Colloidal Nanoparticles of High Entropy Materials: Capabilities, Challenges, and Opportunities in Synthesis and Characterization.

Materials referred to as "high entropy" contain a large number of elements randomly distributed on the lattice sites of a crystalline solid, such that a high configurational entropy is presumed to contribute significantly to their formation and stability. High temperatures are typically required to achieve entropy stabilization, which can make it challenging to synthesize colloidal nanoparticles of high entropy materials. Nonetheless, strategies are emerging for the synthesis of colloidal high entropy nanoparticles, which are of interest for their synergistic properties and unique catalytic functions that arise from the large number of constituent elements and their interactions. In this Perspective, we highlight the classes of materials that have been made as colloidal high entropy nanoparticles as well as insights into the synthetic methods and the pathways by which they form. We then discuss the concept of "high entropy" within the context of colloidal materials synthesized at much lower temperatures than are typically required for entropy to drive their formation. Next, we identify and address challenges and opportunities in the field of high entropy nanoparticle synthesis. We emphasize aspects of materials characterization that are especially important to consider for nanoparticles of high entropy materials, including powder X-ray diffraction and elemental mapping with scanning transmission electron microscopy, which are among the most commonly used techniques in laboratory settings. Finally, we share perspectives on emerging opportunities and future directions involving colloidal nanoparticles of high entropy materials, with an emphasis on synthesis, characterization, and fundamental knowledge that is needed for anticipated advances in key application areas.

Student loan debt and mental health: a comprehensive review of scholarly literature from 1900 to 2019.

PURPOSE: The review had two purposes. The first was to examine the nature and extent of published literature on student loan and the second was to systematically review the literature on student loans and mental health. MATERIALS AND METHODS: Data from academic databases (1900-2019) were analyzed using two methods. First, topic modeling (a text-mining tool that utilized Bayesian statistics to extract hidden patterns in large volumes of texts) was used to understand the topical coverage in peer-reviewed abstracts (n = 988) on student debt. Second, using PRISMA guidelines, 46 manuscripts were systematically reviewed to synthesize literature linking student debt and mental health. RESULTS: A model with 10 topics was selected for parsimony and more accurate clustered representation of the patterns. Certain topics have received less attention, including mental health and wellbeing. In the systematic review, themes derived were categorized into two life trajectories: before and during repayment. Whereas stress, anxiety, and depression dominated the literature, the review demonstrated that the consequences of student loans extend beyond mental health and negatively affect a person's wellbeing. Self-efficacy emerged as a potential solution. DISCUSSION AND CONCLUSION: Across countries and samples, the results are uniform and show that student loan burdens certain vulnerable groups more. Findings indicate diversity in mental health measures has resulted into a lack of a unified theoretical framework. Better scales and consensus on commonly used terms will strengthen the literature. Some areas, such as impact of student loans on graduate students or consumers repaying their loans, warrant attention in future research.

Temporal Evolution of Morphology, Composition, and Structure in the Formation of Colloidal High-Entropy Intermetallic Nanoparticles.

Morphology-controlled nanoparticles of high entropy intermetallic compounds are quickly becoming high-value targets for catalysis. Their ordered structures with multiple distinct crystallographic sites, coupled with the "cocktail effect" that emerges from randomly mixing a large number of elements, yield catalytic active sites capable of achieving advanced catalytic functions. Despite this growing interest, little is known about the pathways by which high entropy intermetallic nanoparticles form and grow in solution. As a result, controlling their morphology remains challenging. Here, we use the high entropy intermetallic compound (Pd,Rh,Ir,Pt)Sn, which adopts a NiAs-related crystal structure, as a model system for understanding how nanoparticle morphology, composition, and structure evolve during synthesis in solution using a slow-injection reaction. By performing a time-point study, we establish the initial formation of palladium-rich cube-like Pd-Sn seeds onto which the other metals deposit over time, concomitant with continued incorporation of tin. For (Pd,Rh,Ir,Pt)Sn, growth occurs on the corners, resulting in a sample having a mixture of flower-like and cube-like morphologies. We then synthesize and characterize a library of 14 distinct intermetallic nanoparticle systems that comprise all possible binary, ternary, and quaternary constituents of (Pd,Rh,Ir,Pt)Sn. From these studies, we correlated compositions, morphologies, and growth pathways with the constituent elements and their competitive reactivities, ultimately mapping out a framework that rationalizes the key features of the high entropy (Pd,Rh,Ir,Pt)Sn intermetallic nanoparticles based on those of their simpler constituents. We then validated these design guidelines by applying them to the synthesis of a morphologically pure variant of flowerlike (Pd,Rh,Ir,Pt)Sn particles as well as a series of (Pd,Rh,Ir,Pt)Sn particles with tunable morphologies based on control of composition.

Comparing Naturalistic Mental Health Expressions on Student Loan Debts Using Reddit and Twitter.

PURPOSE: The primary objective of this study was to identify patterns in users' naturalistic expressions on student loans on two social media platforms. The secondary objective was to examine how these patterns, sentiments, and emotions associated with student loans differ in user posts indicating mental illness. MATERIAL AND METHOD: Data for this study were collected from Reddit and Twitter (2009-2020, n = 85,664) using certain key terms of student loans along with first-person pronouns as a triangulating measure of posts by individuals. Unsupervised and supervised machine learning models were used to analyze the text data. RESULTS: Results suggested 50 topics in reddit finance and 40 each in reddit mental health communities and Twitter. Statistically significant associations were found between mental illness statuses and sentiments and emotions. Posts expressing mental illness showed more negative sentiments and were more likely to express sadness and fear. DISCUSSION AND CONCLUSION: Patterns in social media discussions indicate both academic and non-academic consequences of having student debt, including users' desire to know more about their debts. Interventions should address the skill and information gaps between what is desired by the borrowers and what is offered to them in understanding and managing their debts. Cognitive burden created by student debts manifest itself on social media and can be used as an important marker to develop a nuanced understanding of people's expressions on a variety of socioeconomic issues. Higher volumes of negative sentiments and emotions of sadness, fear, and anger warrant immediate attention of policymakers and practitioners to reduce the cognitive burden of student debts.

The Diagnostic Process of Spinal Post-traumatic Deformity: An Expert Survey of 7 Cases, Consensus on Clinical Relevance Does Exist.

STUDY DESIGN: Survey of cases. OBJECTIVE: To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD). SUMMARY OF BACKGROUND DATA: SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment. The question of when SPTD becomes clinically relevant is yet to be resolved. METHODS: The survey of 7 cases was sent to 31 experts. The case presentation was medical history, diagnostic assessment, evaluation of diagnostic assessment, diagnosis, and treatment options. Means, ranges, percentages of participants, and descriptive statistics were calculated. RESULTS: Seventeen spinal surgeons reviewed the presented cases. The items' fracture type and complaints were rated by the participants as more important, but no agreement existed on the items of medical history. In patients with possible SPTD in the cervical spine (C) area, participants requested a conventional radiograph (CR) (76%-83%), a flexion/extension CR (61%-71%), a computed tomography (CT)-scan (76%-89%), and a magnetic resonance (MR)-scan (89%-94%). In thoracolumbar spine (ThL) cases, full spine CR (89%-100%), CT scan (72%-94%), and MR scan (65%-94%) were requested most often. There was a consensus on 5 out of 7 cases with clinically relevant SPTD (82%-100%). When consensus existed on the diagnosis of SPTD, there was a consensus on the case being compensated or decompensated and being symptomatic or asymptomatic. CONCLUSIONS: There was strong agreement in 5 out of 7 cases on the presence of the diagnosis of clinically relevant SPTD. Among spine experts, there is a strong consensus to use CT scan and MR scan, a cervical CR for C-cases, and a full spine CR for ThL-cases. The lack of agreement on items of the medical history suggests that a Delphi study can help us reach a consensus on the essential items of clinically relevant SPTD. LEVEL OF EVIDENCE: Level V.

Testicular malignancy in persistent Mullerian duct syndrome: Experience from an apex cancer center with review of literature.

OBJECTIVES: Persistent Mullerian duct syndrome (PMDS) is a rare disorder of sexual differentiation resulting from aberrations in the Mullerian inhibiting factor (MIF) pathway, with consequent failure of regression of fetal Mullerian duct. The concomitant association of undescended testis increases the likelihood of developing testicular tumors in these patients. Due to its rarity, clinic-pathologic and treatment outcome data on testicular cancer in PMDS is sparse. We present our institutional experience and review published literature on testicular cancer in PMDS. MATERIAL AND METHODS: We retrospectively queried our institutional testicular cancer database for all patients with a diagnosis of testicular cancer and PMDS, between January 1980 and January 2022. Additionally, a Medline/PubMed search was performed for English language articles published during the same time period. Data on pertinent clinical, radiologic, and pathologic disease characteristics were abstracted, in addition to treatment received and outcomes. RESULTS: Of 637 patients treated for testicular tumors during the specified time period in our institution, 4 patients had a concomitant diagnosis of PMDS. Testicular tumor was pathologically confirmed as seminoma in 3, 1 had mixed germ cell tumor. All patients in our series presented with stage 2B or higher disease and required chemotherapy, either in the neoadjuvant or adjuvant setting, in addition to surgery. With a mean follow up of 67 months, all patients were disease free. Medline/PubMed search retrieved 44 articles (49 patients) of testicular tumors associated with PMDS, with majority (59%) presenting with a large abdominal mass. Only 5 cases (10%) had a preceding history of appropriately managed cryptorchidism. CONCLUSIONS: Testicular cancer in PMDS usually presents in adults with advanced stage disease resulting from neglected or inadequate management of cryptorchidism. Appropriate management of cryptorchidism in childhood is likely to decrease malignant degeneration, if not, enable early-stage diagnosis.

Chemical Insights into the Formation of Colloidal High Entropy Alloy Nanoparticles.

Nanoparticles of high entropy alloys (HEAs) have distinct properties that result from their high surface-to-volume ratios coupled with synergistic interactions among their five or more constituent elements, which are randomly distributed throughout a crystalline lattice. Methods to synthesize HEA nanoparticles are emerging, including solution approaches that yield colloidal products. However, the complex multielement compositions of HEA nanoparticles make it challenging to identify and understand their reaction chemistry and the pathways by which they form, which hinders their rational synthesis. Here, we demonstrate the synthesis and elucidate the reaction pathways of seven colloidal HEA nanoparticle systems that contain various combinations of noble metals (Pd, Pt, Rh, Ir), 3d transition metals (Ni, Fe, Co), and a p-block element (Sn). The nanoparticles were synthesized by slowly injecting a solution containing all five constituent metal salts into oleylamine and octadecene at 275 °C. Using NiPdPtRhIr as a lead system, we confirmed the homogeneous colocalization of all five elements and achieved tunable compositions by varying their ratios. We also observed heterogeneities, including Pd-rich regions, in a subpopulation of the NiPdPtRhIr sample. Halting the reaction at early time points and characterizing the isolated products revealed a time-dependent composition evolution from Pd-rich NiPd seeds to the final NiPdPtRhIr HEA. Similar reactions applied to FePdPtRhIr, CoPdPtRhIr, NiFePdPtIr, and NiFeCoPdPt, with modified conditions to most efficiently incorporate all five elements into each HEA, also revealed similar Pd-rich seeds with system-dependent differences in the rates and sequences of element uptake into the nanoparticles. When moving to SnPdPtRhIr and NiSnPdPtIr, the time-dependent formation pathway was more consistent with simultaneous coreduction rather than through formation of reactive seeds. These studies reveal important similarities and differences among the pathways by which different colloidal HEA nanoparticles form using the same synthetic method, as well as establish generality. The results provide guidelines for incorporating a range of different elements into HEA nanoparticles, ultimately providing fundamental knowledge about how to define and optimize synthetic protocols, expand into different HEA nanoparticle systems, and achieve high phase purity.

The role of attention in status quo bias.

In many decision-making contexts, people often persist with their previous selections. This predisposition to choose to maintain a current (or previous) choice is referred to as the status quo bias (SQB). In this work, we propose that increased attention towards the status quo option-enabled by its visual salience-is a previously underappreciated driver of SQB. We base this hypothesis on three propositions: (1) the status quo bias option is often more visually salient relative to the non-status quo options on offer, (2) greater visual salience of an option biases attention towards that option, and (3) increased attention towards an option leads to that option being selected at greater rates. We examined the attention hypothesis among 6,854 participants in four studies. Studies 1 and 2 showed that increasing the visual salience of a non-status quo option (i.e., the type of visual salience often garnered by the status quo option) increased the selection rate of that option. Study 3 directly tested the hypothesis by lessening the visual salience of the status quo option. Doing so eliminated SQB. Study 4 replicated and extended the findings of Study 3 in a real-world decision context. Collectively, these studies suggest that the selection of the status quo may often be related to its salience relative to other available options.

Spinal Post-traumatic Deformity: An International Expert Survey Among AO Spine Knowledge Forum Members.

STUDY DESIGN: Survey among spine experts. OBJECTIVE: To investigate the different views and opinions of clinically relevant spinal post-traumatic deformity (SPTD). SUMMARY OF BACKGROUND DATA: There is no clear definition of clinically relevant SPTD. This leads to a wide variation in characteristics used for diagnosis and treatment indications of SPTD. To understand the current concepts of SPTD a survey was conducted among spine trauma surgeons. METHODS: Members of the AO Spine Knowledge Forum Trauma participated in an online survey. The survey was divided in 4 domains: Demographics, criteria to define SPTD, risk factors, and management. The data were collected anonymously and analyzed using descriptive statistics, absolute, and relative frequencies. Consensus on dichotomous outcomes was set to 80% of agreement. RESULTS: Fifteen members with extensive experience in treatment of spinal trauma participated, representing the 5 AO Spine Regions. Back pain was the only criterion for definition of SPTD with complete agreement. Consensus (≥80%) was reached for kyphotic angulation outside normative ranges and impaired function. Eighty-seven percent and 100% agreed that a full-spine conventional radiograph was necessary in diagnosing and treating SPTD, respectively. The "missed B-type injury" was rated at most important by all but 1 participant. There was no agreement on other risk factors leading to clinically relevant SPTD. Concerning the management, all participants agreed that an asymptomatic patient should not undergo surgical treatment and that neurological deficit is an absolute surgical indication. For most of the participants the preferred surgical treatment of acute injury in all spine regions but the subaxial region is posterior fixation. CONCLUSION: Some consensus exists among leading experts in the field of spine trauma care concerning the definition, diagnosis, risk factors, and management of SPTD. This study acts as the foundation for a Delphi study among the global spine community.

Risk factors for labor epidural conversion failure requiring general anesthesia for cesarean delivery.

Background and Aims: To evaluate the rate and risk factors of labor epidural conversion failure requiring general anesthesia for Caesarean delivery (CD). Material and Methods: Pregnant patients requiring conversion from labor to CD with a pre-existing labor epidural at our institution from 2009 to 2014 were identified. Through a retrospective review, we compared successful epidural conversion with those who required general anesthesia for CD. Patient characteristics were analyzed to identify risk factors for failed epidural conversion for CD. Results: A total of 673 patients were included in the study. The rate of epidural conversion failure was 21%. Main risk factors for epidural conversion failure requiring general anesthesia included: younger maternal age (95% CI 0.94, P = 0.0002) and supplementation of intravenous fentanyl (95% CI 0.19, P < 0.0001) or midazolam (95% CI 0.26, P = 0.0008) during CD. A higher risk of conversion failure was also associated with a more urgent CD (CD category 1, 2, and 3 vs category 4). Conclusion: Consistent with previous reports, young age and the urgency of CD increases the likelihood of epidural conversion failure. While conversion failure is likely multifactorial and complex, many of these factors are suggestive of inadequate and poorly functioning labor epidurals prior to CD. Prospective studies to further evaluate these factors are necessary, and the best prevention of epidural conversion failure is diligent diagnosis and evaluation of ineffective labor epidural analgesia prior to impending CD.

Electrochemical and DFT studies of andrographolide on electrochemically reduced graphene oxide for anti-viral herbaceutical sensor.

Herbal extracts are re-emerging as potential remedies for various vector-borne diseases. Amongst several phytochemicals, active ingredients of Andrographis paniculata extract is regarded as promising for dengue fever, caused by Aedes species. However, fingerprinting the active phytochemicals from herbal extracts are often relies on sophisticated analytical techniques which are not universally accessible. Herein, an electrochemically reduced graphene oxide on glassy carbon electrode (ErGO/GCE) has been devised as user-friendly and cost-effective sensor platform for fingerprinting of andrographolide (AG) in anti-dengue polyherbal formulation, i.e., Nilavembu kudineer powder. Confocal laser Raman and X-ray photoelectron spectral analyses revealed that the ErGO surfaces exert structural defects augmenting the conductivity at the electrode interface. DFT investigations enabled that C-3 and C-18 OH groups in AG is involved in the electrooxidation and adsorption-diffusion at the ErGO interface, respectively. Complementary electrochemical studies revealed that the diffusion-controlled process follows 1e-/1H+ transfer. Under optimal experimental conditions, ErGO sensor platform exhibit an amplified current sensitivity of 13.3 µA µM-1. cm-2 in the studied analyte concentration range of 10-400 µM. From the polyherbal extract and clinical sample analysis, the proposed sensor system offers selective, and sensitive detection of target AG regardless of common interferents.

Microbial diversity and composition in acidic sediments of freshwater finfish culture ponds fed with two types of feed: a metagenomic approach.

Microbial community profile associated with acidic pond sediments (APS) (pH = 3·0-4·5) of freshwater finfish aquaculture ponds (n = 8) was investigated. Sediment DNA extracted from the eight APS were subjected to high-throughput sequencing of V3 and V4 regions which yielded 7236 operational taxonomic units (OTUs) at a similarity of 97%. Overall results showed higher proportion of bacterial OTUs than archaeal OTUs in all the APS. Euryarchaeota (23%), Proteobacteria (19%), Chloroflexi (17%), Crenarchaeota (5·3%), Bacteroidetes (4·8%), Nitrospirae (3·2%), Nanoarchaeaeota (3%) which together constituted 75% of the microbial diversity. At the genus level, there was high preponderance of methanogens namely Methanolinea (5·4%), Methanosaeta (4·5%) and methanotrops, Bathyarchaeota (5%) in APS. Moreover, the abundant phyla in the APS were not drastically affected by the administration of chicken slaughter waste (R-group ponds) and commercial fish feed (C-group ponds), since 67% of the OTUs generated remained common in the APS of both the groups of ponds. There was a minimal difference of 24-26% of OTUs between C-group and R-group ponds, suggesting the existence of a core microbial community in these ponds driven by acidic pH over the years. This study concludes that microbial diversity in pond sediment was influenced to a lesser extent by the addition of chicken slaughter waste but was majorly driven by acidic nature of the pond.

Analytical similarity assessment of MYL-1402O to reference Bevacizumab.

BACKGROUND: Bevacizumab (BEV) is a recombinant humanized monoclonal immunoglobulin G1 antibody that binds to vascular endothelial growth factor (VEGF)-A and acts as an antiangiogenic agent. It is approved for treatment of many cancer indications, including metastatic colorectal cancer and nonsquamous non-small cell lung cancer. RESEARCH DESIGN AND METHODS: The analytical similarity of the BEV biosimilar MYL-1402O to reference BEV sourced from the European Union and United States was assessed using physicochemical and functional tests to support the clinical development of MYL-1402O. Assessment of physicochemical and analytical similarity showed that MYL-1402O has the same amino acid sequence and similar posttranslational modification profile as the reference BEV products. RESULTS: The functional and biologic activity of MYL-1402O assessed using inhibition of VEGF-induced cell proliferation in human umbilical vein endothelial cells, inhibition of VEGF-induced VEGF receptor 2 phosphorylation, and fragment antigen and fragment crystallizable receptor binding, was comparable to reference BEV products. CONCLUSIONS: The totality of the data assessment confirms the high degree of similarity of MYL-1402O to reference BEV with respect to physicochemical and in vitro functional properties. The product quality data presented here, along with data from phase 1 clinical studies, demonstrate the similarity of MYL-1402O to reference BEV products, supporting further clinical development of this BEV biosimilar.

Substrate Protection with Corrosion Scales: Can We Depend on Iron Carbonate?

Controlling corrosion with naturally occurring corrosion scales is potentially a more environmentally sustainable alternative to current approaches, including dosing of organic corrosion inhibitors. We report operando grazing incidence X-ray diffractograms correlated with electrochemical measurements to elucidate the growth and corrosion protection properties of a corrosion scale composed of FeCO3 crystallites, which is encountered in various key energy industry applications. Data, acquired as a function of time from high-purity iron immersed in CO2-saturated deionized H2O at pH 6.8 and T = 80 °C, show that the FeCO3 scale not only prevents corrosion of the covered substrate but also acts as a significant interfacial diffusion barrier for corrosion reagents and/or products once sufficient coverage is achieved. Most notably, from a corrosion engineering perspective, however, it is determined that corrosion occurring in gaps between scale crystallites remains appreciable; this important insight is gained through the analysis of electrochemical impedance spectra to estimate the variation in electrochemically active surface area as scale coverage increases. These results indicate that naturally occurring FeCO3 scales are not a tenable solution for corrosion protection, as even in their intact state they are highly likely to be, at best, semiprotective.

Chitosan grafted butein: A metal-free transducer for electrochemical genosensing of exosomal CD24.

Metal-free cost-efficient biocompatible molecules are beneficial for opto-electrochemical bioassays. Herein, chitosan (CS) conjugated butein is prepared via graft polymerization. Structural integrity between radical active sites of CS and its probable conjugation routes with reactive OH group of butein during grafting were comprehensively studied using optical absorbance/emission property, NMR, FT-IR and XPS analysis. Fluorescence emission of CS-conjugated butein (CSB) was studied in dried flaky state as well as in drop casted form. Cyclic voltammetric study of CSB modified glassy carbon electrode exhibits 2e-/2H+ transfer reaction in phosphate buffered saline electrolyte following a surface-confined process with a correlation coefficient of 0.99. Unlike pristine butein, CSB modified electrode display a highly reversible redox behavior under various pH ranging from 4 to 9. For the proof-of-concept CSB-modified flexible screen printed electrodes were processed for electrochemical biosensing of exosomal CD24 specific nucleic acid at an ultralow sample concentration, promising for ovarian cancer diagnosis.

Metastases from renal cell carcinoma-Report of three unpredictable cases and literature review.

The capacity to metastasize after long periods of discovery and resection of the primary renal lesion or to present as metastasis with undisclosed primary lesions grant renal cell carcinomas (RCC) a formidable and unpredictable behavior. We report three unusual cases of metastasis from RCC. The first patient presented with metastatic clear cell adenocarcinoma in the right shoulder muscles, with unknown primary and revealed an undetected clear cell right RCC on radiology. The second patient presented with a hemorrhagic nasal metastasis of RCC. A history of nephrectomy for RCC, 10 years prior to the development of nasal metastasis was elicited. The third patient presented with axillary and later abdominal wall metastasis of papillary RCC. He had a history of RCC 3 years prior to the discovery of metastasis. RCC has the propensity to appear as a metastatic carcinoma with unknown primary, requiring exclusion of several diagnostic pathologic entities. The appearance of metastasis many years after disease quiescence is challenging and clinicians need to be sensitized to the need for long-term surveillance in RCC. Though the prognosis remains poor, immune checkpoint inhibitors are currently the modalities of choice in such cases.

Circulating free DNA as a marker of response to chemoradiation in locally advanced head and neck squamous cell carcinoma.

CONTEXT: Liquid biopsy has moved from bench to bedside as a non-invasive biomarker for early diagnosis and monitoring treatment response. OBJECTIVE: This study investigated the role of circulating free DNA (cfDNA) as a diagnostic marker in locally advanced head and neck squamous cell carcinoma (HNSCC) and in monitoring response to chemoradiation therapy. MATERIALS AND METHODS: Serum was collected from treatment naïve, histopathologically diagnosed tumors in 24 HNSCC cases and 16 normal controls. CfDNA levels were quantified using ß globin gene amplification. RESULTS: The cfDNA level was significantly elevated in HNSCC (992.67 ± 657.43 ng/mL) as compared to healthy controls (60.65 ± 30.42 ng/mL, P = <0.001). The levels of cfDNA did not significantly correlate with TNM stage, lymph node involvement and grade. In responders, percentage decrease in cfDNA levels was 9.57% and 29.66%, whereas in nonresponders percentage increase was 13.28% and 24.52% at the end of three months of follow-up. CONCLUSION: Our study adds to the evidence that cfDNA levels are significantly higher in HNSCC cases and provides some evidence that levels increase with tumor progression. CfDNA may be a promising prospective non-invasive marker to predict response in patients undergoing chemo-radiotherapy.

Description and Reliability of the AOSpine Sacral Classification System.

BACKGROUND: Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons. METHODS: A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater agreement were analyzed with use of the kappa statistic (κ) for fracture severity (i.e., A, B, and C) and fracture subtype (e.g., A1, A2, and A3). RESULTS: Seventeen reviewers were included in the final analysis, and a total of 1,292 assessments were performed (646 assessments performed twice). Overall intrarater reproducibility was excellent (κ = 0.83) for fracture severity and substantial (κ = 0.71) for all fracture subtypes. When comparing fracture severity, overall interrater agreement was substantial (κ = 0.75), with the highest agreement for type-A fractures (κ = 0.95) and the lowest for type-C fractures (κ = 0.70). Overall interrater agreement was moderate (κ = 0.58) when comparing fracture subtype, with the highest agreement seen for A2 subtypes (κ = 0.81) and the lowest for A1 subtypes (κ = 0.20). CONCLUSIONS: To our knowledge, the present study is the first to describe the reliability of the AOSpine Sacral Classification System among a worldwide group of expert spine and trauma surgeons, with substantial to excellent intrarater reproducibility and moderate to substantial interrater agreement for the majority of fracture subtypes. These results suggest that this classification system can be reliably applied to sacral injuries, providing an important step toward standardization of treatment.

Manipulations of inhibition in cortical circuitry differentially affect spectral and temporal features of Bengalese finch song.

The interplay between inhibition and excitation can regulate behavioral expression and control, including the expression of communicative behaviors like birdsong. Computational models postulate varying degrees to which inhibition within vocal motor circuitry influences birdsong, but few studies have tested these models by manipulating inhibition. Here we enhanced and attenuated inhibition in the cortical nucleus HVC (used as proper name) of Bengalese finches (Lonchura striata var. domestica). Enhancement of inhibition (with muscimol) in HVC dose-dependently reduced the amount of song produced. Infusions of higher concentrations of muscimol caused some birds to produce spectrally degraded songs, whereas infusions of lower doses of muscimol led to the production of relatively normal (nondegraded) songs. However, the spectral and temporal structures of these nondegraded songs were significantly different from songs produced under control conditions. In particular, muscimol infusions decreased the frequency and amplitude of syllables, increased various measures of acoustic entropy, and increased the variability of syllable structure. Muscimol also increased sequence durations and the variability of syllable timing and syllable sequencing. Attenuation of inhibition (with bicuculline) in HVC led to changes to song distinct from and often opposite to enhancing inhibition. For example, in contrast to muscimol, bicuculline infusions increased syllable amplitude, frequency, and duration and decreased the variability of acoustic features. However, like muscimol, bicuculline increased the variability of syllable sequencing. These data highlight the importance of inhibition to the production of stereotyped vocalizations and demonstrate that changes to neural dynamics within cortical circuitry can differentially affect spectral and temporal features of song.NEW & NOTEWORTHY We reveal that manipulations of inhibition in the cortical nucleus HVC affect the structure, timing, and sequencing of syllables in Bengalese finch song. Enhancing and blocking inhibition led to opposite changes to the acoustic structure and timing of vocalizations, but both caused similar changes to vocal sequencing. These data provide support for computational models of song control but also motivate refinement of existing models to account for differential effects on syllable structure, timing, and sequencing.