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The authors contend that children benefit from play as a form of intervention and as a means of fostering their cognitive, social, and physical growth. They review several standardized instruments developed over the last fifty years to assess this benefit of play on child development. They identify twenty-one such play measures, the majority of them applicable to children under twelve. Some of the measurements can be conducted by children, but most are proxy rated and employ some form of observation. Over half require no or minimal training. Others can be completed in less than thirty minutes. More evaluations exist for the earlier instruments, but these measurements lacked psychometric evidence to back them up. The authors note they based their selections on the distinct characteristics and features of the measures, and they offer their conclusions to assist users in choosing the best systematic instruments for their specific needs.

Despite decades of research efforts, data-based instruction (DBI) for students with intensive intervention needs are not being widely used in practice as anticipated, and many educators have difficulties in implementing it. This systematic review aimed to examine what kinds of implementation drivers and strategies have been used to support educators implementing DBI and what kinds of implementation outcomes researchers have measured. Eighteen studies were synthesized using the Implementation Drivers framework and Implementation Outcomes taxonomy and were quality appraised. We found that the majority of studies primarily used competency drivers to increase teachers' DBI expertise, while a limited number of studies focused on organizational and leadership drivers. Acceptability and fidelity were frequently assessed as implementation outcomes. We discussed the implications of the findings, including the need for researchers to incorporate implementation drivers and outcomes at diverse levels to best support educators' implementation of DBI, as well as the limitations of this review, such as the limited generalizability of the findings.

Measures of attention and memory were evaluated in 6- to 9-month-old infants from two diverse contexts. One sample consisted of African infants residing in rural Malawi (N = 228, 118 girls, 110 boys). The other sample consisted of racially diverse infants residing in suburban California (N = 48, 24 girls, 24 boys). Infants were tested in an eye-tracking version of the visual paired comparison procedure and were shown racially familiar faces. The eye tracking data were parsed into individual looks, revealing that both groups of infants showed significant memory performance. However, how a look was operationally defined impacted some-but not other-measures of infant VPC performance. RESEARCH HIGHLIGHTS: In both the US and Malawi, 6- to 9-month-old infants showed evidence of memory for faces they had previously viewed during a familiarization period. Infant age was associated with peak look duration and memory performance in both contexts. Different operational definitions of a look yielded consistent findings for peak look duration and novelty preference scores-but not shift rate. Operationalization of look-defined measures is an important consideration for studies of infants in different cultural contexts.

Fungi are among the most diverse and ecologically important kingdoms in life. However, the distributional ranges of fungi remain largely unknown as do the ecological mechanisms that shape their distributions1,2. To provide an integrated view of the spatial and seasonal dynamics of fungi, we implemented a globally distributed standardized aerial sampling of fungal spores3. The vast majority of operational taxonomic units were detected within only one climatic zone, and the spatiotemporal patterns of species richness and community composition were mostly explained by annual mean air temperature. Tropical regions hosted the highest fungal diversity except for lichenized, ericoid mycorrhizal and ectomycorrhizal fungi, which reached their peak diversity in temperate regions. The sensitivity in climatic responses was associated with phylogenetic relatedness, suggesting that large-scale distributions of some fungal groups are partially constrained by their ancestral niche. There was a strong phylogenetic signal in seasonal sensitivity, suggesting that some groups of fungi have retained their ancestral trait of sporulating for only a short period. Overall, our results show that the hyperdiverse kingdom of fungi follows globally highly predictable spatial and temporal dynamics, with seasonality in both species richness and community composition increasing with latitude. Our study reports patterns resembling those described for other major groups of organisms, thus making a major contribution to the long-standing debate on whether organisms with a microbial lifestyle follow the global biodiversity paradigms known for macroorganisms4,5.

STUDY DESIGN: Retrospective review of prospective database. OBJECTIVES: Vertebral pelvic angles (VPAs) account for complexity in spine shape by assessing the relative position of each vertebra with regard to the pelvis. This study uses VPAs to investigate the shape of the fused spine after T10-pelvis fusion, in patients with adult spinal deformity (ASD), and then explores its association with proximal junctional kyphosis (PJK). METHODS: Included patients had radiographic evidence of ASD and underwent T10-pelvis realignment. VPAs were used to construct a virtual shape of the post-operative spine. VPA-predicted and actual shapes were then compared between patients with and without PJK. Logistic regression was used to identify components of the VPA-based model that were independent predictors of PJK occurrence and post-operative shape. RESULTS: 287 patients were included. VPA-predicted shape was representative of the true post-operative contour, with a mean point-to-point error of 1.6-2.9% of the T10-S1 spine length. At 6-weeks follow-up, 102 patients (35.5%) developed PJK. Comparison of the true post-operative shapes demonstrated that PJK patients had more posteriorly translated vertebrae from L3 to T7 (P < .001). Logistic regression demonstrated that L3PA (P = .047) and T11PA (P < .001) were the best independent predictors of PJK and were, in conjunction with pelvic incidence, sufficient to reproduce the actual spinal contour (error

Women with negative body image engage in less physical activity. The purpose of this study is to examine the relationship between body image and physical activity in Latinas participating in a lifestyle program. Participants (age 43.8 ± 10.1 years and BMI 30.4 ± 5.2 kg/m2) were enrolled in a 12-month culturally and linguistically adapted, individually tailored, intervention focused on increasing moderate-to-vigorous intensity physical activity (MVPA). Longitudinal assessments were conducted on body image dissatisfaction (BID) using the Figure Rating Scale, MVPA using the 7-day PAR interview, and objectively measured body weight. Pre-intervention BID did not significantly predict MVPA change. Participants experienced considerable reduction in BID. Greater MVPA engagement and weight loss were independently related to BID reduction. Acculturation did not moderate these relationships. Body image improved in Latinas participating in a cognitive and behavioral physical activity intervention regardless of weight loss and acculturation level.

Novel methods for sampling and characterizing biodiversity hold great promise for re-evaluating patterns of life across the planet. The sampling of airborne spores with a cyclone sampler, and the sequencing of their DNA, have been suggested as an efficient and well-calibrated tool for surveying fungal diversity across various environments. Here we present data originating from the Global Spore Sampling Project, comprising 2,768 samples collected during two years at 47 outdoor locations across the world. Each sample represents fungal DNA extracted from 24 m3 of air. We applied a conservative bioinformatics pipeline that filtered out sequences that did not show strong evidence of representing a fungal species. The pipeline yielded 27,954 species-level operational taxonomic units (OTUs). Each OTU is accompanied by a probabilistic taxonomic classification, validated through comparison with expert evaluations. To examine the potential of the data for ecological analyses, we partitioned the variation in species distributions into spatial and seasonal components, showing a strong effect of the annual mean temperature on community composition.

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.

Parkinson's disease (PD) etiology is associated with aggregation and accumulation of α-synuclein (α-syn) proteins in midbrain dopaminergic neurons. Emerging evidence suggests that in certain subtypes of PD, α-syn aggregates originate in the gut and subsequently spread to the brain. However, mechanisms that instigate α-syn aggregation in the gut have remained elusive. In the brain, the aggregation of α-syn is induced by oxidized dopamine. Such a mechanism has not been explored in the context of the gastrointestinal tract, a niche harboring 46% of the body's dopamine reservoirs. Here, we report that Enterobacteriaceae, a bacterial family prevalent in human gut microbiotas, induce α-syn aggregation. More specifically, our in vitro data indicate that respiration of nitrate by Escherichia coli K-12, which results in production of nitrite that mediates oxidation of Fe2+ to Fe3+, creates an oxidizing redox potential. These oxidizing conditions enabled the formation of dopamine-derived quinones and α-syn aggregates. Exposing nitrite, but not nitrate, to enteroendocrine STC-1 cells induced aggregation of α-syn that is natively expressed in these cells, which line the intestinal tract. Taken together, our findings indicate that bacterial nitrate reduction may be critical for initiating intestinal α-syn aggregation.

Animal flesh foods are rich in bioavailable iron but infrequently consumed by young children. We aimed to determine whether flesh food intake was associated with iron and anaemia status among 585 Malawian infants enroled in a 6-month egg-feeding trial. The percentage of days of small fish, large fish and meat consumption were assessed through weekly 7-day animal-source food screeners. Grams of intake were assessed through 24-h recalls conducted at 6-9, 9-12 and 12-15 months of age. Plasma ferritin, soluble transferrin receptor (sTfR) and haemoglobin concentrations were measured at 6-9 and 12-15 months of age. Iron biomarkers were adjusted for inflammation during analysis. At enrolment, each flesh food category was consumed by

IntroductionThe pace of innovation has accelerated in virtually every area of tau research in just the past few years.MethodsIn February 2022, leading international tau experts convened to share selected highlights of this work during Tau 2022, the second international tau conference co-organized and co-sponsored by the Alzheimer's Association, CurePSP, and the Rainwater Charitable Foundation.ResultsRepresenting academia, industry, and the philanthropic sector, presenters joined more than 1700 registered attendees from 59 countries, spanning six continents, to share recent advances and exciting new directions in tau research.DiscussionThe virtual meeting provided an opportunity to foster cross-sector collaboration and partnerships as well as a forum for updating colleagues on research-advancing tools and programs that are steadily moving the field forward.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Identify optimal lumbar lordosis in adult deformity correction to achieve age-adjusted targets and sustained alignment. METHODS: Surgical adult spinal deformity patients reaching an age-adjusted ideal alignment at one year were identified. Multilinear regression analysis was used to identify the relationship between regional curvatures (LL and TK) that enabled achievement of a given global alignment (T1 pelvic angle, TPA) based on pelvic incidence (PI). RESULTS: 347 patients out of 1048 available reached their age-adjusted TPA within 5° (60-year-old, 72% women, body mass index 29 ± 6.2). They had a significant improvement in all sagittal parameters (except PI) from pre-operative baseline to 1 year following surgery (P < .001). Multilinear regression predicting L1-S1 based on TK, TPA, and PI demonstrated excellent results (R2 = .85). Simplification of the coefficients of prediction combined with a conversion to an age-based formula led to the following: LL = PI - 0.3TK - 0.5Age + 10. Internal validation of the formula led to a mean error of -.4°, and an absolute error of 5.0°. Internal validation on patients with an age-adjusted alignment revealed similar accuracy across the entire age-adjusted TPA spectrum (ranges of LL errors: ME = .2° to 1.7°, AE = 4.0° to 5.3°). CONCLUSION: This study provides a simple guideline to identify the amount of LL needed to reach a given alignment (i.e., age-adjusted target) based on PI and associated TK. Implementation of this predictive formula during pre-operative surgical planning may help to reduce unexpected sub-optimal post-operative alignment outcomes.

Abstract Pluripotent stem cells have remarkable self-renewal capacity: the ability to proliferate indefinitely while maintaining the pluripotent identity essential for their ability to differentiate into almost any cell type in the body. To investigate the interplay between these two aspects of self-renewal, we perform four parallel genome-scale CRISPR-Cas9 loss-of-function screens interrogating stem cell fitness in hPSCs and the dissolution of primed pluripotent identity during early differentiation. These screens distinguish genes with distinct roles in pluripotency regulation, including mitochondrial and metabolism regulators crucial for stem cell fitness, and chromatin regulators that control pluripotent identity during early differentiation. We further identify a core set of genes controlling both stem cell fitness and pluripotent identity, including a network of chromatin factors. Here, unbiased screening and comparative analyses disentangle two interconnected aspects of pluripotency, provide a valuable resource for exploring pluripotent stem cell identity versus cell fitness, and offer a framework for categorizing gene function.

Homeless and low-income students share multiple overlapping risk experiences; however, some studies report little to no observed differences in outcomes between these students. From the cumulative risk perspective, homelessness is perched at the extreme edge of economic insecurity, suggesting that homeless students encounter additional hardships beyond poverty experiences alone. Using a continuum of risk framework, this study leveraged statewide administrative data from a 6th grade cohort of Maryland public school students (N = 52,610) to investigate the association between homelessness and educational and early labor market outcomes, above and beyond the associations linked to poverty. Findings provide support for the continuum of risk in relation to educational outcomes; however, no significant differences were observed in early labor market outcomes, although racial differences were detected. This study underscores the importance of targeted interventions in promoting positive, long-term outcomes, particularly for students who were homeless in adolescence.

The power of quantum chemistry to predict the ground and excited state properties of complex chemical systems has driven the development of computational quantum chemistry software, integrating advances in theory, applied mathematics, and computer science. The emergence of new computational paradigms associated with exascale technologies also poses significant challenges that require a flexible forward strategy to take full advantage of existing and forthcoming computational resources. In this context, the sustainability and interoperability of computational chemistry software development are among the most pressing issues. In this perspective, we discuss software infrastructure needs and investments with an eye to fully utilize exascale resources and provide unique computational tools for next-generation science problems and scientific discoveries.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Investigate a composite score to evaluate the relationship between alignment proportionality and risk of distal junctional kyphosis (DJK). METHODS: 84 patients with minimum 1 year follow-up were included (age = 61.1 ± 10.3 years, 64.3% women). The Cervical Score was constructed using offsets from age-adjusted normative values for sagittal vertical axis (SVA), T1 Slope (TS), and TS minus cervical lordosis (CL). Individual points were assigned based on offset with age-adjusted alignment targets and summed to generate the Cervical Score. Rates of mechanical failure (DJK revision or severe DJK [DJK> 20° and ΔDJK> 10°]) were assessed overall and based on Cervical Score. Logistical regressions assessed associations between early radiographic alignment and 1-year failure rate. RESULTS: Mechanical failure rate was 21.4% (N = 18), 10.7% requiring revision. By multivariate logistical regression: 3-month T1S (OR: .935), TS-CL (OR:0.882), and SVA (OR:1.015) were independent predictors of 1-year failure (all P < .05). Cervical Score ranged (-6 to 6), 37.8% of patients between -1 and 1, and 50.0% with 2 or higher. DJK patients had significantly higher Cervical Score (4.1 ± 1.3 vs .6 ± 2.2, P < .001). Patients with a score ≥3 were significantly more likely to develop a failure (71.4%) with OR of 38.55 (95%CI [7.73; 192.26]) and Nagelkerke r2 .524 (P < .001). CONCLUSION: This study developed a composite alignment score predictive of mechanical failures in CD surgery. A score ≥3 at 3 months following surgery was associated with a marked increase in failure rate. The Cervical Score can be used to analyze sagittal alignment and help define realignment objectives to reduce mechanical failure.

OBJECTIVE: The goal of this study was to determine if patients with mild scoliosis and age-appropriate sagittal alignment have favorable outcomes following surgical correction. METHODS: Retrospective review of a prospective, multicenter adult spinal deformity database. Inclusion criteria: operative patients age ≥18 years, and preoperative pelvic tilt, mismatch between pelvic incidence and lumbar lordosis (PI-LL), and C7 sagittal vertical axis all within established age-adjusted thresholds with minimum 2-year follow-up. Health-related quality of life (HRQoL) scores: Oswestry Disability Index (ODI), 36-item Short Form health survey (SF-36), Scoliosis Research Society-22R (SRS22R), back/leg pain Numerical Rating Scale and minimum clinically important difference (MCID)/substantial clinical benefit (SCB). Two-year and preoperative HRQoL radiographic data were compared. Patients with mild scoliosis (Mild Scoli, Max coronal Cobb 10°-30°) were compared to those with larger curves (Scoli). RESULTS: One hundred fifty-one patients included from 667 operative patients (82.8% women; average age, 56.4 ± 16.2 years). Forty-two patients (27.8%) included in Mild Scoli group. Mild Scoli group had significantly worse baseline leg pain, ODI, and physical composite scores (p < 0.02). Mean 2-year maximum coronal Cobb angle was significantly improved compared to baseline (p < 0.001). All 2-year HRQoL measures were significantly improved compared to (p < 0.001) except mental composite score, SRS activity and SRS mental for the Mild Scoli group (p > 0.05). From the mild Scoli group, 36%-74% met either MCID or SCB for the HRQoL measures. Sixty-four point three percent had minimum 1 complication, 28.6% had a major complication, 35.7% had reoperation. CONCLUSION: Mild scoliosis patients with age-appropriate sagittal alignment benefit from surgical correction, decompression, and stabilization at 2 years postoperative despite having a high complication rate.

A miniature nuclear reactor is desirable for deployment as a localized nuclear power station in support of a carbon-free power supply. Coupling aspects of proliferation-resistant fuel with natural burnable absorber loading are evaluated for once-through operation cycle performance to minimize the need for refueling and fuel shuffling operations. The incorporation of 0.075 wt.% 237Np provides favorable plutonium isotopic vectors throughout an operational lifetime of 5.5 years. providing 35 MWe. Core performance was assessed using a verification-by-comparison approach for core designs with or without 237Np and/or gadolinia burnable absorber. Burnup Monte Carlo calculations were performed via MCOS coupling of MCNP and ORIGEN to an achievable burnup of ~62.5 GWd/t. The results demonstrate a minimal penalty to reactor performance due to the addition of these materials as compared against the reference design. Coupling of a proliferation-resistant fuel concept with a uniform loading of natural gadolinia burnable absorber for LEU+ fuel (7.5 wt.% 235U/U UO2) provides favorable excess reactivity considerations with minimized concerns for additional residual waste and more uniform distribution of un-depleted 235U in discharged fuel assemblies.

Background and Aim: The productivity of sheep in humid tropical plantation areas relies on their ability to adapt. Oil palm plantations serve as potential grazing lands for livestock. This study aimed to identify Garut sheep adaptations in oil palm and rubber plantations of the Garut district, West Java, Indonesia. Materials and Methods: The total number of sheep used was 103 as the object of this study. Each individual of sheep was used for several different observations, including: Physiological assessment using 24 sheep of various ages, molecular analysis of heat stress using 31 sheep, worm egg count using 59 sheep, and for morphological assessment using 98 sheep. A general linear model was employed to analyze rectal temperature (RT), heart rate (HR), respiratory rate, number of eggs in each gram of sample feces, body weight (BW), body condition score, and morphometric measurements according to age and sex. Forage was compared between oil palm and rubber plantations during the vegetation analysis. Results: RT, HR, and panting frequency were significantly (p < 0.05) affected by the age and sex of the sheep. The mutation was found in the coding region of the HSP70 gene, which is approximately 232 bp long. Fecal eggs were found in 99% of the fecal samples, consisting of 100% Strongyle eggs and 1.75% Moniezia eggs. BW, body condition score, shoulder height, body length, pelvic height, chest circumference, and number of eggs were significantly affected (p < 0.05) by the age and sex of the sheep. The average fresh matter of vegetation under the plantation was 248.69 ± 120.94 g/m2 and 718.15 ± 249.93 g/m2 for oil palm and rubber plantations, respectively. Conclusion: Garut sheep were adapted to oil palm and rubber plantations in the humid tropical region. Plantations are potential sources of sheep grazing and roughage. Further research is needed regarding the consumption of forages in oil palm and rubber plantations.

Debido a su durabilidad, versatilidad y bajo coste, los productos plásticos resultan fundamentales en la sociedad actual; sin embargo, estas mismas propiedades, responsables de su gran popularidad, también convierten a estos materiales en una amenaza medioambiental, provocando serios problemas entre los que destaca la liberación de microplásticos (MPs). Los MPs, definidos como partículas poliméricas con un tamaño inferior a 5 mm, son muy diversos en cuanto a composición, tamaño y forma, siendo capaces además de transportar sobre su superficie otros contaminantes y microorganismos, lo que incrementa los potenciales efectos adversos de estas micropartículas. Aunque los MPs se encuentran de manera ubicua en todo el planeta, su presencia es notoria en los ecosistemas acuáticos, especialmente los marinos, ya que las masas de agua naturales reciben la gran mayoría de los plásticos vertidos al medioambiente. Recientemente, la biorremediación ha sido propuesta como una interesante alternativa para luchar contra la creciente problemática derivada de la contaminación plástica; por ello, el objetivo de la presente revisión bibliográfica es analizar las posibles vías de eliminación de los MPs de origen fósil y no biodegradables en entornos acuáticos, mediante bacterias, hongos y organismos superiores, recopilando los últimos avances en este campo.

Deployment of clinical testing on a massive scale was an essential control measure for curtailing the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the magnitude of the COVID-19 (coronavirus disease 2019) pandemic during its waves. As the pandemic progressed, new preventive and surveillance mechanisms emerged. Implementation of vaccine programs, wastewater (WW) surveillance, and at-home COVID-19 antigen tests reduced the demand for mass SARS-CoV-2 testing. Unfortunately, reductions in testing and test reporting rates also reduced the availability of public health data to support decision-making. This paper proposes a sequential Bayesian approach to estimate the COVID-19 test positivity rate (TPR) using SARS-CoV-2 RNA concentrations measured in WW through an adaptive scheme incorporating changes in virus dynamics. The proposed modeling framework was applied to WW surveillance data from two WW treatment plants in California; the City of Davis and the University of California, Davis campus. TPR estimates are used to compute thresholds for WW data using the Centers for Disease Control and Prevention thresholds for low (10% TPR) transmission. The effective reproductive number estimates are calculated using TPR estimates from the WW data. This approach provides insights into the dynamics of the virus evolution and an analytical framework that combines different data sources to continue monitoring COVID-19 trends. These results can provide public health guidance to reduce the burden of future outbreaks as new variants continue to emerge. IMPORTANCE We propose a statistical model to correlate WW with TPR to monitor COVID-19 trends and to help overcome the limitations of relying only on clinical case detection. We pose an adaptive scheme to model the nonautonomous nature of the prolonged COVID-19 pandemic. The TPR is modeled through a Bayesian sequential approach with a beta regression model using SARS-CoV-2 RNA concentrations measured in WW as a covariable. The resulting model allows us to compute TPR based on WW measurements and incorporates changes in viral transmission dynamics through an adaptive scheme.

BACKGROUND: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. OBJECTIVE: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. STUDY DESIGN/SETTING: Retrospective cohort study of a prospectively collected multicenter database. METHODS: ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. RESULTS: A total of 930 patients were considered. Following PSM, 253 optimal (O) and 253 not optimal (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, p = 0.021) and major mechanical complications (12% vs. 22%, p = 0.002), and less reoperations (23% vs. 33%, p = 0.008). Adjusted analysis revealed O patients more often met MCID (minimal clinically important difference) in SF-36 PCS, SRS-22 Pain, and Appearance. Cost-utility-adjusted analysis determined that the O group generated better cost-utility by one year and maintained lower overall cost and costs per QALY (both p < 0.001) at two years. CONCLUSIONS: Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success.

BACKGROUND: Adult spinal deformity (ASD) represents a major cause of disability in the elderly population in the United States. Surgical intervention has been shown to reduce disability and pain in properly indicated patients. However, there is a small subset of patients in whom nonoperative treatment is also able to durably maintain or improve symptoms. OBJECTIVE: To examine the factors associated with successful nonoperative management in patients with ASD. METHODS: We retrospectively evaluated a cohort of 207 patients with nonoperative ASD, stratified into 3 groups: (1) success, (2) no change, and (3) failure. Success was defined as a gain in minimal clinically importance difference in both Oswestry Disability Index and Scoliosis Research Society-Pain. Logistic regression model and conditional inference decision trees established cutoffs for success according to baseline (BL) frailty and sagittal vertical axis. RESULTS: In our cohort, 44.9% of patients experienced successful nonoperative treatment, 22.7% exhibited no change, and 32.4% failed. Successful nonoperative patients at BL were significantly younger, had a lower body mass index, decreased Charlson Comorbidity Index, lower frailty scores, lower rates of hypertension, obesity, depression, and neurological dysfunction (all P < .05) and significantly higher rates of grade 0 deformity for all Schwab modifiers (all P < .05). Conditional inference decision tree analysis determined that patients with a BL ASD-frailty index ≤ 1.579 (odds ratio: 8.3 [4.0-17.5], P < .001) were significantly more likely to achieve nonoperative success. CONCLUSION: Success of nonoperative treatment was more frequent among younger patients and those with less severe deformity and frailty at BL, with BL frailty the most important determinant factor. The factors presented here may be useful in informing preoperative discussion and clinical decision-making regarding treatment strategies.