Readmission risk of malignant brain tumor patients undergoing laser interstitial thermal therapy (LITT) and stereotactic needle biopsy (SNB): a covariate balancing weights analysis of the National Readmissions Database (NRD).

PURPOSE: Despite procedural similarities between laser interstitial thermal therapy (LITT) and stereotactic needle biopsy (SNB), LITT induces delayed, pro-inflammatory responses not associated with SNB that may increase the risk of readmission within 30- or 90- days. Here, we explore this hypothesis. METHODS: We queried the National Readmissions Database (NRD, 2010-18) for malignant brain tumor patients who underwent elective LITT or SNB using International Classification of Diseases codes. Readmissions were defined as non-elective inpatient hospitalizations. Survey regression methods and a weighted analysis were utilized to adjust for demographic and clinical differences between LITT and SNB cohorts. RESULTS: During the study period, an estimated 685 malignant brain patients underwent elective LITT and 15,177 underwent elective SNB. Patients undergoing LITT and SNB exhibited comparable median lengths of hospital stay [IQR; LITT = 2 (1, 3); SNB = 1 (1, 2); p = 0.820]. Likelihood of routine discharge was not significantly different between the two procedures (p = 0.263). No significant differences were observed in the odds of 30- or 90-day unplanned readmission between the LITT and SNB cohorts after multivariable adjustment (all p ≥ 0.177). The covariate balancing weighted analysis confirmed comparable 30 or 90-day readmission risk between LITT and SNB treated patients (all p ≥ 0.201). CONCLUSION: The likelihood of 30- and 90-day readmission for malignant brain tumor patients who underwent LITT or SNB are comparable, supporting the safety profile of LITT as therapy for malignant brain cancers.

Using kinematics to re-define the pull test as a quantitative biomarker of the postural response in normal pressure hydrocephalus patients.

Quantitative biomarkers are needed for the diagnosis, monitoring and therapeutic assessment of postural instability in movement disorder patients. The goal of this study was to create a practical, objective measure of postural instability using kinematic measurements of the pull test. Twenty-one patients with normal pressure hydrocephalus and 20 age-matched control subjects were fitted with inertial measurement units and underwent 10-20 pull tests of varying intensities performed by a trained clinician. Kinematic data were extracted for each pull test and aggregated. Patients participated in 103 sessions for a total of 1555 trials while controls participated in 20 sessions for a total of 299 trials. Patients were separated into groups by MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) pull test score. The center of mass velocity profile easily distinguished between patient groups such that score increases correlated with decreases in peak velocity and later peak velocity onset. All patients except those scored as "3" demonstrated an increase in step length and decrease in reaction time with increasing pull intensity. Groups were distinguished by differences in the relationship of step length to pull intensity (slope) and their overall step length or reaction time regardless of pull intensity (y-intercept). NPH patients scored as "normal" on the MDS-UPDRS scale were kinematically indistinguishable from age-matched control subjects during a standardized perturbation, but could be distinguished from controls by their response to a range of pull intensities. An instrumented, purposefully varied pull test produces kinematic metrics useful for distinguishing clinically meaningful differences within hydrocephalus patients as well as distinguishing these patients from healthy, control subjects.

Coronavirus (COVID-19) in Haiti: A Call for Action.

Recently, the cholera outbreak in Haiti demonstrated just how unprepared the country is to rapidly isolate an outbreak of this magnitude, and its vulnerability to the COVID-19 pandemic. This communication briefly examines the health system in Haiti and its vulnerability toward the COVID-19 outbreak.

Utilizing kinematic analysis of postural instability as an objective measure to aid in distinguishing between normal pressure hydrocephalus and Parkinson's disease.

Objective: Patients with normal pressure hydrocephalus (NPH) and Parkinson's Disease (PD) can clinically appear quite similar at baseline evaluation. We sought to investigate the use of kinematic assessment of postural instability (PI) using inertial measurement units (IMUs) as a mechanism of differentiation between the two disease processes. Methods: 20 patients with NPH, 55 patients with PD, and 56 age-matched, healthy controls underwent quantitative pull test examinations while wearing IMUs at baseline. Center of mass and foot position data were used to compare velocity and acceleration profiles, pull test step length, and reaction times between groups and as a function of Unified Parkinson's disease Rating Scale Pull Test (UPDRSPT) score. Results: Overall, the reactive postural response of NPH patients was characterized by slower reaction times and smaller steps compared to both PD patients and healthy controls. However, when patients were grouped by UPDRSPT scores, no reliable objective difference between groups was detected. Conclusion: At their initial evaluation, very few NPH patients demonstrate "normal" or "mild" PI as they appear to be older upon presentation compared to PD patients. As a result, kinematic assessment utilizing IMUs may not be helpful for differentiating between NPH and PD as a function of UPDRSPT score, but rather as a more fine-tuned method to define disease progression. We emphasize the need for further evaluation of incorporating objective kinematic data collection as a way to evaluate PI and improve patient outcomes.

System-Identification-Based Activity Recognition Algorithms With Inertial Sensors.

This paper focuses on activity recognition using a single wearable inertial measurement sensor placed on the subject's chest. The ten activities that need to be identified include lying down, standing, sitting, bending and walking, among others. The activity recognition approach is based on using and identifying a transfer function associated with each activity. The appropriate input and output signals for each transfer function are first determined based on the norms of the sensor signals excited by that specific activity. Then the transfer function is identified using training data and a Wiener filter based on the auto-correlation and cross-correlation of the output and input signals. The activity occurring in real-time is recognized by computing and comparing the input-output errors associated with all the transfer functions. The performance of the developed system is evaluated using data from a group of Parkinson's disease subjects, including data obtained in a clinical setting and data obtained through remote home monitoring. On average, the developed system provides better than 90% accuracy in identifying each activity as it occurs. Activity recognition is particularly useful for PD patients in order to monitor their level of activity, characterize their postural instability and recognize high risk-activities in real-time that could lead to falls.

Synthesis and Morphological Control of UO2F2 Particulates.

Uranium-based microspheres are of interest due to their potential applications as targets for medical isotopes production, as fuel for nuclear reactors, and as standardized materials for nuclear forensics. Here, for the first time, UO2F2 microspheres (1-2 µm) have been prepared from the reaction between UO3 microspheres and AgHF2 in an autoclave. In this preparation, a new fluorination method has been applied, and HF(g)-produced in situ from the thermal decomposition of AgHF2 and NH4HF2-was used as the fluorinating agent. The microspheres were characterized by powder X-ray diffraction (PXRD) and scanning electron microscopy (SEM). Diffraction results indicated that the reaction performed with AgHF2 at 200 °C led to anhydrous UO2F2 microspheres, while at 150 °C, hydrated UO2F2 microspheres were obtained. Meanwhile, NH4HF2 led to the formation of contaminated products as driven by the formation of volatile species.

Real world validation of activity recognition algorithm and development of novel behavioral biomarkers of falls in aged control and movement disorder patients.

The use of wearable sensors in movement disorder patients such as Parkinson's disease (PD) and normal pressure hydrocephalus (NPH) is becoming more widespread, but most studies are limited to characterizing general aspects of mobility using smartphones. There is a need to accurately identify specific activities at home in order to properly evaluate gait and balance at home, where most falls occur. We developed an activity recognition algorithm to classify multiple daily living activities including high fall risk activities such as sit to stand transfers, turns and near-falls using data from 5 inertial sensors placed on the chest, upper-legs and lower-legs of the subjects. The algorithm is then verified with ground truth by collecting video footage of our patients wearing the sensors at home. Our activity recognition algorithm showed >95% sensitivity in detection of activities. Extracted features from our home monitoring system showed significantly better correlation (~69%) with prospectively measured fall frequency of our subjects compared to the standard clinical tests (~30%) or other quantitative gait metrics used in past studies when attempting to predict future falls over 1 year of prospective follow-up. Although detecting near-falls at home is difficult, our proposed model suggests that near-fall frequency is the most predictive criterion in fall detection through correlation analysis and fitting regression models.

Rates of operative intervention for infection after synthetic or autologous cranioplasty: a National Readmissions Database analysis.

OBJECTIVE: The aim of this study was to characterize the clinical utilization and associated charges of autologous bone flap (ABF) versus synthetic flap (SF) cranioplasty and to characterize the postoperative infection risk of SF versus ABF using the National Readmissions Database (NRD). METHODS: The authors used the publicly available NRD to identify index hospitalizations from October 2015 to December 2018 involving elective ABF or SF cranioplasty after traumatic brain injury (TBI) or stroke. Subsequent readmissions were further characterized if patients underwent neurosurgical intervention for treatment of infection or suspected infection. Survey Cox proportional hazards models were used to assess risk of readmission. RESULTS: An estimated 2295 SF and 2072 ABF cranioplasties were performed from October 2015 to December 2018 in the United States. While the total number of cranioplasty operations decreased during the study period, the proportion of cranioplasties utilizing SF increased (p < 0.001), particularly in male patients (p = 0.011) and those with TBI (vs stroke, p = 0.012). The median total hospital charge for SF cranioplasty was $31,200 more costly than ABF cranioplasty (p < 0.001). Of all first-time readmissions, 20% involved surgical treatment for infectious reasons. Overall, 122 SF patients (5.3%) underwent surgical treatment of infection compared with 70 ABF patients (3.4%) on readmission. After accounting for confounders using a multivariable Cox model, female patients (vs male, p = 0.003), those discharged nonroutinely (vs discharge to home or self-care, p < 0.001), and patients who underwent SF cranioplasty (vs ABF, p = 0.011) were more likely to be readmitted for reoperation. Patients undergoing cranioplasty during more recent years (e.g., 2018 vs 2015) were less likely to be readmitted for reoperation because of infection (p = 0.024). CONCLUSIONS: SFs are increasingly replacing ABFs as the material of choice for cranioplasty, despite their association with increased hospital charges. Female sex, nonroutine discharge, and SF cranioplasty are associated with increased risk for reoperation after cranioplasty.

Synthetic diversity in the preparation of metallic uranium.

Uranium metal is associated with several aspects of nuclear technology; it is used as fuel for research and power reactors, targets for medical isotope productions, explosive for nuclear weapons and precursors in synthetic chemistry. The study of uranium metal at the laboratory scale presents the opportunity to evaluate metallic nuclear fuels, develop new methods for metallic spent fuel reprocessing and advance the science relevant to nuclear forensics and medical isotope production. Since its first isolation in 1841, from the reaction of uranium chloride and potassium metal, uranium metal has been prepared by solid-state reactions and in solution by electrochemical, chemical and radiochemical methods. The present review summarizes the methods outlined above and describes the chemistry associated with each preparation.

Thermal Analysis of Benzotriazolium Perrhenate and Its Implication to Rhenium Metal.

The thermal analysis behavior of C6H6N3[ReO4] was studied by simultaneous thermal gravimetric analysis (TGA) and differential scanning calorimetry (DSC) up to 700 °C under argon. Such analysis afforded rhenium metal, which was characterized by powder X-ray diffraction (PXRD), scanning electron microscopy (SEM), and energy-dispersive X-ray (EDX) spectroscopy. XRD peak broadening due to crystallite size and lattice strain was analyzed by both Williamson-Hall (W-H) and Debye-Scherrer (D-S) methods. Efforts to isolate Re metal from the thermal treatment of benzotriazole (BTA = C6H5N3) with NH4ReO4 and Re2O7 under various atmospheres and temperatures are also reported. The results provide a significant insight into the chemistry of group VII transition metals, investigate the potential use of benzotriazole as a reducing agent for metal productions, and demonstrate a successful convenient method for rhenium metal production, which could be applied to other refractory metals.

Coexistence of metamagnetism and slow relaxation of magnetization in ammonium hexafluoridorhenate.

The (NH4)2[ReF6] (1) salt was studied by X-ray diffraction, Raman spectroscopy, theoretical calculations, and magnetic measurements. 1 crystallizes in the trigonal space group P3̄m1 (Re-F = 1.958(5) Å). In the Raman spectrum of 1, splitting of the observed peaks was observed and correlated to the valence frequencies of vibration of the [ReF6]2- anion. The study of the magnetic properties of 1, through DC and AC magnetic susceptibility measurements, reveals the coexistence of metamagnetism and slow relaxation of magnetization at low temperature, which is unusual in the molecular systems based on the paramagnetic 5d metal ions reported so far.

Coronavirus (COVID-19) and Racial Disparities: a Perspective Analysis.

Health disparity refers to systematic differences in health outcomes between groups and communities based on socioeconomic isolation. In the USA, health disparities among minority groups, especially African Americans, limit their access to quality medical care and other beneficial resources and services. Presently, the novel coronavirus (COVID-19) highlights the extreme healthcare challenges that exist in the African American and other minority communities in the USA. African Americans are dying at a rate nearly four times higher than the national average. With inadequate access to quality healthcare, viable resources, and information, COVID-19 will continue to have a disastrous effect on African American communities. This communication provides a brief overview of the health inequalities resulting in African Americans dying disproportionately during the COVID-19 pandemic.

An unexpected rhenium(IV)-rhenium(VII) salt: [Co(NH3)6]3[ReVIIO4][ReIVF6]4·6H2O.

The title hydrated salt, tris-[hexa-amminecobalt(III)] tetraoxidorhenate(VII) tetra-kis-[hexa-fluorido-rhenate(IV)] hexa-hydrate, arose unexpectedly due to possible contamination of the K2ReF6 starting material with KReO4. It consists of octa-hedral [Co(NH3)6]3+ cation (Co1 site symmetry 1), tetra-hedral [ReVIIO4]- anions (Re site symmetry 1) and octa-hedral [ReIVF6]2- anions (Re site symmetries 1and ). The [ReF6]2- octa-hedral anions (mean Re-F = 1.834 Å), [Co(NH3)6]3+ octa-hedral cations (mean Co-N = 1.962 Å), and the [ReO4]- tetra-hedral anion (mean Re-O = 1.719 Å) are slightly distorted. A network of N-H⋯F hydrogen bonds consolidates the structure. The crystal studied was refined as a two-component twin.

Syntheses, Raman spectroscopy and crystal structures of alkali hexa-fluorido-rhenates(IV) revisited.

The A2[ReF6] (A = K, Rb and Cs) salts are isotypic and crystallize in the trigonal space group type P [Formula: see text] m1, adopting the K2[GeF6] structure type. Common to all A2[ReF6] structures are slightly distorted octa-hedral [ReF6]2- anions with an average Re-F bond length of 1.951 (8) Å. In those salts, symmetry lowering on the local [ReF6]2- anions from Oh (free anion) to D3d (solid-state structure) occur. The distortions of the [ReF6]2- anions, as observed in their Raman spectra, are correlated to the size of the counter-cations.

Generation of fluorescent silver nanoscale particles in reverse micelles using gamma irradiation.

Reverse micelles (RMs) containing aqueous solutions of Ag(+) ions in their core produce fluorescent Ag species, upon exposure to gamma irradiation. A two-phase liquid system is used for RM formation. The RMs can be employed in novel gamma radiation detectors with appearance of fluorescence indicating that radiation was once present.

Use of inferior vena caval filters and survival in patients with malignancy.

BACKGROUND: Inferior vena cava (IVC) filters have proven to be a viable alternative to anticoagulation therapy for the prevention of life-threatening pulmonary emboli (PE) for patients who have contraindications to anticoagulation therapy. The clinical benefit of placing IVC filters in patients with advanced-stage cancer is controversial. The current study reported the authors' experience with IVC filters in patients with cancer. METHODS: Between January 2000 and May 2003, IVC filters were placed in 308 patients with venous thromboembolic (VTE) disease. Of these patients, 267 had solid tumors and 41 had liquid tumors. Outcome was reviewed retrospectively with regards to patient survival as well as procedural and filter-related complications. Patients with solid and liquid tumors were used to generate Kaplan-Meier estimates for survival and the probability of surviving 30, 90, and 365 days was also calculated. The prognostic effect of age, primary malignancy, gender, extent of disease, indication, admission to the intensive care unit, and IVC thrombus on overall survival was also evaluated using univariate and multivariate Cox models for patients with solid tumors. RESULTS: The median survival periods for patients with solid and liquid tumors were 145 days and 207 days, respectively. The probability of survival at 30, 90, and 365 days was 0.81, 0.60, and 0.35, respectively, for patients with solid tumors and 0.85, 0.67, and 0.48, respectively, for patients with liquid tumors. There was no statistically significant difference in survival based on primary malignancy for solid tumors (P = 0.628) or between solid and liquid tumors (P = 0.16). For patients with solid tumors, a statistically significant difference in survival was found by extent of disease (P = 0.002). Patients with solid tumors classified as local disease (n = 15), locally advanced disease (n = 95), and widely metastatic or disseminated disease (n = 153) had a probability of survival at 30 days of 0.93, 0.87, and 0.76, respectively. Compared with patients with local disease, patients with metastatic or disseminated disease were 3.7 times more likely to die (P = 0.013). Patients with a history of deep venous thrombosis (DVT) and hemorrhage were 2 times more likely to die than patients with DVT and no history of hemorrhage (P = 0.0057). Documented complications occurred in 22 of 308 (7.1%) patients and included PE (n = 4), new caval thrombosis (n = 14), retroperitoneal hemorrhage (n = 2), and maldeployed filters (n = 2). CONCLUSIONS: IVC filters were shown to be safe and highly effective in preventing PE-related deaths in patients with cancer with VTE disease. Patients with a history of DVT and bleeding or metastatic/disseminated stage of disease had the lowest survival after IVC filter placement.