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Item Open Access fastMitoCalc: an ultra-fast program to estimate mitochondrial DNA copy number from whole-genome sequences(Bioinformatics, 2017-05-01) Qian, Yong; Butler, Thomas J; Opsahl-Ong, Krista; Giroux, Nicholas S; Sidore, Carlo; Nagaraja, Ramaiah; Cucca, Francesco; Ferrucci, Luigi; Abecasis, Gonçalo R; Schlessinger, David; Ding, JunAbstract Mitochondrial DNA (mtDNA) copy number is tightly regulated in tissues, and is both a critical determinant of mitochondrial function and a potential biomarker for disease. We and other groups have shown that the mtDNA copy number per cell can be directly estimated from whole-genome sequencing. The computation is based on the rationale that sequencing coverage should be proportional to the underlying DNA copy number for autosomal and mitochondrial DNA, and most computing time is spent calculating the average autosomal DNA coverage across ∼3 billion bases. That makes analyzing tens of thousands of available samples very slow. Here we present fastMitoCalc, which takes advantage of the indexing of sequencing alignment files and uses a randomly selected small subset (0.1%) of the nuclear genome to estimate autosomal DNA coverage accurately. It is more than 100 times faster than current programs. fastMitoCalc also provides an option to estimate copy number using a single autosomal chromosome, which could also achieve high accuracy but is slower. Using fastMitoCalc, it becomes much more feasible now to conduct analyses on large-scale consortium data to test for association of mtDNA copy number with quantitative traits or nuclear variants. Availability and Implementation fastMitoCalc is available at https://lgsun.irp.nia.nih.gov/hsgu/software/mitoAnalyzer/index.html Supplementary information Supplementary data are available at Bioinformatics online.Item Open Access Patient-derived micro-organospheres enable clinical precision oncology.(Cell stem cell, 2022-06) Ding, Shengli; Hsu, Carolyn; Wang, Zhaohui; Natesh, Naveen R; Millen, Rosemary; Negrete, Marcos; Giroux, Nicholas; Rivera, Grecia O; Dohlman, Anders; Bose, Shree; Rotstein, Tomer; Spiller, Kassandra; Yeung, Athena; Sun, Zhiguo; Jiang, Chongming; Xi, Rui; Wilkin, Benjamin; Randon, Peggy M; Williamson, Ian; Nelson, Daniel A; Delubac, Daniel; Oh, Sehwa; Rupprecht, Gabrielle; Isaacs, James; Jia, Jingquan; Chen, Chao; Shen, John Paul; Kopetz, Scott; McCall, Shannon; Smith, Amber; Gjorevski, Nikolche; Walz, Antje-Christine; Antonia, Scott; Marrer-Berger, Estelle; Clevers, Hans; Hsu, David; Shen, XilingPatient-derived xenografts (PDXs) and patient-derived organoids (PDOs) have been shown to model clinical response to cancer therapy. However, it remains challenging to use these models to guide timely clinical decisions for cancer patients. Here, we used droplet emulsion microfluidics with temperature control and dead-volume minimization to rapidly generate thousands of micro-organospheres (MOSs) from low-volume patient tissues, which serve as an ideal patient-derived model for clinical precision oncology. A clinical study of recently diagnosed metastatic colorectal cancer (CRC) patients using an MOS-based precision oncology pipeline reliably assessed tumor drug response within 14 days, a timeline suitable for guiding treatment decisions in the clinic. Furthermore, MOSs capture original stromal cells and allow T cell penetration, providing a clinical assay for testing immuno-oncology (IO) therapies such as PD-1 blockade, bispecific antibodies, and T cell therapies on patient tumors.Item Open Access DAMPs/PAMPs induce monocytic TLR activation and tolerance in COVID-19 patients; nucleic acid binding scavengers can counteract such TLR agonists.(Biomaterials, 2022-04) Naqvi, Ibtehaj; Giroux, Nicholas; Olson, Lyra; Morrison, Sarah Ahn; Llanga, Telmo; Akinade, Tolu O; Zhu, Yuefei; Zhong, Yiling; Bose, Shree; Arvai, Stephanie; Abramson, Karen; Chen, Lingye; Que, Loretta; Kraft, Bryan; Shen, Xiling; Lee, Jaewoo; Leong, Kam W; Nair, Smita K; Sullenger, BruceMillions of COVID-19 patients have succumbed to respiratory and systemic inflammation. Hyperstimulation of toll-like receptor (TLR) signaling is a key driver of immunopathology following infection by viruses. We found that severely ill COVID-19 patients in the Intensive Care Unit (ICU) display hallmarks of such hyper-stimulation with abundant agonists of nucleic acid-sensing TLRs present in their blood and lungs. These nucleic acid-containing Damage and Pathogen Associated Molecular Patterns (DAMPs/PAMPs) can be depleted using nucleic acid-binding microfibers to limit the patient samples' ability to hyperactivate such innate immune receptors. Single-cell RNA-sequencing revealed that CD16+ monocytes from deceased but not recovered ICU patients exhibit a TLR-tolerant phenotype and a deficient anti-viral response after ex vivo TLR stimulation. Plasma proteomics confirmed such myeloid hyperactivation and revealed DAMP/PAMP carrier consumption in deceased patients. Treatment of these COVID-19 patient samples with MnO nanoparticles effectively neutralizes TLR activation by the abundant nucleic acid-containing DAMPs/PAMPs present in their lungs and blood. Finally, MnO nanoscavenger treatment limits the ability of DAMPs/PAMPs to induce TLR tolerance in monocytes. Thus, treatment with microfiber- or nanoparticle-based DAMP/PAMP scavengers may prove useful for limiting SARS-CoV-2 induced hyperinflammation, preventing monocytic TLR tolerance, and improving outcomes in severely ill COVID-19 patients.Item Open Access Epigenetic and transcriptional responses in circulating leukocytes are associated with future decompensation during SARS-CoV-2 infection.(iScience, 2024-01) McClain, Micah T; Zhbannikov, Ilya; Satterwhite, Lisa L; Henao, Ricardo; Giroux, Nicholas S; Ding, Shengli; Burke, Thomas W; Tsalik, Ephraim L; Nix, Christina; Balcazar, Jorge Prado; Petzold, Elizabeth A; Shen, Xiling; Woods, Christopher WTo elucidate host response elements that define impending decompensation during SARS-CoV-2 infection, we enrolled subjects hospitalized with COVID-19 who were matched for disease severity and comorbidities at the time of admission. We performed combined single-cell RNA sequencing (scRNA-seq) and single-cell assay for transposase-accessible chromatin using sequencing (scATAC-seq) on peripheral blood mononuclear cells (PBMCs) at admission and compared subjects who improved from their moderate disease with those who later clinically decompensated and required invasive mechanical ventilation or died. Chromatin accessibility and transcriptomic immune profiles were markedly altered between the two groups, with strong signals in CD4+ T cells, inflammatory T cells, dendritic cells, and NK cells. Multiomic signature scores at admission were tightly associated with future clinical deterioration (auROC 1.0). Epigenetic and transcriptional changes in PBMCs reveal early, broad immune dysregulation before typical clinical signs of decompensation are apparent and thus may act as biomarkers to predict future severity in COVID-19.Item Open Access 针对华裔学生的美国大学中文教材(Chinese as a Second Language (漢語教學研究—美國中文教師學會學報). The journal of the Chinese Language Teachers Association, USA) Liu, Yan; Ji, Jingjing; Wu, Grace; Liang, Min-Min摘要 近些年来，美国大学中文课中传承语学习者的数量不断增加 (Xiang, 2016)。然而，现有的传承语教材数量比较少，且目前美国大学中文项目所使用的华裔中文教材也存在一定的局限性 (Luo et al., 2019)。因此，编写新的大学中文传承语教材势在必行。本文首先回顾了相关传承语教学以及中文传承语学习者的研究，然后对现有的中文传承语教材进行评估，识别其局限之处。最后，基于以上分析以及与传承语教学法和教材编写原则相关的研究，为未来中文传承语教材所应遵循的编写原则、课文话题和角度、面向群体、教学内容和活动所应遵循的标准和体例等方面提出一些建议。Item Open Access Acquisition of Chinese characters: the effects of character properties and individual differences among second language learners.(Frontiers in psychology, 2015-01) Kuo, Li-Jen; Kim, Tae-Jin; Yang, Xinyuan; Li, Huiwen; Liu, Yan; Wang, Haixia; Hyun Park, Jeong; Li, YingIn light of the dramatic growth of Chinese learners worldwide and a need for cross-linguistic research on Chinese literacy development, this study drew upon theories of visual complexity effect (Su and Samuels, 2010) and dual-coding processing (Sadoski and Paivio, 2013) and investigated (a) the effects of character properties (i.e., visual complexity and radical presence) on character acquisition and (b) the relationship between individual learner differences in radical awareness and character acquisition. Participants included adolescent English-speaking beginning learners of Chinese in the U.S. Following Kuo et al. (2014), a novel character acquisition task was used to investigate the process of acquiring the meaning of new characters. Results showed that (a) characters with radicals and with less visual complexity were easier to acquire than characters without radicals and with greater visual complexity; and (b) individual differences in radical awareness were associated with the acquisition of all types of characters, but the association was more pronounced with the acquisition of characters with radicals. Theoretical and practical implications of the findings were discussed.Item Open Access From lubok to libel: Nineteenth-century Russian historiography and popular memory in the Jester wedding of Prince-Pope Nikita Zotov(Russian Literature, 2014-01-01) Zitser, EAThis article discusses the origins and political significance of an anonymous Old Believer wall-poster depicting, in image and text, one of the most infamous public spectacles ever staged at the court of Peter the Great. Tracing its transition from the visual medium to the verbal, and back again, by way of nineteenth-century Petrine historiography, the article offers a new dating of this piece of Old Believer folk art, disputes its supposed debt to the "spirit of medieval laughter", and, in the process, demonstrates the permeability of late Imperial Russian "elite" and "popular" cultures. © 2014 Elsevier B.V. All rights reserved.Item Open Access Post-Soviet Peter: New Histories of the Late Muscovite and Early Imperial Russian Court(Kritika: Explorations in Russian and Eurasian History, 2005-03) Zitser, Ernest AItem Open Access After the Deluge: Russian Ark and the Abuses of History(Historically Speaking, 2006-07) Kachurin, Pamela; Zitser, Ernest AItem Open Access Politics in the state of sober drunkenness: Parody and piety at the court of Peter the great(Jahrbucher fur Geschichte Osteuropas, 2003) Zitser, EAItem Open Access Il parlait assez bien français et plusieurs langues: Foreign Language Acquisition and the Diplomatic Self-Fashioning of Prince Boris Ivanovich Kurakin(Quaestio Rossica, 2023-01-01) Zitser, EAUsing the example of Prince B. I. Kurakin (1676-1727), the Imperial Russian diplomat who served as extraordinary and plenipotentiary ambassador to France (1724-1727), this article seeks to contribute to the ongoing discussion about the possible reasons for the adoption of French as the language of international communication in general and eighteenth-century diplomacy in particular. It asks when the Moscow-born Gediminid prince learned to speak French and how this non-native speaker of the language became proficient enough to impress a finicky and fastidious interlocutor like Louis de Rouvroy, duc de Saint-Simon (1675-1755). The author suggests that the answer to these questions lies not in Russia or France, but in Poland and Italy; and not in the halls of formal educational institutions, but in the networks of personal connections that were sustained as much by face-to-face communication as by written correspondence. This brief biographical survey of the development of Prince Kurakin’s “linguistic personality” demonstrates the mediating role of modern, vernacular languages (Russian, Polish, Italian) in the transition from Latin to French as the lingua franca of international diplomacy. It also emphasizes the intimate connection between foreign language acquisition and diplomatic self-fashioning, showing how linguistic knowledge could be instrumentalized for both personal and professional advancement. In doing so, it illustrates the active role that individual brokers - especially, but not exclusively, aristocratic royal servitors with broad linguistic skills and extensive international connections, like Prince Kurakin and the duc de Saint-Simon - played in creating the very notion of an early modern “European” style of diplomacy based on the cultural dominance of the French language.Item Open Access Establishing the longitudinal hemodynamic mapping framework for wearable-driven coronary digital twins(npj Digital Medicine) Tanade, Cyrus; Khan, Nusrat Sadia; Rakestraw, Emily; Ladd, William D; Draeger, Erik W; Randles, AmandaItem Open Access Cost-effectiveness of posterior lumbar interbody fusion and/or transforaminal lumbar interbody fusion for grade 1 lumbar spondylolisthesis: a 5-year Quality Outcomes Database study.(Journal of neurosurgery. Spine, 2024-08) Yee, Timothy J; Liles, Campbell; Johnson, Sarah E; Ambati, Vardhaan S; DiGiorgio, Anthony M; Alan, Nima; Coric, Domagoj; Potts, Eric A; Bisson, Erica F; Knightly, John J; Fu, Kai-Ming G; Foley, Kevin T; Shaffrey, Mark E; Bydon, Mohamad; Chou, Dean; Chan, Andrew K; Meyer, Scott; Asher, Anthony L; Shaffrey, Christopher I; Slotkin, Jonathan R; Wang, Michael Y; Haid, Regis W; Glassman, Steven D; Virk, Michael S; Mummaneni, Praveen V; Park, PaulObjective
Posterior lumbar interbody fusion (PLIF) and/or transforaminal lumbar interbody fusion (TLIF), referred to as "PLIF/TLIF," is a commonly performed operation for lumbar spondylolisthesis. Its long-term cost-effectiveness has not been well described. The aim of this study was to determine the 5-year cost-effectiveness of PLIF/TLIF for grade 1 degenerative lumbar spondylolisthesis using prospective data collected from the multicenter Quality Outcomes Database (QOD).Methods
Patients enrolled in the prospective, multicenter QOD grade 1 lumbar spondylolisthesis module were included if they underwent single-stage PLIF/TLIF. EQ-5D scores at baseline, 3 months, 12 months, 24 months, 36 months, and 60 months were used to calculate gains in quality-adjusted life years (QALYs) associated with surgery relative to preoperative baseline. Healthcare-related costs associated with the index surgery and related reoperations were calculated using Medicare reimbursement-based cost estimates and validated using price transparency diagnosis-related group (DRG) charges and Medicare charge-to-cost ratios (CCRs). Cost per QALY gained over 60 months postoperatively was assessed.Results
Across 12 surgical centers, 385 patients were identified. The mean patient age was 60.2 (95% CI 59.1-61.3) years, and 38% of patients were male. The reoperation rate was 5.7%. DRG 460 cost estimates were stable between our Medicare reimbursement-based models and the CCR-based model, validating the focus on Medicare reimbursement. Across the entire cohort, the mean QALY gain at 60 months postoperatively was 1.07 (95% CI 0.97-1.18), and the mean cost of PLIF/TLIF was $31,634. PLIF/TLIF was associated with a mean 60-month cost per QALY gained of $29,511. Among patients who did not undergo reoperation (n = 363), the mean 60-month QALY gain was 1.10 (95% CI 0.99-1.20), and cost per QALY gained was $27,591. Among those who underwent reoperation (n = 22), the mean 60-month QALY gain was 0.68 (95% CI 0.21-1.15), and the cost per QALY gained was $80,580.Conclusions
PLIF/TLIF for degenerative grade 1 lumbar spondylolisthesis was associated with a mean 60-month cost per QALY gained of $29,511 with Medicare fees. This is far below the well-established societal willingness-to-pay threshold of $100,000, suggesting long-term cost-effectiveness. PLIF/TLIF remains cost-effective for patients who undergo reoperation.Item Open Access Predictors of patient satisfaction in the surgical treatment of cervical spondylotic myelopathy.(Journal of neurosurgery. Spine, 2024-08) Schupper, Alexander J; DiDomenico, Joseph; Farber, S Harrison; Johnson, Sarah E; Bisson, Erica F; Bydon, Mohamad; Asher, Anthony L; Coric, Domagoj; Potts, Eric A; Foley, Kevin T; Wang, Michael Y; Fu, Kai-Ming; Virk, Michael S; Shaffrey, Christopher I; Gottfried, Oren N; Park, Christine; Knightly, John J; Meyer, Scott; Park, Paul; Upadhyaya, Cheerag; Shaffrey, Mark E; Chan, Andrew K; Tumialán, Luis M; Chou, Dean; Haid, Regis W; Mummaneni, Praveen V; Uribe, Juan S; Turner, Jay DObjective
Patients with cervical spondylotic myelopathy (CSM) experience progressive neurological impairment. Surgical intervention is often pursued to halt neurological symptom progression and allow for recovery of function. In this paper, the authors explore predictors of patient satisfaction following surgical intervention for CSM.Methods
This is a retrospective review of prospectively collected data from the multicenter Quality Outcomes Database. Patients who underwent surgical intervention for CSM with a minimum follow-up of 2 years were included. Patient-reported satisfaction was defined as a North American Spine Society (NASS) satisfaction score of 1 or 2. Patient demographics, surgical parameters, and outcomes were assessed as related to patient satisfaction. Patient quality of life scores were measured at baseline and 24-month time points. Univariate regression analyses were performed using the chi-square test or Student t-test to assess patient satisfaction measures. Multivariate logistic regression analysis was conducted to assess for factors predictive of postoperative satisfaction at 24 months.Results
A total of 1140 patients at 14 institutions with CSM who underwent surgical intervention were included, and 944 completed a patient satisfaction survey at 24 months postoperatively. The baseline modified Japanese Orthopaedic Association (mJOA) score was 12.0 ± 2.8. A total of 793 (84.0%) patients reported satisfaction (NASS score 1 or 2) after 2 years. Male and female patients reported similar satisfaction rates (female sex: 47.0% not satisfied vs 48.5% satisfied, p = 0.73). Black race was associated with less satisfaction (26.5% not satisfied vs 13.2% satisfied, p < 0.01). Baseline psychiatric comorbidities, obesity, and length of stay did not correlate with 24-month satisfaction. Crossing the cervicothoracic junction did not affect satisfactory scores (p = 0.19), and minimally invasive approaches were not associated with increased patient satisfaction (p = 0.14). Lower baseline numeric rating scale neck pain scores (5.03 vs 5.61, p = 0.04) and higher baseline mJOA scores (12.28 vs 11.66, p = 0.01) were associated with higher satisfaction rates.Conclusions
Surgical treatment of CSM results in a high rate of patient satisfaction (84.0%) at the 2-year follow-up. Patients with milder myelopathy report higher satisfaction rates, suggesting that intervention earlier in the disease process may result in greater long-term satisfaction.Item Open Access Predictors of patient satisfaction after surgery for grade 1 degenerative spondylolisthesis: a 5-year analysis of the Quality Outcomes Database.(Journal of neurosurgery. Spine, 2024-08) Dru, Alexander; Johnson, Sarah E; Linzey, Joseph R; Foley, Kevin T; Digiorgio, Anthony; Alan, Nima; Coric, Domagoj; Potts, Eric A; Bisson, Erica F; Knightly, John J; Fu, Kai-Ming; Shaffrey, Mark E; Weaver, Jason; Bydon, Mohamad; Chou, Dean; Meyer, Scott A; Asher, Anthony L; Shaffrey, Christopher I; Slotkin, Jonathan R; Wang, Michael Y; Haid, Regis W; Glassman, Steven D; Virk, Michael S; Mummaneni, Praveen V; Park, PaulObjective
Lumbar decompression and/or fusion surgery is a common operation for symptomatic lumbar spondylolisthesis refractory to conservative management. Multiyear follow-up of patient outcomes can be difficult to obtain but allows for identification of preoperative patient characteristics associated with durable pain relief, improved functional outcome, and higher patient satisfaction.Methods
A query of the Quality Outcomes Database (QOD) low-grade spondylolisthesis module for patients who underwent surgery for grade 1 lumbar spondylolisthesis (from July 2014 to June 2016 at the 12 highest-enrolling sites) was used to identify patient satisfaction, as measured with the North American Spine Society (NASS) questionnaire, which uses a scale of 1-4. Patients were considered satisfied if they had a score ≤ 2. Multivariable logistic regression was performed to identify baseline demographic and clinical predictors of long-term satisfaction 5 years after surgery.Results
Of 573 eligible patients from a cohort of 608, patient satisfaction data were available for 81.2%. Satisfaction (NASS score of 1 or 2) was reported by 389 patients (83.7%) at 5-year follow-up. Satisfied patients were predominantly White and ambulation independent and had lower baseline BMI, lower back pain levels, lower Oswestry Disability Index (ODI) scores, and greater EQ-5D index scores at baseline when compared to the unsatisfied group. No significant differences in reoperation rates between groups were reported at 5 years. On multivariate analysis, patients who were independently ambulating at baseline had greater odds of long-term satisfaction (OR 1.12, p = 0.04). Patients who had higher 5-year ODI scores (OR 0.99, p < 0.01) and were uninsured (OR 0.43, p = 0.01) were less likely to report long-term satisfaction.Conclusions
Lumbar surgery for the treatment of grade 1 spondylolisthesis can provide lasting pain relief with high patient satisfaction. Baseline independent ambulation is associated with a higher long-term satisfaction rate after surgery. Higher ODI scores at 5-year follow-up and uninsured status are associated with lower postoperative long-term satisfaction.Item Open Access Incremental Increase in Hospital Length of Stay Due to Complications of Surgery for Adult Spinal Deformity.(Global spine journal, 2024-09) Lafage, Renaud; Sheehan, Connor; Smith, Justin S; Daniels, Alan; Diebo, Bassel; Ames, Christopher; Bess, Shay; Eastlack, Robert; Gupta, Munish; Hostin, Richard; Kim, Han Jo; Klineberg, Eric; Mundis, Gregory; Hamilton, Kojo; Shaffrey, Christopher; Schwab, Frank; Lafage, Virginie; Burton, Douglas; International Spine Study Group (ISSG)Retrospective Cohort Study. Length of Stay (LOS) and resource utilization are of primary importance for hospital administration. This study aimed to understand the incremental effect of having a specific complication on LOS among ASD patients. A retrospective examination of prospective multicenter data utilized patients without a complication prior to discharge to develop a patient-adjusted and surgery-adjusted predictive model of LOS among ASD patients. The model was later applied to patients with at least 1 complication prior to discharge to investigate incremental effect of each identified complication on LOS vs the expected LOS. 571/1494 (38.2%) patients experienced at least 1 complication before discharge with a median LOS of 7 [IQR 5 to 9]. Univariate analysis demonstrated that LOS was significantly affected by patients' demographics (age, CCI, sex, disability, deformity) and surgical strategy (invasiveness, fusion length, posterior MIS fusion, direct decompression, osteotomy severity, IBF use, EBL, ASA, ICU stay, day between stages, Date of Sx). Using patients with at least 1 complication prior discharge and compared to the patient-and-surgery adjusted prediction, having a minor complication increased the expected LOS by 0.9 day(s), a major complication by 3.9 days, and a major complication with reoperation by 6.3 days. Complications following surgery for ASD correction have different, but predictable impact on LOS. Some complications requiring minimal intervention are associated with significant and substantial increases in LOS, while complications with significant impact on patient quality of life may have no influence on LOS.Item Open Access Comparative analysis of patient-reported outcomes in myelopathy and myeloradiculopathy: a Quality Outcomes Database study.(Journal of neurosurgery. Spine, 2024-09) Porche, Ken; Bisson, Erica F; Sherrod, Brandon; Dru, Alexander; Chan, Andrew K; Shaffrey, Christopher I; Gottfried, Oren N; Bydon, Mohamad; Asher, Anthony L; Coric, Domagoj; Potts, Eric A; Foley, Kevin T; Wang, Michael Y; Fu, Kai-Ming; Virk, Michael S; Knightly, John J; Meyer, Scott; Upadhyaya, Cheerag D; Shaffrey, Mark E; Uribe, Juan S; Tumialán, Luis M; Turner, Jay D; Chou, Dean; Haid, Regis W; Mummaneni, Praveen V; Park, PaulMyelopathy in the cervical spine can present with diverse symptoms, many of which can be debilitating for patients. Patients with radiculopathy symptoms demonstrate added complexity because of the overlapping symptoms and treatment considerations. The authors sought to assess outcomes in patients with myelopathy presenting with or without concurrent radiculopathy. The Quality Outcomes Database, a prospectively collected multi-institutional database, was used to analyze demographic, clinical, and surgical variables of patients presenting with myelopathy or myeloradiculopathy as a result of degenerative pathology. Outcome measures included arm (VAS-arm) and neck (VAS-neck) visual analog scale (VAS) scores, modified Japanese Orthopaedic Association (mJOA) scale score, EuroQol VAS (EQ-VAS) score, and Neck Disability Index (NDI) at 3, 12, and 24 months compared with baseline. A total of 1015 patients were included in the study: 289 patients with myelopathy alone (M0), 239 with myeloradiculopathy but no arm pain (MRAP-), and 487 patients with myeloradiculopathy and arm pain (MRAP+). M0 patients were older than the myeloradiculopathy cohorts combined (M0 64.2 vs MRAP- + MRAP+ 59.5 years, p < 0.001), whereas MRAP+ patients had higher BMI and a greater incidence of current smoking compared with the other cohorts. There were more anterior approaches used in in MRAP+ patients and more posterior approaches used in M0 patients. In severely myelopathic patients (mJOA scale score ≤ 10), posterior approaches were used more often for M0 (p < 0.0001) and MRAP+ (p < 0.0001) patients. Patients with myelopathy and myeloradiculopathy both exhibited significant improvement at 1 and 2 years across all outcome domains. The amount of improvement did not vary based on surgical approach. In comparing cohort outcomes, postoperative outcome differences were associated with patient-reported scores at baseline. Patients with myelopathy and those with myeloradiculopathy demonstrated significant and similar improvement in arm and neck pain scores, myelopathy, disability, and quality of life at 3 months that was sustained at 1- and 2-year follow-up intervals. More radicular symptoms and arm pain increased the likelihood of a surgeon choosing an anterior approach, whereas more severe myelopathy increased the likelihood of approaching posteriorly. Surgical approach itself was not an independent predictor of outcome.Item Open Access Film Theory after Copjec(Canadian Review of American Studies, 2021-02) Ballas, AThe importation of Lacanian psychoanalysis into film theory in the 1970s and 1980s ushered in a new era of cinema scholarship and criticism. Figures including Raymond Bellour, Laura Mulvey, and Christian Metz are often considered the pioneers of applying Lacanian psychoanalysis in the context of film theory, most notably through their writings in Screen Journal. However, where French and British scholarship on Lacan and film reached its limits, American Lacanianism flourished. When Joan Copjec’s now classic essay “The Orthopsychic Subject: Film Theory and the Reception of Lacan” was published in 1989, the trajectory of Lacanian film theory would become radically altered; as Todd McGowan recently put it, the “butchered operation” on Lacan committed by Mulvey and (quoting Copjec) the “Foucaultianization” of Lacan under the auspices of Screen Journal were finally indicted in one gesture through Copjec’s critique. Copjec and McGowan’s unique American view of Lacan marks a pivotal point in the convergence of psychoanalytic theory and cinema studies; by seeking to wrest Lacan from historist/deconstructionist theories of the subject, and by revisiting Lacan beyond the mirror stage, Copjec and McGowan can be said to have instantiated a resuscitation or even a renaissance of Lacanian theory in film studies in particular and in American scholarship more generally. In this essay, this renaissance of Lacanian theory is examined, focusing on the innovations these two American thinkers brought to psychoanalytic film theory and the multiple paths carved out into other disciplines that followed. First, a detailed summation of the contentions between screen theory and Copjec’s position is introduced, as well as McGowan’s assessment thereof. Then, the trajectory of psychoanalytic film theory after Copjec’s arrival is the focus, including the major innovations in her thought from cinematic subjectivity to sexual difference (most notably from Read My Desire) and the way her position spread to philosophy and ontology. Finally, the article identifies the limitations of Copjec’s and McGowan’s thought and seeks new possibilities through which we may continue to apply psychoanalysis to the cinema in the wake of these two important thinkers.Item Open Access Colonialism, Cinema and Revolution(Caribbean Quarterly, 2022-10-02) Ballas, AnthonyItem Open Access