bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical gait analysis and rehabilitation in a traumatic hallux deficit patient: a case report
Authors: Doi Naoki , Pataky Todd , Tateuchi Hiroshige , Nagai-Tanima Momoko , Aoyama Tomoki
Published: March 2024

Background

The hallux plays a crucial role in maintaining standing balance and facilitating forward and backward movements during gait.

Case presentation

A 21-year-old Japanese patient, suffering from a traumatic hallux deficit with only a portion of the basal phalanx intact, underwent rehabilitation treatment. The thenar area exhibited instability, leading to impaired balance and walking difficulties. Biomechanical assessment revealed the need for a rehabilitation strategy for the foot, as well as the knee, hip, and trunk. A rehabilitation protocol was designed to enhance medial foot loading during walking and standing, including balance and trunk strength training. After a 12-week rehabilitation period, the patient’s gait showed significant improvement. Specifically, the load response and single-support phases of the gait cycle on the affected side increased from 46.9% to 49.3%, while the pre-swing phase decreased from 14.6% to 11.6%. The vertical component of the ground reaction force rose from 599.8 to 647.5 N. The enhanced stability from balance training and increased muscle strength contributed to the patient’s improved walking and balance.

Conclusion

A patient with a traumatic hallux deficit underwent conservative treatment through strategic rehabilitation according to biomechanical assessment. This case report underscores the value of biomechanical gait analysis in the conservative management of similar conditions.
A redescription of Trachelosaurus fischeri from the Buntsandstein (Middle Triassic) of Bernburg, Germany: the first European Dinocephalosaurus-like marine reptile and its systematic implications for long-necked early archosauromorphs
Authors: Spiekman Stephan N. F. , Ezcurra Martín D. , Rytel Adam , Wang Wei , Mujal Eudald , Buchwitz Michael , Schoch Rainer R.
Published: March 2024

Some of the earliest members of the archosaur-lineage (i.e., non-archosauriform archosauromorphs) are characterised by an extremely elongated neck. Recent fossil discoveries from the Guanling Formation (Middle Triassic) of southern China have revealed a dramatic increase in the known ecomorphological diversity of these extremely long-necked archosauromorphs, including the fully marine and viviparous Dinocephalosaurus orientalis. These recent discoveries merit a reinvestigation of enigmatic Triassic diapsid fossils from contemporaneous European deposits housed in historical collections. Here, we provide a redescription of Trachelosaurus fischeri, represented by a single, disarticulated specimen first described in 1918. Due to its unique morphology, which includes short, bifurcating cervical ribs, and a high presacral vertebral count, this taxon has been referred to either as a “protorosaurian” archosauromorph or a sauropterygian. Our revision clearly shows that Trachelosaurus represents the first unambiguous Dinocephalosaurus-like archosauromorph known from outside the Guanling Formation. Our finding has important systematic implications. Trachelosauridae Abel, 1919 represents the senior synonym for the recently identified Dinocephalosauridae Spiekman, Fraser and Scheyer, 2021. Based on our phylogenetic analyses, which employ two extensive datasets, we also corroborate previous findings that tanystropheids and trachelosaurids represent two families within a larger monophyletic group among non-crocopodan archosauromorphs, which is here named Tanysauria (clade nov.). Trachelosauridae is minimally composed of Trachelosaurus fischeri, Dinocephalosaurus orientalis, Pectodens zhenyuensis, and Austronaga minuta, but one of our analyses also found a probably taxonomically broader clade that may also include Gracilicollum latens and Fuyuansaurus acutirostris. Trachelosaurus fischeri considerably expands the known spatial and temporal range of Trachelosauridae to the earliest Anisian and the Central European Basin. Our findings add to the growing evidence for the presence of a diverse group of fully marine reptiles during the Middle Triassic among Tanysauria. These trachelosaurids possess flipper-like limbs, high vertebral counts, and elongate necks, thus superficially resembling long-necked Jurassic and Cretaceous plesiosaurs in some regards.
An efficient algorithm with fast convergence rate for sparse graph signal reconstruction
Authors: Cao Yuting , Jiang Xue-Qin , Wang Jian , Zhou Shubo , Hou Xinxin
Published: March 2024

In this paper, we consider the graph signals are sparse in the graph Fourier domain and propose an iterative threshold compressed sensing reconstruction (ITCSR) algorithm to reconstruct sparse graph signals in the graph Fourier domain. The proposed ITCSR algorithm derives from the well-known compressed sensing by considering a threshold for sparsity-promoting reconstruction of the underlying graph signals. The proposed ITCSR algorithm enhances the performance of sparse graph signal reconstruction by introducing a threshold function to determine a suitable threshold. Furthermore, we demonstrate that the suitable parameters for the threshold can be automatically determined by leveraging the sparrow search algorithm. Moreover, we analytically prove the convergence property of the proposed ITCSR algorithm. In the experimental, numerical tests with synthetic as well as 3D point cloud data demonstrate the merits of the proposed ITCSR algorithm relative to the baseline algorithms.
Performance recovery of creative sector industries: strengthening management literacy and digital business innovation
Authors: Wahyudiono  , Hermanto Yustinus Budi , Estiasih Soffia Pudji , Aminatuzzuhro
Published: March 2024

This study examined the effect of strengthening management literacy on digital business innovation and accelerating performance recovery and examined the impact of digital business innovation on accelerating performance recovery. This study is explanative/associative research accompanied by hypothesis testing. The unit of analysis in this study was creative industry entrepreneurs, with a total population of 354. Sampling in this study used purposive sampling with specific criteria and obtained 194 as a sample size, after which they were referred to as respondents. Path analysis results show that strengthening management literacy directly and significantly influences digital business innovation and accelerates performance recovery; digital business innovation directly and substantially influences the acceleration of performance recovery in the creative industry sector. The findings of this study indicate that strengthening management literacy, which is carried out in a structured and massive manner, will encourage innovative behavior in implementing digital business. Digital business innovation will spur business activities to become more effective, because they are not limited by space and time.
Heterogeneity in farmers’ stage of behavioural change in intercropping adoption: an application of the Transtheoretical Model
Authors: Ha Thanh Mai , Manevska-Tasevska Gordana , Weih Martin , Hansson Helena
Published: March 2024

Despite its potential economic and environmental benefits, intercropping adoption remains limited in Europe. Drawing upon the Transtheoretical Model, this paper views adoption decision as stages of behavioural change. The paper aims to investigate socioeconomic, behavioural, and policy factors associated with stage of change in intercropping adoption in Sweden. Exploratory factor analysis and generalized ordered logit regression were performed on data from a nation-wide farmer survey conducted in 2021 with 388 usable replies. Results show that farmers with better knowledge of intercropping, a higher evaluation of financial benefits and ease of intercropping, and ley growers were more likely to progress to higher stages of the adoption process. Farmers who have higher perceived seed separation costs, a lower education level, and are older tend to remain at lower stages. Perceived environmental benefits of intercropping, household income, and instrumental values of farming could turn non-adopters into either potential adopters or actual adopters. We found no significant association between policy support and stage of change in intercropping adoption. Policy implications aimed at fostering intercropping adoption were discussed.
A first characterization of the microbiota-resilience link in swine
Authors: Mancin Enrico , Maltecca Christian , Huang Yi Jian , Mantovani Roberto , Tiezzi Francesco
Published: March 2024

Background

The gut microbiome plays a crucial role in understanding complex biological mechanisms, including host resilience to stressors. Investigating the microbiota-resilience link in animals and plants holds relevance in addressing challenges like adaptation of agricultural species to a warming environment. This study aims to characterize the microbiota-resilience connection in swine. As resilience is not directly observable, we estimated it using four distinct indicators based on daily feed consumption variability, assuming animals with greater intake variation may face challenges in maintaining stable physiological status. These indicators were analyzed both as linear and categorical variables. In our first set of analyses, we explored the microbiota-resilience link using PERMANOVA, α-diversity analysis, and discriminant analysis. Additionally, we quantified the ratio of estimated microbiota variance to total phenotypic variance (microbiability). Finally, we conducted a Partial Least Squares-Discriminant Analysis (PLS-DA) to assess the classification performance of the microbiota with indicators expressed in classes.

Results

This study offers four key insights. Firstly, among all indicators, two effectively captured resilience. Secondly, our analyses revealed robust relationship between microbial composition and resilience in terms of both composition and richness. We found decreased α-diversity in less-resilient animals, while specific amplicon sequence variants (ASVs) and KEGG pathways associated with inflammatory responses were negatively linked to resilience. Thirdly, considering resilience indicators in classes, we observed significant differences in microbial composition primarily in animals with lower resilience. Lastly, our study indicates that gut microbial composition can serve as a reliable biomarker for distinguishing individuals with lower resilience.

Conclusion

Our comprehensive analyses have highlighted the host-microbiota and resilience connection, contributing valuable insights to the existing scientific knowledge. The practical implications of PLS-DA and microbiability results are noteworthy. PLS-DA suggests that host-microbiota interactions could be utilized as biomarkers for monitoring resilience. Furthermore, the microbiability findings show that leveraging host-microbiota insights may improve the identification of resilient animals, supporting their adaptive capacity in response to changing environmental conditions. These practical implications offer promising avenues for enhancing animal well-being and adaptation strategies in the context of environmental challenges faced by livestock populations.
A genome-wide association study of neutrophil count in individuals associated to an African continental ancestry group facilitates studies of malaria pathogenesis
Authors: Constantinescu Andrei-Emil , Hughes David A. , Bull Caroline J. , Fleming Kathryn , Mitchell Ruth E. , Zheng Jie , Kar Siddhartha , Timpson Nicholas J. , Amulic Borko , Vincent Emma E.
Published: March 2024

Background

'Benign ethnic neutropenia' (BEN) is a heritable condition characterized by lower neutrophil counts, predominantly observed in individuals of African ancestry, and the genetic basis of BEN remains a subject of extensive research. In this study, we aimed to dissect the genetic architecture underlying neutrophil count variation through a linear-mixed model genome-wide association study (GWAS) in a population of African ancestry (N = 5976). Malaria caused by P. falciparum imposes a tremendous public health burden on people living in sub-Saharan Africa. Individuals living in malaria endemic regions often have a reduced circulating neutrophil count due to BEN, raising the possibility that reduced neutrophil counts modulate severity of malaria in susceptible populations. As a follow-up, we tested this hypothesis by conducting a Mendelian randomization (MR) analysis of neutrophil counts on severe malaria (MalariaGEN, N = 17,056).

Results

We carried out a GWAS of neutrophil count in individuals associated to an African continental ancestry group within UK Biobank, identifying 73 loci (r2 = 0.1) and 10 index SNPs (GCTA-COJO loci) associated with neutrophil count, including previously unknown rare loci regulating neutrophil count in a non-European population. BOLT-LMM was reliable when conducted in a non-European population, and additional covariates added to the model did not largely alter the results of the top loci or index SNPs. The two-sample bi-directional MR analysis between neutrophil count and severe malaria showed the greatest evidence for an effect between neutrophil count and severe anaemia, although the confidence intervals crossed the null.

Conclusion

Our GWAS of neutrophil count revealed unique loci present in individuals of African ancestry. We note that a small sample-size reduced our power to identify variants with low allele frequencies and/or low effect sizes in our GWAS. Our work highlights the need for conducting large-scale biobank studies in Africa and for further exploring the link between neutrophils and severe malaria.
Culture shock among international students in Turkey: an analysis of the effects of self-efficacy, life satisfaction and socio-cultural adaptation on culture shock
Authors: Almukdad Mustafa , Karadag Engin
Published: March 2024

In this study, we investigated whether the interaction effects of self-efficacy, life satisfaction, and sociocultural adjustment have significant negative effects on culture shock. The data were collected from 323 international students in Turkey, and the sample comprised 197 undergraduates (61%) and 126 graduates (39%). We administered the “Culture Shock Questionnaire,” “General Self-Efficacy Scale”, “The Satisfaction with Life Scale”, and “Sociocultural Adaptation Scale” through an online survey. Of the participants, 86 were female (26.6%), and 237 were male (73.4%). The ages of the participants ranged from 18 to 32 (M = 22.11; SD = 4.23). In this study, we identified three structural models to test the relationships between culture shock, self-efficacy, life satisfaction, and sociocultural adjustment. The results supported our hypothesis (H1) that there would be a significant negative relationship between self-efficacy and culture shock. One-way MANOVA revealed that students with lower self-efficacy scores experienced greater culture shock. Conversely, students with higher self-efficacy scores experienced lower culture shock and interpersonal stress. Additionally, a multigroup analysis was conducted to test the assumed relationships in structural models for Muslim (such as Turkey, where the research was conducted, which is 90% Muslim) and Christian students. The results indicated that self-efficacy has a significantly greater negative impact on culture shock for Christian students than for Muslim students. Our study confirmed the hypothesis (H4) that life satisfaction and sociocultural adjustment serve as mediating variables between self-efficacy and culture shock. Both life satisfaction and sociocultural adjustment were found to have significant direct impacts on culture shock, and a meaningful mediating effect on the relationship between self-efficacy and culture shock was identified. Based on these findings, we concluded that self-efficacy may be particularly beneficial for coping with culture shock for people who do not embrace dominant religious beliefs in a local culture.
Development of craquelure patterns in paintings on panels
Authors: Antropov Sergii , Bratasz Łukasz
Published: March 2024

Panel paintings are multi-layer structures composed of humidity-sensitive materials. Preventing or limiting stresses in these structures, generated by the loss or gain of moisture, requires an understanding of the relevant processes and risks. A three-dimensional elastic model of a panel painting was used to analyse surface stresses and understand how crack patterns are developed in the two-layer structure of the pictorial layer—the gesso and the paints. Two historically important paint types were considered—egg tempera and oil paints, laid on a gesso produced following historical procedures. Two scenarios of stress development were analysed: permanent cumulative drying shrinkage of paints or gesso, owing to gradual loss of water or evolution of the molecular composition of the binders, and moisture-induced cyclic swelling of the wood substrate. Ratios of distances between cracks in the tangential and longitudinal directions of a wood panel to the layer thickness were estimated for increasing magnitudes of materials’ dimensional change in the two scenarios. The critical values of the ratios for which stress in the midpoint between the cracks dropped below the value inducing strain at break in the materials and saturation of the crack patterns occurred, was approximately 3–4 or 5–6 for the paints and the gesso, respectively. The critical distance normalized to the gesso thickness between cracks parallel to the wood grain induced by cyclic swelling of the wood substrate due to relative humidity variation in the range of 50–70% was 6. The study demonstrated that crack spacings in the fully developed crack systems remain sensitive only to the thicknesses of paint or gesso layers which, therefore, can be derived from the crack pattern geometry. Existing flaws in gesso were found not to increase the risk of new crack development.
Investigation of the subsurface structure at the target site in Kumamoto, Japan, and the distributed data of the blind prediction exercise: report for the experiments for the 6th international symposium on effects of surface geology on seismic motion
Authors: Matsushima Shinichi , Yamanaka Hiroaki , Tsuno Seiji , Chimoto Kosuke , Suzuki Haruhiko , Kawase Hiroshi , Matsushima Takeshi
Published: March 2024

This technical report explains details on the results of the investigation to build a subsurface structural model and a selection of earthquake data at the target site of the blind prediction exercise for “The 6th International Association of Seismology and Physics of the Earth’s Interior/International Association of Earthquake Engineering International Symposium on the Effect of Surface Geology on Seismic Motion (ESG6).” The selection process of the target site in the Kumamoto Plain, Japan, in ESG6 was explained with a historical review of the blind prediction tests in the previous ESG conferences. We have collected existing subsurface structural and earthquake data and conducted geophysical and geotechnical surveys in and around the target site to generate important velocity structure and the earthquake data used in the blind test. Microtremor data were obtained in triangular arrays ranging in side lengths from 1 to 962 m, and active surface wave data were derived along a 36-m line at the site. These data were provided for the prediction of a subsurface structural model in the first step of the blind prediction exercise. We also conducted a velocity logging in a borehole to a bottom depth of 39 m at the site and laboratory tests of soil samples from the borehole. We constructed a velocity profile of the shallow and deep sedimentary layers from a combination of the geophysical and geotechnical data at the site, and validated it by comparing the characteristics of the ground motion data from the moderate event. This “preferred velocity model” was provided as a standard model to the participants in the second and third steps of the blind prediction test to predict the earthquake ground motions of a moderate event and the mainshock of the 2016 Kumamoto earthquake.

Graphical Abstract
155Tb production by cyclotrons: what level of 155Gd enrichment allows clinical applications?
Authors: Barbaro Francesca , Canton Luciano , Uzunov Nikolay , De Nardo Laura , Melendez-Alafort Laura
Published: March 2024

Background

155Tb represents a potentially useful radionuclide for diagnostic medical applications, but its production remains a challenging problem, in spite of the fact that many production routes have been already investigated and tested. A recent experimental campaign, conducted with low-energy proton beams impinging on a 155Gd target with 91.9% enrichment, demonstrated a significant co-production of 156gTb, a contaminant of great concern since its half-life is comparable to that of 155Tb and its high-energy γ emissions severely impact on the dose released and on the quality of the SPECT images. In the present investigation, the isotopic purity of the enriched 155Gd target necessary to minimize the co-production of contaminant radioisotopes, in particular 156gTb, was explored using various computational simulations.

Results

Starting from the recent experimental data obtained with a 91.9% 155Gd-enriched target, the co-production of other Tb radioisotopes besides 155Tb has been theoretically evaluated using the Talys code. It was found that 156Gd, with an isotopic content of 5.87%, was the principal contributor to the co-production of 156gTb. The analysis also demonstrated that the maximum amount of 156Gd admissible for 155Tb production with a radionuclidic purity higher than 99% was 1%. A less stringent condition was obtained through computational dosimetry analysis, suggesting that a 2% content of 156Gd in the target can be tolerated to limit the dose increase to the patient below the 10% limit. Moreover, it has been demonstrated that the imaging properties of the produced 155Tb are not severely affected by this level of impurity in the target.

Conclusions

155Tb can be produced with a quality suitable for medical applications using low-energy proton beams and 155Gd-enriched targets, if the 156Gd impurity content does not exceed 2%. Under these conditions, the dose increase due to the presence of contaminant radioisotopes remains below the 10% limit and good quality images, comparable to those of 111In, are guaranteed.
Pitting the olive seed microbiome
Authors: Wentzien Nuria M. , Fernández-González Antonio J. , Valverde-Corredor Antonio , Lasa Ana V. , Villadas Pablo J. , Wicaksono Wisnu Adi , Cernava Tomislav , Berg Gabriele , Fernández-López Manuel , Mercado-Blanco Jesús
Published: March 2024

Background

The complex and co-evolved interplay between plants and their microbiota is crucial for the health and fitness of the plant holobiont. However, the microbiota of the seeds is still relatively unexplored and no studies have been conducted with olive trees so far. In this study, we aimed to characterize the bacterial, fungal and archaeal communities present in seeds of ten olive genotypes growing in the same orchard through amplicon sequencing to test whether the olive genotype is a major driver in shaping the seed microbial community, and to identify the origin of the latter. Therefore, we have developed a methodology for obtaining samples from the olive seed’s endosphere under sterile conditions.

Results

A diverse microbiota was uncovered in olive seeds, the plant genotype being an important factor influencing the structure and composition of the microbial communities. The most abundant bacterial phylum was Actinobacteria, accounting for an average relative abundance of 41%. At genus level, Streptomyces stood out because of its potential influence on community structure. Within the fungal community, Basidiomycota and Ascomycota were the most abundant phyla, including the genera Malassezia, Cladosporium, and Mycosphaerella. The shared microbiome was composed of four bacterial (Stenotrophomonas, Streptomyces, Promicromonospora and Acidipropionibacterium) and three fungal (Malassezia, Cladosporium and Mycosphaerella) genera. Furthermore, a comparison between findings obtained here and earlier results from the root endosphere of the same trees indicated that genera such as Streptomyces and Malassezia were present in both olive compartments.

Conclusions

This study provides the first insights into the composition of the olive seed microbiota. The highly abundant fungal genus Malassezia and the bacterial genus Streptomyces reflect a unique signature of the olive seed microbiota. The genotype clearly shaped the composition of the seed’s microbial community, although a shared microbiome was found. We identified genera that may translocate from the roots to the seeds, as they were present in both organs of the same trees. These findings set the stage for future research into potential vertical transmission of olive endophytes and the role of specific microbial taxa in seed germination, development, and seedling survival.
Factors associated with modern contraceptive utilization among reproductive age women in Kenya; evidenced by the 2022 Kenyan demographic and health survey
Authors: Mankelkl Gosa , Kassaw Altaseb Beyene , Kinfe Beletu
Published: March 2024

Background

Globally, sexual and reproductive health is a significant public health issue for women of the reproductive age group. A modern contraceptive method enables individuals and families to manage fertility by reducing unintended pregnancies, abortions, pregnancy-related morbidity, and death. A modern contraceptive method is a drug or medical treatment that prevents sexual activity from leading to pregnancy. However, there is limited reliable and updated data on factors associated with modern contraceptive utilization among reproductive-age women at the national level in Kenya. So, the major goal of this study was to evaluate factors associated with modern contraceptive utilization among women of reproductive age in Kenya at the national level, as evidenced by the 2022 Kenyan demographic and health survey.

Methods

The most recent datasets from the Kenyan Demographic and Health Survey were used for secondary data analysis. In all, 14,987 women of reproductive age participated in the investigation. Data for multivariable analysis on the factors influencing modern contraceptive utilization among Kenyan women of reproductive age can be obtained from the Kenyan Demographic and Health Survey. Finally, the odd ratio and percentages were presented along with their 95% confidence intervals.

Result

This study includes a total weighted sample of 14,987 reproductive-age women from the Kenyan demographic and health survey. Of the total contraceptive use, 90.1% of the study participants used modern contraceptives. Being married [AOR: 1.593, 95% CI (1.302, 1.948)], living in an urban area [AOR: 1.230, 95% CI (1.060, 1.428)], reading a magazine [1.002, 95% CI (0.921, 1.091)], listening to radio [AOR: 1.265, 95% CI (1.101, 1.454)], not breastfeeding [AOR: 1.296, 95% CI (1.114, 1.507), and having more than two children [AOR: 2.350, 95% CI (1.603, 3.445)] were the factors that promote modern contraceptive utilization. Conversely, having a history of terminated pregnancy [AOR: 0.767, 95% CI (0.657, 0.897), being Muslim [AOR: 0.566, 95% CI (0.418, 0.766)], and being in the 35–39 age range [AOR: 0.766, 95% CI (0.605, 0.971)] were all associated with a lower use of modern contraceptives.

Conclusion

Certain factors such as marriage, living in urban areas, having more than two children, having a female-led household, belonging to the middle class, reading magazines, listening to the radio, and not breastfeeding have a positive correlation with the use of modern contraceptives. Conversely, being a Muslim, aged between 35 and 39, and having a history of miscarriages are negatively correlated with the use of modern contraceptives. This indicates that addressing socioeconomic, geographic, and cultural barriers could improve the effectiveness of modern contraceptive.
Effect of walkability on the physical activity of hemodialysis patients: a multicenter study
Authors: Sato Yoichi , Usui Naoto , Abe Yoshifumi , Okamura Daisuke , Kuramochi Yota , Kojima Sho , Shinozaki Nobuto , Shimano Yu , Shirai Nobuyuki , Mikami Kenta , Yamada Yoji , Saitoh Masakazu
Published: March 2024

Introduction

Physical activity is an important prognostic factor in patients undergoing hemodialysis. Walkability also affects physical activity. This study aimed to examine the effects of walkability on the physical activity of patients undergoing hemodialysis.

Methods

This multicenter study included 372 outpatients (69.1 ± 11.9 years, 229 males) undergoing hemodialysis at eight facilities in Japan. Patients were classified into two groups according to the walk score (WS) at home: WS ≥ 50 (walkable area group) and WS < 50 (car-dependent area group). The effects of WS on total physical activity, moderate-to-vigorous physical activity (MVPA), and walking that was assessed using the International Physical Activity Questionnaire (IPAQ) were examined.

Results

In the multivariate analysis, WS ≥ 50 was positively associated with walking (β = 0.129, p = 0.013) and negatively associated with MVPA (β = −0.102, p = 0.045). Subgroup analysis stratified by the age of 65 years showed similar results in both groups.

Conclusions

Walkability is associated with various intensities of physical activity in Japanese patients undergoing hemodialysis. Exercise management should take into account the characteristics of physical activity, depending on the residential area.

Trial registration: UMIN, UMIN000050089. Registered 2023/01/20, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057060.
Branching out: species-specific canopy architecture limits live crown fuel consumption in Intermountain West USA conifers
Authors: Conrad Elliott T. , Jolly W. Matt , Brown Tegan P. , Hillman Samuel C.
Published: March 2024

Background

Accurate estimates of available live crown fuel loads are critical for understanding potential wildland fire behavior. Existing crown fire behavior models assume that available crown fuels are limited to all tree foliage and half of the fine branches less than 6 mm in diameter (1 h fuel). They also assume that this relationship is independent of the branchwood moisture content. Despite their widespread use, these assumptions have never been tested, and our understanding of the physiochemical properties that govern live crown flammability and consumption remains limited. To test these assumptions, we sampled branches from 11 common Intermountain West USA conifers and determined the corrected available fuel estimates using physiochemical measurements, diameter subsize class distributions, and a bench-scale consumption experiment. Additional branches were air-dried to explore interaction between moisture content and consumption. Corrected available live crown fuel was compared to existing models across species and then used to determine potential differences in crown fire energy release.

Results

Across the 11 common conifers, distinct patterns of sub 1 h fuel distributions were strong predictors of whether the existing available live crown fuel models overestimated, approximately correctly estimated, or underestimated available live fuel. Fine branchwood distributions generally fell into three archetypes: fine skewed, normally distributed, and coarse skewed. Based on our corrected estimates, existing models overestimated the potential canopy energy by 34% for an average-sized western larch and underestimated it by 18.8% for western hemlock. The critical fine branchwood consumption diameter varied with species and moisture content. Larger proportions of fine branches were consumed as the branchwood dried, and nearly all the 1 h fuel was consumed when the branches were completely dry.

Conclusions

These results suggest that available live canopy fuel load estimates should consider species and moisture content to accurately assess and map fuel loads across landscapes. This work has implications for forest and fire management in conifer-dominated forests throughout western North America, and in other similar forests worldwide.
Pheochromocytoma Diagnosed During First Trimester of Pregnancy
Authors: Beard Victoria , Ghawji Maher , Salman Fariha , Oktaei Hooman
Published: March 2024

Pheochromocytomas are rare catecholamine-secreting tumors that occur in 0.002% of pregnancies. These tumors result in high maternal and fetal morbidity and mortality unless diagnosed in early stages of development, because excess levels of catecholamines cause vasoconstriction of both maternal and uteroplacental vasculature. Paroxysmal hypertension is the most common manifestation, but its variability in presentation and similarity to other pregnancy-related conditions often make diagnosis of pheochromocytoma difficult. Thus, it is essential to consider underlying pathological causes of hypertension during gestation. Diagnosis and treatment of pheochromocytoma must be approached uniquely given the physiologic changes during pregnancy. The standard of care for diagnostic imaging during pregnancy is with magnetic resonance imaging. For these reasons, knowledge of therapy for pheochromocytomas in the pregnant patient is essential for clinical endocrinology practice.
1080 Preoperative Prealbumin Level as a Risk Factor for Pseudoarthrosis Following Lumbar Spine Surgery
Authors: Fernandez-de Thomas Ricardo Jose , Colan Jhair Alejandro , Sharma Nikhil , Fields Daryl , Nturibi Eric , Buell Thomas J. , Gerszten Peter C. , Hamilton D. Kojo , Okonkwo David O. , Agarwal Nitin
Published: March 2024

INTRODUCTION:

Preoperative nutritional status is essential for predicting postoperative outcomes. Studies have shown that prealbumin levels can be a prognostic indicator for surgical outcomes in spine surgery.

METHODS:

A retrospective cohort study of 697 patients was conducted between April 1st, 2018, to October 31st, 2022. Collected data included patient demographics, PPL, chronic steroid use, index surgery, length of surgery, postoperative hospital length of stay, 30-day return, and pseudoarthrosis (verified by a board certified neuroradiologist via radiographic imaging). PPL were first analyzed as absolute values, and then categorized as binary values. The first cut point used for binary categorization was =30 and >30. We then repeated statistical analyses similarly using =25, =20, and =15 as additional cut points (all as binary values).

RESULTS:

Fifty-six patients had pseudoarthrosis (8%), while 641 (92%) did not. There was no statistical difference between patients who had pseudoarthrosis and patients who did not, in terms of age (62 vs. 62.9, p=0.298), BMI (29.9 vs. 29.8, p=0.441), and preoperative prealbumin level (26.6 vs 26.4, p=0.387). There was a significant difference regarding the length of surgery (337.9 mins vs. 253.8, p=0.008) and hospital length of stay (6.2 days vs. 4.2 days, p<0.001) in patients with pseudoarthrosis. Finally, there was no significant difference between PPL and developing pseudoarthrosis when the data was categorized as binary values with cut points at =30 (p=0.595), =25 (p=0.987), =20 (p=0.799), and =15 (p=0.333).

CONCLUSIONS:

Preoperative nutritional assessment is essential in spine surgery as it can predict postoperative outcomes and recovery. In our cohort of patients, low serum prealbumin levels did not correlate with a higher rate of pseudoarthrosis following lumbar spine surgery.
1082 Creation of a Spine Healthcare Resource Utilization Grouping (SHRUG) to Complement Patient-reported Outcome Measurements in Assessing Surgical Success
Authors: Habboub Ghaith , Huang Kevin T. , Shost Michael , Lapin Brittany , Patel Arpan A. , Salas-Vega Sebastian , Sundar Swetha J. , Steinmetz Michael P. , Mroz Thomas E.
Published: March 2024

INTRODUCTION:

Patient-reported outcome measures (PROs) are increasingly utilized to assess surgical success. However, when taken as the sole measure of surgical success they have limitations due to the requirement of collection time and infrastructure, response bias, and inherently subjective nature. The large volume of digital data generated by modern health systems may instead offer a method to track healthcare utilization and surgical outcome.

METHODS:

We retrospectively reviewed a consecutive patients undergoing elective surgery to the cervical and lumbar spine for degenerative pathologies at our institution. Pre- and post-operative 12-month change in PROMIS Global Health was collected. Post-operative measures of healthcare utilization included clinic visits, inpatient encounters, telephone encounters, opioid use, physical therapy, injections, and imaging. A SHRUG metric was then constructed through latent profile analysis.

RESULTS:

A total of 8039 surgeries were included in our analysis. Four utilization groups were identified: 1) low utilizer group, representing 53.9% of all patients; 2) moderate utilizer group (13.2%); 3) heterogenous utilizer group (25.2%); and 4) high utilizer group (7.7%). Patients were placed into one of four groups with high average probability (97%, 92%, 95%, 93% respectively).

CONCLUSIONS:

Our study developed a novel method for defining surgical outcomes based on healthcare utilization. These groupings have the potential to add an objective measure of operative success to supplement the use of PROs clinically. SHRUG can approximates PROMIS, nonbiased, provides new insight on outcome and healthcare utilization, and finally clinically feasible to implement.
113 The Effect of Civilian Purchased Care on Military Neurosurgery Wartime Readiness
Authors: Dewar Callum , Woodle Samuel , Hooten Kristopher G.
Published: March 2024

INTRODUCTION:

The current landscape of military neurosurgery reflects the relative peacetime for the US-World relationship - a problem of intrinsically low case volume compounded by patients being deferred away from Military Treatment Facilities (MTFs). TRICARE is the healthcare program of the US Department of Defense Military Health Care System, in which ‘Purchased Care’ or civilian based health care, is used to supplement healthcare needs when services are not readily available to TRICARE beneficiaries. Within military neurosurgery, case volume and complexity continue to be diverted via purchased case pathways, greatly affecting wartime readiness. Neurosurgery wartime readiness can be measured through the Knowledge, Skills and Abilities (KSA) metric based on case complexity and volume.

METHODS:

We analyzed case counts and KSA values of active-duty military neurosurgery capable MTFs and purchased care counterparts using the CarePoint Access portal. Residents, civilian contractors, and retirees were excluded.

RESULTS:

In 2022, the KSA total for 16 MTFs was 139005, a result of 2286 cases and 47 surgeons. The average KSA/surgeon/month was 393.8, extrapolating to 4725.5/surgeon/year - 59% of the KSA goal of 8000/surgeon/year. The purchased care KSA of 10 MTFs totaled 301535 in 2022 from 7324 cases. Purchased care out-performed MTF case volume by over 300%. Recovering full purchased care volume would increase the individual MTF neurosurgeon KSA by 135%.

CONCLUSIONS:

The military neurosurgical community cannot maintain wartime readiness as defined by the KSA metric with current trends in military neurosurgery case volume and high incidence of purchased care. The solution lies in either recovering purchased care patients or expanding military-civilian partnerships to base military neurosurgeons at local academic hospitals and trauma centers.
1133 Biologically Effective Dose and Prediction of Obliteration of Arteriovenous Malformations in Pediatric Patients Treated by Gamma Knife Radiosurgery
Authors: Grogan Dayton , Dumot Chloe , Tewari Anant , Mantziaris Georgios , Dayawansa Sam , Schlesinger David , Sheehan Jason P.
Published: March 2024

INTRODUCTION:

Stereotactic radiosurgery (SRS) represents an effective treatment for pediatric arteriovenous malformations (AVMs). Biologic effective dose (BED) is recognized as a predictive variable for outcomes in the adult population, but its role has never been studied in pediatric outcomes.

METHODS:

Retrospective data for = 18 years old patients treated with single-session SRS for AVM was collected from 1989 – 2019. BED calculations were performed using an a/b ratio of 2.47. Kaplan-Meier analysis was used to evaluate obliteration, new hemorrhage, and radiation-induced changes (RIC). Cox-regression analysis was used for obliteration prediction using two models (margin dose versus BED).

RESULTS:

One-hundred-ninety-seven patients [median age = 13.1 years, Interquartile range (IQR) = 5.2] were included; 72.6% presented initially with spontaneous hemorrhage. A median margin dose of 22 Gy (IQ = 4.0) with a median BED of 183.2Gy (IQR = 70.54) was used to treat AVMs with a median volume of 2.8 cm3 (IQR = 2.9). Following SRS, obliteration was confirmed in 115 patients (58.4%) using MRI and angiography at a median follow-up of 2.85 years (IQR = 2.26). The cumulative obliteration probability was 43.6% (95% CI = 36.1-50.3), 60.5% (95% CI+=2.2-67.4), 66.0% (95% CI= 56.0-73.7) at 3, 5 and 10 years respectively. In multivariate analysis, a BED >180 Gy [HR = 2.11, 95% CI=1.30-3.40, p = 0.002] in model 1, and a margin dose >20 Gy [HR = 1.90, 95% CI = 1.15-3.13, p = 0.019] in model 2, were associated with obliteration. An AVM nidus volume >4 cm3 was associated with lower obliteration rates in both models. The probability of symptomatic RIC at 10 years was 8.6% (95% CI = 3.5-13.4). Neither BED nor margin dose were associated with RIC occurrence, with the only predictive factor being deep AVM location [HR = 3, 95% CI = 1-9.1, p = 0.048].

CONCLUSIONS:

This study confirms BED as a predictor for pediatric AVM obliteration. Optimization of BED in pediatric AVM SRS planning may improve cumulative obliteration rates.
122 Use of Automated Active and Continuous CSF Irrigation and Drainage for Treatment of Intraventricular Hemorrhage a Retrospective Comparative Study With Volumetric Analysis
Authors: Baig Ammad , Hess Ryan M. , Santo Briana , Donnelly Brianna M. , Turner Ryan C. , Lim Jaims , Hashmi Eisa , Tutino Vincent , Levy Elad I. , Siddiqui Adnan Hussain
Published: March 2024

INTRODUCTION:

Intraventricular hemorrhage (IVH) is a common neurosurgical pathological conditon that can occur in isolation or along with intraparenchymal and subarachnoid hemorrhage and is associated with poor outcome. Hydrocephalus associated with IVH is often treated with external ventricular drain (EVD) placement, although occlusion and replacement of the drain are common.

METHODS:

A prospectively maintained database was retrospectively searched for consecutive patients who presented with IVH between September 2020 and Febuary 2023 who were treated with an EVD or the IRRAflow. Pretreatment and posttreatment noncontrast computed tomography scans were segmented to determine IVH volumes. Change in hematoma volume, catheter related conversion and infections, in-hospital mortality, shunt dependency, and symptom resolution or improvement were recorded for outcome assessment.

RESULTS:

A total of 51 patients were included (21 in the active irrigation and drainage [IRRAflow] group vs. 30 in the passive EVD group. Demographic, disease severity, and presenting variables betweeen the groups were statistically similar. Mean hematoma volume change (8.8 ± 11.3 vs. 17.7 ± 19.4 mL, p = 0.0459) of IVH was significantly lower in the EVD group than the IRRAflow group. No. of days catheter was put in was longer in the EVD group compared to IRRAflow (15.2 ± 10.0 vs. 9.4 ± 4.5; p = 0.0019). On multivaritate logistic regression, shunt dependency on follow-up was higher in the passive EVD group compared to active irrigation and drainage group (p = 0.0215).

CONCLUSIONS:

Active irrigation with drainage along with CSF exchange for IVH patients appears to be superor to passive drainage alone using EVD.
123 How Early Is Too Early for Cranioplasty Following Craniectomy? A Propensity-Matched Study
Authors: Sioutas Georgios , Salem Mohamed , Shekhtman Oleg , Srinivasan Visish M. , Jankowitz Brian T. , Burkhardt Jan-Karl
Published: March 2024

INTRODUCTION:

Nearly 30% of patients experience complications following cranioplasty after decompressive craniectomy. However, the optimal timing for this procedure is not well established.

METHODS:

Using the TriNetX Research Network, we included patients who underwent either late cranioplasty (91 days to 1 year), or cranioplasty in the first (1-30 days), second (31-60 days), or third (61-90 days) month after craniectomy. Propensity score matching was used to match the late cranioplasty group separately with the other three cranioplasty groups based on demographics, comorbidities, anticoagulant/antiplatelet use, and laboratory values. Postoperative outcomes were assessed within six months after cranioplasty.

RESULTS:

We analyzed 2545 patients. After matching, 301 patients remained in the first-month, 314 in the second-month, and 406 in the third-month group. The prevalence of postoperative complications, including seizures/epilepsy, infections, wound disruption, intracranial/intraspinal abscess/granuloma, repeat craniectomy/craniotomy, removal/replacement of bone flap/prosthetic plate of skull, and dependence on wheelchair/care provider were similar across all groups. Compared to late cranioplasty, intracerebral hemorrhage was significantly more common in the first-month (p = 0.033) and second-month (p = 0.01) groups, but not in the third-month (p = 0.502) group. Epidural hemorrhage was significantly more common in the second-month (p = 0.0492) group, while subdural hemorrhage was significantly more common in all early cranioplasty groups. Meningitis/Encephalitis/myelitis/encephalomyelitis were significantly more common only in the first-month group (p = 0.009). Hydrocephalous was significantly more common only in the second-month group (p = 0.0046). The need for repeat cranioplasty was significantly higher in the first-month (p = 0.005) and second-month (p = 0.043) groups. Mortality rate was significantly higher in the first-month (p = 0.004) and second-month (p = 0.02) groups.

CONCLUSIONS:

Cranioplasty in the first 60 days following craniectomy is associated with increased postoperative morbidity and mortality. Prospective studies are needed to establish the best timing for cranioplasty.