Publications by authors named "Gabriel Smith"

45 Publications

Multiple distinct, scale-dependent links between fungi and decomposition.

Ecol Lett 2021 Jul 24;24(7):1352-1362. Epub 2021 Apr 24.

Department of Biology, Stanford University, Stanford, CA, USA.

Decomposition has historically been considered a function of climate and substrate but new research highlights the significant role of specific micro-organisms and their interactions. In particular, wood decay is better predicted by variation in fungal communities than in climate. Multiple links exist: interspecific competition slows decomposition in more diverse fungal communities, whereas trait variation between different communities also affects process rates. Here, we paired field and laboratory experiments using a dispersal gradient at a forest-shrubland ecotone to examine how fungi affect wood decomposition across scales. We observed that while fungal communities closer to forests were capable of faster decomposition, wood containing diverse fungal communities decomposed more slowly, independent of location. Dispersal-driven stochasticity in small-scale community assembly was nested within large-scale turnover in the regional species pool, decoupling the two patterns. We thus find multiple distinct links between microbes and ecosystem function that manifest across different spatial scales.
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http://dx.doi.org/10.1111/ele.13749DOI Listing
July 2021

Virtual reality in presurgical patient education: A scoping review and recommended trial design guidelines.

Am J Surg 2021 10 16;222(4):704-705. Epub 2021 Mar 16.

Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.

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http://dx.doi.org/10.1016/j.amjsurg.2021.03.022DOI Listing
October 2021

Decadal changes in fire frequencies shift tree communities and functional traits.

Nat Ecol Evol 2021 04 25;5(4):504-512. Epub 2021 Feb 25.

Department of Earth System Science, Stanford University, Stanford, CA, USA.

Global change has resulted in chronic shifts in fire regimes. Variability in the sensitivity of tree communities to multi-decadal changes in fire regimes is critical to anticipating shifts in ecosystem structure and function, yet remains poorly understood. Here, we address the overall effects of fire on tree communities and the factors controlling their sensitivity in 29 sites that experienced multi-decadal alterations in fire frequencies in savanna and forest ecosystems across tropical and temperate regions. Fire had a strong overall effect on tree communities, with an average fire frequency (one fire every three years) reducing stem density by 48% and basal area by 53% after 50 years, relative to unburned plots. The largest changes occurred in savanna ecosystems and in sites with strong wet seasons or strong dry seasons, pointing to fire characteristics and species composition as important. Analyses of functional traits highlighted the impact of fire-driven changes in soil nutrients because frequent burning favoured trees with low biomass nitrogen and phosphorus content, and with more efficient nitrogen acquisition through ectomycorrhizal symbioses. Taken together, the response of trees to altered fire frequencies depends both on climatic and vegetation determinants of fire behaviour and tree growth, and the coupling between fire-driven nutrient losses and plant traits.
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http://dx.doi.org/10.1038/s41559-021-01401-7DOI Listing
April 2021

Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility.

Spine (Phila Pa 1976) 2021 Jul;46(14):958-964

School of Medicine, Case Western Reserve University, Cleveland, OH.

Study Design: Retrospective review at a single institution of all adult patients who underwent elective lumbar fusion surgery for degenerative spinal disease from 2013 to 2018. Reoperation rates and change in clinical management due to routine imaging findings were the primary outcomes.

Objective: To investigate what effects immediate routine postoperative imaging has on the clinical management of patients following lumbar fusion surgery.

Summary Of Background Data: The clinical utility of routine postoperative imaging following lumbar fusion surgery remains uncertain. Existing studies on the clinical utility of postoperative imaging in lumbar fusion patients have largely focused on imaging obtained post-discharge. We present a retrospective analysis that to our knowledge is the first study reporting on the clinical utility of routine imaging in lumbar fusion patients during the immediate postoperative period.

Methods: The medical records of patients who had undergone elective lumbar instrumented fusion for degenerative disease from 2013 to 2018 by neurosurgeons across one regional healthcare system were retrospectively analyzed. Inpatient records and imaging orders for patients were reviewed. Routine immediate postoperative imaging was defined by any lumbar spine imaging prior to discharge in the absence of specific indications.

Results: Analysis identified 115 patients who underwent elective lumbar instrumented fusion for degenerative disease. One-hundred-twelve patients received routine postoperative imaging. Routine imaging was abnormal in four patients (4%). There was one instance (<1%) where routine immediate postoperative imaging led to change in clinical management. Abnormal routine imaging was not associated with either reoperation or development of neurological symptoms postoperatively (P = 0.10), however, new or worsening neurologic deficits did predict reoperation (P < 0.01).

Conclusion: New neurologic deficit was the only significant predictor of reoperation. Routine imaging, whether normal or abnormal, was not found to be associated with reoperation. The practice of routine imaging prior to discharge following elective lumbar fusion surgery appears to provide little utility to clinical management.Level of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003953DOI Listing
July 2021

Contrasting fungal responses to wildfire across different ecosystem types.

Mol Ecol 2021 02 15;30(3):844-854. Epub 2020 Dec 15.

Department of Biology, Stanford University, Stanford, CA, USA.

Wildfire affects our planet's biogeochemistry both by burning biomass and by driving changes in ecological communities and landcover. Some plants and ecosystem types are threatened by increasing fire pressure while others respond positively to fire, growing in local and regional abundance when it occurs regularly. However, quantifying total ecosystem response to fire demands consideration of impacts not only on aboveground vegetation, but also on soil microbes like fungi, which influence decomposition and nutrient mineralization. If fire-resistant soil fungal communities co-occur with similarly adapted plants, these above- and belowground ecosystem components should shift and recover in relative synchrony after burning. If not, fire might decouple ecosystem processes governed by these different communities, affecting total functioning. Here, we use a natural experiment to test whether fire-dependent ecosystems host unique, fire-resistant fungal communities. We surveyed burned and unburned areas across two California ecosystem types with differing fire ecologies in the immediate aftermath of a wildfire, finding that the soil fungal communities of fire-dependent oak woodlands differ from those of neighbouring mixed evergreen forests. We discovered furthermore that the latter are more strongly altered compositionally by fire than the former, suggesting that differences in fungal community structure support divergent community responses to fire across ecosystems. Our results thus indicate that fire-dependent ecosystems may host fire-resistant fungal communities.
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http://dx.doi.org/10.1111/mec.15767DOI Listing
February 2021

Building a global database of soil microbial biomass and function: a call for collaboration.

Soil Org 2020 Jul;91(3):139-142

Global Ecosystem Ecology, Institute of Integrative Biology, Department of Environmental Systems Science, ETH Zürich, 8092 Zürich, Switzerland.

Global analyses are emerging as valuable complements to local and regional scale studies in ecology and are useful for examining many of the major environmental issues that we face today. Soil ecology has significantly benefited from these developments, with recent syntheses unearthing interesting, unexpected biogeographic patterns in belowground biotic communities. However, some questions still remain unanswered, and the accuracy of these studies is inevitably limited by the extent of the data they draw upon. This is a particular problem in global ecology because most datasets used exhibit geographic bias in sample distribution. Here, we work towards addressing this problem with an open call for collaboration on a planned global analysis of soil phospholipid fatty acid and potential enzyme activity measurements. We summarize the current extent of our dataset, outline the planned analyses, and provide information for prospective collaborators who would like to contribute or learn more.
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http://dx.doi.org/10.25674/so91iss3pp140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311196PMC
July 2020

Klippel-Feil Syndrome with Cervical Diastematomyelia in an Adult with Extensive Cervicothoracic Fusions: Case Report and Review of the Literature.

World Neurosurg 2020 07 25;139:274-280. Epub 2020 Apr 25.

Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A.

Split cord malformation (SCM) is a developmental disorder that is usually symptomatic and diagnosed in childhood. The majority of these lesions are in the thoracic and lumbar spine, with only 1%-3% of cases found in the cervical spine. This is a case report of a 55-year-old female patient with an unremarkable medical history who presented with neck pain. Upon workup, she was found to have extensive developmental anomalies throughout her cervical and thoracic spine, including an incidentally found type 2 SCM and multiple autofused vertebrae. There are only 6 similar studies published in the literature. There was extensive facet degeneration in her cervical spine, which was suspected to be the etiology of her neck pain. This case illustrates the rare finding of asymptomatic adult cervical SCM and the likely significance of her autofused vertebrae causing accelerated symptomatic facet spondylosis.
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http://dx.doi.org/10.1016/j.wneu.2020.04.148DOI Listing
July 2020

Stepping forward from relevance in mycorrhizal ecology.

New Phytol 2020 04 13;226(2):292-294. Epub 2020 Feb 13.

Department of Biology, Stanford University, 371 Jane Stanford Way, Stanford, CA, 94305, USA.

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http://dx.doi.org/10.1111/nph.16432DOI Listing
April 2020

Morbidity and Mortality After Burr Hole Craniostomy Versus Craniotomy for Chronic Subdural Hematoma Evacuation: A Single-Center Experience.

World Neurosurg 2020 Feb 9;134:e196-e203. Epub 2019 Oct 9.

Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA. Electronic address:

Background: Chronic subdural hematomas (cSDHs) are common neurosurgical pathological entities and typically occur after trauma in elderly patients. The 2 most commonly used strategies for treatment have included burr hole drainage and craniotomy with decompression. However, the choice of these procedures has remained controversial and has been primarily determined by surgeon preference. We designed a matched-cohort analysis to compare these 2 procedures and identify the risk factors associated with the postoperative outcomes. Thus, we compared the rates of reoperation and mortality for patients who had undergone craniotomy versus burr hole evacuation for cSDH.

Methods: A retrospective review examining the data from 299 consecutive patients with cSHDs from 2002 to 2015 was performed. We compared the following endpoints between the 2 procedures: 30-day mortality, discharge to a skilled nursing facility, and the need for reoperation. We also compared the potential risk factors in the patients with different primary outcomes.

Results: Patients undergoing craniotomy had a decreased need for reoperation compared with patients treated with burr hole evacuation (7.5% vs. 15.7%; P = 0.044). Older age was associated with both increased disposition to a nursing facility and increased 30-day mortality in both groups. Increased 30-day mortality was associated with aspirin usage in patients who had undergone craniotomy and with warfarin (Coumadin) in patients who had undergone burr hole evacuation.

Conclusions: Our study identified an increased need for reoperation for patients treated with burr hole evacuation compared with those undergoing craniotomy. Older age and low Glasgow coma scale scores were associated with worse outcomes in both groups. Certain methods of anticoagulation were also associated with worse outcomes, which varied between the 2 groups. We recommend that surgeons individualize the choice of procedure according to the specific patient characteristics with consideration of these findings.
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http://dx.doi.org/10.1016/j.wneu.2019.10.023DOI Listing
February 2020

Facial Sensory Restoration After Trigeminal Sensory Rhizotomy by Collateral Sprouting From the Occipital Nerves.

Neurosurgery 2020 05;86(5):E436-E441

School of Medicine, Case Western Reserve University, Cleveland, Ohio.

Background And Importance: Lesioning procedures are effective for trigeminal neuralgia (TN), but late pain recurrence associated with sensory recovery is common. We report a case of recurrence of type 1A TN and recovery of facial sensory function after trigeminal rhizotomy associated with collateral sprouting from upper cervical spinal nerves.

Clinical Presentation: A 41-yr-old woman presented 2 yr after open left trigeminal sensory rhizotomy for TN with pain-free anesthesia in the entire left trigeminal nerve distribution. Over 18 mo, she developed gradual recovery of facial sensation migrating anteromedially from the occipital region, eventually extending to the midpupillary line across the distribution of all trigeminal nerve branches. She reported recurrence of her triggered lancinating TN pain isolated to the area of recovered sensation with no pain in anesthetic areas. Nerve ultrasound demonstrated enlargement of ipsilateral greater and lesser occipital nerves, and occipital nerve block restored facial anesthesia and resolved her pain, indicating that recovered facial sensation was provided exclusively by the upper cervical spinal nerves. She underwent C2/C3 ganglionectomy, and ganglia were observed to be hypertrophic. Postoperatively, trigeminal anesthesia was restored with complete resolution of pain that persisted at 12-mo follow-up.

Conclusion: This is the first documented case of a spinal nerve innervating a cranial dermatome by collateral sprouting after cranial nerve injury. The fact that typical TN pain can occur even when sensation is mediated by spinal nerves suggests that the disorder can be centrally mediated and late failure after lesioning procedures may result from maladaptive reinnervation.
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http://dx.doi.org/10.1093/neuros/nyz306DOI Listing
May 2020

The radiation chemistry of focused electron-beam induced etching of copper in liquids.

Nanoscale 2019 Jun;11(24):11550-11561

Department of Electrical and Computer Engineering, University of Kentucky, Lexington, Kentucky 40506, USA.

Well-controlled, focused electron-beam induced etching of copper thin films has been successfully conducted on bulk substrates in an environmental scanning electron microscope by controlling liquid-film thickness with an in situ correlative interferometry system. Knowledge of the liquid-film thickness enables a hybrid Monte Carlo/continuum model of the radiation chemistry to accurately predict the copper etch rate using only electron scattering cross-sections, radical yields, and reaction rates from previous studies. Etch rates depended strongly on the thickness of the liquid film and simulations confirmed that this was a result of increased oxidizing radical generation. Etch rates also depended strongly, but non-linearly, on electron beam current, and simulations showed that this effect arises through the dose-rate dependence of reactions of radical species.
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http://dx.doi.org/10.1039/c9nr01857cDOI Listing
June 2019

Impact of length of stay on HCAHPS scores following lumbar spine surgery.

J Neurosurg Spine 2019 May;31(3):366-371

1Center for Spine Health, Cleveland Clinic Foundation; and.

Objective: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures.

Methods: The authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of "top-box" ("9-10" or "always or usually") versus "low-box" ("1-8" and "somewhat or never") scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher's exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables.

Results: Two hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control.

Conclusions: Here, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.
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http://dx.doi.org/10.3171/2019.3.SPINE181180DOI Listing
May 2019

Resource-ratio theory predicts mycorrhizal control of litter decomposition.

New Phytol 2019 08;223(3):1595-1606

Department of Environmental Systems Science, ETH Zürich, 8092, Zürich, Switzerland.

Ecosystems with ectomycorrhizal plants have high soil carbon : nitrogen ratios, but it is not clear why. The Gadgil effect, where competition between ectomycorrhizal and saprotrophic fungi for nitrogen slows litter decomposition, may increase soil carbon. However, experimental evidence for the Gadgil effect is equivocal. Here, we apply resource-ratio theory to assess whether interguild fungal competition for different forms of organic nitrogen can affect litter decomposition. We focus on variation in resource input ratios and fungal resource use traits, and evaluate our model's predictions by synthesizing prior experimental literature examining ectomycorrhizal effects on litter decomposition. In our model, resource input ratios determined whether ectomycorrhizal fungi suppressed saprotrophic fungi. Recalcitrant litter inputs favored the former over the latter, allowing the Gadgil effect only when such inputs predominated. Although ectomycorrhizal fungi did not always hamper litter decomposition, ectomycorrhizal nitrogen uptake always increased carbon : nitrogen ratios in litter. Our meta-analysis of empirical studies supports our theoretical results: ectomycorrhizal fungi appear to slow decomposition of leaf litter only in forests where litter inputs are highly recalcitrant. We thus find that the specific contribution of the Gadgil effect to high soil carbon : nitrogen ratios in ectomycorrhizal ecosystems may be smaller than predicted previously.
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http://dx.doi.org/10.1111/nph.15884DOI Listing
August 2019

Mind-wandering rates fluctuate across the day: evidence from an experience-sampling study.

Cogn Res Princ Implic 2018 Dec 29;3(1):54. Epub 2018 Dec 29.

The University of British Columbia, Vancouver, Canada.

Previous research has demonstrated reliable fluctuations in attentional processes during the course of the day. Everyday life experience sampling, during which participants respond to "probes" delivered at random intervals throughout the day on their mobile devices, is an effective tool for capturing such diurnal fluctuations in a naturalistic way. The existence of diurnal fluctuations in the case of mind-wandering, however, has not been examined to date. We did so in two studies. In the first study, we employed everyday experience sampling to obtain self-reports from 146 university students who rated the degree of free movement in their thoughts multiple times per day over five days. These time course data were analyzed using multilevel modelling. Freely moving thought was found to fluctuate reliably over the course of the day, with lower ratings reported in the early morning and afternoon and higher ratings around midday and evening. In the second study, we replicated these effects with a reanalysis of data from a past everyday experience-sampling study. We also demonstrated differences in parameter values for the models representing freely moving thought and two common conceptualizations of mind-wandering: task-unrelated thought and stimulus-independent thought. Taken together, the present results establish and replicate a complex pattern of change over the course of the day in how freely thought moves, while also providing further evidence that freedom of movement is dissociable from other dimensions of thought such as its task-relatedness and stimulus-dependence. Future research should focus on probing possible mechanisms behind circadian fluctuations of thought dynamics.
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http://dx.doi.org/10.1186/s41235-018-0141-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311173PMC
December 2018

Direct-Write Laser Greyscale Lithography for Multi-Layer Lead Zirconate Titanate Thin Films.

IEEE Trans Ultrason Ferroelectr Freq Control 2018 Mar 9. Epub 2018 Mar 9.

Direct-write laser greyscale lithography has been used to facilitate a single step patterning technique for multi-layer lead zirconate titanate (PZT) thin films. A 2.55 μm thick photoresist was patterned with a direct-write laser. The intensity of the laser was varied to create both tiered and sloped structures that are subsequently transferred into multi-layer PZT(52/48) stacks using a single Ar ion mill etch. Traditional processing requires a separate photolithography step and an ion mill etch for each layer of the substrate, which can be costly and time consuming. The novel process allows access to buried electrode layers in the multi-layer stack in a single photolithography step. The greyscale process was demonstrated on three 150 mm diameter Si substrates configured with a 0.5 μm thick SiO2 elastic layer, a base electrode of Pt/TiO2, and a stack of four PZT(52/48) thin films of either 0.25 μm thickness per layer or 0.50 μm thickness per layer, and using either Pt or IrO2 electrodes above and below each layer. Stacked capacitor structures were patterned and results will be reported on the ferroelectric and electromechanical properties using various wiring configurations and compared to comparable single layer PZT configurations.
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http://dx.doi.org/10.1109/TUFFC.2018.2814349DOI Listing
March 2018

Self-referrals versus physician referrals: What new patient visit yields an actual surgical case?

J Neurosurg Spine 2018 Sep 15;29(3):314-321. Epub 2018 Jun 15.

2Center for Spine Health, Cleveland Clinic; and.

OBJECTIVE Spine surgeons in the United States continue to be overwhelmed by an aging population, and patients are waiting weeks to months for appointments. With a finite number of clinic visits per surgeon, analysis of referral sources needs to be explored. In this study, the authors evaluated patient referrals and their yield for surgical volume at a tertiary care center. METHODS This is a retrospective study of new patient visits by the spine surgery group at the Cleveland Clinic Center for Spine Health from 2011 to 2016. Data on all new or consultation visits for 5 identified spinal surgeons at the Center for Spine Health were collected. Patients with an identifiable referral source and who were at least 18 years of age at initial visit were included in this study. Univariate analysis was used to identify demographic differences among referral groups, and then multivariate analysis was used to evaluate those referral groups as significant predictors of surgical yield. RESULTS After adjusting for demographic differences across all referrals, multivariate analysis identified physician referrals as more likely (OR 1.48, 95% CI 1.04-2.10, p = 0.0293) to yield a surgical case than self-referrals. General practitioner referrals (OR 0.5616, 95% CI 0.3809-0.8278, p = 0.0036) were identified as less likely to yield surgical cases than referrals from interventionalists (OR 1.5296, p = 0.058) or neurologists (OR 1.7498, 95% CI 1.0057-3.0446, p = 0.0477). Additionally, 2 demographic factors, including distance from home and age, were identified as predictors of surgery. Local patients (OR 1.21, 95% CI 1.13-1.29, p = 0.018) and those 65 years of age or older (OR 0.80, 95% CI 0.72-0.87, p = 0.0023) were both more likely to need surgery after establishing care with a spine surgeon. CONCLUSIONS In conclusion, referrals from general practitioners and self-referrals are important areas where focused triaging may be necessary. Further research into midlevel providers and nonsurgical spine provider's role in these referrals for spine pathology is needed. Patients from outside of the state or younger than 65 years could benefit from pre-visit screening as well to optimize a surgeon's clinic time use and streamline patient care.
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http://dx.doi.org/10.3171/2018.1.SPINE17793DOI Listing
September 2018

National Trends in Demographics and Outcomes Following Cervical Fusion for Cervical Spondylotic Myelopathy.

Global Spine J 2018 May 22;8(3):244-253. Epub 2017 Sep 22.

Cleveland Clinic, Cleveland, OH, USA.

Study Design: Retrospective trends analysis.

Objectives: Cervical fusion is a common adjunctive surgical modality used in the treatment of cervical spondylotic myelopathy (CSM). The purpose of this study was to quantify national trends in patient demographics, hospital characteristics, and outcomes in the surgical management of CSM.

Methods: This was a retrospective study that used the National Inpatient Sample. The sample included all patients over 18 years of age with a diagnosis of CSM who underwent cervical fusion from 2003 to 2013. The outcome measures were in-hospital mortality, length of stay, and hospital charges. Chi-square tests were performed to compare categorical variables. Independent tests were performed to compare continuous variables.

Results: We identified 62 970 patients with CSM who underwent cervical fusion from 2003 to 2013. The number of fusions performed per year in the treatment of CSM increased from 3879 to 8181. The average age of all fusion patients increased from 58.2 to 60.6 years ( < .001). Length of stay did not change significantly from a mean of 3.7 days. In-hospital mortality decreased from 0.6% to 0.3% ( < .01). Hospital charges increased from $49 445 to $92 040 ( < .001).

Conclusions: This study showed a dramatic increase in cervical fusions to treat CSM from 2003 to 2013 concomitant with increasing age of the patient population. Despite increases in average age and number of comorbidities, length of stay remained constant and a decrease in mortality was seen across the study period. However, hospital charges increased dramatically.
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http://dx.doi.org/10.1177/2192568217722562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958486PMC
May 2018

Direct-Write Laser Grayscale Lithography for Multilayer Lead Zirconate Titanate Thin Films.

IEEE Trans Ultrason Ferroelectr Freq Control 2018 05;65(5):889-894

Direct-write laser grayscale lithography has been used to facilitate a single-step patterning technique for multilayer lead zirconate titanate (PZT) thin films. A 2.55- -thick photoresist was patterned with a direct-write laser. The intensity of the laser was varied to create both tiered and sloped structures that are subsequently transferred into multilayer PZT(52/48) stacks using a single Ar ion-mill etch. Traditional processing requires a separate photolithography step and an ion mill etch for each layer of the substrate, which can be costly and time consuming. The novel process allows access to buried electrode layers in the multilayer stack in a single photolithography step. The grayscale process was demonstrated on three 150-mm diameter Si substrates configured with a 0.5- -thick SiO elastic layer, a base electrode of Pt/TiO, and a stack of four PZT(52/48) thin films of either 0.25- thickness per layer or 0.50- thickness per layer, and using either Pt or IrO electrodes above and below each layer. Stacked capacitor structures were patterned and results will be reported on the ferroelectric and electromechanical properties using various wiring configurations and compared to comparable single layer PZT configurations.
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http://dx.doi.org/10.1109/TUFFC.2018.2814349DOI Listing
May 2018

Competition-colonization tradeoffs structure fungal diversity.

ISME J 2018 06 28;12(7):1758-1767. Epub 2018 Feb 28.

Department of Biology, Stanford University, Stanford, CA, 94305, USA.

Findings of immense microbial diversity are at odds with observed functional redundancy, as competitive exclusion should hinder coexistence. Tradeoffs between dispersal and competitive ability could resolve this contradiction, but the extent to which they influence microbial community assembly is unclear. Because fungi influence the biogeochemical cycles upon which life on earth depends, understanding the mechanisms that maintain the richness of their communities is critically important. Here, we focus on ectomycorrhizal fungi, which are microbial plant mutualists that significantly affect global carbon dynamics and the ecology of host plants. Synthesizing theory with a decade of empirical research at our study site, we show that competition-colonization tradeoffs structure diversity in situ and that models calibrated only with empirically derived competition-colonization tradeoffs can accurately predict species-area relationships in this group of key eukaryotic microbes. These findings provide evidence that competition-colonization tradeoffs can sustain the landscape-scale diversity of microbes that compete for a single limiting resource.
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http://dx.doi.org/10.1038/s41396-018-0086-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018791PMC
June 2018

Rare Neurosurgical Complications of Epidural Injections: An 8-Yr Single-Institution Experience.

Oper Neurosurg (Hagerstown) 2017 04;13(2):271-279

Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio.

Background: Neurosurgical complications from epidural injections have rarely been reported.

Objective: To define the spectrum of complications from these procedures in order to identify risk factors and strategies for prevention.

Methods: A prospectively maintained database of 14 247 neurosurgical admissions over 8 yr was screened to identify patients who had suffered procedural complications associated with 1182 cervical and 4617 lumbar interlaminar epidural injection procedures performed at a single institution. Patients who developed new neurological symptoms or deficits were included. A retrospective analysis of demographic and procedural features was performed.

Results: Thirteen patients experienced complications requiring neurosurgical treatment, accounting for an overall procedural complication rate of 0.22% (0.51% and 0.15% for cervical and lumbar injections, respectively), and representing 0.09% of all neurosurgical admissions over 8 yr. There were 3 categories: hemorrhage (n = 7), infection (n = 3), and inadvertent dural penetration (n = 3). There was significant association with anticoagulation use among patients with hemorrhagic vs nonhemorrhagic complications ( P < .01, Fisher's exact test). Six patients who developed epidural hematoma had been managed in accordance with current guidelines, either after prolonged cessation of anticoagulation (n = 3) or taking only aspirin (n = 3); all were decompressed promptly with good long-term outcome. All infections were associated with lumbar injection. Dural penetration resulted in diffuse pneumocephalus (n = 1), intramedullary air at the site of injection (n = 1), and acutely symptomatic colloid cyst (n = 1).

Conclusion: A majority of neurosurgical complications from epidural injections are hemorrhagic and associated with anticoagulation, although infection and inadvertent dural penetration also occur. Prompt treatment of compressive lesions is associated with good outcome.
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http://dx.doi.org/10.1093/ons/opw014DOI Listing
April 2017

Emergency department visits after lumbar spine surgery are associated with lower Hospital Consumer Assessment of Healthcare Providers and Systems scores.

Spine J 2018 Feb 21;18(2):226-233. Epub 2017 Jul 21.

Cleveland Clinic Center for Spine Health, 9500 Euclid Avenue, S-40 Cleveland, Ohio 44195, USA; Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, S-40 Cleveland, Ohio 44195, USA.

Background: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are used to assess the quality of the patient experience following an inpatient stay. Hospital Consumer Assessment of Healthcare Providers and Systems scores are used to determine reimbursement for hospital systems and incentivize spine surgeons nationwide. There are conflicting data detailing whether early readmission or other postdischarge complications are associated with patient responses on the HCAHPS survey. Currently, the association between postdischarge emergency department (ED) visits and HCAHPS scores following lumbar spine surgery is unknown.

Purpose: To determine whether ED visits within 30 days of discharge are associated with HCAHPS scores for patients who underwent lumbar spine surgery.

Study Design: Retrospective cohort study.

Patient Sample: A total of 453 patients who underwent lumbar spine surgery who completed the HCAHPS survey between 2013 and 2015 at a single tertiary care center.

Outcome Measures: The HCAHPS survey-the Centers for Medicare and Medicaid Services' official measure of patient experience-results for each patient were analyzed as the primary outcome of this study.

Methods: All patients undergoing lumbar spine surgery between 2013 and 2015 who completed an HCAHPS survey were studied. Patients were excluded from the study if they had been diagnosed with spinal malignancy or scoliosis. Patients who had an ED visit at our institution within 30 days of discharge were included in the ED visit cohort. The primary outcomes of this study include 21 measures of patient experience on the HCAHPS survey. Statistical analysis included Pearson chi-square for categorical variables, Student t test for normally distributed continuous variables, and Mann-Whitney U test for nonparametric variables. Additionally, log-binomial regression models were used to analyze the association between ED visits within 30 days after discharge and odds of top-box HCAHPS scores. No funds were received in support of this study, and the authors report no conflict of interest-associated biases.

Results: After adjusting for patient-level covariates using log-binomial regression models, we found postdischarge ED visits were independently associated with lower likelihood of top-box score for several individual questions on HCAHPS. Emergency department visits within 30 days of discharge were negatively associated with perceiving your doctor as "always" treating you with courtesy and respect (risk ratio [RR] 0.26, p<.001), as well as perceiving your doctor as "always" listeningcarefully to you (RR 0.40, p=.003). Also, patients with an ED visit were less likely to feel as if their preferences were taken into account when leaving the hospital (RR 0.61, p=.008), less likely to recommend the hospital to family or friends (RR 0.46, p=.020), and less likely to rate the hospital as a 9 or a 10 out of 10, the top-box score (RR 0.43, p=.005).

Conclusions: Our results demonstrate a strong association between postdischarge ED visits and low HCAHPS scores for doctor communication, discharge information, and global measures of hospital satisfaction in a lumbar spine surgery population.
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http://dx.doi.org/10.1016/j.spinee.2017.06.043DOI Listing
February 2018

The association between the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and real-world clinical outcomes in lumbar spine surgery.

Spine J 2017 11 8;17(11):1586-1593. Epub 2017 May 8.

Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, S-40, Cleveland, OH 44195, USA; Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, S-40, Cleveland, OH, USA.

Background Context: The patient experience of care as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is currently used to determine hospital reimbursement. The current literature inconsistently demonstrates an association between patient satisfaction and surgical outcomes.

Purpose: To determine whether patient satisfaction with hospital experience is associated with better clinical outcomes in lumbar spine surgery.

Study Design: A retrospective cohort study conducted at a single institution.

Patient Sample: A total of 249 patients who underwent lumbar spine surgery between 2013 and 2015 and completed the HCAHPS survey.

Outcome Measures: Self-reported health status measures, including the EuroQol 5 Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and visual analog score for back pain (VAS-BP).

Methods: All patients undergoing lumbar spine surgery between 2013 and 2015 who completed an HCAHPS survey were studied. Patients were excluded from the study if they had been diagnosed with spinal malignancy, scoliosis, or had less than 1 year of follow-up. Patients who selected a 9 or 10 overall hospital rating (OHR) on HCAHPS were placed in the satisfied group, and the remaining patients comprised the unsatisfied group. The primary outcomes of this study include patient-reported health status measures such as EQ-5D, PDQ, and VAS-BP. No funds were received in support of this study, and the authors report no conflict of interest-associated biases.

Results: Our study population consisted of 249 patients undergoing lumbar spine surgery. Of these, 197 (79%) patients selected an OHR of 9 or 10 on the HCAHPS survey and were included in the satisfied group. The only preoperative characteristics that differed significantly between the twogroups were gender, a diagnosis of degenerative disc disease (DDD), heavy preoperative narcotic use, and a diagnosis of chronic renal failure. At 1 year follow-up, no statistically significant differences in EQ-5D, PDQ, or VAS-BP were observed. After using multivariable linear regression models to assess the association between patient satisfaction and pre- to 1-year postoperative changes in health status measures, selecting a top-box OHR was not found to be significantly associated with change in either EQ-5D (beta=0.055 [95% confidence interval {CI}: -0.035 to 0.145]), PDQ (beta=-9.013 [95% CI: -23.782 to 5.755]), or VAS-BP (beta=-0.849 [95% CI: -2.125 to 0.426]). These results suggest high satisfaction with the hospital experience may not necessarily correlate with favorable clinical outcomes.

Conclusions: Top-box OHR was not associated with pre- to 1-year postoperative improvement in EQ-5D, PDQ, and VAS-BP. Although the associations between high satisfaction and improvement in health status did not reach statistical significance, the best estimates from our multivariable models reflect greater clinical improvement with top-box satisfaction. Future studies should seek to investigate whether HCAHPS are a reliable indicator of quality care in lumbar spine surgery.
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http://dx.doi.org/10.1016/j.spinee.2017.05.002DOI Listing
November 2017

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

Global Spine J 2017 Apr 1;7(1 Suppl):64S-70S. Epub 2017 Apr 1.

Boston Medical Center, Scituate, MA, USA.

Study Design: A multicenter, retrospective review of C5 palsy after cervical spine surgery.

Objective: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery.

Methods: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. values were calculated using 2-sample test for continuous variables and χ tests or Fisher exact tests for categorical variables.

Results: Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%).

Conclusion: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.
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http://dx.doi.org/10.1177/2192568216688189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400195PMC
April 2017

A Multicenter Study of the Presentation, Treatment, and Outcomes of Cervical Dural Tears.

Global Spine J 2017 Apr 1;7(1 Suppl):58S-63S. Epub 2017 Apr 1.

Johns Hopkins Hospital, Baltimore, MD, USA.

Study Design: Retrospective multicenter case series study.

Objective: Because cervical dural tears are rare, most surgeons have limited experience with this complication. A multicenter study was performed to better understand the presentation, treatment, and outcomes following cervical dural tears.

Methods: Multiple surgeons from 23 institutions retrospectively identified 21 rare complications that occurred between 2005 and 2011, including unintentional cervical dural tears. Demographic data and surgical history were obtained. Clinical outcomes following surgery were assessed, and any reoperations were recorded. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), Nurick classification (NuC), and Short-Form 36 (SF36) scores were recorded at baseline and final follow-up at certain centers. All data were collected, collated, and analyzed by a private research organization.

Results: There were 109 cases of cervical dural tears among 18 463 surgeries performed. In 101 cases (93%) there was no clinical sequelae following successful dural tear repair. There were statistical improvements ( < .05) in mJOA and NuC scores, but not NDI or SF36 scores. No specific baseline or operative factors were found to be associated with the occurrence of dural tears. In most cases, no further postoperative treatments of the dural tear were required, while there were 13 patients (12%) that required subsequent treatment of cerebrospinal fluid drainage. Analysis of those requiring further treatments did not identify an optimum treatment strategy for cervical dural tears.

Conclusions: In this multicenter study, we report our findings on the largest reported series (n = 109) of cervical dural tears. In a vast majority of cases, no subsequent interventions were required and no clinical sequelae were observed.
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http://dx.doi.org/10.1177/2192568216688186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400193PMC
April 2017

Incidence and Outcomes of Acute Implant Extrusion Following Anterior Cervical Spine Surgery.

Global Spine J 2017 Apr 1;7(1 Suppl):40S-45S. Epub 2017 Apr 1.

Cleveland Clinic Foundation, Cleveland, OH, USA.

Study Design: Multi-institutional retrospective case series of 8887 patients who underwent anterior cervical spine surgery.

Objective: Anterior decompression from discectomy or corpectomy is not without risk. Surgical morbidity ranges from 9% to 20% and is likely underreported. Little is known of the incidence and effects of rare complications on functional outcomes following anterior spinal surgery. In this retrospective review, we examined implant extrusions (IEs) following anterior cervical fusion.

Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of 21 predefined treatment complications.

Results: Following anterior cervical fusion, the incidence of IE ranged from 0.0% to 0.8% across 21 institutions with 11 cases reported. All surgeries involved multiple levels, and 7/11 (64%) involved either multilevel corpectomies or hybrid constructs with at least one adjacent discectomy to a corpectomy. In 7/11 (64%) patients, constructs ended with reconstruction or stabilization at C7. Nine patients required surgery for repair and stabilization following IE. Average length of hospital stay after IE was 5.2 days. Only 2 (18%) had residual deficits after reoperation.

Conclusions: IE is a very rare complication after anterior cervical spine surgery often requiring revision. Constructs requiring multilevel reconstruction, especially at the cervicothoracic junction, have a higher risk for failure, and surgeons should proceed with caution in using an anterior-only approach in these demanding cases. Surgeons can expect most patients to regain function after reoperation.
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http://dx.doi.org/10.1177/2192568216686752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400179PMC
April 2017

Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study.

Global Spine J 2017 Apr 1;7(1 Suppl):21S-27S. Epub 2017 Apr 1.

Columbia University, New York, NY, USA.

Study Design: A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI).

Objective: To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery.

Methods: Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36).

Results: VAIs were identified in a total of 14 of 16 582 patients screened (8.4 per 10 000). The mean age of patients with VAI was 59 years (±10) with a female predominance (78.6%). Patient diagnoses included myelopathy, radiculopathy, cervical instability, and metastatic disease. VAI was associated with substantial blood loss (770 mL), although only 3 cases required transfusion. Of the 14 cases, 7 occurred with an anterior-only approach, 3 cases with posterior-only approach, and 4 during circumferential approach. Fifty percent of cases of VAI with available preoperative imaging revealed anomalous vessel anatomy during postoperative review. Average length of hospital stay was 10 days (±8). Notably, 13 of the 14 (92.86%) cases resolved without residual deficits. Compared to preoperative baseline NDI, Nurick, mJOA, and SF-36 scores for these patients, there were no observed changes after surgery ( = .20-.94).

Conclusions: Vertebral artery injuries are potentially catastrophic complications that can be sustained from anterior or posterior cervical spine approaches. The data from this study suggest that with proper steps to ensure hemostasis, patients recover function at a high rate and do not exhibit residual deficits.
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http://dx.doi.org/10.1177/2192568216686753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400180PMC
April 2017

Thoracic Duct Injury Following Cervical Spine Surgery: A Multicenter Retrospective Review.

Global Spine J 2017 Apr 1;7(1 Suppl):115S-119S. Epub 2017 Apr 1.

Cleveland Clinic, Cleveland, OH, USA.

Study Design: Multicenter retrospective case series.

Objective: To determine the rate of thoracic duct injury during cervical spine operations.

Methods: A retrospective case series study was conducted among 21 high-volume surgical centers to identify instances of thoracic duct injury during anterior cervical spine surgery. Staff at each center abstracted data for each identified case into case report forms. All case report forms were collected by the AOSpine North America Clinical Research Network Methodological Core for data processing, cleaning, and analysis.

Results: Of a total of 9591 patients reviewed that underwent cervical spine surgery, 2 (0.02%) incurred iatrogenic injury to the thoracic duct. Both patients underwent a left-sided anterior cervical discectomy and fusion. The interruption of the thoracic duct was addressed intraoperatively in one patient with no residual postoperative effects. The second individual developed a chylous fluid collection approximately 2 months after the operation that required drainage via needle aspiration.

Conclusions: Damage to the thoracic duct during cervical spine surgery is a relatively rare occurrence. Rapid identification of the disruption of this lymphatic vessel is critical to minimize deleterious effects of this complication.
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http://dx.doi.org/10.1177/2192568216688194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400197PMC
April 2017

Rare Complications of Cervical Spine Surgery: Pseudomeningocoele.

Global Spine J 2017 Apr 1;7(1 Suppl):109S-114S. Epub 2017 Apr 1.

University of Virginia, Charlottesville, VA, USA.

Study Design: This study was a retrospective, multicenter cohort study.

Objectives: Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience.

Methods: This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC.

Results: Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects.

Conclusions: PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.
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http://dx.doi.org/10.1177/2192568216687769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400191PMC
April 2017

Growing evidence for facultative biotrophy in saprotrophic fungi: data from microcosm tests with 201 species of wood-decay basidiomycetes.

New Phytol 2017 Jul 6;215(2):747-755. Epub 2017 Apr 6.

Department of Forest Mycology and Plant Pathology, Uppsala BioCenter, Swedish University of Agricultural Sciences, PO Box 7026, Uppsala, SE-75007, Sweden.

Ectomycorrhizal (ECM) symbioses have evolved a minimum of 78 times independently from saprotrophic lineages, indicating the potential for functional overlap between ECM and saprotrophic fungi. ECM fungi have the capacity to decompose organic matter, and although there is increasing evidence that some saprotrophic fungi exhibit the capacity to enter into facultative biotrophic relationships with plant roots without causing disease symptoms, this subject is still not well studied. In order to determine the extent of biotrophic capacity in saprotrophic wood-decay fungi and which systems may be useful models, we investigated the colonization of conifer seedling roots in vitro using an array of 201 basidiomycete wood-decay fungi. Microtome sectioning, differential staining and fluorescence microscopy were used to visualize patterns of root colonization in microcosm systems containing Picea abies or Pinus sylvestris seedlings and each saprotrophic fungus. Thirty-four (16.9%) of the tested fungal species colonized the roots of at least one tree species. Two fungal species showed formation of a mantle and one showed Hartig net-like structures. These features suggest the possibility of an active functional symbiosis between fungus and plant. The data indicate that the capacity for facultative biotrophic relationships in free-living saprotrophic basidiomycetes may be greater than previously supposed.
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http://dx.doi.org/10.1111/nph.14551DOI Listing
July 2017

Impact of Preoperative Depression on Hospital Consumer Assessment of Healthcare Providers and Systems Survey Results in a Lumbar Fusion Population.

Spine (Phila Pa 1976) 2017 May;42(9):675-681

Center for Spine Health, Cleveland Clinic, Cleveland, OH.

Study Design: A retrospective cohort study at a single institution.

Objective: To determine the effect of preoperative depression on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores in a lumbar fusion population.

Summary Of Background Data: HCAHPS surveys are used to assess the quality of the patient experience, and directly influences reimbursement for hospital systems and spine surgeons nationwide. Untreated depression has been linked to worse functional outcomes in spine surgery. We, however, aimed to elucidate whether HCAHPS survey responses were different in depressed patients.

Methods: Prospectively collected functional outcome data including Patient Health Questionnaire 9, EuroQol five dimensions, and Pain Disability Questionnaire were analyzed preoperatively. Preoperative Patient Health Questionnaire 9 scores of greater than or equal to 10 (moderate to severe depression) defined our depressed cohort of patients. HCAHPS responses were obtained for each individual, allowing for real-world analysis of outcomes in this population.

Results: In our 237 patient cohort, depressed patients were younger, female; were on full disability; and had lower scores on EuroQol five dimensions and Pain Disability Questionnaire preoperatively. Approximately 73.2% of depressed patients felt doctors treated them with respect, compared to 88.8% of patients without depression (P = 0.005). Also, depressed patients felt nurses treated them with less respect (P = 0.014) and that physicians did not listen to them as carefully (P = 0.029). Multivariate regression analysis revealed that patients with preoperative depression had higher odds of patients feeling less respected by both physicians and nurses. Multivariate analysis also revealed that depression was an independent predictor of lower patient satisfaction with nursing response to their needs.

Conclusion: In patients undergoing lumbar fusion, preoperative depression was shown to have negative effect on patient experience measured by the HCAHPS survey. These results suggest that depression may be a modifiable risk factor for poor hospital experience.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000002101DOI Listing
May 2017
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