Indiana University Fort Wayne

Abstract Reanalysis proximity vertical profile attributes associated with long-track tornadoes [LTTs; pathlength ≥ 48 km (30 mi)] and short-track tornadoes [STTs; pathlengths < 48 km (30 mi)] for a total of 48 212 tornadoes with pathlengths ≥ 0.016 km (0.01 mi) from 1979 to 2022 in the United States were examined. Both longer- and shorter-track tornadoes were associated with vast ranges of mixed-layer convective available potential energy, together with relatively low mixed-layer lifted condensation level heights and minimal convective inhibition. A large range of 500–9000-m wind speeds and bulk wind differences, 500–3000-m streamwise vorticities, storm-relative helicities, and storm-relative wind speeds were found for STTs. In stark contrast, LTTs only occurred when these kinematic attributes were larger in amplitude through the troposphere, supporting previously documented associations between observed longer-track tornado pathlengths and faster-propagating parent storms. A novel parameter, heavily weighted by kinematic parameters and lightly weighted by thermodynamic parameters, outperformed the significant tornado parameter in differentiating environments that were more supportive of both LTTs and tornadoes rated <EF5. The high correlation values R2 = 0.79 between tornado pathlength and Bunkers’ approximate tornado duration (pathlength/VBunkers) call for improved understanding of mesocyclone periodicities, which impact tornado longevity, to improve tornado pathlength diagnoses and forecasts. Pragmatically, diagnosing LTT environments using vertical profile attributes, perhaps, is not so much a problem of determining when there might be higher expectations for LTTs, but rather a problem of when there might be lower expectations for LTTs, e.g., weaker kinematic attributes in the lower troposphere. Significance Statement The majority of tornadoes have pathlengths less than a few kilometers. As tornado pathlengths increase, their probability of causing impacts to society also increases. We study >40 years of modeled atmospheric vertical profiles to better understand the environmental conditions that support long-track tornadoes (pathlength ≥ 48 km or ≥30 mi). Consistent with previous studies, long-track tornadoes occurred with substantially stronger vertical wind shear profiles and low-level winds compared to short-track tornadoes; however, most tornadoes did not form in environments with exceedingly large vertical instability, regardless of pathlength or intensity. A proposed composite long-track tornado parameter (LTTP) provided better discrimination between longer and shorter pathlength events compared to preexisting parameters.

IntroductionAchieving successful arthrodesis after lumbar interbody fusion remains a challenge, especially for minimally invasive surgical approaches that limit the amount of local bone autograft. However, using an allograft blend as an autograft extension mixture may hold promise but requires further research. The purpose of this study is to examine the impact of an allograft blend added to autograft on the quality of arthrodesis after lumbar interbody fusion in adult patients.MethodsThis study is a retrospective case series of adult patients (>21 years old) who underwent lumbar interbody fusion between October 2021 and January 2022, performed by a single spine surgeon. The quality of arthrodesis was assessed via the Bridwell grade (I-IV) for up to six months. The impact of surgical technique, age, sex, or amount of allograft utilized during fusion on Bridwell grade was assessed.ResultsPatients (n = 18; 27 levels fused) had a mean age of 58.6 (1.9) years and a mean BMI of 32.8 (1.2) kilograms per meter squared (kg/m²). A mean of 18.0 (standard deviation = 2.4) cubic centimeters (cc) (range: 3.4-50.0 cc) of allograft was used per fused level. A Bridwell grade of I (successful arthrodesis) was achieved at three months in 11.1% (3/27) of fusions and at six months in 85.2% (23/27) of fusions. Four fusions remained at a Bridwell grade of II at six months and subsequently achieved complete arthrodesis at 12 months. No patients received a Bridwell grade of IV (lucency with collapse of graft) at three- or six-month follow-up. There was no difference in Bridwell grade when stratified by surgical technique, age, sex, or amount of allograft used.ConclusionThe allograft and autograft blend utilized in this study resulted in successful arthrodesis at all fused levels after one year, irrespective of surgical technique or other patient factors. Prospective studies with larger sample sizes are needed to corroborate the findings of this small case series.

Venous leg ulcers (VLUs) are open skin lesions of the lower legs arising in areas affected by venous hypertension that are associated with substantial morbidity. Clinical trials testing innovative approaches to improve healing outcomes are critically needed because standard therapies are often ineffective. However, patients with VLUs frequently have multiple physical, emotional and socioeconomic challenges that can negatively impact their decision to enrol in a clinical trial. To benefit clinical researchers and ultimately the community of patients with chronic wounds, this paper describes the monitoring and modification of recruitment strategies in an ongoing clinical trial testing effects of omega-3 fatty acid oral supplementation on VLU healing in ageing adults (n=208). Multiple modifications over time in this study have targeted participation barriers identified through data monitoring and include expanding inclusion criteria, adding recruitment sites, enhancing communication methods, and meeting patients' transportation needs. Recruitment activities from January 2019 to June 2022 have resulted in 57 participants (mean age: 63.7 years). Overall, the recruitment rate is 42.5% of patients contacted during face-to-face visits. Overcoming barriers to participation is key to helping patients with VLUs interested in research enrol in clinical trials aiming to improve healing outcomes in this vulnerable population.

Background:Heart transplantation volumes have increased in recent years, yet less than a third of donors are typically accepted for transplantation. Whether donor sex, donor drug use, or perception of increased risk affects utilization for transplantation is unclear.Methods:The United Network for Organ Sharing database was queried for donors from January 1, 2007, to December 31, 2017. Donor toxicology was collected when available. Multivariate analysis was conducted to examine correlations with donor utilization.Results:Between January 1, 2007, and December 31, 2017, there were 87 816 heart donors aged ≥15 years. The mean age was 42.7±15.8 years, and 24 831 donors (28.3%) were utilized for heart transplantation. Subsequent analyses focused on donors between 15 and 39 years old.The strongest associations with donor acceptance were for male donor sex, blood type, hepatitis C antibody, donor age, left ventricular hypertrophy, and history of donor drug use. After removing hepatitis C, Public Health Service Increased Risk was identified as a strong negative predictor. Most positive drug toxicology results were associated with donor nonuse except for donors between 15 and 19 years of age. Exceptions included alcohol, marijuana, and cocaine. Opiates were associated with less utilization at all donor ages. The Public Health Service Increased Risk status was associated with significantly less utilization in all age groups except 15- to 19-year-old donors.Conclusions:While male donors were preferentially utilized, donors with drug use or those deemed Public Health Service Increased Risk were significantly less utilized for heart transplantation. Further consideration of such donors would be appropriate particularly as the demand for transplantation continues to increase.

Right heart failure is a major cause of morbidity and mortality following left ventricular assist device implantation. Over the past few decades, the definition proposed by the Interagency Registry of Mechanical Circulatory Support and Society of Thoracic Surgeons has continually evolved to better identify this complex pathology. We propose that the latest definition proposed by the Mechanical Circulatory Support Academic Research Consortium in 2020 will increase our recognition and understanding of this complex disease phenomenon.

The HeartMate 3 (HM3) (Abbott Laboratories, Illinois) was approved by the FDA in 2018. In this issue of the Journal, Bansal et al perform a single center review of their experience with implantation of the HeartMate 3 before and after FDA approval. The analysis by Bansal et al included 82 patients who were part of the RCT pre-approval group and 92 patients who underwent HM3 implantation after FDA approval. The authors found that the post-approval group was younger, had a higher preoperative INR, was more likely to be undergoing HM3 implantation as part of a bridge to transplant strategy, more likely to have other mechanical support pre-operatively, and included more patients with an INTERMACS profile. This study demonstrates the weakness of randomized controlled trials in that they do not reflect the reality of clinical practice which underscores the need for studies such as this one for a complete understanding of any medical intervention or technology.

Hospice care is designed to help individuals with pain, physical and psychological, that arises during the advanced stage of a disease so that the patient can face their impending death with dignity. Through the hospice lens, the patient is viewed as an entity that needs both medical and non-medical care, which differentiates hospices from other forms of care available. However, despite hospice care having been integrated into the medical sphere and its widespread availability to patients, it has begun to be met with social reluctance and fear. This article is a review of theories, concepts, and research in the context of the social construct of cancer, palliative treatment, and hospice care. The texts analyzed in this article have been selected to show both the time-changing approach to the issues discussed, as well as the indication of threads that are characteristic of the USA and Europe, including Poland. The aim of the article is to reflect on the social stigmatization of hospice care, changes in the identity of patients, especially the transition from oncological treatment to palliative and hospice care, and thus draw attention to the patient experience before the impending death.

Pentosan polysulfate sodium (PPS) maculopathy is a clinical entity characterized by a pigmentary maculopathy in the setting of chronic exposure to PPS. Pentosan polysulfate sodium is indicated for discomfort related to interstitial cystitis/painful bladder syndrome. Given a reported interstitial cystitis/painful bladder syndrome prevalence up to 2%, recognition is critical to mitigate visual sequelae. We present an observational case report demonstrating typical findings of PPS maculopathy in a patient originally diagnosed with a pattern macular dystrophy. We demonstrate the importance of medical history, medication profile review, and multimodal imaging in the diagnosis and management. The patient provided written informed consent for medical information and images to be published. A 55-year-old White woman presented with a painless, bilateral loss of vision and bilateral pigmentary maculopathy that was initially diagnosed as pattern macular dystrophy. Detailed review of medical history, medication profile, and subsequent studies, including optical coherence tomography, near-infrared reflectance imaging, fundus autofluorescence, fluorescein angiography, and genetic studies, ultimately led to the diagnosis of PPS maculopathy. Pentosan polysulfate sodium was discontinued, and ongoing surveillance with multimodal imaging was encouraged. Because toxic maculopathies are an uncommon diagnosis, screening and recognition of PPS maculopathy are critical in the primary eye care setting. Discontinuation of the insulting agent may be necessary to prevent potentially severe and irreversible vision loss in the at-risk population.