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Background and Objectives: Endoscopic epidural neuroplasty (EEN) facilitates adhesiolysis through direct epiduroscopic visualization, offering more precise neural decompression than that exhibited by percutaneous epidural neuroplasty (PEN). We aimed to compare the effects of EEN and PEN for 6 months after treatment with lower back and radicular pain in patients. Methods: This retrospective study compared the visual analog scale (VAS) and Oswestry disability index (ODI) scores in patients with low back and radicular pain who underwent EEN or PEN with a steering catheter. The medical records of 107 patients were analyzed, with 73 and 34 undergoing EEN and PEN, respectively. Results: The VAS and ODI scores decreased at all time points after EEN and PEN. VAS and ODI scores decreased more in the EEN group than those in the PEN group at 1 day and 1- and 6-months post-procedure, indicating superior pain relief for both lower back and radicular pain through EEN. Conclusions: EEN is a superior treatment of pain control than PEN in lower back and radicular pain patients.

This was a cross-sectional study conducted to evaluate the association between hearing impairment and low back pain (LBP) using data from the Korean National Health and Nutrition Examination Survey. A total of 5,504 middle-aged and older Korean adults (aged ≥50 years old) who underwent plain radiography of the lumbar spine and pure tone audiometry were included. The presence of LBP was evaluated using a questionnaire, which included a question on whether the patient had experienced LBP that lasted for more than 30 days during the past three months. Patients with age-related hearing loss (ARHL) were defined as those with bilateral hearing impairment who met the following criteria: 1) normal otologic examination results, 2) average pure-tone hearing thresholds of ≤15 dB in both ears, and 3) no occupational noise exposure. Multivariable logistic regression analysis showed that ARHL was not associated with LBP (odds ratio, 1.33; 95% CI, 0.94-1.89) after adjusting for potential confounders in the final model. However, when participants without both ARHL and tinnitus were defined as the reference group, the results showed that the participants with both ARHL and tinnitus were more likely to have LBP (OR, 1.86; 95% CI, 1.11-3.11). These results indicate that ARHL with tinnitus is significantly associated with LBP. We recommend that elderly patients with ARHL and tinnitus increase their daily physical activities and engage in more muscle-strengthening exercises to prevent LBP.

Abstract Immunoenrichment-based matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS), termed MASS-FIX, offers several advantages over immunofixation for the detection and isotyping of serum monoclonal protein, including superior sensitivity and specificity, the ability to differentiate therapeutic monoclonal antibodies, and the rapid identification of light chain (LC) N-glycosylation. We identified 6315 patients with MASS-FIX performed at our institution since 2018. Of these, 4118 patients (65%) with a wide array of plasma cell disorders (PCD), including rare monoclonal gammopathies of clinical significance, had a positive MASS-FIX. Two-hundred twenty-one (5%) of the MASS-FIX positive patients had evidence of LC N-glycosylation, which was more commonly identified in IgM heavy chain isotype, kappa LC isotype, and in diagnoses of immunoglobulin light chain (AL) amyloidosis and cold agglutinin disease (CAD) compared to other PCD. This cross-sectional study describes the largest cohort of patients to undergo MASS-FIX in routine clinical practice. Our findings demonstrate the widespread utility of this assay, and confirm that LC N-glycosylation should prompt suspicion for AL amyloidosis and CAD in the appropriate clinical context.

Objective The bispectral index (BIS) has been used to monitor sedation during spinal anesthesia. We evaluated the correlation between BIS and the Observer’s Assessment of Alertness/Sedation Scale (OAA/S) in patients sedated with dexmedetomidine, propofol, or midazolam. Methods This prospective, randomized study included 46 patients scheduled for knee arthroplasty under spinal anesthesia with sedation. The patients were randomized to receive sedation with dexmedetomidine (n = 15), propofol (n = 15), or midazolam (n = 16). Correlation between BIS and OAA/S was assessed during sedation in the three groups. Results A linear correlation was observed between BIS and OAA/S, and there was no significant difference in BIS score between the groups during mild to moderate sedation status (OAA/S 3–5). During deep sedation (OAA/S 1–2), the BIS score in the midazolam group was significantly higher than that in the propofol and dexmedetomidine groups (74.4 ± 11.9 vs 67.7 ± 9.5 vs 62.6 ± 12.2). Conclusions BIS values differed at the same level of sedation between different sedative agents. Objective sedation scores should therefore be used in combination with BIS values for the assessment of sedation levels during spinal anesthesia.

This qualitative study explores school leaders' (principals and assistant principals) perspectives on crisis leadership roles and their competencies in responding to and managing a crisis. The role of school leaders has become increasingly disrupted by unexpected incidents that are diverse and complex in nature. As such, their knowledge of crisis leadership roles and competencies is critical for schools' effectiveness in an era of crisis management. The study draws on complex adaptive system theory (CAST) to explore the roles necessary for school leaders to become crisis leaders and analyze school leaders' experiences and responses to crises in the educational setting. This study investigates qualitative interview data from 20 principals and assistant principals who were knowledgeable of safety protocols and experienced a crisis in one southern K-12 school district in the United States. Data analysis yielded three main leadership roles: (a) agile decision-maker, (b) influencer, and (c) coordinator. Each role is supported with interview data and literature to describe the competencies that guide the action of leaders as they respond to and manage a crisis. The roles support school leaders in reshaping their understanding of a crisis leader, and the competencies explain the actions during crisis response for a school leader. Exploring school leadership roles to manage a crisis in the K-12 system contributes to the literature on crisis leadership in the educational setting during a crisis.

Although the major mechanism of complex regional pain syndrome (CRPS) involves dysfunctional central or sympathetic nervous system activation, the peripheral nervous system also contributes significantly to its clinical manifestations. Pulsed radiofrequency (PRF) is a recently developed treatment option for neuropathic pain syndromes. Here, we report a case of CRPS Type II after a femur fracture and sciatic nerve injury, in which the pain was treated successfully with ultrasonography-guided selective sciatic nerve PRF application.

Sedimentation is a problem for all reservoirs in the Black Hills of South Dakota. Before working on sediment removal, a survey on the extent and distribution of the sediment is needed. Two sample lakes were used to determine which of three interpolation methods gave the most accurate volume results. A secondary goal was to see if fewer samples could be taken while still providing similar results. The smaller samples would mean less field time and thus lower costs. Subsamples of 50%, 33% and 25% were taken from the total samples and evaluated for the lowest Root Mean Squared Error values. Throughout the trials, the larger sample sizes generally showed better accuracy than smaller samples. Graphing the sediment volume estimates of the full sample, 50%, 33% and 25% showed little improvement after a sample of approximately 40%–50% when comparing the asymptote of the separate samples. When we used smaller subsamples the predicted sediment volumes were normally greater than the full sample volumes. It is suggested that when planning future sediment surveys, workers plan on gathering data at approximately every 5.21 meters. These sample sizes can be cut in half and still retain relative accuracy if time savings are needed. Volume estimates may slightly suffer with these reduced samples sizes, but the field work savings can be of benefit. Results from these surveys are used in prioritization of available funds for reclamation efforts.

Background: Leptin is an adipokine that is recently reported to be a biomarker of systemic inflammation. Although atherosclerosis causes cardiovascular diseases, it is not clear whether leptin contributes to the acceleration of this process. In this study, we investigated whether alterations of plasma leptin levels were related to diabetic nephropathy and systemic inflammation. In addition, we examined the physiologic action of leptin in cultured vascular smooth muscle cells (VSMCs). Methods: A total of 126 type 2 diabetic participants and 37 healthy controls were studied. The diabetic participants were divided into three groups according to stage of nephropathy. We investigated whether leptin induced monocyte chemotactic peptide-1 (MCP-1) synthesis through the mitogen-activated protein kinase (MAPK) pathway using cultured VSMCs. Results: Plasma leptin concentrations were significantly higher in the diabetic group than in the controls. Plasma leptin levels were positively correlated with body mass index, fasting and postprandial blood glucose, hemoglobin A1c, total cholesterol, urinary albumin excretion, high-sensitivity C-reactive protein (hsCRP), and MCP-1 plasma levels, and negatively correlated with creatinine clearance values. In cultured VSMCs, leptin increased MCP-1 production in a dose-dependent manner, and this stimulating effect of leptin on MCP-1 expression was reversed by the MAPK (MEK) inhibitor PD98059. In addition, leptin stimulated the phosphorylation of MEK, extracellular signal–regulated kinase, and E26-like transcription factor, which are components of the MAPK pathway. Conclusions: Overall, these findings suggest that activation of leptin synthesis may promote MCP-1 activation in a diabetic environment via the MAPK pathway in VSMCs and that it possibly contributes to the acceleration of atherosclerosis.

Wellbeing in schools is often focused at the individual level, exploring students' or teachers' individual traits, habits, or actions that influence wellbeing. However, studies rarely take a whole-school approach that includes staff wellbeing, and frequently ignore relational and organizational level variables. We take a systems informed positive psychology approach and argue that it is essential to build greater understanding about organizational and relational influences on wellbeing in order for schools to support educator wellbeing. Our study evaluated the relative contributions of individual, relational, and organizational factors to educator wellbeing. Our measure of wellbeing focused on the life satisfaction and flourishing of 559 educators in 12 New Zealand schools. We used a social network analysis approach to capture educators' relational ties, and demographic data and psychometric scales to capture individual and organizational level variables. Results of hierarchical blockwise regressions showed that individual, relational, and organizational factors were all significantly associated with educator wellbeing; however, it was educators' perceptions of trusting and collaborative school conditions that were most strongly associated with their wellbeing. The number of relational ties educators had explained the least amount of variance in wellbeing. Educators were more likely to experience high levels of support when their close contacts also experienced high levels of support. However, for many educators, there was a negative association between their most frequent relational ties and their reported levels of support. Our results suggest that attending to the organizational factors that influence wellbeing, through creating trusting and collaborative school conditions, may be one of the most influential approaches to enhancing educator wellbeing. We call for whole-school approaches to wellbeing that not only consider how to support and enhance the wellbeing of school staff as well as students, but also view the conditions created within a school as a key driver of wellbeing within schools.

Purpose: Educational reform is a complex undertaking and the interactions between leaders as they go about a change are consequential for realizing desired outcomes. Advice relationships are one such interaction and can play a key role in driving knowledge transfer and development and as such are an important social capital asset supporting organizational change. Building on the growing scholarship around a social network approach to understanding educational leadership and systems change, the study draws from network concepts to examine advice relationships within a district-wide leadership team as the leaders engages a reform initiative, and what accounts for the development of these important relational ties. Design/methodology/approach: Quantitative data were collected through an annual survey at six points over six years from the leadership team in one public school district in the Western United States, including perceptions of organizational learning, beliefs about reform, and reform-related advice relationships. Findings: Using multilevel mixed modeling, findings reveal downward trends in leaders' advice-seeking and -receiving ties over time and that seeking and receiving advice is positively related to organizational learning, beliefs about reform impact, or beliefs about their efficacy in implementing the reform. However, views about reform-related resources are negatively associated with seeking and receiving advice ties over time. Originality/value: This study contributes to the literature on the social side of change specifically related to leadership, reform, organizational learning, and leader beliefs about reform implementation. Further, the work offers practical implications for potential social infrastructure design for joint work.

Online courses provide the flexibility of time and location for both students and educators. From an administration viewpoint, online courses do not require physical classrooms, hence they require less university resources; as such, online courses are often seen as cash cows. Unfortunately, in some cases online courses are still considered second-tier because of delayed interactions between students and faculty members in an asynchronous class. In order for an administration to properly allocate university resources to online faculty, it is essential to know where online students are from. Similarly, online faculty must know when their students conduct course activities in order to provide timely and quality responses. This study examined 97 online students attending an MS in GIScience program over where they are from, and when they do their course activities. Our findings concluded that around 90% of online students were not from the traditional catchment area, and around 70% were from out of state. We also found that an average of 72% of course activities were conducted during weeknights (40%) and weekends (32%).

The success of implementing Common Core State Standards (CCSS) depends not only on the extent to which educators deeply understand the new standards but also on the expectations, values, and resources that support their readiness for making necessary instructional change. Educators' understanding of and beliefs about CCSS may largely drive their behaviors and action toward implementation. This study investigated a longitudinal dataset of teachers and principals in one large school district serving a diverse student population in California, examining the relationship between educators' beliefs and trust and the organizational climate. Findings suggest that both teachers' trust in the principal and an innovative climate play a consistent, critical role in educators' beliefs about implementing CCSS.

Educational leadership is a widely discussed topic in educational science. However, although the study of social networks in (informal) educational settings is gaining interest in recent years, the intersection between leadership and online social networks has received limited attention. This article investigates the informal sets of networks in both social media and face-to-face spaces in which elementary principals engage in the access, use, and diffusion of information. We undertook an exploratory case study in an urban midsize public school district in the United States and collected online and face-to-face network data from a districtwide leadership team of 97 leaders. Our results shed some light on the underlying information exchange patterns and identify commonalities and differences that are useful to consider for practitioners and policy makers who would like to foster the (informal) professional development of educators, and particularly elementary principals, who often do not have access to more formalized forms of professional development or just-in-time access to resources.