Relationship between number of prior lumbar spine surgeries and outcomes following spinal cord stimulator implantation: A multisite, retrospective pooled analysis.

OBJECTIVES: Lumbar spine surgery is a common procedure for treating disabling spine-related pain. In recent decades, both the number and cost of spine surgeries have increased despite technological advances and modification in surgical technique. For those patients that have continued uncontrolled back and/or lower extremity pain following lumbar spine surgery, spinal cord stimulation (SCS) has emerged as a viable treatment option. However, the impact of lumbar spine surgical history remains largely unstudied. Specifically, the current study considers the impact of number of prior lumbar spine surgeries on pain relief outcomes following SCS implantation. MATERIALS AND METHODS: We queried the electronic medical record of five separate pain practices for all patients who have undergone a SCS implant between January 1, 2017, and March 1, 2020. Inclusion criteria consisted of any patients with an SCS implant who underwent a prior lumbar spine surgery. The primary outcome was the mean calculated percentage pain relief in patients based on number of prior lumbar spine surgeries. RESULTS: There was a total of 1974 total SCS implant cases identified across five separate pain clinics. There was no difference in mean calculated pain relief in patients with one prior spine surgery versus those with two or more prior spine surgeries (28.2% vs. 25.8%, adjusted ß-coefficient -3.1, 95% CI -8.9 to 2.7, p = 0.290). Similarly, when analyzing number of spine surgeries as a continuous variable, there was no association between number of spine surgeries and calculated pain relief (adjusted ß-coefficient -1.5, 95% CI -4.0 to 1.1, p = 0.257). Additionally, after patients were stratified based on waveform, there was no association between number of prior lumbar spine surgeries (analyzed both as a categorical and continuous variable) and calculated percentage pain relief. CONCLUSIONS: This multicentered retrospective study found that there was no significant difference in pain scores in individuals who received SCS following one or more lumbar spine surgeries. Additionally, the waveform of the SCS device had no statistically significant impact on post-operative pain scores following one or more lumbar spine surgeries.

Explantation of 10 kHz Spinal Cord Stimulation Devices: A Retrospective Review of 744 Patients Followed for at Least 12 Months.

OBJECTIVES: High-frequency 10 kHz spinal cord stimulation (10 kHz-SCS) has achieved analgesia superior to traditional SCS in a number of studies. However, there is concern regarding long-term outcomes of 10 kHz-SCS. Prior work has suggested that explant rates are higher with 10 kHz-SCS. Our primary objective was to determine the explant rate of 10 kHz-SCS in a large patient cohort from multiple centers followed for at least 12 months after implant surgery. MATERIALS AND METHODS: We performed a retrospective chart review of all patients who received a 10 kHz-SCS implant before July 1, 2019. We abstracted patient demographics, implant date, primary site of pain, implant indication, explant date, and reason for explant. A total of 744 patients were included in the study analysis. RESULTS: Average age of the overall cohort was 65.53 years and 407 (54.7%) were women. Average follow-up for all patients was 793 days. There were a total of 76 explants (10.2%). The most common reason for explant was loss of efficacy, which accounted for 39 explants (51.3% of total explants, 5.2% of overall cohort). Female sex and radiculopathy as the SCS indication were associated with statistically significant decreased risk of 10 kHz-SCS explant. CONCLUSIONS: We found 10 kHz-SCS explant rates to be similar to prior reported explant rates for traditional SCS devices. Patient-related factors including female sex and radiculopathy as the primary SCS indication may be protective factors against explantation.

Ligand-Directed Reticular Synthesis of Catalytically Active Missing Zirconium-Based Metal-Organic Frameworks.

Zirconium-based metal-organic frameworks (Zr-MOFs) based on edge-transitive nets such as fcu, spn, she, csq, and ftw with diverse potential applications have been widely reported. Zr-MOFs based on the highly connected 6,12-connected alb net, however, remain absent on account of synthetic challenges. Herein we report the ligand-directed reticular syntheses and isoreticular expansion of a series of Zr-MOFs with the edge-transitive alb net from 12-connected hexagonal-prismatic Zr6 nodes and 6-connected trigonal-prismatic linkers, i.e., microporous NU-1600, mesoporous NU-1601, and mesoporous NU-1602. These Zr-MOFs exhibit remarkable activities toward the destruction of a nerve agent (soman) and a nerve agent simulant (DMNP).

Effect of a randomised 12-week resistance training programme on muscular strength, cross-sectional area and muscle quality in women having undergone Roux-en-Y gastric bypass.

The purpose of this study was to examine the effect of a 12-week resistance training programme on fat-free mass (FFM), muscle cross-sectional area, muscular strength and muscle quality in women who underwent Roux-en-Y gastric bypass surgery. Participants were 16 women (mean age = 44.9 ± 10.2 years) from bariatric surgical groups who were randomly assigned into either a control or an intervention group. Air displacement plethysmography measured FFM and magnetic resonance imaging measured quadriceps muscle cross-sectional area and whole thigh muscle cross-sectional area. Muscular strength and quality was assessed using an estimated 1-Repetition Maximum assessment. All measurements were collected twice, at baseline and at a 12-week follow-up. There were significantly greater improvements in leg press strength (mean differences = 55.4%, P < 0.001, Cohen's d = 2.4), leg extension strength (mean differences = 18.0%, P = 0.014, Cohen's d = 0.86) and leg press muscle quality (mean differences = 54.5%, P < 0.001, Cohen's d = 1.9) in the intervention group compared to the control group following the resistance training programme. The resistance training intervention significantly improved muscular strength and quality; however, it did not illicit changes in FFM or muscle cross-sectional area in women who underwent Roux-en-Y gastric bypass surgery.

Optimizing Toxic Chemical Removal through Defect-Induced UiO-66-NH2 Metal-Organic Framework.

For the first time, an increasing number of defects were introduced to the metal-organic framework UiO-66-NH2 in an attempt to understand the structure-activity trade-offs associated with toxic chemical removal. It was found that an optimum exists with moderate defects for toxic chemicals that react with the linker, whereas those that require hydrolysis at the secondary building unit performed better when more defects were introduced. The insights obtained through this work highlight the ability to dial-in appropriate material formulations, even within the same parent metal-organic framework, allowing for trade-offs between reaction efficiency and mass transfer.

Destruction of chemical warfare agents using metal-organic frameworks.

Chemical warfare agents containing phosphonate ester bonds are among the most toxic chemicals known to mankind. Recent global military events, such as the conflict and disarmament in Syria, have brought into focus the need to find effective strategies for the rapid destruction of these banned chemicals. Solutions are needed for immediate personal protection (for example, the filtration and catalytic destruction of airborne versions of agents), bulk destruction of chemical weapon stockpiles, protection (via coating) of clothing, equipment and buildings, and containment of agent spills. Solid heterogeneous materials such as modified activated carbon or metal oxides exhibit many desirable characteristics for the destruction of chemical warfare agents. However, low sorptive capacities, low effective active site loadings, deactivation of the active site, slow degradation kinetics, and/or a lack of tailorability offer significant room for improvement in these materials. Here, we report a carefully chosen metal-organic framework (MOF) material featuring high porosity and exceptional chemical stability that is extraordinarily effective for the degradation of nerve agents and their simulants. Experimental and computational evidence points to Lewis-acidic Zr(IV) ions as the active sites and to their superb accessibility as a defining element of their efficacy.

Detoxification of Chemical Warfare Agents Using a Zr6 -Based Metal-Organic Framework/Polymer Mixture.

Owing to their high surface area, periodic distribution of metal sites, and water stability, zirconium-based metal-organic frameworks (Zr6 -MOFs) have shown promising activity for the hydrolysis of nerve agents GD and VX, as well as the simulant, dimethyl 4-nitrophenylphosphate (DMNP), in buffered solutions. A hurdle to using MOFs for this application is the current need for a buffer solution. Here the destruction of the simulant DMNP, as well as the chemical warfare agents (GD and VX) through hydrolysis using a MOF catalyst mixed with a non-volatile, water-insoluble, heterogeneous buffer is reported. The hydrolysis of the simulant and nerve agents in the presence of the heterogeneous buffer was fast and effective.

Ultra-Fast Degradation of Chemical Warfare Agents Using MOF-Nanofiber Kebabs.

The threat associated with chemical warfare agents (CWAs) motivates the development of new materials to provide enhanced protection with a reduced burden. Metal-organic frame-works (MOFs) have recently been shown as highly effective catalysts for detoxifying CWAs, but challenges still remain for integrating MOFs into functional filter media and/or protective garments. Herein, we report a series of MOF-nanofiber kebab structures for fast degradation of CWAs. We found TiO2 coatings deposited via atomic layer deposition (ALD) onto polyamide-6 nanofibers enable the formation of conformal Zr-based MOF thin films including UiO-66, UiO-66-NH2 , and UiO-67. Cross-sectional TEM images show that these MOF crystals nucleate and grow directly on and around the nanofibers, with strong attachment to the substrates. These MOF-functionalized nanofibers exhibit excellent reactivity for detoxifying CWAs. The half-lives of a CWA simulant compound and nerve agent soman (GD) are as short as 7.3 min and 2.3 min, respectively. These results therefore provide the earliest report of MOF-nanofiber textile composites capable of ultra-fast degradation of CWAs.

Tailoring the Pore Size and Functionality of UiO-Type Metal-Organic Frameworks for Optimal Nerve Agent Destruction.

Evaluation of UiO-66 and UiO-67 metal-organic framework derivatives as catalysts for the degradation of soman, a chemical warfare agent, showed the importance of both the linker size and functionality. The best catalysts yielded half-lives of less than 1 min. Further testing with a nerve agent simulant established that different rate-assessment techniques yield similar values for degradation half-lives.

All-Weather Dry Decontaminant Polymer-H2O2 Complex for HD Degradation.

Hydrogen peroxide (H2O2) is a highly effective decontaminant against chemical warfare agents (CWAs) when present both in a liquid and as a solid powder. For the latter, this can be in the form of H2O2 being complexed to a polymer, such as polyvinylpyrrolidone (PVP). While a H2O2-PVP complex is indeed effective at decontaminating CWAs, it is vulnerable to environmental conditions such as high relative humidities (RH), which can dissociate the H2O2 from the complex before it is given the opportunity to react with CWAs. In this paper, we demonstrate that the cross-linked version of PVP forms a highly stable complex with H2O2, which can withstand both high (40 °C) and low (-20 °C) temperatures as well as maintain stability at high RH up to 90% over several days. Collectively, this lays the framework for processing the H2O2-PVP complex in a variety of form factors that can maintain efficacy under a wide range of real-world environmental conditions.

Experimental Study of the Adsorption and Decomposition of Sarin on Dry Copper(II) Oxide.

Organophosphonates were originally developed as insecticides but were quickly identified as highly toxic acetylcholinesterase inhibitors, leading to their exploitation as chemical warfare agents (CWA). To develop next generation filtration technologies, there must be a fundamental understanding of the molecular interactions occurring with toxic chemicals, such as CWAs. In this paper, we investigate the interaction between dry CuO nanoparticles and sarin (GB), using infrared (IR) spectroscopy in an effort to build an atomic understanding. We show sarin strongly interacts with CuO and then quickly degrades, primarily through the cleavage of the P-F bond, creating a bridging species on the CuO surface with the assistance of lattice oxygen. Upon heating, the decomposition product isopropyl methyl phosphonic acid (IMPA) does not continue to decompose but desorbs from the surface. These observations are further elaborated through theoretical models of sarin on dry CuO (111).

Patient and practitioner perspectives of psychological need support in physical therapy.

PURPOSE: To examine strategies utilized by physical therapists that contributed to patient perceptions of basic psychological needs support articulated within Self-Determination Theory (SDT). METHODS: Semi-structured interviews were conducted with physical therapists (n = 9) and physical therapy patients (n = 9) undergoing rehabilitation for a variety of musculoskeletal injuries. RESULTS: Both patients and practitioners articulated the value of specific competence (e.g. matching rehabilitation challenges with patient abilities) and autonomy support strategies (e.g. active decision-making). Interestingly, both patients and therapists emphasized the salience of relatedness need support, a finding indicative of the potential importance of this need in a rehabilitation environment. The possibility that relatedness need support may be of equal - or potentially greater - importance than the other two needs in a rehabilitation setting, is however, antithetical to SDT contentions. Whether the primacy of relatedness need support is an artifact of the sample used in the current study or a reflection of a broader rehabilitation trend, is uncertain and remains a topic for further investigation. CONCLUSIONS: Understanding the strategies physical therapists use to support patients' psychological needs may have substantial implications for patient motivation and rehabilitation adherence, such as, improved psychological well-being, enhanced function, and increased adherence to physical therapists' recommendations.

Does motivation mediate the relationship between competence perceptions and patient outcomes among individuals with chronic low back pain? A multiple mediation analysis.

PURPOSE: The aim of this study was to examine: (1) motivations of patients with chronic low back pain to attend physical therapy; (2) relationships between competence perceptions, motivational regulations, and pain/disability; and (3) whether patient motivations to attend physical therapy mediate the relationship between competence perceptions and pain/disability. METHODS: A sample of 64 participants completed baseline assessment (1-week prior to initiation of physical therapy) and 6-week follow-up assessment. Differences between motivation variables at baseline were examined using one-way within-person ANOVA. Relationships between competence perceptions, motivation subscales, and pain/disability were calculated using bivariate correlations and multiple mediation analyses. RESULTS: Participants reported significantly higher levels of autonomous versus controlled motivation (mean difference = 3.5, p < 0.001, d = 2.3) and amotivation (mean difference = 3.6, p < 0.001, d = 2.4). Competence was positively associated with autonomous motivation (r = 0.45, p ≤ 0.05) and negatively associated with controlled motivation (r = -0.26, p ≤ 0.05), amotivation (r = -0.57, p ≤ 0.05), pain (r = -0.35, p ≤ 0.05), and disability (r = -0.34, p ≤ 0.05). Amotivation significantly mediated the competence-pain relationship (Amotivation IE = -0.19, 95% CI (-0.44, -0.06), p < 0.05) and the competence-disability relationship (Amotivation IE = -0.07, 95% CI (-0.17, -0.01), p < 0.05). CONCLUSION: Findings highlight the role of competence perceptions in mitigating amotivation for physical therapy and the deleterious implications of amotivation for patient-centered outcomes.Implications for rehabilitationWhile it is normal for patients to experience periods where they lack motivation for rehabilitation exercises, practitioners can encourage patients to assume responsibility for their recovery by informing them that amotivated states may increase the likelihood of increased pain perceptions and disability.Health-care practitioners should seek to foster competence perceptions in patients about to undergo physical therapy.Competence building strategies such as patient education, goal setting, and role modeling may be valuable in facilitating autonomous motivation and reducing amotivation for physical therapy.

The basic psychological need support in physical therapy questionnaire.

Given the limitations of current inventories of basic psychological need measurement, and the importance of psychological need support within an injury rehabilitation context, there is an evident need to develop the present inventory. Utilizing Self-Determination Theory (SDT) as a theoretical framework, two studies were conducted to develop and psychometrically test a measure of patients' perceptions of basic psychological needs support in physical therapy: The Basic Psychological Needs Support in Physical Therapy Questionnaire (BPNS-PT). In study 1, a panel of Self-Determination Theory academics assessed a pool of items for content relevance, representativeness, and item clarity. In study 2, responses from 199 physical therapy patients were used to identify the best fitting model through confirmatory factor analysis. A 3-factor 10-item measure displayed good fit to the data and illustrated evidence of internal consistency. Findings from these studies provide initial psychometric support (i.e. internal consistency and evidence of construct validity) for the BPNSPT as a measure of patient perceptions of basic psychological needs support in a physical therapy context.

Insights into the solvent-assisted degradation of organophosphorus compounds by a Zr-based metal-organic framework.

The degradation of a chemical warfare agent simulant using a catalytically active Zr-based metal-organic framework (MOF) as a function of different solvent systems was investigated. Complementary molecular modelling studies indicate that the differences in the degradation rates are related to the increasing size in the nucleophile, which hinders the rotation of the product molecule during degradation. Methanol was identified as an appropriate solvent for non-aqueous degradation applications and demonstrated to support the MOF-based destruction of both sarin and soman.

Acute Exercise and Academic Achievement in Middle School Students.

(1) The purpose of this study was to examine the acute effects of aerobic exercise, resistance exercise, and non-exercise on measures of academic achievement and cognition in pre-adolescent students. (2) In a randomized crossover design, sixty-three participants with a mean age of 13.7 ± 0.47 years completed 20 min of aerobic exercise, resistance exercise, or non-exercise with a period of seven days between each bout. Immediately after each bout, participants were tested for academic achievement and cognitive performance. Academic achievement was assessed using standardized, age-appropriate mathematics tests. Cognition was measured using the Dot, Word, and Color tasks of the Stroop Test (Victoria version). (3) Participants scored significantly higher on the mathematics tests (F1,62 = 4.50, p = 0.038) and all elements of the Stroop Test (Dot: F1,62 = 8.14, p = 0.006; Word: F1,62 = 9.90, p = 0.003; Color: F1,62 = 7.57, p = 0.008) following acute resistance exercise as compared to non-exercise. Math test performance was not statistically different between the aerobic and resistance exercise treatments (F1,62 = 0.214, p = 0.645), but participants did perform significantly better on all elements of the Stroop Test following resistance exercise as compared to aerobic exercise (Dot: F1,61 = 25.82, p < 0.001; Word: F1,62 = 14.73, p < 0.001; Color: F1,62 = 20.14, p < 0.001). (4) Resistance exercise acutely influenced academic achievement and cognition in a positive manner. Such results add to the growing body of research that may support an increase in the prescription of varied exercise modalities within school settings for the purposes of improving academic performance and student health.

Understanding posttraumatic growth of paratriathletes with acquired disability.

PURPOSE: To examine the relevance of key components of Organismic Valuing Theory of Growth through Adversity in understanding posttraumatic growth amongst paratriathletes with acquired disability. METHODS: Semi-structured interviews informed by organismic valuing theory of growth through adversity were conducted with 14 elite paratriathletes (eight male, six female). To increase the likelihood that participants had experienced posttraumatic growth, a short form of the Posttraumatic Growth Inventory was completed prior to interview participation. Interview data were analyzed using directed content analysis. RESULTS: Although the initial response to disability was largely negative, paratriathlon experiences were reported to be a mechanism through which growth was facilitated. In particular, participants suggested that social, competence, empowerment, and identity development processes were instrumental in facilitating posttraumatic growth. CONCLUSIONS: Analysis identified themes largely consistent with the main tenets of organismic valuing theory of growth through adversity, supporting its utility in understanding response to a traumatic event and subsequent growth. These findings also suggest that para sport may be an efficacious means for promoting posttraumatic growth, especially for individuals with severe initial reactions to their disability. Lastly, findings suggest that fostering perceptions of competence, autonomy, and social connection may promote posttraumatic growth. Implications for Rehabilitation Acquiring a physical disability may have a detrimental impact on the satisfaction of an individual's fundamental psychological needs. In order to foster posttraumatic growth, the para sport environment should allow for participants to feel competent, autonomous, and to have meaningful interactions with fellow athletes and coaches. Para sport may be particularly beneficial for individuals with previous sporting backgrounds and for those with severe initial reactions to their disability.

Caring Interactions in Secondary Prevention Programs: A Qualitative Inquiry of Individuals With Parkinson's Disease.

BACKGROUND AND PURPOSE: With Parkinson's disease (PD) prevalence rates steadily increasing and long-term adherence to regular physical activity and exercise often difficult to achieve, it is imperative to investigate factors promoting adherence to secondary prevention programs (SPP) that help limit the progression of motor and nonmotor signs and symptoms of the disease. Caring interactions between patients and their rehabilitation team may be particularly germane to individuals with PD, given the physical and psychosocial issues that often accompany this disease (eg, loss of physical function, depression, apathy, and cognitive impairments). Considering this reasoning, the purpose of the present study was twofold: (1) to gain a better understanding of the nature of caring in an SPP setting from a patient perspective and (2) to discover what implications, if any, caring has on relevant patient-centered behaviors such as effort and adherence to SPPs. METHOD: Ten individuals with PD were recruited. In-depth, qualitative interviews were performed using a semistructured interview guide. Inductive content analysis was used to identify themes representing participants' experiences of caring in the SPP setting. RESULTS AND DISCUSSION: Six themes emerged from the data analysis. The first 4 themes described how rehabilitation providers fostered caring in the SPP setting: showing interest, creating a supportive atmosphere, benevolence, and paying attention. Participants described instances when rehabilitation providers (physical therapy assistants, physical therapy students, and exercise specialists) showed interest by asking personal questions and remembering personal information. A supportive environment was facilitated by making participants feel supported, welcomed, and valued. Benevolence was apparent when rehabilitation providers demonstrated kindness and approached their work as "more than just a job." Finally, the importance of feeling that rehabilitation providers "paid attention" to patients by giving them undivided consideration and by aiding with exercises was emphasized. This latter finding is akin to Nodding's concept of "engrossment," a key component of caring, which may be an important issue in the face of increasing use of technological devices (eg, laptop computers and i-pads) that may unintentionally direct rehabilitation providers' attention away from their patients. The final 2 themes-rehabilitation attendance and rehabilitation effort-pertaining to aim 2 of the study, are novel in underscoring the importance of caring with respect to patient behaviors. CONCLUSIONS: Several practical implications can be gleaned from the current study including (but not limited to) remembering personal information about the patient, providing patients with undivided attention, providing support for patients, and making patients feel welcome. These findings underscore the importance of addressing affective skills in training future rehabilitation practitioners. Findings also reveal salient implications associated with caring, namely enhanced rehabilitation attendance and effort. Finally, results highlight the need to examine the generalizability of caring elements identified in the current study and to quantitatively assess caring antecedents and outcomes in SPP settings.

Solid-Phase Detoxification of Chemical Warfare Agents using Zirconium-Based Metal Organic Frameworks and the Moisture Effects: Analyze via Digestion.

Zirconium-based metal organic frameworks (Zr-MOFs) are highly chemically and thermally stable and have been of particular interest as reactive sorbents for chemical warfare agent (CWA) removal due to their fast and selective reactivity toward CWAs reported in buffer solutions. However, we find that decontamination of neat CWAs directly on Zr-MOFs, UiO-66, UiO-66-NH2, and NU-1000 is rather slow, and the reactivity trend and products generated are very different from those in solution. Furthermore, we show that their decontamination rates are affected by the amount of moisture present in the MOFs. Although the effects are minor for UiO-66-NH2 and NU-1000, the hydrolytic activity of UiO-66 toward CWAs dramatically improves as the amount of water present increases. Specifically, the initial hydrolysis rate of methyl paraoxon by UiO-66 increases from 6 µmol/d with 0 wt % water loading to 140 µmol/d with 400 wt % water loading. The results reported here suggest that decontamination of CWAs by Zr-MOFs in solid phase behaves very differently than solution decontamination. Additionally, we present for the first time a digestion method for analyzing and quantifying solid-phase decontamination, which is a daunting challenge itself due to the lack of a convenient analytical method.

MOFwich: Sandwiched Metal-Organic Framework-Containing Mixed Matrix Composites for Chemical Warfare Agent Removal.

This work describes a new strategy for fabricating mixed matrix composites containing layered metal-organic framework (MOF)/polymer films as functional barriers for chemical warfare agent protection. Through the use of mechanically robust polymers as the top and bottom encasing layers, a high-MOF-loading, high-performance-core layer can be sandwiched within. We term this multifunctional composite "MOFwich". We found that the use of elastomeric encasing layers enabled core layer reformation after breakage, an important feature for composites and membranes alike. The incorporation of MOFs into the core layer led to enhanced removal of chemical warfare agents while simultaneously promoting moisture vapor transport through the composite, showcasing the promise of these composites for protection applications.