bluuebunny/crossref_metadata_2025 huggingface dataset:
A low-friction graphene nanoplatelets film from suspension high velocity oxy-fuel thermal spray
Authors: Venturi F. , Rance G. A. , Thomas J. , Hussain T.
Published: February 2019

The addition of graphene-based nanomaterials is known to improve the tribology properties of materials by lowering the coefficient of friction and reducing wear. The covering of small areas with thin graphene-based films is routinely carried out; however, a fast and efficient way of covering large areas represents an outstanding challenge. Here we present a method for the deposition of graphene nanoplatelets (GNPs) on stainless steel substrates based on suspension high-velocity oxy fuel thermal spray. GNPs were radially injected into the combustion jet, providing sufficient momentum and moderate heat transfer to facilitate effective bonding with the substrate. Upon unlubricated ball-on-disc wear testing against an alumina counterbody, GNPs undergo gradual exfoliation, covering the substrate and thus lowering the friction coefficient (<0.1). We have reported the formation of a thin layer, composed of GNPs having different amounts of disorder, which protects the underlying substrate from wear. GNP structural ordering is studied throughout deposition and wear tests, showing an increase of inter- and intralayer disorder at the nanoscale, whilst largely preserving the GNP microstructure.
Dynamic evolution of microturbulence with an improved confinement mode in the ramp-down phase of plasma current on EAST
Authors: Bi J , Li Y D , Wu G J , Li P , Sun P J , Lan T , Wang S X , Zhao H L
Published: February 2019

Micro-instabilities are often invoked to account for the anomalous transport of energy and particles in fusion plasmas, whose origin and contributions to anomalous transport remain uncertain. The dynamic features of the microturbulence in the plasma core and the gradient region are investigated simultaneously by a poloidal CO2 laser coherent scattering diagnostic system on the experimental advanced superconducting tokamak (EAST). In 2018, an improved confinement mode characterized by a peaked density profile is observed in the current ramp-down phase with no auxiliary heating, which has rarely been studied. The experimental result suggests that the gradual shut off of the LHW heating might trigger the mode transition. The transition is accompanied with a great suppression of microturbulence and significant change in the cross-correlation spectrum. A possible mechanism for the suppression could be ascribed to the increasing

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shear flow. These results could shed light on the understanding of the nonlinear mechanism of confinement mode transition on EAST.
Charles Dickens: A Very Short Introduction
Authors: Hartley Jenny
Published: February 2019

Charles Dickens is credited with creating some of the world’s best-known fictional characters, and is widely regarded as the greatest novelist of the Victorian age. Charles Dickens: A Very Short Introduction explores the key themes running through his corpus of works, and considers how they reflect his attitudes towards the harsh realities of 19th-century society and its institutions. It considers Dickens’s multiple lives and careers: as magazine editor for much of his working life, as travel writer and journalist, and his work on behalf of social causes. Finally, it discusses what is meant by the use of the term ‘Dickensian’ today, and the enduring impact of his work.
2. Public and private
Authors: Hartley Jenny
Published: February 2019

Charles Dickens was born in Portsmouth in February 1812. ‘Public and private’ describes his early childhood, his first jobs, and his move into writing. His father’s imprisonment for debt when he was just 12 led to the most painful episode of his life. His first sketch appeared in December 1833 and he went on to write many more under the nickname of Boz. He married Catherine Hogarth in 1836 and before he was 30 was one of the most famous men in Britain. By the late 1840s, he felt financially secure and could devote time to social reform issues. His later work and the failure of his marriage are also described.
1. The idea of film noir
Authors: Naremore James
Published: February 2019

The term ‘film noir’ originated with French film critics during the 1930s, but it soon became associated with American films in the mid-1940s. ‘The idea of film noir’ explains the strong influence of the Surrealists on French attitudes toward the new American films. The first and most important book on film noir was A Panorama of the American Film Noir: 1941–1953, compiled by Raymond Borde and Etienne Chaumeton. They define noir in terms of five affective qualities typical of Surrealist art: oneiric, strange, erotic, ambivalent, and cruel. Film noir continued through the 1950s, 1960s, and 1970s, and forms of the genre have spread all around the world.
2. The modernist crime novel and Hollywood noir
Authors: Naremore James
Published: February 2019

‘The modernist crime novel and Hollywood noir’ considers how an atmosphere of ‘modernism’ in 1940s American film noir is largely due to the ‘thriller genre’ in literature. Many aspects of modernity—the interest in subjectivity and multiple points of view, the unorthodox handling of time, the stripping away of genteel rhetoric, the critique of modernity, explicit sex, and fears of women—came together in film noir, but were a potential threat to the entertainment industry. The tension was evident in Hollywood adaptations of four influential crime writers and major contributors to film noir—Samuel Dashiell Hammett, Graham Greene, James M. Cain, and Raymond Chandler—whose work needed to be lightened or ameliorated.
5. Identity in politics
Authors: Coulmas Florian
Published: February 2019

‘Identity in politics: promises and dangers’ concludes that identity in politics is a challenge to democratic rule rooted in the principle of self-determination. As a natural child of nationalism, it gives rise to conflicts that political scientists study at multiple levels. At the subnational level, the focus is on ethnicities and group affiliations. At the supranational level, they are concerned with civilization identities. Considering conflicts in terms of civilization identities is sometimes persuasive for there is the risk of stereotyping, while identities are historically contingent and can be instrumentalized for various political purposes. Because identities tend to be presented as non-negotiable, identity politics is hard to reconcile with deliberative democracy as it makes compromise difficult to achieve.
9. ‘They don’t speak our language’
Authors: Coulmas Florian
Published: February 2019

‘ “They don’t speak our language”: identity in linguistics’ considers the relationship between language and identity. For individuals and groups, language has instrumental and symbolic functions, which can be in conflict with each other. The instrumental function of communication stands for inclusion, while the symbolic function of identity manifestation stands for exclusion. Language serves identity manifestation with regard to nation, region, social class, ethnicity (race), gender, and age. The respective linguistic differences can be highlighted or downplayed. Yet, on the level of individual expression in both speech and writing, language has biometric qualities allowing for highly reliable speaker identification.
Italy
Authors: Campbell Gordon
Published: February 2019

‘Italy’ discusses the essential features of the 16th-century Italian Renaissance garden—terraces, symmetry, statues, water, and a balance between constructed and natural materials—that were to influence gardens all over the world both in layout and in content. The two best-known surviving gardens of 16th-century Italy are Villa d’Este in Tivoli and the Boboli Gardens in Florence. The design of Italian gardens through the 17th and 18th centuries is also considered, when there was a greater French influence. Many gardens became derelict during the political and economic difficulties of a fragmented Italy in the late 18th and early 19th centuries, but the past forty years have witnessed the restoration of many Renaissance gardens.
Spain and Portugal
Authors: Campbell Gordon
Published: February 2019

‘Spain and Portugal’ highlights the key garden designs of Spain and Portugal from the 16th century to the present day. The two greatest gardens of the Spanish Golden Age were commissioned by King Philip II at Aranjuez and the Escorial, which showed the influence of both Flemish and Italian gardens. Other key Spanish gardens described include La Granja de San Ildefonso in Segovia and Antoni Gaudí’s Parc Güell in Barcelona. Portuguese gardens of the 16th and 17th centuries incorporated glazed tiles—azulejos—and Arabic water tanks. Gardens described include the Golden Age Quinta da Bacalhoa and Castelo Branco, the 18th-century garden of the Palácio Nacional de Queluz; and Jacques Gréber’s modernist Parque de Serralves.
Northern Europe
Authors: Campbell Gordon
Published: February 2019

‘Northern Europe’ considers the garden history of the Low Countries, Germany, and Russia. Dutch and Flemish gardens of the 16th century had a markedly different character from the Renaissance gardens in Italy; garden art is one of the forms in which the differences are readily apparent. Gardens described include the gardens of Jan Vredeman de Vries, which contained medieval and Erasmian elements laid out with a painterly attention to detail and form; the Honselaarsdijk estate of Prince Frederik Hendrik, between The Hague and the Hook of Holland; the Hortus Academicus at Leiden; Germany’s first important public garden, the Englische Garten in Munich; and Pavlovsk in Russia, one of the world’s greatest landscape gardens.
Expanding the role of pharmacy technicians to facilitate a proactive pharmacist practice
Authors: Newby Brandi
Published: February 2019

Purpose

This study describes a change in pharmacy practice to expand pharmacy technician roles to allow dispensing without a pharmacist check, thereby enhancing the pharmacist role in direct patient care.

In an effort to optimize patient care with limited resources, we set out to change our pharmacy practice model. We transferred duties that did not require clinical judgment in the dispensary from the pharmacist to the regulated technician. The transferred roles included order entry, order entry verification, and final check of medications and preparations. The changes in roles were well received by the pharmacy staff. The pharmacist practice changed from a reactive process, where the pharmacist waited for orders to be sent to the pharmacy, to a proactive process where the pharmacist collaborated directly with patients and the health care team. The pharmacists were able to provide daily medication therapy management for every inpatient in the new practice model compared with only reactive targeted care in the former practice model. Implementation of the new practice model at our site led to a reduction in time for medications to be delivered to the patient and reduced pharmacy-related medication errors.

Conclusion

A new pharmacy practice model was successfully implemented whereby the pharmacy technician roles were expanded to the point where they perform all the distribution roles in the dispensary. This, in turn, allowed a change in the pharmacist role, which was focused on daily proactive direct patient care and medication therapy management.
Validation of a CD30 Enzyme-Linked Immunosorbant Assay for the Rapid Detection of Breast Implant-Associated Anaplastic Large Cell Lymphoma
Authors: Hanson Summer E , Hassid Victor J , Branch-Brooks Cynthia , Liu Jun , Kadin Marshall E , Miranda Roberto , Butler Charles E , Clemens Mark W
Published: February 2019

Background

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of non-Hodgkin lymphoma occurring in the fluid or capsule adjacent to textured breast implants. Diagnosis of BIA-ALCL of symptomatic patients requires demonstration of large anaplastic cells with uniform expression of CD30 protein on immunohistochemistry.

Objectives

The authors investigated a novel, rapid, office-based, and economic in-situ enzyme-linked immunosorbent assay (ELISA) for screening BIA-ALCL patients.

Methods

A commercially available in-situ ELISA was standardized and validated for patients with confirmed BIA-ALCL diagnosis with clinical isolates. A panel of 9 pathologically confirmed BIA-ALCL patients was screened by serum, plasma, and periprosthetic effusion specimens and compared against serum, plasma, and nonneoplastic delayed seromas in 7 control patients. Statistical analysis demonstrated assay consistency and reliability.

Results

All BIA-ALCL effusions demonstrated CD30 ELISA detection at full and all serial concentrations. BIA-ALCL serum specimens and all control specimens were negative at full concentration and serial dilutions (1:100, 1:250, 1:500, and 1:1000). BIA-ALCL plasma specimens were weakly positive at full concentration and revealed no activity with serial dilution.

Conclusions

This is the first study to demonstrate a viable alternative to CD30 immunohistochemistry for the screening of BIA-ALCL. Our study demonstrates 100% sensitivity in seroma fluid with no detectable CD30 in benign seroma samples. A CD30 ELISA represents a novel, low-cost screening test, which may be used to screen suspicious aspirations of delayed periprosthetic fluid collections in an office-based setting.

Level of Evidence: 3
Easybiotics: a GUI for 3D physical modelling of multi-species bacterial populations
Authors: Naylor Jonathan , Fellermann Harold , Krasnogor Natalio
Published: February 2019

Motivation

3D physical modelling is a powerful computational technique that allows for the simulation of complex systems such as consortia of mixed bacterial species. The complexities in physical modelling reside in the knowledge intensive model building process and the computational expense in calculating their numerical solutions. These models can offer insights into microbiology, both in understanding natural systems and as design tools for developing novel synthetic bacterial systems. Developing a robust synthetic system typically requires multiple iterations around the specify→design→build→test cycle to meet specifications. This process is laborious and expensive for both the computational and laboratory aspects, hence any improvement in any of the workflow steps would be welcomed. We have previously introduced Simbiotics, a powerful and flexible platform for designing and analyzing 3D simulations of mixed species bacterial populations. Simbiotics requires programming experience to use which creates barriers to entry for use of the tool.

Results

In the spirit of enabling biologists who may not have programming skills to install and utilize Simbiotics, we present in this application note Easybiotics, a user-friendly graphical user interface for Simbiotics. Users may design, simulate and analyze models from within the graphical user interface, with features such as live graph plotting and parameter sweeps. Easybiotics provides full access to all of Simbiotics simulation features, such as cell growth, motility and gene regulation.

Availability and implementation

Easybiotics and Simbiotics are free to use under the GPL3.0 licence, and can be found at: http://ico2s.org/software/simbiotics.html. We also provide readily downloadable virtual machine sandboxes to facilitate rapid installation.
Endocarditis after percutaneous edge-to-edge in a heart transplant recipient: management through the HeartPort technique
Authors: Anselmi Amedeo , Flecher Erwan , Leurent Guillaume , Verhoye Jean-Philippe
Published: February 2019

In the case illustrated in this study, a heart transplant recipient received percutaneous mitral edge-to-edge for secondary mitral regurgitation on the basis of increased reoperative risk. After development of mitral endocarditis, reoperation and mitral valve replacement were successfully performed through the HeartPort technique. We discuss the technical aspects, including the positioning of the Intraclude® device and the access to the mitral valve in this context. We address the decision-making issues (role of minimally invasive surgery to reduce operative risk in patients with one or more previous sternotomies).
Archives, Collections and Curatorship: Virtual Special Issue for the Journal of Design History, 2019
Authors: Hendon Zoë
Published: February 2019

Design historians frequently find their interest in a particular subject prompted by archival materials, or begin their research with collections of designed objects supported by online databases. While these are the raw materials, the primary sources of the design historian’s work, they are also deserving of attention in their own right. This Virtual Special Issue is comprised of twelve articles drawn from past issues of the Journal of Design History’s Archives, Collections and Curatorship section, drawing out key themes and highlighting ongoing dialogues between academic design historians, curators, librarians and archivists. This Introduction seeks to contextualise these within the wider discipline of design history, and to draw connections to scholarship beyond the Journal of Design History itself. Articles under the first heading look at archives, while articles under the second consider collections of objects. The third section turns to the related challenges of presenting design historical research to public audiences. This Virtual Special issue also offers a reminder that as both the processes and products of design move into the digital sphere, it is pertinent to ask what this means for the ways in which design historians, students, and the general public will engage with design history in future.
Claiming the Crisis: Mediated Public Debates about the Refugee Crisis in Austria, the Czech Republic and Slovakia
Authors: Kluknavská Alena , Bernhard Jana , Boomgaarden Hajo G.
Published: February 2019

The arrival of refugees to Europe increased dramatically in 2015. This situation produced polarized responses across the European Union and caused intensive media attention and public debate. This study investigates claim-making on the so-called refugee crisis in the public sphere in three countries: Austria, the Czech Republic and Slovakia. It asks who shaped the discourse on the crisis in national public realms, how the discourse took shape and to what degree a common European discourse would emerge. Actors’ positions and claims in the mediated discourse during the first peak of the crisis between August and October 2015 are examined, drawing on an analysis of 3,226 claims in a cross-country comparison. Results indicate institutionalization and shift between security–humanitarian discourses and balanced threat–victim-framing. The findings suggest that the debate was confined to national public spheres, but with first signs of a common European discourse. This study contributes to the literature on representation of migration in the media in a cross-national perspective within the context of the recent crisis.
Formation of high-mass stars in an isolated environment in the Large Magellanic Cloud
Authors: Harada Ryohei , Onishi Toshikazu , Tokuda Kazuki , Zahorecz Sarolta , Hughes Annie , Meixner Margaret , Sewiło Marta , Indebetouw Remy , Nayak Omnarayani , Fukui Yasuo , Tachihara Kengo , Tsuge Kisetstu , Kawamura Akiko , Saigo Kazuya , Wong Tony , Bernard Jean-Philippe , Stephens Ian W
Published: February 2019

The aim of this study is to characterize the distribution and basic properties of the natal gas associated with high-mass young stellar objects (YSOs) in isolated environments in the Large Magellanic Cloud. High-mass stars usually form in giant molecular clouds (GMCs) as part of a young stellar cluster, but some OB stars are observed far from GMCs. By examining the spatial coincidence between the high-mass YSOs and 12CO (J = 1–0) emission detected by NANTEN and Mopra observations, we selected ten high-mass YSOs that are located away from any of the NANTEN clouds but are detected by the Mopra pointed observations. The ALMA observations revealed that a compact molecular cloud whose mass is a few thousand solar masses or smaller is associated with the high-mass YSOs, which indicates that these compact clouds are the sites of high-mass star formation. The high density and high temperature throughout the clouds are explained by the severe photodissociation of CO due to the lower metallicity than in the Galaxy. The star formation efficiency ranges from several to as high as ∼40%, indicating efficient star formation in these environments. The enhanced turbulence may be a cause of the efficient star formation therein, as judged from the gas velocity information and the association with the lower density gas.
Treating pediatric acute-onset neuropsychiatric syndrome
Authors: Heavey Elizabeth , Peterson Kathleen
Published: February 2019

Pediatric acute-onset neuropsychiatric syndrome (PANS) can be caused by infectious and noninfectious triggers. NPs can help children with PANS recover from their symptoms and prevent future recurrences by appropriately screening, recognizing, and diagnosing the clinical presentation of PANS. PANS treatment includes pharmacologic therapies as well as cognitive behavioral therapy.
Mannitol Improves Intraoperative Brain Relaxation in Patients With a Midline Shift Undergoing Supratentorial Tumor Surgery: A Randomized Controlled Trial
Authors: Li Shu , Sun Huihui , Liu Xiaoyuan , Ren Xiaohui , Hao Shuyu , Zeng Min , Wang Dexiang , Dong Jia , Kan Qing , Peng Yuming , Han Ruquan
Published: February 2019

Background:

Mannitol is widely used to reduce brain tissue swelling and improve brain relaxation during neurosurgery. However, the optimal dosage for patients with midline shift undergoing supratentorial tumor resection remains unclear.

Methods:

In this randomized, controlled double-blinded study, 204 patients with preoperative midline shift who underwent elective supratentorial brain tumor surgery were equally allocated to receive placebo or 0.7, 1.0, or 1.4 g/kg mannitol infusion. The primary outcome was the proportion of satisfactory brain relaxation.

Results:

Demographics and baseline characteristics were similar among the 4 groups. Trend analysis showed that mannitol infusion increased satisfactory brain relaxation (P<0.0001), relaxed dural tension (P<0.0001) and adequate surgical exposure (P<0.0001), and decreased the requirement for rescue therapy for brain swelling (P<0.0005), all in a dose-dependent manner. Tumor size (odds ratio [OR]: 0.99 per 1 mm3, 95% confidence interval [CI]: 0.989-0.998, P=0.004), peritumoral edema classification (OR: 0.60, 95% CI: 0.37-0.97; P=0.038) as well as mannitol dose (OR: 2.81, 95% CI: 1.97-4.02, P<0.0001) were significantly associated with satisfactory brain relaxation. An increased risk of moderate to severe postoperative cerebral edema was found in the group receiving 1.4 g/kg mannitol (P=0.025) in a dose-dependent manner (P=0.018).

Conclusions:

An optimal mannitol infusion dosage of 1.0 g/kg is recommended to improve brain relaxation with lower risk of moderate to severe postoperative cerebral edema in patients with midline shift undergoing supratentorial tumor resections. The effect of mannitol on brain relaxation is affected by tumor size and severity of peritumoral edema, rather than by midline shift.
Society for Neuroscience in Anesthesiology & Critical Care (SNACC) Neuroanesthesiology Education Milestones for Resident Education
Authors: Sharma Deepak , Easdown Letitia J. , Zolyomi Arpad , Ayrian Eugenia , Wheeler Peggy J. , Edelman Guy , Mahla Michael E.
Published: February 2019

Background:

The Accreditation Council for Graduate Medical Education (ACGME) has introduced competency-based assessments (milestones) for resident education. However, the existing milestones for Anesthesiology are not specific to Neuroanesthesiology. The Society for Neuroscience in Anesthesiology & Critical Care (SNACC) commissioned a task force to adapt the ACGME anesthesiology milestones for use in Neuroanesthesiology training, and to provide recommendations for implementing milestones.

Methods:

A 7-member expert task force supported by an advisory committee developed the initial milestones by consensus. Written permission was given by the ACGME. The milestones were refined following 3-month pilot use in 14 departments across the United States and inputs from SNACC members. Final milestones were approved by the SNACC Board of Directors.

Results:

Twelve Neuroanesthesiology-specific milestones in 5 major ACGME domains are recommended; these were identified as most pertinent to this subspecialty rotation. These pertain to patient care (7 milestones), medical knowledge (2 milestones), practice-based learning and improvement (1 milestone), and interpersonal and communication skills (2 milestones). Each milestone was described in detail, with clear outline of expectations at various levels of training.

Conclusions:

The SNACC Neuroanesthesiology milestones provide a framework for reviewing resident performance and are expected to facilitate improved use of ACGME milestones during Neuroanesthesiology subspecialty training. The task force recommends that the target should be to accomplish level 4 or higher milestones by the end of residency training. Individual programs should decide the implications of a resident not meeting the expected milestones.
Pulse Pressure Variations and Plethysmographic Variability Index Measured at Ear Are Able to Predict Fluid Responsiveness in the Sitting Position for Neurosurgery
Authors: Bapteste Lionel , Carrillon Romain , Javelier Stéphanie , Guyotat Jacques , Desgranges François-P. , Lehot Jean-j. , Lukaszewicz Anne-c.
Published: February 2019

Background:

Pulse pressure variation (PPV) and plethysmographic variability index (PVI), dynamic indicators of preload dependence based on heart-lung interactions, are used to predict fluid responsiveness in mechanically ventilated patients in the supine position. The sitting position for neurosurgery, by changing intrathoracic blood volume, could affect the capacity of PPV and PVI to predict fluid responsiveness. The aim of the study was to assess the ability of PPV and PVI to predict fluid responsiveness during general anesthesia in the sitting position.

Methods:

In total, 31 patients were included after settling in the sitting position but before surgery began. PPV, PVI with a finger sensor (PVI finger), and PVI with an ear sensor (PVI ear) were recorded before and after a fluid challenge of hydroxylethylstarch 250 mL over 10 minute. Esophageal Doppler was used to record stroke volume. Patients were defined as fluid responders if stroke volume increased by more than 10% after the fluid challenge.

Results:

In total, 13 (42%) patients were fluid responders. PPV and PVI ear were higher in responders than in nonresponders before the fluid challenge (12±5 vs. 7±3; P=0.0005 and 14±5 vs. 8±3; P=0.001, respectively). Areas under the receiver-operating curves to predict fluid responsiveness were 0.87 for PPV (P<0.0001), 0.87 for PVI ear (P<0.0001), and 0.64 for PVI finger (P=0.17). PPV ≥8% or PVI ear ≥11% predicted fluid responsiveness with sensitivities of 83% for both, and specificities of 83% and 91%, respectively. However PVI ear data were not available in 26% of patients.

Conclusions:

PPV can be used to predict fluid responsiveness in the sitting position for neurosurgery.
Prediction of infection risk in rheumatoid arthritis patients treated with biologics: are we any closer to risk stratification?
Authors: Jani Meghna , Barton Anne , Hyrich Kimme
Published: February 2019

Purpose of review

There are currently several available biologics for rheumatoid arthritis (RA) with similar efficacy in most trials. A major consideration therefore in choosing a biologic, continues to be safety concerns such as infection. Considerable advances have been made in the understanding of biologic safety on a population level; however, how close are we to stratifying risk for individual patients? This review discusses evidence published in the last year, with reference to key previous literature.

Recent findings

Comparative safety of biologics has been studied in observational cohorts, with a possible increased risk of serious infection in tocilizumab-treated patients compared with etanercept. Rheumatoid arthritis patients on biologics are often on concomitant medications such as steroids and opioids, and the advances in relation to infection are summarized. Pharmacological biomarkers and optimizing existing risk prediction scores may allow better future risk stratification.

Improved quantification of personalized benefit:harms would allow better-informed decisions, reduction of infection-associated morbidity as well as direct/indirect costs associated with biologics. Although advances have been made to better understand and predict risk, future studies are likely to require a range of novel data sources and methodologies for the goal of precision medicine to be truly realized.
Does Hospital Volume Affect Outcomes in Spine Surgeries? A Systematic Review
Authors: Adkins Zachary B. , Malik Azeem T. , Jain Nikhil , Yu Elizabeth , Kim Jeffery , Khan Safdar N.
Published: February 2019

Study Design:

Systematic review.

Objective:

To assess the impact of hospital volume on postoperative outcomes in spine surgery.

Summary of Background Data:

Several strategies have recently been proposed to optimize provider outcomes, such as regionalization to higher volume centers and setting volume benchmarks.

Materials and Methods:

We performed a systematic review examining the association between hospital volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior/posterior cervical fusions, anterior/posterior lumbar fusions, laminectomies, discectomies, spinal deformity surgeries, and surgery for spinal malignancies. We searched the Pubmed, OVID MEDLINE (1966–2018), Google Scholar, and Web of Science (1900–2018) databases in January 2018 using the search criteria (“Hospital volume” OR “volume” OR “volume-outcome” OR “volume outcome”) AND (“spine” OR “spine surgery” OR “lumbar” OR “cervical” OR “decompression” OR “deformity” OR “fusions”). There were no restrictions placed on study design, publication date, or language. The studies were evaluated with respect to the quality of methodology as outlined by the Grading of Recommendations Assessment, Development, and Evaluation system.

Results:

Twelve studies were included in the review. Studies were variable in defining hospital volume thresholds. Higher hospital volume was associated with statistically significant lower risks of postoperative complications, a shorter length of stay, lower cost of hospital stay, and a lower risk of readmissions and reoperations/revisions.

Conclusions:

Our findings suggest a trend toward better outcomes for higher volume hospitals; however, further study needs to be carried out to define objective volume thresholds for specific spine surgeries for hospitals to use as a marker of proficiency.
Cost-utility Analysis for Recurrent Lumbar Disc Herniation
Authors: Selva-Sevilla Carmen , Ferrara Paula , Gerónimo-Pardo Manuel
Published: February 2019

Study Design:

This study was an ambispective long-term cost-utility analysis with retrospective chart review and included the prospective completion of health questionnaires by patients.

Objective:

This was a cost-utility analysis, comparing conservative treatment, discectomy, and discectomy with spinal fusion for patients with recurrent lumbar disc herniation after a previous discectomy.

Summary of Background Data:

Lumbar disc herniation is an important health problem, with recurrence rates ranging from 5% to 15%. Management of recurrences is controversial due to a lack of high-level evidence. Cost-effectiveness analyses are useful when making clinical decisions. There are economic assessments for first herniations, but not in the context of recurrent lumbar disc herniations.

Materials and Methods:

Fifty patients with disc herniation recurrence underwent conservative treatment (n=11), discectomy (n=20), or discectomy with fusion (n=19), and they completed the Short-Form 36, EuroQol-5D, and Oswestry Disability Index.

Baseline case quality-adjusted life year (QALY) values, cost-utility ratios, and incremental cost-utility ratios were calculated on the basis of the SF-36. Direct health costs were calculated by applying the health care system perspective. Both QALY and costs were discounted at a rate of 3%. One-way sensitivity analyses were conducted for uncertainty variables, such as other health surveys or 2-year follow-up.

Results:

Cost-utility analysis of conservative treatment versus discectomy showed that the former is dominant, mainly because it is significantly more economical (€904 vs. €6718, P<0.001), while health results were very similar (3.48 vs. 3.18, P=0.887). Cost-utility analysis of discectomy versus discectomy with fusion revealed that discectomy is dominant, showing a trend to be both more economical (€6718 vs. €9364, P=0.054) and more effective (3.18 vs. 1.92 QALY, P=0.061).

Conclusions:

This cost-utility analysis showed that conservative treatment is more cost-effective than discectomy in patients with lumbar disc herniation recurrence. In cases of recurrence in which conservative treatment is not feasible, and another surgery must be performed for the patient, discectomy is a more cost-effective surgical alternative than discectomy with fusion.

Level of Evidence:

Level II.
The Use of Bone Morphogenetic Protein in the Intervertebral Disk Space in Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: White Ian K. , Tuohy Megan , Archer Jacob , Schroeder Gregory D. , Vaccaro Alexander R. , Mobasser Jean-Pierre
Published: February 2019

Study Design:

Retrospective Cohort.

Objective:

The objective of this study was to characterize one surgeon’s experience over a 10-year period using rhBMP-2 in the disk space for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:

MIS TLIF has been utilized as a technique for decreasing patients’ immediate postoperative pain, decreasing blood loss, and shortened hospital stays. Effectiveness and complications of rhBMP-2’s use in the disk space is limited because of its off-label status.

Methods:

Retrospective analysis of consecutive MIS TLIFs performed by senior author between 2004 and 2014. rhBMP-2 was used in the disk space in all cases. Patients were stratified based on the dose of rhBMP-2 utilized. Patients had 9 to 12 month computerized tomography scan to evaluate for bony fusion and continued follow-up for 18 months.

Results:

A total of 688 patients underwent a MIS TLIF. A medium kit of rhBMP-2 was utilized in 97 patients, and small kit was used in 591 patients. Fusion rate was 97.9% and this was not different between the 2 groups with 96/97 patients fusing in the medium kit group and 577/591 patients fusing in the small kit group. Five patients taken back to the operating room for symptomatic pseudoarthrosis, 4 reoperated for bony hyperostosis, and 10 radiographic pseudoarthroses that did not require reoperation. A statistically significant difference in the rate of foraminal hyperostosis was found when using a medium sized kit of rhBMP-2 was 4.12% (4/97 patients), compared with a small kit (0/591 patients, P=0.0004).

Conclusions:

Utilization of rhBMP-2 in an MIS TLIF leads to high fusion rate (97.9%), with an acceptable complication profile. The development of foraminal hyperostosis is a rare complication that only affected 0.6% of patients, and seems to be a dose related complication, as this complication was eliminated when a lower dose of rhBMP-2 was utilized.

Level of Evidence:

Level IV.
Safety Profile of Lumbosacropelvic Fixation in Patients Aged 60 Years or Older
Authors: Ishida Wataru , Ramhmdani Seba , Casaos Joshua , Perdomo-Pantoja Alexander , Elder Benjamin D. , Theodore Nicholas , Gokaslan Ziya L. , Wolinsky Jean-Paul , Sciubba Daniel M. , Bydon Ali , Witham Timothy F. , Lo Sheng-Fu L.
Published: February 2019

Study Design:

This is a retrospective study.

Objective:

To report the safety profile of S2-alar-iliac (S2AI) in patients over 60, comparing S2AI screws with iliac screws (ISs).

Summary of Background Data:

The surgical management involving the lumbosacropelvic spine remains a challenge due to high mechanical demand and risk of pseudarthrosis. Previous articles showed lower rates of complications in patients receiving S2AI screws than ISs; however, none of them have focused on patients aged over 60 who may harbor significant comorbidities and thus require more meticulous perioperative management, given these invasive and lengthy procedures.

Materials and Methods:

Retrospective review of clinical records from 2010 to 2015 identified 60 patients undergoing lumbosacropelvic fixation (17 patients with ISs and 43 patients with S2AI screws) who satisfied the following criteria: (1) patients aged over 60 years old and (2) patients with >1-year follow-up periods. Rates of complications such as unplanned reoperation and cardiorespiratory complications were collected and statistically analyzed.

Results:

Baseline characteristics such as age, sex, and comorbidities were similar in both groups. The S2AI group had lower rates of reoperation (18.6% vs. 47.4%; P=0.02), surgical site infection (2.3% vs. 29.4%; P=0.006), wound dehiscence (2.3% vs. 29.4%; P=0.006), and postoperative anemia (7.0% vs. 29.4%; P=0.03) and had lower total volume of estimated blood loss (EBL) (mL) (1846.4 vs. 2721.2; P=0.02) and transfused red blood cell units (7.2 vs. 4.7; P=0.04) than the IS group, while rates of L5–S1 pseudarthrosis and other cardiorespiratory complications were similar in both groups. In multivariate analysis, operative time, body mass index, and use of S2AI screws over ISs were independent predictors of EBL.

Conclusions:

Use of S2AI screws over ISs in patients aged over 60 was associated with lower rates of reoperation, surgical site infection, wound dehiscence, and lower volume of EBL and red blood cell transfusion and is a viable surgical option.
Navigation Versus Fluoroscopy in Multilevel MIS Pedicle Screw Insertion
Authors: Konieczny Markus R. , Krauspe Rüdiger
Published: February 2019

Study Design:

This study was a retrospective radiographic analysis of consecutive patients.

Objectives:

To analyze exposure to radiation of the surgeon and—separately—of patients in minimally invasive surgery (MIS) of multilevel posterior stabilization by percutaneous pedicle screw insertion guided by navigation (PIN) versus percutaneous pedicle screw insertion guided by fluoroscopy (PIF).

Summary of Background Data:

Spine surgeons are exposed to a 12-fold higher dose of radiation than other nonspinal musculoskeletal surgeons and PIF in MIS leads to a 2-fold higher dose of radiation than in open surgery. PIN might reduce the dose of radiation for the surgeon and the patient, especially in multilevel MIS surgery. To the best of our knowledge, there are only rare data of short-segment fusions that do not focus on exposure to radiation of surgeons.

Methods:

After power analysis, we included 205 consecutive screws (22 patients). We monitored dose of radiation (recorded separately for patient and surgeon), accuracy of screw placement, time of operation, and approach-related complications.

Results:

In PIN, only 58.7% of dose area product (cGy×cm2) per screw of PIF was determined for patients (P<0.01). The surgeon was only exposed to 19.9% of radiation per screw in PIN compared with dosage in PIF (P<0.01). Four of 205 screws (2.0%) were classified as being incorrectly positioned: 2 of 87 screws (2.3%) in PIF and 2 of 118 screws (1.7%) in PIN (P>0.05). We did not observe any wound infections.

Conclusions:

PIN in MIS is a safe procedure and does, compared with PIF, lead to significant reduction of radiation dose for patients and—even more—for spine surgeons.
The Use of Tranexamic Acid to Reduce Surgical Blood Loss
Authors: Slattery Casey , Kark Jonathan , Wagner Theodore , Verma Kushagra
Published: February 2019

Significant blood loss is often seen in orthopedic surgeries, especially complex spinal procedures that constitute long surgical times, large incisions, and rich blood supplies. Tranexamic acid (TXA), a synthetic analog of the amino acid lysine, has proven to be a cost-effective method in decreasing transfusion rates and avoiding complications associated with low blood volume. Recent data on TXA’s use in spine surgery suggest that TXA remains both efficacious and safe, although the ideal dosing and timing of administration is still a point of disagreement. The purpose of this study is to review the literature for the use of TXA in spine surgery to better understand its safety profile and ideal dosage. This narrative review on TXA was conducted on prospective orthopedic studies that used TXA in spine deformity surgery. TXA in adult and pediatric spine surgery has decreased intraoperative and postoperative blood loss, decreasing the need for blood transfusions. The most common dose in the literature is a 10 mg/kg loading dose, followed by 1 mg/kg per hour. Although the proper dosing of TXA for spine surgery remains debatable, studies have proven that TXA is effective at reducing blood loss without increasing the risk of thrombotic events.
Transarticular Screw Technique for Stabilization of Lisfranc Injuries
Authors: Vaupel Zachary
Published: February 2019

Injuries to the tarsometatarsal joint complex are known as Lisfranc injuries. Although relatively rare when considered with all other injuries about the foot and ankle, they are frequently seen in the orthopedic clinic. These injuries are often missed and can lead to long-standing pain and disability. Therefore, a high index of suspicion must be maintained by the evaluating orthopedic surgeon. Studies have shown that anatomic reduction is critical to obtain a good result. Transarticular screw fixation has the ability to obtain and maintain an anatomic reduction. This technique has historically been the most common method of treatment. But, follow-up studies have shown a high rate of posttraumatic arthritis and reoperation. This has led to the consideration of other means of treatment such as primary arthrodesis, extra-articular plating, and suture button fixation. Regardless of the chosen method, the goal of treatment is a stable, pain-free, plantigrade foot.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Impact of Body Temperature Abnormalities on the Implementation of Sepsis Bundles and Outcomes in Patients With Severe Sepsis: A Retrospective Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study
Authors: Kushimoto Shigeki , Abe Toshikazu , Ogura Hiroshi , Shiraishi Atsushi , Saitoh Daizoh , Fujishima Seitaro , Mayumi Toshihiko , Hifumi Toru , Shiino Yasukazu , Nakada Taka-aki , Tarui Takehiko , Otomo Yasuhiro , Okamoto Kohji , Umemura Yutaka , Kotani Joji , Sakamoto Yuichiro , Sasaki Junichi , Shiraishi Shin-ichiro , Takuma Kiyotsugu , Tsuruta Ryosuke , Hagiwara Akiyoshi , Yamakawa Kazuma , Masuno Tomohiko , Takeyama Naoshi , Yamashita Norio , Ikeda Hiroto , Ueyama Masashi , Fujimi Satoshi , Gando Satoshi
Published: February 2019

Objectives:

To investigate the impact of body temperature on disease severity, implementation of sepsis bundles, and outcomes in severe sepsis patients.

Design:

Retrospective sub-analysis.

Setting:

Fifty-nine ICUs in Japan, from January 2016 to March 2017.

Patients:

Adult patients with severe sepsis based on Sepsis-2 were enrolled and divided into three categories (body temperature < 36°C, 36–38°C, > 38°C), using the core body temperature at ICU admission.

Interventions:

None.

Measurements and Main Results:

Compliance with the bundles proposed in the Surviving Sepsis Campaign Guidelines 2012, in-hospital mortality, disposition after discharge, and the number of ICU and ventilator-free days were evaluated. Of 1,143 enrolled patients, 127, 565, and 451 were categorized as having body temperature less than 36°C, 36–38°C, and greater than 38°C, respectively. Hypothermia—body temperature less than 36°C—was observed in 11.1% of patients. Patients with hypothermia were significantly older than those with a body temperature of 36–38°C or greater than 38°C and had a lower body mass index and higher prevalence of septic shock than those with body temperature greater than 38°C. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on the day of enrollment were also significantly higher in hypothermia patients. Implementation rates of the entire 3-hour bundle and administration of broad-spectrum antibiotics significantly differed across categories; implementation rates were significantly lower in patients with body temperature less than 36°C than in those with body temperature greater than 38°C. Implementation rate of the entire 3-hour resuscitation bundle + vasopressor use + remeasured lactate significantly differed across categories, as did the in-hospital and 28-day mortality. The odds ratio for in-hospital mortality relative to the reference range of body temperature greater than 38°C was 1.760 (95% CI, 1.134–2.732) in the group with hypothermia. The proportions of ICU-free and ventilator-free days also significantly differed between categories and were significantly smaller in patients with hypothermia.

Conclusions:

Hypothermia was associated with a significantly higher disease severity, mortality risk, and lower implementation of sepsis bundles.
Renal Replacement Therapy in the ICU
Authors: Rachoin Jean-Sebastien , Weisberg Lawrence S.
Published: February 2019

Objectives:

The incidence of acute kidney injury in critically ill patients is increasing steeply. Acute kidney injury in this setting is associated with high morbidity and mortality. There is no doubt that renal replacement therapy for the most severe forms of acute kidney injury can be life saving, but there are a number of uncertainties about the optimal application of renal replacement therapy for patients with acute kidney injury. The objective of this synthetic review is to present current evidence supporting best practices in renal replacement therapy for critically ill patients with acute kidney injury.

Data Sources:

We reviewed literature regarding timing of initiation of renal replacement therapy, optimal vascular access for renal replacement therapy in acute kidney injury, modality selection and dose or intensity of renal replacement therapy, and anticoagulation during renal replacement therapy, using the following databases: MEDLINE and PubMed. We also reviewed bibliographic citations of retrieved articles.

Study Selection:

We reviewed only English language articles.

Conclusions:

Current evidence sheds light on many areas of controversy regarding renal replacement therapy in acute kidney injury, providing a foundation for best practices. Nonetheless, important questions remain to be answered by ongoing and future investigation.