bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambivalent implications of health care information systems: a study in the Brazilian public health care system
Authors: Albuquerque João Porto de , Prado Edmir P. V. , Machado Gabriel Raja
Published: July 2014

This article evaluates social implications of the "SIGA" Health Care Information System (HIS) in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.
Joint propagation of ontological and epistemic uncertainty across risk assessment and fuzzy time series models
Authors: Georgescu Vasile
Published: July 2014

This paper discusses hybrid probabilistic and fuzzy set approaches to
propagating randomness and imprecision in risk assessment and fuzzy time
series models. Stochastic and Computational Intelligence methods, such as
Probability bounds analysis, Fuzzy a-levels analysis, Fuzzy random vectors,
Wavelets decomposition and Wavelets Networks are combined to capture
different kinds of uncertainty. Their most appropriate applications are
probabilistic risk assessments carried out in terms of probability
distributions with imprecise parameters and stochastic processes modeled in
terms of fuzzy time series.
A distributed near-optimal LSH-based framework for privacy-preserving record linkage
Authors: Karapiperis Dimitrios , Verykios Vassilios
Published: July 2014

In this paper, we present a framework which relies on the Map/Reduce paradigm
in order to distribute computations among underutilized commodity hardware
resources uniformly, without imposing an extra overhead on the existing
infrastructure. The volume of the distance computations, required for records
comparison, is largely reduced by utilizing the so-called Locality-Sensitive
Hashing technique, which is optimally tuned in order to avoid highly
redundant computations. Experimental results illustrate the effectiveness of
our distributed framework in finding the matched record pairs in voluminous
data sets.
Surface tension and suspensibility of spray liquids of fungicides, insecticides and non-pesticide substances depending on water quality
Authors: Vukovic Slavica , Indjic Dusanka , Gvozdenac Sonja
Published: July 2014

The aim of this work was to determine the surface tension and suspensibility
of spray liquids of fungicides (Quadris and Dithane M-70), insecticides
(Actara WG-25 and Cipkord EC-20) and two and/or three component mixtures with
non-pesticide substances (complex fertilizer - Mortonjic plus and adjuvant -
Sillwet L-77), depending on water quality. For this work the following waters
were used: well water from Becej (slightly alkaline, slightly soft), well
water from Adice (slightly alkaline, very hard), tap water from Novi Sad
(neutral, slightly hard) and surface water from Sava and Karas rivers
(slightly alkaline, slightly hard). Surface tension of fungicide and
insecticide spray liquids and their mixtures in mentioned waters was
determined using tensiometer and suspensibility according to a standard
method (CIPAC MT 15). The surface tension of all tested waters was high.
However, the reduction of surface tension by 50 % (or more in water from Sava
river) compared to the control waters, was achieved by adding the adjuvant
(Sillwet L-77) and insecticide formulated as emulsifiable concentrate
(Cipkord EC-20). Surface tension was slightly decreased in a single component
spray liquids of fungicides and the complex fertilizer, as well as in
mixtures that did not contain adjuvant and/or Cipkord EC-20, regardless on
water quality. Suspensibility of all spray liquids, regardless on tested
water was above the lower limit (60 %). In general, the suspensibility all
mixtures containing Dithane M-70 was reduced compared to Dithane M-70 spray
liquid, in all tested waters. The most pronounced decrease in suspensibility,
below 70 %, was registered in the case of spray liquids with tap water,
compared to others (99.8 %).
Evaluation of the perioperative analgesic efficacy of buprenorphine, compared with butorphanol, in cats
Authors: Warne Leon N. , Beths Thierry , Holm Merete , Carter Jennifer E. , Bauquier Sébastien H.
Published: July 2014

Objective—To compare the analgesic effects of buprenorphine and butorphanol in domestic cats.

Design—2-phase positive-controlled randomized masked clinical trial.

Animals—39 healthy female cats (10 in phase 1 and 29 in phase 2).

Procedures—Cats admitted for ovariohysterectomy received buprenorphine (4 in phase 1; 14 in phase 2) or butorphanol (6 in phase 1; 15 in phase 2). In phase 1, cats were premedicated with buprenorphine (0.02 mg/kg [0.009 mg/lb], IM) or butorphanol (0.4 mg/kg [0.18 mg/lb], IM), in combination with medetomidine. Anesthesia was induced with propofol (IV) and maintained with isoflurane in oxygen. After extubation, medetomidine was antagonized with atipamezole. A validated multidimensional composite scale was used to assess signs of pain after surgery starting 20 minutes after extubation and continuing for up to 360 minutes, and pain score comparisons were made between the 2 groups. Phase 2 proceeded similar to phase 1 with the following addition: during wound closure, cats from the butorphanol and buprenorphine groups received butorphanol (0.4 mg/kg, IM) or buprenorphine (0.02 mg/kg, IM), respectively.

Results—Phase 1 of the study was stopped after 10 cats were ovariohysterectomized because 9 of 10 cats required rescue analgesia at the first evaluation. In phase 2, at the first pain evaluation, pain scores from the buprenorphine group were lower, and all cats from the butorphanol group required rescue analgesia. None of the cats from the buprenorphine group required rescue analgesia at any time.

Conclusions and Clinical Relevance—Buprenorphine (0.02 mg/kg, IM) given before surgery and during wound closure provided adequate analgesia for 6 hours following ovariohysterectomy in cats, whereas butorphanol did not.
Use of ethylene-vinyl alcohol copolymer as a liquid embolic agent to treat a peripheral arteriovenous malformation in a dog
Authors: Culp William T. N. , Glaiberman Craig B. , Pollard Rachel E. , Wisner Erik R.
Published: July 2014

Case Description—An 11-year-old castrated male Tibetan Mastiff was evaluated because of a visibly enlarged blood vessel and progressively worsening swelling of the right hind limb.

Clinical Findings—On physical examination, the right hind limb was markedly larger than the left hind limb and the dog was minimally weight bearing on the affected limb. A bruit was auscultated over the affected region. Ultrasonography of the tarsal region of the right hind limb revealed an artery with turbulent flow that communicated with venous drainage. A CT scan confirmed the presence of an arteriovenous malformation (AVM).

Treatment and Outcome—Embolization of the AVM with a liquid embolic agent (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) was elected. An arteriogram was performed prior to treatment and delineated the vessels that were targeted for embolization. The embolic agent was infused into the AVM, and a postinjection arteriogram confirmed complete occlusion of the AVM nidus and normal arterial flow to the paw with subsequent normal venous drainage. The circumference of the abnormal paw was 51 cm before the procedure and 22.9 cm at 4 weeks after the procedure. Additionally, the gait of the dog dramatically improved. No complications associated with the procedure developed.

Clinical Relevance—Peripheral AVMs in dogs are uncommon, and described treatment options are limited and generally associated with serious morbidity. A liquid embolic agent, ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide, was successfully administered in this case, and no morbidity was observed secondary to the procedure. Clinical success was characterized by substantial improvement in limb swelling and marked improvement in the gait of the dog.
Participatory Needs Assessment in Local Development: Rhetoric or Reality: A Case of Putalibazaar, Syangja
Authors: Bhandari Amrit Kumar
Published: July 2014

Based on the first hand data collected through fieldwork, this article highlights the rhetoric and reality of people’s participation in the local development activities in Putalibazaar Syangja. Concentrating on the foundational aspect of participatory development i.e. needs assessment, this article explains that the needs assessment program being practiced by Putalibazaar Municipality is weaker and ineffective one. In the name of participatory planning, there has been the domination of the leader-centric approach as opposed to the people-centric one in needs assessment. Thus, this article posits that people’s participation in development activities in Putalibazaar is more rhetoric than reality.DOI: http://dx.doi.org/10.3126/hjsa.v5i0.7035 Himalayan Journal of Sociology & Anthropology-Vol. V (2012) 1-9
Social Stigma on "ain't"
Authors: Singh Abadhesh
Published: July 2014

'Ain't' appeared as a contraction of 'am not' around 1600 and then was extended to mean 'are not', 'is not', 'has not' and 'have not' later. In the early l8th century it began to be criticized. Though it has been disparaged and its use marks the speaker as being inferior. It has been used even by the best speakers and writers to serve useful purposes. Sociolinguistic force behind 'ain't' seems to be taking it to full acceptance.DOI: http://dx.doi.org/10.3126/hjsa.v5i0.7036 Himalayan Journal of Sociology & Anthropology-Vol. V (2012) 10-18
Knowledge and Practice of Traditional Skill Technology among Hill Dalit of Kaski (A study based on Pariyars, Nepali and Bishowkarma of Kaski District)
Authors: Parajuli Biswo Kallyan
Published: July 2014

There is a rapid change in traditional occupation and traditional skill technology of Dalit. The study shows that knowledge of the Traditional Skill Technology among Hill Dalit of Kaski district is declining.DOI: http://dx.doi.org/10.3126/hjsa.v5i0.7037 Himalayan Journal of Sociology & Anthropology-Vol. V (2012) 19-33
Tourism in Nepal: A Historical Perspective and Present Trend of Development
Authors: Shrestha Hari Prasad , Shrestha Prami
Published: July 2014

Tourism is the movement or travel of people from one place to another; whether it is within their own country or to other countries, for pleasure, business, pilgrimage and other purpose. The evolution of tourism dates back to ancient times. In Nepal, tourism, despite having a long history was, developed since 1950s only. The recent trend of tourists' arrival in Nepal seems satisfactory. However, from the perspective of tourism based resources and its availability in the country seems rather pessimistic. To promote tourism sector and its contribution to socio-economic sector of the country, we need to utilize available resources properly and beneficially. For this, there is need of dynamic and tourism friendly policy and joint effort of the government and the private sector as well.DOI: http://dx.doi.org/10.3126/hjsa.v5i0.7039 Himalayan Journal of Sociology & Anthropology-Vol. V (2012) 54-75
Paul Hiebert's Worldview Model: Understanding Cultural Encounters
Authors: Sharma Manju
Published: July 2014

According to Paul Hiebert, worldview is a set of our assumptions which lies in the core of a culture. Worldviews provide us cognitive foundation, validate our norms, and give emotional security. His worldview model has three dimensions: cognitive, affirmative and evaluative. Cognitive dimension relates to the knowledge which guides us to perceive the reality of self and surroundings. Affirmative dimension relates to our feelings, emotions, and behavior. So we react to the action on the basis of our feelings. Likewise evaluative dimension relates to the judgment - what is right and wrong. This paper discusses how his worldview model can be used to understand encounters among the cultures. Further, it explores how culture affects the construct of social reality and vice versa. It also investigates how it is useful to theorize concepts of 'us' and 'them'.DOI: http://dx.doi.org/10.3126/hjsa.v5i0.7041 Himalayan Journal of Sociology & Anthropology-Vol. V (2012) 82-94
Interpretivist Tradition in Qualitative Anthropological Research Writings
Authors: Upadhyay Prakash
Published: July 2014

Stranded in a philosophical position, qualitative research is fundamentally “Interpretivist” in the sense that it is concerned with how the social world is realized, interpreted, understood and experienced, or produced. Qualitative investigation based researches rummage around for answers to their questions in the realistic world. They congregate what they see, hear and read from the people and places and from events and activities and their main purposes are to learn about some aspects of the social world and to generate new understandings that can be used by that social world. Anthropological qualitative research is about the interpretation of social world especially of cultures and people’s life-ways rather than seeking causal explanations for cultural practices. In anthropological writings as much attempt and consideration should be given to the organization of the scientific paper and article as was given to the execution of the anthropological study, the writer should employ assorted techniques to make the belief, faith based qualitative anthropological study more and more empirical.DOI: http://dx.doi.org/10.3126/hjsa.v5i0.7044 Himalayan Journal of Sociology & Anthropology-Vol. V (2012) 123-137
The Influence of Workplace Learning on Attitudes toward Animal Welfare in Veterinary Students
Authors: Pollard-Williams Sarah , Doyle Rebecca E. , Freire Rafael
Published: July 2014

Several studies suggest that veterinary students' empathy for animals declines during the years spent at university, yet the factors responsible for this change are not well understood. This study focused on the influence of workplace learning (WPL) on veterinary students' empathy for animals. WPL comprises off-campus placements and is common to all veterinary degree programs. A survey of 150 veterinary students at Charles Sturt University was conducted using an established animal-empathy scale. In general, our findings supported previous studies that empathy for animals declines between the first and fifth year and is lower in male students than in female students. Our findings indicated that specific factors relating to WPL such as pre-clinical extramural studies and clinical placements significantly influenced the students' beliefs on animal welfare. The findings presented here suggest that closer examination of the impact of WPL within the veterinary curricula is important to understanding students' changes in empathy for animals and the development of ethical principles in veterinary education.
Relationships between Learning Strategies, Stress, and Study Success Among First-Year Veterinary Students During an Educational Transition Phase
Authors: Laakkonen Juha , Nevgi Anne
Published: July 2014

We investigated the relationships between stress, learning strategies, and study success among first-year veterinary students at the very beginning of their veterinary studies. The study was carried out during the first course on macroscopic anatomy (osteology), which students have in the past found to be exceptionally stressful. Students (N=45) completed a questionnaire concerning their self-reported views on stress and learning strategies, which were compared with their self-reported written-test scores. Participants who had previously gained university credits did not have significantly better test scores, but they achieved the learning goals with significantly less stress than other participants. Previous experience of university study helped students not only to adjust to a new type of course content and to achieve the learning goal of the osteology course, but also to cope with the stress experienced from taking concurrently running courses. Of the respondents who specifically named factors relating to self-regulation and modification of their learning strategy, all had gained prior credits. These students were able to use their study time efficiently and adjust their schedules according to the course demands.
Use of Advanced Aggregate Imaging Systems to Evaluate Aggregate Resistance to Breakage, Abrasion, and Polishing
Authors: Moaveni Maziar , Mahmoud Enad , Ortiz Eduardo Madrigal , Tutumluer Erol , Beshears Sheila
Published: July 2014

Aggregate gradation and shape properties are known to affect pavement mechanistic response and performance significantly. Under repeated traffic loading, aggregate particles in pavement courses are routinely subjected to degradation through attrition, impact, grinding, and polishing mechanisms, which alter their shape and size properties. Machine vision provides an objective and quantitative measurement of aggregate particle shape or morphological properties, including flatness and elongation, angularity, and surface texture. This paper focuses on the effectiveness of two advanced and validated aggregate imaging systems: an enhanced University of Illinois aggregate image analyzer (E-UIAIA) and a second-generation aggregate imaging system (AIMS-II)—for capturing changes in shape and size properties of aggregate particles caused by breakage, abrasion, and polishing actions. The micro-Deval apparatus was used in the laboratory to evaluate field degradation and polishing resistance of 11 aggregate materials with different mineralogical properties, collected from throughout Illinois and neighboring states. More than 26,000 particles were scanned with both imaging systems at various time intervals, and changes in aggregate morphological indexes were recorded. Despite differences in image acquisition and processing capabilities, both E-UIAIA and AIMS-II successfully quantified changes in morphological properties of particles from the micro-Deval tests. However, AIMS-II more closely reflected historical data on aggregate frictional properties obtained by the Illinois Department of Transportation. The imaging results were used to develop regression-based statistical models for determining aggregate polishing and degradation trends by considering both rate and magnitude of changes in shape properties.
Evaluation of Recementation Reactivity of Recycled Concrete Aggregate Fines
Authors: Kim Jinyoung , Nam BooHyun , Behring Zachary , Al Muhit Baig
Published: July 2014

The use of recycled concrete aggregate (RCA) as a drainage material in exfiltration trenches and base and subbase layers is becoming increasingly common. During crushing, stockpiling, transporting, and placing, however, RCA may produce fines that could recement and clog the pavement drainage system. Many previous studies indicated that not only the structural capacity but also drainage of pavement subsurface layers can be greatly affected by the properties and gradation of the aggregate used. This study evaluated the recementation reactivity of RCA fines that could eventually impair drainage performance. RCA fines passing the No. 200 sieve (less than 75 μm) were produced through the simulation of an in-place aggregate abrasion process, and cement paste cylinders were cast with complete replacement of cement with RCA fines. The hydration properties of the paste samples with RCA fines were evaluated by means of heat of hydration, pH variation, and Vicat needle penetration in their early age. Compressive strength tests and petrographic examinations such as scanning electron microscopy, energy dispersive X-ray, and X-ray diffraction were also performed to mechanically and chemically verify the recementation reactivity of the hardened paste with RCA fines. Test results demonstrated that recementation of RCA fines was modest, and therefore the compressive strength of the paste specimens with RCA fines was minimal compared with that of ordinary cement paste specimens. The microstructural and chemical composition analyses also indicated that the recementation reactivity of RCA fines was negligible.
Short-Term Effect of Pavement Surface Aging on Tire–Pavement Noise Measured with Onboard Sound Intensity Methodology
Authors: Mogrovejo Daniel E. , Flintsch Gerardo W. , de León Izeppi Edgar D. , McGhee Kevin K. , Burdisso Ricardo A.
Published: July 2014

This paper compares the potential short-term noise reduction generated by the use of two quiet concrete technologies [Next Generation Concrete Surface (NGCS) and conventional diamond grind] and three quiet asphalt surfaces (porous friction course surfaces with and without rubber and different maximum-sized aggregates) with control pavement sections (conventional transverse-tined portland cement concrete pavement and stone matrix asphalt pavement surface). The potentially quiet pavement surfaces were placed along five demonstration projects in Virginia. This paper investigates the susceptibility of the proposed surfaces to external factors, such as aging (four seasons were involved) and air temperature differentials. The statistical analysis of the collected data showed that all proposed surfaces presented benefits in terms of noise reduction; the NGCS exhibited noise reduction potential as high as 5 dB(A) when compared with the control section. For the asphalt surfaces, the sections with higher amounts of voids showed the lowest noise levels. In addition, the rubber-modified mixes showed an improved noise reduction potential. Air temperature normalization was performed, and air temperature was found to have a significant influence on the noise measurements, especially during the first months of use.
Effect of Porous Pavement on Wayside Traffic Noise Levels
Authors: Donavan Paul R.
Published: July 2014

In 2011, pavement on an eight-lane portion of U.S. Highway 101 in San Rafael and Novato, California, was rehabilitated with the application of an open-graded asphalt concrete (OGAC) overlay as part of a larger project to improve the traffic flow along the 101 corridor. Residents in the area of rehabilitation had periodically complained to the local transportation agency about traffic noise. For an understanding of the noise reduction expected after the application of the new OGAC, wayside traffic noise levels and onboard sound intensity (OBSI) levels were measured at two sites: the site where the new pavement was to be placed and a nearby site that had received new OGAC 1 year earlier. The results indicated that a reduction of 7.8 dB in OBSI tire–pavement noise should be expected, along with a reduction of 7.8 to 8.4 dB in wayside traffic noise. The measurements were repeated after the OGAC application; OBSI reductions of 7.1 dB were found, and reductions of 10.5 and 11.2 dB were found for the wayside levels measured 60 ft from the highway. The comparison of results from previous studies of sound propagation over porous pavements led to the conclusion that this additional reduction in the wayside levels of 3.4 and 4.1 dB compared with the tire–pavement source levels was attributable to the sound absorption provided by the porous pavement.
Bracing for thoracolumbar fractures
Authors: Chang Victor , Holly Langston T.
Published: July 2014

Traumatic fractures of the thoracolumbar spine are relatively common occurrences that can be a source of pain and disability. Similarly, osteoporotic vertebral fractures are also frequent events and represent a significant health issue specific to the elderly. Neurologically intact patients with traumatic thoracolumbar fractures can commonly be treated nonoperatively with bracing. Nonoperative treatment is not suitable for patients with neurological deficits or highly unstable fractures. The role of operative versus nonoperative treatment of burst fractures is controversial, with high-quality evidence supporting both options. Osteoporotic vertebral fractures can be managed with bracing or vertebral augmentation in most cases. There is, however, a lack of high-quality evidence comparing operative versus nonoperative fractures in this population. Bracing is a low-risk, cost-effective method to treat certain thoracolumbar fractures and offers efficacy equivalent to that of surgical management in many cases. The evidence for bracing of osteoporotic-type fractures is less clear, and further investigation will be necessary to delineate its optimal role.
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 1: Introduction and methodology
Authors: Kaiser Michael G. , Eck Jason C. , Groff Michael W. , Watters William C. , Dailey Andrew T. , Resnick Daniel K. , Choudhri Tanvir F. , Sharan Alok , Wang Jeffrey C. , Mummaneni Praveen V. , Dhall Sanjay S. , Ghogawala Zoher
Published: July 2014

Fusion procedures are an accepted and successful management strategy to alleviate pain and/or neurological symptoms associated with degenerative disease of the lumbar spine. In 2005, the first version of the “Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine” was published in the Journal of Neurosurgery: Spine. In an effort to incorporate evidence obtained since the original publication of these guidelines, an expert panel of neurosurgical and orthopedic spine specialists was convened in 2009. Topics reviewed were essentially identical to the original publication. Selected manuscripts from the first iteration of these guidelines as well as relevant publications between 2005 through 2011 were reviewed. Several modifications to the methodology of guideline development were adopted for the current update. In contrast to the 2005 guidelines, a 5-tiered level of evidence strategy was employed, primarily allowing a distinction between lower levels of evidence. The qualitative descriptors (standards/guidelines/options) used in the 2005 recommendations were abandoned and replaced with grades to reflect the strength of medical evidence supporting the recommendation. Recommendations that conflicted with the original publication, if present, were highlighted at the beginning of each chapter. As with the original guideline publication, the intent of this update is to provide a foundation from which an appropriate treatment strategy can be formulated.
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: Assessment of functional outcome following lumbar fusion
Authors: Ghogawala Zoher , Resnick Daniel K. , Watters William C. , Mummaneni Praveen V. , Dailey Andrew T. , Choudhri Tanvir F. , Eck Jason C. , Sharan Alok , Groff Michael W. , Wang Jeffrey C. , Dhall Sanjay S. , Kaiser Michael G.
Published: July 2014

Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 3: Assessment of economic outcome
Authors: Ghogawala Zoher , Whitmore Robert G. , Watters William C. , Sharan Alok , Mummaneni Praveen V. , Dailey Andrew T. , Choudhri Tanvir F. , Eck Jason C. , Groff Michael W. , Wang Jeffrey C. , Resnick Daniel K. , Dhall Sanjay S. , Kaiser Michael G.
Published: July 2014

A comprehensive economic analysis generally involves the calculation of indirect and direct health costs from a societal perspective as opposed to simply reporting costs from a hospital or payer perspective. Hospital charges for a surgical procedure must be converted to cost data when performing a cost-effectiveness analysis. Once cost data has been calculated, quality-adjusted life year data from a surgical treatment are calculated by using a preference-based health-related quality-of-life instrument such as the EQ-5D. A recent cost-utility analysis from a single study has demonstrated the long-term (over an 8-year time period) benefits of circumferential fusions over stand-alone posterolateral fusions. In addition, economic analysis from a single study has found that lumbar fusion for selected patients with low-back pain can be recommended from an economic perspective. Recent economic analysis, from a single study, finds that femoral ring allograft might be more cost-effective compared with a specific titanium cage when performing an anterior lumbar interbody fusion plus posterolateral fusion.
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5: Correlation between radiographic outcome and function
Authors: Dhall Sanjay S. , Choudhri Tanvir F. , Eck Jason C. , Groff Michael W. , Ghogawala Zoher , Watters William C. , Dailey Andrew T. , Resnick Daniel K. , Sharan Alok , Mummaneni Praveen V. , Wang Jeffrey C. , Kaiser Michael G.
Published: July 2014

In an effort to diminish pain or progressive instability, due to either the pathological process or as a result of surgical decompression, one of the primary goals of a fusion procedure is to achieve a solid arthrodesis. Assuming that pain and disability result from lost mechanical integrity of the spine, the objective of a fusion across an unstable segment is to eliminate pathological motion and improve clinical outcome. However, conclusive evidence of this correlation, between successful fusion and clinical outcome, remains elusive, and thus the necessity of documenting successful arthrodesis through radiographic analysis remains debatable. Although a definitive cause and effect relationship has not been demonstrated, there is moderate evidence that demonstrates a positive association between radiographic presence of fusion and improved clinical outcome. Due to this growing body of literature, it is recommended that strategies intended to enhance the potential for radiographic fusion are considered when performing a lumbar arthrodesis for degenerative spine disease.
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: Lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis
Authors: Eck Jason C. , Sharan Alok , Ghogawala Zoher , Resnick Daniel K. , Watters William C. , Mummaneni Praveen V. , Dailey Andrew T. , Choudhri Tanvir F. , Groff Michael W. , Wang Jeffrey C. , Dhall Sanjay S. , Kaiser Michael G.
Published: July 2014

Establishing an appropriate treatment strategy for patients presenting with low-back pain, in the absence of stenosis or spondylolisthesis, remains a controversial subject. Inherent to this situation is often an inability to adequately identify the source of low-back pain to justify various treatment recommendations, such as lumbar fusion. The current evidence does not identify a single best treatment alternative for these patients. Based on a number of prospective, randomized trials, comparable outcomes, for patients presenting with 1- or 2-level degenerative disc disease, have been demonstrated following either lumbar fusion or a comprehensive rehabilitation program with a cognitive element. Limited access to such comprehensive rehabilitative programs may prove problematic when pursuing this alternative. For patients whose pain is refractory to conservative care, lumbar fusion is recommended. Limitations of these studies preclude the ability to present the most robust recommendation in support of lumbar fusion. A number of lesser-quality studies, primarily case series, also support the use of lumbar fusion in this patient population.
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 14: Brace therapy as an adjunct to or substitute for lumbar fusion
Authors: Dailey Andrew T. , Ghogawala Zoher , Choudhri Tanvir F. , Watters William C. , Resnick Daniel K. , Sharan Alok , Eck Jason C. , Mummaneni Praveen V. , Wang Jeffrey C. , Groff Michael W. , Dhall Sanjay S. , Kaiser Michael G.
Published: July 2014

The utilization of orthotic devices for lumbar degenerative disease has been justified from both a prognostic and therapeutic perspective. As a prognostic tool, bracing is applied prior to surgery to determine if immobilization of the spine leads to symptomatic relief and thus justify the performance of a fusion. Since bracing does not eliminate motion, the validity of this assumption is questionable. Only one low-level study has investigated the predictive value of bracing prior to surgery. No correlation between response to bracing and fusion outcome was observed; therefore a trial of preoperative bracing is not recommended. Based on low-level evidence, the use of bracing is not recommended for the prevention of low-back pain in a general working population, since the incidence of low-back pain and impact on productivity were not reduced. However, in laborers with a history of back pain, a positive impact on lost workdays was observed when bracing was applied. Bracing is recommended as an option for treatment of subacute low-back pain, as several higher-level studies have demonstrated an improvement in pain scores and function. The use of bracing following instrumented posterolateral fusion, however, is not recommended, since equivalent outcomes have been demonstrated with or without the application of a brace.
Timing of surgery in thoracolumbar trauma: is early intervention safe?
Authors: O'Boynick Christopher Paul , Kurd Mark F. , Darden Bruce V. , Vaccaro Alexander R. , Fehlings Michael G.
Published: July 2014

The understanding of the optimal surgical timing for stabilization in thoracolumbar fractures is severely limited. Thoracolumbar spine fractures can be devastating injuries and are often associated with significant morbidity and mortality. The role of early surgical stabilization (within 48–72 hours of injury) as a vehicle to improve outcomes in these patients has generated significant interest. Goals of early stabilization include improved neurological recovery, faster pulmonary recovery, improved pain control, and decreased health care costs. Opponents cite the potential for increased bleeding, hypotension, and the risk of further cord injury as a few factors that weigh against early stabilization. The concept of spinal cord injury and its relationship to surgical timing remains in question. However, when neurological outcomes are eliminated from the equation, certain measures have shown positive influences from prompt surgical fixation.

Early fixation of thoracolumbar spine fractures can significantly decrease the duration of hospital stay and the number of days in the intensive care unit. Additionally, prompt stabilization can reduce rates of pulmonary complications. This includes decreased rates of pneumonia and fewer days on ventilator support. Cost analysis revealed as much as $80,000 in savings per patient with early stabilization. All of these benefits come without an increase in morbidity or evidence of increased mortality. In addition, there is no evidence that early stabilization has any ill effect on the injured or uninjured spinal cord. Based on the existing data, early fixation of thoracolumbar fractures has been linked with positive outcomes without clear evidence of negative impacts on the patient's neurological status, associated morbidities, or mortality. These procedures can be viewed as “damage control” and may consist of simple posterior instrumentation or open reductions with internal fixation as indicated. Based on the current literature it is advisable to proceed with early surgical stabilization of thoracolumbar fractures in a well-resuscitated patient, unless extenuating medical conditions would prevent it.
Sacral fractures
Authors: Bydon Mohamad , Fredrickson Vance , De la Garza-Ramos Rafael , Li Yiping , Lehman Ronald A. , Trost Gregory R. , Gokaslan Ziya L.
Published: July 2014

Sacral fractures are uncommon lesions and most often the result of high-energy trauma. Depending on the fracture location, neurological injury may be present in over 50% of cases. In this article, the authors conducted a comprehensive literature review on the epidemiology of sacral fractures, relevant anatomy of the sacral and pelvic region, common sacral injuries and fractures, classification systems of sacral fractures, and current management strategies. Due to the complex nature of these injuries, surgical management remains a challenge for the attending surgeon. Few large-scale studies have addressed postoperative complications or long-term results, but current evidence suggests that although fusion rates are high, long-term morbidity, such as residual pain and neurological deficits, persists for many patients.
Use of computed tomography for assessing bone mineral density
Authors: Schreiber Joseph J. , Anderson Paul A. , Hsu Wellington K.
Published: July 2014

Assessing local bone quality on CT scans with Hounsfield unit (HU) quantification is being used with increasing frequency. Correlations between HU and bone mineral density have been established, and normative data have been defined throughout the spine. Recent investigations have explored the utility of HU values in assessing fracture risk, implant stability, and spinal fusion success. The information provided by a simple HU measurement can alert the treating physician to decreased bone quality, which can be useful in both medically and surgically managing these patients.
Venous stenting with concurrent intracranial pressure monitoring for the treatment of pseudotumor cerebri
Authors: Ding Dale , Starke Robert M. , Durst Christopher R. , Crowley R. Webster , Liu Kenneth C.
Published: July 2014

Increasing evidence supports dural venous sinus stenosis as the patho-etiology of pseudotumor cerebri (PTC) in a subset of affected patients. In this video, we demonstrate our technique for 1) diagnostic venous manometry to identify a flow-limiting stenosis of the transverse sinus in a PTC patient; and 2) successful treatment of the patient with venous stenting across the structural and physiological stricture in the dural sinus. The pressure gradient decreased from 20 mmHg pre-stent to 3 mmHg post-stent. In order to further quantify the effect of our intervention, concurrent intracranial pressure monitoring was performed.

The video can be found here: http://youtu.be/auxRg17F8yI.
Balloon-assisted transarterial embolization of type 1 spinal dural arteriovenous fistula
Authors: Lee Brian , Mehta Vivek A. , Mack William J. , Tenser Matthew S. , Amar Arun P.
Published: July 2014

Type 1 spinal dural arteriovenous fistula (dAVF) constitute the vast majority of all spinal vascular malformations. Here we present the case of a 71-year-old male with progressive myelopathy, lower-extremity weakness and numbness, and urinary incontinence. MRI imaging of the thoracic spine demonstrated cord edema, and catheter spinal angiography confirmed a type 1 spinal dAVF. The fistula was supplied by small dural branches of the left L-2 segmental artery. Angiographic cure was achieved with a one-stage procedure in which coils were used to occlude the distal segmental vessels, followed by balloon-assisted embolization with Onyx.

The video can be found here: http://youtu.be/8aehJbueH0U.
Y-stent-assisted coil embolization of cerebral aneurysms
Authors: Tan Lee A. , Johnson Andrew K. , Keigher Kiffon M. , Moftakhar Roham , Lopes Demetrius K.
Published: July 2014

Y-stent–assisted coiling is a technique used by neuroendovascular surgeons to treat complex, wide-necked, bifurcation aneurysms in locations such as basilar tip and middle cerebral artery bifurcation. Several recent studies have demonstrated low complication rate and favorable clinical and angiographic outcomes. The Y-stent technique is illustrated here in detail and the intraoperative nuances are also discussed to minimize potential complications associated with technique.

The video can be found here: http://youtu.be/77pEmqx_fyQ.
Endovascular treatment of complex dural arteriovenous fistula using the dual-microcatheter technique
Authors: Levitt Michael R. , Osbun Joshua W. , Nerva John D. , Kim Louis J.
Published: July 2014

A 71-year-old woman presented with headache and dilated vessels on CTA. Angiography demonstrated a complex dural arteriovenous fistula with retrograde cortical venous hypertension, supplied by branches of internal and external carotids bilaterally into a fistulous pouch paralleling the left transverse and sigmoid sinuses, which was occluded at the jugular bulb. The patient refused treatment and was lost to follow-up, returning with sudden confusion and hemianopsia from left temporo-occipital hemorrhage. Transvenous endovascular embolization was performed using the dual-microcatheter technique with a combination of coiling and Onyx copolymer, completely occluding the sinus and fistula while preserving normal venous drainage.

The video can be found here: http://youtu.be/u_4Oc7tSmDM.
Endovascular treatment of a spinal dural arteriovenous malformation (DAVF)
Authors: Agarwal Vijay , Zomorodi Ali , Jabbour Pascal , Chalouhi Nohra , Tjoumakaris Stavropoula , Babu Ranjith , Back Adam , Gonzalez L. Fernando
Published: July 2014

We present a case of a patient with rapid loss of motor strength in his lower extremities. He became bedridden with bowel and bladder incontinence, and developed saddle anesthesia. MRI of the lumbar spine showed edema in the conus medullaris and multiple flow voids within the spinal canal. A spinal angiogram showed a dorsal Type I spinal AVF. This was treated successfully with Onyx 18 (eV3, Irvine, CA). The patient showed rapid post-procedure improvement, and at discharge from the hospital to a rehabilitation center he was fully ambulatory. At 3-year follow-up, the patient was found to ambulate without difficulty. He also had improved saddle anesthesia, and he was voiding spontaneously. There was no evidence of flow voids on repeat MRI of the lumbar spine.

The video can be found here: http://youtu.be/SDYNIGNQIW8.
Introduction: Endovascular Neurosurgery video supplement
Authors: Hoh Brian , Lanzino Giuseppe
Published: July 2014

It is with great pride that we present this Neurosurgical Focus video supplement on endovascular neurosurgery. We were privileged to view a multitude of outstanding quality videos demonstrating the current state-of-the-art in endovascular neurosurgery. Careful and critical review was required to narrow down the videos to a workable volume for this supplement, though there were many more that we would have liked to have included.

This issue consists of several videos that represent modern neuroendovascular techniques for the treatment of cerebrovascular disease. The videos demonstrate the cutting-edge as well as standard endovascular therapies, which will be valuable to both the novice and the expert endovascular neurosurgeons. We are greatly honored to be involved with this project, and are very proud of its content and expert authors. We confidently believe you will enjoy the video content of this supplement.
The Next Generation Feedstock of Biofuel: Jatropha or Chlorella as Assessed by Their Life-Cycle Inventories
Authors: Peng Pu , Zhou Wenguang
Published: July 2014

Promising energy crops such as Jatropha curcas Linnaeus (JCL), which are planted on marginal lands, or microalgae such as Chlorella, which are cultivated in ponds located on mudflats or deserts, have been regarded with high hopes to solve the shortage of food crops and increase the amount of biodiesel (Fatty Acid Methyl Ester, FAME) production. However, the annual yields of biomass and transport fuels (t/ha) of both are still unclear and often exaggerated in the literature. Large portions of JCL biomass, including tree trunks and leaves, can also be used to generate electricity along with FAME, which is produced from seed lipids. Meanwhile, lipid extracted algae (LEA) are composed of proteins, polysaccharides, and lipids other than glycerides which are unable to be esterified to form FAME and much more abundant in the microalgae than oil cake in the oil crops. Therefore, it has been strongly suggested that not only transesterification or esterification but also Fischer-Tropsch (FT) process and bio-electricity generation should be considered as routes to produce biofuels. Otherwise, the yield of biofuel would be extremely low using either JCL or Chlorella as feedstock. The Life-Cycle Inventories (LCI) of the biofuel processes with whole biomass of JCL and Chlorella were compared based on their net energy ratio (NER) and CO2 emission saving (CES). It was shown that the technological improvement of irrigation, cultivation, and processing for either economic-crops or microalgae were all necessary to meet the requirements of commercial biofuel production.
Evolution of Metallo-β-lactamases: Trends Revealed by Natural Diversity and in vitro Evolution
Authors: Meini María-Rocío , Llarrull Leticia , Vila Alejandro
Published: July 2014

The production of β-lactamase enzymes is one of the most distributed resistance mechanisms towards β-lactam antibiotics. Metallo-β-lactamases constitute a worrisome group of these kinds of enzymes, since they present a broad spectrum profile, being able to hydrolyze not only penicillins, but also the latest generation of cephalosporins and carbapenems, which constitute at present the last resource antibiotics. The VIM, IMP, and NDM enzymes comprise the main groups of clinically relevant metallo-β-lactamases. Here we present an update of the features of the natural variants that have emerged and of the ones that have been engineered in the laboratory, in an effort to find sequence and structural determinants of substrate preferences. This knowledge is of upmost importance in novel drug design efforts. We also discuss the advances in knowledge achieved by means of in vitro directed evolution experiments, and the potential of this approach to predict natural evolution of metallo-β-lactamases.The production of β-lactamase enzymes is one of the most distributed resistance mechanisms towards β-lactam antibiotics. Metallo-β-lactamases constitute a worrisome group of these kinds of enzymes, since they present a broad spectrum profile, being able to hydrolyze not only penicillins, but also the latest generation of cephalosporins and carbapenems, which constitute at present the last resource antibiotics. The VIM, IMP, and NDM enzymes comprise the main groups of clinically relevant metallo-β-lactamases. Here we present an update of the features of the natural variants that have emerged and of the ones that have been engineered in the laboratory, in an effort to find sequence and structural determinants of substrate preferences. This knowledge is of upmost importance in novel drug design efforts. We also discuss the advances in knowledge achieved by means of in vitro directed evolution experiments, and the potential of this approach to predict natural evolution of metallo-β-lactamases.