Natural History of Quantitative Fatty Infiltration and 3D Muscle Volume After Nonoperative Treatment of Symptomatic Rotator Cuff Tears: A Prospective MRI Study of 79 Patients

BACKGROUND: The severity of fatty infiltration (FI) predicts the treatment outcome of rotator cuff tears. The purpose of this investigation was to quantitatively analyze supraspinatus (SSP) muscle FI and volume at the initial presentation and after a 3-month minimum of conservative management. We hypothesized that progression of FI could be predicted with initial tear size, FI, and muscle volume. METHODS: Seventy-nine shoulders with rotator cuff tears were prospectively enrolled, and 2 magnetic resonance imaging (MRI) scans with 6-point Dixon sequences were acquired. The fat fraction within the SSP muscle was measured on 3 sagittal slices, and the arithmetic mean was calculated (FI SSP ). Advanced FI SSP was defined as >/=8%, pathological FI SSP was defined as >/=13.5%, and relevant progression was defined as a >/=4.5% increase in FI SSP . Furthermore, muscle volume, tear location, size, and Goutallier grade were evaluated. RESULTS: Fifty-seven shoulders (72.2%) had normal FI SSP , 13 (16.5%) had advanced FI SSP , and 9 (11.4%) had pathological FI SSP at the initial MRI scan. Eleven shoulders (13.9%) showed a >/=4.5% increase in FI SSP at 19.5 +/- 14.7 months, and 17 shoulders (21.5%) showed a >/=5-mm 3 loss of volume at 17.8 +/- 15.3 months. Five tears (7.1%) with initially normal or advanced FI SSP turned pathological. These tears, compared with tears that were not pathological, had significantly higher initial mediolateral tear size (24.8 compared with 14.3 mm; p = 0.05), less volume (23.5 compared with 34.2 mm 3 ; p = 0.024), more FI SSP (9.6% compared with 5.6%; p = 0.026), and increased progression of FI SSP (8.6% compared with 0.5%; p /=20 mm yielded a relevant FI SSP progression rate of 81.8% (odds ratio [OR], 19.0; p /=9.9% (OR, 17.5; p /=17 mm (OR, 8.0; p = 0.003). Combining these parameters in a logistic regression analysis led to an area under the receiver operating characteristic curve (AUC) of 0.913. The correlation between FI SSP progression and the time between MRI scans was weak positive (rho = 0.31). CONCLUSIONS: Three risk factors for relevant FI progression, quantifiable on the initial MRI, were identified: >/=20-mm mediolateral tear size, >/=9.9% FI SSP , and >/=17-mm anteroposterior tear size. These thresholds were associated with a higher risk of tear progression: 19 times higher for >/=20-mm mediolateral tear size, 17.5 times higher for >/=9.9% FI SSP , and 8 times higher for >/=17-mm anteroposterior tear size. The presence of all 3 yielded a 91% chance of >/=4.5% progression of FI SSP within a mean of 19.5 months. LEVEL OF EVIDENCE: Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence

Origins of the Ambient Solar Wind: Implications for Space Weather

The Sun's outer atmosphere is heated to temperatures of millions of degrees, and solar plasma flows out into interplanetary space at supersonic speeds. This paper reviews our current understanding of these interrelated problems: coronal heating and the acceleration of the ambient solar wind. We also discuss where the community stands in its ability to forecast how variations in the solar wind (i.e., fast and slow wind streams) impact the Earth. Although the last few decades have seen significant progress in observations and modeling, we still do not have a complete understanding of the relevant physical processes, nor do we have a quantitatively precise census of which coronal structures contribute to specific types of solar wind. Fast streams are known to be connected to the central regions of large coronal holes. Slow streams, however, appear to come from a wide range of sources, including streamers, pseudostreamers, coronal loops, active regions, and coronal hole boundaries. Complicating our understanding even more is the fact that processes such as turbulence, stream-stream interactions, and Coulomb collisions can make it difficult to unambiguously map a parcel measured at 1 AU back down to its coronal source. We also review recent progress -- in theoretical modeling, observational data analysis, and forecasting techniques that sit at the interface between data and theory -- that gives us hope that the above problems are indeed solvable.Comment: Accepted for publication in Space Science Reviews. Special issue connected with a 2016 ISSI workshop on "The Scientific Foundations of Space Weather." 44 pages, 9 figure

Assessing the quality of models of the ambient solar wind

In this paper we present an assessment of the status of models of the global Solar Wind in the inner heliosphere. We limit our discussion to the class of models designed to provide solar wind forecasts, excluding those designed for the purpose of testing physical processes in idealized configurations. In addition, we limit our discussion to modeling of the ‘ambient’ wind in the absence of coronal mass ejections. In this assessment we cover use of the models both in forecast mode and as tools for scientific research. We present a brief history of the development of these models, discussing the range of physical approximations in use. We discuss the limitations of the data inputs available to these models and its impact on their quality. We also discuss current model development trends

Paramedics' Newborn Life Support Knowledge and Skills Before and After a Targeted Simulation-Based Educational Intervention

Objective: Resuscitation of neonates after birth in the out-of-hospital setting is challenging. Thus, we aimed to assess paramedics' newborn life support knowledge and skills before and after targeted simulation-based training.Methods: Voluntary paramedics were recruited from a single Red Cross division. During a 1-day simulation-based educational intervention, essential aspects of neonatal resuscitation were taught and practiced. Before and after simulation-based training, we assessed (1) knowledge of current European Resuscitation Council (ERC) guidelines using a 20-item-questionnaire and (2) the quality of simulated bag-valve-mask ventilation by measuring face mask leakage, using a respiratory function monitor (Standardized Measurement of Airway Resuscitation Training [SMART], GM Instruments Ltd., United Kingdom).Results: Forty-one paramedics participated in the initial survey and 12 took part in the simulation-based educational intervention. There was a significant increase in the number of correctly answered questions: median 62.1% (IQR 37.5–77.4%) vs. 91.7% (IQR 83.3–100%; p = 0.001). A total of 1,332 inflations were analyzed. The incidence of substantial mask leakage >75% decreased significantly after training (15.8 vs. 6.1%; p < 0.001), while median mask leakage was similar (17.0% [IQR 0.0–55.0%] vs. 18.0% [IQR 6.0–34.0%]; p = 0.414).Conclusions: Among paramedics, theoretical knowledge of current ERC guidelines was moderate in this study. Participation in a targeted simulation-based educational intervention was associated with a significant increase in theoretical knowledge. The initially high incidence of substantial mask leakage >75% was decreased after simulation-based training using respiratory function monitoring

Continuous solar wind forcing knowledge: Providing continuous conditions at Mars with the WSA‐ENLIL + Cone model

Knowledge of solar wind conditions at Mars is often necessary to study the planet’s magnetospheric and ionospheric dynamics. With no continuous upstream solar wind monitor at Mars, studies have used a variety of methods to measure or predict Martian solar wind conditions. In situ measurements, when available, are preferred, but can often be limited in continuity or scope, and so studies have also utilized solar wind proxies, spacecraft flybys, and Earth‐Mars alignment to provide solar wind context. Despite the importance of solar wind knowledge and the range of methods used to provide it, the use of solar wind models remains relatively unutilized. This study uses the Wang‐Sheeley‐Arge (WSA)‐ENLIL + Cone solar wind model to calculate solar wind parameters at Mars’ orbital location to provide a new approach to determining solar wind conditions at Mars. Comparisons of the model results with observations by the MAVEN spacecraft indicate that the WSA‐ENLIL + Cone model can forecast solar wind conditions at Mars as accurately as it has predicted them historically at the Earth, although at Mars the model systematically mispredicts solar wind speed and density, likely a result of magnetogram calibration. Particular focus is placed on modeling the early March 2015 interplanetary coronal mass ejections (ICMEs) that interacted with Mars. Despite the complexity of the ICMEs, the model accurately predicted the speed and arrival time of the ICME‐driven interplanetary shock, although it underpredicted other solar wind parameters. These results suggest that solar wind models can be used to provide the necessary general context of the heliospheric conditions to planetary studies.Key PointsThe WSA‐ENLIL + Cone model provides continuous, generally accurate solar wind conditions at MarsThe WSA‐ENLIL + Cone model captures both background and disturbed solar wind conditions accuratelyThese continuous solar wind parameters can provide context to planetary and magnetospheric studiesPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134218/1/jgra52721_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134218/2/jgra52721.pd

Comparison of MHD simulations of the solar wind with in-situ measured plasma and magnetic rield parameters at 1 AU

Modelle für Simulationen des Sonnenwindes sind ein wichtiges Werkzeug für die Vorhersage des Weltraumwetters in Erdnähe. Die stärksten geoeffektiven Stürme werden von koronalen Massenauswürfen (CMEs) verursacht. CMEs auf dem Weg zur Erde werden vom umgebenden Sonnenwind beeinflusst. Informationen über den Sonnenwind sind notwendig, um die Ausbreitungsrichtung und Geschwindigkeiten von CMEs vorherzusagen. Die Modelle ENLIL/MAS und ENLIL/WSA simulieren den ruhigen Sonnenwind und verwenden dafür synoptische Magnetogramme der Sonnenphotosphäre als Ausgangsparameter.Um die Sonnenwindmodelle ENLIL/MAS und ENLIL/WSA auf ihre Zuverlässigkeit zu testen, wurden die Parameter Protonen-Dichte, Geschwindigkeit, Temperatur und radiale sowie totale Magnetfeldstärke aus den Modellrechnungen mit in-situ Messungen der Satelliten Wind und ACE verglichen. Für den Vergleich wurde das Jahr 2005 ausgewählt, da für diesen Zeitraum die Sonnenaktivität niedrig war. Für die Auswertung wurden die Ergebnisse für die exakte Position der Satelliten extrahiert. Durch Berechnung von Korrelationskoeffizienten wurde die allgemeine Übereinstimmung der Modellrechnungen mit den gemessenen Parametern quantifiziert. Die Richtigkeit der vorhergesagten Ankunftszeit von Sonnenwind-Strukturen wurde mittels Kreuzkorrelation quantifiziert.Die Ergebnisse zeigten, dass ENLIL/MAS und ENLIL/WSA die Grundstrukturen des Sonnenwindes, sowie wiederkehrende Strukturen wiedergeben, die Vorhersagen der Ankunftszeit jedoch typische Ungenauigkeiten von 1 ? 1.5 Tagen aufweisen. Die besten Simulationsergebnisse wurden für den Parameter Geschwindigkeit erzielt. Die Simulationen von Temperatur und Magnetfeldstärke bei einer Entfernung zur Sonne von 1 AU ergaben durchgehend zu niedrige Werte. Die Sektorstruktur des Magnetfeldes wurde von den Modellen gut wiedergegeben. Außerdem zeigte es sich, dass die Richtigkeit der Vorhersagen der Modelle von der Sonnenaktivität abhängig ist.Solar wind models are an important tool for space weather forecasting. The most geo-effective storms are caused by coronal mass ejections (CMEs). CMEs on route to the Earth are highly influenced by the ambient solar wind flow, therefore information about the solar wind is needed for predicting the direction and speed of CMEs. The solar wind models ENLIL/MAS and ENLIL/WSA simulate the background solar wind by using synoptic magnetograms of the solar photosphere as input parameter.For testing of the solar wind models ENLIL/MAS and ENLIL/WSA we compared the parameters proton density, solar wind speed, temperature, and radial and total magnetic field strength to in-situ measurements from Wind and ACE at 1 AU. For the comparison we chose the year 2005 as a time period with low solar activity. The simulation results were provided by CCMC/NASA. For the analysis we extracted the data at the exact position of the spacecraft. We calculated correlation coefficients to quantify the agreement between model predictions and measurements. The accuracy of the predicted arrival times of solar wind structures was quantified by carrying out cross-correlations.We found that ENLIL/MAS and ENLIL/WSA are able to simulate general features of the background solar wind and to reproduce recurring structures in the heliosphere. However, the predicted arrival times of high speed solar wind streams have typical uncertainties of the order of 1 ? 1.5 days. The best results were obtained for the parameter solar wind speed. The predicted temperatures and magnetic field strengths at 1 AU were systematically too low. The sector structure of the interplanetary magnetic field was well reproduced by both models. The results showed that the accuracy of the predictions is strongly dependent on solar activity.Corinna GresslAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersGraz, Univ., Dipl.-Arb., 2012Zsfassungen in dt. und engl. Sprach

Imaging of Female Primary Urethral Adenocarcinoma - a Scoping Review

This review aims to summarize imaging features of female primary urethral adenocarcinoma. We hypothesized that it is possible to identify commonly reported characteristics of this tumor entity on ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography

Comparison of MHD simulations of the solar wind with in-situ measured plasma and magnetic rield parameters at 1 AU

Modelle f\ufcr Simulationen des Sonnenwindes sind ein wichtiges Werkzeug f\ufcr die Vorhersage des Weltraumwetters in Erdn\ue4he. Die st\ue4rksten geoeffektiven St\ufcrme werden von koronalen Massenausw\ufcrfen (CMEs) verursacht. CMEs auf dem Weg zur Erde werden vom umgebenden Sonnenwind beeinflusst. Informationen \ufcber den Sonnenwind sind notwendig, um die Ausbreitungsrichtung und Geschwindigkeiten von CMEs vorherzusagen. Die Modelle ENLIL/MAS und ENLIL/WSA simulieren den ruhigen Sonnenwind und verwenden daf\ufcr synoptische Magnetogramme der Sonnenphotosph\ue4re als Ausgangsparameter.Um die Sonnenwindmodelle ENLIL/MAS und ENLIL/WSA auf ihre Zuverl\ue4ssigkeit zu testen, wurden die Parameter Protonen-Dichte, Geschwindigkeit, Temperatur und radiale sowie totale Magnetfeldst\ue4rke aus den Modellrechnungen mit in-situ Messungen der Satelliten Wind und ACE verglichen. F\ufcr den Vergleich wurde das Jahr 2005 ausgew\ue4hlt, da f\ufcr diesen Zeitraum die Sonnenaktivit\ue4t niedrig war. F\ufcr die Auswertung wurden die Ergebnisse f\ufcr die exakte Position der Satelliten extrahiert. Durch Berechnung von Korrelationskoeffizienten wurde die allgemeine cbereinstimmung der Modellrechnungen mit den gemessenen Parametern quantifiziert. Die Richtigkeit der vorhergesagten Ankunftszeit von Sonnenwind-Strukturen wurde mittels Kreuzkorrelation quantifiziert.Die Ergebnisse zeigten, dass ENLIL/MAS und ENLIL/WSA die Grundstrukturen des Sonnenwindes, sowie wiederkehrende Strukturen wiedergeben, die Vorhersagen der Ankunftszeit jedoch typische Ungenauigkeiten von 1 ? 1.5 Tagen aufweisen. Die besten Simulationsergebnisse wurden f\ufcr den Parameter Geschwindigkeit erzielt. Die Simulationen von Temperatur und Magnetfeldst\ue4rke bei einer Entfernung zur Sonne von 1 AU ergaben durchgehend zu niedrige Werte. Die Sektorstruktur des Magnetfeldes wurde von den Modellen gut wiedergegeben. Au ferdem zeigte es sich, dass die Richtigkeit der Vorhersagen der Modelle von der Sonnenaktivit\ue4t abh\ue4ngig ist.Solar wind models are an important tool for space weather forecasting. The most geo-effective storms are caused by coronal mass ejections (CMEs). CMEs on route to the Earth are highly influenced by the ambient solar wind flow, therefore information about the solar wind is needed for predicting the direction and speed of CMEs. The solar wind models ENLIL/MAS and ENLIL/WSA simulate the background solar wind by using synoptic magnetograms of the solar photosphere as input parameter.For testing of the solar wind models ENLIL/MAS and ENLIL/WSA we compared the parameters proton density, solar wind speed, temperature, and radial and total magnetic field strength to in-situ measurements from Wind and ACE at 1 AU. For the comparison we chose the year 2005 as a time period with low solar activity. The simulation results were provided by CCMC/NASA. For the analysis we extracted the data at the exact position of the spacecraft. We calculated correlation coefficients to quantify the agreement between model predictions and measurements. The accuracy of the predicted arrival times of solar wind structures was quantified by carrying out cross-correlations.We found that ENLIL/MAS and ENLIL/WSA are able to simulate general features of the background solar wind and to reproduce recurring structures in the heliosphere. However, the predicted arrival times of high speed solar wind streams have typical uncertainties of the order of 1 ? 1.5 days. The best results were obtained for the parameter solar wind speed. The predicted temperatures and magnetic field strengths at 1 AU were systematically too low. The sector structure of the interplanetary magnetic field was well reproduced by both models. The results showed that the accuracy of the predictions is strongly dependent on solar activity.Corinna GresslAbweichender Titel laut cbersetzung der Verfasserin/des VerfassersGraz, Univ., Dipl.-Arb., 2012Zsfassungen in dt. und engl. Sprach