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Gemas dem 1. Energiewirtschaftsgesetz (EnWG) aus dem Jahre 1935 erfolgte die Stromerzeugung in Deutschland vorrangig unter dem Gesichtspunkt minimaler Stromkosten bzw. -preise (s. a. 2.1.1 und 2.1.2). Der kostenoptimale Strommix aus fossil befeuerten Kraftwerken, Wasserkraftwerken und spater Kernkraftwerken richtete sich neben betrieblichen Erfordernissen nach den aktuellen Preisen bzw. Kosten fur die verschiedenen Primarenergietrager. Mit Ausnahme der Wasserkraft wurde die Nutzung Erneuerbarer Energien mittels Windradern und Solarzellen anfanglich vielfach belachelt.

Kernkraftwerke sind grundsatzlich auch thermische Kraftwerke bzw. Dampfkraftwerke. In ihnen wird jedoch die zum Verdampfen des Wassers benotigte Warme nicht durch Verbrennungsvorgange, sondern durch Freisetzen von Kernenergie in Kernreaktoren gewonnen. Ein Problem der Kernenergie ist ihre geteilte gesellschaftliche Akzeptanz angesichts mehrerer massiver Reaktorunfalle in anderen Landern und der Problematik der Endlagerung derzeit nur zwischengelagerter radioaktiver Abfalle.

Twenty-six balloon-borne ozonesondes were launched near the north shore of central Long Island in the summers of 2018 and 2019 as part of the Long Island Sound Tropospheric Ozone Study (LISTOS). Wh...

INTRODUCTION Outcomes after anterior cervical diskectomy and fusion (ACDF) and cervical total disk arthroplasty (TDA) are satisfactory, but related morbidity and revision surgery rates are notable. This study sought to determine complication variations among ACDF, TDA, and combined ACDF-TDA as well as predictors of postoperative complications. METHODS Patients undergoing 1- to 2-level ACDF and/or TDA with at least a 2-year follow-up from 2009 to 2011 were identified from the Statewide Planning and Research Cooperative System database. Patient demographics, hospital-related parameters, mortality, and postoperative outcomes were compared, and their predictors were identified using multivariate logistic regression. RESULTS A total of 16,510 and 449 individuals underwent ACDF and cervical TDA, respectively, and 201 underwent ACDF-TDA. ACDF-TDA patients had the highest rates of cardiac complications and pulmonary embolism (PE) (P ≤ 0.006), whereas TDA patients had higher individual surgical and device/implant/internal fixation complications (P ≤ 0.025). ACDF-TDA patients experienced the lowest rate of revisions. Cervical TDA increased the odds of any surgical complications (OR = 2.5, P = 0.002), overall complications (OR = 1.57, P = 0.034), and revisions (OR = 2.29, P < 0.001). Deyo index predicted any medical/surgical complications (OR = 1.43 and 1.19, respectively). Female sex was associated with increased odds of readmission (OR 1.30, P < 0.001) but was protective against medical complications (OR = 0.81, P = 0.013). DISCUSSION Combined ACDF-TDA procedures were not associated with increases in 2-year individual or overall complications, readmissions, or revisions. LEVEL OF EVIDENCE Level 3-Therapeutic study.

The Lumbar Stiffness Disability Index (LSDI) assesses impact of lumbar stiffness on activities of daily living. We hypothesized that patients60 years old would perceive greater lumbar stiffness-related functional limitation following fusion for adult spinal deformity.Patients completed the LSDI and Scoliosis Research Society 22 Questionnaire, Revised (SRS-22r) preoperatively and at 2 years postoperatively. The primary independent variable was patient age60 versus ≥60. Multivariable regression analyses were used.Analysis included 267 patients. Patients60 years old (51.3%) and ≥60 years old (48.7%) were evenly represented. In bivariable analysis, patients age60 exhibited lower LSDI at baseline versus patients age ≥60 (25.7 vs. 35.5, β -9.8, P0.0001), but a directionally smaller difference at 2 years (26.4 vs. 32.3, β -5.8, P = 0.0147). LSDI was associated with lower SRS-22r total score among both age groups at baseline and 2 years (all P0.0001); the association was stronger among patients age60 versus ≥60 at 2 years. LSDI was associated with SRS-22r satisfaction scores at 2 years among patients age60 (P0.0001), but not patients age ≥60 (P = 0.2250). The difference in SRS-22r satisfaction per unit LSDI between patients60 years old and ≥60 years old was significant (P = 0.0021).Among patients with adult spinal deformity managed operatively, higher LSDI was associated with inferior SRS-22r total score and satisfaction at 2 years postoperatively. The association between increased LSDI and worse patient-reported outcome measures was greater among patients age60 versus ≥60. Preoperative counseling is needed for patients age60 undergoing adult spinal deformity surgery regarding effects that lumbar stiffness may have on postoperative function and satisfaction.

Sea-salt aerosol (SSA) has significant impact on the formation of secondary nitrate and its dry deposition in the coastal region. In this study, size-segregated aerosols were collected for water-soluble ions analysis in the coastal cities and sea cruises in the western Taiwan Strait of China from 2016 to 2017 to investigate the impact of SSA on particulate inorganic N deposition. The size distributions of NH4+ were characterized by a unimodal pattern peaking at 0.44–1.0 μm while NO3− exhibited typical bimodal distributions peaking at 0.44–1.0 μm and 2.5–10 μm. Furthermore, the fine mode peaks of NO3− became insignificant or disappeared in summer and fall due to the volatilization and dissociation of NH4NO3 at higher temperatures. Elevated sea-salt contributions in the largest size bin (>16 μm) during sea cruises were attributed to vessel induced wave breaking, while there was no peak for NO3− at this range due to its short atmospheric lifetime. Although the concentrations of particulate NH4+-N showed higher levels than those of NO3−-N for both coastal and marine aerosols, the dry deposition fluxes of the particulate NO3−-N were significant higher than those of the particulate NH4+-N due to their different size distributions. The contribution of SSA to particulate inorganic N deposition was estimated on average to be 20.33% and 36.91% in the coastal and offshore region, respectively, assuming all of the chlorine depletion was caused by the reaction between nitric acid and SSA in the coarse mode. In addition, dry deposition fluxes using constant deposition velocities for fine/coarse particles and NH4+/NO3− were higher than those using size-dependent dry deposition velocities. Considering the increasing human activities at the coastal urban zone in the western Taiwan Strait, the atmospheric N deposition could have an important ecological impact on the marine environment that is already under pressure from riverine inputs and urban waste discharges.

It’s increasingly common for surgeons to operate on more challenging cases and higher risk patients, resulting in longer op-time and inpatient LOS. Factors predicting extended op-time and LOS for cervical deformity (CD) patients are understudied. This study identified predictors of extended op-time and length of stay (LOS) after CD-corrective surgery. CD patients with baseline (BL) radiographic data were included. Patients were stratified by extended LOS (ELOS; >75th percentile) and normal LOS (N-LOS; 12 h. A Conditional Variable Importance Table used non-replacement sampling set of Conditional Inference trees to identify influential factors. Mean comparison tests compared LOS and op-time for top factors. 142 surgical CD patients (61 yrs, 62%F, 8.2 levels fused). Op-time and LOS were 358 min and 7.2 days; 30% of patients experienced E-LOS (14 ± 13 days). Overlapping predictors of E-LOS and op-time included levels fused (>7 increased LOS 2.7 days; >5 increased op-time 96 min, P 38 kg/m2 increased LOS 8.1 days; >39 kg/m2 increased op-time 17 min), and osteotomy (LOS 2.0 days, op-time 62 min, P 42 mm increased LOS; >50 mm increased op-time, P @−0.9° increased LOS, >0.3° increased op-time, P

We show that the evidence for a local arrow of time, which is equivalent to the entropy production in thermodynamic systems, can be decomposed. In a system with many degrees of freedom, there is a term that arises from the irreversible dynamics of the individual variables, and then a series of non--negative terms contributed by correlations among pairs, triplets, and higher--order combinations of variables. We illustrate this decomposition on simple models of noisy logical computations, and then apply it to the analysis of patterns of neural activity in the retina as it responds to complex dynamic visual scenes. We find that neural activity breaks detailed balance even when the visual inputs do not, and that this irreversibility arises primarily from interactions between pairs of neurons., 6 pages, 3 figures

Study Objectives Tongue fat is associated with obstructive sleep apnea (OSA). Magnetic resonance imaging (MRI) is the standard for quantifying tongue fat. Ultrasound echo intensity has been shown to correlate to the fat content in skeletal muscles but has yet to be studied in the tongue. The objective of this study is to evaluate the relationship between ultrasound echo intensity and tongue fat. Methods Ultrasound coronal cross-sections of ex-vivo cow tongues were recorded at baseline and following three 1 mL serial injections of fat into the tongue. In humans, adults with and without OSA had submental ultrasound coronal cross-sections of their posterior tongue. The average echo intensity of the tongues (cow/human) was calculated in ImageJ software. Head and neck MRIs were obtained on human subjects to quantify tongue fat volume. Echo intensity was compared to injected fat volume or MRI-derived tongue fat percentage. Results Echo intensity in cow tongues showed a positive correlation to injected fat volume (rho = 0.93, p < .001). In human subjects, echo intensity of the tongue base strongly correlated with MRI-calculated fat percentage for both the posterior tongue (rho = 0.95, p < .001) and entire tongue (rho = 0.62, p < .001). Larger tongue fat percentages (rho = 0.38, p = .001) and higher echo intensity (rho = 0.27, p = .024) were associated with more severe apnea-hypopnea index, adjusted for age, body mass index, sex, and race. Conclusions Ultrasound echo intensity is a viable surrogate measure for tongue fat volume and may provide a convenient modality to characterize tongue fat in OSA.

Osteoporosis affects nearly 200 million individuals worldwide. There are little available data regarding outcomes in patients with osteoporosis who undergo short-segment lumbar fusion for degenerative disk disease (DDD). We sought to identify a relationship between osteoporosis and risk of adverse outcomes in patients with DDD undergoing short-segment lumbar fusion.Using the New York State Statewide Planning and Research Cooperative System, all patients with DDD who underwent 2- to 3-level lumbar fusion from 2009 through 2011 were identified. Patients with bone mineralization disorders and other systemic and endocrine disorders and surgical indications of trauma, systemic disease(s), and infection were excluded. Patients were stratified by the presence or absence of osteoporosis and compared for demographics, hospital-related parameters, and 2-year complications and revision surgeries. Multivariate binary logistic regression models were used to identify notable predictors of complications.A total of 29,028 patients (osteoporosis = 1,353 [4.7%], nonosteoporosis = 27,675 [95.3%]) were included. Patients with osteoporosis were older (66.9 vs 52.6 years), more often female (85.1% vs 48.4%), and White (82.8% vs 73.5%) (all P0.001). The Charlson/Deyo comorbidity index did not significantly differ between groups. Hospital lengths of stay and total charges were higher for patients with osteoporosis (4.9 vs 4.1 days; $74,484 vs $73,724; both P0.001). Medical complication rates were higher in patients with osteoporosis, including acute renal failure and deep-vein thrombosis (both P0.01). This cohort also had higher rates of implant-related (3.4% vs 1.9%) and wound (9.8% vs 5.9%) complications (both P0.01). Preoperative osteoporosis was strongly associated with 2-year medical and surgical complications (odds ratios, 1.6 and 1.7) as well as greater odds of revision surgeries (odds ratio, 1.3) (all P0.001).Patients with osteoporosis undergoing 2- to 3-level lumbar fusion for DDD were at higher risk of 2-year medical and surgical complications, especially implant-related and wound complications. These findings highlight the importance of rigorous preoperative metabolic workup and patients' optimization before spinal surgery.

Aniridia is a condition characterized by defects or absence of the iris. Since the eyes are a central point of attention in the human face, these deformities are often covered with cosmetic implants. However, patients suffer from the static pupil diameter of these implants, resulting in high light sensitivity or inadequate night vision. Therefore, we present a functional iris implant based on dielectric elastomer actuators. These electric drives are characterized by a silent and continuous adaptation as well as a small construction volume and a low heat emission. Since they normally exhibit in-plane uniaxial motion, this displacement must be focused to operate similarly to the iris sphincter. Therefore, we investigated possible mechanical modifications of the setups to generate a directional motion. The results of the study are presented and discussed.Clinical Relevance- The proposed system design enables the functional treatment of aniridia and other accidental iris defects. In addition, the system serves as a basis for later developments of e.g. functional lenses that allow focus adjustment.

OBJECTIVE The objective of this study was to initially validate a recent morphological classification of cervical spine deformity pathology. METHODS The records of 10 patients for each of the 3 classification subgroups (flat neck, focal deformity, and cervicothoracic), as well as for 8 patients with coronal deformity only, were extracted from a prospective multicenter database of patients with cervical deformity (CD). A panel of 15 physicians of various training and professional levels (i.e., residents, fellows, and surgeons) categorized each patient into one of the 4 groups. The Fleiss kappa coefficient was utilized to evaluate intra- and interrater reliability. Accuracy, defined as properly selecting the main driver of deformity, was reported overall, by morphotype, and by reviewer experience. RESULTS The overall classification demonstrated a moderate to substantial agreement (round 1: interrater Fleiss kappa = 0.563, 95% CI 0.559–0.568; round 2: interrater Fleiss kappa = 0.612, 95% CI 0.606–0.619). Stratification by level of training demonstrated similar mean interrater coefficients (residents 0.547, fellows 0.600, surgeons 0.524). The mean intrarater score was 0.686 (range 0.531–0.823). A substantial agreement between rounds 1 and 2 was demonstrated in 81.8% of the raters, with a kappa score > 0.61. Stratification by level of training demonstrated similar mean intrarater coefficients (residents 0.715, fellows 0.640, surgeons 0.682). Of 570 possible questions, reviewers provided 419 correct answers (73.5%). When considering the true answer as being selected by at least one of the two main drivers of deformity, the overall accuracy increased to 86.0%. CONCLUSIONS This initial validation of a CD morphological classification system reiterates the importance of dynamic plain radiographs for the evaluation of patients with CD. The overall reliability of this CD morphological classification has been demonstrated. The overall accuracy of the classification system was not impacted by rater experience, demonstrating its simplicity.

Retrospective review of prospectively collected multicenter registry data.The aim of this study was to determine whether surgical variables and complications as graded by treatment severity impact postoperative hospital length of stay (LOS).Surgical treatment can substantially improve quality of life for patients with adult spinal deformity (ASD). However, surgical treatment is associated with high complication rates, which may impact hospital LOS. Classifying complications by severity of subsequent treatment may allow surgeons to better understand complications and predict their impact on important outcome metrics, including LOS.Patients enrolled in a multicenter, prospectively enrolled database for ASD were assessed for study inclusion. Complications were graded based on intervention severity. Associations between LOS, complication intervention severity, and surgical variables (fusion length, use of interbody fusion, use of major osteotomy, primary versus revision surgery, same day vs. staged surgery, and surgical approach), were assessed. Two multivariate regression models were constructed to assess for independent associations with LOS.Of 1183 patients meeting inclusion criteria, 708 did not and 475 did experience a perioperative complication during their index hospitalization, with 660 and 436 included in the final cohorts, respectively. Among those with complications, intervention severities included 14.9% with no intervention, 68.6% with minor, 8.9% with moderate, and 7.6% with severe interventions. Multivariate regression modeling demonstrated that length of posterior fusion, use of major osteotomy, staged surgery, and severity of intervention for complications were significantly associated with LOS.Careful selection of surgical factors may help reduce hospital LOS following surgery for ASD. Classification of complications by treatment severity can help surgeons better understand and predict the implications of complications, in turn assisting with surgical planning and patient counseling.Level of Evidence: 4.

Background Carbapenem resistant (CR) Klebsiella pneumoniae (Kp) and Acinetobacter baumannii (Ab) are emerging multidrug resistant bacteria with very limited treatment options in case of infection. Both are well-known causes of nosocomial infections and outbreaks in healthcare facilities. Methods A retrospective study was conducted to investigate the epidemiology of inpatients with CR Kp and CR Ab in a 1500-bed German university hospital from 2015 to 2019. We present our infection control concept including a weekly microbiologic screening for patients who shared the ward with a CR Kp or CR Ab index patient. Results Within 5 years, 141 CR Kp and 60 CR Ab cases were hospitalized corresponding to 118 unique patients (74 patients with CR Kp, 39 patients with CR Ab and 5 patients with both CR Ab and CR Kp). The mean incidence was 0.045 (CR Kp) and 0.019 (CR Ab) per 100 inpatient cases, respectively. Nosocomial acquisition occurred in 53 cases (37.6%) of the CR Kp group and in 12 cases (20.0%) of the CR Ab group. Clinical infection occurred in 24 cases (17.0%) of the CR Kp group and in 21 cases (35.0%) of the CR Ab group. 14 cases (9.9%) of the CR Kp group and 29 cases (48.3%) of the CR Ab group had a history of a hospital stay abroad within 12 months prior to admission to our hospital. The weekly microbiologic screening revealed 4 CR Kp cases caused by nosocomial transmission that would have been missed without repetitive screening. Conclusions CR Kp and CR Ab cases occurred infrequently. A history of a hospital stay abroad, particularly in the CR Ab group, warrants pre-emptive infection control measures. The weekly microbiologic screening needs further evaluation in terms of its efficiency.

This is an international multicenter retrospective review of 219 surgically treated consecutive adult spinal deformity (ASD) patients who had a minimum of five fused segments, completed a 2-year follow-up.The purpose of this study was to add the indices of preventive procedures to improve and to validate the predictive probability of the PRISM (patient demographics, radiographic index, and surgical invasiveness for mechanical failure) for mechanical failure (MF) following ASD surgery.The PRISM was developed from the data of 321 ASD patients, which stratified the risk of MF from six types of risk.Data from 136 Japanese ASD patients (age 49 ± 21 yr, 88% female) were used to develop PRISM2, and data from 83 US ASD patients (age 58 ± 12 yr, 86% female) were used for the external validation. We analyzed the associations between three preventive procedures (UIV+1 tethering [TH], teriparatide [TP], and multirod [MR]) and MF by multivariate logistic regression analysis (MRA). The values for the nearest integer of the β of the procedures were added to the six indices of the original PRISM to establish the PRISM2. The discriminative ability of the PRISM/ PRISM2 for MF was evaluated using the area under the receiver operating characteristic curve (AUC) and the precision-recall (PR) curve. The Cochran-Armitage test was used to analyze the trend between PRISM/PRISM2 scores and MF.MF developed in 25% (34 cases). The β values for the preventive procedures calculated by MRA were TH: -2.5, TP: -3.0, and MR: -2.1. The Cochran-Armitage test showed an excellent trend between MF and PRISM/2. The diagnostic ability was superior for the PRISM2 compared with the PRISM (PRISM2; AUC = 0.94 [0.90-0.98], PRISM; AUC = 0.87 [0.81-0.93], difference = -0.07 [-0.11 to -0.03], P 0.01). The AUC of the PRISM2 was 0.70 [0.59-0.81, P 0.01] in the US patient cohort.We refined the PRISM by adding preventive procedures to the risk indices. Further validation and adjustment in a large different patient cohorts may improve the predictive probability of PRISM2.Level of Evidence: 3.

Study design Retrospective cohort study of a prospectively collected database. Objective To compare clinical utility of two common classification systems for ASD and determine whether both should be considered in surgical planning to improve patient outcomes. Summary of background data Surgical restoration of appropriate Roussouly classification shape or SRS-Schwab adult spinal deformity (ASD) classification may improve outcomes. Methods ASD patients with pre- and 2-year postop (2Y) radiographic/HRQL data were grouped by "theoretical" and "current" Roussouly type. Univariate analyses assessed outcomes of patients who mismatched Roussouly types at both pre- and 2Y intervals (Mismatched) and those of preoperative mismatched patients who matched at 2-years (Matched). Subanalysis assessed outcomes of patients who improved in Schwab modifiers, and patients who both improved in both Schwab modifiers and matched Roussouly type by 2Y. Results Included: 515 ASD patients (59 ± 14yrs, 80%F). Preoperative breakdown of "current" Roussouly types: Type 1 (10%), 2 (54%), 3 (24%), and 4 (12%). Matched and Mismatched groups did not differ in rates of reaching MCID for any HRQL metrics by 2Y (all p > 0.10). Reoperation, PJK, and complications did not differ between Matched and Mismatched (all p > 0.10), but Roussouly Matched patients had toward lower rates of instrumentation failure (17.2% vs 24.8%, p=0.038). By 2Y, 28% of patients improved in PT Schwab modifier, 37% in SVA, and 46% in PI-LL. Patients who both Matched Roussouly at 2Y and improved in all Schwab modifiers met MCID for ODI and SRS Activity at higher rates than patients who did not. Conclusions Isolated restoration per the Roussouly system was not associated with superior outcomes. Patients who both matched Roussouly type and improved in Schwab modifiers had superior patient-reported outcomes at 2-years. Concurrent consideration of both systems may offer utility in establishing optimal realignment goals.Level of Evidence: 3.

Peracetic acid (PAA) is an alternative to traditional wastewater disinfection as it has a high oxidation potential without producing chlorinated disinfection byproducts. Reports have shown the effectiveness of PAA to reduce waterborne viruses, but the mechanism of inactivation is understudied. This study evaluated PAA consumption by amino acids and nucleotides that are the building blocks of both viral capsids and genomes. Cysteine (>1.7 min-1) and methionine (>1.2 min-1) rapidly consumed PAA, while cystine (1.9 × 10-2 min-1) and tryptophan (1.4 × 10-4 min-1) reactions occurred at a slower rate. All other amino acids and nucleotides did not react significantly (p < 0.05) with PAA during experiments. Also, PAA treatment did not result in significant (p < 0.05) reductions of purified RNA from MS2 bacteriophage and murine norovirus. Data in this study suggest that PAA effectively inactivates viruses by targeting susceptible amino acids on capsid proteins and does not readily damage viral genomes. Knowledge of virus capsid structures and protein compositions can be used to qualitatively predict the relative resistance or susceptibility of virus types to PAA. Capsid structures containing a higher total number of target amino acids may be more susceptible to PAA reactions that damage structural integrity resulting in inactivation.

Retrospective cohort study.We hypothesized that adult spinal deformity (ASD) surgery would be associated with improved work- and school-related productivity, as well as decreased rates of absenteeism.ASD patients experience markedly decreased health-related quality of life along many dimensions.Only patients eligible for 2-year follow-up were included, and those with a history of previous spinal fusion were excluded. The primary outcome measures in this study were Scoliosis Research Society-22r score (SRS-22r) questions 9 and 17. A repeated measures mixed linear regression was used to analyze responses over time among patients managed operatively (OP) versus nonoperatively (NON-OP).In total, 1188 patients were analyzed. 66.6% were managed operatively. At baseline, the mean percentage of activity at work/school was 56.4% (standard deviation [SD] 35.4%), and the mean days off from work/school over the past 90 days was 1.6 (SD 1.8). Patients undergoing ASD surgery exhibited an 18.1% absolute increase in work/school productivity at 2-year follow-up versus baseline (P 0.0001), while no significant change was observed for the nonoperative cohort (P 0.5). Similarly, the OP cohort experienced 1.1 fewer absent days over the past 90 days at 2 years versus baseline (P 0.0001), while the NON-OP cohort showed no such difference (P 0.3). These differences were largely preserved after stratifying by baseline employment status, age group, sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis (PI-LL), and deformity curve type.ASD patients managed operatively exhibited an average increase in work/school productivity of 18.1% and decreased absenteeism of 1.1 per 90 days at 2-year follow-up, while patients managed nonoperatively did not exhibit change from baseline. Given the age distribution of patients in this study, these findings should be interpreted as pertaining primarily to obligations at work or within the home. Further study of the direct and indirect economic benefits of ASD surgery to patients is warranted.Level of Evidence: 3.

Widespread contamination of groundwater with per- and polyfluoroalkyl substances (PFAS) has required drinking water producers to quickly adopt practical and efficacious treatments to limit human exposure and deleterious health outcomes. This pilot-scale study comparatively investigated PFAS adsorption behaviors in granular activated carbon (GAC) and two strong-base gel anion exchange resin (AER) columns operated in parallel over a 441-day period to treat contaminated groundwater dominated by short-chain perfluorocarboxylic acids (PFCA). Highly-resolved breakthrough profiles of homologous series of 2-8 CF

Objectives. The Menstrual Practice Needs Scale (MPNS) is a comprehensive measure of menstrual self-care experience including access to sufficient, comfortable absorbents, supportive spaces for managing menstruation and for disposal and laundering of used materials. It addresses a critical measurement gap to improve quantitative menstrual health research. The scale was validated in a population of adolescent schoolgirls. This study appraises its performance among adult women.Methods. Seven cognitive interviews provided insights into the interpretability and acceptability of scale items. A cross sectional survey of 525 working women who had menstruated in the past six months (including 435 working in markets, 45 in schools and 45 working in health care facilities) in Mukono District, Uganda was used to test the dimensionality, reliability, and validity of the measure. Results. The 36 scale items were well understood by the study population. Dimensionality was tested for the 28 items relevant to women disposing of menstrual materials and 32 items relevant to those washing and reusing materials. The original subscale structure fit with the data, however fell short of recommended thresholds for those disposing of materials (RMSEA=0.069; CFI=0.840; TLI=0.824). An alternative sub-scale structure was an acceptable fit for those disposing (RMSEA = 0.051; CFI=0.911; TLI=0.897) and reusing materials (RMSEA=0.053; CFI=0.915; TLI=0.904). MPNS total and sub-scale scores demonstrated acceptable internal consistency. Higher scores reflected more positive menstrual experiences and were associated with greater wellbeing (total score r=0.24, p

The purpose of this study was to determine the discriminatory ability of age-adjusted alignment offset and the global alignment and proportion (GAP) score parameters to predict postoperative mechanical complications.Surgical patients from the Adult Symptomatic Lumbar Scoliosis cohort were reviewed at 2 year follow up. Age-adjusted alignment offsets and GAP parameters were calculated for each patient. A series of nonlinear logistic regression models were fit, and the odds of mechanical complications were calculated. The discriminatory ability of the GAP score, GAP score parameters, and age-adjusted alignment offsets were determined plotting receiver operative characteristic (ROC) with the C statistic (AUC).A total of 165 patients were included. A total of 49 mechanical complications occurred in 41 patients (21 proximal junctional kyphosis and 28 pseudoarthrosis). The GAP score had no discriminatory ability in this cohort. Relative lumbar lordosis 15 degrees greater than ideal lumbar lordosis was associated with greater mechanical complications. A lumbar distribution index of 90% was associated with fewer mechanical complications compared to a lumbar distribution index of 65%. Age-adjusted offset alignment targets had no discriminatory ability to predict mechanical complications.Radiographic alignment targets using either age-adjusted alignment target offset or GAP score parameters had minimal ability to predict mechanical complications in isolation. Mechanical complications following adult spinal deformity surgery are complex, and patient factors play a critical role. Clinical trial registeration This study was registered at ClinicalTrials.gov (number NCT00854828) in March 2009.

Retrospective study of a prospective multicenter database.The purpose of this study was to identify predictors of lower total surgery costs at 3 years for adult spinal deformity (ASD) patients.ASD surgery involves complex deformity correction.Inclusion criteria: surgical ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥25°, or thoracic kyphosis ≥60°) patients18 years. Total costs for surgery were calculated using the PearlDiver database. Cost per quality-adjusted life year was assessed. A Conditional Variable Importance Table used nonreplacement sampling set of 20,000 Conditional Inference trees to identify top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) SRS Schwab SVA grades.Three hundred sixtee of 322 ASD patients met inclusion criteria. At 3-year follow up, the potential cost of ASD surgery ranged from $57,606.88 to $116,312.54. The average costs of surgery at 3 years was found to be $72,947.87, with no significant difference in costs between deformity groups (P 0.05). There were 152 LSVA patients, 53 MSVA patients, and 111 HSVA patients. For all patients, the top predictors of lower costs were frailty scores0.19, baseline (BL) SRS Activity1.5, BL Oswestry Disability Index50 (all P 0.05). For LSVA patients, no history of osteoporosis, SRS Activity scores1.5, age64, were the top predictors of lower costs (all P 0.05). Among MSVA patients, ASD invasiveness scores94.16, no past history of cancer, and frailty scores0.3 trended toward lower total costs (P = 0.071, P = 0.210). For HSVA, no history of smoking and body mass index27.8 trended toward lower costs (both P = 0.060).ASD surgery has the potential for improved cost efficiency, as costs ranged from $57,606.88 to $116,312.54. Predictors of lower costs included higher BL SRS activity, decreased frailty, and not having depression. Additionally, predictors of lower costs were identified for different BL deformity profiles, allowing for the optimization of cost efficiency for all patients.Level of Evidence: 3.

STUDY DESIGN Multicenter retrospective review of prospective database. OBJECTIVE The aim of this study was to investigate potential associations between postoperative alignment and satisfaction. SUMMARY OF BACKGROUND DATA Achieving high satisfaction is the main goal of any treatment, including adult spinal deformity (ASD) surgery. Despite being one of the key elements, literature is sparse regarding postoperative factors influencing patient satisfaction. METHODS ASD patients with 2-year follow-up were retrospectively reviewed. Patients without revision after the index procedure were stratified according to deformity type: sagittal (T1 pelvic angle >22°), coronal (C7 plumb line [C7PL] >5 cm or MaxCobb >50°), or mixed. Bivariate correlation between satisfaction and postoperative data was conducted on the entire cohort as well as by type of preoperative deformity. Multivariate regression controlling for pre-op alignment and demographic information was used to identify independent predictors of 2Y satisfaction. RESULTS A total of 509 patients were included in the analysis (58.7 ± 14.8, 80% females). The quality of life significantly improved between pre- and 2-year (ΔOswestry Disability Index [ODI]: 17.6, p

Aerosol element solubility is essential to evaluate the damage to the environment and human health. In this work, the size distribution of total and soluble elements in eight particle size ranges with diameter0.25, 0.25-0.44, 0.44-1.0, 1.0-1.4, 1.4-2.5, 2.5-10, 10-16 and16 μm was investigated in Xiamen Island, southeast China from March 2018 to June 2020. The results showed that both total and soluble elements exhibited significant size dependence without obvious seasonal variations, and their relative contributions to PM