Prevalence of Staphylococcus aureus Colonization in Spinal Cord Stimulator Surgical Procedures.

OBJECTIVES: To determine the prevalence of Staphylococcus aureus (S aureus) colonization for spinal cord stimulation (SCS) surgical patients and to identify specific at-risk patient populations. MATERIALS AND METHODS: Following Institutional Review Board approval, a retrospective review identified 232 SCS surgical patients. Preoperative Saureus nasal swab results were reviewed. Preoperative characteristics that included age at the time of procedure, body mass index, and medical comorbidities including, but not limited to, diabetes, smoking, obesity, and a history of surgical site infections were identified for each patient. The Clopper-Pearson method was used to calculate 95% CIs for proportions, and Fisher exact tests were used to estimate odds ratios (95% CI) for patient characteristics. RESULTS: The 232 SCS surgical patients who were identified underwent 396 unique neuromodulation procedures, with 100% screened for methicillin-resistant Saureus (MRSA) and 98.3% screened for methicillin-sensitive Saureus (MSSA). Overall, 23.3% (n = 54/232, 95% CI: 18.0%-29.3%) of patients were preoperatively colonized with Saureus, according to the following classification: 4.3% (n = 10/232, 95% CI: 2.1%-7.8%) were positive for MRSA and 20.2% (n = 46/228, 95% CI: 15.2%-26.0%) were positive for MSSA. Two patients were colonized with both MRSA and MSSA. Furthermore, 95.7% (n = 44/46, 95% CI: 85.2%-99.5%) of patients that were MSSA colonized were MRSA negative. Analysis of independent patient characteristics revealed anxiety and hypothyroidism as the only conditions associated with significantly increased odds of MRSA and MSSA colonization, respectively. CONCLUSIONS: Staphylococcusaureus colonization was present in >20% of SCS patients, with MSSA carriage occurring at a rate nearly five times that of MRSA. MRSA screening alone would not have identified >90% of Saureus-colonized patients with only MSSA carrier status. Therefore, consideration should be given to preoperative screening for both MRSA and MSSA. Since limited patient characteristics were associated with greater risk for Saureus colonization, all patient populations should be screened.

Where Is Garlic Mustard? Understanding the Ecological Context for Invasions of Alliaria petiolata.

The invasive plant Alliaria petiolata (garlic mustard) has spread throughout forest understory and edge communities in much of North America, but its persistence, density, and impacts have varied across sites and time. Surveying the literature since 2008, we evaluated both previously proposed and new mechanisms for garlic mustard's invasion success and note how they interact and vary across ecological contexts. We analyzed how and where garlic mustard has been studied and found a lack of multisite and longitudinal studies, as well as regions that may be under- or overstudied, leading to poor representation for understanding and predicting future invasion dynamics. Inconsistencies in how sampling units are scaled and defined can also hamper our understanding of invasive species. We present new conceptual models for garlic mustard invasion from a macrosystems perspective, emphasizing the importance of synergies and feedbacks among mechanisms across spatial and temporal scales to produce variable ecological contexts.

Radiation safety and knowledge: an international survey of 708 interventional pain physicians.

INTRODUCTION: Interventional pain procedures have increased in complexity, often requiring longer radiation exposure times and subsequently higher doses. The practicing physician requires an in-depth knowledge and evidence-based knowledge of radiation safety to limit the health risks to themselves, patients and healthcare staff. The objective of this study was to examine current radiation safety practices and knowledge among interventional pain physicians and compare them to evidence-based recommendations. MATERIALS AND METHODS: A 49-question survey was developed based on an extensive review of national and international guidelines on radiation safety. The survey was web-based and distributed through the following professional organizations: Association of Pain Program Directors, American Academy of Pain Medicine, American Society of Regional Anesthesia and Pain Medicine, European Society of Regional Anesthesia and Pain Therapy, International Neuromodulation Society, and North American Neuromodulation Society. Responses to radiation safety practices and knowledge questions were evaluated and compared with evidence-based recommendations. An exploratory data analysis examined associations with radiation safety training/education, geographical location, practice type, self-perceived understanding, and fellowship experience. RESULTS: Of 708 responding physicians, 93% reported concern over the health effects of radiation, while only 63% had ever received radiation safety training/education. Overall, ≥80% physician compliance with evidence-based radiation safety practice recommendations was demonstrated for only 2/15 survey questions. Physician knowledge of radiation safety principles was low, with 0/10 survey questions having correct response rates ≥80%. CONCLUSION: We have identified deficiencies in the implementation of evidence-based practices and knowledge gaps in radiation safety. Further education and training are warranted for both fellowship training and postgraduate medical practice. The substantial gaps identified should be addressed to better protect physicians, staff and patients from unnecessary exposure to ionizing radiation during interventional pain procedures.

Effects of flow restoration on mussel growth in a Wild and Scenic North American River.

BACKGROUND: Freshwater mussels remain among the most imperiled species in North America due primarily to habitat loss or degradation. Understanding how mussels respond to habitat changes can improve conservation efforts. Mussels deposit rings in their shell in which age and growth information can be read, and thus used to evaluate how mussels respond to changes in habitat. However, discrepancies between methodological approaches to obtain life history information from growth rings has led to considerable uncertainty regarding the life history characteristics of many mussel species. In this study we compared two processing methods, internal and external ring examination, to obtain age and growth information of two populations of mussels in the St. Croix River, MN, and evaluated how mussel growth responded to changes in the operation of a hydroelectric dam. RESULTS: External ring counts consistently underestimated internal ring counts by 4 years. Despite this difference, internal and external growth patterns were consistent. In 2000, the hydroelectric dam switched from operating on a peaking schedule to run-of-the-river/partial peaking. Growth patterns between an upstream and downstream site of the dam were similar both before and after the change in operation. At the downstream site, however, older mussels had higher growth rates after the change in operation than the same sized mussels collected before the change. CONCLUSIONS: Because growth patterns between internal and external processing methods were consistent, we suggest that external processing is an effective method to obtain growth information despite providing inaccurate age information. External processing is advantageous over internal processing due to its non-destructive nature. Applying this information to analyze the influence of the operation change in the hydroelectric dam, we suggest that changing to run-of-the-river/partial peaking operation has benefited the growth of older mussels below the dam.

Soil type affects Pinus ponderosa var. scopulorum (Pinaceae) seedling growth in simulated drought experiments.

PREMISE OF THE STUDY: Effects of drought stress and media type interactions on growth of Pinus ponderosa var. scopulorum germinants were investigated. • METHODS AND RESULTS: Soil properties and growth responses under drought were compared across four growth media types: two native soils (dolomitic limestone and granite), a soil-less industry standard conifer medium, and a custom-mixed conifer medium. After 35 d of growth, the seedlings under drought stress (reduced watering) produced less shoot and root biomass than watered control seedlings. Organic media led to decreased root biomass, but increased root length and shoot biomass relative to the mineral soils. • CONCLUSIONS: Media type affected root-to-shoot biomass partitioning of P. ponderosa var. scopulorum, which may influence net photosynthetic rates, growth, and long-term seedling survival. Further work should examine how specific soil properties like bulk density and organic matter influence biomass allocation in greenhouse studies.