First ptychographic X-ray computed tomography experiment on the NanoMAX beamline

Documentation is presented for the first ptychographic X-ray computed tomography experiment on the NanoMAX beamline, along with a quantitative analysis of the reconstruction quality and a discussion of possibilities for future improvements.

Ptychographic X-ray computed tomography is a quantitative three-dimensional imaging technique offered to users of multiple synchrotron radiation sources. Its dependence on the coherent fraction of the available X-ray beam makes it perfectly suited to diffraction-limited storage rings. Although MAX IV is the first, and so far only, operating fourth-generation synchrotron light source, none of its experimental stations is currently set up to offer this technique to its users. The first ptychographic X-ray computed tomography experiment has therefore been performed on the NanoMAX beamline. From the results, information was gained about the current limitations of the experimental setup and where attention should be focused for improvement. The extracted parameters in terms of scanning speed, size of the imaged volume and achieved resolutions should provide a baseline for future users designing nano-tomography experiments on the NanoMAX beamline.

A review of Mandarin speech recognition test materials for use in Singapore

OBJECTIVE

This study aimed to evaluate word lists of current Mandarin speech recognition test materials on their adaptability for use on adult Singapore Mandarin speakers.

DESIGN

This scoping review involved literature search through electronic databases for studies published in English or Mandarin, detailing the development or validation of Mandarin speech recognition test materials meant to be used in quiet. Word lists of materials were evaluated for phonemic balance (Stage 1) and familiarity to Singapore Mandarin speakers by comparing the test items against a list of 1,000 common Singapore Mandarin words (Stage 2).

STUDY SAMPLE

Thirty articles that fulfilled the inclusion and exclusion criteria were reviewed.

RESULTS

Nine sets of materials were found and evaluated in Stage 1. Among these, two sets of materials did not contain phonemically balanced word lists. The remaining seven sets of materials were evaluated in Stage 2. The percentage of unfamiliar characters to Singapore Mandarin speakers was found to be between 15% and 41% across the word lists.

CONCLUSION

None of the currently available materials contain word lists that can be readily adapted for re-recording with the voice of a Singapore Mandarin speaker. There is a need to develop original Singapore Mandarin speech recognition test materials.

Agreement between left ventricular ejection fraction assessed in patients with gated IQ-SPECT and conventional imaging

BACKGROUND

The aim of the study was to assess the agreement between the left ventricular ejection fraction (LVEF) values obtained with IQ-SPECT and those obtained with a conventional gamma camera equipped with low-energy high-resolution (LEHR), considered as the method of reference.

METHODS

Gated-stress MPI using 99mTc-tetrofosmin was performed in 55 consecutive patients. The patients underwent two sequential acquisitions (Method A and B) performed on Symbia-IQ SPECT with different acquisition times and one (Method C) on a Ecam SPECT equipped with LEHR collimators. The values of the different datasets were compared using the Bland-Altman analysis method: the bias and the limits of agreement (LA) were estimated in a head-to-head comparison of the three protocols.

RESULTS

In the (Method A-Method C) comparison for LVEF, the bias was 3.8% and the LAs ranged from - 9.3% to 16.8%. The agreement was still lower between Method B and C, whilst only slightly improved when Methods A and B were compared.

CONCLUSIONS

The wide amplitude in LA intervals of about 30% indicates that IQ and LEHR GSPECT are not interchangeable. The values obtained with IQ-SPECT should only be used with caution when evaluating the functional state of the heart.

Rupture of Unscarred Uterus With Intestinal Prolapse From Vagina Following Criminal Abortion

A 21-year-old unmarried and primigravida female indulged in criminal abortion at 18 weeks of gestation with the help of a village midwife. Instrumentation was done, and it led to uterine perforation with prolapse of 200 cm of small bowel through vagina. She was managed with resection of 160 cm of necrotic small bowel, repair of the uterine defect, and end jejunostomy, which was anastomosed with distal ileum three months later. This case highlights the risks of illegal abortion and the primitive societal mindset that forces unmarried women to resort to such means.

Comparative evaluation of flexural fracture resistance of mandibular premolars after instrumentation with four different endodontic file systems: An In Vitro study

Background

Under axial loading, there is stress concentration around the cervical areas especially in the premolars because of their location in the arch.

Aim

To evaluate and compare flexural fracture resistance of mandibular premolars after instrumentation with ProTaper^®Universal, ProTaper Next^®, OneShape^®, and WaveOne^® endodontic file systems.

Methods

Seventy-five mandibular premolar teeth with single straight canals were divided into five different groups (n = 15): Group A: Control, Group B: ProTaper Universal (PTU), Group C: ProTaper Next (PTN), Group D: OneShape, Group E: WaveOne. The teeth were instrumented as per the manufacturer's instructions. After obturation and core placement, the teeth were placed in a customized jig mounted on a universal testing machine where force was applied at 45° on the buccal cusp and the force required to fracture the teeth was noted.

Results

Amongst all the instrumented groups, WaveOne showed the highest resistance to fracture (1065.56 ± 175.05) and the control group was 1104.13 ± 188.42. All groups showed a significant difference in the fracture load values with the control group. However, there was a statistically significant (P < 0.05) difference seen with WaveOne vs PTU and WaveOne vs OneShape.

Conclusions

Root canals instrumented with reciprocating motion have better flexural fracture resistance than continuous rotary motion. Mandibular premolars when instrumented with ProTaper Universal and OneShape endodontic files showed similar fracture resistance, proving that dentin removal does not depend on the number of files used.

A versatile X-ray phase retarder for lock-in XMCD measurements

X-ray magnetic circular dichroism (XMCD) is a technique commonly used to probe magnetic properties of materials with element and orbital selectivity, which requires the use of circularly polarized (CP) X-rays. It is possible to accomplish XMCD experiments with fixed CP and alternating the magnetic field orientation, but most reliable data are obtained when alternating the magnetization orientation and the polarization between right and left helicities. A versatile strategy has been developed to perform XMCD experiments using a hard X-ray quarter-wave plate, at both polychromatic dispersive and conventional monochromatic optics, in combination with synchronous data acquisition. The switching frequency waveform is fed into a lock-in amplifier to detect and amplify the XMCD signal. The results on a reference sample demonstrate an improvement in data quality and acquisition time. The instrumentation successfully generated 98% of CP X-rays switching the beam helicity at 13 Hz, with the possibility of faster helicity switching once it is installed at the new Brazilian fourth-generation source, SIRIUS.

Soft X-ray absorption of thin films detected using substrate luminescence: a performance analysis

X-ray absorption spectroscopy of thin films is central to a broad range of scientific fields, and is typically detected using indirect techniques. X-ray excited optical luminescence (XEOL) from the sample's substrate is one such detection method, in which the luminescence signal acts as an effective transmission measurement through the film. This detection method has several advantages that make it versatile compared with others, in particular for insulating samples or when a probing depth larger than 10 nm is required. In this work a systematic performance analysis of this method is presented with the aim of providing guidelines for its advantages and pitfalls, enabling a wider use of this method by the thin film community. The efficiency of XEOL is compared and quantified from a range of commonly used substrates. These measurements demonstrate the equivalence between XEOL and X-ray transmission measurements for thin films. Moreover, the applicability of XEOL to magnetic studies is shown by employing XMCD sum rules with XEOL-generated data. Lastly, it is demonstrated that above a certain thickness XEOL shows a saturation-like effect, which can be modelled and corrected for.

Instrumented Four Square Step Test in Adults with Transfemoral Amputation: Test-Retest Reliability and Discriminant Validity between Two Types of Microprocessor Knees

Technology-based outcomes have recently been proposed to complement the standard Four Square Step Test (FSST) by providing a decomposition of the sequences and information about the stepping pattern. A test-retest study and a randomized crossover design have been used to determine immediate test-retest reliability and to assess discriminant validity, in persons with a unilateral transfemoral amputation, for the parameters computed by an instrumented version of the Four Square Step Test. Twenty adults, independent and unlimited community ambulators, with a unilateral transfemoral amputation, performed two Four Square Step Tests on a pressure mat first with a microprocessor knee, then, a few weeks later with another one. One of these prosthetic knees was acknowledged to be superior and to provide functional improvement. Test-retest, intraclass correlation coefficients and minimal detectable change at 95% confidence level were calculated for each variable. Paired samples t-tests were then used to identify differences between the two microprocessor knee systems. The test-retest reliability of most outcome measures was good to excellent. Few variables showed a systematic difference and a trend to improve between test 1 and test 2. When comparing both microprocessor knees, significant differences in the expected direction were observed, with interpretation in accordance with a functional improvement. Importantly, we highlighted that various strategies to improve the performance in the test might complexify the interpretation of the most detailed measurement. The instrumented Four Square Step test provides reliable measures with satisfactory test-retest reliability and discriminant validity in persons with unilateral transfemoral amputation.

Removal of Large Primary Vaginal Calculus Using the Nephroscope and Endoscopic Ultrasonic Lithotrite: A Case Report

Background: Vaginal calculi are rare and can grow quite large if they remain undetected. Vaginal stones are caused by the pooling of urine in the vagina and can be classified as either primary or secondary, depending on the absence or presence, respectively, of a nidus. Primary stones without any urethrovaginal or vesicovaginal fistula are even more uncommon but appear to be more commonly reported in incontinent women with significant physical disabilities. Case Presentation: We present a case of an ∼11 cm primary vaginal stone in a 61-year-old woman with cerebral palsy. This was removed using a nephroscope and an endoscopic ultrasonic lithotrite through the vaginal introitus with subsequent analysis demonstrating a struvite stone composition. Conclusion: This case is unique not only for the large size of the calculi but also for our less invasive approach, using a nephroscope and endoscopic ultrasonic lithotrite to fragment and remove the stone. We hope that this report will assist other providers in the timely and accurate diagnosis and treatment of future vaginal stone patients.

Terahertz Spectroscopy: Encoding the Discovery, Instrumentation, and Applications toward Pharmaceutical Prospectives

Terahertz (THz) spectroscopy is an emerging field for quality control of pharmaceuticals, which uses T-waves for detection. T-waves fall in between infrared and microwave radiations while possessing some of the characteristics of both. THz spectroscopy reveals its existence in between 0.1 and 10 THz. These radiations have the ability to penetrate a broad range of non-conductive materials and it is nonionizing. The first article stating the use of THz radiations was found in late 1960 for the generation of the astronomical images. This review essentially creates attention toward different forms and instrumentation of THz spectroscopy along with the updates for timely and upbeat pharmaceutical applications. The most frequently used technique is THz-TDS which has profoundly privileged applicability for the pharmaceuticals. The existing literature of THz spectroscopy further created albeit interest to explore the applications for future implementation in concern with the pharmaceuticals. The review critically outlines here all the pharmaceutical applications of THz spectroscopy including protein analyses, crystallinity studies, evaluating tablet films and coats, medicinal aging variations, and detection of illicit drugs, along with the advantages over traditional techniques. The other side of THz spectroscopy stating limitations is also studied and taken into the note to present here. This review is a genuine attempt to quote and crucially assess the possible as well as anticipated prospectives for the pharmaceuticals. The present article will further promote the awareness, opportunities, and scientific exploration of this exciting technology as THz spectroscopy.

Outcomes of Revision Surgery for Pseudarthrosis After Anterior Cervical Fusion: Case Series and Systematic Review

STUDY DESIGN

Case series/systematic review.

OBJECTIVES

To report on patients undergoing posterior cervical fusion for symptomatic pseudarthrosis following anterior cervical discectomy and fusion (ACDF), and to assess outcomes reporting in the literature.

METHODS

Patients undergoing posterior instrumented fusion for pseudarthrosis after primary ACDF from 2013 to 2018 by a single surgeon were reviewed consecutively. Neck Disability Index (NDI) and visual analogue scale (VAS) arm/neck were recorded at preoperative, 6-month, and 1-year time points. A systematic review of the literature was performed, and outcomes reporting was recorded.

RESULTS

NDI scores were 54.4 (SD 19.1), 36.6 (SD 18.1), and 41.2 (SD 19.2) at preoperative, 6-month, and 1-year time points, respectively, with improvement from preoperatively to 6 months (P = .004). VAS neck scores were 8.1 (SD 1.3), 5.0 (SD 2.9), and 5.8 (SD 2.2) at preoperative, 6-month, and 1-year time points, respectively, with improvement from preoperatively to 6 months (P = .038). VAS arm scores were 5.1 (SD 4.1), 3.5 (SD 3.2), and 3.6 (SD 2.7) at preoperative, 6-month, and 1-year time points, respectively, with improvement although these did not reach statistical significance (P = .145). The most common subjective outcomes reported in the literature were general symptoms assessments (43%), ordinal scales (43%), and VAS neck (19%) scales, with the majority of studies (67%) documenting one measure.

CONCLUSIONS

Patient-reported outcomes demonstrate clinically meaningful improvement within the first 6 months after posterior fusion for pseudarthrosis. Studies demonstrate substantial variability and no standardization in outcomes reporting, limiting the ability to compare results across interventions and pathologies. Standardized reporting will enable comparisons to inform patients and physicians on the optimal approach to treat this difficult problem.

Moving Fast-Scan Cyclic Voltammetry toward FDA Compliance with Capacitive Decoupling Patient Protection

Carbon-fiber microelectrodes allow for high spatial and temporal measurements of electroactive neurotransmitter measurements in vivo using fast-scan cyclic voltammetry (FSCV). However, common instrumentation for such measurements systems lack patient safety precautions. To add safety precautions as well as to overcome chemical and electrical noise, a two-electrode FSCV headstage was modified to introduce an active bandpass filter on the electrode side of the measurement amplifier. This modification reduced the measured noise and ac-coupled the voltammetric measurement and moved it from a classical direct current response measurement. ac-coupling not only reduces the measured noise, but also moves FSCV toward compliance with IEC-60601-1, enabling future human trials. Here, we develop a novel ac-coupled voltammetric measurement method of electroactive neurotransmitters. Our method allows for the modeling of a system to then calculate a waveform to compensate for added impedance and capacitance for the system. We describe how first by measuring the frequency response of the system and modeling the analogue response as a digital filter we can then calculate a predicted waveform. The predicted waveform, when applied to the bandpass filter, is modulated to create a desired voltage sweep at the electrode interface. Further, we describe how this modified FSCV waveform is stable, allowing for the measurement of electroactive neurotransmitters. We later describe a 32.7% sensitivity enhancement for dopamine with this new measurement as well as maintaining a calibration curve for dopamine, 3,4-dihydroxyphenylacetic acid, ascorbic acid, and serotonin in vitro. We then validate dopamine in vivo with stimulated release. Our developed measurement method overcame the added capacitance that would traditionally make a voltammetric measurement impossible, and it has wider applications in electrode sensor development, allowing for measurement with capacitive systems, which previously would not have been possible.

Solar Blue Light Radiation Enhancement during Mid to Low Solar Elevation Periods under Cloud Affected Skies

Solar blue-violet wavelengths (380-455 nm) are at the high energy end of the visible spectrum; referred to as "high energy visible" (HEV). Both chronic and acute exposure to these wavelengths has been often highlighted as a cause for concern with respect to ocular health. The sun is the source of HEV which reaches the Earth's surface either directly or after scattering by the atmosphere and clouds. This research has investigated the effect of clouds on HEV for low solar elevation (solar zenith angles between 60° and 80°), simulating time periods when the opportunity for ocular exposure in global populations with office jobs is high during the early morning and late afternoon. The enhancement of "bluing" of the sky due to the influence of clouds was found to increase significantly with the amount of cloud. A method is presented for calculating HEV irradiance at sub-tropical latitudes from the more commonly measured global solar radiation (300-3000 nm) for all cases when clouds do and do not obscure the sun. The method; when applied to global solar radiation data correlates well with measured HEV within the solar zenith angle range 60° and 80° (R2 = 0.82; mean bias error (MBE) = -1.62%, mean absolute bias error (MABE) = 10.3% and root mean square error (RMSE) = 14.6%). The technique can be used to develop repeatable HEV hazard evaluations for human ocular health applications.

Assessment of emergency trolley drugs in a children's hospital. Before and after study on an educational intervention

INTRODUCTION

The approach to pediatric emergencies requires specialized resources, and medication errors are common.

OBJECTIVES

To describe the contents of emergency trolleys (ETs) in a children's hospital and compare them after an educational intervention.

METHODS

The ETs from 9 hospitalization wards were included. A checklist of 30 drugs was developed. ETs were assessed by determining whether drugs were present or absent and their amount. An educational intervention was conducted and assessments were repeated 30 and 90 days after the intervention.

RESULTS

The baseline measurement indicated an overall ratio of adequate drugs of 43.9 % (95 % confidence interval [Cl]: 38.4-49.4) with a variation among ETs from 29 % to 54.8 %, and from 15 % to 85 % among drug groups. At 30 days, the adequate ratio reached 70.3 % (95 % CI: 65.275.4), with a wide variation among the different ETs and drug groups (from 51.6 % to 93.5 % and from 50 % to 95 %, respectively). At 90 days, the percentages were similar. The comparison between the first and second measurement showed an improvement in all ETs (range: 3.2 %-45.1 %), odds ratio: 3.73 (95 % CI: 2.5-5.6), p < 0.001. Results were similar between the second and third measurement.

CONCLUSIONS

The baseline measurement showed a low level of adequate ET drugs. After the intervention, this improved significantly and was maintained during the studied period.

Posterior short segment pedicle screw fixation for the treatment of thoracolumbar fracture

The choice of the type of stabilization device in the osteosynthesis of dorso-lumbar spine fractures remains a subject of controversy. The present study aims to evaluate the efficiency of short segment in patients suffering post-traumatic thoracolumbar fractures. This study was conducted in the Department of Orthopedic Surgery and Traumatology of the Habib Bourguiba University Hospital, Sfax, Tunisia. All our patients had a spinal osteosynthesis via the posterior approach with a short segment pedicle screw fixation. We established a record of the pre and post-operative data, the functional results in the post-operative stage during the follow-up period and in retrospect according to the Denis Pain Scale, as well as the Oswestry score. The correction was evaluated by determining the relative gain and loss at the last period of retrospect: vertebral kyphosis, regional kyphosis, Gardner Segment Kyphotic Deformity (GSKD), and computed tomography (CT) scan in retrospect to check the quality of the arthrodesis. The average Oswestry score was 14%. Twenty-nine patients had an Oswestry score ≤40%. The relative gain obtained postoperatively was 57.3% for vertebral kyphosis, 67.2% for regional kyphosis and 71.3% for Gardner kyphosis deformity; while the loss of correction at the last follow-up was 0.6° for vertebral kyphosis, 1.5° for regional kyphosis and 0.9° for GSKD. No cases of non-union were reported. The short segment fixation makes it possible to limit operating time, the abundance of bleeding and the aggression of the soft tissues.

Method Comparison Using 2 Point-of-Care Meters and a Reference Analyzer for Measuring Blood Triglycerides in Psittacine Birds

Female reproductive disorders, such as chronic egg laying, are common in captive psittacine birds. While a disease diagnosis related to reproductive disorders can often be accomplished by physical examination and diagnostic imaging, monitoring of the response to environmental modification and medical treatment is more challenging. Monitoring ideally would involve measurement of luteinizing hormone or estrogen to assess ovarian activity. However, the amount of blood required for hormone analysis is greater than the small sample size that one can collect from these birds. Additionally, the lack of reference intervals limits their use as a diagnostic tool. Because plasma triglyceride increases during sustained estrogen release from the ovary, it may be used as an alternative method for assessing ovarian activity in birds. Point-of-care (POC) analyzers for measuring lipids in human plasma use very small sample volumes and have been used for measuring triglycerides in animals, including chickens. The authors therefore performed a method comparison study with 2 POC analyzers and a reference analyzer and plasma and whole blood from psittacine birds to determine whether these meters are suitable for triglyceride measurement in a known population of psittacine birds. Correlation, Deming regression, and Bland-Altman analyses were used to assess performance, and the total observed error for each meter relative to the reference analyzer was calculated. One of the meters exhibited fair performance and, with species-specific reference intervals, is likely to be clinically useful for triglyceride measurement in psittacine birds. The other meter demonstrated poor performance with unacceptable error, and its use for this purpose is strongly discouraged.

Thoracic Pedicle Morphometry of Dry Vertebral Columns in Relation to Trans-Pedicular Fixation: A Cross-Sectional Study From Central India

Introduction

Trans-pedicular screw fixation is one of the main modalities of spinal instrumentation today. It is particularly challenging in the thoracic spine due to the narrow pedicle dimensions especially in the upper and mid-thoracic levels. We aimed to study the anatomical variations like pedicle dimensions and angulation in transverse and sagittal planes.

Material and methods

We conducted an anatomical investigation on 20 dry vertebral columns (14 male and six female), from T1 to T12 levels. The measurements included pedicle width, height, and transverse and sagittal angles of the pedicle. Numerical variables were summarized using mean and standard deviation.

Results

T12 vertebra was found to have the widest pedicle width (mean 7.89 ± 0.70 mm) and the widest pedicle height (mean 15.45±0.78 mm) while T5 vertebra (mean 3.65±0.40 mm) had the narrowest pedicle width. T1 vertebra had the maximum transverse angle of the pedicle (mean 30.37±2.56 degree); whereas, T2 vertebra had the maximum sagittal angle (mean 19.22±2.24 degree).

Conclusion

We have reported detailed pedicle measurements including their angulation for the thoracic spine in dry vertebral columns of central India. The pedicles are directed more medially from T1 to T10 levels and are almost neutral at T11 and T12 levels. These findings would not only be of immense help to the spinal surgeons but also help in designing implants and instrumentations specific for the thoracic spine for the central Indian population as well as aiding surgeons to perform more precise and, therefore, safe surgical procedures.

Quantitative Analysis of Root Canal System and Apical Part with Vertucci Type II Configuration Following Preparation with Three Different Preparation Systems: A Micro-computed Tomography Study

OBJECTIVE

Isthmuses are narrow communications between root canals, and form as the result of the merging of the two root canals widening in a buccolingual direction. This widening causes the high ovality of isthmuses. The shaping and cleaning of all root canal systems are regarded as one of the major difficulties in long-oval shaped root canals. This study aims to make quantitative analysis of Vertucci type II root canal systems following preparation with Self- Adjusting file (SAF), Reciproc or Revo-S.

METHODS

Major diameter and roundness values were measured at the level 1.2 mm from apical foramen before and after preparation. A 'post-preparation node' point was described when the minimum minor diameter value was smaller than major diameter of apical 1.2 mm. Data were analysed using one-way ANOVA, Tukey and Chi-square tests.

RESULTS

Preparation resulted in a significant increase in the major diameter values regardless of the instrumentation (p = 0.000). Preparation with Reciproc led to the significant increase in roundness values (p = 0.000), whereas no significant difference was detected in specimens prepared with SAF (p = 0.21) and Revo-S (p = 0.15).

CONCLUSION

Root canal preparation with SAF, Reciproc and Revo-S led to a significant increase in the major diameter of apical 1.2 mm and resulted in high frequencies of the post-preparation node.

Minor impact of constraint from perivascular flow probes on wave intensity analysis

Perivascular flow probes are considered the gold-standard for measuring volumetric blood flow in animal studies. Although flow probes are generally placed non-constrictively around the vessel of interest, pressure-elevating interventions performed during an experiment may lead to vessel expansion and some probe-vessel impingement, particularly in highly compliant vessels such as adult sheep aorta or major pulmonary arteries in fetus lambs. This study assessed to what extent such mild flow probe constraint may impact on wave intensity analysis. We also investigated whether errors arising from flow probe constraint could explain apparent pressure reflection indices (R_p > 1) that have been observed in fetus lamb pulmonary arteries under some experimental conditions. These questions were investigated with one-dimensional models of an adult sheep aorta and fetus lamb pulmonary artery, with a virtual flow probe incorporated as a non-linear external constraint term in the vessel constitutive equation. Model-derived flow and pressure were subjected to standard analysis procedures that would be applied experimentally (correcting for apparent velocity lags and calculating wave speed via the PU-loop method). For the adult sheep model, simulations covering a wide range of haemodynamic conditions revealed a mostly minor effect (<10%) of probe constraint on the intensity and pressure effects of the three major waves (forward compression wave, forward decompression wave, backward compression wave). Moreover, flow probe constraint had essentially no impact on R_p in the fetus lamb model, suggesting that such constraint is unlikely to be responsible for an observed R_p > 1. Mild flow probe constraint is likely to have little impact on wave intensity analysis.

Improving recovery after elective degenerative spine surgery: 5-year experience with an enhanced recovery after surgery (ERAS) protocol

OBJECTIVEEnhanced recovery after surgery (ERAS) has led to a paradigm shift in various surgical specialties. Its application can result in substantial benefits in perioperative healthcare utilization through preoperative physical and mental patient optimization and modulation of the recovery process. Still, ERAS remains relatively new to spine surgery. The authors report their 5-year experience, focusing on ERAS application to a broad population of patients with degenerative spine conditions undergoing elective surgical procedures, including anterior lumbar interbody fusion (ALIF).METHODSA multimodal ERAS protocol was applied between November 2013 and October 2018. The authors analyze hospital stay, perioperative outcomes, readmissions, and adverse events obtained from a prospective institutional registry. Elective tubular microdiscectomy and mini-open decompression as well as minimally invasive (MI) anterior or posterior fusion cases were included. Their institutional ERAS protocol contains 22 pre-, intra-, and postoperative elements, including preoperative patient counseling, MI techniques, early mobilization and oral intake, minimal postoperative restrictions, and regular audits.RESULTSA total of 2592 consecutive patients were included, with 199 (8%) undergoing fusion. The mean hospital stay was 1.1 ± 1.2 days, with 20 (0.8%) 30-day and 36 (1.4%) 60-day readmissions. Ninety-four percent of patients were discharged after a maximum 1-night hospital stay. Over the 5-year period, a clear trend toward a higher proportion of patients discharged home after a 1-night stay was observed (p < 0.001), with a concomitant decrease in adverse events in the overall cohort (p = 0.025) and without increase in readmissions. For fusion procedures, the rate of 1-night hospital stays increased from 26% to 85% (p < 0.001). Similarly, the average length of hospital stay decreased steadily from 2.4 ± 1.2 days to 1.5 ± 0.3 days (p < 0.001), with a notable concomitant decrease in variance, resulting in an estimated reduction in nursing costs of 46.8%.CONCLUSIONSApplication of an ERAS protocol over 5 years to a diverse population of patients undergoing surgical procedures, including ALIF, for treatment of degenerative spine conditions was safe and effective, without increase in readmissions. The data from this large case series stress the importance of the multidisciplinary, iterative improvement process to overcome the learning curve associated with ERAS implementation, and the importance of a dedicated perioperative care team. Prospective trials are needed to evaluate spinal ERAS on a higher level of evidence.

Instrumenting Polyodon spathula (Paddlefish) Rostra in Flowing Water with Strain Gages and Accelerometers

The prominent rostrum of the North American Paddlefish, supported by a lattice-like endoskeleton, is highly durable, making it an important candidate for bio-inspiration studies. Energy dissipation and load-bearing capacity of the structure from extreme physical force has been demonstrated superior to that of man-made systems, but response to continuous hydraulic forces is unknown and requires special instrumentation for in vivo testing on a live fish. A single supply strain gage amplifier circuit has been combined with a digital three-axis accelerometer, implemented in a printed circuit board (PCB), and integrated with the commercial-off-the-shelf Adafruit Feather M0 datalogger with a microSD card. The device is battery powered and enclosed in silicon before attachment around the rostrum with a silicon strap "watch band." As proof-of-concept, we tested the instrumentation on an amputated Paddlefish rostrum in a water-filled swim tunnel and successfully obtained interpretable data. Results indicate that this design could work on live swimming fish in future in vivo experiments.

The Additive Effects of Cell Phone Use and Dental Hygiene Practice on Finger Muscle Strength: A Pilot Study

Purpose: The purpose of this study was to determine strength of muscles involved with instrumentation (scaling) by dental hygienists and the additive effects of cellular (mobile) phone usage, as indicated by measurements of muscular force generation.Methods: A convenience sample of licensed dental hygienists currently in clinical practice (n=16) and an equal number of individuals not currently using devices/tools repetitively for work (n=16), agreed to participate in this pilot study. All participants completed a modified cell phone usage questionnaire to determine their use pattern and frequency. Upon completion of the questionnaire, participants' force production in six muscle groups was measured using a hand-held dynamometer. Descriptive statistics were used to analyze the data.Results: A total of 16 licensed dental hygienists (n=16) and 16 participants with no history of using tools/devices repetitively for work (n=16), comprised the experimental and control groups, repectively. The control group generated greater muscle force than the experimental group for the abductor pollicis longus (p=0.045). Significant differences were identified when comparing the low mobile phone users in the experimental group to the control group for the flexor pollicis brevis (p=0.031), abductor pollicis longus (p=0.031), and flexor digitorum (p=0.006), with the control group demonstrating higher muscle force. Years in clinical practice and mobile phone use was shown to have a significant effect on muscular force generation for the flexor pollicis brevis (F=3.645, df=3, p=0.020) and flexor digitorum (F=3.560, df=3, p=0.022); subjects who practiced dental hygiene the longest produced the least amount of muscle force.Conclusion: Results from this pilot study indicate there are no significant additive effects of cell phone use and dental hygiene practice on finger muscles used for instrumentation. However, results indicate that dental hygiene practice demonstrated significant effects on muscular strength as compared to individuals who do not use tools/devices repetitively for work. The small sample size may have impacted results and the study should be repeated with a larger sample.

Spinal Infections: An Update

Spinal infection poses a demanding diagnostic and treatment problem for which a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required. Infections are usually caused by bacterial microorganisms, although fungal infections can also occur. The most common route for spinal infection is through hematogenous spread of the microorganism from a distant infected area. Most patients with spinal infections diagnosed in early stages can be successfully managed conservatively with antibiotics, bed rest, and spinal braces. In cases of gross or pending instability, progressive neurological deficits, failure of conservative treatment, spinal abscess formation, severe symptoms indicating sepsis, and failure of previous conservative treatment, surgical treatment is required. In either case, close monitoring of the patients with spinal infection with serial neurological examinations and imaging studies is necessary.

Enhancing Radiation Detection by Drones through Numerical Fluid Dynamics Simulations

This study addresses the optimization of the location of a radioactive-particle sensor on a drone. Based on the analysis of the physical process and of the boundary conditions introduced in the model, computational fluid dynamics simulations were performed to analyze how the turbulence caused by drone propellers may influence the response of the sensors. Our initial focus was the detection of a small amount of radioactivity, such as that associated with a release of medical waste. Drones equipped with selective low-cost sensors could be quickly sent to dangerous areas that first responders might not have access to and be able to assess the level of danger in a few seconds, providing details about the source terms to Radiological-Nuclear (RN) advisors and decision-makers. Our ultimate application is the simulation of complex scenarios where fluid-dynamic instabilities are combined with elevated levels of radioactivity, as was the case during the Chernobyl and Fukushima nuclear power plant accidents. In similar circumstances, accurate mapping of the radioactive plume would provide invaluable input-data for the mathematical models that can predict the dispersion of radioactivity in time and space. This information could be used as input for predictive models and decision support systems (DSS) to get a full situational awareness. In particular, these models may be used either to guide the safe intervention of first responders or the later need to evacuate affected regions.

Assessment of Indoor Air Quality and Users Perception of a Renovated Office Building in Manchester

Building renovations can adversely affect building occupants through the release of biological contaminants, gases and particulates. In this study, the research aim was to monitor the air quality of a renovated building and assess the impact of sick building syndrome (SBS) on the occupants. Post occupancy monitoring of the building was carried out after two months occupancy for the following environmental parameters: airborne microflora using an air sampler (SAS super 180) and a hand-held monitoring device (Graywolf advance sense IQ-610) to measure total volatile organic compounds (TVOC), CO₂, CO and temperature and relative humidity in each office environment. In addition, an online (Qualtrics) structured questionnaire was used to assess occupants’ perceptions of the indoor environment. Results of the airborne flora showed 833 cfu/m³ recovered on a Malt Extract Agar (MEA) plate in the morning and 1213 cfu/m³ in the afternoon. A similar result was noticed on a Plate Count Agar (PCA) plate during the morning period (731 cfu/m³) and afternoon (1358 cfu/m³). Results of TVOC monitored over one week showed that the first two days of monitoring had a high reading that peaked at 10,837 ppb and that the CO₂ concentration during that period was 1163 ppm. Online questionnaire analysis indicates that a majority of the staff who took part in the survey experienced some form of health abnormality, including headache, shortness of breath, itchy eyes/ears, loss of concentration and so on, especially in the first few weeks of returning to the office. The results from the study indicate that a large proportion (41%) of the respondents experienced thermal discomfort as a result of varying room temperature during their working hours. A high number of female participants experienced some form of SBS as compared to their male counterparts. The study findings show a direct relationship between high airborne mold counts, TVOC and adverse staff health perception of the building. The study raised a number of opportunities for estate managers to improve building performance based on occupants’ preferences.

Exploratory and Confirmatory Factor Analysis of the Maslach Burnout Inventory to Measure Burnout Syndrome in Critical Care Nurses

BACKGROUND AND PURPOSE

Burnout syndrome is common in critical care nursing. The Critical Care Societies Collaborative recently released a joint statement and call to action on burnout in critical care professionals.

METHODS

We conducted an exploratory factor analysis and confirmatory factor analysis (CFA) of the 22-item MBI.

RESULTS

The exploratory factor analysis identified three factors but after questions were removed; we were left with a 2-factor, 10-item abridged version of the MBI-HSS to test with CFA modeling. The CFA indicated conflicting fit indices.

CONCLUSIONS

we conducted an exploratory and CFA of the abridged MBI-HSS in critical care nurses from the United States and found the two-factor model was the best fit achieved.

Resonant inelastic X-ray scattering using a miniature dispersive Rowland refocusing spectrometer

X-ray absorption spectroscopy (XAS) beamlines worldwide are steadily increasing their emphasis on full photon-in/photon-out spectroscopies, such as resonant inelastic X-ray scattering (RIXS), resonant X-ray emission spectroscopy (RXES) and high energy resolution fluorescence detection XAS (HERFD-XAS). In such cases, each beamline must match the choice of emission spectrometer to the scientific mission of its users. Previous work has recently reported a miniature tender X-ray spectrometer using a dispersive Rowland refocusing (DRR) geometry that functions with high energy resolution even with a large X-ray spot size on the sample [Holden et al. (2017). Rev. Sci. Instrum. 88, 073904]. This instrument has been used in the laboratory in multiple studies of non-resonant X-ray emission spectroscopy using a conventional X-ray tube, though only for preliminary measurements at a low-intensity microfocus synchrotron beamline. This paper reports an extensive study of the performance of a miniature DRR spectrometer at an unfocused wiggler beamline, where the incident monochromatic flux allows for resonant studies which are impossible in the laboratory. The results support the broader use of the present design and also suggest that the DRR method with an unfocused beam could have important applications for materials with low radiation damage thresholds and that would not survive analysis on focused beamlines.

High-Resolution Depth-Encoding PET Detector Module with Prismatoid Light-Guide Array

Depth-encoding detectors with single-ended readout provide a practical, cost-effective approach for constructing high-resolution and high-sensitivity PET scanners. However, the current iteration of such detectors uses a uniform glass light-guide to achieve depth encoding, resulting in nonuniform performance throughout the detector array due to suboptimal intercrystal light sharing. We introduce Prism-PET, a single-ended-readout PET detector module with a segmented light-guide composed of an array of prismatoids that introduce enhanced, deterministic light sharing. Methods: High-resolution PET detector modules were fabricated with single-ended readout of polished multicrystal lutetium yttrium orthosilicate scintillator arrays directly coupled 4-to-1 and 9-to-1 to arrays of 3 × 3 mm silicon photomultiplier pixels. Each scintillator array was coupled at the nonreadout side to a light-guide (one 4-to-1 module with a uniform glass light-guide, one 4-to-1 Prism-PET module, and one 9-to-1 Prism-PET module) to introduce intercrystal light sharing, which closely mimics the behavior of dual-ended readout, with the additional benefit of improved crystal identification. Flood histogram data were acquired using a 3-MBq ²²Na source to characterize crystal identification and energy resolution. Lead collimation was used to acquire data at specific depths to determine depth-of-interaction (DOI) resolution. Results: The flood histogram measurements showed excellent and uniform crystal separation throughout the Prism-PET modules, whereas the uniform glass light-guide module had performance degradation at the edges and corners. A DOI resolution of 5.0 mm full width at half maximum (FWHM) and an energy resolution of 13% FWHM were obtained in the uniform glass light-guide module. By comparison, the 4-to-1 coupled Prism-PET module achieved a DOI resolution of 2.5 mm FWHM and an energy resolution of 9% FWHM. Conclusion: PET scanners based on our Prism-PET modules with segmented prismatoid light-guide arrays can achieve high and uniform spatial resolution (9-to-1 coupling with ∼1-mm crystals), high sensitivity (20-mm-thick detectors and intercrystal Compton scatter recovery), good energy and timing resolutions (using polished crystals and after applying DOI correction), and compact size (depth encoding eliminates parallax error and permits smaller ring-diameter).

Assessment of Mobile Health Apps Using Built-In Smartphone Sensors for Diagnosis and Treatment: Systematic Survey of Apps Listed in International Curated Health App Libraries

Background

More than a million health and well-being apps are available from the Apple and Google app stores. Some apps use built-in mobile phone sensors to generate health data. Clinicians and patients can find information regarding safe and effective mobile health (mHealth) apps in third party–curated mHealth app libraries.

Objective

These independent Web-based repositories guide app selection from trusted lists, but do they offer apps using ubiquitous, low-cost smartphone sensors to improve health? This study aimed to identify the types of built-in mobile phone sensors used in apps listed on curated health app libraries, the range of health conditions these apps address, and the cross-platform availability of the apps.

Methods

This systematic survey reviewed three such repositories (National Health Service Apps Library, AppScript, and MyHealthApps), assessing the availability of apps using built-in mobile phone sensors for the diagnosis or treatment of health conditions.

Results

A total of 18 such apps were identified and included in this survey, representing 1.1% (8/699) to 3% (2/76) of all apps offered by the respective libraries examined. About one-third (7/18, 39%) of the identified apps offered cross-platform Apple and Android versions, with a further 50% (9/18) only dedicated to Apple and 11% (2/18) to Android. About one-fourth (4/18, 22%) of the identified apps offered dedicated diagnostic functions, with a majority featuring therapeutic (9/18, 50%) or combined functionality (5/18, 28%). Cameras, touch screens, and microphones were the most frequently used built-in sensors. Health concerns addressed by these apps included respiratory, dermatological, neurological, and anxiety conditions.

Conclusions

Diligent mHealth app library curation, medical device regulation constraints, and cross-platform differences in mobile phone sensor architectures may all contribute to the observed limited availability of mHealth apps using built-in phone sensors in curated mHealth app libraries. However, more efforts are needed to increase the number of such apps on curated lists, as they offer easily accessible low-cost options to assist people in managing clinical conditions.

SPECT myocardial perfusion imaging in liver transplantation candidates

BACKGROUND

The optimal cardiovascular evaluation prior to liver transplantation remains controversial and includes stress echocardiography, stress MPI, cardiac CTA, and coronary angiography. This study summarizes our experience of the past decade using SPECT MPI in patients with end-stage liver disease, including patient characteristics, stress testing protocols, test results, the need for repeat testing, and downstream testing.

METHODS

All patients who underwent a clinically indicated stress SPECT MPI study as part of their pre-liver transplant evaluation from 2004 to 2014 were reviewed from the Nuclear Cardiology database. Results of perfusion imaging, repeat testing, subsequent angiography, and need for revascularization were reviewed.

RESULTS

A total of 2500 patients were referred for SPECT MPI, of those 111 had known CAD and 271 underwent more than one MPI study. Compared to other patients undergoing stress MPI, pre-liver transplant patients were younger, had fewer cardiac risk factors and lower prevalence of prior cardiac history, and used pharmacologic stress more often. During the study decade, patient age increased, prevalence of hypertension increased and smoking decreased, prevalence of known CAD increased, and the number of abnormal studies decreased. Abnormal perfusion results were present in 7.8% of pre-liver transplant patients compared to 34.3% of all other patients. In a multivariate model, age and lower ejection fraction were associated with an abnormal MPI result. Of the 64 patients who underwent subsequent invasive or non-invasive coronary angiography after an abnormal MPI, obstructive CAD was diagnosed in 25 patients (1.0%), non-obstructive CAD was diagnosed in 23 patients (0.9%), and normal coronaries found in 16 patients (0.6%); a total of 18 (0.7%) of these underwent coronary revascularization. The average time to repeat testing was 27.2 ± 17.9 months. In a multivariate model, younger age and exercise stress were associated with repeat testing. In only 17 patients out of 271 with a normal initial perfusion, the repeat study became abnormal. The use of stress-first imaging was successful in 80% of patients with a reduction in Tc-99m dose from 39.1 to 18.3 mCi.

CONCLUSION

Abnormal SPECT MPI results in candidates for liver transplantation are infrequent compared to non-liver transplant patients and the incidence of obstructive CAD on subsequent angiography even less. Repeat testing in those on the transplant waiting list after initial normal test results appears to be of limited value. Stress-first protocols may be considered for the majority of these patients to reduce testing time and radiation exposure.

On the Development of a Transparent Enclosure for 360° Video Cameras to Observe Severe Fires In Situ

360-degree video recorded in fires provides a unique perspective that allows the viewer to change the viewing direction as regions of interest change during a fire. Use of 360-degree and traditional cameras at some locations in intense fires for extended durations has been hampered in the past by the high levels of radiant heat flux that will damage the camera's imaging sensor. This paper describes how a thin layer of moving water can be used to significantly reduce unwanted infrared radiation generated by a fire while allowing visual imaging using a simple and inexpensive enclosure. Essential details to replicate this system are provided and three illustrative example deployments are discussed.

Imaging Isomers on a Biological Surface: A Review

Mass spectrometry imaging is an imaging technology that allows the localization and identification of molecules on (biological) sample surfaces. Obtaining the localization of a compound in tissue is of great value in biological research. Yet, the identification of compounds remains a challenge. Mass spectrometry alone, even with high-mass resolution, cannot always distinguish between the subtle structural differences of isomeric compounds. This review discusses recent advances in mass spectrometry imaging of lipids, steroid hormones, amino acids and proteins that allow imaging with isomeric resolution. These improvements in detailed identification can give new insights into the local biological activity of isomers.

Fate of Hardware in Spinal Infections

Background: Removal of hardware with irrigation and debridement in patients with surgical site infections (SSIs) is performed commonly. However, the removal of hardware from patients with SSIs after spinal procedures is controversial. Moreover, primary spinal infections such as spondylodiscitis may require instrumentation along with surgical debridement. The purpose of this article was to evaluate critically and summarize the available evidence related to retention of hardware in patients with deep SSIs, and the use of instrumentation in surgical treatment of primary spinal infections. Methods: A literature search utilizing PubMed database was performed. Studies reporting the management of deep SSIs after instrumented spinal procedures, and of primary spinal infections using instrumentation published in peer-reviewed journals were included. Identified publications were evaluated for relevance, and data were extracted from the studies deemed relevant. Results: Because SSIs occur typically during the early post-operative period before stable bony fusion has been achieved, the removal of instrumentation may be associated with instability of the spinal column, pseudarthrosis, progressive deformity, pain, loss of function, and deterioration in the activities of daily living (ADL). Hence, early SSIs after spinal instrumentation are usually treated without removal of hardware. Moreover, primary spinal infections such as spondylodiscitis may require surgical debridement and instrumentation in cases with associated instability. Conclusions: Retaining or using instrumentation in patients with SSIs after spinal procedures or in patients with primary spinal infections, respectively, are commonly practiced in the field of spine surgery. Further evidence is required for the development of definitive algorithms to guide spine surgeons in decision making regarding the fate of instrumentation in the treatment of spinal infections.

Different anesthetics on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A network systematic review and meta-analysis

BACKGROUND

The authors of this systematic review and meta-analysis aimed to evaluate the effect of different anesthetics on the efficacy of inferior alveolar nerve block (IANB) in patients with irreversible pulpitis.

TYPES OF STUDIES REVIEWED

The authors conducted a search of MEDLINE databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Brazilian Library of Dentistry). There was no restriction on publication year or idiom. The gray literature was also explored. The authors included only randomized clinical trials that compared different anesthetics in the efficacy of IANB in patients with irreversible pulpitis. The risk of bias was evaluated by using the Cochrane Collaboration's tool. A random-effects Bayesian mixed treatment comparison model was used to compare different anesthetic solutions in randomized clinical trials with low or unclear risk of bias. Heterogeneity was assessed by using Cochran Q test and I² statistics. Quality of evidence was assessed by using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

A total of 7,981 studies were identified; only 16 met the eligibility criteria, and they were all meta-analyzed. A significant difference was observed in the pair lidocaine versus articaine, with higher success with articaine (risk ratio, 0.76; 95% confidence interval, 0.63 to 0.88) in the mixed treatment comparison analysis, as this comparison was graded as high-quality evidence. The probability of success for each treatment was 73% for articaine, 57% for prilocaine, 55% for mepivacaine, 53% for bupivacaine, and 12% for lidocaine. This ranking was considered high quality of evidence.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The use of articaine can increase the IANB success rate in patients with irreversible pulpitis. Among the anesthetic solutions, lidocaine was the least effective.

History and advances in spinal neurosurgery

Insight into the historic contributions made to modern-day spine surgery provides context for understanding the monumental accomplishments comprising current techniques, technology, and clinical success. Only during the last century did surgical growth occur in the treatment of spinal disorders. With that growth came a renaissance of innovation, particularly with the evolution of spinal instrumentation and fixation techniques. In this article, the authors capture some of the key milestones that have led to the field of spine surgery today, with an emphasis on the historical advances related to instrumentation, navigation, minimally invasive surgery, robotics, and neurosurgical training.

Hand-Held Near-Infrared Spectroscopy for Authentication of Fengdous and Quantitative Analysis of Mulberry Fruits

Recently, miniaturization of Raman, mid-infrared (MIR) and near-infrared (NIR) spectrometers have made substantial progress, and marketing companies predict this segment of instrumentation a significant growth rate within the next few years. This increase will be based on a more frequent implementation for industrial quality and process control and a broader adoption of spectrometers for in-the-field testing, on-site measurements, and every-day-life consumer applications. The reduction in size, however, must not lead to compromises in measurement performance and the hand-held instrumentation will only have a real impact if spectra of comparable quality to laboratory spectrometers can be obtained. The present communication will, on the one hand, explain the instrumental reasons why NIR spectroscopy is presently the most advanced technique regarding miniaturization and on the other hand, it will emphasize the impact of NIR spectroscopy for plant analysis by discussing in some detail a qualitative and a quantitative application example.

Comparing the Netra smartphone refractor to subjective refraction

BACKGROUND

Among technologies targeting mobile eye care, EyeNetra is a smartphone-based subjective refraction system. This study compared the results from this system with those of professional subjective refraction. Participant visual comfort and preference of results were also measured.

METHODS

Thirty-six optometry-naïve participants (n = 36 eyes, aged 18-35 years), were randomly subjected to three refraction methods: professional subjective refraction, unassisted Netra (participants alone) and refined Netra (sphere results refined by a practitioner). Using a randomised, double-blind design, refraction results were mounted in a trial frame and distance logMAR visual acuities were measured. Subjective appreciation and visual comfort were assessed by questionnaire. Overall preference was ranked.

RESULTS

Unassisted Netra yielded a median myopic overcorrection of 0.60 D (interquartile range [IQR] 0.25 to 0.94) compared to professional subjective refraction. Median equivalent sphere with unassisted Netra (-1.40 D, IQR -3.10 to -0.90) was significantly more myopic than refined Netra (-0.70 D, IQR -1.60 to -0.30) and then subjective refraction (-0.80 D, IQR -1.60 to -0.30) (all p-values < 0.01). Median visual acuity with professional subjective refraction (-0.16, IQR -0.22 to -0.09) was superior than unassisted Netra (-0.08, IQR -0.20 to 0.03) (p < 0.01). Subjective refraction was ranked first in preference of trial framed results by 72 per cent of participants; median preference rank favoured professional subjective refraction to both Netra results (all p < 0.01). For all questionnaire items, visual comfort was higher with subjective refraction than with unassisted Netra (all p < 0.04).

CONCLUSION

The Netra device - especially when used without professional assistance and compared to subjective refraction - induces significant myopic overcorrection and lower levels of visual acuity, subjective preference and visual comfort.

Infection with Spinal Instrumentation: A 20-Year, Single-Institution Experience with Review of Pathogenesis, Diagnosis, Prevention, and Management

Objective and Importance

Instrumentation has become an integral component in the management of various spinal pathologies. The rate of infection varies from 2% to 20% of all instrumented spinal procedures. Postoperative spinal implant infection places patients at risk for pseudo-arthrosis, correction loss, spondylodiscitis, and adverse neurological sequelae and increases health-care costs.

Materials and Methods

We performed a cohort study of 1065 patients who underwent instrumented spinal procedures in our institution between 1995 and 2014. Fifty-one patients (4.79%) contracted postoperative spinal infection. Isolated bacterial species, infection severity, diagnosis/treatment timing, surgical/medical strategy treatment, and patient's medical background were evaluated to assess their relationship with management outcome.

Results

Multiple risk factors for postoperative spinal infection were identified. Infections may be early or delayed. C-reactive protein and magnetic resonance imaging are important diagnostic tools. Prompt diagnosis and aggressive therapy (debridement and parenteral antibiotics) were responsible for implant preservation in 49 of 51 cases, whereas implant removal noted in two cases was attributed to delayed treatment and uncontrolled infection with implant loosening or late infection with spondylodesis. Infection in the setting of instrumentation is more difficult to diagnose and treat due to biofilm.

Conclusion

Retention of the mechanically sound implants in early-onset infection permits fusion to occur, whereas delayed treatment and multiple comorbidities will most likely result in a lack of effectiveness in eradicating the infecting pathogens. An improved understanding of the role of biofilm and the development of newer spinal implants has provided insight into the pathogenesis and management of infected spinal implants. It is important to accurately identify and treat postoperative spinal infections. The treatment is multimodal and prolonged.

A Complete EGSE Solution for the SpaceWire and SpaceFibre Protocol Based on the PXI Industry Standard

This article presents a complete test equipment for the promising on-board serial high-speed SpaceFibre protocol, published by the European Committee for Space Standardization. SpaceFibre and SpaceWire are standard communication protocols for the latest technology sensor devices intended for on-board satellites and spacecrafts in general, especially for sensors based on image acquisition, such as scanning radiometers or star-tracking devices. The new design aims to provide the enabling tools to the scientific community and the space industry in order to promote the adoption of open standards in space on-board communications for current- and future-generation spacecraft missions. It is the first instrument expressly designed for LabVIEW users, and it offers tools and advanced features for the test and development of new SpaceFibre devices. In addition, it supports the previous SpaceWire standard and cross-communications. Thanks to novel cutting-edge design methods, the system complex architecture can be implemented on natively supported LabVIEW programmable devices. The presented system is highly customizable in terms of interface support and is provided with a companion LabVIEW application and LabVIEW Application Programming Interface (API) for user custom automated test-chains. It offers real-time capabilities and supports data rates up to 6.25 Gbps.The proposed solutions is then fairly compared with other currently available SpaceFibre test equipment. Its comprehensiveness and modularity make it suitable for either on-board device developments or spacecraft system integrations.

Transmission measurement at the Bernina branch of the Aramis Beamline of SwissFEL

The transmission of the optical components of the Bernina branch of the Aramis beamline at SwissFEL has been measured with an X-ray gas monitor from DESY and compared with a PSI gas detector upstream of the optical components. The transmission efficiencies of the Mo, Si and SiC mirror coatings of the Aramis beamline and the various other in-beam components were evaluated and compared with theoretical calculations, showing an agreement of 6% or better in all cases. The experiment has also shown the efficacy of the high-harmonic rejection mirrors at the Bernina branch of the Aramis beamline at SwissFEL, and characterized the transmission efficiency of the on-line spectrometer in the Aramis beamline. The theoretical transmission of the mirror coatings match the experimental data to within 7%. The accuracy of these measurements was checked against a radiative bolometer from a Japanese collaboration and found to agree to a level of 4% or better. Further comparisons with a diamond detector from a US-based inter-institute collaboration demonstrated a good agreement for the attenuator settings of the beamline.

A multicenter retrospective research of anterior debridement, decompression, bone grafting, and instrumentation for cervical tuberculosis

Objective: To observe the clinical effect of anterior debridement, decompression, bone grafting, and instrumentation for cervical spinal tuberculosis in four hospitals. Materials and Methods: This research retrospectively analyzed 146 patients with cervical spinal tuberculosis who were treated by anterior debridement, decompression, bone grafting, and instrumentation in four institutions between January 2000 and January 2015. There were 68 males and 78 females with an average age of 31.32 ± 11.69 years. All patients received chemotherapy for 18 months after surgery, and fixed by brace for 3 months. Clinical outcome, laboratory indexes and radiological results were analyzed to evaluate the efficacy of anterior approach surgery in the treatment of cervical spinal tuberculosis. Results: All cases were followed up about 18 to 52 months later (average 24 months). At the last follow-up, all patients obtained bone fusion, pain relief and neurological recovery. There was no recurrence in any of the patients, and no complications related to internal fixation. There were statistically significant differences before and after treatment in terms of Visual analog scale (VAS), Neck disability index (NDI) and Japanese Orthopedic Association (JOA)(P < 0.05). During the last follow-up examination, in 83 patients with neurological deficit, 78 patients improved. The kyphosis was significantly improved postoperatively (P < 0.05). At the last follow-up, the Cobb angle had some degree of correction loss, but the difference was not statistically significant. Conclusion: Our study suggests that one-stage anterior debridement, decompression, bone grafting, and instrumentation are safe and effective methods in the surgical management of cervical spinal tuberculosis. Abbreviation: VAS: Visual Analog Scale; JOA: Japanese Orthopaedic Association; NDI: Neck Disability Index; ESR: Erythrocyte Sedimentation Rate; ASIA: American Spinal Injury Association; TB: Tuberculosis.

Comparison of postoperative pain intensity following the use of three different instrumentation techniques: A randomized clinical trial

Background. The aim of this study was to compare the postoperative pain intensity following the root canal preparation carried out with XP-endo Shaper (XPS; FKG Dentaire SA, La Chauxde-Fonds, Switzerland), iRace (iRC; FKG Dentaire SA) and Reciproc Blue (REC Blue; VDW, Munich, Germany) files. Methods. Mandibular molar teeth with asymtomatic necrotic pulps in 69 patients were randomly divided into three groups (n=23). The root canals were prepared using XPS, iRC or REC Blue instruments and obturated using the lateral condensation technique. The patients were asked to record their pain intensity at 24-, 48- and 72-hour and 1-week postoperative intervals on VAS. For intolerable pain after the procedure, ibuprofen (400 mg) was prescribed. Data were analyzed using chi-squared, Friedman, Kruskal-Wallis, and Mann-Whitney U tests. Results. The postoperative pain gradually decreased during the study period in all the groups (P<0.05). No statistically significant difference was found between iRC system and the two other systems at 12-, 24- 48-hour and 1-week intervals (P>0.05). When compared to XPS system, a higher level of postoperative pain was observed with REC Blue system at 24- and 48-hour intervals (P<0.05). Conclusion. The XPS group exhibited less postoperative pain than the REC Blue group at 24- and 48-hour intervals. iRC, XPS and REC Blue systems were found to be similar in terms of postoperative pain severity.

Design and psychometric properties of an instrument to assess metacognition in moral reasoning in medicine

AIM

The present study aims at designing and assessing the psychometric properties of MCMR instruments to lead the medical ethics education to further goals and more definite steps.

DESIGN

This is a cross sectional study.

METHOD

This study was conducted in two phases; identifying the items and designing the instrument. In the preliminary phase, the qualitative study was carried out using conventional content analysis method. In the second phase, psychometric evaluation of instrument was done using face and content validity, construct validity and reliability.

RESULTS

On the first phase of this study, 135 items were identified. After determining face and content validity, 111 items reached the stage of exploratory factor analysis. This instrumental analysis indicated the existence of 74 items and ten factors whose variance of the total is explained as 46.883%. Cronbach's alpha value was 0/75. And the intra-cluster correlation coefficient was 0.808.

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion

INTRODUCTION

Robotic guidance (RG) and computer-assisted navigation (NV) have seen increased adoption in instrumented spine surgery over the last decade. Although there exists some evidence that these techniques increase radiological pedicle screw accuracy compared with conventional freehand (FH) surgery, this may not directly translate to any tangible clinical benefits, especially considering the relatively high inherent costs. As a non-randomised, expertise-based study, the European Robotic Spinal Instrumentation Study aims to create prospective multicentre evidence on the potential comparative clinical benefits of RG, NV and FH in a real-world setting.

METHODS AND ANALYSIS

Patients are allocated in a non-randomised, non-blinded fashion to the RG, NV or FH arms. Adult patients that are to undergo thoracolumbar pedicle screw instrumentation for degenerative pathologies, infections, vertebral tumours or fractures are considered for inclusion. Deformity correction and surgery at more than five levels represent exclusion criteria. Follow-up takes place at 6 weeks, as well as 12 and 24 months. The primary endpoint is defined as the time to revision surgery for a malpositioned or loosened pedicle screw within the first postoperative year. Secondary endpoints include patient-reported back and leg pain, as well as Oswestry Disability Index and EuroQOL 5-dimension questionnaires. Use of analgesic medication and work status are recorded. The primary analysis, conducted on the 12-month data, is carried out according to the intention-to-treat principle. The primary endpoint is analysed using crude and adjusted Cox proportional hazards models. Patient-reported outcomes are analysed using baseline-adjusted linear mixed models. The study is monitored according to a prespecified monitoring plan.

ETHICS AND DISSEMINATION

The study protocol is approved by the appropriate national and local authorities. Written informed consent is obtained from all participants. The final results will be published in an international peer-reviewed journal.

TRIAL REGISTRATION NUMBER

Clinical Trials.gov registry NCT03398915; Pre-results, recruiting stage.

Student perceptions of two simulated learning environments in paediatric audiology

Objective: To determine audiology student perceptions of two simulated learning environments (SLE) in paediatric audiology.Design: A one-shot case study design.Study sample: Fifteen audiology students who completed questionnaires after participating in two SLEs, one simulating auditory brainstem response (ABR) assessments of neonates in a hospital ward and one simulating visually reinforced orientation audiometry (VROA) assessments of young children in an audiology clinic.Results: The students responded positively to 11/11 areas of audiometric testing and client interaction in both SLEs, to 7/7 aspects of their interactions with the mannequins in both SLEs, and to 8/8 aspects of their interactions with fellow students playing the role of parent in the ABR SLE and 7/8 of these aspects in the VROA SLE. The students reported low levels of anxiety towards both SLEs but rated the ABR SLE more highly than the VROA SLE in areas of preparedness, effectiveness, realism, pre-SLE training, reinforcement of lecture content, and overall usefulness.Conclusions: The participating students responded positively to almost all aspects of both SLEs. Further research is warranted using research designs capable of determining if these SLEs directly improve student abilities as they transition from academic settings to clinical placements in paediatric audiology.

Delayed Instrumentation Following Removal of Cranio-Vertebral Junction Chordomas: A Technical Note

Objective  To investigate on the feasibility and safety of a new approach which consists of delaying instrumentation after destabilizing craniovertebral junction (CVJ) chordoma surgery, allowing proton beam radiotherapy to be performed in a metal-free tumoral cavity. Design  This is a retrospective series of a prospectively maintained database. Participants  Five consecutive patients operated on for a CVJ chordomas for which instrumentation after tumor resection was deferred to after radiotherapy treatment. Main Outcome Measures  The main outcome consisted of measurements of the following parameters: C0-C2 angle, atlanto-dens interval (ADI), condylar gap, and the position of the dens relative to McGregor's line and coronal inclination, performed at 3 different times for all patients: before tumor surgery (baseline), before instrumentation surgery, and after instrumentation surgery. Results  For all patients, CVJ parameters deteriorated during the delay period, but stayed within normal limits for most. Because of radiological instability, one patient necessitated instrumentation before receiving radiotherapy. All parameters except condylar gap were partially corrected after instrumentation. No new neurological symptom or evolving neck pain occurred during the delay period. Conclusion  Delayed instrumentation of CVJ chordomas can be a safe alternative that might lead to improved subsequent radiotherapeutical treatment. Patient's selection and close clinical and radiological follow-up are mandatory for the success of this approach.

X-ray photon diagnostics at the European XFEL

The European X-ray Free-Electron Laser (European XFEL) (Altarelli et al., 2006; Tschentscher et al., 2017), the world's largest and brightest X-ray free-electron laser (Saldin et al., 1999; Pellegrini et al., 2016), went into operation in 2017. This article describes the as-built realization of photon diagnostics for this facility, the diagnostics commissioning and their application for commissioning of the facility, and results from the first year of operation, focusing on the SASE1 beamline, which was the first to be commissioned. The commissioning consisted of pre-beam checkout, first light from the bending magnets, X-rays from single undulator segments, SASE tuning with many undulator segments, first lasing, optics alignment for FEL beam transport through the tunnel up to the experiment hutches, and finally beam delivery to first users. The beam properties assessed by photon diagnostics throughout these phases included per-pulse intensity, beam position, shape, lateral dimensions and spectral properties. During this time period, the machine provided users with up to 14 keV photon energy, 1.5 mJ pulse energy, 300 FEL pulses per train and 4.5 MHz intra-bunch train repetition rate at a 10 Hz train repetition rate. Finally, an outlook is given into the diagnostic prospects for the future.

New Design of the Electrophoretic Part of CLARITY Technology for Confocal Light Microscopy of Rat and Human Brains

Background: CLARITY is a method of rendering postmortem brain tissue transparent using acrylamide-based hydrogels so that this tissue could be further used for immunohistochemistry, molecular biology, or gross anatomical studies. Published papers using the CLARITY method have included studies on human brains suffering from Alzheimer’s disease using mouse spinal cords as animal models for multiple sclerosis. Methods: We modified the original design of the Chung CLARITY system by altering the electrophoretic flow-through cell, the shape of the platinum electrophoresis electrodes and their positions, as well as the cooling and recirculation system, so that it provided a greater effect and can be used in any laboratory. Results: The adapted CLARITY system is assembled from basic laboratory components, in contrast to the original design. The modified CLARITY system was tested both on rat brain stained with a rabbit polyclonal anti-Iba-1 for microglial cells and on human nucleus accumbens stained with parvalbumin and tyrosine hydroxylase for visualization of specific neurons by confocal laser scanning microscopy. Conclusions: Our design has the advantage of simplicity, functional robustness, and minimal requirement for specialized additional items for the construction of the CLARITY apparatus.

Laser-based radiocarbon detection in the laboratory: How soon?

Research over the past 25 years and the use of accelerator mass spectrometry (AMS) have demonstrated benefits of single-atom counting of ¹⁴ C compared with scintillation monitoring of ¹⁴ C radioactive decay for a multitude of applications in drug development studies. These include pharmacokinetics and metabolism studies, microdosing studies, and quantification of DNA adducts. In the last decade, the possibility of single-atom counting using lasers has been demonstrated, providing the possibility of simplified laboratory-based systems, which can equal or excel AMS sensitivity and provide scintillation system convenience without high levels of radioactivity. To achieve the required sensitivity, optical storage cavities have been used to enhance the laser interaction of the low densities of radiocarbon present. Two types of laser technologies have been used-cavity ring-down spectroscopy (CRDS) and intracavity opto-galvanic spectroscopy (ICOGS). Problems to be overcome to achieve routine use have included separation of the ¹⁴ C signal from backgrounds, achievement of acceptable precision and accuracy, reduction of measurement times for small samples, and improvement in the ease of use for the operator. Both technologies have achieved impressive results to date using samples of order 1 mg with CRDS and 10 μg with ICOGS. Commercial development is the next step.

Confirmatory factor analysis of the Insomnia Severity Index (ISI) and invariance across race: a pooled analysis of MsFLASH data

OBJECTIVE

Women's sleep at menopause is widely reported to be problematic. The Insomnia Severity Index (ISI) is a commonly used tool for quantifying sleep problems in clinical and research settings, but psychometric properties in postmenopausal women have not been reported. Our study aim was to examine the factor structure of the ISI in a large and diverse sample of midlife women with hot flashes.

METHODS

Baseline data were from 899 women enrolled in one of the three clinical trials using similar entry criteria conducted by the Menopause Strategies Finding Lasting Answers to Symptoms and Health research network. We conducted confirmatory factor analyses for the total sample and within strata defined by race/ethnicity (black and white women).

RESULTS

The ISI had two factors in the total sample. The two-factor structure was consistent across black and white women, with the exception of one item "difficulty falling asleep."

CONCLUSIONS

The ISI in midlife women with hot flashes is composed of two factors that capture dimensions of the insomnia severity and daytime impact. The instrument is a psychometrically sound scale appropriate for use in research and clinical practice to capture the severity and daytime impact of insomnia symptoms in diverse samples of midlife women with hot flashes. An abbreviated screening of two items could be considered to determine if further evaluation is needed of sleep complaints.