Researchers collaborate on scientific projects that are often measured by both the quantity and the quality of the resultant peerreviewed publications. However, not all collaborators contribute to these publications equally, making metrics such as the total number of publications and the H-index insufficient measurements of individual scientific impact. To remedy this, we use an axiomatic approach to assign relative credits to the coauthors of a given paper, referred to as the A-index for its axiomatic foundation. In this paper, we use the A-index to compute the weighted sums of peer-reviewed publications and journal impact factors, denoted as the C-and P-indexes for collaboration and productivity, respectively. We perform an in-depth analysis of bibliometric data for 186 biomedical engineering faculty members and from extensive simulation. It is found that these axiomatically weighted indexes better capture a researcher's scientific caliber than do the total number of publications and the H-index, allowing for fairer and sharper evaluation of researchers with diverse collaborative behaviors.

Skin-resident T cells have been shown to play important roles in tissue homeostasis and wound repair, but their role in UV radiation (UVR)–mediated skin injury and subsequent tissue regeneration is less clear. In this study, we demonstrate that acute UVR rapidly activates skin-resident T cells in humans and dendritic epidermal γδ T cells (DETCs) in mice through mechanisms involving the release of ATP from keratinocytes. Following UVR, extracellular ATP leads to an increase in CD69 expression, proliferation, and IL-17 production, and to changes in DETC morphology. Furthermore, we find that the purinergic receptor P2X7 and caspase-1 are necessary for UVR-induced IL-1 production in keratinocytes, which increases IL-17 secretion by DETCs. IL-17, in turn, induces epidermal TNF-related weak inducer of apoptosis and growth arrest and DNA damage–associated gene 45, two molecules linked to the DNA repair response. Finally, we demonstrate that DETCs and human skin-resident T cells limit DNA damage in keratinocytes. Taken together, our findings establish a novel role for skin-resident T cells in the UVR-associated DNA repair response and underscore the importance of skin-resident T cells to overall skin regeneration.

Study Design: Cross sectional database study. Objective: To develop a fully automated artificial intelligence and computer vision pipeline for assisted evaluation of lumbar lordosis. Methods: Lateral lumbar radiographs were used to develop a segmentation neural network (n = 629). After synthetic augmentation, 70% of these radiographs were used for network training, while the remaining 30% were used for hyperparameter optimization. A computer vision algorithm was deployed on the segmented radiographs to calculate lumbar lordosis angles. A test set of radiographs was used to evaluate the validity of the entire pipeline (n = 151). Results: The U-Net segmentation achieved a test dataset dice score of 0.821, an area under the receiver operating curve of 0.914, and an accuracy of 0.862. The computer vision algorithm identified the L1 and S1 vertebrae on 84.1% of the test set with an average speed of 0.14 seconds/radiograph. From the 151 test set radiographs, 50 were randomly chosen for surgeon measurement. When compared with those measurements, our algorithm achieved a mean absolute error of 8.055° and a median absolute error of 6.965° (not statistically significant, P > .05). Conclusion: This study is the first to use artificial intelligence and computer vision in a combined pipeline to rapidly measure a sagittal spinopelvic parameter without prior manual surgeon input. The pipeline measures angles with no statistically significant differences from manual measurements by surgeons. This pipeline offers clinical utility in an assistive capacity, and future work should focus on improving segmentation network performance.

Study Design: Retrospective radiographic study. Objectives: T1 slope is an important parameter of sagittal spinal balance. However, the T1 superior endplate can be difficult to visualize on radiographs due to overlying anatomical structures. C7 slope has been proposed as a potential substitute for T1 slope when the T1 superior endplate is not well visualized. The objective of this study was 2-fold: (1) to assess the correlation between C7 and T1 slopes on upright cervical spine radiographs and (2) to evaluate the interrater reliability of C7 slope. Methods: Cervical spine radiographs taken between December 2017 and June 2018 at a single institution were reviewed. Two observers measured upper C7 slope, lower C7 slope, and T1 slope. The correlations between upper and lower C7 slope and T1 slope were evaluated, and linear regression analyses were performed. Interrater reliability of C7 slope was also assessed. Results: In this cohort of 152 patients, there was a strong correlation between upper C7 slope and T1 slope ( r = 0.91, P < .001), as well as between lower C7 slope and T1 slope ( r = 0.90, P < .001). T1 slope could be estimated from the linear regression equation, T1 slope = 0.87 × C7 slope + 7, with an overall model fit of R 2 = 0.8. There was strong interrater reliability for upper (intraclass correlation coefficient [ICC] = 0.95, P < .001) and lower C7 slope (ICC = 0.96, P < .001). Conclusions: Both the upper and lower C7 slope are strongly correlated with T1 slope and can be used as a substitute to estimate T1 slope when the superior endplate of T1 is not well visualized.

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Study Design. Retrospective cohort study. Objective. To identify age-related changes in cervical sagittal parameters using standard radiographs. Summary of Background Data. Cervical sagittal balance is important for the maintenance of neutral head posture and horizontal gaze. Degenerative changes in the cervical spine that occur with aging may alter cervical sagittal balance, which can lead to chronic neck pain and predispose to various cervical spine pathologies. Methods. We performed a retrospective cohort study of 151 patients with lateral cervical spine radiographs taken at our institution between December 2017 and June 2018. Cervical sagittal parameters were measured, including C1 inclination, C2 slope, C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA), cervical tilt, upper and lower C7 slopes, T1 slope, and T1 slope minus cervical lordosis (TS-CL). The association between age and cervical sagittal parameters was assessed using the Pearson correlation coefficient and a linear regression analysis. An analysis of variance (ANOVA) with Tukey adjustments was then performed to identify differences in cervical sagittal parameters among patients aged 18 to 39 years, 40 to 64 years, and >64 years of age. Results. There were positive correlations between age and C2-C7 Cobb angle (r = 0.231, P = 0.004), upper C7 slope (r = 0.280, P < 0.001), lower C7 slope (r = 0.283, P < 0.001), and T1 slope (r = 0.189, P = 0.020). Upper C7 slope (R2 = 0.079) and lower C7 slope (R2 = 0.074) had the strongest correlation with age in the linear regression analysis. The ANOVA found significant differences among the age subgroups in terms of C2-C7 Cobb angle (P = 0.002), upper C7 slope (P < 0.001), lower C7 slope (P < 0.001), and T1 slope (P = 0.031). Patients >64 years old had significantly higher C2-C7 Cobb angle, upper C7 slope, lower C7 slope, and T1 slope. Conclusion. Changes in cervical sagittal alignment with age are characterized by increased cervical lordosis and increased thoracic kyphosis. Level of Evidence: 3

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Study Design Retrospective cohort study. Objectives The objective of this study is to compare the likelihood of missing a scheduled telemedicine and in-person appointments for spine patients. The secondary objective is to assess the impact of socioeconomic status on missed telemedicine and in-person appointments. Methods Patients with scheduled outpatient appointments with orthopedic spine faculty between 2019 and 2021 were divided by appointment type: telemedicine (N = 4,387) and in-person (N = 3810). Socioeconomic status was assessed using Area Deprivation Index (ADI) stratified based on percentile: low (<25), medium (25–75), and high (>75) levels of socioeconomic disadvantage. The primary outcome measure was missed clinic appointments, which was defined as having at least one appointment that was cancelled or labeled “no show.” Results Patients with in-person appointments missed appointments more often than patients with telemedicine visits (51.3% vs 24.7%, P < .001). Patients with high ADI missed their in-person appointments more often than patients with medium and low ADI (59.5% vs 52.2% and 47.5%, P < .001). There was no difference in missed telemedicine visits between patients with high, medium, and low ADI (27.6% vs 24.8% vs 23.8%, P = .294). Patients that missed an appointment were 41.9% more likely to be high ADI (OR 1.42, 95% CI 1.20–1.68, P < .001) and 13.4% more likely to be medium ADI (OR 1.13, 95% CI 1.03–1.26, P = .015) compared with low ADI patients. Conclusions Telemedicine may serve a role in reducing disparity in appointment attendance. While further studies are needed to validate these findings, spine surgeons should consider offering telemedicine as an option to patients.