Key Takeaways From the ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 2: Polytomous Rasch Analysis of Learning Curve and Surgeon Endorsement of Biportal, Interlaminar, and Transforaminal Endoscopic Stenosis Decompression, Discectomy, and Laminectomy in Combination With Interspinous Process Spacers.

Background: The International Society for the Advancement of Spine Surgery hosted the second of a series of 4 webinars on endoscopic spine surgery techniques. The second webinar focused on the application of unilateral biportal endoscopy for discectomy and laminectomy in combination with interbody fusion and interspinous process spacers. This series was intended to identify current trends with contemporary modern endoscopic spine surgery techniques.

The resilience of the Brazilian Unified Health System is not (only) in responding to disasters.

Coping with the recent COVID-19 pandemic has shown that the Brazilian Unified Health System (SUS) needs to improve its resilience to handle the rapid spread of communicable diseases while ensuring the necessary care for an aging population with comorbidities and in a vulnerable situation. This article identifies, analyzes, and discusses critical aspects of the resilience of the SUS, calling into question the prevailing focus on the robustness and volume of resources mobilized during the outbreak of major disasters. Recent studies demonstrate that the skills that favor adaptation to unexpected situations emerge from the daily functioning of organizations.

Dynamically predicting comprehension difficulties through physiological data and intelligent wearables.

Comprehending digital content written in natural language online is vital for many aspects of life, including learning, professional tasks, and decision-making. However, facing comprehension difficulties can have negative consequences for learning outcomes, critical thinking skills, decision-making, error rate, and productivity. This paper introduces an innovative approach to predict comprehension difficulties at the local content level (e.

Comparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study.

Background: Effective 1 January 2017, single-level endoscopic lumbar discectomy received a Category I Current Procedural Terminology (CPT) code 62380. However, no work relative value units (RVUs) are currently assigned to the procedure. An international team of endoscopic spine surgeons conducted a study, endorsed by several spine societies, analyzing the learning curve, difficulty, psychological intensity, and estimated work RVUs of endoscopic lumbar spinal decompression compared with other common lumbar spine surgeries.

Polytomous Rasch Analyses of Surgeons' Decision-Making on Choice of Procedure in Endoscopic Lumbar Spinal Stenosis Decompression Surgeries.

Background: With the growing prevalence of lumbar spinal stenosis, endoscopic surgery, which incorporates techniques such as transforaminal, interlaminar, and unilateral biportal (UBE) endoscopy, is increasingly considered. However, the patient selection criteria are debated among spine surgeons.

Objective: This study used a polytomous Rasch analysis to evaluate the factors influencing surgeon decision-making in selecting patients for endoscopic surgical treatment of lumbar spinal stenosis.

Disability-adjusted life years from bone and joint infections associated with antimicrobial resistance: an insight from the 2019 Global Burden of Disease Study.

Purpose: Bone and joint infections, complicated by the burgeoning challenge of antimicrobial resistance (AMR), pose significant public health threats by amplifying the disease burden globally. We leveraged results from the 2019 Global Burden of Disease Study (GBD) to explore the impact of AMR attributed to bone and joint infections in terms of disability-adjusted life years (DALYs), elucidating the contemporary status and temporal trends.

Methods: Utilizing GBD 2019 data, we summarized the burden of bone and joint infections attributed to AMR across 195 countries and territories in the 30 years from 1990 to 2019.

EEG as a potential ground truth for the assessment of cognitive state in software development activities: A multimodal imaging study.

Cognitive human error and recent cognitive taxonomy on human error causes of software defects support the intuitive idea that, for instance, mental overload, attention slips, and working memory overload are important human causes for software bugs. In this paper, we approach the EEG as a reliable surrogate to MRI-based reference of the programmer's cognitive state to be used in situations where heavy imaging techniques are infeasible. The idea is to use EEG biomarkers to validate other less intrusive physiological measures, that can be easily recorded by wearable devices and useful in the assessment of the developer's cognitive state during software development tasks.

Nondestructive Evaluation of Metal Bioaccumulation and Biochemical Biomarkers in Blood of Broad-Snouted Caiman (Caiman latirostris) from Northeastern Brasil.

Studies on the bioaccumulation and toxicity of contaminants in Crocodylians are scarce. We evaluated alterations in concentrations of the nondestructive biomarkers butyrylcholinesterase (BChE), glutathione-S-transferase (GST), superoxide dismutase (SOD), and reduced glutathione (GSH), together with bioaccumulation of the metals iron (Fe), copper (Cu), zinc (Zn), manganese (Mn), chronium (Cr), aluminium (Al), and lead (Pb) in Caiman latirostris captured in Tapacurá Reservoir (TR; São Lourenço da Mata, Pernambuco, Brasil), in urbanized areas of Pernambuco State (UA; Brasil) and from the AME Brasil caiman farm (AF; Marechal Deodoro, Alagoas, Brasil); the latter was used as a potential reference with low levels of contamination. For metal analysis, 500 µL of blood was digested in 65% HNO and 30% HO.

PAH residues and toxicity levels two years after an extensive oil spill on the northeast Brazilian coast.

The most extensive oil spill ever recorded in tropical oceans occurred between August 2019 and March 2020, affecting approximately 3000 km of the Brazilian coast. This study assessed the chemical contamination and toxicity of sediments collected from affected reef areas during two sampling surveys conducted 17 and 24 months after the peak of oil slick inputs. Our results indicated that neither PAH levels nor measured toxicity showed a significant contribution from the spilled oil, with concentrations and biological effects indistinguishable from those in unaffected areas.

Development of Potential Multi-Target Inhibitors for Human Cholinesterases and Beta-Secretase 1: A Computational Approach.

Alzheimer's disease causes chronic neurodegeneration and is the leading cause of dementia in the world. The causes of this disease are not fully understood but seem to involve two essential cerebral pathways: cholinergic and amyloid. The simultaneous inhibition of AChE, BuChE, and BACE-1, essential enzymes involved in those pathways, is a promising therapeutic approach to treat the symptoms and, hopefully, also halt the disease progression.

Decentralizing referral prioritization to general practitioners at the primary care level: A qualitative case study based on the Grounded Theory.

Background: Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources.

Objective: This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics.

Methods: A qualitative case study was carried out in the municipality of Rio de Janeiro.

BRACETS: Bimodal repository of auscultation coupled with electrical impedance thoracic signals.

Background And Objective: Respiratory diseases are among the most significant causes of morbidity and mortality worldwide, causing substantial strain on society and health systems. Over the last few decades, there has been increasing interest in the automatic analysis of respiratory sounds and electrical impedance tomography (EIT). Nevertheless, no publicly available databases with both respiratory sound and EIT data are available.

Randomized Clinical Trials and Observational Tribulations: Providing Clinical Evidence for Personalized Surgical Pain Management Care Models.

Proving clinical superiority of personalized care models in interventional and surgical pain management is challenging. The apparent difficulties may arise from the inability to standardize complex surgical procedures that often involve multiple steps. Ensuring the surgery is performed the same way every time is nearly impossible.

Patient Perceptions of Paramedian Minimally Invasive Spine Skin Incisions.

Background: In clinical outcome studies, patient input into the factors that drive higher satisfaction with lumbar minimally invasive spinal surgery (MISS) is rare. The skin incision is often the only visible consequence of surgery that patients can assess. The authors were interested in patients' opinions about the type of lumbar paramedian minimally invasive spinal (MIS) skin incision employed during MISS and how novel skin incisions could impact patients' interpretation of the outcome.

The Changing Environment in Postgraduate Education in Orthopedic Surgery and Neurosurgery and Its Impact on Technology-Driven Targeted Interventional and Surgical Pain Management: Perspectives from Europe, Latin America, Asia, and The United States.

Personalized care models are dominating modern medicine. These models are rooted in teaching future physicians the skill set to keep up with innovation. In orthopedic surgery and neurosurgery, education is increasingly influenced by augmented reality, simulation, navigation, robotics, and in some cases, artificial intelligence.

Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis.

Pain generator-based lumbar spinal decompression surgery is the backbone of modern spine care. In contrast to traditional image-based medical necessity criteria for spinal surgery, assessing the severity of neural element encroachment, instability, and deformity, staged management of common painful degenerative lumbar spine conditions is likely to be more durable and cost-effective. Targeting validated pain generators can be accomplished with simplified decompression procedures associated with lower perioperative complications and long-term revision rates.

A framework to assess potential health system resilience using fuzzy logic.

Objectives: To develop and test a framework to assess the potential of public health systems to maintain a resilient performance.

Methods: Quantitative data from public databases and qualitative data from technical reports of Brazilian health authorities were used to develop the framework which was assessed and modified by experts. Fuzzy logic was used for the mathematical model to determine scores for four resilient abilities - monitoring, anticipation, learning, and response - and an aggregated coefficient of resilient potential in health care.

Ergonomics management model based on good practices of large industrial companies: Structured elements through the fuzzy set theory.

Background: Most organizations perceive the concept of ergonomic actions as a local tool used to improve workplace issues. Ergonomics however is not included in global management systems. The paradigm of ergonomics action in large organizations proposed by this study is that of management systems whose primary objective is the pressing need for continuous performance improvement, acquisition of excellence, and integration into all aspects of the business.

Transformative dimensions of resilience and brittleness during health systems' collapse: a case study in Brazil using the Functional Resonance Analysis Method.

Background: As health systems struggle to tackle the spread of Covid-19, resilience becomes an especially relevant attribute and research topic. More than strength or preparedness, to perform resiliently to emerging shocks, health systems must develop specific abilities that aim to increase their potential to adapt to extraordinary situations while maintaining their regular functioning. Brazil has been one of the most affected countries during the pandemic.

Automatic wheeze segmentation using harmonic-percussive source separation and empirical mode decomposition.

Wheezes are adventitious respiratory sounds commonly present in patients with respiratory conditions. The presence of wheezes and their time location are relevant for clinical reasons, such as understanding the degree of bronchial obstruction. Conventional auscultation is usually employed to analyze wheezes, but remote monitoring has become a pressing need during recent years.

Unveiling conflicting strategies in the Brazilian response to COVID-19: A cross-sectional study using the Functional Resonance Analysis Method.

By the time the present study was completed, Brazil had been the second epicenter of COVID-19. In addition, the actions taken to respond to the pandemic in Brazil were the subject of extensive debate, since some diverged from recommendations from health authorities and scientists. Since then, the resulting political and social turmoil showed conflicting strategies to tackle the pandemic in Brazil, with visible consequences in the numbers of casualties, but also with effects on the resilience of the overall health system.

Training and Credentialing Standards for Minimally Invasive Spinal Surgery Techniques: Results of a Survey.

Background: BACKGROUND: The controversy continues on how to best become proficient in contemporary minimally invasive spinal surgery techniques (MISST). Postgraduate training programs typically lag behind the innovation. Other subspecialty spine care providers often compete with spine surgeons particularly when they do not offer the treatments needed by their patients.

Analysis of government agencies and stakeholders' twitter communications during the first surge of COVID-19 in Brazil.

Background: Official authorities are in charge of communicating with the public in a consistent and coherent manner. The impact of social media on managing the coronavirus 2019 (COVID-19) pandemic potentially influenced social behavior in Brazil.

Objective: Using Twitter, this study analyzes communications about the COVID-19 pandemic from official agencies of the Brazilian government and key public sector decision-makers.