically present with pain and disability. Aim Our objective was to compare outcomes for operative (op) and nonoperative (nonop) treatment for ASD based on a prospective, multicenter patient population. Material and Methods This is a multicenter, prospective analysis of consecutive ASD patients electing for op or nonop care at enrollment. Inclusion criteria: age > 18 year and ASD. Propensity scores were used to match op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI-LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met with the criteria, including 286 op and 403 nonop, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS ( p Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, nonop treatment appears to at best maintain presenting levels of pain and disability.

Introduction A high prevalence of cervical deformity (CD) has been identified among adult spinal deformity (ASD) patients undergoing surgical treatment. The clinical impact of this is uncertain. This study aims to quantify the difference in patient-reported outcomes among ASD patients based on presence of CD before treatment. Material and Methods Retrospective review of a multicenter prospective database of surgical ASD patients with 2-year follow-up. CD was defined as: C2C7 SVA > 4 cm, cervical kyphosis (CK) C2C7angle > 0. Univariate testing was performed using t-tests, or tests of proportion. Multivariate models determined impact of preoperative CD on health-related quality of life (HRQL) scores (SF-36, ODI, and SRS) and obtaining minimally clinically important difference (MCID) at 2 years. Results A total of 235 patients met the criteria, of which 65 with preoperative C2C7 SVA > 4 cm, 57 with CK. Patients with and without CD saw improvements in 2-year HRQL scores ( p 4 cm had worse ODI, PCS, SRS activity, appearance, pain, and total, and were less likely to meet MCID for ODI, PCS, SRS activity, and pain scores (odds ratio 0.39 for ODI CI 0.19:0.81 p Conclusion Despite experiencing significant improvements in HRQL scores, preoperative CD in ASD patients is a strong predictor of inferior outcomes and failure to reach MCID at 2-year follow-up. This information will help surgeons educate patients at risk for inferior outcomes and direct future research to improve patient outcomes.

Objective We sought to evaluate an intrapartum nucleic acid amplification test (NAAT) for group B streptococcus (GBS). Study Design This was a prospective cohort study of 559 women comparing intrapartum GBS culture with antepartum culture and intrapartum NAAT. Results GBS prevalence was 19.5% by antepartum culture and 23.8% by intrapartum culture. Compared with intrapartum culture, antepartum culture had 69.2% sensitivity (60.6-76.9%) and 96.0% specificity (93.7-97.7%). The NAAT demonstrated sensitivity of 90.8% (84.6-95.2%), specificity of 97.6% (95.6-98.8%), and predictive values >92%. The incidence of discordant cultures was 10.4%. Of the women with negative antepartum and positive intrapartum cultures, only 1 (2.4%) received intrapartum antibiotics. Compared with white women, black ( P = .02) and Hispanic ( P = .02) women were more likely to have discordant cultures. Conclusion This intrapartum NAAT has excellent characteristics. It may be superior to antepartum culture for detecting intrapartum GBS–allowing more accurate management of laboring mothers and reducing neonatal GBS sepsis.