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OBJECTIVE: The study objective was to evaluate intraoperative experience with newly developed high-spatial-resolution microelectrode grids composed of poly(3,4-ethylenedioxythiophene) with polystyrene sulfonate (PEDOT:PSS), and those composed of platinum nanorods (PtNRs). METHODS: A cohort of patients who underwent craniotomy for pathological tissue resection and who had high-spatial-resolution microelectrode grids placed intraoperatively were evaluated. Patient demographic and baseline clinical variables as well as relevant microelectrode grid characteristic data were collected. The primary and secondary outcome measures of interest were successful microelectrode grid utilization with usable resting-state or task-related data, and grid-related adverse intraoperative events and/or grid dysfunction. RESULTS: Included in the analysis were 89 cases of patients who underwent a craniotomy for resection of neoplasms (n = 58) or epileptogenic tissue (n = 31). These cases accounted for 94 grids: 58 PEDOT:PSS and 36 PtNR grids. Of these 94 grids, 86 were functional and used successfully to obtain cortical recordings from 82 patients. The mean cortical grid recording duration was 15.3 ± 1.15 minutes. Most recordings in patients were obtained during experimental tasks (n = 52, 58.4%), involving language and sensorimotor testing paradigms, or were obtained passively during resting state (n = 32, 36.0%). There were no intraoperative adverse events related to grid placement. However, there were instances of PtNR grid dysfunction (n = 8) related to damage incurred by suboptimal preoperative sterilization (n = 7) and improper handling (n = 1); intraoperative recordings were not performed. Vaporized peroxide sterilization was the most optimal sterilization method for PtNR grids, providing a significantly greater number of usable channels poststerilization than did steam-based sterilization techniques (median 905.0 [IQR 650.8-935.5] vs 356.0 [IQR 18.0-597.8], p = 0.0031). CONCLUSIONS: High-spatial-resolution microelectrode grids can be readily incorporated into appropriately selected craniotomy cases for clinical and research purposes. Grids are reliable when preoperative handling and sterilization considerations are accounted for. Future investigations should compare the diagnostic utility of these high-resolution grids to commercially available counterparts and assess whether diagnostic discrepancies relate to clinical outcomes.

Intraoperative neuromonitoring (IONM) is a widely used practice in spine surgery for early detection and minimization of neurological injury. IONM is most commonly conducted by indirectly recording motor and somatosensory evoked potentials from either muscles or the scalp, which requires large-amplitude electrical stimulation and provides limited spatiotemporal information. IONM may inform of inadvertent events during neurosurgery after they occur, but it does not guide safe surgical procedures when the anatomy of the diseased spinal cord is distorted. To overcome these limitations and to increase our understanding of human spinal cord neurophysiology, we applied a microelectrode array with hundreds of channels to the exposed spinal cord during surgery and resolved spatiotemporal dynamics with high definition. We used this method to construct two-dimensional maps of responsive channels and define with submillimeter precision the electrophysiological midline of the spinal cord. The high sensitivity of our microelectrode array allowed us to record both epidural and subdural responses at stimulation currents that are well below those used clinically and to resolve postoperative evoked potentials when IONM could not. Together, these advances highlight the potential of our microelectrode arrays to capture previously unexplored spinal cord neural activity and its spatiotemporal dynamics at high resolution, offering better electrophysiological markers that can transform IONM.

An array of lake sediment proxies including paleobotanic, geochemical, and historical records has been used to determine former environments of Bugbee Pond, a small, mesotrophic pond in northeastern Minnesota. Much research has been produced on the history of climate and vegetation change of the region, yet we have little information on the impact of human settlement. This well-dated, high resolution, multi-proxy record is important for its length and concentration on the historic period. The lake itself became established by ~7000 years ago. Pollen evidence suggests a transition between the regional Prairie Period to the Great Lakes mixed conifer – hardwood forest was established in the region at this time. XRF data suggest dry basin accumulation early in the record after ~7000 cal yr BP, but lake levels substantially increased by ~5600 cal yr BP, during a regionwide climatic transition to more humid conditions. Birch and boreal conifers increased after about 3800 cal yr BP; further increases in boreal conifers occurred by ~2000 cal yr BP. Anthropogenic vegetation changes during the Historic period, beginning in the late 19th century, is well represented by forest clearance of white pine (Pinus strobus), followed by increases in early successional species and an increased sediment accumulation rate due to land clearance. Establishment of farming communities locally are shown by occurrence of corn (Zea mays) and oat (Avena sativa) pollen, and pasturing and grazing are documented by Rumex, Fabaceae and Poaceae pollen, as well as coprophilous fungi, such as Sordaria. The increase and subsequent decline in Pb and S concentrations in the uppermost sediments are mirrored by historically documented, nearby industrial activities. [ABSTRACT FROM AUTHOR]

The lumbar drain exit site purse string oversew stitch is a well-described bedside intervention to stop or prevent cerebrospinal fluid (CSF) leak. It is not routinely placed at the time of lumbar drain placement. Via four plan-do-study-act (PDSA) cycles, we test the effect of prophylactic utilization of the lumbar drain exit site oversew stitch on house officers' paging burden, need to redress the drain, need to oversew the drain to stop a CSF leak, and need to replace the drain. We found that the simple act of placing an oversew stitch at the time of lumbar drain placement significantly reduced paging burden and reduced the frequency at which an oversew stitch was required to stop a CSF leak. Subjectively, during PDSA cycles during which overstitches were placed prophylactically, in-house residents perceived that there were less lumbar drains on service, although objectively, the overall number was unchanged. We conclude that prophylactic lumbar drain exit site stitch placement reduces risk and bedside interventions for patients and also reduces overall call burden on house officers. This simple intervention may therefore provide a more widespread improvement in care quality beyond lumbar drain care because house officers experience less burnout during their call shifts. [ABSTRACT FROM AUTHOR]

Terrestrial‐marine dust fluxes, pedogenic carbonate δ13C values, and various paleovegetation proxies suggest that Africa experienced gradual cooling and drying across the Pliocene‐Pleistocene (Plio‐Pleistocene) boundary (2.58 million years ago [Ma]). However, the timing, magnitude, resolution, and relative influences of orbitally‐driven changes in high latitude glaciations and low latitude insolation differ by region and proxy. To disentangle these forcings and investigate equatorial eastern African climate across the Plio‐Pleistocene boundary, we generated a high‐resolution (∼3,000‐year) data set of compound‐specific n‐alkane leaf wax δ2H values—a robust proxy for atmospheric circulation and precipitation amount—from the HSPDP‐BTB13‐1A core, which spans a ∼3.3–2.6 Ma sequence in the Baringo‐Tugen Hills‐Barsemoi Basin of central Kenya. In combination with the physical sedimentology, our data indicate that precipitation varied strongly with orbital obliquity, not precession, during the late Pliocene, perhaps imparted by variations in the cross‐equatorial insolation gradient. We also observe a marked shift toward wetter conditions beginning ∼3 Ma that corresponds with global cooling, drying in western Australia, and a steepening of the west‐east zonal Indian Ocean (IO) sea surface temperature (SST) gradient. We propose that northward migration of the Subtropical Front reduced Agulhas current leakage, warming the western IO and causing changes in the IO zonal SST gradient at 3 Ma, a process that has been observed in the latest Pleistocene‐Holocene but not over longer timescales. Thus, the late Cenozoic moisture history of eastern Africa is driven by a complex mixture of low‐latitude insolation, the IO SST gradient, and teleconnections to distal high‐latitude cooling. Key Points: We present new high resolution (3,000‐year) leaf wax δ2H data from central Kenya spanning 3.3–2.6 million years before present (Ma)Pronounced 41,000‐year variability throughout is potentially attributable to the cross‐equatorial insolation gradientLong‐term (>200,000‐year) variability in eastern African hydroclimate tracks the zonal Indian Ocean surface temperature gradient [ABSTRACT FROM AUTHOR]