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BACKGROUND: Vitamin D has been shown to play important roles in both calcium homeostasis and bone healing. Only three studies have directly examined the relationship between vitamin D deficiency and hardware failure, nonunion, and/or revision surgery. Results are contradictory and none were large enough to provide the statistical power necessary to make definitive conclusions. METHODS: A retrospective analysis was performed utilizing the PearlDiver national insurance claims database consisting of 91 million individual patient records. Patients aged 30 and over who underwent a non-segmental posterior lumbar fusion procedure (CPT-22840) in 2012-2019 were included. Data collected included, hardware failure, revision surgery occurrence, and vitamin D deficiency. Hardware failure and revision rates were compared between vitamin D deficient and non-deficient groups. We ran a logistic regression analysis using the following variables: age, Charlson Comorbidity Index (CCI), gender, vitamin D deficiency, obesity, tobacco use, diabetes, osteoporosis, rheumatoid arthritis, and Crohn's disease. RESULTS: 108,137 patients matching inclusion criteria were identified, with an overall hardware failure rate of 2.7% and revision rate of 4.1%. Failure rates were significantly higher for patients diagnosed with vitamin D deficiency during the full queried period (3.3% vs. 2.6%, OR = 1.26; p < 0.0001), as were revision rates (4.3% vs 3.5%, OR = 1.25; p < 0.0001). Patients diagnosed with deficiency pre-surgery, higher failure (3.1% vs 2.6%, OR = 1.19; p < 0.01) and rates of revision (4.4% vs 3.5%, OR = 1.27; p < 0.0001) were increased compared to the non-deficient group. In the logistic regression analysis, vitamin D deficiency remains a significant contributor to hardware failure and revision surgery. CONCLUSIONS: These results demonstrate that pre- and/or post-operative vitamin D deficiency is independently correlated with risk for hardware failure and revision surgery in single-level lumbar fusion patients.

Study Design Retrospective Cohort Study Objective To determine the incidence of vertebral artery injury (VAI), risk factors, intervention, associated complications, and mortality in patients undergoing anterior cervical corpectomy. Methods We performed a retrospective review of the incidence of VAI during anterior cervical corpectomy using the PearlDiver database from 2010-2017. The CPT code 63 081 to identify corpectomy patients. Patient data extracted included, incidence of VAI, demographic factors, intervention, and future complications of death and stroke. The risk were calculated compared with those patients who did not have VAI. Results 26 126 patients were identified to have undergone cervical corpectomy. Multivariate analysis of risk factors showed that younger age and male sex were associate with higher rate of injury (t = -11.5; P < .0001 and t = 3.8; P = .0001, respectively). Vertebral artery injuries occurred in 78 patients at an incidence of .3%. 11 (14%) VAI patients had a cerebral infarction compared with 1705 (7%) for non-VAI patients (OR = 2.13; 95% CI = [1.18 – 3.85; P = .0179]) during the follow up period. 1-year mortality rates were higher in patients who suffered a VAI (14%) compared to those who did not suffer a VAI (4%; OR = 3.85; CI = [2.04 – 7.14]; P < .0001). Conclusion Consequence of VAI may not be known for months following the injury. Although the same admission mortality is rare with this injury, there is a significant increase in post-discharge complications. This study suggests that further investigations into long term health risk of VAI is needed.

The purpose of this chapter is to contextualize cultural dispositions as an integral component in the development of teacher candidates' professional dispositions. Through a culturally relevant pedagogical (CRP) lens, the chapter defines cultural dispositions using the CRP tenets: academic success, cultural competence, and critical consciousness in the field of teacher education. The authors, two Black women teacher educators, argue that developing and supporting teacher candidates' cultural dispositions should be integrated into teacher education programs. The authors center the lived experiences as Black women educators to offer insight and perspectives on the value of developing teacher candidates' cultural dispositions. Other teacher educators can use the teacher cultural dispositions to inform their pedagogical and instructional practices.

This article uses critical race theory (CRT) to explore institutional racial paralysis (IRP) in organizational culture. Utilizing a CRT lens, the authors identify four stages of IRP: idleness, conc...

Developing college access in high schools for students from marginalized backgrounds (i.e., low socioeconomic status, people of color, and first-generation) is important because these students enroll in postsecondary education at lower rates than White, wealthier, and non-first-generation students. A qualitative case study was conducted to examine how an African-centered charter high school’s personnel, who were teachers and administrators of color, cultivated students’ college-going aspirations while affirming their cultural identities. This study used a social constructivist paradigm to understand how Ubuntu school personnel were active agents in both the school’s college-going culture and African-centered culture. The selected site was an urban public African-centered coeducational charter high school with a postsecondary education focus located in the Northeastern United States. The school has excelled academically both in terms of graduation rates and postsecondary enrollment. The findings suggest that personnel worked collaboratively with each other to develop and foster environments that supported a college-preparatory ethos while simultaneously affirming African Americans and Blacks. They believed that students being successful led to the school being successful, which led to the community being successful, which most importantly led to the Black race being successful. Success began at the individual level but had the potential impact of improving the community and nation as a whole. Personnel believed it was their responsibility to provide students with the necessary social and cultural capital to develop college-going aspirations.

Most post-secondary institutions implement diversity initiatives to create safe, welcoming, and inclusive environments for all campus constituents. Faculty can proactively encourage dialogue by intentionally facilitating workshops where students have courageous conversations on challenging topics such as prejudice, discrimination, biases, and microaggressions. These difficult topics, conscious or unconscious, have historically plagued society and are displayed on college campuses. Allowing faculty to facilitate these necessary discussions benefits the campus twofold: Students are able to view faculty as social justice resources and the institutions are able to leverage resources by utilizing existing personnel, ultimately increasing diversity sustainability efforts. Association Awareness was a faculty led workshop to explore a student’s implicit biases. The workshop was designed to uncover student biases in hopes of proactively changing their perspectives and advancing cultural awareness. Campus faculty from different demographic backgrounds and academic disciplines facilitated the two-part workshop. During the workshop, participants engaged in a brief implicit bias introduction, took the Implicit Association Test (IAT), and lastly discussed their results with peers. Through self-reflection and guided dialogue, participants could challenge assumptions about bias. In this essay, the authors will: (1) explain the challenge of facilitating difficult dialogue and (2) share an innovative pedagogical model employed to have courageous conversations on implicit bias.

Food production is increasingly being challenged by limited resources of energy and land as well as by growing demand for food. In a future with less availability of fossil fuels, land area will become very important for capturing the flow-limited renewable resources. Emergy assessment has been applied to calculate scale dependent indicators, which account for the land area needed, if agricultural systems were to be supported solely on renewable sources. These indicators are designated emergy footprints (EmFs) and expand the concept of support area defined previously in emergy accounting. The EmF (in ha) is calculated based on renewable empower densities which convert resource use into area equivalents able to capture renewable flows. The spatial division between on-site, local and non-local land areas applied in this study, identifies where the support area is located in order to apply a site-specific renewable empower density. A new indicator applying the EmF is the emergy overshoot factor, which estimates the ratio between EmF and the geographical system boundary (in ha). We apply this approach on three innovative food supply systems in Europe located at farms characterised by combining high diversity, reduced use of resources, nutrient cycling and local sales. The question is whether this type of food system may be considered sustainable from a resource use point of view measured as resource use efficiency by means of unit emergy value (UEV), renewability (Ron-site and Rglobal), direct and indirect occupation of land on different spatial scales (EmF and Emergy overshoot factor) and productivity per ha of the directly observed areas and the EmF area, respectively. Labour inputs constituted between 13 and 80% of the total emergy flow. The proportion of resource use from renewable sources was between 31 and 60% when excluding the inputs of direct labour. The food system with the lowest UEV, excluding direct labour, had the highest emergy overshoot factor, which even exceeded the global average of seven. However, this system had the highest productivity. The system with the highest UEV, excluding direct labour, had the lowest overshoot factor. In conclusion, each food system strategy has its pros and cons and it depends on the priorities, which is judged the most sustainable from an emergy point of view.

Inflexible work schedules affect job satisfaction and influence nurse turnover. Job satisfaction is a significant predictor of nurse retention. Acute care hospitals report that job satisfaction is influenced by autonomy and educational opportunity. This project discusses implementation of computer-based self-scheduling in a hospital system and its impact. It is important for staff development educators to be aware that self-scheduling may play a key role in autonomy, professional development, turnover, and hospital costs.

Lymph nodes were removed from the para-aortic area in both nonpregnant and pregnant women for morphologic comparison. The same morphologic changes were noted as reported earlier in pelvic lymph nodes removed from pregnant women at term, namely, loss of germinal centers as well as general loss in cellularity. Lymphocyte transformation also was studied in nonpregnant women and in pregnant women in the first, second, and third trimesters with the use of phytohemagglutinin. There was a significant reduction in lymphocyte transformation in the pregnant patients' lymphocytes. It is suggested that these two studies represent additional evidence for the concept of a depression in the immune responses of women in pregnancy.

In work presented at the first germinal center conference, we showed that pregnancy and malignant trophoblastic disease are associated with disappearance of germinal centers from lymph nodes [1, 2]. These findings were discussed in relation to other changes known to occur in the thymus and lymphatic tissue during pregnancy in small mamnals: a reversible atrophy of the thymus [3, 4], reduction in size of lymph nodes as well as a marked reduction in the number of small lymphocytes in lymph nodes, and an absolute lymphopenia in peripheral blood [5]. We also noted the lympholytic effects of adrenal steroids and the thymolytic effect of estrogen and the adrenal steroids [6, 7] and emphasized that these hormones are produced in increased amounts in pregnancy. We pointed out that the foregoing suggests an inhibitory effect of pregnancy on the thymus and lymphatic tissue; the inhibitory effect seemed to be more profound in cases of malignant trophoblastic disease.