Cannabis use Disorder and Complications After Anterior Cervical Diskectomy and Fusion.

OBJECTIVE: The aim of this study, a retrospective database analysis, was to assess the impact of baseline cannabis use disorder (CUD) on perioperative complication outcomes in patients undergoing primary 1- to 2-level anterior cervical diskectomy and fusion (ACDF) surgery. METHODS: The PearlDiver Database was queried from January 2010 to December 2021 for patients who underwent primary 1- to 2-level ACDF surgery for degenerative spine disease. Patients with CUD diagnosis 6 months before the index ACDF surgery (i.e., CUD) were propensity matched with patients without CUD (i.e., control in a ratio of 1:1, employing age, gender, and Charlson Comorbidity Index as matching covariates). Univariate and multivariable analysis models with adjustment of confounding variables were used to evaluate the risk of CUD on perioperative complications between the propensity-matched cohorts. RESULTS: The 1:1 matched cohort included 838 patients in each group. Following multivariate analysis, CUD was demonstrated to be associated with an increased incidence of hospital readmission at 90 days (odds ratio [OR] = 2.64, 95% confidence interval: [1.19 to 6.78], [P = 0.027]) and revision surgery at 1 year postoperative (OR = 3.36, 95% confidence interval: [1.17 to 14.18], [P = 0.049]). CUD was additionally associated with reduced risk of overall medical complications at both 6 months and 1 year postoperative (OR = 0.55, [P = 0.021], and OR = 0.54, [P = 0.015], respectively). CONCLUSIONS: These findings indicate that isolated baseline CUD is associated with an increased risk of hospital readmission at 90 days postoperative and cervical spine reoperation at 1 year after primary 1- to 2-level ACDF surgery with a decrease in overall medical complications, cardiac arrhythmias, and acute renal failure.

Jean Baptiste Lucien Baudens: The father of trauma laparotomy.

Jean Baptiste Lucien Baudens (1804-1857) was a French military surgeon. He served in numerous military conflicts throughout his career. Baudens was an innovator and a leader. Going against traditional dogma, he was the first to attempt laparotomy in the setting of trauma. Although the first patient died, his second survived without further complication. Despite this historical landmark, little is known or written about him within the English literature. Jean Baptiste Lucien Baudens was a pioneer of surgery and the father of trauma laparotomy. He was a passionate educator and dedicated to the training of future surgeons. His contributions to the field of surgery deserve recognition and appreciation.

An evaluation of preference stability within MSWO preference assessments for children with autism.

Previous research has commonly evaluated preference stability over time and across multiple preference assessment administrations. No studies have evaluated shifts in preference across consecutive rounds of a single preference assessment, where rounds refer to each time the experimenter resets the stimulus-presentation array. The purpose of the present study was to examine the stability of stimulus selections across successive rounds of a multiple-stimulus-without-replacement (MSWO) preference assessment with different classes of stimuli for children with autism. The study involved a secondary data analysis and calculation of preference stability across consecutive rounds using Spearman rank-order correlation coefficients (Spearman's ρ ) for 17 participants across 40 MSWO preference assessments. Patterns of preference stability were observed in 24 out of the 40 assessments (60%) indicating that children's preferences in this study were slightly more likely to be classified as stable than other observed patterns of responding.

Jean Baptiste Lucien Bauden's Clinique des Plaies D'Armes a Feu: The First English Translation of the First Trauma Laparotomy.

Historically, abdominal trauma was managed nonoperatively with rest and local wound cares. Jean Baptiste Lucien Baudens (1804-1857) was a French military surgeon and performed the first 2 trauma laparotomies. The first patient died but the second survived. Laparotomy in trauma has since evolved, now a life-saving intervention and a fundamental tool in the management of abdominal trauma. Baudens documented these case reports in his 1836 work Clinical Reports of Gun Wounds (Clinique des Plaies D'Armes a Feu). The work of Baudens has been largely unrecognized and underappreciated in the English literature. This manuscript serves as the first translation of this event.

Integrative Review of Methods From Youth Risk Behavior Survey Secondary Data Analyses Examining HIV Syndemic Factors Among Adolescent Gay and Bisexual Men.

BACKGROUND: Adolescent gay/bisexual men exhibit the highest prevalence of undiagnosed HIV infections. Ascertaining antecedents of behaviorally acquired HIV infections among adolescent gay/bisexual men can be challenging; however, these challenges can be overcome through the utilization of secondary data, such as the Youth Risk Behavior Survey. OBJECTIVE: Syndemics theory suggests that HIV infections are not a singular phenomenon; instead, many infections occur at the intersection of syndemic factors, such as substance use, violence, and mental health. Our objective is to describe and synthesize research methods of secondary data analyses that examine syndemic factors in relation to HIV risk behavior outcomes among subsamples of adolescent gay/bisexual men. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo were systematically searched. Inclusion criteria were (a) peer-reviewed Youth Risk Behavior Survey secondary data analyses conducted in the United States after 1991, (b) subsamples with adolescent gay/bisexual men, (c) one or more syndemic factor(s), and (d) one or more HIV risk behavior outcome(s). We used the National Institutes of Health Quality Assessment Tools for quality appraisal. RESULTS: Of 1,036 citations retrieved, nine studies met inclusion criteria. Results included using logistic regression analysis and data from 2015 to 2017 in six studies and underpinnings with minority stress theory in four studies. Eight studies omitted race/ethnicity in subsamples and six grouped lesbians with adolescent gay/bisexual men. Seven studies examined substance use, six examined violence, and five examined mental health. Condom use and number of partners were the most studied HIV risk behavior outcomes in four studies, whereas intercourse in the last 3 months was an outcome in only one study. Protective factors were not present. CONCLUSION: Limitations found the need to highlight better inclusion of race/ethnicity and sexual orientation. Adding contemporary survey items is also necessary, such as nonbinary sex and gender identity, access to HIV prevention (condoms, HIV testing, and preexposure prophylaxis), and experiences with stigma, to elucidate risk behaviors among populations disproportionately affected by HIV infections, including Blacks/African Americans and Hispanics/Latinos.

Modern Didactic Formats in Surgery: A Systematic Review.

Introduction: "Traditional teaching" models often fail to engage millennial residents. Multiple modern didactic methods have been employed. The most frequently used objective measure to assess the effectiveness of didactic formats has been American Board of Surgery In-Training Examination performance.Methods: A literature search was conducted searching PubMed, EMBASE, and JAMA Network from June 2011 to June 2021, in accordance with the PRISMA guidelines. Searches were performed for the terms "ABSITE" and "American Board of Surgery In-Training Examination." Only studies discussing didactic structures were included.Results: A final 16 studies were included. Modern methods such as a "flipped classroom," Team Based Learning (TBL), and "gamification" have all shown increased engagement and significantly improved ABSITE performance. Structured biostatistics reviews may be used to supplement research and statistics which are often missed by other resources.Discussion: Programs have a duty to promote excellent resident education. In addition to fostering individual study habits, didactics and program structures should be optimized for resident development. As opposed to focusing on the pure amount of scheduled protected time, programs may instead consider focusing on the quality of the didactic format used and modern didactic methods may be beneficial.

Spartan Caregiver Support: Program Description and Key Findings During Michigan's Stay-At-Home Order.

Objectives: The purpose of this paper is to describe a university program, Spartan Caregiver Support, that provided free on-demand telehealth services to caregivers of people with autism during the State of Michigan's 2020 Stay-at-Home order. Method: Participants (n = 17) were caregivers of people with autism residing within the State of Michigan. Participants engaged with program members over video-conference technology, where participants received specific advice to support social and behavioral needs. Results: We found that caregivers reported a variety of social and behavioral concerns, including concerns related to problem behavior, social/play skills, school/academics, and daily living. Conclusions: This program description provides a framework for how to deliver on-demand telehealth support to caregivers of people with autism, especially during moments of crisis or emergency. Supplementary Information: The online version contains supplementary material available at 10.1007/s41252-022-00281-7.

Insomnia and Poor Sleep in CKD: A Systematic Review and Meta-analysis.

Rationale & Objective: Poor sleep quality and insomnia are pervasive among patients with advanced chronic kidney disease (CKD); however, these health issues have not been systematically evaluated. Study Design: Systematic review and meta-analysis. Setting & Study Populations: Adult patients with CKD not receiving kidney replacement therapy (KRT), as well as adults receiving KRT, including hemodialysis, peritoneal dialysis, and kidney transplantation. Selection Criteria for Studies: A systematic literature search using PubMed, Embase, and PsycNET, was conducted for articles published between January 1, 1990, and September 28, 2018. Data Extraction: Data on the prevalences of poor sleep quality and insomnia in patients with CKD, including those receiving and not receiving KRT, were extracted. Analytical Approach: Pooled prevalences were estimated using a random-effects meta-analysis and were stratified according to age, CKD stage, World Health Organization region, risk of bias, Pittsburgh Sleep Quality Index score, and the different criteria for insomnia that were used at diagnosis. Results: Of 3,708 articles, 93 were selected, and significant methodological heterogeneity was present. The pooled prevalences of poor sleep quality for CKD without KRT, hemodialysis, peritoneal dialysis, and kidney transplantation were 59% (95% CI, 44%-73%), 68% (95% CI, 64%-73%), 67% (95% CI, 44%-86%), and 46% (95% CI, 34%-59%), respectively. The corresponding prevalences of insomnia were 48% (95% CI, 30%-67%), 46% (95% CI, 39%-54%), 61% (95% CI, 41%-79%), and 26% (95% CI, 9%-49%), respectively. Insomnia was significantly more prevalent among patients aged 51-60 years and those aged >60 years than among those aged <50 years. The prevalence of insomnia in the European region was the lowest of all World Health Organization regions. Limitations: High interstudy heterogeneity. Conclusions: Approximately half of the patients with advanced CKD had poor sleep quality or insomnia, and the prevalence was even higher among those who received KRT. Kidney transplantation may reduce the burden of poor sleep quality and insomnia.

Paradoxical mortality of high estimated glomerular filtration rate reversed by 24-h urine creatinine excretion rate adjustment: sarcopenia matters.

BACKGROUND: Muscle wasting may explain the paradoxical mortality of patients with high estimated glomerular filtration rates (eGFRs) derived from equation methods. However, empirical evidence and solutions remain insufficient. METHODS: In this retrospective cohort study, we compared the performance of equation methods for predicting all-cause mortality; we used 24-h creatinine clearance (24-h CrCl), equation-based eGFRs, and a new eGFR estimating equation weighting for population 24-h urine creatinine excretion rate (U-CER). From 2003 to 2018, we identified 4986 patients whose data constituted the first 24-h CrCl measurement data in the Clinical Research Data Repository of China Medical University Hospital and were followed up for at least 5 years after careful exclusion. Three GFR estimation equations [the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD) Study, and Taiwanese MDRD], 24-h CrCl, and 24-h U-CER-adjusted eGFR were used. RESULTS: A high correlation was observed among the eGFR levels derived from the equation methods (0.995-1.000); however, the correlation decreased to 0.895-0.914 when equation methods were compared with the 24-h CrCl or 24-h U-CER-adjusted equation-based eGFR. In the Bland-Altman plots, the average discrepancy between the equation methods and the 24-h CrCl method was close to zero (maximal bias range: 5.12 for the Taiwanese MDRD equation vs. 24-h CrCl), but the range in limit of agreement was wide, from ±43.7 mL/min/1.73 m2 for the CKD-EPI equation to ±54.3 mL/min/1.73 m2 for the Taiwanese MDRD equation. A J-shaped dose-response relationship was observed between all equation-based eGFRs and all-cause mortality. Only 24-h CrCl exhibited a non-linear negative dose-response relationship with all-cause mortality. After adjustment for 24-h U-CER in the statistical model, the paradoxical increase in mortality risk for an eGFR of >90 mL/min/1.73 m2 returned to null. When 24-h U-CER was used directly to correct eGFR, the monotonic non-linear negative relationship with all-cause mortality was almost identical to that of 24-h CrCl. CONCLUSIONS: The 24-h U-CER-adjusted eGFR and 24-h CrCl are viable options for informing mortality risk. The 24-h U-CER adjustment method can be practically implemented to eGFR-based care and effectively mitigate the inherent confounding biases from individual's muscle mass amount due to both sex and racial differences.

Decision-Support Needs of Caregivers Considering Hospice Enrollment for a Family Member With Dementia.

Background: There are few evidence-based interventions to support the growing number of family caregivers of persons living with advanced dementias (PWADs) in surrogate decision-making roles. This study identifies needs for decision support among family caregivers considering hospice enrollment for PWADs, in order to better inform efforts for decision support. Method: Individual and focus group interviews were conducted with caregivers (n = 13) and healthcare professionals (n = 14). Directed content analysis was used to identify and organize themes that emerged from interview transcripts. Results: Analysis revealed 2 themes concerning PWAD caregivers' hospice-related decision-support needs: (1) detailed and practical information about hospice and (2) discussions clarifying meaning around quality of life (QOL) for PWADs. Caregivers needed to know when they should consider hospice, what treatments would be stopped, what services would help caregivers, and what costs would be involved. Caregivers varied in their perceptions of what it might mean for a PWAD to have QOL at the end of life and whether or not hospice would enhance it. Discussion: This study's findings underscore the importance of decision-support tools and patient- and family-centered education for PWADs and caregivers about the trajectory of dementia and end-stage symptoms, along with practical information for hospice care planning and discussions addressing end of life values.

How to Prepare for the American Board of Surgery In-Training Examination (ABSITE): A Systematic Review.

INTRODUCTION: Performance on ABSITE is an important factor when monitoring resident progress. It predicts future performance and has lasting effects. Understanding the highest-yield preparation strategies can help residents in their study efforts and optimize performance. METHODS: A literature search was conducted searching PubMed, EMBASE and JAMA Network in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed for the terms "ABSITE" and "American Board of Surgery In-Training Examination". Only studies discussing individual study habits from May 2011 to May 2021 were included. RESULTS: 19 studies were included in qualitative synthesis. Year-round clinical study failed to show significant correlation to ABSITE performance although year-round ABSITE review was more consistently correlated. During a dedicated study period, increased time and increased total practice questions completed are associated with improved performance. The correlation of individual resources such as ABSITE review books, textbooks, audio podcasts and ABSITE preparatory courses to improved ABSITE performance was not proven. CONCLUSIONS: Residents should optimize study strategies based on methods that have consistently shown to improve performance. Recommendations for best preparation strategies are provided.

The ratio and difference of urine protein-to-creatinine ratio and albumin-to-creatinine ratio facilitate risk prediction of all-cause mortality.

The role of the difference and ratio of albuminuria (urine albumin-to-creatinine ratio, uACR) and proteinuria (urine protein-to-creatinine ratio, uPCR) has not been systematically evaluated with all-cause mortality. We retrospectively analyzed 2904 patients with concurrently measured uACR and uPCR from the same urine specimen in a tertiary hospital in Taiwan. The urinary albumin-to-protein ratio (uAPR) was derived by dividing uACR by uPCR, whereas urinary non-albumin protein (uNAP) was calculated by subtracting uACR from uPCR. Conventional severity categories of uACR and uPCR were also used to establish a concordance matrix and develop a corresponding risk matrix. The median age at enrollment was 58.6 years (interquartile range 45.4-70.8). During the 12,391 person-years of follow-up, 657 deaths occurred. For each doubling increase in uPCR, uACR, and uNAP, the adjusted hazard ratios (aHRs) of all-cause mortality were 1.29 (95% confidence interval [CI] 1.24-1.35), 1.12 (1.09-1.16), and 1.41 (1.34-1.49), respectively. For each 10% increase in uAPR, it was 1.02 (95% CI 0.98-1.06). The linear dose-response association with all-cause mortality was only observed with uPCR and uNAP. The 3 × 3 risk matrices revealed that patients with severe proteinuria and normal albuminuria had the highest risk of all-cause mortality (aHR 5.25, 95% CI 1.88, 14.63). uNAP significantly improved the discriminative performance compared to that of uPCR (c statistics: 0.834 vs. 0.828, p-value = 0.032). Our study findings advocate for simultaneous measurements of uPCR and uACR in daily practice to derive uAPR and uNAP, which can provide a better mortality prognostic assessment.

Urban stormwater characterization, control, and treatment.

This review summarizes over 280 studies published in 2019 related to the characterization, control, and management of urban stormwater runoff. A summary of quantity and quality concerns is provided in the first section of the review, serving as the foundation for the following sections which focus on the control and treatment of stormwater runoff. Finally, the impact of stormwater control devices at the watershed scale is discussed. Each section provides a self-contained overview of the 2019 literature, common themes, and future work. Several themes emerged from the 2019 literature including exploration of substrate amendments for improved water quality effluent from stormwater controls, the continued study of the role of vegetation in green infrastructure practices, and a call to action for the development of new models which generate reliable, computationally efficient results under the physical, chemical, biological, and social complexity of stormwater management. PRACTITIONER POINTS: Over 280 studies were published in 2019 related to the characterization, control, and treatment of urban stormwater. Studies on bioretention and general stormwater characteristics represented the two most common subtopics in 2019. Trends in 2019 included novel substrate amendments, studies on the role of vegetation, and advancements in computational models.

Urban stormwater characterization, control, and treatment.

This review summarizes over 250 studies published in 2018 related to the characterization, control, and management of urban stormwater runoff. The review covers three broad themes: (a) quantity and quality characterization of stormwater, (b) control and treatment of stormwater runoff, and (c) implementation and assessment of watershed-scale green stormwater infrastructure (GSI). Each section provides an overview of the 2018 literature, common themes, and future work. Several themes emerged from the 2018 literature including exploration of contaminants of emerging concern within stormwater systems, characterization and incorporation of vegetation-driven dynamics in stormwater control measures, and the need for interdisciplinary perspectives on the implementation and assessment of GSI. PRACTITIONER POINTS: Over 250 studies were published in 2018 related to the characterization, control, and treatment of stormwater. Studies cover general stormwater characteristics, control and treatment systems, and watershed-scale assessments. Trends in 2018 include treatment trains, vegetation dynamics, and interdisciplinary perspectives.

Compression tests of Fusarium graminearum ascocarps provide insights into the strength of the perithecial wall and the quantity of ascospores.

The plant pathogenic ascomycete Fusarium graminearum produces perithecia on corn and small grain residues. These perithecia forcibly discharge ascospores into the atmosphere. Little is known about the relationship among the strength of the perithecial wall, the age of the perithecium, and the quantity of ascospores produced. We used a mechanical compression testing instrument to examine the structural failure rate of perithecial walls from three different strains of F. graminearum (two wild type strains, and a mutant strain unable to produce asci). The force required to compress a perithecium by one micrometer (the mean perithecium compression constant, MPCC) was used to determine the strength of the perithecial wall. Over the course of perithecial maturation (5-12days after the initiation of perithecial development), the MPCC was compared to the number of ascospores contained inside the perithecia. The MPCC increased as perithecia matured, from 0.06Nµm-1 at 5d to 0.12Nµm-1 at 12d. The highest number of ascospores was found in older perithecia (12d). The results indicated that for every additional day of perithecial aging, the perithecia become more resilient to compression forces. Every additional day of perithecial aging resulted in ∼900 more ascospores. Knowledge of how perithecia respond to external forces may provide insight into the development of ascospores and the accumulation of turgor pressure. In the future, compression testing may provide a unique method of determining perithecial age in the field, which could extend to management practices that are informed by knowledge of ascospore release and dispersal.

A pulse-width modulation controlled wire-mesh heater apparatus for investigation of solid fuel pyrolysis.

A novel wire mesh heater apparatus has been developed to study the devolatilization of solid fuels under pressurized conditions at well-controlled heating rates on the order of 1000 K/s. The apparatus combines direct current and pulse-width modulation with a fast-acting and high current-capacity relay to achieve operating frequencies up to 2000 Hz. This frequency allows much quicker feedback and tighter control of temperature than conventional ac-based systems that operate at 50 to 60 Hz. The present apparatus has been successfully operated at 63 bars with final temperatures of 1473 K and heating rates of 1100 K/s.

Psychiatric concerns in pediatric epilepsy.

Pediatric epilepsy is a common, chronic, and challenging physical illness for children and their families. This article provides a medical overview and discusses the cognitive functioning and psychosocial adjustment as well as the psychiatric management for children and adolescents with pediatric epilepsy. The management of these children involves establishing a collaborative health care approach, evaluating academic functioning, considering psychotherapy, and managing psychopharmacologic treatment. A thorough understanding of the biopsychosocial concerns in pediatric epilepsy can enable medical providers and mental health clinicians to promote resiliency and adaptation in children and their families facing troubling seizure disorders.

Psychiatric concerns in pediatric epilepsy.

Pediatric epilepsy is a common, chronic, and challenging physical illness for children and their families. This article provides a medical overview and discusses the cognitive functioning and psychosocial adjustment as well as the psychiatric management for children and adolescents with pediatric epilepsy. The management of these children involves establishing a collaborative health care approach, evaluating academic functioning, considering psychotherapy, and managing psychopharmacologic treatment. A thorough understanding of the biopsychosocial concerns in pediatric epilepsy can enable medical providers and mental health clinicians to promote resiliency and adaptation in children and their families facing troubling seizure disorders.