Static wind imaging Michelson interferometer for the measurement of stratospheric wind fields.

The stratospheric wind field provides significant information on the dynamics, constituent, and energy transport in the Earth's atmosphere. The measurement of the atmospheric wind field on a global basis at these heights is still lacking because few wind imaging interferometers have been developed that can measure wind in this region. In this paper, we describe an advanced compact static wind imaging Michelson interferometer (SWIMI) developed to measure the stratospheric wind field using near-infrared airglow emissions. The instrument contains a field widened and thermal compensated interferometer with a segmented reflective mirror in one arm, which replace the moving mirror in a conventional Michelson interferometer, to provide interference phase steps. The field widened, achromatic, temperature compensated scheme has been designed and manufactured. The characterization, calibration, inversion software, and test of the instrument have been completed. The capacity of two-dimensional wind, temperature, and ozone measurement of the instrument has been verified in the lab experiment and model simulation. What we believe to be the novel principle, modeling, design, and experiment demonstrated in this paper will offer a significant reference to the static, simultaneous and real-time detection and inversion of the global wind field, temperature, and ozone.

A hybrid soft material robotic end-effector for reversible in-space assembly of strut components.

Based on the NASA in-Space Assembled Telescope (iSAT) study (Bulletin of the American Astronomical Society, 2019, 51, 50) which details the design and requirements for a 20-m parabolic in-space telescope, NASA Langley Research Center (LaRC) has been developing structural and robotic solutions to address the needs of building larger in-space assets. One of the structural methods studied involves stackable and collapsible modular solutions to address launch vehicle volume constraints. This solution uses a packing method that stacks struts in a dixie-cup like manner and a chemical composite bonding technique that reduces weight of the structure, adds strength, and offers the ability to de-bond the components for structural modifications. We present in this paper work towards a soft material robot end-effector, capable of suppling the manipulability, pressure, and temperature requirements for the bonding/de-bonding of these conical structural components. This work is done to investigate the feasibility of a hybrid soft robotic end-effector actuated by Twisted and Coiled Artificial Muscles (TCAMs) for in-space assembly tasks. TCAMs are a class of actuator which have garnered significant recent research interest due to their allowance for high force to weight ratio when compared to other popular methods of actuation within the field of soft robotics, and a muscle-tendon actuation design using TCAMs leads to a compact and lightweight system with controllable and tunable behavior. In addition to the muscle-tendon design, this paper also details the early investigation of an induction system for adhesive bonding/de-bonding and the sensors used for benchtop design and testing. Additionally, we discuss the viability of Robotic Operating System 2 (ROS2) and Gazebo modeling environments for soft robotics as they pertain to larger simulation efforts at LaRC. We show real world test results against simulation results for a method which divides the soft, continuous material of the end-effector into discrete links connected by spring-like joints.

Lethal and sublethal effects of five common herbicides on the wolf spider, Pardosa milvina (Araneae: Lycosidae).

We tested lethal and sublethal effects of five commonly applied herbicides on the agrobiont wolf spider Pardosa milvina. Pardosa were collected from two agricultural fields; one kept under continuous crop rotation and sprayed for over twenty years, the other had no pesticide application for the last twelve years. Male and female Pardosa from each site were exposed to one of seven herbicide treatments (atrazine, glyphosate, mesotrione, S-metolachlor, rimsulfuron, a combination of all five herbicides, or a distilled water control; N = 1201) and maintained for 52 days on the treated soil substrate. We recorded mortality, prey capture behavior, weight change, courtship behavior, and egg sac production across treatments. Mesotrione and the five-herbicide combination showed significantly higher mortality than control substrates while atrazine, glyphosate and S-metolachlor showed significantly higher survival than the control. Both male spiders and spiders collected from the conventional field had reduced survival under some herbicide treatments. Prey capture behavior varied significantly by herbicide treatment, sex, and site. We observed significant weight change differences in males and differences in egg sac production in females, with, compared to the control, significant male weight loss in the rimsulfuron treatment collected from the no herbicide field, and a decrease in egg sac production in rimsulfuron and S-metolachlor treatments among females collected from the no herbicide field. Our results show some herbicides may have modest but significant fitness benefits (atrazine, glyphosate, and S-metolachlor) while others strongly increase the mortality of a generalist predator (mesotrione and the combination herbicide treatment).

Wind imaging using simultaneous fringe sampling with field-widened Michelson interferometers.

The first, to our knowledge, successful laboratory implementation of an approach to image winds using simultaneous (as opposed to sequential) fringe imaging of suitable isolated spectral emission lines is described. Achieving this in practice has been a long-standing goal for wind imaging using airglow. It avoids the aliasing effects of source irradiance variations that are possible with sequential fringe sampling techniques. Simultaneous fringe imaging is accomplished using a field-widened Michelson interferometer by depositing phase steps on four quadrants of one of the mirrors and designing an optical system so that four images of the scene of interest, each at a different phase, are simultaneously produced. In this paper, the instrument characteristics, its characterization, and the analysis algorithms necessary for use of the technique for this type of interferometer are described for the first time, to the best of our knowledge. The large throughput associated with field-widened Michelson interferometers is sufficient for the spatial resolutions and temporal cadences necessary for ground based imaging of gravity waves in wind and irradiance to be achieved. The practical demonstration of this technique also validates its use for proposed monolithic satellite instruments for wind measurements using airglow on the Earth and Mars.

Two-Year Clinical and Radiographic Evaluation of Scheker Prosthesis (Aptis) Distal Radioulnar Joint Arthroplasty.

PURPOSE: To evaluate the clinical and radiographic outcomes of patients who underwent semiconstrained distal radioulnar joint arthroplasty. METHODS: A retrospective analysis was performed on a series of patients who underwent distal radioulnar joint arthroplasty with more than a 23-month follow up. The quantitative outcome variables included the visual analog scale for pain; Disability of the Arm, Shoulder, and Hand (DASH) score; Patient-Rated Wrist Evaluation (PRWE); and Mayo wrist score. The range of motion, grip strength, torque, and lifting capacity were measured at final follow up and compared with that of the nonsurgical extremity. Complications related to the prosthesis were assessed. RESULTS: Twenty-one patients (mean age 57 years) were assessed at an average 41-month follow up (23-73 months). Fifteen underwent prior hand, wrist, or elbow procedures. Four patients required 5 reoperations. The postoperative median visual analog scale pain score was 0.6 at rest and 2.1 with activity. The median postoperative DASH score was 26.7, PRWE 41, and Mayo wrist score was 65. Upon comparing the supination torque of the operative and intact sides, the operative side was found to average 87% of the intact side on a work simulator and 77% on the simulator's D-ring. Eight of 20 patients had lysis around the collar of the ulnar component (40%), as detected using radiography. Three of 21 (14%) radial plates were malpositioned, with 2 resulting in a fracture. The overall complication rate was 29%. CONCLUSIONS: Distal radioulnar joint arthroplasty using the Scheker prosthesis demonstrated good patient pain scores and the restoration of supination strength. The collar lysis resulted in weaker supination and grip strength. Still, the patients experienced mild levels of pain and moderate disability. A moderate complication rate persisted, as reported by other authors. Accurate radial component placement is important. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Advanced prehospital resuscitative care: Can we identify trauma patients who might benefit?

BACKGROUND: Uncontrolled truncal hemorrhage remains the most common cause of potentially preventable death after injury. The notion of earlier hemorrhage control and blood product resuscitation is therefore attractive. Some systems have successfully implemented prehospital advanced resuscitative care (ARC) teams. Early identification of patients is key and is reliant on rapid decision making and communication. The purpose of this simulation study was to explore the feasibility of early identification of patients who might benefit from ARC in a typical US setting. METHODS: We conducted a prospective observational/simulation study at a level I trauma center and two associated emergency medical service (EMS) agencies over a 9-month period. The participating EMS agencies were asked to identify actual patients who might benefit from the activation of a hypothetical trauma center-based ARC team. This decision was then communicated in real time to the study team. RESULTS: Sixty-three patients were determined to require activation. The number of activations per month ranged from 2 to 15. The highest incidence of calls occurred between 4 pm to midnight. Of the 63 patients, 33 were transported to the trauma center. The most common presentation was with penetrating trauma. The median age was 27 years (interquartile range, 24-45 years), 75% were male, and the median Injury Severity Score was 11 (interquartile range, 7-20). Based on injury patterns, treatment received, and outcomes, it was determined that 6 (18%) of 33 patients might have benefited from ARC. Three of the patients died en-route to or soon after arrival at the trauma center. CONCLUSION: The prehospital identification of patients who might benefit from ARC is possible but faces challenges. Identifying strategies to adapt existing processes may allow better utilization of the existing infrastructure and should be a focus of future efforts. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, level III.

Rebound and overshoot of donor-specific antibodies to human leukocyte antigens (HLA) during desensitization with plasma exchanges in hematopoietic progenitor cell transplantation: A case report.

BACKGROUND: Donor-specific antibodies (DSA) to HLA have been associated with graft loss in hematopoietic progenitor cell (HPC) transplantation. Limited data associate therapeutic plasma exchange (TPE) with desensitization and successful engraftment. We report an attempt of desensitization and observed overshooting of DSA during transplantation. CASE REPORT AND RESULTS: A 27-year-old female with cutaneous T cell lymphoma was scheduled for HPC transplantation from her HLA-haploidentical half-sister, who carried the HLA-DRB1*13:03:01 allele. The patient had the corresponding DSA. Lacking an alternative donor option at the time, we attempted a desensitization approach by immunosuppression with tacrolimus and mycophenolate mofetil (MMF). Unexpectedly, DSA increased from a mean fluorescence intensity (MFI) of 1835 on day -63 to 9008 on day -7. The MFI increased further during 3 TPE procedures and intravenous immunoglobulin (IVIG) until day -1. After transplantation, the DSA remained elevated despite 2 more TPE/IVIG procedures and graft-versus-host disease prophylaxis with high-dose cyclophosphamide, sirolimus, and MMF. Flow cytometric crossmatch, initially negative, turned positive after transplantation. Primary graft failure occurred and was attributed to antibody-mediated rejection. A second transplantation from a 7/8 HLA-matched unrelated donor, not carrying DRB1*13:03 allele, resulted in successful engraftment. CONCLUSION: Unexpected and rapid increases of a DSA can occur despite the use of current desensitization approaches. This is problematic when conditioning has already started, as such increases are unlikely to be overcome by TPE or other interventions for desensitization. Overshoot of DSA in HPC transplantation has rarely been reported. Its cause remains unclear and can include underlying disease, immunotherapy, chemotherapy, or TPE.

Feasibility of Fitness Tracker Usage to Assess Activity Level and Toxicities in Patients With Colorectal Cancer.

PURPOSE: Performance status (PS) is a subjective assessment of patients' overall health. Quantification of physical activity using a wearable tracker (Fitbit Charge [FC]) may provide an objective measure of patient's overall PS and treatment tolerance. MATERIALS AND METHODS: Patients with colorectal cancer were prospectively enrolled into two cohorts (medical and surgical) and asked to wear FC for 4 days at baseline (start of new chemotherapy [± 4 weeks] or prior to curative resection) and follow-up (4 weeks [± 2 weeks] after initial assessment in medical and postoperative discharge in surgical cohort). Primary end point was feasibility, defined as 75% of patients wearing FC for at least 12 hours/d, 3 of 4 assigned days. Mean steps per day (SPD) were correlated with toxicities of interest (postoperative complication or ≥ grade 3 toxicity). A cutoff of 5,000 SPD was selected to compare outcomes. RESULTS: Eighty patients were accrued over 3 years with 55% males and a median age of 59.5 years. Feasibility end point was met with 68 patients (85%) wearing FC more than predefined duration and majority (91%) finding its use acceptable. The mean SPD count for patients with PS 0 was 6,313, and for those with PS 1, it was 2,925 (122 and 54 active minutes, respectively) (P = .0003). Occurrence of toxicity of interest was lower among patients with SPD > 5,000 (7 of 33, 21%) compared with those with SPD < 5,000 (14 of 43, 32%), although not significant (P = .31). CONCLUSION: Assessment of physical activity with FC is feasible in patients with colorectal cancer and well-accepted. SPD may serve as an adjunct to PS assessment and a possible tool to help predict toxicities, regardless of type of therapy. Future studies incorporating FC can standardize patient assessment and help identify vulnerable population.

Spinal Accessory and Suprascapular Nerve Injury After Human Bite.

ABSTRACT: This is a unique clinical case of spinal accessory and suprascapular nerve injury related to a human bite not yet described elsewhere. The case emphasizes the importance of considering local trauma of the posterior triangle of the neck in case of shoulder weakness with electrophysiologic evidence of combined spinal accessory and suprascapular nerve injury.

Perioperative Outcomes Following Combined Versus Isolated Colorectal and Liver Resections: Insights From a Contemporary, National, Propensity Score-Based Analysis.

Our objective was to compare outcomes following combined versus isolated resections for metastatic colorectal cancer and/or liver metastases using a large, contemporary national database. Background: Controversy persists regarding optimal timing of resections in patients with synchronous colorectal liver metastases. Methods: We analyzed 11,814 patients with disseminated colorectal cancer and/or liver metastases who underwent isolated colon, rectal, or liver resections (CRs, RRs, or LRs) or combined colon/liver or rectal/liver resections (CCLRs or CRLRs) in the National Surgical Quality Improvement Program Participant Use File (2011-2015). We examined associations between resection type and outcomes using univariate/multivariate analyses and used propensity adjustment to account for nonrandom receipt of isolated versus combined resections. Results: Two thousand four hundred thirty-seven (20.6%); 2108 (17.8%); and 6243 (52.8%) patients underwent isolated CR, RR, or LR; 557 (4.7%) and 469 (4.0%) underwent CCLR or CRLR. Three thousand three hundred ninety-five patients (28.7%) had serious complications (SCs). One hundred forty patients (1.2%) died, of which 113 (80.7%) were failure to rescue (FTR). One thousand three hundred eighty-six (11.7%) patients experienced unplanned readmission. After propensity adjustment and controlling for procedural complexity, wound class, and operation year, CCLR/CRLR was independently associated with increased risk of SC, as well as readmission (compared with LR). CCLR was also independently associated with increased risk of FTR and death (compared with LR). Conclusions: Combined resection uniformly confers increased risk of SC and increased risk of mortality after CCLR; addition of colorectal to LR increases risk of readmission. Combined resections are less safe, and potentially more costly, than isolated resections. Effective strategies to prevent SC after combined resections are warranted.

Analytical Model for the Tidal Evolution of the Evection Resonance and the Timing of Resonance Escape.

A high-angular momentum giant impact with the Earth can produce a Moon with a silicate isotopic composition nearly identical to that of Earth's mantle, consistent with observations of terrestrial and lunar rocks. However, such an event requires subsequent angular momentum removal for consistency with the current Earth-Moon system. The early Moon may have been captured into the evection resonance, occurring when the lunar perigee precession period equals 1 year. It has been proposed that after a high- angular momentum giant impact, evection removed the angular momentum excess from the Earth-Moon pair and transferred it to Earth's orbit about the Sun. However, prior N-body integrations suggest this result depends on the tidal model and chosen tidal parameters. Here, we examine the Moon's encounter with evection using a complementary analytic description and the Mignard tidal model. While the Moon is in resonance, the lunar longitude of perigee librates, and if tidal evolution excites the libration amplitude sufficiently, escape from resonance occurs. The angular momentum drain produced by formal evection depends on how long the resonance is maintained. We estimate that resonant escape occurs early, leading to only a small reduction (~ few to 10%) in the Earth-Moon system angular momentum. Moon formation from a high-angular momentum impact would then require other angular momentum removal mechanisms beyond standard libration in evection, as have been suggested previously.

Preoperative Delays in the Treatment of DCIS and the Associated Incidence of Invasive Breast Cancer.

BACKGROUND: Although treatment delays have been associated with survival impairment for invasive breast cancer, this has not been thoroughly investigated for ductal carcinoma in situ (DCIS). With trials underway to assess whether DCIS can remain unresected, this study was performed to determine whether longer times to surgery are associated with survival impairment or increased invasion. METHODS: A population-based study of prospectively collected national data derived from women with a clinical diagnosis of DCIS between 2004 and 2014 was conducted using the National Cancer Database. Overall survival (OS) and presence of invasion were assessed as functions of time by evaluating five intervals (≤ 30, 31-60, 61-90, 91-120, 121-365 days) between diagnosis and surgery. Subset analyses assessed those having pathologic DCIS versus invasive cancer on final pathology. RESULTS: Among 140,615 clinical DCIS patients, 123,947 had pathologic diagnosis of DCIS and 16,668 had invasive ductal carcinoma. For all patients, 5-year OS was 95.8% and unadjusted median delay from diagnosis to surgery was 38 days. With each delay interval increase, added relative risk of death was 7.4% (HR 1.07; 95% CI 1.05-1.10; P < 0.001). On final pathology, 5-year OS for noninvasive patients was 96.0% (95% CI 95.9-96.1%) versus 94.9% (95% CI 94.6-95.3%) for invasive patients. Increasing delay to surgery was an independent predictor of invasion (OR 1.13; 95% CI 1.11-1.15; P < 0.001). CONCLUSIONS: Despite excellent OS for invasive and noninvasive cohorts, invasion was seen more frequently as delay increased. This suggests that DCIS trials evaluating nonoperative management, which represents infinite delay, require long term follow up to ensure outcomes are not compromised.

Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care.

BACKGROUND: Empirical studies examined the associations between hospital competition and quality of care by using different methodology, measures, patient groups and geographic locations; however, results remained inconclusive. This study aimed to apply meta-analysis to evaluate the effect of hospital competition on quality of care and to explore the potential implications to care for senior patients. METHODS: A systematic review and meta-analysis combining results from various studies to obtain an overall outcome was performed. Measure of effect size, I2 test, meta-regression to find sources of heterogeneity, tests for publication bias, sensitivity analysis and cumulative analysis were performed. The mean effect size is estimated by coefficient and standard error with P values less than 0.05 which was considered statistically significant. RESULTS: Based on the selection criteria, only 11 studies were eligible for this meta-analysis. The pooled effect of hospital competition on quality of care was reported by all of the 11 included studies. Results of the meta-analysis suggested that hospital competition reduced quality of care, but the overall effect was relatively insignificant from a statistical perspective (Point estimate = 0.008, 95% CI = -0.004 ˜ 0.020, P > 0.05). CONCLUSIONS: Hospital competition slightly increased mortality rates of acute myocardial infarction, but not statistically significant. The negative impact may be lessened over time as medical technology, practices, and techniques improve. Older patients with complex care needs may be at risk for poorer quality of care related to hospital competition.

Differential Effects of Nano TiO2 and CeO2 on Normal Human Lung Epithelial Cells In Vitro.

Nano-TiO2 and nano-CeO2 are among the most widely used engineered nanoparticles (NPs). We investigated a variety of endpoints to assess the toxicity of eight of these NPs to induce potentially adverse health effects in an In Vitro human respiratory epithelial cell model. These endpoints include cytotoxicity, reactive oxygen species (ROS)/reactive nitrogen species (RNS) production, 8-hydroxy-2_-deoxyguanosine (8-oxo-dG), endogenous DNA adducts, Apurinic/apyrimidinic (AP) sites, 4-Hrdoxynonenal (4-HNE) protein adducts, Malondialdehyde (MDA) protein adducts, and genomics analysis on altered signaling pathways. Our results indicated that cytotoxicity assays are relatively insensitive, and we detected changes in other endpoints at concentrations much lower than those inducing cytotoxicity. Among the ROS-related endpoints, 8-oxo-dG is relatively more sensitive than other assays, and nano-TiO2 induced more 8-oxo-dG formation than nano-CeO2. Finally, there are many signaling pathways changes at concentrations at which no cytotoxicity was observed. These alterations in signaling pathways correlated well with In Vitro toxicity that was observed at higher concentrations, and with in vivo adverse outcome pathways caused by nano-TiO2 and nano-CeO2 in experimental animals.

Revisiting the association of HLA alleles and haplotypes with CYP21A2 mutations in a large cohort of patients with congenital adrenal hyperplasia.

The CYP21A2 gene encoding 21­hydroxylase is on chromosome 6p21.3 within the human leukocyte antigen (HLA) class III major histocompatibility complex and an association between congenital adrenal hyperplasia (CAH) due to 21­hydroxylase deficiency and HLA class I and II alleles has been shown in genetically isolated populations. One-third of CAH causing alleles are 30-kb deletions due to homologous recombination events between active and pseudogenes resulting in chimeric genes. The aim of this study was to re-visit the association between the CYP21A2 variants and HLA polymorphisms in a large ethnically diverse cohort of patients with CAH who underwent comprehensive CYP21A2 genotyping, including specification of chimeric gene subtypes (CAH CH-1 through CH-9 of CYP21A1P/CYP21A2 chimeras; CAH-X CH-1 through CH-3 of TNXA/TNXB chimeras) in alleles with 30-kb deletions. The study population included 201 patients (86 males, 115 females, age 3-75 years) with CAH due to 21­hydroxylase deficiency (159 classic, 42 nonclassic) and 194 parents. Based on the availability of parental genotype, we determined the haplotypes of CYP21A2 mutations and HLA types in 95 probands (190 alleles). Five prevalent haplotype associations were found: p.V281L and B*14-C*08 (P < 0.0001); p.I172N and DQB1*03 (P = 0.035); and of the chimeric genes caused by 30-kb deletions: CH-1 and A*03 (P = 0.033); CH-5 and C*06-DRB1*07 (P < 0.0001); and CAH-X CH-1 and DQB1*03 (P = 0.004). Our findings show that a number of associations between HLA alleles and haplotypes and CYP21A2 mutations, including large 30-kb deletions, exist commonly across ethnicities. These HLA associations may have clinical implications for patients with CAH and may provide insight into the genetics of this highly complex region of the human genome.

Predictive Value of Leukocyte- and Platelet-Derived Ratios in Rectal Adenocarcinoma.

BACKGROUND: Advances in treatment of rectal cancer have improved survival, but there is variability in response to therapy. Recent data suggest the utility of the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in predicting survival. Our aim was to examine these ratios in rectal cancer patients and determine whether any association exists with overall survival (OS). METHODS: Using prospectively maintained institutional data, a query was completed for clinical stage II-III rectal adenocarcinoma patients treated from 2002 to 2016. We included patients who had a complete blood count collected before neoadjuvant chemoradiation (pre-CRT) and again before surgery (post-CRT). The LMR, NLR, and PLR were calculated for the pre-CRT and post-CRT time points. Potential cutpoints associated with OS differences were determined using maximally selected rank statistics. Survival curves were compared using log-rank tests and were adjusted for age and stage using Cox regression. RESULTS: A total of 146 patients were included. Cutpoints were significantly associated with OS for pre-CRT ratios but not for post-CRT ratios. Within the pretreatment group, a "low" (<2.86) LMR was associated with decreased OS (log-rank P = 0.004). In the same group, a "high" (>4.47) NLR and "high" PLR (>203.6) were associated with decreased OS (log-rank P < 0.001). With covariate adjustment for age, and separately for final pathologic stage, the associations between OS and LMR, NLR, and PLR each retained statistical significance. CONCLUSIONS: If obtained before the start of neoadjuvant chemoradiation, LMR, NLR, and PLR values are accurate predictors of 5-y OS in patients with locally advanced rectal adenocarcinoma.

Does the Surgical Apgar Score predict serious complications after elective major cancer surgery?

BACKGROUND: Major cancer surgery is associated with significant risks of perioperative morbidity and mortality, resulting in delayed adjuvant therapy, higher recurrence rates, and worse overall survival. Previous retrospective studies have used the Surgical Apgar Score (SAS) for perioperative risk assessment. This study prospectively evaluated the predictive value of SAS to predict serious complication (SC) after elective major cancer surgery. METHODS: Demographic, comorbidity, procedure, and intraoperative data were collected prospectively for 405 patients undergoing elective major cancer surgery between 2014-17. The SAS was calculated immediately postoperative and outcome data were collected prospectively. Rates of SC according to SAS risk category were compared using Cochran-Armitage trend test. Receiver operating characteristic curves and area under the receiver operating characteristic curves were generated and 95% confidence intervals were calculated. RESULTS: Eighty percent, 17.3%, and 2.7% of patients were low (SAS 7-10), intermediate (SAS 5-6), and high risk (SAS 0-4), respectively, for SC based on their SAS. Forty-six (11.4%) had an SC within 30 days; 3.7% returned to the operating room, 3.7% experienced a urinary tract infection, 3.2% experienced a respiratory complication, 2.7% experienced a wound complication, and 1.2% experienced a cardiac complication. Overall, 9.3%, 18.6%, and 27.3% of patients with SAS 7-10, 5-6, and 0-4 experienced an SC, respectively (P = 0.005). The overall discriminatory ability of the SAS was modest (area under the receiver operating characteristic curves 0.661; 95% confidence intervals, 0.582-0.740). CONCLUSIONS: Although there was an overall association between SAS and higher risk of subsequent postoperative SC in our cohort, the ability of the SAS to accurately predict risk of postoperative SC at the patient level was limited.