Purpose To (1) report clinical outcomes, complication rates, and total hip arthroplasty (THA) conversion rates for patients age 40 or older who underwent hip arthroscopy, and (2) report any ...age-related predictors of outcome identified in the literature. Methods MEDLINE, EMBASE, and PubMed were searched for relevant studies and pertinent data were abstracted from eligible studies. No meta-analysis was performed because of heterogeneity amongst studies. Results Seventeen studies were included in this review comprising 16,327 patients, including 9,954 patients age 40 or older. All studies reported statistically significant improvements in outcomes after hip arthroscopy for femoral osteochondroplasty, labral repair, or unspecified indications. In patients 40 or older who underwent labral debridement, these improvements were not clinically significant. Obesity and osteoarthritic changes predicted poorer outcomes. Only 1 of 3 studies directly comparing the 2 groups found that patients 40 or older had a significantly less improvement in a standardized hip outcome score than patients under 40 after hip arthroscopy, but all found that patients 40 or older had significantly higher rates of THA conversion. The rate of conversion to THA was 18.1% for patients 40 or older, 23.1% for patients over 50, and 25.2% for patients over 60 with a mean of 25.0 months to THA. Conclusions Indications for hip arthroscopy including femoral osteochondroplasty and labral repair resulted in clinically significant improvements in patients 40 or older in most research studies examined in this review, whereas labral debridement did not produce clinically significant improvements postoperatively in the same studies. In these studies, the rate of conversion to THA is higher than in patients under 40 and increases with each decade of life, with many individual studies showing a significant increase in the rate of THA conversion. Hip arthroscopy may be suitable for some patients 40 or older, but patient selection is key and patients should be informed of the higher risk of conversion to THA. Level of Evidence Level IV, systematic review of Level III and IV studies.
Purpose To evaluate the indications, preoperative workup outcomes, and postoperative rehabilitation of patients with femoroacetabular impingement (FAI) receiving microfracture as an adjunct to hip ...arthroscopy for chondral defects. Methods The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate for studies involving patients with FAI treated arthroscopically with microfracture of the hip for chondral defects either solely or as an adjunct to hip arthroscopy. Data regarding indications, investigations, outcomes, and postoperative rehabilitation were abstracted from eligible studies. The references of included studies were additionally searched, and descriptive statistics are provided. Results There were 12 studies included in this review, involving 267 patients. With the exception of a single, one-patient case report, 11 of the 12 studies reported positive outcomes after hip arthroscopy with microfracture. Only 0.7% of the total patients experienced a complication, and 1.1% required further surgery on the basis of outcomes evaluated at a mean follow-up of 29.5 (range, 4 to 60) months across the studies. Eight of 12 studies discussed the preoperative workup of these patients, with X-rays and magnetic resonance imaging being the most common preoperative imaging used. There was little reported on weight-bearing status during postoperative rehabilitation. Conclusions The outcomes reported in the literature after hip arthroscopy with microfracture for chondral defects are, in general, positive, with a very low percentage of patients requiring further surgery or experiencing complications. The most common indication used in the literature for microfracture is a full-thickness, focal chondral defect (Outerbridge grade IV). The vast majority of literature recommends limited weight bearing after microfracture; however, there was significant variation among the specific rehabilitation protocols used. More research is needed to explore what indications and postoperative rehabilitation result in the best outcomes for patients. Level of Evidence Level IV, systematic review of Level II, III, and IV studies.
Abstract
Three sets of idealized, cloud-resolving simulations are performed to investigate the sensitivity of tropical cyclone (TC) structure and intensity to the height and depth of environmental ...vertical wind shear. In the first two sets of simulations, shear height and depth are varied independently; in the third set, orthogonal polynomial expansions are used to facilitate a joint sensitivity analysis. Despite all simulations having the same westerly deep-layer (200–850 hPa) shear of 10 m s−1, different intensity and structural evolutions are observed, suggesting the deep-layer shear alone may not be sufficient for understanding or predicting the impact of vertical wind shear on TCs. In general, vertical wind shear that is shallower and lower in the troposphere is more destructive to model TCs because it tilts the TC vortex farther into the downshear-left quadrant. The vortices that tilt the most are unable to precess upshear and realign, resulting in their failure to intensify. Shear height appears to modulate this tilt response by modifying the thermodynamic environment above the developing vortex early in the simulations, while shear depth modulates the tilt response by controlling the vertical extent of the convective vortex. It is also found that TC intensity predictability is reduced in a narrow range of shear heights and depths. This result underscores the importance of accurately observing the large-scale environmental flow for improving TC intensity forecasts, and for anticipating when such forecasts are likely to have large errors.
Abstract
It is widely known that strong vertical wind shear (exceeding 10 m s
−1
) often weakens tropical cyclones (TCs). However, in some circumstances, a TC is able to resist this strong shear and ...even restrengthen. To better understand this phenomenon, a series of idealized simulations are conducted, followed by a statistical investigation of 40 years of Northern Hemisphere TCs. In the idealized simulations, a TC is embedded within a time-varying point-downscaling framework, which is used to gradually increase the environmental vertical wind shear to 14 m s
−1
and then hold it constant. This controlled framework also allows for the separation of the TC-induced flow from the prescribed environmental flow. The TC-induced outflow is found to withstand the strong upper-tropospheric environmental flow, and this is manifested in the TC-induced shear difference (TCSD) vector. The TCSD vector, together with the environmental shear vector, defines an azimuthal range within which most of the asymmetric convection is located. The statistical analysis confirms the findings from the idealized simulations, and the results are not strongly sensitive to the TC intensity or basin. Moreover, compared with total shear, the inclusion of TCSD information creates a slightly better correlation with TC intensity change. Overall, the TCSD vector serves as a diagnostic to explain the ability of a TC to resist strong environmental shear through its outflow, and it could potentially be used as a parameter to predict future intensity change.
Background Cardiovascular disease (CVD) is the leading cause of death in the United States and African Americans (AA) have a disproportionately greater burden of CVD as compared to Whites. The ...American Heart Association (AHA) Life's Simple 7 (LS7) framework outlines goals for attaining ideal cardiovascular health. Yet, there is a lack of evidence summarizing best practices to maximize LS7 attainment. The objective of the present study was to systematically review the extant peer-reviewed literature on community-engaged and community-based participatory research (CBPR) aimed at improving one or more LS7 metrics among AA. Methods PubMed, CINAHL, and Embase databases were searched. We included articles that reported quantitative results for one or more of the following LS7 metrics: physical activity, diet, cholesterol, blood pressure, body mass index, smoking, and glycemia. We included analyses with a greater than 50% AA study population focused on adults (greater than or equal to18 years of age). Results Of the 1008 unique studies identified, 54 met inclusion criteria; 27 of which were randomized controlled trials. 50% of studies assessed more than one LS7 metric but only two studies evaluated all seven of the LS7 metrics. No studies had a high proportion of AA males. 40 studies improved at least one LS7 metric at the study end-point. Formative research was used in many studies to guide intervention design. Studies were of varying quality, but overall rated "fair" using a modified approach to the National Institute of Health quality assessment tool. Conclusion There is insufficient data to recommend a specific community-engaged or CBPR intervention to improve attainment of LS7 metrics among AA. Future studies using rigorous methodology with increased gender diversity and utilizing the AHA LS7 framework are required to establish a validated program to improve LS7 in AAs.
Abstract
This study investigates the role of the asymmetric interaction between the tropical cyclone (TC) and the environmental flow in governing the TC inner-core asymmetric structure. Motivated by ...the limitations of bulk measures of vertical wind shear in representing the complete environmental flow, the TC outflow is used as a focus for the asymmetric interaction. By analyzing an idealized numerical simulation, it is demonstrated that parcels can go directly from the asymmetric rainband to the upper-level outflow. The relatively large vertical mass flux in the rainband region also suggests that the asymmetric rainband is an important source of the outflow. In a simulation that suppresses convection by reducing the water vapor within the rainband region, the upper-level outflow is weakened, further supporting the hypothesis that the rainband and outflow are directly connected. Finally, it is demonstrated that the asymmetric outflow and the outer rainband are coupled through the descending inflow below the outflow. Some of the main characteristics of the outflow–rainband relationship are also supported by a real-case numerical simulation of Hurricane Bill (2009). The relationship is potentially useful for understanding and predicting the evolution of the TC inner-core structure during the interaction with the large-scale environmental flow.
Abstract
This study uses idealized numerical simulations to show that the interaction between tropical cyclones and a midlatitude jet can result in secondary eyewall formation. It is argued that the ...eddy activity by the outflow–jet interaction can enhance the upper-level outflow, thereby creating an asymmetric stratiform region outside of the primary eyewall. Numerous long-lasting deep convective cells are able to form in the stratiform cloud, creating forcing necessary for the secondary eyewall. The low-level inflow and the TC’s primary circulation advect the deep convective cells inward and cyclonically. The secondary eyewall forms after the deep convection has surrounded the TC. In contrast, numerical simulations without the jet do not show secondary eyewall formation. For moderately strong jets of wind speed 15–30 m s−1, there is little sensitivity to the jet strength. There is sensitivity to the distance between the jet and the TC, with secondary eyewall formation evident when their separation is 15° latitude but not when the separation exceeds 20°.
Descent into sleep is accompanied by disengagement of the conscious brain from the external world. It follows that this process should be associated with reduced neural activity in regions of the ...brain known to mediate interaction with the environment. We examined blood oxygen dependent (BOLD) signal functional connectivity using conventional seed-based analyses in 3 primary sensory and 3 association networks as normal young adults transitioned from wakefulness to light sleep while lying immobile in the bore of a magnetic resonance imaging scanner. Functional connectivity was maintained in each network throughout all examined states of arousal. Indeed, correlations within the dorsal attention network modestly but significantly increased during light sleep compared to wakefulness. Moreover, our data suggest that neuronally mediated BOLD signal variance generally increases in light sleep. These results do not support the view that ongoing BOLD fluctuations primarily reflect unconstrained cognition. Rather, accumulating evidence supports the hypothesis that spontaneous BOLD fluctuations reflect processes that maintain the integrity of functional systems in the brain.
Arboviruses (arthropod-borne-viruses) are an emerging global health threat that are rapidly spreading as climate change, international business transport, and landscape fragmentation impact local ...ecologies. Since its initial detection in 1999, West Nile virus has shifted from being a novel to an established arbovirus in the United States of America. Subsequently, more than 25,000 cases of West Nile neuro-invasive disease have been diagnosed, cementing West Nile virus as an arbovirus of public health importance. Given its novelty in the United States of America, high-risk ecologies are largely underdefined making targeted population-level public health interventions challenging. Using the Centers for Disease Control and Prevention ArboNET neuroinvasive West Nile virus data from 2000–2021, this study aimed to predict neuroinvasive West Nile virus human cases at the county level for the contiguous USA using a spatio-temporal Bayesian negative binomial regression model. The model includes environmental, climatic, and demographic factors, as well as the distribution of host species. An integrated nested Laplace approximation approach was used to fit our model. To assess model prediction accuracy, annual counts were withheld, forecasted, and compared to observed values. The validated models were then fit to the entire dataset for 2022 predictions. This proof-of-concept mathematical, geospatial modelling approach has proven utility for national health agencies seeking to allocate funding and other resources for local vector control agencies tackling West Nile virus and other notifiable arboviral agents.
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