bluuebunny/crossref_metadata_2025 huggingface dataset:
Educational chatbots for project-based learning: investigating learning outcomes for a team-based design course
Authors: Kumar Jeya Amantha
Published: December 2021

Educational chatbots (ECs) are chatbots designed for pedagogical purposes and are viewed as an Internet of Things (IoT) interface that could revolutionize teaching and learning. These chatbots are strategized to provide personalized learning through the concept of a virtual assistant that replicates humanized conversation. Nevertheless, in the education paradigm, ECs are still novel with challenges in facilitating, deploying, designing, and integrating it as an effective pedagogical tool across multiple fields, and one such area is project-based learning. Therefore, the present study investigates how integrating ECs to facilitate team-based projects for a design course could influence learning outcomes. Based on a mixed-method quasi-experimental approach, ECs were found to improve learning performance and teamwork with a practical impact. Moreover, it was found that ECs facilitated collaboration among team members that indirectly influenced their ability to perform as a team. Nevertheless, affective-motivational learning outcomes such as perception of learning, need for cognition, motivation, and creative self-efficacy were not influenced by ECs. Henceforth, this study aims to add to the current body of knowledge on the design and development of EC by introducing a new collective design strategy and its pedagogical and practical implications.
Inversion-based interpretation of borehole spontaneous potential measurements for accurate estimation of water resistivity in the presence of shoulder-bed and mud-filtrate invasion effects
Authors: Bautista-Anguiano Joshua , Torres-Verdín Carlos
Published: December 2021

Electrical resistivity of formation water is a fundamental property used to quantify in situ water quality for human consumption or for assessment of hydrocarbon pore volume. Resistivity interpretation methods commonly used to quantify the electrical resistivity of formation water invoke rock porosity and fitting parameters that require additional and independent core measurements. Alternatively, the spontaneous potential (SP) log can be used to calculate water resistivity without knowledge of rock porosity in wells drilled with water-based mud. In combination with resistivity and gamma-ray logs, SP logs can be used to estimate water quality, apparent volumetric concentration of shale, and for qualitative assessments of permeability. However, SP logs often exhibit shoulder-bed and mud-filtration effects; these effects need to be mitigated before using SP logs for calculation of water resistivity. We have developed a new inversion-based method to simultaneously mitigate shoulder-bed and mud-filtrate invasion effects present in SP logs via fast numerical simulations based on Green functions. The interpretation method was implemented on SP logs acquired across aquifers with various degrees of complexity using noisy synthetic and field measurements to estimate equivalent NaCl concentration, radius of mud-filtrate invasion, and sodium macroscopic transport number. Interpretation results compared well to those obtained from resistivity and nuclear logs, provided estimates of uncertainty, and could incorporate a priori knowledge of aquifer petrophysical properties in the estimation.
Estimating SHmax azimuth with P sources and vertical geophones: Use P-P reflection amplitudes or use SV-P reflection times?
Authors: Hardage Bob , Graul Mike , Hall Tim , Hall Chris , Kelley Mark , Smith Valerie , Modroo Allen
Published: December 2021

We compared two methods for extracting the azimuth of maximum horizontal stress (SHmax) from 3D land-based seismic data generated by a P source and recorded with vertical geophones. In the first method, we used the direct-SV mode that is produced by all land-based P sources. P sources generate SV illumination that radiates in all azimuth directions from a source station and creates SV-P reflections that are recorded by vertical geophones. Unless stratigraphy has steep dip, SV-P raypaths recorded by vertical geophones are the reverse of P-SV raypaths recorded by horizontal geophones. Thus, SV-P data provide the same S-wave sensitivity to stress fields as popular P-SV data do. In the second method, we retrieved P-P reflections and then performed an amplitude-variation-with-azimuth (AVA) analysis of the amplitude-gradient behavior of P-P reflection wavelets. We did this analysis in narrow azimuth corridors to determine the gradient of reflection-wavelet amplitudes as a function of azimuth. This P-P AVA amplitude-gradient method has been of great interest in the reflection seismology community since it was introduced in the late 1990s. Each of these methods, AVA analysis of the gradient of P-P reflection amplitudes and azimuth-dependent arrival times of SV-P reflections, can be used to determine the azimuth of SHmax stress. We compare the results of the two methods with ground truth measurements of SHmax azimuth at a CO2 sequestration site in the Michigan Basin. SHmax azimuths were determined from P-P and SV-P data at three major boundaries at depths of approximately 3500 ft (1067 m), 5500 ft (1676 m), and 7500 ft (2286 m). Two estimates of SHmax azimuth (one using SV-P data and one using P-P data) were made at each stacking bin inside a 24 mi2 (62 km2) image space. The result was approximately 98,000 estimates of SHmax azimuth across each of these three boundaries for each of these two prediction strategies. Histogram displays of PP AVA gradient estimates had peaks at correct azimuths of SHmax at all three depths, but the spread of the distributions widened with depth and split into two peaks at the deepest boundary. In contrast, each histogram of SHmax azimuth predicted by azimuth-dependent SV-P traveltimes had a single, definitive peak that was positioned at the correct SHmax azimuth at all three boundary depths.
A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea
Authors: Bruera Eduardo , Sweeney Catherine , Willey Jie , Palmer J Lynn , Strasser Florian , Morice Rodolfo C , Pisters Katherine
Published: December 2021

Context: The symptomatic benefits of oxygen in patients with cancer who have nonhypoxic dyspnea are not well defined.

Objective: To determine whether or not oxygen is more effective than air in decreasing dyspnea and fatigue and increasing distance walked during a 6-minute walk test.

Patients and methods: Patients with advanced cancer who had no severe hypoxemia (i.e., had an O2 saturation level of] / 90%) at rest and had a dyspnea intensity of] / 3 on a scale of 0–10 (03/4/no shortness of breath, 103/4/worst imaginable shortness of breath) were recruited from an outpatient thoracic clinic at a comprehensive cancer center. This was a double-blind, randomized crossover trial. Supplemental oxygen or air (5 L/min) was administered via nasal cannula during a 6-minute walk test. The outcome measures were dyspnea at 3 and 6 minutes, fatigue at 6 minutes, and distance walked. We also measured oxygen saturation levels at baseline, before second treatment phase, and at the end of study.

Results: In 33 evaluable patients (31 with lung cancer), no significant differences between treatment groups were observed in dyspnea, fatigue, or distance walked (dyspnea at 3 minutes: P = 0.61; dyspnea, fatigue, and distance walked at 6 minutes: P = 0.81, 0.37, and 0.23, respectively).

Conclusions: Currently, the routine use of supplemental oxygen for dyspnea during exercise in this patient population cannot be recommended.
Use of complementary and alternative medicine and quality of life: changes at the end of life
Authors: Correa-Velez Ignacio , Clavarino Alexandra , Barnett Adrian G , Eastwood Heather
Published: December 2021

The purpose of this study was to compare the physical, psychological and social dimensions associated with quality-of-life outcomes over the last year of life, between advanced cancer users and nonusers of complementary and alternative medicine. One hundred and eleven patients were identified through Queensland Cancer Registry records, and followed up every four to six weeks until close to death using standardized protocols. Outcome measures were symptom burden, psychological distress, subjective wellbeing, satisfaction with conventional medicine and need for control over treatment decisions. At the initial interview, 36 (32%) participants had used complementary/alternative medicine the previous week; mainly vitamins, minerals and tonics and herbal remedies. Among all participants, 53 (48%) used at least one form of complementary/alternative medicine over the study period. Only six (11%) visited alternative practitioners on a regular basis. Overall, complementary/alternative medicine users reported higher levels of anxiety and pain, less satisfaction with conventional medicine and lower need for control over treatment decisions compared with nonusers. These differences tend to change as death approaches. A more rigorous assessment of complementary/alternative medicine use, psychological distress, pain and subjective wellbeing among patients with advanced cancer is needed in the clinical setting.
Cancer pain management in Lanarkshire: a communitybased audit
Authors: Oxenham David , Duncan Robert , Fischbacher Moira
Published: December 2021

Background: A prospective, longitudinal audit of pain management in patients with cancer was conducted in an unselected community population in Lanarkshire, Scotland.

Methods:Using a modified Delphi technique, a recording form was developed and a dedicated project manager was appointed to oversee the development and implementation of the audit. Community staff recorded pain level and analgesic prescribing on consecutive home visits to patients with cancer-related pain. Areas of good and poor prescribing were assessed using standards previously developed for the Scottish Cancer Pain Audit. These results were fed back to prescribers in a variety of ways and used as a focus for a programme of primary care-based education.

Results: Five hundred and forty-one patients have been entered in the audit between May 1999 and end October 2002. A total of 3259 visits have been recorded and 88% of general practices in Lanarkshire submitted forms during this period. Pain scores were recorded in 90% of visits. Specific gaps in prescribing practice were identified.

Conclusion: The audit demonstrated that it is possible to engage primary care teams in a continuing audit of cancer pain management, which is achievable within the context of normal care. It provided a means to collect and analyse serial data on pain level and pain management and to identify areas of prescribing in need of improvement. Concerted efforts to establish the legitimacy and relevance of the project in the eyes of key stakeholders proved fundamental to encouraging longer-term behavioural change in the management of cancer pain.
The validity of EORTC QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors
Authors: Knobel Heidi , Loge Jon HaKvard , Brenne Elisabeth , Fayers Peter , Hjermstad Marianne Jensen , Kaasa Stein
Published: December 2021

Fatigue is a major complaint among advanced cancer patients. Several instruments are available for measuring fatigue. The EORTC QLQ-C30 is one of the most frequently used health-related quality of life (HRQOL) instruments, and it includes a three-item fatigue subscale. Limited knowledge exists about the validity, performance and sensitivity of EORTC QLQ-C30 fatigue scale as compared with a fatigue-specific instrument. The aim of the present study was to validate the EORTC QLQ-C30 fatigue scale (FA) against the Fatigue Questionnaire (FQ). The FQ is frequently used and was developed to measure fatigue in both cancer and noncancer populations. The FQ measures physical (PF, seven items) and mental fatigue (MF, four items). The study population included two different cohorts: A) patients with advanced metastatic cancer included in a prospective randomized study of palliative radiotherapy ( n = 238); B) patients with leukaemia and malignant lymphoma curatively treated with stem-cell transplantation and high-dose chemotherapy ( n = 128). The analysis demonstrated that the FA correlated higher with the PF scale (r = 0.67–0.75) as compared with the MF scale (r = 0.49–0.61). The item–scale correlations between FA items and the PF scale were consistently higher than between FA items and the MF scale. A factor analysis including all the items within the FA and the FQ identified two factors. All FA items loaded on a PF factor (0.70–0.85). A floor/ ceiling effect, indicating a high number of respondents with lowest, respectively, highest scores was observed more frequently in the FA as compared with the FQ. The PF discriminated better between diagnostic groups with different levels of fatigue than the FA did. In conclusion, the EORTC QLQ-C30 fatigue scale is measuring physical fatigue. A floor/ ceiling effect seems to appear for the EORTC QLQ-C30 fatigue scale. The validity of the EORTC QLQ-C30 fatigue scale is to be questioned for use in palliative care patients. In studies with fatigue as a defined end point, a domain-specific instrument should, therefore, be added.
Hospital based palliative care teams improve the insight of cancer patients into their disease
Authors: Jack Barbara , Hillier Valerie , Williams Anne , Oldham Jackie
Published: December 2021

It is reported that cancer patients want as much information as possible about their diagnosis and prognosis. This input regarding patients' insight into their disease is undoubtedly a major part of providing optimal palliative care. Despite this, there is little information regarding the impact of hospital based palliative care teams. An evaluation study comprising a nonequivalent control group design, using a quota sample, investigated 100 cancer patients who had been admitted to hospital for symptom control. Fifty patients received hospital palliative care team intervention compared with 50 patients receiving traditional care. Outcome was assessed using the Palliative Care Assessment tool (PACA) assessment tool on three occasions that measured the patients self-reported understanding of their illness. A supplementary qualitative approach that included 31 semistructured interviews with doctors and nurses to explore their perception of the impact of the palliative care team was also undertaken. The results indicated that cancer patients admitted to hospital for symptom control demonstrated an improvement in their insight to their diagnosis. Those patients who had the additional input of the palliative care team had a significantly greater improvement in their insight scores (reported by the doctors and nurses as being invaluable for the patients). Potential explanations are made for these results including enhanced communication skills of the palliative care team are explored.
Opioid-induced respiratory effects: new data on buprenorphine
Authors: Dahan Albert
Published: December 2021

When selecting the appropriate long-acting opioid to treat cancer pain, both analgesic efficacy and safety need consideration. Generally, opioids are well tolerated. However, of opioid-typical adverse events, respiratory depression is especially important because of the risk of a fatal outcome. Although all potent opioid analgesics act via the μ-opioid receptor system, they differ in how they affect respiratory control. Recently, the respiratory effects of fentanyl (1 - 7 μg/kg) and buprenorphine (0.7 - 9 μg g/kg) were compared in healthy opioidnaïve volunteers. Fentanyl produced dose-dependent depression of respiration with apnoea at doses ≥3 μg/kg, while buprenorphine caused depression that levelled at ~50% of baseline with doses ≥2 μg/kg. These findings indicate the occurrence of a ceiling in the respiratory depression induced by buprenorphine but not by fentanyl. Surprisingly few studies have addressed the clinically important ability to reverse the respiratory effects of opioids. A recent assessment of the naloxone dose required to reverse 0.2 μg intravenous buprenorphine-induced respiratory depression in healthy opioid-naïve volunteers, found that the accumulated naloxone dose causing 50% reversal of respiratory depression was 1.20∓0.32 μg/70 kg (given in 30 min); 80% reversal was observed at 2.50∓0.60 μg/70 kg (given in 30 min). At greater buprenorphine doses, full reversal is observed when the duration of naloxone infusion is increased. These findings indicate the need for a continuous rather than bolus administration of naloxone to reverse the respiratory effects of buprenorphine. In conclusion, buprenorphine is more favourable compared with fentanyl in respect to ventilatory control. Buprenorphine causes limited respiratory depression with a ceiling effect at higher doses, while fentanyl causes dose-dependent respiratory depression with apnoea at high dose levels. In the rare instance of respiratory depression, reversal is possible with a sufficient and continuous infusion of naloxone.
Measurable Residual Disease Response and Prognosis in Treatment-Naïve Acute Myeloid Leukemia With Venetoclax and Azacitidine
Authors: Pratz Keith W. , Jonas Brian A. , Pullarkat Vinod , Recher Christian , Schuh Andre C. , Thirman Michael J. , Garcia Jacqueline S. , DiNardo Courtney D. , Vorobyev Vladimir , Fracchiolla Nicola S. , Yeh Su-Peng , Jang Jun Ho , Ozcan Muhit , Yamamoto Kazuhito , Illes Arpad , Zhou Ying , Dail Monique , Chyla Brenda , Potluri Jalaja , Döhner Hartmut
Published: December 2021

PURPOSE

There is limited evidence on the clinical utility of monitoring measurable residual disease (MRD) in patients with acute myeloid leukemia treated with lower-intensity therapy. Herein, we explored the outcomes of patients treated with venetoclax and azacitidine who achieved composite complete remission (CRc; complete remission + complete remission with incomplete hematologic recovery) and MRD < 10–3 in the VIALE-A trial.

METHODS

The patients included in this report were treated with venetoclax and azacitidine. Bone marrow aspirate samples for multiparametric flow cytometry assessments were collected for central analysis at baseline, end of cycle 1, and every three cycles thereafter. MRD-negative response was defined as < 1 residual blast per 1,000 leukocytes (< 10–3 or 0.1%) with an estimated analytic sensitivity of 0.0037%-0.0027%. CRc, duration of remission (DoR), event-free survival (EFS), and overall survival (OS) were assessed. A multivariate Cox regression analysis identified prognostic factors associated with OS.

RESULTS

One hundred sixty-four of one hundred ninety (86%) patients with CRc were evaluable for MRD. MRD < 10–3 was achieved by 67 of 164 (41%), and 97 of 164 (59%) had MRD ≥ 10–3. The median DoR, EFS, and OS were not reached in patients with CRc and MRD < 10–3, and the 12-month estimates for DoR, EFS, and OS in this group were 81.2%, 83.2%, and 94.0%. Among patients with CRc and MRD ≥ 10–3, the median DoR, EFS, and OS were 9.7, 10.6, and 18.7 months. Multivariate analysis showed that CRc with MRD < 10–3 was a strong predictor of OS (adjusted hazard ratio = 0.285; 95% CI, 0.159 to 0.510; P < .001).

CONCLUSION

Patients who achieved CRc and MRD < 10–3 with venetoclax and azacitidine had longer DoR, EFS, and OS, than responding patients with MRD ≥ 10–3.
Upgrading the Chemotherapy Consent: Trading in Paper for Tablet
Authors: Wu Lesley , Smith Cardinale B. , Parra Jessica , Liu Mark , Theroux Haley Hines , Bhardwaj Aarti S.
Published: December 2021

PURPOSE:

Our institution participated in the Oncology Care Model, which required us to include many of the 13 elements of the National Academy of Medicine (NAM) care plan into care pathways for our patients. We optimized our existing chemotherapy consent process to meet this need and maximized completion.

METHODS:

Our multidisciplinary committee developed a three-phase Plan-Do-Study-Act process in our breast cancer clinic: (1) update and educate providers on our paper chemotherapy form with multiple components of the NAM care plan including prognosis and treatment effects on quality of life; (2) piloted an electronic chemotherapy consent form to decrease the administrative burden; and (3) autopopulated fields within the electronic consent. We assessed feedback after cycle 1 and created a Pareto chart. The outcome measure was percent completion of chemotherapy consent documents.

RESULTS:

Baseline monthly random chart audit of 40 patients revealed 20% of paper chemotherapy consent forms were completed in their entirety among patients. When we re-educated clinicians about the new paper consent containing the NAM elements, compliance rose to nearly 30%. A Pareto chart confirmed that content redundancy and wordiness were leading to under-completion. After creating and piloting the electronic consent, compliance increased to 90%. Finally, autopopulation with drop-down selections increased and sustained completion to 100%.

CONCLUSION:

Incorporating regulatory requirements into an existing workflow using Plan-Do-Study-Act methodology can reduce administrative burden on clinicians. Additional use of innovative technology can further increase clinician compliance with regulatory requirements while delivering high-value quality care to patients with cancer.
Initial Stress Hyperglycemia Is Associated With Malignant Cerebral Edema, Hemorrhage, and Poor Functional Outcome After Mechanical Thrombectomy
Authors: Cannarsa Gregory J. , Wessell Aaron P. , Chryssikos Timothy , Stokum Jesse A. , Kim Kevin , De Paula Carvalho Helio , Miller Timothy R. , Morris Nicholas , Badjatia Neeraj , Chaturvedi Seemant , Gandhi Dheeraj , Simard J. Marc , Jindal Gaurav
Published: December 2021

BACKGROUND:

Malignant cerebral edema (MCE) and intracranial hemorrhage (ICH) are associated with poor neurological outcomes despite revascularization after mechanical thrombectomy (MT). The factors associated with the development of MCE and ICH after MT are not well understood.

OBJECTIVE:

To determine periprocedural factors associated with MCE, ICH, and poor functional outcome.

METHODS:

We retrospectively analyzed anterior cerebral circulation large vessel occlusion cases that underwent MT from 2012 to 2019 at a single Comprehensive Stroke Center. Multivariate logistic regression analyses were performed to determine significant predictors of MCE, ICH, and poor functional outcome (modified Rankin Scale, 3-6) at 90 d.

RESULTS:

Four hundred patients were included. Significant independent predictors of MCE after MT included initial stress glucose ratio (iSGR) (odds ratio [OR], 14.26; 95% CI, 3.82-53.26; P < .001), National Institutes of Health Stroke Scale (NIHSS) (OR, 1.10; 95% CI, 1.03-1.18; P = .008), internal carotid artery compared with M1 or M2 occlusion, and absence of successful revascularization (OR, 0.16; 95% CI, 0.06-0.44; P < .001). Significant independent predictors of poor functional outcome included MCE (OR, 7.47; 95% CI, 2.20-25.37; P = .001), iSGR (OR, 5.15; 95% CI, 1.82-14.53; P = .002), ICH (OR, 4.77; 95% CI, 1.20-18.69; P = .024), NIHSS (OR, 1.10; 95% CI, 1.05-1.16; P < .001), age (OR, 1.04; 95% CI, 1.03-1.07; P < .001), and thrombolysis in cerebral infarction 2C/3 recanalization (OR, 0.12; 95% CI, 0.05-0.29; P < .001).

CONCLUSION:

Elevated iSGR significantly increases the risk of MCE and ICH and is an independent predictor of poor functional outcome. Thrombolysis in cerebral infarction 2C/3 revascularization is associated with reduced risk of MCE, ICH, and poor functional outcome. Whether stress hyperglycemia represents a modifiable risk factor is uncertain, and further investigation is warranted.
Effects of Preoperative Embolization on Spetzler–Martin Grade I and II Arteriovenous Malformations: A Propensity-Adjusted Analysis
Authors: Catapano Joshua S. , Srinivasan Visish M. , Rumalla Kavelin , Koester Stefan W. , Kimata Anna R. , Ma Kevin L. , Labib Mohamed A. , Baranoski Jacob F. , Cole Tyler S. , Rutledge Caleb , Ducruet Andrew F. , Albuquerque Felipe C. , Spetzler Robert F. , Lawton Michael T.
Published: December 2021

BACKGROUND:

Cerebral arteriovenous malformations (AVMs) with low Spetzler–Martin grades (I and II) are associated with good neurological outcomes after microsurgical resection; however, the use of preoperative embolization for these lesions is controversial.

OBJECTIVE:

To compare the neurological outcomes of preoperative embolization with no embolization in patients with low-grade AVMs.

METHODS:

Patients with a Spetzler–Martin grade I or II AVM who underwent microsurgical resection during January 1, 1997, through December 31, 2019, were analyzed. Patients undergoing preoperative embolization were compared with patients not undergoing embolization. A propensity score was constructed from baseline characteristics and used to match intervention (embolization) and control (nonembolization) groups in a 1:1 ratio. The primary outcome was poor neurological status on last follow-up examination, defined as a modified Rankin Scale score >2 and a modified Rankin Scale score worse at follow-up than at the preoperative examination.

RESULTS:

Of the 603 patients analyzed, 310 (51.4%) underwent preoperative embolization and 293 (48.6%) did not. Patients in the embolization cohort compared with those in the nonembolization cohort had a higher percentage of Spetzler–Martin grade II AVMs (71.6% vs 52.6%, P < .001) and a lower percentage of hemorrhage (41% vs 55%, P = .001). After propensity score matching, no differences were found between paired cohorts (each N = 203) for baseline characteristics with a significant reduction in absolute standardized mean differences. No significant differences were found in primary outcomes between treatment groups in the matched or unmatched cohorts.

CONCLUSION:

Preoperative embolization of low-grade Spetzler–Martin AVMs is not associated with improved neurological outcomes after microsurgical resection.
Treatment Outcomes in American Football Players After Intervertebral Disk Herniation: Systematic Review and Meta-Analysis
Authors: Abola Matthew V. , Lin Charles C. , Colasanti Christopher A. , Schreiber-Stainthorp William , Passias Peter G.
Published: December 2021

BACKGROUND:

American football players are at increased risk for many forms of spinal injury. Intervertebral disk herniations are particularly concerning as they are the leading cause of days lost to injury and can have long-term effects on player careers. Disk herniation management plays a major role in the likelihood and success of return-to-play (RTP).

OBJECTIVE:

To assess the incidence, demographic variables, treatment approaches, outcomes, and RTP rates of disk herniations in American football players.

METHODS:

A systematic review of the literature investigating disk herniations in American football players using PubMed, Cochrane Library, and Embase was performed. RTP estimates were calculated by pooling study-specific data using a random-effects model.

RESULTS:

Four hundred twenty-two studies were identified, with 18 meeting inclusion criteria. Offensive and defensive linemen were the 2 most commonly injured positions. Players undergoing operations were on average younger, with higher body mass indexes, fewer seasons played, and longer post-treatment careers than nonsurgical counterparts. Postsurgical recovery periods lasted an average 106 d, with a mean RTP duration of 33 games over 2.7 yr and an 8.45% reoperation rate. Operative treatment offered a nonsignificant increase in the likelihood of return-to-play compared with nonoperative treatment (odds ratio = 2.81, 95% CI 0.83-9.51).

CONCLUSION:

Disk herniations are a common injury, with surgery potentially improving post-treatment outcomes. The literature suffers from heterogeneous definitions of RTP and varying performance metrics, making it difficult to draw clear conclusions. To better understand the impact of disk herniation and treatment on player health and performance, more studies should be performed prospectively and with standardized metrics.
Racial and Socioeconomic Disparities in Patients With Meningioma: A Retrospective Cohort Study
Authors: Jackson Hudin N. , Hadley Caroline C. , Khan A. Basit , Gadot Ron , Bayley James C. , Shetty Arya , Mandel Jacob , Jalali Ali , Gallagher K. Kelly , Sweeney Alex D. , Harmanci Arif O. , Harmanci Akdes S. , Klisch Tiemo , Gopinath Shankar P. , Rao Ganesh , Yoshor Daniel , Patel Akash J.
Published: December 2021

BACKGROUND:

Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors.

OBJECTIVE:

To determine factors that contribute to different clinical outcomes in racial populations.

METHODS:

We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences.

RESULTS:

Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival.

CONCLUSION:

Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.
Does Neuromodulation Reduce Chronic Pain Patient Emergency Department Utilization?
Authors: Figueroa Christopher , Hadanny Amir , Kroll Kyle , DiMarzio Marisa , Ahktar Kainat , Gillogly Michael , Mitchell Dorothy , Cangero Theodore , Pilitsis Julie G.
Published: December 2021

BACKGROUND:

Chronic pain (CP) affects roughly 100 million adults in the United States. These subjects present disproportionately to the emergency department (ED). Neuromodulation (NM) has been shown to reduce ED visits longitudinally in subjects.

OBJECTIVE:

To compare ED utilization rates between subjects with CP with and without NM.

METHODS:

Subjects with failed back surgery syndrome, complex regional pain syndrome, or neuropathic pain diagnosis who visited the hospital between January 1, 2019, and December 31, 2019, were included. Subjects were divided into a NM-treated cohort and a non-NM cohort. Demographic information, medications, and pain provider visits were obtained. Pain-related ED visits between 2017 and 2019 were compared.

RESULTS:

A total of 2516 subjects were identified; 291 (11.6%) previously underwent NM. The non-NM cohort had significantly higher rate of pain-related ED visits compared with the NM cohort (15.1% vs 10.0%, P = .018). Younger age (odds ratio [OR] = 0.888 [0.843-0.935]), shorter distance to the hospital (OR = 0.807 [0.767-0.849]), lower household income (OR = 0.865 [0.831-0.901]), opioid use (OR = 1.375 [1.291-1.465]), nonopioid use (OR = 1.079 [1.033-1.128]), and non-NM therapy (OR = 1.751 [1.283-2.390]) were significant predictors of ED visits. Opioid use was the only significant predictor (OR = 6.124 [1.417-26.473]) associated with ED visits in the NM cohort.

CONCLUSION:

Subjects who underwent NM had fewer visits to the ED when compared with similar subjects who received conventional treatment. Opioid use prompted increased ED utilization in both cohorts. We posit that NM leads to improvement in pain outcomes, integration with multidisciplinary pain specialists, and reduction in severity and frequency of acute pain exacerbations, thereby limiting health care resource utilization.
Multicentric Chordoma With Initial Resection by Bilateral Transcondylar Approach: 2-Dimensional Operative Video
Authors: Ibn Essayed Walid , Rassi Marcio , Chi John H. , Al-Mefty Ossama
Published: December 2021

Chordoma is a rare skull base tumor with malignant behavior.
1–3
It invades locally with high recurrences, metastasizes distally, and seeds after interventions.
1–4
Chordoma exemplifies the malignant progression doctrine as it accumulated genetic mutations. The natural history of untreated disease is 2.4 yr on average survival.
5
Best tumor control is achieved by radical resection, followed by high doses radiation. Multicentric chordoma is an ill-defined challenging entity extremely rare in the literature. However, chordoma is known for distal metastasis, particularly to the lungs, iatrogenic cerebrospinal fluid (CSF) dissemination with drop metastasis, or surgical implantation. A subset of patients present with synchronous or metachronous regional or distal neuraxial lesions associated with the initial chordoma. Patients presenting with multicentric bony axial lesions and no extra-axial metastases point toward the multicentric chordoma concept rather than local, hematogenous, or CSF spread.
6–12
Biopsy of these multicentric lesions can show a spectrum of abnormalities ranging from benign notochordal tumor to chordomas confirming the multicentric hypothesis.
9
We present a patient who underwent a bilateral transcondylar approach for giant craniovertebral junction chordoma and then treated with radiation and a second lesion at the C6 transverse foramen. Six years later, she presented with a chordoma at the petrous apex. The patient consented to surgery and to the publications of her image. The participants and any identifiable individuals consented to publication of his/her image.

Image at 1:39 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas. Vol 1, © LWW, 1998.
Trans-Sulcal Parafascicular Port-Based Resection of a Subcortical Occipital High-Grade Glioma: 2-Dimensional Operative Video
Authors: Revuelta Barbero Juan M. , Rindler Rima S. , Lamanna Jason , Soriano Roberto M. , Pradilla Gustavo
Published: December 2021

Minimally invasive trans-sulcal parafascicular port-based approaches can provide safe access to a wide variety of deep brain lesions.
1,2
This surgical video illustrates the use of a minimally invasive port-based approach for resection of a subcortical right medial occipital lobe lesion in a 63-year-old woman who presented with seizures and bilateral left homonymous hemianopia.

MRI showed a 2.5-cm contrast enhancing lesion with a necrotic center and significant T2 and fluid-attenuated inversion recovery signal consistent with vasogenic edema. Diffusion tensor imaging revealed compromise of the right optic radiations and edema extending through the right corticospinal tract. A minimally invasive trans-sulcal parafascicular port-based approach to the deep occipital lobe and periatrial region was performed under full exoscopic visualization. A gross total tumor resection was achieved, and histopathology revealed an IDH1-mutant, MGMT-methylated–positive glioblastoma. The patient's presentation, rationale, key surgical steps, and outcomes are discussed, and informed consent for surgery was obtained. The participants and any identifiable individuals consented to the publication of their image. Images at 3:50 used with permission from Nico Corporation. All rights reserved.
Sugita–Kobayashi Maneuver for Preservation of Large Bridging Veins in the Interhemispheric Approach: 2-Dimensional Operative Video
Authors: Mooney Michael A. , Al-Mefty Ossama
Published: December 2021

Giants of neurosurgery have made contributions that might at times seem to be minor maneuvers but have a major impact on safe surgery, such as Sugita and Kobayashi's description of the preservation of the bridging sagittal veins.
1

The interhemispheric approach is haunted by risk to the bridging veins and resultant venous infarction. At the midsegment, this could produce devastating neurological deficits.
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This is an especially critical factor in falcine meningiomas in which the location of the tumor narrows the options for the surgical corridor, particularly if an additional falcine margin, “Grade Zero” resection, is to be performed.
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Detailed preoperative neuroimaging workup is required to plan the appropriate surgical strategy and minimize risk for venous complications. This may include magnetic resonance or computed tomography venogram, dynamic computed tomography angiography,
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or in some cases formal angiography to assess the relationship with the superior sagittal sinus, the anatomy of parasagittal bridging veins in relation to the lesion, and the patterns of collateral venous drainage.

While bridging veins may be displaced, compressed, or obscured by tumor involvement,
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microsurgical technique can facilitate the safe identification and preservation of this crucial anatomy. Bridging veins are separated from the underlying cortex to a distance from the sinus, allowing for improved relaxation of the ipsilateral cortex, without venous compromise.
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Herein, we demonstrate a case of a large falcine meningioma with a “Grade Zero” resection, with mobilization of the parasagittal bridging veins to develop the interhemispheric surgical corridor.

The patient consented for surgery.
Suboccipital Microsurgical Resection of Pediatric Ependymoma in the Foramen of Luschka: 2-Dimensional Operative Video
Authors: Parikh Kara A. , Merchant Thomas E. , Boop Frederick A.
Published: December 2021

Ependymoma tumors are the third most common pediatric brain tumor. They can be found along the entirety of the neuroaxis, but pediatric ependymomas are most commonly found in the posterior fossa.
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We provide videographic
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description of an anatomic approach to the foramen of Luschka in a pediatric patient through a redo suboccipital craniotomy. In this surgical video, we present a 5-yr-old patient with previously resected ependymoma with recurrence in the foramen of Luschka. The patient underwent microsurgical gross total resection of the ependymoma by using a suboccipital approach. He tolerated the surgery well with an uneventful postoperative course followed by radiation therapy. Regardless of molecular subgroup, numerous studies have shown that near or gross total surgical resection followed by radiation therapy provides the greatest progression-free survival.
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Ependymomas of the posterior fossa, particularly recurrences or second look resections, can present a challenge to the surgeon because of scarred tissue and precarious location along the brainstem and cranial nerves. Although it has been our institution's observation that these tumors are often debulked, it has been our experience that with an appropriate approach by anatomic dissection, near and gross total resections can be achieved safely and confidently by the surgeon and thus maximize the patient's potential for progression-free survival. The legal guardian of the patient in the presented operative case has given consent for publication of this operative video, and the patient's family provided consent to the procedure.
Far Lateral Approaches: Far Lateral Approach With Minimal Condylectomy for C2 Schwannoma: 3-Dimensional Operative Video
Authors: Budohoski Karol P. , Barone Damiano G. , Kirollos Ramez W. , Santarius Thomas , Trivedi Rikin A.
Published: December 2021

Upper cervical schwannomas are rare lesions and together with meningiomas constitute around 5% of spinal tumors. The approach to these lesions is difficult because of the close proximity of the medulla and cervical spinal cord, lower cranial nerves, and the vertebral artery. Schwannomas in the upper cervical area typically arise from the dorsal roots and are located posterior to the dentate ligament. Nevertheless, a far lateral approach is often required for these lesions because of their lateral extent through the neural foramen and the proximity of both the V3 and V4 segments of the vertebral artery. With these lesions, an extensive condylectomy is rarely required. We present a case of a 40-yr-old woman who presented with an 8-mo history of deteriorating mobility and feeling of heaviness in the lower limbs with a further acute deterioration 1 wk before admission. She had a dissociated sensory loss and myelopathy in keeping with a partial hemicord syndrome. Imaging revealed a right-sided C2 intradural lesion extending through the C2 foramen in keeping with a C2 schwannoma. The patient was counseled on the treatment options, and informed consent for surgery was obtained. We describe a right-sided far lateral approach with minimal condylectomy for gross total resection of this lesion. We demonstrate the relationship of the tumor with the C2 nerve root, the spinal accessory nerve, and the cervical cord. We supplement the discussion with a 3D surgical video.
Far Lateral Approaches: Dural Arteriovenous Fistulae at the Hypoglossal Canal: 3-Dimensional Operative Video
Authors: Budohoski Karol P. , Barone Damiano G. , Mediratta Saniya , Ross Matthew , Kirollos Ramez W. , Santarius Thomas , Trivedi Rikin A.
Published: December 2021

Cognard type V dural arteriovenous fistulae (dAVF) are typically located at the foramen magnum. Their presentation often mimics that of cervical myelopathy, and they can be easily misdiagnosed even if spinal vascular imaging is undertaken. Treatment typically involves endovascular embolization or surgery when embolization is not possible. We describe a case of a 67-yr-old man who presented with progressive symptoms of cervical myelopathy with a significant reduced ambulation and upper motor neuron signs. Imaging disclosed upper cervical cord edema, and angiography confirmed a Cognard type V dAVF with drainage into the perimedullary and spinal venous system. The dAVF was supplied by the hypoglossal division of the ascending pharyngeal artery. Endovascular treatment was believed to pose a risk of ischemic injury to the hypoglossal nerve, and therefore, surgery was offered. Informed consent was obtained. A far lateral approach was used to access the fistulous point. We describe the relevant vascular anatomy and the benefits of the far lateral approach for this lesion. We also demonstrate a tailored inferior condylectomy to gain access to the intracranial part of the hypoglossal canal, where the draining vein is expected to be found. We supplement the discussion with a 3D surgical video.
More than two populations of microtubules comprise the dynamic mitotic spindle
Authors: Tipton Aaron R. , Gorbsky Gary J.
Published: December 2021

The microtubules of the mitotic spindle mediate chromosome alignment to the metaphase plate, then sister chromatid segregation to the spindle poles in anaphase. Previous analyses of spindle microtubule kinetics utilizing fluorescence dissipation after photoactivation described two main populations, a slow and a fast turnover population, and these were ascribed as reflecting kinetochore versus non-kinetochore microtubules, respectively. Here, we test this categorization by disrupting kinetochores through depletion of the Ndc80 complex in U2OS cells. In the absence of functional kinetochores, microtubule dynamics still exhibit slow and fast turnover populations, although the proportion of each population and the timings of turnover are altered. Importantly, the data obtained following Hec1 (also known as Ndc80) depletion suggests that other subpopulations, in addition to kinetochore microtubules, contribute to the slow turnover population. Further manipulation of spindle microtubules revealed a complex landscape. For example, although Aurora B kinase functions to destabilize kinetochore bound microtubules it might also stabilize certain slow turnover non-kinetochore microtubules. Dissection of the dynamics of microtubule populations provides a greater understanding of mitotic spindle kinetics and insight into their roles in facilitating chromosome attachment, movement and segregation during mitosis.
Chiffon triggers global histone H3 acetylation and expression of developmental genes in Drosophila embryos
Authors: Torres-Zelada Eliana F. , George Smitha , Blum Hannah R. , Weake Vikki M.
Published: December 2021

The histone acetyltransferase Gcn5 is critical for gene expression and development. In Drosophila, Gcn5 is part of four complexes (SAGA, ATAC, CHAT and ADA) that are essential for fly viability and have key roles in regulating gene expression. Here, we show that although the SAGA, ADA and CHAT complexes play redundant roles in embryonic gene expression, the insect-specific CHAT complex uniquely regulates expression of a subset of developmental genes. We also identify a substantial decrease in histone acetylation in chiffon mutant embryos that exceeds that observed in Ada2b, suggesting broader roles for Chiffon in regulating histone acetylation outside of the Gcn5 complexes. The chiffon gene encodes two independent polypeptides that nucleate formation of either the CHAT or Dbf4-dependent kinase (DDK) complexes. DDK includes the cell cycle kinase Cdc7, which is necessary for maternally driven DNA replication in the embryo. We identify a temporal switch between the expression of these chiffon gene products during a short window during the early nuclear cycles in embryos that correlates with the onset of zygotic genome activation, suggesting a potential role for CHAT in this process.

This article has an associated First Person interview with the first author of the paper.
Além da balança comercial
Authors: Ochman Renato
Published: December 2021

Brasil e Israel intensificam os negócios na área de tecnologia, particularmente em agricultura, empreendedorismo e em soluções para cidades inteligentes.
Seu ESG é sustentável?
Authors: Belinky Aron
Published: December 2021

Sustentabilidade empresarial é mais que um rótulo da moda e seguir apenas a atual onda pode ser um risco para o negócio e para a sociedade.
Ética nos algoritmos: a nova fronteira da governança
Authors: Maura Costa Ligia
Published: December 2021

Será que em breve teremos algoritmos verificando a conformidade dos algoritmos?
Emendas parlamentares, orçamento secreto e desequilíbrio da democracia
Authors: Antonio Carvalho Teixeira Marco
Published: December 2021

É importante que os parlamentares façam parte do processo decisório de forma transparente e aberta à sociedade. Todavia, não é republicano que isso seja feito à meia-luz ou orientado pela cultura do segredo, além de ser antidemocrático.