bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraseasonal Tropical Cyclogenesis Prediction in a Global Coupled Model System
Authors: Jiang Xianan , Xiang Baoqiang , Zhao Ming , Li Tim , Lin Shian-Jiann , Wang Zhuo , Chen Jan-Huey 
Published: May 2018

AbstractMotivated by increasing demand in the community for intraseasonal predictions of weather extremes, predictive skill of tropical cyclogenesis is investigated in this study based on a global coupled model system. Limited intraseasonal cyclogenesis prediction skill with a high false alarm rate is found when averaged over about 600 tropical cyclones (TCs) over global oceans from 2003 to 2013, particularly over the North Atlantic (NA). Relatively skillful genesis predictions with more than 1-week lead time are only evident for about 10% of the total TCs. Further analyses suggest that TCs with relatively higher genesis skill are closely associated with the Madden–Julian oscillation (MJO) and tropical synoptic waves, with their geneses strongly phase-locked to the convectively active region of the MJO and low-level cyclonic vorticity associated with synoptic-scale waves. Moreover, higher cyclogenesis prediction skill is found for TCs that formed during the enhanced periods of strong MJO episodes than those during weak or suppressed MJO periods. All these results confirm the critical role of the MJO and tropical synoptic waves for intraseasonal prediction of TC activity. Tropical cyclogenesis prediction skill in this coupled model is found to be closely associated with model predictability of several large-scale dynamical and thermodynamical fields. Particularly over the NA, higher predictability of low-level relative vorticity, midlevel humidity, and vertical zonal wind shear is evident along a tropical belt from the West Africa coast to the Caribbean Sea, in accord with more predictable cyclogenesis over this region. Over the extratropical NA, large-scale variables exhibit less predictability due to influences of extratropical systems, leading to poor cyclogenesis predictive skill.
A Study of the HWRF Analysis and Forecast Impact of Realistically Simulated CYGNSS Observations Assimilated as Scalar Wind Speeds and as VAM Wind Vectors
Authors: Annane Bachir , McNoldy Brian , Leidner S. Mark , Hoffman Ross , Atlas Robert , Majumdar Sharanya J. 
Published: May 2018

Abstract
In preparation for the launch of the NASA Cyclone Global Navigation Satellite System (CYGNSS), a variety of observing system simulation experiments (OSSEs) were conducted to develop, tune, and assess methods of assimilating these novel observations of ocean surface winds. From a highly detailed and realistic hurricane nature run (NR), CYGNSS winds were simulated with error characteristics that are expected to occur in reality. The OSSE system makes use of NOAA’s HWRF Model and GSI data assimilation system in a configuration that was operational in 2012. CYGNSS winds were assimilated as scalar wind speeds and as wind vectors determined by a variational analysis method (VAM). Both forms of wind information had positive impacts on the short-term HWRF forecasts, as shown by key storm and domain metrics. Data assimilation cycle intervals of 1, 3, and 6 h were tested, and the 3-h impacts were consistently best. One-day forecasts from CYGNSS VAM vector winds were the most dynamically consistent with the NR. The OSSEs have a number of limitations; the most noteworthy is that this is a case study, and static background error covariances were used.
New, optimized, dual-lumen cannula for veno-venous ECMO
Authors: von Segesser Ludwig K. , Berdajs Denis , Abdel-Sayed Saad , Ferrari Enrico , Halbe Maximilian , Wilhelm Markus , Maisano Francesco 
Published: May 2018

Objective: The present study was designed to assess in vivo a new, optimized, virtually wall-less, dual-lumen, bi-caval cannula for veno-venous ECMO in comparison to a commercially available cannula. Methods: Veno-venous extracorporeal membrane oxygenation (ECMO) was carried out in a bovine study (n=5, bodyweight 75±5kg). Following systemic heparinization, ECMO was established in a trans-jugular fashion through a calibrated 23F orifice, using a new, optimized, virtually wall-less, dual-lumen, bi-caval 24F cannula (Smartcanula LLC, Lausanne, Switzerland) versus a commercially available 23F bi-caval, dual-lumen control cannula (Avalon Elite®, Maquet, Rastatt, Germany) in a veno-venous ECMO setup. Veno-venous ECMO was initiated at 500 revolutions per minute (RPM) and increased by incremental steps of 500 RPM up to 2500 RPM. Catheter outlet pressure, catheter inlet pressure, oxygen saturation and pump flow were recorded at each stage. Results: Mean flow accounted for 0.37±0.04 L/min for wall-less versus 0.29± 0.07 L/min for control at 500 RPM, 0.97±0.12 versus 0.67±0.06 at 1000 RPM, 1.60±0.14 versus 1.16±0.08 at 1500 RPM, 2.31±0.13 versus 1.52±0.13 for 2000 RPM and 3.02±0.5 versus 2.11±0.18 (p<0.004). The mean venous suction required was 19±8 mmHg for wall-less versus 20±3 mmHg for control at 500 RPM, 7±3 versus 9±4 for 1000 RPM, -11±10 versus -12±8 at 1500 RPM, -39±15 versus -49±10 for 2000 RPM and -60±28 versus -94±7 for 2500 RPM. The mean venous injection pressure accounted for 29±7 mmHg for wall-less versus 27±5 mmHg for control at 500 RPM, 50±6 versus 61±7 at 1000 RPM, 89±10 versus 99±17 for 1500 RPM, 142±14 versus 161±9 at 2000 RPM and 211±41 versus 252 ±3 for 2500 RPM. Conclusion: Compared to the commercially available control cannula, the new, optimized, virtually wall-less, dual-lumen, bi-caval 24F cannula allows for significantly higher blood flows, requires less suction and results in lower injection pressures in vivo.
In vitro and in vivo assessment of oxygenator blood volume for the prediction of clot formation in an ECMO circuit (theory and validation)
Authors: Krivitski Nikolai , Galyanov Gregory , Cooper Deborah , Said Mariam M. , Rivera Oswaldo , Mikesell Gerald T. , Rais-Bahrami Khodayar 
Published: May 2018

Introduction: Clotting is one of the major causes of mortality and morbidity during extracorporeal membrane oxygenation (ECMO). A large meta-analysis study suggests that 29% of patients require the oxygenator to be replaced during ECMO. As clots usually form in the oxygenator, the oxygenator blood volume (OXBV) decreases over time. The currently used pressure gradient as a predicator of clot formation is unreliable. Objective: The aim of this study was to develop and validate ultrasound dilution technology in a quantitative assessment of clotting, using measurements of OXBV. Methods: OXBV was measured using the ELSA monitor (Transonic Systems Inc., Ithaca, NY, USA) from the transit time of a saline bolus passing through the oxygenator as recorded by a sensor placed after the oxygenator. The accuracy and reproducibility (coefficient of variation [CV]) of OXBV measurement and its independence from ECMO flow was assessed in vitro in lambs and from a clinical data archive. Results: The in vitro accuracy compared with volumetric measurements of OXBV of 22-134 ml at flows of 300-700 ml/min was −0.8±6.6%. For an OXBV of 355 ml at flows of 1020-7000 ml/min, accuracy was −0.4±1.6%. In 88 animal OXBV measurements, the CV was 1.49±1.12%. For an OXBV of 153 (range 42-387 ml), clinical measurements at flow ranged from 210-5960 ml/min, with a CV of 3.20±2.44 %. Conclusion: Dilution technology has the ability to accurately and reproducibly assess the clotting process in the oxygenator. Larger studies are needed to establish guidelines for the prediction of imminent clotting and may help to avoid unnecessary circuit changes.
Intracranial hemorrhage in adults on ECMO
Authors: Cavayas Yiorgos Alexandros , del Sorbo Lorenzo , Fan Eddy 
Published: May 2018

Rationale: Extracorporeal membrane oxygenation (ECMO) use has exploded over the last decade. However, it remains invasive and associated with significant complications, including tamponade, infection, thrombosis, gas embolism and bleeding. The most dreaded complication is intracranial hemorrhage (ICH). In this article, we review the literature on the incidence, diagnosis, risk factors, pathophysiology, prognosis, prevention and management of ICH in adults on ECMO. Main findings: We found a high incidence of ICH in the literature with a poor prognosis. Important risk factors included pre-ECMO cardiac arrest, sepsis, influenza, renal failure, renal replacement therapy, hemolysis and thrombocytopenia. The optimal anticoagulation strategy is still uncertain. As platelet dysfunction and depletion appear to play an important role in the pathogenesis of ICH in patients on ECMO, a liberal platelet transfusion strategy may be advised. Prompt computed tomography (CT) diagnosis is of great importance as interventions to limit hematoma expansion and secondary neurological injury are most effective if instituted early. Transporting patients to the radiology department can be performed safely while on ECMO. A strategy combining screening CT on admission with a heparin-free period of extracorporeal support was demonstrated to be safe in VV-ECMO patients and resulted in a better prognosis compared to similar cohorts in the literature. Conclusion: Despite major technological improvements and all the experience gained in adults, ECMO remains associated with a high incidence of ICH. There are still wide gaps in our understanding of the disease. Optimal management strategies that minimize the risk of ICH and improve prognosis need to be further studied.
Addressing the challenges of ECMO simulation
Authors: Alinier Guillaume , Hassan Ibrahim Fawzy , Alsalemi Abdullah , Al Disi Mohammed , Ait Hssain Ali , Labib Ahmed , Alhomsi Yahya , Bensaali Fayçal , Amira Abbes , Ibrahim Abdulsalam Saif 
Published: May 2018

Introduction/Aim: The patient’s condition and high-risk nature of extracorporeal membrane oxygenation (ECMO) therapy force clinical services to ensure clinicians are properly trained and always ready to deal effectively with critical situations. Simulation-based education (SBE), from the simplest approaches to the most immersive modalities, helps promote optimum individual and team performance. The risks of SBE are negative learning, inauthenticity in learning and over-reliance on the participants’ suspension of disbelief. This is especially relevant to ECMO SBE as circuit/patient interactions are difficult to fully simulate without confusing circuit alterations. Methods: Our efforts concentrate on making ECMO simulation easier and more realistic in order to reduce the current gap there is between SBE and real ECMO patient care. Issues to be overcome include controlling the circuit pressures, system failures, patient issues, blood colour and cost factors. Key to our developments are the hospital-university collaboration and research funding. Results: A prototype ECMO simulator has been developed that allows for realistic ECMO SBE. The system emulates the ECMO machine interface with remotely controllable pressure parameters, haemorrhaging, line chattering, air bubble noise and simulated blood colour change. Conclusion: The prototype simulator allows the simulation of common ECMO emergencies through innovative solutions that enhance the fidelity of ECMO SBE and reduce the requirement for suspension of disbelief from participants. Future developments will encompass the patient cannulation aspect.
Nicotine metabolite ratio and smoking outcomes using nicotine replacement therapy and varenicline among smokers with and without psychiatric illness
Authors: Clyde Matthew , Pipe Andrew , Els Charl , Reid Robert , Fu Angel , Clark Alexa , Tulloch Heather 
Published: May 2018

Introduction: It has been suggested that the effectiveness of nicotine replacement smoking cessation pharmacotherapy may be enhanced by assessing rates of nicotine metabolism using the nicotine metabolite ratio – which reflects differences in the activity of the CYP2A6 hepatic enzyme – and titrating doses appropriately. To date, supporting evidence is equivocal, with little information regarding the assessment and effectiveness of the nicotine metabolite ratio among smokers with psychiatric conditions. Methods: The nicotine metabolite ratio of 499 smokers from the FLEX trial was determined using urine samples obtained at baseline. They were randomized to receive either: standard transdermal nicotine (nicotine replacement therapy); extended nicotine replacement therapy + adjunct nicotine agent; or varenicline. Primary cessation outcomes were seven-day point prevalence at 5, 10, 22, and 52 weeks post-target quit date, comparing across treatment and psychiatric status. Our principal analysis employed logistic regression (outcome: abstinence), using slow metabolizers as the reference category. Results: No differences were observed by nicotine metabolite ratio classification (slow, moderate, fast) with respect to any demographic or smoking-related variables. Nicotine metabolite ratio class did not predict smoking cessation in either the overall sample, or by treatment condition at any time-point (week 52 moderate metabolizers: odds ratio 1.34, 95% confidence interval (0.68–2.63), p=0.394; fast metabolizers: odds ratio 1.04 (0.56–1.91), p=0. 906). Conclusion: Our results did not find any associations between nicotine metabolite ratio and cessation outcomes among smokers using nicotine replacement therapy or varenicline with and without lifetime psychiatric conditions.
Season-Ending Shoulder Injuries in the National Collegiate Athletic Association: Data From the NCAA Injury Surveillance Program, 2009-2010 Through 2013-2014
Authors: Goodman Avi D. , DeFroda Steven F. , Gil Joseph A. , Kleiner Justin E. , Li Neill Y. , Owens Brett D. 
Published: May 2018

Background: Examination of the incidence of shoulder season-ending injury (SEI) in the collegiate athlete population is limited. Purpose: To determine the incidence of shoulder SEI in the National Collegiate Athletic Association (NCAA) and to investigate the risk factors for a shoulder injury ending an athlete’s season. Study Design: Descriptive epidemiology study. Methods: All shoulder injuries from the NCAA Injury Surveillance Program database for the years 2009-2010 to 2013-2014 were extracted, and SEI status was noted. The incidences of SEI and non-SEI were calculated for athlete, activity, and injury characteristics and compared via univariable analysis and risk ratios to determine risk factors for an injury being season ending. Results: Shoulder injuries were season ending in 4.3% of cases. The overall incidence of shoulder SEI was 0.31 per 10,000 athlete exposures (AEs), as opposed to 7.25 per 10,000 AEs for all shoulder injuries. Shoulder instability constituted 49.1% of SEI, with an incidence of 0.15 per 10,000 AEs, while fractures had the highest rate of being season ending (41.9%). Men’s wrestling had the highest incidence of shoulder SEI (1.65 per 10,000 AEs), while men’s soccer had the highest proportion of shoulder injuries that ended a season (14.6%). Overall, men had a 6.3-fold higher incidence of SEI than women and a 2.4-fold increased likelihood that an injury would be season ending. Conclusion: Injury to the shoulder of an NCAA athlete, while somewhat infrequent, can have significant implications on time lost from play. Incidence of these injuries varies widely by sport and injury, with a number of associated risk factors. Athletes sustaining potentially season-ending shoulder injuries, with their coaches and medical providers, may benefit from these data to best manage expectations and outcomes.
Effects of Bone Incorporation After Arthroscopic Stabilization Surgery for Bony Bankart Lesion Based on Preoperative Glenoid Defect Size
Authors: Park In , Lee Jae-Hoo , Hyun Hwan-Sub , Oh Min-Joon , Shin Sang-Jin 
Published: May 2018

Background: Recurrent shoulder instability occurs more frequently after soft tissue surgery when the glenoid defect is greater than 20%. However, for lesions less than 20%, no scientific guidance is available regarding what size of bone fragments may affect shoulder functional restoration after bone incorporation. Purpose/Hypothesis: The purpose was to analyze how preoperative glenoid defect size and bone fragment incorporation alter postoperative clinical outcomes, we compared the functional outcomes of shoulders with and without bony Bankart lesion. It was hypothesized that differences in postoperative clinical outcomes between patients with and without bony fragments would be found only in patients with a larger glenoid defect. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 223 patients who underwent arthroscopic stabilization surgery for recurrent anterior shoulder instability were divided into two groups based on the presence of anterior glenoid bone fragments. In each group, postoperative shoulder functional outcomes, sports activity level, and recurrence rates were evaluated according to preoperative glenoid defect size (small, <10%; medium, 10%-15% and 15%-20%; large, >20%). Results: In patients with small or medium defects, no significant differences were found in postoperative clinical outcomes and sports activity levels between the two groups. However, in patients with a large defect, the patients with bone fragments (mean ± SD American Shoulder and Elbow Surgeons [ASES] score, 92.3 ± 2.7; Rowe score, 90.9 ± 5.4) showed significantly superior clinical outcomes compared with patients who did not have fragments (ASES score, 87.3 ± 6.2, P = .02; Rowe score, 84.8 ± 7.3, P = .04). Among patients without bone fragments, recurrence increased significantly with increasing preoperative glenoid defect size (recurrence rates: 0% in small defects, 7.4% in medium defects, 22.2% in large defects), whereas patients with bone fragments showed no tendency for increasing or decreasing recurrence rates (0% in small defects, 7.9% in medium defects, 5.9% in large defects). Conclusion: In the treatment of bony Bankart lesion, the effect of bone fragment incorporation was different according to preoperative glenoid defect size. In patients with preoperative glenoid defects less than 20% of the glenoid width, bone fragment incorporation after arthroscopic bony Bankart repair did not alter clinical outcomes, sports activity levels, or recurrence rates, whereas in patients with defects greater than 20% of the glenoid width, bone fragment incorporation improved clinical outcomes and recurrence rates.
A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS)
Authors: Messier Stephen P. , Martin David F. , Mihalko Shannon L. , Ip Edward , DeVita Paul , Cannon D. Wayne , Love Monica , Beringer Danielle , Saldana Santiago , Fellin Rebecca E. , Seay Joseph F. 
Published: May 2018

Background: The National Center for Injury Prevention and Control, noting flaws in previous running injury research, called for more rigorous prospective designs and comprehensive analyses to define the origin of running injuries. Purpose: To determine the risk factors that differentiate recreational runners who remain uninjured from those diagnosed with an overuse running injury during a 2-year observational period. Study Design: Cohort study; Level of evidence, 2. Methods: Inclusion criteria were running a minimum of 5 miles per week and being injury free for at least the past 6 months. Data were collected at baseline on training, medical and injury histories, demographics, anthropometrics, strength, gait biomechanics, and psychosocial variables. Injuries occurring over the 2-year observation period were diagnosed by an orthopaedic surgeon on the basis of predetermined definitions. Results: Of the 300 runners who entered the study, 199 (66%) sustained at least 1 injury, including 73% of women and 62% of men. Of the injured runners, 111 (56%) sustained injuries more than once. In bivariate analyses, significant ( P ≤ .05) factors at baseline that predicted injury were as follows: Short Form Health Survey–12 mental component score (lower mental health–related quality of life), Positive and Negative Affect Scale negative affect score (more negative emotions), sex (higher percentage of women were injured), and knee stiffness (greater stiffness was associated with injury); subsequently, knee stiffness was the lone significant predictor of injury (odds ratio = 1.18) in a multivariable analysis. Flexibility, quadriceps angle, arch height, rearfoot motion, strength, footwear, and previous injury were not significant risk factors for injury. Conclusion: The results of this study indicate the following: (1) among recreational runners, women sustain injuries at a higher rate than men; (2) greater knee stiffness, more common in runners with higher body weights (≥80 kg), significantly increases the odds of sustaining an overuse running injury; and (3) contrary to several long-held beliefs, flexibility, arch height, quadriceps angle, rearfoot motion, lower extremity strength, weekly mileage, footwear, and previous injury are not significant etiologic factors across all overuse running injuries.
Facilitators and Barriers to Oncologists’ Conduct of Goals of Care Conversations
Authors: Schulman-Green Dena , Lin Jenny J. , Smith Cardinale B. , Feder Shelli , Bickell Nina A. 
Published: May 2018

Introduction: Goals of care (GoC) conversations optimally begin early in the course of cancer care, yet most happen near the end of life. We sought to describe oncologist-reported facilitators of and barriers to GoC conversations with patients who have advanced cancer. Methods and Materials: We conducted individual, semistructured qualitative interviews with oncologists from 4 academic, community, municipal, and rural hospitals in New York and Connecticut. Interview topics included approach to GoC conversations, facilitators, barriers, and organizational influences. We analyzed data using interpretive description. We collected demographic and practice information and surveyed oncologists on their communication skills training. We calculated descriptive statistics for quantitative data. Results: Oncologists (n = 21) had a mean age of 46 years (range: 34-68), 67% were male, 71% were White, 24% were Asian, 10% were Hispanic, and 5% were Black. They reported an average of 20 years in practice (range: 8-42), and 62% had received training on having GoC conversations. Facilitators included patient’s poor functional status, patient’s high health literacy, family understanding and acceptance, oncologist’s practice experience, and a supportive practice environment. Barriers included certain patient demographic and clinical characteristics, patient religion and culture, patient’s denial, and lack of time. Conclusion: GoC conversations may be facilitated by enabling oncologists to conduct these conversations despite difficult circumstances and emotional reactions by activating patients and family via increased health literacy and by advancing palliative-informed practice environments.