bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trapped Gravity Waves and Their Association with Turbulence in a Large Thunderstorm Anvil during PECAN
Authors: Trier Stanley B. , Sharman Robert D. 
Published: August 2018

Abstract
Geostationary Operational Environmental Satellite-14 (GOES-14) 1-km visible satellite data with 1-min frequency revealed horizontally propagating internal gravity waves emanating from tropopause-penetrating deep convection on 3–4 June 2015 during the Plains Elevated Convection at Night (PECAN) field experiment. These waves had horizontal wavelengths of ~6–8 km and approximate ground-relative phase speeds of 35 m s−1. PECAN radiosonde data are used to document the environment supporting the horizontally propagating gravity waves within the 200-km-long downstream thunderstorm anvil. Comparisons among soundings within the anvil core, at the downstream anvil edge, and outside of the anvil, together with supporting high-resolution numerical simulations, establish the importance of the storm-induced upper-tropospheric/lower-stratospheric (UTLS) outflow in providing conditions allowing vertical trapping of internal gravity waves over large horizontal distances within the mesoscale anvil. Turbulence was reported by commercial aviation in proximity to the gravity waves near the downstream anvil edge. The simulations suggest that the strongest turbulence was consistent with a mesoscale destabilization of the outer portion of the downstream anvil at elevations immediately below the outflow jet, where differential temperature advection owing to the strong associated vertical shear reduces static stability. The simulated gravity waves are trapped at this elevation and extend for several kilometers below. Local minima of moist gradient Richardson number occur immediately above the simulated warm gravity wave temperature perturbations at anvil base, suggesting a possible role these waves could play in establishing precise locations for the onset of turbulence.
Effects of combined intervention of physical exercise and cognitive training on cognitive function in stroke survivors with vascular cognitive impairment: a randomized controlled trial
Authors: Bo Wang , Lei Mao , Tao Shen , Jie Liu Tuan , Qian Li , Lin Fang Qi , Ping Wang Xiao 
Published: August 2018

Objective: This study evaluated the possible effect of the combined intervention of physical exercise and cognitive training on cognitive function in stroke survivals with vascular cognitive impairment. Design: A single-blind (investigator-blinded but not subject-blinded) randomized controlled trial. Setting: Medical Rehabilitation Center of Shanghai General Hospital, China. Subjects: A total of 225 patients (mean age 64.59 years, SD = 4.27) who exhibited vascular cognitive impairment were included in this study. Interventions: Patients were randomly allocated into one of the four groups: (1) physical exercise ( n = 56; 50-minute session), (2) cognitive training ( n = 57; 60-minute session), (3) combined intervention of physical exercise and cognitive training ( n = 55; 50-minute session + 60-minute session), or (4) control groups ( n = 57; 45-minute session). All participants received training for 36 sessions, three days per week, for 12 weeks. Primary measures: Measures were recorded at baseline, after the intervention and at a six-month follow-up. Primary measurements included the Trail Making Part B, Stroop, forward digit span, and mental rotation tests. Results: A total of 179 participants (79.56% response rate) completed the study. Cognitive performances on all four tasks in the combined training group improved significantly after the intervention ( P < 0.01). Changes in cognitive performance were greater in the combined intervention group than those in the physical exercise group (e.g. forward digit span, 13.61% vs. 2.18%, P = 0.003), the cognitive training group (e.g. mental rotation, 17.36% vs. 0.87%, P  = 0.002), and the control group (e.g. Stroop, −4.11% vs. −0.72%, P  = 0.026). Conclusion: The combined intervention produced greater benefits on cognitive function compared to either training alone in stroke survivors with vascular cognitive impairment.
Time Required to Achieve Minimal Clinically Important Difference and Substantial Clinical Benefit After Arthroscopic Treatment of Femoroacetabular Impingement
Authors: Nwachukwu Benedict U. , Chang Brenda , Adjei Joshua , Schairer William W. , Ranawat Anil S. , Kelly Bryan T. , Nawabi Danyal H. 
Published: August 2018

Background: Minimal clinically important difference (MCID) defines the minimum degree of quantifiable outcome improvement that a patient perceives as the result of an intervention or in the process of healing. Substantial clinical benefit (SCB) defines the amount of quantifiable outcome improvement that is needed for a patient to feel substantially better. Little is known about when clinically significant outcome improvement is achieved. Purpose: To investigate the time-dependent nature of MCID and SCB after hip arthroscopy for femoroacetabular impingement (FAI). Study Design: Cohort study; Level of evidence, 2. Methods: An institutional hip preservation registry was queried. The modified Harris Hip Score, Hip Outcome Score, and 33-item International Hip Outcome Tool (iHOT-33) were administered to patients undergoing hip arthroscopy for FAI. Follow-up times for outcome measures were classified into 3 periods: 5 to 11 months (6 months), 12 to 23 months (1 year), and 24 to 35 months (2 years). Cumulative probabilities for achieving MCID and SCB were calculated with Kaplan-Meier survival curve analysis and interval censoring. A Weibull parametric regression analysis evaluated the odds of achieving earlier MCID. Results: A total of 719 patients undergoing primary hip arthroscopy were included. The mean ± SD age was 32.5 ± 10.5 years, and the majority were female (n = 380, 52.9%). Across all 4 outcome instruments, patients had the highest probability for achieving MCID and SCB by the 6-month postoperative period. The iHOT-33 demonstrated the highest probability for capturing MCID and SCB improvement at each of the 3 periods, with 76.0%, 84.8%, and 93.6% achieving MCID by 6 months, 1 year, and 2 years, respectively. Similarly, the probabilities of achieving SCB on the iHOT-33 were as follows: 57.1%, 68.0%, and 71.7%. A similar trend was demonstrated across other outcome tools. Older male patients and those with Outerbridge classification 1 to 4 (vs grade 0) had a significantly increased risk for taking a longer time to achieve MCID and SCB. Additionally, patients with higher preoperative outcome scores took a longer time to achieve MCID and SCB. Conclusion: At least half of patients treated with hip arthroscopy for FAI achieve MCID and SCB within the first 6 months after the procedure. However, clinically significant outcome improvement continues to be attained until 2 years postoperatively. Female patients, younger individuals, and those without chondral defects achieve faster clinical outcome improvement. These findings can be helpful for establishing shared decision-making aids and follow-up guidelines for arthroscopic treatment of FAI.
Return to Sport and Performance After Hip Arthroscopy for Femoroacetabular Impingement in 18- to 30-Year-Old Athletes: A Cross-sectional Cohort Study of 189 Athletes
Authors: Ishøi Lasse , Thorborg Kristian , Kraemer Otto , Hölmich Per 
Published: August 2018

Background:A recent systematic review found that 87% of athletes return to sport after hip surgery for femoroacetabular impingement syndrome. However, the proportion of athletes returning to preinjury sport at their preinjury level of sport is less clear.Purpose:The main purpose of this study was to determine the rate of athletes returning to preinjury sport at preinjury level including their associated sports performance after hip arthroscopy for femoroacetabular impingement syndrome. Furthermore, self-reported hip and groin function was investigated.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Eligible subjects were identified in the Danish Hip Arthroscopy Registry. A self-reported return to sport questionnaire was used to collect data after hip arthroscopy. If athletes reported they were engaged in preinjury sport at their preinjury level, the associated sports performance and participation were assessed as either (1) optimal sports performance including full sports participation; (2) impaired sports performance, but full sports participation; or (3) impaired sports performance including restricted sports participation. Self-reported hip and groin function was assessed for all athletes by use of the Copenhagen Hip and Groin Outcome Score.Results:The study included 189 athletes (mean ± SD age at follow-up, 26.9 ± 3.4 years) at a mean ± SD follow-up of 33.1 ± 16.3 months after surgery. At follow-up, 108 athletes (57.1%) were playing preinjury sport at preinjury level, whereas the remaining 81 athletes (42.9%) failed to return to preinjury sport at preinjury level. Of the 108 athletes engaged in their preinjury sport at preinjury level at follow-up, 32 athletes (29.6%) reported optimal sports performance including full sports participation, corresponding to 16.9% of the study sample. Better self-reported hip and groin function was observed in athletes who were engaged in preinjury sport at preinjury level compared with athletes who were not.Conclusion:Fifty-seven percent of athletes returned to preinjury sport at their preinjury level. This is considerably lower than a previously reported return to sport rate of 87% and may reflect that the present study used a clear and strict definition of return to sport. Of note, only one-third of athletes who returned to preinjury sport at preinjury level reported their sports performance to be optimal, corresponding to 16.9% of the study sample. Better self-reported hip and groin function was observed in athletes who were playing preinjury sport at preinjury level compared with athletes who were not.
Facility Placement as a Barrier to Hospice for Older Adult Patients Discharged From a Palliative Care Unit
Authors: Shinall Myrick C. , Wilson Jo Ellen , Karlekar Mohana , Ely E. Wesley 
Published: August 2018

Context: Many older adults discharged from an inpatient stay require postacute facility placement, which can be a barrier to hospice enrollment since the Medicare hospice benefit does not cover facility costs for patients under routine hospice care. Objectives: To evaluate the extent to which need for postdischarge facility care was a barrier to hospice enrollment for older patients with short life expectancy discharged from a palliative care unit. Methods: Retrospective cohort using a prospectively collected database of patients 65 and older with a life expectancy of <6 months admitted to a palliative care unit in an urban, academic medical center and discharged alive from 2012 to 2017. Primary outcome was hospice enrollment at hospital discharge. Exposure of interest was need for facility placement at discharge. Results: Of 817 included patients, 649 (79%) were discharged with hospice. Patients discharged home had a significantly higher rate of hospice enrollment than patients discharged to a facility—92% versus 71% ( P < .0001). On multivariate logistic regression analysis, discharge to home versus facility remained a strong predictor of hospice enrollment, with an odds ratio for hospice enrollment of 6.04 (95% confidence interval: 3.73-9.79). Conclusion: Need for postdischarge facility placement represents a barrier for hospice enrollment among older patients who are otherwise hospice appropriate. The structure of the hospice benefit may require modification so that these hospice appropriate patients can utilize the benefit.
Neurofilaments and 10-year follow-up in multiple sclerosis
Authors: Bhan Alok , Jacobsen Cecilie , Myhr Kjell Morten , Dalen Ingvild , Lode Kirsten , Farbu Elisabeth 
Published: August 2018

Background: The role of biomarkers to predict clinical outcome in multiple sclerosis (MS) is still debated. Objective: To test whether cerebrospinal fluid (CSF) light-chain neurofilament (NfL) levels in newly diagnosed patients with MS could predict clinical outcome over a 10-year period. Methods: Patients with newly diagnosed MS underwent standardized clinical assessments at baseline and 5 and 10 years of follow-up. Expanded Disability Status Scale (EDSS) progression between assessments was defined as an increase in one point or more if <6 and 0.5 or more if ≥6. CSF obtained at baseline was analyzed for levels of NfL using enzyme-linked immunosorbent assay technology. Results: A total of 44 patients were included. In all, 35 patients (80%) had relapsing–remitting multiple sclerosis (RRMS). Patients who progressed in EDSS showed a trend for higher median baseline CSF-NfL levels than patients who did not progress after 5 years (947 ng/L vs 246 ng/L, p = 0.05), and although not statistically significant, after 10 years (708 ng/L vs 265 ng/L, p = 0.28). Patients who converted from RRMS to secondary-progressive multiple sclerosis (SPMS) at 5 years had a statistical significant higher median CSF level of NfL (2122 ng/L vs 246 ng/L, p = 0.01). Conclusion: CSF levels of NfL at the time of diagnosis seems to be an early predictive biomarker of long-term clinical outcome and conversion from RRMS to SPMS.
A qualitative study of clinical champions in context: Clinical champions across three levels of acute care
Authors: Flanagan Mindy E , Plue Laurie , Miller Kristine K , Schmid Arlene A , Myers Laura , Graham Glenn , Miech Edward J , Williams Linda S , Damush Teresa M 
Published: August 2018

Objectives: To compare activities and field descriptions of clinical champions across three levels of stroke centers. Methods: A cross-sectional qualitative study using quota sampling was conducted. The setting for this study was 38 acute stroke centers based in US Veterans Affairs Medical Centers with 8 designated as Primary, 24 as Limited Hours, and 6 as Stroke Support Centers. Key informants involved in stroke care were interviewed using a semi-structured approach. A cross-case synthesis approach was used to conduct a qualitative analysis of clinical champions’ behaviors and characteristics. Clinical champion behaviors were described and categorized across three dimensions: enthusiasm, persistence, and involving the right people. Results: Clinical champions at Primary Stroke Centers represented diverse medical disciplines and departments (education, quality management); directed implementation of acute stroke care processes; coordinated processes across service lines; and benefited from supportive contexts for implementation. Clinical champions at Limited Hours Stroke Centers varied in steering implementation efforts, building collaboration across disciplines, and engaging in other clinical champion activities. Clinical champions at Stroke Support Centers were implementing limited changes to stroke care and exhibited few behaviors fitting the three clinical champion dimensions. Other clinical champion behaviors included educating colleagues, problem-solving, implementing new care pathways, monitoring progress, and standardizing processes. Conclusion: These data demonstrate clinical champion behaviors for implementing changes to complex care processes such as acute stroke care. Changes to complex care processes involved coordination among clinicians from multiple services lines, persistence facing obstacles to change, and enthusiasm for targeted practice changes.
Marked Response of a Hypermutated ACTH-Secreting Pituitary Carcinoma to Ipilimumab and Nivolumab
Authors: Lin Andrew L , Jonsson Philip , Tabar Viviane , Yang T Jonathan , Cuaron John , Beal Katherine , Cohen Marc , Postow Michael , Rosenblum Marc , Shia Jinru , DeAngelis Lisa M , Taylor Barry S , Young Robert J , Geer Eliza B 
Published: August 2018

Abstract

Context
Pituitary carcinoma is a rare and aggressive malignancy with a poor prognosis and few effective treatment options.

Case
A 35-year-old woman presented with an aggressive ACTH-secreting pituitary adenoma that initially responded to concurrent temozolomide and capecitabine prior to metastasizing to the liver. Following treatment with ipilimumab and nivolumab, the tumor volume of the dominant liver metastasis reduced by 92%, and the recurrent intracranial disease regressed by 59%. Simultaneously, her plasma ACTH level decreased from 45,550 pg/mL to 66 pg/mL.

Molecular Evaluation
Both prospective clinical sequencing with Memorial Sloan Kettering–Integrated Mutation Profiling of Actionable Cancer Targets and retrospective whole-exome sequencing were performed to characterize the molecular alterations in the chemotherapy-naive pituitary adenoma and the temozolomide-resistant liver metastasis. The liver metastasis harbored a somatic mutational burden consistent with alkylator-induced hypermutation that was absent from the treatment-naive tumor. Resistance to temozolomide treatment, acquisition of new oncogenic drivers, and subsequent sensitivity to immunotherapy may be attributed to hypermutation.

Conclusion
Combination treatment with ipilimumab and nivolumab may be an effective treatment in pituitary carcinoma. Clinical sequencing of pituitary tumors that have relapsed following treatment with conventional chemotherapy may identify the development of therapy-induced somatic hypermutation, which may be associated with treatment response to immunotherapy.
Wrist-worn Accelerometry for Runners: Objective Quantification of Training Load
Authors: STILES VICTORIA H. , PEARCE MATTHEW , MOORE ISABEL S. , LANGFORD JOSS , ROWLANDS ALEX V. 
Published: August 2018

ABSTRACT

Purpose
This study aimed to apply open-source analysis code to raw habitual physical activity data from wrist-worn monitors to: 1) objectively, unobtrusively, and accurately discriminate between “running” and “nonrunning” days; and 2) develop and compare simple accelerometer-derived metrics of external training load with existing self-report measures.

Methods
Seven-day wrist-worn accelerometer (GENEActiv; Activinsights Ltd, Kimbolton, UK) data obtained from 35 experienced runners (age, 41.9 ± 11.4 yr; height, 1.72 ± 0.08 m; mass, 68.5 ± 9.7 kg; body mass index, 23.2 ± 2.2 kg·m−2; 19 [54%] women) every other week over 9 to 18 wk were date-matched with self-reported training log data. Receiver operating characteristic analyses were applied to accelerometer metrics (“Average Acceleration,” “Most Active-30mins,” “Mins≥400 mg”) to discriminate between “running” and “nonrunning” days and cross-validated (leave one out cross-validation). Variance explained in training log criterion metrics (miles, duration, training load) by accelerometer metrics (Mins≥400 mg, “workload (WL) 400-4000 mg”) was examined using linear regression with leave one out cross-validation.

Results
Most Active-30mins and Mins≥400 mg had >94% accuracy for correctly classifying “running” and “nonrunning” days, with validation indicating robustness. Variance explained in miles, duration, and training load by Mins≥400 mg (67%–76%) and WL400–4000 mg (55%–69%) was high, with validation indicating robustness.

Conclusions
Wrist-worn accelerometer metrics can be used to objectively, unobtrusively, and accurately identify running training days in runners, reducing the need for training logs or user input in future prospective research or commercial activity tracking. The high percentage of variance explained in existing self-reported measures of training load by simple, accelerometer-derived metrics of external training load supports the future use of accelerometry for prospective, preventative, and prescriptive monitoring purposes in runners.
School Physical Activity Intervention Effect on Adolescents’ Performance in Mathematics
Authors: LUBANS DAVID R. , BEAUCHAMP MARK R. , DIALLO THIERNO M. O. , PERALTA LOUISA R. , BENNIE ANDREW , WHITE RHIANNON L. , OWEN KATHERINE , LONSDALE CHRIS 
Published: August 2018

ABSTRACT

Purpose
The primary aim of this study was to test the effect of a school-based physical activity intervention on adolescents’ performance in mathematics. A secondary aim was to explore potential mechanisms that might explain the intervention effect.

Methods
The Activity and Motivation in Physical EDucation intervention was evaluated using a two-arm cluster randomized controlled trial in 14 secondary schools located in low socioeconomic areas of Western Sydney, Australia. Study participants (n = 1173) were grade 8 students (mean age = 12.94 yr, SD = 0.54). The multicomponent intervention was designed to help teachers maximize students’ opportunities for moderate-to-vigorous physical activity (MVPA) during physical education (PE) and enhance students’ motivation toward PE. Mathematics performance was assessed as part of national testing in grade 7, which was the year before the trial began and then again in grade 9. Potential mediators were: (i) proportion of PE lesson time that students spent in MVPA and leisure time MVPA (%), measured using Actigraph GT3X+ accelerometers, and (ii) students’ self-reported engagement (behavioral, emotional, and cognitive) during mathematics lessons. Mediators were assessed at baseline (grade 8) and follow-up (grade 9, 14–15 months after baseline).

Results
The effect of the intervention on mathematics performance was small-to-medium (β = 0.16, P < 0.001). An intervention effect was observed for MVPA% in PE (β = 0.59, P < 0.001), but not for leisure time MVPA or any of the engagement mediators. There were no significant associations between changes in potential mediators and mathematics performance.

Conclusions
The Activity and Motivation in Physical EDucation intervention had a significant positive effect on mathematics performance in adolescents. However, findings should be interpreted with caution as the effect was small and not associated with changes in hypothesized mediators.
Biceps Femoris Long-Head Architecture Assessed Using Different Sonographic Techniques
Authors: PIMENTA RICARDO , BLAZEVICH ANTHONY J. , FREITAS SANDRO R. 
Published: August 2018

ABSTRACT

Purpose
To assess the repeatability of, and measurement agreement between, four sonographic techniques used to quantify biceps femoris long head (BFlh) architecture: (i) static-image with linear extrapolation; extended field-of-view (EFOV) with linear ultrasound probe path (linear-EFOV), using either (ii) straight or (iii) segmented analyses; and (iv) EFOV with nonlinear probe path and segmented analysis (nonlinear-EFOV) to follow the complex fascicle trajectories.

Methods
Twenty individuals (24.4 ± 5.7 yr; 175 ± 0.8 cm; 73 ± 9.0 kg) without history of hamstrings strain injury were tested in two sessions separated by 1 h. An ultrasound scanner coupled with 6-cm linear probe was used to assess BFlh architecture in B-mode.

Results
The ultrasound probe was positioned at 52.0% ± 5.0% of femur length and 57.0% ± 6.0% of BFlh length. We found an acceptable repeatability when assessing BFlh fascicle length (ICC3,k = 0.86–0.95; SEM = 1.9–3.2 mm) and angle (ICC3,k = 0.86–0.97; SEM = 0.8°–1.1o) using all sonographic techniques. However, the nonlinear-EFOV technique showed the highest repeatability (fascicle length ICC3,k = 0.95; fascicle angle, ICC3,k = 0.97). The static-image technique, which estimated 35.4% ± 7.0% of the fascicle length, overestimated fascicle length (8%–11%) and underestimated fascicle angle (8%–9%) compared with EFOV techniques. Also, the rank order of individuals varied by approximately 15% between static-image and nonlinear-EFOV (segmented) when assessing the fascicle length.

Conclusions
Although all techniques showed good repeatability, absolute errors were observed using static-image (7.9 ± 6.1 mm for fascicle length) and linear-EFOV (between 3.7 ± 3.0 and 4.2 ± 3.7 mm), probably because the complex fascicle trajectories were not followed. The rank order of individuals for fascicle length and angle were also different between static-image and nonlinear-EFOV, so different muscle function and injury risk estimates could likely be made when using this technique.