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To examine differences in surgical practices between salaried and fee-for-service (FFS) surgeons for two common degenerative spine conditions. Surgeons may offer different treatments for similar conditions on the basis of their compensation mechanism.
The study assessed the practices of 63 spine surgeons across eight Canadian provinces (39 FFS surgeons and 24 salaried) who performed surgery for two lumbar conditions: stable spinal stenosis and degenerative spondylolisthesis. The study included a multicenter, ambispective review of consecutive spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network registry between October 2012 and July 2018. The primary outcome was the difference in type of procedures performed between the two groups. Secondary study variables included surgical characteristics, baseline patient factors, and patient-reported outcome.
For stable spinal stenosis (n = 2234), salaried surgeons performed statistically fewer uninstrumented fusion (p < 0.05) than FFS surgeons. For degenerative spondylolisthesis (n = 1292), salaried surgeons performed significantly more instrumentation plus interbody fusions (p < 0.05). There were no statistical differences in patient-reported outcomes between the two groups.
Surgeon compensation was associated with different approaches to stable lumbar spinal stenosis and degenerative lumbar spondylolisthesis. Salaried surgeons chose a more conservative approach to spinal stenosis and a more aggressive approach to degenerative spondylolisthesis, which highlights that remuneration is likely a minor determinant in the differences in practice of spinal surgery in Canada. Further research is needed to further elucidate which variables, other than patient demographics and financial incentives, influence surgical decision-making.
Scanning transmission electron microscopy (STEM) allows for imaging, diffraction, and spectroscopy of materials on length scales ranging from microns to atoms. By using a high-speed, direct electron detector, it is now possible to record a full two-dimensional (2D) image of the diffracted electron beam at each probe position, typically a 2D grid of probe positions. These 4D-STEM datasets are rich in information, including signatures of the local structure, orientation, deformation, electromagnetic fields, and other sample-dependent properties. However, extracting this information requires complex analysis pipelines that include data wrangling, calibration, analysis, and visualization, all while maintaining robustness against imaging distortions and artifacts. In this paper, we present py4DSTEM, an analysis toolkit for measuring material properties from 4D-STEM datasets, written in the Python language and released with an open-source license. We describe the algorithmic steps for dataset calibration and various 4D-STEM property measurements in detail and present results from several experimental datasets. We also implement a simple and universal file format appropriate for electron microscopy data in py4DSTEM, which uses the open-source HDF5 standard. We hope this tool will benefit the research community and help improve the standards for data and computational methods in electron microscopy, and we invite the community to contribute to this ongoing project.
Studies suggest that alcohol consumption and alcohol use disorders have distinct genetic backgrounds.
We examined whether polygenic risk scores (PRS) for consumption and problem subscales of the Alcohol Use Disorders Identification Test (AUDIT-C, AUDIT-P) in the UK Biobank (UKB; N = 121 630) correlate with alcohol outcomes in four independent samples: an ascertained cohort, the Collaborative Study on the Genetics of Alcoholism (COGA; N = 6850), and population-based cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC; N = 5911), Generation Scotland (GS; N = 17 461), and an independent subset of UKB (N = 245 947). Regression models and survival analyses tested whether the PRS were associated with the alcohol-related outcomes.
In COGA, AUDIT-P PRS was associated with alcohol dependence, AUD symptom count, maximum drinks (R2 = 0.47–0.68%, p = 2.0 × 10−8–1.0 × 10−10), and increased likelihood of onset of alcohol dependence (hazard ratio = 1.15, p = 4.7 × 10−8); AUDIT-C PRS was not an independent predictor of any phenotype. In ALSPAC, the AUDIT-C PRS was associated with alcohol dependence (R2 = 0.96%, p = 4.8 × 10−6). In GS, AUDIT-C PRS was a better predictor of weekly alcohol use (R2 = 0.27%, p = 5.5 × 10−11), while AUDIT-P PRS was more associated with problem drinking (R2 = 0.40%, p = 9.0 × 10−7). Lastly, AUDIT-P PRS was associated with ICD-based alcohol-related disorders in the UKB subset (R2 = 0.18%, p < 2.0 × 10−16).
AUDIT-P PRS was associated with a range of alcohol-related phenotypes across population-based and ascertained cohorts, while AUDIT-C PRS showed less utility in the ascertained cohort. We show that AUDIT-P is genetically correlated with both use and misuse and demonstrate the influence of ascertainment schemes on PRS analyses.
Dry permafrost - ground with temperature always below 0°C and containing negligible ice - overlying ice-cemented ground has been reported in the Dry Valleys of Antarctica and on Mars. Here we report on a new site (79°49.213'S, 83°18.860'W, 718 m elevation) located on the side of Mount Dolence in Ellsworth Land, Antarctica. Year-round temperature and humidity measurements indicate that dry permafrost is present between depths of 13.5 and 49.0 cm - the location of ice-cemented ground. The mean annual frost point of the ice-cemented ground is -17.0 ± 0.2°C and the mean annual frost point of the atmosphere is -22.7 ± 1°C. The corresponding mean annual temperatures are -19.2°C and -20.3°C. Neither the temperature of the ice-cemented ground nor the air rise above freezing. Both the dry permafrost and the ice table may be habitable. In the dry soil at 3 cm depth there are 80 hours in the summer when temperature exceeds -5°C and water activity exceeds 0.8. At the ice table, temperature exceeds -10°C and water activity exceeds 0.8 for 35 hours in the year. The ice table and the dry permafrost above it would be considered a ‘Special Region’ on Mars. Further microbial investigation of this site is indicated.
We present the first quantitative assessment of combustion dynamics of on-chip porous silicon (PS) energetic material using sulfur and nitrate-based oxidizers with potential for improved moisture stability and/or minimized environmental impact compared to sodium perchlorate (NaClO4). Material properties of the PS films were characterized using gas adsorption porosimetry, and profilometry to calculate specific surface area, porosity and etch depth. The PS/sulfur energetic composite was formed using three pore loading techniques, where the combustion speeds ranged from 2.9 – 290 m/s. The nitrate-based oxidizers were solution-deposited using different compatible solvents, and depending on the metal-nitrate yielded combustion speeds of 3.1 – 21 m/s. Additionally, the combustion enthalpies from bomb calorimetry experiments are reported for the alternative PS/oxidizer systems in both nitrogen and oxygen environments.
The seventh annual Teaching and Learning Conference (TLC) was held in Philadelphia, Pennsylvania, from February 5 to 7, 2010, with 224 attendees onsite. The theme for the meeting was “Advancing Excellence in Teaching Political Science.” Using the working-group model, the TLC track format encourages in-depth discussion and debate on research dealing with the scholarship of teaching and learning.
Among the Ethiopic manuscripts in the British Museum, which originate from the Emperor Theodore's Magdala collection, were two copies of the Kebra Nagast ‘Glory of the Kings’, the Ethiopian national saga, catalogued as Orient. 818 and 819 (=Wright, Catalogue of the Ethiopic MSS in the BM, NO. CCXCI). But Orient. 819, written during the reign of the Emperor Iyasu I (1682–1706), was returned to Ethiopia in circumstances which throw a dramatic light on the paramount importance of this work. In August 1872, the Emperor Yohannes of Ethiopia wrote to Queen Victoria and to Earl Granville, the British Foreign Secretary, and requested the return of the Kebra Nagast which had been taken to England by the Napier expedition in 1868.