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Toxicity of water accommodated fractions (WAF) from the oil spilled on the Brazilian coast at different stages of weathering were investigated using Danio rerio. Weathering stages included emulsified oil that reached the coast (OM) and oil collected 50 days later deposited on beach sand (OS) or adhered to shore rocks (OR). Parent and alkylated naphthalenes decreased whereas phenanthrenes increased from less weathered WAF-OM to more weathered WAF-OS and WAF-OR. More weathered WAF-OS and WAF-OR were more potent inducers of zebrafish developmental delay, suggesting that parent and alkylated phenanthrenes are involved. However, less weathered WAF-OM was a more potent inducer of failure in swim-bladder inflation than more weathered WAF-OS and WAF-OR, suggesting that parent and alkylated naphthalenes are involved. Decreases in heart rates and increased heart and skeletal deformities were observed in exposed larvae. Lowest observed effect concentrations for different developmental toxicity endpoints are within environmentally relevant polycyclic aromatic hydrocarbon concentrations.
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To investigate the potential relationship between HLA alleles and haplotypes and the age at diagnosis of type 1 diabetes (T1DAgeD) in an admixed Brazilian population. This nationwide study was conducted in public clinics across 12 Brazilian cities. We collected demographic and genetic data from 1,600 patients with T1D. DNA samples were utilised to determine genomic ancestry (GA) and perform HLA typings for DRB1, DQA1 and DQB1. We explored allele and haplotype frequencies and GA in patients grouped by T1DAgeD categories (<6 years, ≥6-<11 years, ≥11-<19 years and ≥19 years) through univariate and multivariate analyses and primary component analyses. Additionally, we considered self-reported colour-race and identified a familiar history of T1D in first-degree relatives. The homozygosity index for DRB1~DQA1~DQB1 haplotypes exhibited the highest variation among T1DAgeD groups, and the percentages of Sub-Saharan African and European ancestries showed opposite trends in principal component analysis (PCA) analyses. Regarding the association of alleles and haplotypes with T1DAgeD, risk alleles such as HLA-DQB1*03:02g, -DQA1*03:01g, -02:01g, DRB1*04:05g and -04:02g were more frequently observed in heterozygosity or homozygosity in T1D patients with an early disease onset. Conversely, alleles such as DRB1*07:01g, -13:03g, DQB1*06:02g and DQA1*02:01 were more prevalent in older T1D patients. The combination DR3/DR4.5 was significantly associated with early disease onset. However, gender, GA, familiar history of T1D and self-reported colour-race identity did not exhibit significant associations with the onset of T1D. It is worth noting that the very common risk haplotype DRB1*03:01g~DQA1*05:01g~DQB1*02:01g did not differentiate between T1DAgeD groups. In the admixed Brazilian population, the high-risk haplotype DRB1*04:05~DQA1*03:01~DQB1*03:02 was more prevalent in individuals diagnosed before 6 years of age. In contrast, the protective alleles DQA1*01:02g, DQB1*06:02g, DRB1*07:01g and DRB1*13:03g and haplotypes DRB1*13:03g~DQA1*05:01g~DQB1*03:01g and DRB1*16:02g~DQA1*01:02g~DQB1*05:02g were more frequently observed in patients diagnosed in adulthood. Notably, these associations were independent of factors such as sex, economic status, GA, familiar history of T1D and region of birth in Brazil. These alleles and haplotypes contribute to our understanding of the disease onset heterogeneity and may have implications for early interventions when detected in association with well-known genomic risk or protection factors for T1D.
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Alelos , Diabetes Mellitus Tipo 1 , Frecuencia de los Genes , Haplotipos , Humanos , Brasil/epidemiología , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/diagnóstico , Masculino , Femenino , Niño , Adolescente , Adulto , Preescolar , Adulto Joven , Predisposición Genética a la Enfermedad , Cadenas HLA-DRB1/genética , Cadenas alfa de HLA-DQ/genética , Cadenas beta de HLA-DQ/genética , Edad de Inicio , Lactante , Persona de Mediana EdadRESUMEN
OBJECTIVES: To compare spinal and lower limb pain in adolescents regarding prevalence, characteristics, causes, and impact. METHODS: A descriptive cross-sectional study was conducted in 13-year-old adolescents (female n=2210; male n=2353) from the Portuguese Generation XXI birth cohort. Data were collected between 2018 and 2020 through personal interviews by applying the Luebeck Pain Questionnaire. The pain features examined in each anatomical location (back and lower limb) were recurrence, duration, frequency, intensity, perceived causes, and impact on school and leisure activities. Frequencies and the Chi-square test were used. RESULTS: Questionnaires from 4563 adolescents were analysed, 57.9% had pain in the last three months (main pain in the spine: 11.6%; main pain in the lower limb: 29.0%). Of those, 69.4% and 62.4% reported recurrent pain in the spine and lower limb, respectively. Recurrent pain was more frequent in girls than in boys (spine: 80.0%; 57.0%; lower limb: 70.4%; 58.1% respectively). Pain lasted more than three months in most adolescents (spine: about 60%; lower limb: above 50%); frequency was similarly high in both regions and both sexes (girls: 47.0%; boys: 45.7% in the spine; girls: 45.7%; boys: 40.3% in the lower limb); intensity was rated as high by girls (spine: 45.5%; lower limb: 47.3%) and moderate by boys (spine: 42.0%; lower limb: 41.0%). The leading causes of pain were daily living activities, both for the spine (girls: 65.9%; boys: 76.5%) and the lower limb (girls: 62.2%; boys: 72.1%). Psychosocial causes were the second most common cause of spinal pain (girls: 25.0%; boys: 21.0%). Other causes of lower limb pain were traumatic (girls: 25.5%; boys: 16.6%) and physical factors (girls: 20.7%; boys: 23.8%). Absences from school (girls: 11.7%; boys: 4.8%) and restrictions of leisure activities (girls: 20.7%; boys: 25.2%) were more related to pain in the lower limb. CONCLUSION: More than half of the adolescents reported spinal or lower limb recurrent pain, which presents a higher frequency, higher intensity, and longer duration in the spine. However, lower limb pain led to more concurrent limitations.
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Extremidad Inferior , Recurrencia , Humanos , Masculino , Femenino , Adolescente , Estudios Transversales , Prevalencia , Extremidad Inferior/fisiopatología , Portugal/epidemiología , Encuestas y Cuestionarios , Dimensión del Dolor , Dolor de Espalda/epidemiologíaRESUMEN
The advent of ultra-minimally invasive endoscopic spine surgery, characterized by significantly reduced surgery times, minimal blood loss, and minimal tissue trauma, has precipitated a paradigm shift in the preoperative management of patients with cardiac disease undergoing elective spine procedures. This perspective article explores how these advancements have influenced the requirements for preoperative cardiac workups and the protocols surrounding the cessation of anticoagulation and antiplatelet therapies. Traditionally, extensive cardiac evaluations and the need to stop anticoagulation and antiplatelet agents have posed challenges, increasing the risk of cardiac events and delaying surgical interventions. However, the reduced invasiveness of endoscopic spine surgery presents a safer profile for patients with cardiac comorbidities, potentially minimizing the necessity for rigorous cardiac clearance and allowing for more flexible anticoagulation management. This perspective article synthesizes current research and clinical practices to provide a comprehensive overview of these evolving protocols. It also discusses the implications of these changes for patient safety, surgical outcomes, and overall healthcare efficiency. Finally, the article suggests directions for future research, emphasizing the need for updated guidelines that reflect the reduced perioperative risk associated with these innovative surgical techniques. This discussion is pivotal for primary care physicians, surgeons, cardiologists, and the broader medical community in optimizing care for this high-risk patient population.
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The aim of this study is to identify the factors associated with mortality in patients with COVID-19 undergoing invasive mechanical ventilation at a university hospital in Northeastern Brazil. This is a retrospective cohort from April to August 2020 through an analysis of medical records, considering the demographic profile, comorbidities, complications, supports, respiratory and laboratory parameters. A total of 65 patients required invasive mechanical ventilation, of which 64.6% died in the ICU. They were older, had more comorbidities, shorter length of stay in the intensive care unit, received more support such as palliative care and two vasopressors simultaneously, showed lower levels of pH, hemoglobin and calcium, and higher levels of bicarbonate, lactate, prothrombin time, international normalized ratio, troponin and ferritin at the start of invasive mechanical ventilation. Furthermore, the time course of pH, arterial oxygen partial pressure to fractional inspired oxygen ratio, arterial carbon dioxide partial pressure, lactate, hemoglobin, platelets, lymphocytes, neutrophil-to-lymphocyte ratio, coagulation parameters, calcium, urea, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, ferritin, static compliance, airway resistance, tidal volume, and noradrenaline doses showed association with mortality. There was a high mortality rate in invasively mechanically ventilated COVID-19 patients, with some associated factors identified at the start of invasive mechanical ventilation and others identified over time.
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COVID-19 , Hospitales Universitarios , Respiración Artificial , Humanos , COVID-19/mortalidad , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Brasil/epidemiología , Respiración Artificial/estadística & datos numéricos , Anciano , SARS-CoV-2 , Unidades de Cuidados Intensivos/estadística & datos numéricos , Mortalidad Hospitalaria , Factores de Riesgo , Adulto , Comorbilidad , Tiempo de Internación/estadística & datos numéricosRESUMEN
RATIONALE: Conjugation sites are a quality attribute of conjugate vaccines. Proteolysis of bioconjugates synthesized by maleimide-thiol chemistry generates type 2 peptides with a hydrolyzed thiosuccinimide linker containing information on the conjugation sites. A mass spectrometry (MS)-cleavable linker could make the identification of conjugation sites by MS more reliable. METHODS: Four synthetic type 2 peptides with a hydrolyzed thiosuccinimide linker were analyzed by matrix-assisted laser desorption ionization (MALDI) MS/MS with and without collision gas. These peptides were also partially labeled with 18O in the linker to confirm the proposed fragmentation mechanism. A conjugate vaccine with the hydrolyzed thiosuccinimide linker was reduced and S-alkylated, digested with trypsin and analyzed by liquid chromatography-MS/MS using collision-induced dissociation (CID) and higher-energy collisional dissociation (HCD) fragmentation methods at a normalized collision energy of 30. RESULTS: A metastable fragmentation preferentially cleaves the newly formed pseudopeptide bond within the hydrolyzed thiosuccinimide linker of type 2 peptides to yield P + 71 and C + 98 ions. These ions make the assignment of conjugation sites more reliable. Partial 18O-labeling and MS/MS analysis confirmed the proposed structures. CID produces these ions as the two most intense signals more favorably than HCD. The latter also yields these ions, guarantees better sequence coverage and promotes other fragmentations in the linker. CONCLUSIONS: Hydrolyzed thiosuccinimide linker is cleavable in MALDI and electrospray ionization MS/MS analysis by a gas-phase metastable fragmentation. The resulting fragment ions (P + 71 and C + 98) make the identification of conjugation sites more reliable. These results could be extended to self-hydrolyzing maleimides, which efficiently stabilize the thiosuccinimide linker upon hydrolysis, in antibody-drug conjugates.
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Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Succinimidas , Espectrometría de Masas en Tándem , Vacunas Conjugadas , Succinimidas/química , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Espectrometría de Masas en Tándem/métodos , Vacunas Conjugadas/química , Péptidos/química , HidrólisisRESUMEN
This study evaluated the bone incorporation process of a screw-shaped internal fixation device made of poly (L-lactide-co-D, L-lactide) (PLDLLA). Thirty-two male Wistar rats received 32 fixation devices (2 mm × 6 mm) randomly assigned to either the right or left tibia and one implant in each animal. After 7, 14, 28, and 42 days, the rats were euthanized and the specimens were subjected to microtomographic computed tomography (microCT) and histomorphometric analyses to evaluate bone interface contact (BIC%) and new bone formation (NBF%) in cortical and cancellous bone areas. The animals euthanized on days 28 and 42 were treated with calcein and alizarin red, and confocal LASER microscopy was performed to determine the mineral apposition rate (MAR). Micro-CT revealed a higher percentage of bone volume (p < 0.006), trabecular separation (p < 0.001), and BIC in the cortical (p < 0.001) and cancellous (p = 0.003) areas at 28 and 42 days than at 7 and 14 days. The cortical NBF at 42 days was greater than that at 7 and 14 days (p = 0.022). No statistically significant differences were observed in cancellous NBF or MAR at 28 and 42 days. Based on these results, it can be seen that the PLDLLA internal fixation device is biocompatible and allows new bone formation around the screw thread.
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Comprehending digital content written in natural language online is vital for many aspects of life, including learning, professional tasks, and decision-making. However, facing comprehension difficulties can have negative consequences for learning outcomes, critical thinking skills, decision-making, error rate, and productivity. This paper introduces an innovative approach to predict comprehension difficulties at the local content level (e.g., paragraphs). Using affordable wearable devices, we acquire physiological responses non-intrusively from the autonomous nervous system, specifically pulse rate variability, and electrodermal activity. Additionally, we integrate data from a cost-effective eye-tracker. Our machine learning algorithms identify 'hotspots' within the content and regions corresponding to a high cognitive load. These hotspots represent real-time predictors of comprehension difficulties. By integrating physiological data with contextual information (such as the levels of experience of individuals), our approach achieves an accuracy of 72.11% ± 2.21, a precision of 0.77, a recall of 0.70, and an f1 score of 0.73. This study opens possibilities for developing intelligent, cognitive-aware interfaces. Such interfaces can provide immediate contextual support, mitigating comprehension challenges within content. Whether through translation, content generation, or content summarization using available Large Language Models, this approach has the potential to enhance language comprehension.
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Comprensión , Aprendizaje Automático , Dispositivos Electrónicos Vestibles , Humanos , Comprensión/fisiología , Femenino , Masculino , Adulto , Algoritmos , Adulto Joven , Cognición/fisiología , Frecuencia Cardíaca/fisiologíaRESUMEN
Dacarbazine (DTIC) is a widely prescribed oncolytic agent to treat advanced malignant melanomas. Nevertheless, the drug is known for exhibiting low and pH-dependent solubility, in addition to being photosensitive. These features imply the formation of the inactive photodegradation product 2-azahypoxanthine (2-AZA) during pharmaceutical manufacturing and even drug administration. We have focused on developing novel DTIC salt/cocrystal forms with enhanced solubility and dissolution behaviors to overcome or minimize this undesirable biopharmaceutical profile. By cocrystallization techniques, two salts, two cocrystals, and one salt-cocrystal have been successfully prepared through reactions with aliphatic carboxylic acids. A detailed structural study of these new multicomponent crystals was conducted using X-ray diffraction (SCXRD, PXRD), spectroscopic (FT-IR and 1H NMR), and thermal (TG and DSC) analyses. Most DTIC crystal forms reported display substantial enhancements in solubility (up to 19-fold), with faster intrinsic dissolution rates (from 1.3 to 22-fold), contributing positively to reducing the photodegradation of DTIC in solution. These findings reinforce the potential of these new solid forms to enhance the limited DTIC biopharmaceutical profile.
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Cristalización , Dacarbazina , Fotólisis , Solubilidad , Difracción de Rayos X , Dacarbazina/química , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Espectroscopía de Resonancia Magnética , Rastreo Diferencial de CalorimetríaRESUMEN
Coping with the recent COVID-19 pandemic has shown that the Brazilian Unified Health System (SUS) needs to improve its resilience to handle the rapid spread of communicable diseases while ensuring the necessary care for an aging population with comorbidities and in a vulnerable situation. This article identifies, analyzes, and discusses critical aspects of the resilience of the SUS, calling into question the prevailing focus on the robustness and volume of resources mobilized during the outbreak of major disasters. Recent studies demonstrate that the skills that favor adaptation to unexpected situations emerge from the daily functioning of organizations. Restricting the discussion to the mobilization of structures to respond to adverse events has the effect of limiting their potential, inhibiting the emergence of the transformative, adaptive, anticipatory, and learning skills necessary for the sustainable development of resilience.
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COVID-19 , Programas Nacionales de Salud , Pandemias , Humanos , Brasil , COVID-19/prevención & control , COVID-19/epidemiología , Planificación en Desastres , SARS-CoV-2 , Atención a la SaludRESUMEN
PURPOSE: The main purpose of our study was to evaluate satisfaction, recurrence, bone union and other complications after a minimum of two years follow-up in patients who had percutaneous claw and hammer (CHT) second toe correction utilizing a novel distal and bicortical proximal phalanx osteotomy (DBPPO). METHODS: A minimum two-year follow-up prospective cohort study was conducted on consecutive patients with symptomatic CHT deformities of the second toe corrected with percutaneous surgery. Primary outcomes included satisfaction, recurrence, bony union, and other complication rates specific to the second toe deformity correction. Secondary outcomes included Metatarsophalangeal-Interphalangeal AOFAS scale and Visual Analogue Scale (VAS). RESULTS: Between January and October 2020, 34 patients (43 feet) were clinically and radiologically evaluated pre and postoperatively at a mean of 26.6 months. Thirty-eight feet (88.4 %) were satisfied or very satisfied with their second toe deformity correction and 41 feet (95.3 %) would undergo surgery on this toe again. No deformity recurrence requiring revision was found. There were two complications (4.7 %): one toe (2.3 %) with persistent numbness and one (2.3 %) had a simple infection that resolved with oral antibiotics. All 43 s toe osteotomies demonstrated bony consolidation. Stiffness was reported in nine second toes (20.9 %), seven of them (77.8 %) having a rigid pre-operative deformity. Secondary outcomes demonstrated significant improvement in the mean ( ± standard deviation) AOFAS score which increased from 47.5 ± 17.9 preoperatively to 95.7 ± 7.7 postoperatively (p < .001). Mean VAS significantly improved from 4.9 ± 2.5 preoperatively to 0.3 ± 1.3 postoperatively (p < .001). CONCLUSION: Percutaneous treatment of claw and hammer second toe deformities utilizing a DBPPO resulted in high levels of satisfaction with bony consolidation, no recurrence and low complication rates at two years follow-up. LEVEL OF EVIDENCE: Level II - Prospective cohort study.
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BACKGROUND: Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries. OBJECTIVE: To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil. DESIGN AND SETTING: Retrospective cohort study conducted in two tertiary reference centers. METHODS: This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge. RESULTS: Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit. CONCLUSION: Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.
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Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Femenino , Embarazo , Estudios Retrospectivos , Brasil/epidemiología , Adulto , Recién Nacido , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Embarazo , Enfermedades Fetales/cirugía , Complicaciones del Embarazo/cirugía , Edad Gestacional , Adulto Joven , Mortalidad PerinatalRESUMEN
The thermal conductivity κ of cyclopentane clathrate hydrate (CP CH) of type II was measured at temperatures down to 100 K and at pressures up to 1.3 GPa. The results show that CP CH displays amorphous-like κ characteristic of many crystalline clathrate hydrates, e.g., tetrahydrofuran (THF) CH. The magnitude of κ is 0.47 W m-1 K-1 near the melting point of 280 K at atmospheric pressure, and it is almost independent of pressure and temperature T: ln κ = -0.621-40.1/T at atmospheric pressure (in SI-units). This is slightly less than κ of type II CHs of water-miscible solvents such as THF. Intriguingly, unlike other water-rich type II clathrate hydrates of water-miscible molecules M (M·17 H2O), CP CH does not amorphize at pressures up to 1.3 GPa at 130 K and also remains stable up to 0.5 GPa at 240 K. This shows that CP CH is mechanically more stable than the previously studied water-rich type II CHs, and suggests that repulsive forces between CP and the H2O cages increase the mechanical stability of crystalline CP CH. Moreover, we show that κ of an ice-CH mixture, which often arises for CHs that form naturally, is described by the average of the parallel and series heat conduction models to within 5% for ice contents up to 22 wt%. The findings provide a better understanding of the thermal and stability properties of clathrate hydrates for their applications such as gas storage compounds.
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Photoaging is the premature aging of the skin caused by prolonged exposure to solar radiation. The visual alterations manifest as wrinkles, reduced skin elasticity, uneven skin tone, as well as other signs that surpass the expected outcomes of natural aging. Beyond these surface changes, there is a complex interplay of molecular alterations, encompassing shifts in cellular function, DNA damage, and protein composition disruptions. This data descriptor introduces a unique dataset derived from ten individuals, each with a minimum of 18 years of professional experience as a driver, who are asymmetrically and chronically exposed to solar radiation due to their driving orientation. Skin samples were independently collected from each side of the face using a microdermabrasion-like procedure and analyzed on an Exploris 240 mass spectrometer. Our adapted proteomic statistical framework leverages the sample pairing to provide robust insights. This dataset delves into the molecular differences in exposed skin and serves as a foundational resource for interdisciplinary research in photodermatology, targeted skincare treatments, and computational modelling of skin health.
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Cara , Espectrometría de Masas , Proteómica , Envejecimiento de la Piel , Piel , Piel/efectos de la radiación , Piel/metabolismo , Humanos , Luz SolarRESUMEN
This study aimed to assess an ultra-diluted (UD) complex, as a replacement for an antimicrobial growth promoter in diets, on growth performance, intestinal health, and inflammatory response of nursery piglets. The experiment lasted 37 days and involved 126 animals weaned at 21 ± 1.3 d, with an initial body weight of 5.62 ± 1.16 kg. Piglets were assigned to six dietary treatments in a randomized block design with seven replicates and three piglets per pen as experimental unit. The treatments were: positive control (PC)- basal diet + 120 mg/kg of chlorohydroxyquinoline; negative control (NC)- basal diet without additives; and NC containing 4.5; 6.0; 7.5 or 9.0 kg of UD additive/ton diet. Performance data were calculated, and daily diarrhea was observed. Blood samples were collected for hematological analysis. At the end of the experiment, one animal per pen was slaughtered for organ weighing, pH, and the collection of intestinal samples for histopathology. Feces and cecal contents were collected for microbiological and antibiogram analyses. There was no difference in the performance between the treatments. Throughout the study, UD levels were equal to those of PC for diarrhea occurrence. Higher levels of UD complex led to higher total leukocyte counts. The 4.5 treatment showed a reduction in total and thermotolerant Enterobacteriaceae populations in piglet feces and an increase in lactic acid bacteria compared to PC. All treatments resulted in fewer duodenal histopathological alterations than those in the NC group. The use of UD additives, especially at 4.5 kg/ton, is a good alternative to chlorohydroxyquinoline in piglet diets.
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Alimentación Animal , Dieta , Animales , Alimentación Animal/análisis , Dieta/veterinaria , Porcinos , Suplementos Dietéticos/análisis , Intestinos/efectos de los fármacos , Intestinos/microbiología , Enfermedades de los Porcinos/prevención & control , Enfermedades de los Porcinos/microbiología , Diarrea/veterinaria , Diarrea/prevención & control , Distribución Aleatoria , Sus scrofaRESUMEN
BACKGROUND: With the growing prevalence of lumbar spinal stenosis, endoscopic surgery, which incorporates techniques such as transforaminal, interlaminar, and unilateral biportal (UBE) endoscopy, is increasingly considered. However, the patient selection criteria are debated among spine surgeons. OBJECTIVE: This study used a polytomous Rasch analysis to evaluate the factors influencing surgeon decision-making in selecting patients for endoscopic surgical treatment of lumbar spinal stenosis. METHODS: A comprehensive survey was distributed to a representative sample of 296 spine surgeons. Questions encompassed various patient-related and clinical factors, and responses were captured on a logit scale graphically displaying person-item maps and category probability curves for each test item. Using a Rasch analysis, the data were subsequently analyzed to determine the latent traits influencing decision-making. RESULTS: The Rasch analysis revealed that surgeons' preferences for transforaminal, interlaminar, and UBE techniques were easily influenced by comfort level and experience with the endoscopic procedure and patient-related factors. Harder-to-agree items included technological aspects, favorable clinical outcomes, and postoperative functional recovery and rehabilitation. Descriptive statistics suggested interlaminar as the best endoscopic spinal stenosis decompression technique. However, logit person-item analysis integral to the Rasch methodology showed highest intensity for transforaminal followed by interlaminar endoscopic lumbar stenosis decompression. The UBE technique was the hardest to agree on with a disordered person-item analysis and thresholds in category probability curve plots. CONCLUSION: Surgeon decision-making in selecting patients for endoscopic surgery for lumbar spinal stenosis is multifaceted. While the framework of clinical guidelines remains paramount, on-the-ground experience-based factors significantly influence surgeons' selection of patients for endoscopic lumbar spinal stenosis surgeries. The Rasch methodology allows for a more granular psychometric evaluation of surgeon decision-making and accounts better for years-long experience that may be lost in standardized clinical guideline development. This new approach to assessing spine surgeons' thought processes may improve the implementation of evidence-based protocol change dictated by technological advances was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the International Society for Minimal Intervention in Spinal Surgery (ISMISS), the Mexican Spine Society (AMCICO), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Society (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS).
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BACKGROUND: Effective 1 January 2017, single-level endoscopic lumbar discectomy received a Category I Current Procedural Terminology (CPT) code 62380. However, no work relative value units (RVUs) are currently assigned to the procedure. An international team of endoscopic spine surgeons conducted a study, endorsed by several spine societies, analyzing the learning curve, difficulty, psychological intensity, and estimated work RVUs of endoscopic lumbar spinal decompression compared with other common lumbar spine surgeries. METHODS: A survey comparing CPT 62380 to 10 other comparator CPT codes reflective of common spine surgeries was developed to assess the work RVUs in terms of learning curve, difficulty, psychological intensity, and work effort using a paired Rasch method. RESULTS: The survey was sent to 542 spine specialists. Of 322 respondents, 150 completed the survey for a 43.1% completion rate. Rasch analysis of the submitted responses statistically corroborated common knowledge that the learning curve with lumbar endoscopic spinal surgery is steeper and more complex than with traditional translaminar lumbar decompression surgeries. It also showed that the psychological stress and mental and work effort with the lumbar endoscopic decompression surgery were perceived to be higher by responding spine surgeons compared with posterior comparator decompression and fusion surgeries and even posterior interbody and posterolateral fusion surgeries. The regression analysis of work effort vs procedural difficulty showed the real-world evaluation of the lumbar endoscopic decompression surgery described in CPT code 62380 with a calculated work RVU of 18.2464. CONCLUSION: The Rasch analysis suggested the valuation for the endoscopic lumbar decompression surgery should be higher than for standard lumbar surgeries: 111.1% of the laminectomy with exploration and/or decompression of spinal cord and/or cauda equina (CPT 63005), 118.71% of the laminectomy code (CPT 63047), which includes foraminotomy and facetectomy, 152.1% of the hemilaminectomy code (CPT 63030), and 259.55% of the interlaminar or interspinous process stabilization/distraction without decompression code (CPT 22869). This research methodology was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the Mexican Society of Spinal Surgeons (AMCICO), the International Society For Minimally Invasive Spine Surgery (ISMISS), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Surgery (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS). CLINICAL RELEVANCE: This study provides an updated reimbursement recommendation for endoscopic spine surgery. LEVEL OF EVIDENCE: Level 3.
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Cognitive human error and recent cognitive taxonomy on human error causes of software defects support the intuitive idea that, for instance, mental overload, attention slips, and working memory overload are important human causes for software bugs. In this paper, we approach the EEG as a reliable surrogate to MRI-based reference of the programmer's cognitive state to be used in situations where heavy imaging techniques are infeasible. The idea is to use EEG biomarkers to validate other less intrusive physiological measures, that can be easily recorded by wearable devices and useful in the assessment of the developer's cognitive state during software development tasks. Herein, our EEG study, with the support of fMRI, presents an extensive and systematic analysis by inspecting metrics and extracting relevant information about the most robust features, best EEG channels and the best hemodynamic time delay in the context of software development tasks. From the EEG-fMRI similarity analysis performed, we found significant correlations between a subset of EEG features and the Insula region of the brain, which has been reported as a region highly related to high cognitive tasks, such as software development tasks. We concluded that despite a clear inter-subject variability of the best EEG features and hemodynamic time delay used, the most robust and predominant EEG features, across all the subjects, are related to the Hjorth parameter Activity and Total Power features, from the EEG channels F4, FC4 and C4, and considering in most of the cases a hemodynamic time delay of 4 seconds used on the hemodynamic response function. These findings should be taken into account in future EEG-fMRI studies in the context of software debugging.
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Encéfalo , Electroencefalografía , Humanos , Electroencefalografía/métodos , Encéfalo/fisiología , Imagen por Resonancia Magnética/métodos , Programas Informáticos , Imagen Multimodal , CogniciónRESUMEN
Cognitive science of learning points to solutions for making use of existing study and instruction time more effectively and efficiently. However, solutions are not and cannot be one-size-fits-all. This paper outlines the danger of overreliance on specific strategies as one-size-fits-all recommendations and highlights instead the cognitive learning processes that facilitate meaningful and long-lasting learning. Three of the most commonly recommended strategies from cognitive science provide a starting point; understanding the underlying processes allows us to tailor these recommendations to implement at the right time, in the right way, for the right content, and for the right students. Recommendations regard teacher training, the funding and incentivizing of educational interventions, guidelines for the development of educational technologies, and policies that focus on using existing instructional time more wisely.
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Small molecules are components of fungal extracellular vesicles (EVs), but their biological roles are only superficially known. NOP16 is a eukaryotic gene that is required for the activity of benzimidazoles against Cryptococcus deuterogattii. In this study, during the phenotypic characterization of C. deuterogattii mutants expected to lack NOP16 expression, we observed a reduced EV production. Whole-genome sequencing, RNA-Seq, and cellular proteomics revealed that, contrary to our initial findings, these mutants expressed Nop16 but exhibited altered expression of 14 genes potentially involved in sugar transport. Based on this observation, we designated these mutant strains as Past1 and Past2, representing potentially altered sugar transport. Analysis of the small molecule composition of EVs produced by wild-type cells and the Past1 and Past2 mutant strains revealed not only a reduced number of EVs but also an altered small molecule composition. In a Galleria mellonella model of infection, the Past1 and Past2 mutant strains were hypovirulent. The hypovirulent phenotype was reverted when EVs produced by wild-type cells, but not mutant EVs, were co-injected with the mutant cells in G. mellonella. These results connect EV biogenesis, cargo, and cryptococcal virulence.