External Validation of the National Surgical Quality Improvement Program Calculator Utilizing a Single Institutional Experience for Adult Spinal Deformity Corrective Surgery.

BACKGROUND: Identify the external applicability of the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) risk calculator in the setting of adult spinal deformity (ASD) and subsets of patients based on deformity and frailty status. METHODS: ASD patients were isolated in our single-center database and analyzed for the shared predictive variables displayed in the NSQIP calculator. Patients were stratified by frailty (not frail <0.03, frail 0.3-0.5, severely frail >0.5), deformity [T1 pelvic angle (TPA) > 30, pelvic incidence minus lumbar lordosis (PI-LL) > 20], and reoperation status. Brier scores were calculated for each variable to validate the calculator's predictability in a single center's database (Quality). External validity of the calculator in our ASD patients was assessed via Hosmer-Lemeshow test, which identified whether the differences between observed and expected proportions are significant. RESULTS: A total of 1606 ASD patients were isolated from the Quality database (48.7 years, 63.8% women, 25.8 kg/m2); 33.4% received decompressions, and 100% received a fusion. For each subset of ASD patients, the calculator predicted lower outcome rates than what was identified in the Quality database. The calculator showed poor predictability for frail, deformed, and reoperation patients for the category "any complication" because they had Brier scores closer to 1. External validity of the calculator in each stratified patient group identified that the calculator was not valid, displaying P values >0.05. CONCLUSION: The NSQIP calculator was not a valid calculator in our single institutional database. It is unable to comment on surgical complications such as return to operating room, surgical site infection, urinary tract infection, and cardiac complications that are typically associated with poor patient outcomes. Physicians should not base their surgical plan solely on the NSQIP calculator but should consider multiple preoperative risk assessment tools.

Evaluation of the automated reference toolset as a method to select reference plots for oil and gas reclamation on Colorado Plateau rangelands.

Rangelands are typically characterized by low precipitation and low biomass which makes them susceptible to disturbance and difficult to reclaim. These characteristics become a management issue when considering the widespread and significant impact of oil and gas development on rangelands. Reclamation from this land use involves the complexities of dealing with multiple state and federal agencies, private landowners, and their sometimes conflicting rules. Reference plots (e.g., nearby undisturbed sites) can help with these issues by providing an objective context for reclamation planning. They are selected to provide a comparison that is similar to a reclamation site in most aspects except for the disturbance activity. This allows for the relative condition of the reclamation site to be determined. Because selection of reference plots is normally expert-driven on a site-by-site basis, it can be time consuming and thus ineffective in helping to meet reclamation goals over large landscapes. The Automated Reference Tool (ART) was developed to improve the efficiency and efficacy of reference plot selection. The ART improves reference plot selection through remote sensing and indicators of land potential by selecting reference plots of similar land potential to the reclamation site based on soil texture, topography, and geology. We evaluated the ART in the context of well-pad reclamation to determine if ART-selected plots were appropriate to use as reference when compared to an existing reference plot network. We applied the ART to reclamation sites managed by the Bureau of Land Management's (BLM) White River Field Office, Colorado which had existing expert-selected reference plots. We found that the ART-selected reference plots and their matching expert-selected reference plot had similar large-scale vegetative cover characteristics (total foliar: R2 = 0.34, p-value = 0.0012) and dissimilar finer-scale cover characteristics (plant diversity: R2 = 0.079, p-value = 0.15). In addition, we detected similarities in their soil water content (R2 = 0.43, p-value<0.001), depth to restricting layer (RMSD = 21.90), and rock fragment (RMSD = 19.99). These results demonstrate that ART could be a useful tool for managers to help meet their reclamation goals over large landscapes, but it is not a complete automation of the reference selection process.

The American College of Preventive Medicine Position Statement on Hepatitis C Virus Infection.

The American College of Preventive Medicine Prevention Practice Committee contributes to policy guidelines and recommendations on preventive health topics for clinicians and public health decision makers. After review of the currently available evidence, the College is providing a consensus-based set of recommendations designed to increase screening for and prevention of hepatitis C virus infection, increase linkage to care, improve access to treatment, and encourage development of hepatitis C virus-related quality measures.

Kepler-36: a pair of planets with neighboring orbits and dissimilar densities.

In the solar system, the planets' compositions vary with orbital distance, with rocky planets in close orbits and lower-density gas giants in wider orbits. The detection of close-in giant planets around other stars was the first clue that this pattern is not universal and that planets' orbits can change substantially after their formation. Here, we report another violation of the orbit-composition pattern: two planets orbiting the same star with orbital distances differing by only 10% and densities differing by a factor of 8. One planet is likely a rocky "super-Earth," whereas the other is more akin to Neptune. These planets are 20 times more closely spaced and have a larger density contrast than any adjacent pair of planets in the solar system.

Design, synthesis and selection of DNA-encoded small-molecule libraries.

Biochemical combinatorial techniques such as phage display, RNA display and oligonucleotide aptamers have proven to be reliable methods for generation of ligands to protein targets. Adapting these techniques to small synthetic molecules has been a long-sought goal. We report the synthesis and interrogation of an 800-million-member DNA-encoded library in which small molecules are covalently attached to an encoding oligonucleotide. The library was assembled by a combination of chemical and enzymatic synthesis, and interrogated by affinity selection. We describe methods for the selection and deconvolution of the chemical display library, and the discovery of inhibitors for two enzymes: Aurora A kinase and p38 MAP kinase.

Bilateral patellar dislocation associated with alpha-mannosidase deficiency.

Mannosidosis is an extremely rare genetic disease characterized by a deficiency of the lysosomal enzyme, alpha-mannosidase. This enzyme is necessary for cleavage of mannose from many glycoproteins. In the absence of this enzyme, mannose accumulates in cells throughout the body, including the joints and the synovium. This disease causes many skeletal changes including dysostosis multiplex, synovial hypertrophy, and Charcot-type joints. We report the case of a girl, aged 9 years and 6 months, who developed bilateral patellar dislocation and severe synovial hypertrophy secondary to alpha-mannosidase deficiency. Her disease was further complicated by Charcot elbow and bilateral hip and elbow avascular necrosis.

Hearing a face: cross-modal speaker matching using isolated visible speech.

An experiment was performed to test whether cross-modal speaker matches could be made using isolated visible speech movement information. Visible speech movements were isolated using a point-light technique. In five conditions, subjects were asked to match a voice to one of two (unimodal) speaking point-light faces on the basis of speaker identity. Two of these conditions were designed to maintain the idiosyncratic speech dynamics of the speakers, whereas three of the conditions deleted or distorted the dynamics in various ways. Some of these conditions also equated video frames across dynamically correct and distorted movements. The results revealed generally better matching performance in the conditions that maintained the correct speech dynamics than in those conditions that did not, despite containing exactly the same video frames. The results suggest that visible speech movements themselves can support cross-modal speaker matching.

Prevalence and high rate of asymptomatic infection of Chlamydia trachomatis in male college Reserve Officer Training Corps cadets.

BACKGROUND: Prevalence of Chlamydia trachomatis and risk factors for infection are not well described in male college students enrolled in the Reserved Officer Training Corps (ROTC). GOAL: The goal was to determine prevalence of C. trachomatis infection, percentage of asymptomatic infections, and risk factors for infection in a population of male college ROTC students. STUDY DESIGN: We conducted a prevalence survey of C. trachomatis infection and risk factors using urine ligase chain reaction and questionnaire. Participants were 1443 ROTC male college cadets at Ft. Lewis, Washington, from June to July 2001. RESULTS: Prevalence of C. trachomatis infection was 31 of 1252 (2.48%); 93.6% of the infections were asymptomatic. Black race, exposure to a partner with a prior sexually transmitted disease, and self-reported symptoms were significant risk factors. CONCLUSIONS: The prominence of asymptomatic infection in a male population with comparatively low prevalence suggests that risk factor rather than clinically based screening could be beneficial in this population.