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Easily accessible robust synthesis of metallic nanoparticles (NPs) and their colloidal stabilization via successive surface functionalization with desired molecules are crucial for catalytic applications. In this research, tannic acid (TA)-functionalized bismuth (Bi)-based novel NPs were prepared via a simple in situ aqueous reduction of Bi3+ ions for the catalytic reduction of azo groups. The synthesis, morphology, and structure of Bi/TANPs were confirmed through spectroscopic, electron microscopic and X-ray diffraction analyses. The Bi/TANPs comprise Bi, carbon, oxygen and sodium as building components and possess a high negative surface charge of -58 mV, colloidal dispersity, thermal stability and crystalline structure. The Bi/TANPs are almost spherical shaped with an average diameter of 33 nm. The surface of the catalyst is mesoporous with a high specific surface area of 267 m2 g-1. The designed Bi/TANPs exhibit pH-specific affinity for azo dye molecules and reduced azo moieties in the presence of aqueous NaBH4 without requiring any hydrogen gas supply. The catalytic reduction efficiencies of Bi/TANPs against methylene blue and Congo red are almost 100%. These reduction reactions are very fast owing to the presence of TA moieties on the catalyst surface, which facilitate direct electron transfer to azo groups, and follow a pseudo-first-order kinetic model. The catalyst is mechanically recyclable, and shows a minimal loss (<3%) of its initial efficiency until the fifth cycle. This study not only developed an efficient catalyst for the remediation of azo dye-contaminated water, but also offers novel insights into the synergistic effects of TA and glycerin on the reduction mechanism of aqueous Bi3+ ions and the concomitant colloidal stabilization of Bi NPs.
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pH-responsive polymer microspheres undergoing reversible changes in their surface properties have been proved useful for drug delivery to targeted sites. This paper is aimed at preparing pH-responsive polymer-modified magnetic mesoporous SiO2 particles. First, mesoporous magnetic (Fe3O4) core-particles are prepared using a one-pot solvothermal method. Then, magnetic Fe3O4 particles are covered with a C[double bond, length as m-dash]C functional mesoporous SiO2 layer before seeded emulsion polymerization of 2-carboxyethyl acrylate (2-CEA). The composite polymer particles are named Fe3O4/SiO2/P(2-CEA). The average diameters of the Fe3O4 core and Fe3O4/SiO2/P(2-CEA) composite polymer particles are 414 and 595 nm, respectively. The mesoporous (pore diameter = 3.41 nm) structure of Fe3O4/SiO2/P(2-CEA) composite polymer particles is confirmed from Brunauer-Emmett-Teller (BET) surface analysis. The synthesized Fe3O4/SiO2/P(2-CEA) composite polymer exhibited pH-dependent changes in volume and surface charge density due to deprotonation of the carboxyl group under alkaline pH conditions. The change in the surface properties of Fe3O4/SiO2/P(2-CEA) composite polymer particles following pH change is confirmed from the pH-dependent sorption of cationic methylene blue (MB) and anionic methyl orange (MO) dye molecules. The opening of the pH-responsive P(2-CEA) gate valve at pH 10.0 allowed the release of loaded vancomycin up to 99% after 165 min and p-acetamido phenol (p-AP) up to 46% after 225 min. Comparatively, the amount of release is lower at pH 8.0 but still suitable for drug delivery applications. These results suggested that the mesoporous Fe3O4/SiO2 composite seed acted as a microcapsule, while P(2-CEA) functioned as a gate valve across the porous channel. The prepared composite polymer can therefore be useful for treating intestine/colon cancer, where the pH is comparatively alkaline.
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Persistent trigeminal artery (PTA) is the most common remnant of the primitive carotid-vertebrobasilar anastomoses, which typically form and obliterate during the early stages of human embryonic development. While PTA can be non-pathologic and is usually an incidental finding, it is also associated with various other vascular abnormalities, such as arteriovenous malformations and fistulae, but most commonly cerebral aneurysms. In these cases, aneurysms are usually reported in the anterior cerebral circulation or in the PTA trunk itself; to date, only one report exists of an associated aneurysm in the posterior circulation (basilar artery). These associated vascular pathologies are not only a source of morbidity and mortality but can also complicate subsequent endovascular treatment due to different flow patterns and increased vessel tortuosity. In this case report, we present the first reported case of PTA-associated aneurysm in the anterior inferior cerebellar artery and its resulting impact on the endovascular treatment of this aneurysm.
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An alternative way for the coating of polypyrrole (PPy) polymer on hydrophobic magnetite (Fe3O4) nanoparticles is reported here to capture toxic chromium ions, Cr (VI), present in water. Iron oxide magnetic nanoparticles (Fe3O4) were synthesized by the conventional coprecipitation technique using FeCl3·6H2O and FeSO4·7H2O iron precursors and subsequently modified with oleic acid (OA). Then OA-Fe3O4 hydrophobic nanoparticles were oxidized using the Lemieux-von Rudloff reaction to transfer OA into hydrophilic azelaic acid (AA) (HOOC(CH2)7COOH-modified magnetic nanoparticles (AA-Fe3O4). Finally, a PPy polymer coating was formed by a seeded polymerization of pyrrole, using AA-Fe3O4 as seeds. The average size of PPy/Fe3O4 nanocomposites is 12.33 nm and is almost spherical in shape. The surface composition is confirmed by FTIR and thermogravimetry analyses. An X-ray diffraction study confirmed the formation of highly crystalline Fe3O4 nanoparticles, and the crystallinity was retained after the surface modification. The adsorption study suggested that the Cr(VI) ion adsorption is highly pH-dependent and the maximum amount of adsorption is obtained at pH 2.0. The adsorption results revealed that the Langmuir model provided the best fit for the isotherm, with a maximum adsorption capacity reaching approximately 173.22 mg g-1 at 323 K. Spontaneous and endothermic adsorption processes were confirmed by evaluating the thermodynamic parameters obtained in this investigation. The kinetics study showed that the interaction between Cr(VI) ions and magnetic nanocomposites was directed by a pseudo-second-order rate process indicating chemisorption. The prepared PPy/Fe3O4 nanocomposites would be promising adsorbents to purify water by eliminating Cr(VI) metal ions from wastewater.
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Surface active amine-functionalized silica coated magnetic iron oxide nanoparticles were prepared by a simple two-step process for adsorbing CO2 gas from aqueous medium. First, oleic acid (OA) coated iron oxide magnetic particles (denoted as Fe3O4-OA) were prepared by a simple coprecipitation method. Then, the surface of the Fe3O4-OA particles was coated with silica by using tetraethyl orthosilicate. Finally, aminated Fe3O4/SiO2-NH2 nanoparticles were concomitantly formed by the reactions of 3-aminopropyl triethoxysilane with silica-coated particles. The formation of materials was confirmed by Fourier transform infrared spectral analysis. Transmission electron microscopic analysis revealed both spherical and needle-shaped morphologies of magnetic Fe3O4/SiO2-NH2 particles with an average size of 15 and 68.6 nm, respectively. The saturation magnetization of Fe3O4/SiO2-NH2 nanoparticles was found to be 33.6 emu g-1, measured by a vibrating sample magnetometer at ambient conditions. The crystallinity and average crystallite size (7.0 nm) of the Fe3O4/SiO2-NH2 particles were revealed from X-ray diffraction data analyses. Thermogravimetric analysis exhibited good thermal stability of the nanoadsorbent up to an elevated temperature. Zeta potential measurements revealed pH-sensitive surface activity of Fe3O4/SiO2-NH2 nanoparticles in aqueous medium. The produced magnetic Fe3O4/SiO2-NH2 nanoparticles also exhibited efficient proton capturing activity (92%). The particles were used for magnetically recyclable adsorption of aqueous CO2 at different pH values and temperatures. Fe3O4/SiO2-NH2 nanoparticles demonstrated the highest aqueous CO2 adsorption efficiency (90%) at 40 °C, which is clearly two times higher than that of nonfunctionalized Fe3O4-OA particles.
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This study investigates groundwater contamination by arsenic and iron and its health implications within the Sylhet district in Bangladesh. Utilizing geographic information system (GIS) and inverse distance weighting (IDW) methods, hazard maps have been developed to evaluate contamination risk across various upazilas. The findings show significant arsenic and iron pollution, particularly in the northwestern part of the district. In about 50% of the area, especially in Jaintiapur, Zakiganj, Companiganj, and Kanaighat where arsenic levels surpass 0.05 mg/L which is the standard limit of Bangladesh. Iron levels peak at 13.83 mg/L, severely impacting 45% of the region, especially in Gowainghat, northeastern Jaintiapur, Zakigonj, and Golabganj. The study employs USEPA health risk assessment methods to calculate the hazard quotient (HQ) and hazard index (HI) for both elements via oral and dermal exposure. Results indicate that children face greater noncarcinogenic and carcinogenic risks than adults, with oral HI showing significant risk in Balagonj and Bishwanath. Dermal adsorption pathways exhibit comparatively lower risks. Cancer risk assessments demonstrate high carcinogenic risks from oral arsenic intake in all areas. This comprehensive analysis highlights the urgent need for effective groundwater management and policy interventions in the Sylhet district to mitigate these health risks and ensure safe drinking water.
Subject(s)
Arsenic , Groundwater , Iron , Water Pollutants, Chemical , Groundwater/analysis , Groundwater/chemistry , Arsenic/analysis , Bangladesh , Water Pollutants, Chemical/analysis , Iron/analysis , Risk Assessment , Humans , Environmental Monitoring/methods , Geographic Information Systems , Drinking Water/analysis , Drinking Water/chemistryABSTRACT
OBJECTIVES: To evaluate the capability of using generative artificial intelligence (AI) in summarizing alert comments and to determine if the AI-generated summary could be used to improve clinical decision support (CDS) alerts. MATERIALS AND METHODS: We extracted user comments to alerts generated from September 1, 2022 to September 1, 2023 at Vanderbilt University Medical Center. For a subset of 8 alerts, comment summaries were generated independently by 2 physicians and then separately by GPT-4. We surveyed 5 CDS experts to rate the human-generated and AI-generated summaries on a scale from 1 (strongly disagree) to 5 (strongly agree) for the 4 metrics: clarity, completeness, accuracy, and usefulness. RESULTS: Five CDS experts participated in the survey. A total of 16 human-generated summaries and 8 AI-generated summaries were assessed. Among the top 8 rated summaries, five were generated by GPT-4. AI-generated summaries demonstrated high levels of clarity, accuracy, and usefulness, similar to the human-generated summaries. Moreover, AI-generated summaries exhibited significantly higher completeness and usefulness compared to the human-generated summaries (AI: 3.4 ± 1.2, human: 2.7 ± 1.2, P = .001). CONCLUSION: End-user comments provide clinicians' immediate feedback to CDS alerts and can serve as a direct and valuable data resource for improving CDS delivery. Traditionally, these comments may not be considered in the CDS review process due to their unstructured nature, large volume, and the presence of redundant or irrelevant content. Our study demonstrates that GPT-4 is capable of distilling these comments into summaries characterized by high clarity, accuracy, and completeness. AI-generated summaries are equivalent and potentially better than human-generated summaries. These AI-generated summaries could provide CDS experts with a novel means of reviewing user comments to rapidly optimize CDS alerts both online and offline.
Subject(s)
Artificial Intelligence , Decision Support Systems, Clinical , Medical Order Entry Systems , Humans , Electronic Health Records , Natural Language ProcessingABSTRACT
BACKGROUND: There are limited data on the impact of transcatheter heart valve (THV) type on the outcomes of surgical explantation after THV failure. AIMS: We sought to determine the outcomes of transcatheter aortic valve replacement (TAVR) explantation for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS: From November 2009 to February 2022, 401 patients across 42 centres in the EXPLANT-TAVR registry underwent TAVR explantation during a separate admission from the initial TAVR. Mechanically expandable valves (N=10, 2.5%) were excluded. The outcomes of TAVR explantation were compared for 202 (51.7%) failed BEV and 189 (48.3%) failed SEV. RESULTS: Among 391 patients analysed (mean age: 73.0±9.8 years; 33.8% female), the median time from index TAVR to TAVR explantation was 13.3 months (interquartile range 5.1-34.8), with no differences between groups. Indications for TAVR explantation included endocarditis (36.0% failed SEV vs 55.4% failed BEV; p<0.001), paravalvular leak (21.2% vs 11.9%; p=0.014), structural valve deterioration (30.2% vs 21.8%; p=0.065) and prosthesis-patient mismatch (8.5% vs 10.4%; p=0.61). The SEV group trended fewer urgent/emergency surgeries (52.0% vs 62.3%; p=0.057) and more root replacement (15.3% vs 7.4%; p=0.016). Concomitant cardiac procedures were performed in 57.8% of patients, including coronary artery bypass graft (24.8%), and mitral (38.9%) and tricuspid (14.6%) valve surgery, with no differences between groups. In-hospital, 30-day, and 1-year mortality and stroke rates were similar between groups (allp>0.05), with no differences in cumulative mortality at 3 years (log-rank p=0.95). On multivariable analysis, concomitant mitral surgery was an independent predictor of 1-year mortality after BEV explant (hazard ratio [HR] 2.00, 95% confidence interval [CI]: 1.07-3.72) and SEV explant (HR 2.00, 95% CI: 1.08-3.69). CONCLUSIONS: In the EXPLANT-TAVR global registry, BEV and SEV groups had different indications for surgical explantation, with more root replacements in SEV failure, but no differences in midterm mortality and morbidities. Further refinement of TAVR explantation techniques are important to improving outcomes.
Subject(s)
Transcatheter Aortic Valve Replacement , Humans , Female , Middle Aged , Aged , Aged, 80 and over , Male , Transcatheter Aortic Valve Replacement/adverse effects , Device Removal , Catheters , Heart Valves , RegistriesABSTRACT
BACKGROUND AND OBJECTIVES: Smartphone activity data recorded through high-fidelity accelerometry can provide accurate postoperative assessments of patient mobility. The "big data" available through smartphones allows for advanced analyses, yielding insight into patient well-being. This study compared rate of change in functional activity data between lumbar fusion (LF) and lumbar decompression (LD) patients to determine preoperative and postoperative course differences. METHODS: Twenty-three LF and 18 LD patients were retrospectively included. Activity data (steps per day) recorded in Apple Health, encompassing over 70 000 perioperative data points, was classified into 6 temporal epochs representing distinct functional states, including acute preoperative decline, immediate postoperative recovery, and postoperative decline. The daily rate of change of each patient's step counts was calculated for each perioperative epoch. RESULTS: Patients undergoing LF demonstrated steeper preoperative declines than LD patients based on the first derivative of step count data (P = .045). In the surgical recovery phase, LF patients had slower recoveries (P = .041), and LF patients experienced steeper postoperative secondary declines than LD patients did (P = .010). The rate of change of steps per day demonstrated varying perioperative trajectories that were not explained by differences in age, comorbidities, or levels operated. CONCLUSION: Patients undergoing LF and LD have distinct perioperative activity profiles characterized by the rate of change in the patient daily steps. Daily steps and their rate of change is thus a valuable metric in phenotyping patients and understanding their postsurgical outcomes. Prospective studies are needed to expand upon these data and establish causal links between preoperative patient mobility, patient characteristics, and postoperative functional outcomes.
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OBJECTIVE: Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels. METHODS: A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ2 analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared. RESULTS: The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P = 0.017) and attending neurosurgeon (P = 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P = 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P = 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P = 0.69). CONCLUSIONS: AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.
Subject(s)
Augmented Reality , Pedicle Screws , Robotic Surgical Procedures , Spinal Fusion , Surgery, Computer-Assisted , Humans , Neurosurgical Procedures , Lumbar Vertebrae/surgeryABSTRACT
BACKGROUND: Cervical fusion rates increased in the U.S. exponentially 1990-2014, but trends leading up to/during the COVID-19 pandemic have not been fully evaluated by patient socioeconomic status (SES). Here, we provide the most recent, comprehensive characterization of demographic and SES trends in cervical fusions, including during the pandemic. METHODS: We collected the following variables on adults undergoing cervical fusions, 1/1/2004-3/31/2021, in Optum's Clinformatics Data Mart: age, Charlson Comorbidity Index, provider's practicing state, gender, race, education, and net worth. We performed multivariate linear and logistic regression to evaluate associations of cervical fusion rates with SES variables. RESULTS: Cervical fusion rates increased 2004-2016, then decreased 2016-2020. Proportions of Asian, Black, and Hispanic patients undergoing cervical fusions increased (OR = 1.001,1.001,1.004, P < 0.01), with a corresponding decrease in White patients (OR = 0.996, P < 0.001) over time. There were increases in cervical fusions in higher education groups (OR = 1.006, 1.002, P < 0.001) and lowest net worth group (OR = 1.012, P < 0.001). During the pandemic, proportions of White (OR = 1.015, P < 0.01) and wealthier patients (OR ≥ 1.015, P < 0.01) undergoing cervical fusions increased. CONCLUSIONS: We present the first documented decrease in annual cervical surgery rates in the U.S. Our data reveal a bimodal distribution for cervical fusion patients, with racial-minority, lower-net-worth, and highly-educated patients receiving increasing proportions of surgical interventions. White and wealthier patients were more likely to undergo cervical fusions during the COVID-19 pandemic, which has been reported in other areas of medicine but not yet in spine surgery. There is still considerable work needed to improve equitable access to spine care for the entire U.S.
Subject(s)
COVID-19 , Spinal Diseases , Spinal Fusion , Adult , Humans , Pandemics , COVID-19/epidemiology , Spinal Diseases/surgery , Socioeconomic Factors , Demography , Retrospective StudiesABSTRACT
Multifunctional surface-active polymeric composites are attractive materials for the adsorption of various small molecules. Herein, dual-functionalized micron-sized surface-active composite polymer particles were prepared by a three-step process for CO2 adsorption. First, polystyrene (PS) seed particles were prepared via the dispersion polymerization of styrene. PS/P(MMA-AAm-EGDMA) composite polymer particles were then synthesized by aqueous seeded copolymerization of methyl methacrylate (MMA) and acrylamide (AAm) in the presence of an ethylene glycol dimethacrylate (EGDMA) cross-linker. Finally, the amide moieties of PS/P(MMA-AAm-EGDMA) composite particles were converted into an amine-functionalized composite by using the Hofmann degradation reaction. The presence of primary amine groups on the surface of aminated composite particles was confirmed by some conventional chemical routes, such as diazotization and Schiff's base formation reactions. The formation and functionality of the PS seed, PS/P(MMA-AAm-EGDMA), and aminated PS/P(MMA-AAm-EGDMA) composite polymer particles were confirmed by Fourier transform infrared (FTIR) spectra analyses. Scanning electron microscopy (SEM) analysis revealed spherical shape, size, and surface morphologies of the PS seed, reference composite, and aminated composites. The elemental surface compositions, surface porosity, pore volume, pore diameter, and surface area of both composite particles were evaluated by energy-dispersive X-ray (EDX) mapping, X-ray photoelectron spectroscopy, and Brunauer-Emmett-Teller (BET) and Barrett-Joyner-Halenda (BJH) analyses. Dynamic light scattering (DLS) and ζ-potential measurements confirmed the pH-dependent surface properties of the functionalized particles. The amount of the adsorbed anionic emulsifier, sodium dodecyl sulfate (SDS), on the surface of aminated PS/P(MMA-AAm-EGDMA) is higher at pH 4 than that at pH 10. A vice versa result was found in the case of cationic surfactant, hexadecyltrimethylammonium bromide (HTABr), adsorption. Synthesized aminated composite particles were used as an adsorbent for CO2 adsorption via bubbling CO2 in an aqueous medium. The changes in dispersion pH were monitored continuously during the adsorption of CO2 under various conditions. The amount of CO2 adsorption by aminated composite particles was found to be 209 mg/g, which is almost double that of reference composite particles.
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BACKGROUND: We describe a technique to assess blood flow distal to the decannulation site after deployment of Perclose ProGlide (Abbott Vascular, Abbott Park, Ill) in patients on femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. TECHNIQUE: An antegrade distal perfusion catheter was placed in all patients, and decannulation was primarily performed at bedside (N = 11/12). With the VA-ECMO circuit switched off, a needle was inserted into the arterial tubing, passed through the femoral arterial cannula into the artery. The arterial cannula was removed over a wire and the previously placed Proglide Perclose sutures were secured. Back bleeding from the antegrade distal perfusion catheter, confirmed using a three-way connector, indicated blood flow to the superficial femoral artery. This was followed by confirmation of blood flow to the lower leg using a Doppler ultrasound. Hemostasis of the antegrade perfusion catheter was achieved through manual compression. RESULTS: We implemented this technique in 12 patients with a technical success rate of 100%. There were no ipsilateral leg ischemia, bleeding, pseudoaneurysm, or infection after decannulation. CONCLUSIONS: This technique allows prompt assessment of blood flow to the distal leg immediately following arterial decannulation.
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Citrus assamensis, commonly known as Adajamir, is an underutilized fruit with distinctive sensory and nutritional properties. The limited amount of research on this particular citrus type was recognized as one of the research gaps for this study. The objective of this study was to evaluate and compare the impacts of sonication, pasteurization, and thermosonication techniques on the quality and sensory attributes of Adajamir juice. A randomized experimental design was used in the study, wherein the juice underwent three different treatments. The results indicate that there were no significant changes in pH or titratable acidity following all treatments. Yet, notable differences in juice color were observed. The use of sonication and thermosonication resulted in an increase in ß-carotenoid levels. Additionally, total phenolic content and antioxidant activities were observed to increase. All three treatments led to a reduction in ascorbic acid levels relative to the control. However, the complete elimination of microbial growth was observed during the thermal treatment. Compared to other approaches, sonication has been shown to be notably more efficacious in enhancing both the flavor and aroma. Sonication has been observed to improve the perceived bitterness to a certain degree. These findings support the potential of sonication as an alternative preservation method for Adajamir juice, offering enhanced quality and sensory acceptance.
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INTRODUCTION: Technological advancements are reshaping medical education, with digital tools becoming essential in all levels of training. Amidst this transformation, the study explores the potential of ChatGPT, an artificial intelligence model by OpenAI, in enhancing neurosurgical board education. The focus extends beyond technology adoption to its effective utilization, with ChatGPT's proficiency evaluated against practice questions from the Primary Neurosurgery Written Board Exam. METHODS: Using the Congress of Neurologic Surgeons (CNS) Self-Assessment Neurosurgery (SANS) Exam Board Review Prep questions, we conducted 3 rounds of analysis with ChatGPT. We developed a novel ChatGPT Neurosurgical Evaluation Matrix (CNEM) to assess the output quality, accuracy, concordance, and clarity of ChatGPT's answers. RESULTS: ChatGPT achieved spot-on accuracy for 66.7% of prompted questions, 59.4% of unprompted questions, and 63.9% of unprompted questions with a leading phrase. Stratified by topic, accuracy ranged from 50.0% (Vascular) to 78.8% (Neuropathology). In comparison to SANS explanations, ChatGPT output was considered better in 19.1% of questions, equal in 51.6%, and worse in 29.3%. Concordance analysis showed that 95.5% of unprompted ChatGPT outputs and 97.4% of unprompted outputs with a leading phrase were aligned. CONCLUSIONS: Our study evaluated the performance of ChatGPT in neurosurgical board education by assessing its accuracy, clarity, and concordance. The findings highlight the potential and challenges of integrating AI technologies like ChatGPT into medical and neurosurgical board education. Further research is needed to refine these tools and optimize their performance for enhanced medical education and patient care.
Subject(s)
Neurosurgery , Humans , Artificial Intelligence , Educational Status , Neurosurgical Procedures , LanguageABSTRACT
OBJECTIVE: Patient-reported outcome measures (PROMs) are the gold standard for assessing postoperative outcomes in spine surgery. However, PROMs are also limited by the inherent subjectivity of self-reported qualitative data. Recent literature has highlighted the utility of patient mobility data streamed from smartphone accelerometers as an objective measure of functional outcomes and complement to traditional PROMs. Still, for activity-based data to supplement existing PROMs, they must be validated against current metrics. In this study, the authors assessed the relationships and concordance between longitudinal smartphone-based mobility data and PROMs. METHODS: Patients receiving laminectomy (n = 21) or fusion (n = 10) between 2017 and 2022 were retrospectively included. Activity data (steps-per-day count) recorded in the Apple Health mobile application over a 2-year perioperative window were extracted and subsequently normalized to allow for intersubject comparison. PROMS, including the visual analog scale (VAS), Patient Reported Outcome Measurement Information System Pain Interference (PROMIS-PI), Oswestry Disability Index (ODI), and EQ-5D, collected at the preoperative and 6-week postoperative visits were retrospectively extracted from the electronic medical record. Correlations between PROMs and patient mobility were assessed and compared between patients who did and those who did not achieve the established minimal clinically important difference (MCID) for each measure. RESULTS: A total of 31 patients receiving laminectomy (n = 21) or fusion (n = 10) were included. Change between preoperative and 6-week postoperative VAS and PROMIS-PI scores demonstrated moderate (r = -0.46) and strong (r = -0.74) inverse correlations, respectively, with changes in normalized steps-per-day count. In cohorts of patients who achieved PROMIS-PI MCID postoperatively, indicating subjective improvement in pain, there was a 0.784 standard deviation increase in normalized steps per day, representing a 56.5% improvement (p = 0.027). Patients who did achieve the MCID of improvement in either PROMIS-PI or VAS after surgery were more likely to experience an earlier sustained improvement in physical activity commensurate to or greater than their preoperative baseline (p = 2.98 × 10-18) than non-MCID patients. CONCLUSIONS: This study demonstrates a strong correlation between changes in mobility data extracted from patient smartphones and changes in PROMs following spine surgery. Further elucidating this relationship will allow for more robust supplementation of existing spine outcome measure tools with analyzed objective activity data.