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2. Vector spaces

Author

Richard Bronson, Gabriel B. Costa, John T. Saccoman, and Daniel Gross

Published
2024

5. Fundamentals

Author

Richard Bronson, Gabriel B. Costa, John T. Saccoman, and Daniel Gross

Published
2024

6. Disaster Nursing

Author

John T. Groves, Kathryn M. Vear, and Montray Smith

Published
2024

7. Contributors

Author

Axel Adams, Clara Affun-Adegbulu, Rakan S. Al-Rasheed, Yasser A. Alaska, Abdulaziz D. Aldawas, Saleh Ali Alesa, George A. Alexander, Abdullah Ahmed Alhadhira, Fahad Saleha Alhajjaj, Hazem H. Alhazmi, Zainab Abdullah Alhussaini, Nawfal Aljerian, Majed Aljohani, Khaldoon H. AlKhaldi, Eyad Alkhattabi, Bryant Allen, Austin Almand, Moza M. Alnoaimi, Mohammad Alotaibi, Evan Avraham Alpert, Yasir A. Alrusayni, Mai Alshammari, Loui K. Alsulimani, Siraj Amanullah, Arian Anderson, David Arastehmanesh, Ali Ardalan, Killiam A. Argote-Araméndiz, Andrew W. Artenstein, Olivia E. Bailey, Russell Baker, Satchit Balsari, Gregory T. Banner, Fermin Barrueto M, Susan A. Bartels, Joshua J. Baugh, Frederic Berg, Vijai Bhola, William Binder, Michelangelo Bortolin, Vincent Bounes, Michael Bouton, Natasha Brown, Frederick M. Burkle, Jr, Lynn Barkley Burnett, Michele M. Burns, Nicholas V. Cagliuso, Sr, John Cahill, David W. Callaway, Duane C. Caneva, Srihari Cattamanchi, Alejandra Caycedo, Edward W. Cetaruk, Sneha Chacko, James C. Chang, Crystal Chiang, David T. Chiu, Gregory R. Ciottone, Jonathan Peter Ciottone, Melissa A. Ciottone, Robert A. Ciottone, Robert G. Ciottone, Vigen G. Ciottone, Alexander Clark, Jonathan Clark, Sean P. Conley, Joanne Cono, Arthur Cooper, Scott B. Cormier, Michael F. Court, Cord W. Cunningham, Fabrice Czarnecki, Supriya Davis, Timothy E. Davis, Gerard DeMers, Sharon Dilling, Ahmadreza Djalali, Timothy Donahoe, Joseph Donahue, Caleb Dresser, Jason Dylik, Benjamin Easter, Alexander Eastman, Laura Ebbeling, Chigozie Emetarom, Nir Eyal, Andrew J. Eyre, David J. Freeman, Franklin D. Friedman, Christie Fritz, Frederick Fung, Fiona E. Gallahue, Stephanie Chow Garbern, Mark E. Gebhart, William A. Gluckman, Craig Goolsby, Robert M. Gougelet, Fredrik Granholm, P. Gregg Greenough, Jennifer O. Grimes, Steve Grosse, Shamai A. Grossman, John T. Groves Jr, Tee L. Guidotti, George Guo, Sarah Haessler, Matthew M. Hall, John W. Hardin, Mason Harrell, Alexander Hart, MD, Melissa Harvey, Attila J. Hertelendy, PhD, Nishanth S. Hiremath, Jordan Hitchens, Christopher P. Holstege, Simon T. Horne, Steven Horng, Amer Hosin, Hans R. House, Pier Luigi Ingrassia, Fadi S. Issa, Irving 'Jake' Jacoby, Rajnish Jaiswal, Gregory Jay, J. Lee Jenkins, Josh W. Joseph, Shane Kappler, Mark E. Keim, Julie Kelman, Andrew R. Ketterer, Anas A. Khan, Ramu Kharel, Chetan U. Kharod, Thomas D. Kirsch, Anita Knopov, Max Kravitz, J. Austin Lee, Jay Lemery, Evan L. Leventhal, Jesse Loughlin, Stephanie Ludy, Brian J. Maguire, Selwyn E. Mahon, Paul M. Maniscalco, Philip Manners, Leonard Jay Marcus, Colton Margus, Taha M. Masri, Jeff Matthews, Sean D. McKay, Zeke J. McKinney, Robert K. McLellan, Eric J. McNulty, Faroukh Mehkri, Mandana Mehta, Rebecca A. Mendelsohn, Ofer Merin, Andrew Milsten, Dale M. Molé, Michael Sean Molloy, Ilaria Morelli, Jerry L. Mothershead, John Mulhern, Nicole F. Mullendore, Nicholas J. Musisca, Sonya Naganathan, Larry A. Nathanson, Erica L. Nelson, Lewis S. Nelson, Bradford A. Newbury, Kimberly Newbury, Ansley O’Neill, Robert Obernier, Jacopo M. Olagnero, Leonie Oostrom-Shah, Catherine Y. Ordun, Scott Parazynski, Andrew J. Park, Robert Partridge, Jeffrey S, James P. Phillips, Emily Pinter, David P. Polatty IV, Patrick Popieluszko, William Porcaro, Lawrence Proano, Peter B. Pruitt, Moiz Qureshi, Luca Ragazzoni, Murtaza Rashid, Paul Patrick Rega, Michael J. Reilly, Marc C. Restuccia, James J. Rifino, Paul M. Robben, Joy L. Rosenblatt, Kevin M. Ryan, Heather Rybasack-Smith, Richard James Salway, Daniel Samo, Leon D. Sanchez, Shawn M. Sanford, Ritu R. Sarin, Deesha Sarma, Jesse Schacht, Valarie Schwind, Geoffrey L. Shapiro, Joshua Sheehan, Brian Shreve, Grigor Simonyan, Devin M. Smith, E. Reed Smith, MD, Jack E. Smith, MA, Montray Smith, Peter B. Smulowitz, Angela M. Snyder, Joshua J. Solano, Bryan A. Stenson, Charles Stewart, M. Kathleen Stewart, Patrick Sullivan, Jared S. Supple, Derrick Tin, Jonathan Harris Valente, Kathryn M. Vear, P.R. Vidyalakshmi, Faith Vilas, Gary M. Vilke, Janna H. Villano, Amalia Voskanyan, C. James Watson, Nancy Weber, Scott G. Weiner, Brielle Weinstein, Eric S. Weinstein, Jordan R. Werner, Roy Karl Werner, MD, James D. Whitledge, Sage W. Wiener, Lauren Wiesner, Kenneth A. Williams, Robyn Wing, Richard E. Wolfe, Wendy Hin-Wing Wong, Robert Woolard, Prasit Wuthisuthimethawee, and Nadine A. Youssef

Published
2024

8. Contributors

Author

Steven H. Abman, Noorjahan Ali, Karel Allegaert, Jamie E. Anderson, Deidra A. Ansah, Bhawna Arya, David Askenazi, Susan W. Aucott, Stephen A. Back, Gerri R. Baer, H. Scott Baldwin, Jerasimos Ballas, Maneesh Batra, Cheryl Bayart, Gary A. Bellus, John T. Benjamin, Gerard T. Berry, Zeenia C. Billimoria, Gil Binenbaum, Matthew S. Blessing, Markus D. Boos, Brad Bosse, Maryse L. Bouchard, Heather A. Brandling-Bennett, Colleen Brown, Erin G. Brown, Katherine H. Campbell, Katie Carlberg, Brian S. Carter, Shilpi Chabra, Irene J. Chang, Edith Y. Cheng, Kai-wen Chiang, Robert D. Christensen, Terrence Chun, Ronald I. Clyman, Donna, Maria E. Cortezzo, C.M. Cotten, Sherry E. Courtney, Jonathan M. Davis, Alejandra G. de Alba Campomanes, Benjamin Dean, Ellen Dees, Sara B. De, Mauro, Scott C. Denne, Emöke Deschmann, Carolina Cecilia Di Blasi, Sara A. Di, Vall, Dan Doherty, David J. Durand, Nicolle Fernández Dyess, Eric C. Eichenwald, Kelsey B. Eitel, Rachel M. Engen, Kelly N. Evans, Diana L. Farmer, Emily Fay, Patricia Y. Fechner, Rachel Fleishman, Bobbi Fleiss, Joseph Flynn, Katherine T. Flynn-O’Brien, G. Kyle Fulton, Renata C. Gallagher, Estelle B. Gauda, W. Christopher Golden, Michelle M. Gontasz, Natasha González Estévez, Sidney M. Gospe, Pierre Gressens, Deepti Gupta, Sangeeta Hingorani, Ashley P. Hinson, Susan R. Hintz, W. Alan Hodson, Kara K. Hoppe, Alyssa Huang, Benjamin Huang, Kathy Huen, Katie A. Huff, Cristian Ionita, J. Craig Jackson, Jordan E. Jackson, Tom Jaksic, Patrick J. Javid, Julia Johnson, Cassandra D. Josephson, Emily S. Jungheim, Sandra E. Juul, Mohammad Nasser Kabbany, Heidi Karpen, Gregory Keefe, Jennifer C. Keene, Amaris M. Keiser, Roberta L. Keller, Thomas F. Kelly, Kate Khorsand, Grace Kim, John P. Kinsella, Allison S. Komorowski, Ildiko H. Koves, Joanne M. Lagatta, Satyan Lakshminrusimha, Christina Lam, John D. Lantos, Janessa B. Law, Su Yeon Lee, Ofer Levy, David B. Lewis, Philana Ling Lin, Scott A. Lorch, Tiffany L. Lucas, Akhil Maheshwari, Emin Maltepe, Erica Mandell, Winston M. Manimtim, Richard J. Martin, Dennis E. Mayock, Irene Mc, Aleer, Patrick McQuillen, Ann J. Melvin, Paul A. Merguerian, Lina Merjaneh, J. Lawrence Merritt, Valerie Mezger, Marian G. Michaels, Ulrike Mietzsch, Steven P. Miller, Thomas R. Moore, Karen F. Murray, Debika Nandi-Munshi, Niranjana Natarajan, Kathryn D. Ness, Josef Neu, Shahab Noori, Thomas Michael O’Shea, Julius T. Oatts, Nigel Paneth, Thomas A. Parker, Ravi Mangal Patel, Simran Patel, Anna A. Penn, Christian M. Pettker, Shabnam Peyvandi, Catherine Pihoker, Erin Plosa, Brenda Poindexter, Michael A. Posencheg, Mihai Puia-Dumitrescu, Vilmaris Quiñones Cardona, Samuel E. Rice-Townsend, Art Riddle, Elizabeth Robbins, Mark D. Rollins, Mark A. Rosen, Courtney K. Rowe, Inderneel Sahai, Sulagna C. Saitta, Parisa Salehi, Pablo J. Sanchez, Taylor Sawyer, Matthew A. Saxonhouse, Katherine M. Schroeder, David T. Selewski, T. Niroshi Senaratne, Istvan Seri, Emily E. Sharpe, Sarah E. Sheppard, Margarett Shnorhavorian, Robert Sidbury, La, Vone Simmons, Rebecca A. Simmons, Rachana Singh, Martha C. Sola-Visner, Lakshmi Srinivasan, Heidi J. Steflik, Robin H. Steinhorn, Caleb Stokes, Helen Stolp, Jennifer Sucre, Angela Sun, Dalal K. Taha, Jessica Tenney, Janet A. Thomas, George E. Tiller, Benjamin A. Torres, William E. Truog, Kirtikumar Upadhyay, Gregory C. Valentine, John N. van den Anker, Betty Vohr, Linda D. Wallen, Peter (Zhan Tao) Wang, Bradley A. Warady, Robert M. Ward, Jon F. Watchko, Elias Wehbi, Joern-Hendrik Weitkamp, David Werny, Klane K. White, K. Taylor Wild, Susan Wiley, Laurel Willig, George A. Woodward, Clyde J. Wright, Karyn Yonekawa, Elizabeth Yu, and Elaine H. Zackai

Published
2024

9. Matrices

Author

Richard Bronson, Gabriel B. Costa, John T. Saccoman, and Daniel Gross

Published
2024

10. Linear transformations

Author

Richard Bronson, Gabriel B. Costa, John T. Saccoman, and Daniel Gross

Published
2024

11. Euclidean inner product

Author

Richard Bronson, Gabriel B. Costa, John T. Saccoman, and Daniel Gross

Published
2024

13. Thermal and ablation properties of a high-entropy metal diboride: (Hf0.2Zr0.2Ti0.2Ta0.2Nb0.2)B2

Author

Md Shafkat Bin Hoque, Milena Milich, Md Sabbir Akhanda, Sashank Shivakumar, Eric R. Hoglund, Dragos Staicu, Mingde Qin, Kathleen F. Quiambao-Tomko, John A. Tomko, Jeffrey L. Braun, Joshua Gild, David H. Olson, Kiumars Aryana, Yee Rui Koh, Roisul Galib, Luka Vlahovic, Davide Robba, John T. Gaskins, Mona Zebarjadi, Jian Luo, and Patrick E. Hopkins

Subjects
Materials Chemistry, Ceramics and Composites
Published
2023

15. Do Regions of Increased Inflammation Progress to New White Matter Hyperintensities?: A Longitudinal Positron Emission Tomography-Magnetic Resonance Imaging Study

Author

Tozer, Daniel J, Brown, Robin B, Walsh, Jessica, Hong, Young T, Williams, Guy B, O'Brien, John T, Aigbirhio, Franklin I, Fryer, Tim D, Markus, Hugh S, Tozer, Daniel J [0000-0002-0404-3214], Brown, Robin B [0000-0003-0431-7841], Walsh, Jessica [0000-0001-9723-3043], Williams, Guy B [0000-0001-5223-6654], O'Brien, John T [0000-0002-0837-5080], Markus, Hugh S [0000-0002-9794-5996], and Apollo - University of Cambridge Repository

Subjects
Inflammation, Advanced and Specialized Nursing, positron emission tomography, cerebral small vessel disease, Brain, CADASIL, Cerebral Infarction, White Matter, Magnetic Resonance Imaging, Diffusion Tensor Imaging, Leukoencephalopathies, Positron-Emission Tomography, Neuroinflammatory Diseases, Humans, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract

Background: Recent studies have demonstrated increased microglial activation using 11 C-PK11195 positron emission tomography imaging, indicating central nervous system inflammation, in cerebral small vessel disease. However, whether such areas of neuroinflammation progress to tissue damage is uncertain. We determined whether white matter destined to become white matter hyperintensities (WMH) at 1 year had evidence of altered inflammation at baseline. Methods: Forty subjects with small vessel disease (20 sporadic and 20 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) and 20 controls were recruited to this case-control observational study from in- and out-patient clinics at Addenbrooke’s Hospital, Cambridge, UK and imaged at baseline with both 11 C-PK11195 positron emission tomography and magnetic resonance imaging; and magnetic resonance imaging including diffusion tensor imaging was repeated at 1 year. WMH were segmented at baseline and 1 year, and areas of new lesion identified. Baseline 11 C-PK11195 binding potential and diffusion tensor imaging parameters in these voxels, and normal appearing white matter, was measured. Results: Complete positron emission tomography-magnetic resonance imaging data was available for 17 controls, 16 sporadic small vessel disease, and 14 cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy participants. 11 C-PK11195 binding in voxels destined to become new WMH was lower than in normal appearing white matter, which did not progress to WMH (−0.133[±0.081] versus −0.045 [±0.044]; P −6 versus 1045 [±149]×10 −6 mm 2 /s and 0.37±0.05 versus 0.29±0.06, both P Conclusions: White matter tissue destined to develop into new WMH over the subsequent year is associated with both lower neuroinflammation, and white matter ultrastructural damage at baseline. Our results suggest that this tissue is already damaged 1 year prior to lesion formation. This may reflect that the role of neuroinflammation in the lesion development process occurs at an early stage, although more studies over a longer period would be needed to investigate this further.

Published
2023

16. Sentinel lymph node biopsy in patients with T1a cutaneous malignant melanoma: A multicenter cohort study

Author

Adrienne B, Shannon, Cimarron E, Sharon, Richard J, Straker, Michael J, Carr, Andrew J, Sinnamon, Kita, Bogatch, Alexandra, Thaler, Nicholas, Kelly, John T, Vetto, Graham, Fowler, Danielle, DePalo, Vernon K, Sondak, John T, Miura, Mark B, Faries, Edmund K, Bartlett, Jonathan S, Zager, and Giorgos C, Karakousis

Subjects
Dermatology
Abstract

Sentinel lymph node biopsy is not routinely recommended for T1a cutaneous melanoma due to the overall low risk of positivity. Prognostic factors for positive sentinel lymph node (SLNTo determine factors associated with SLNPatients with pathologic T1a (0.80 mm, nonulcerated) cutaneous melanoma from 5 high-volume melanoma centers from 2001 to 2020 who underwent wide local excision with sentinel lymph node biopsy were included in the study. Patient and tumor characteristics associated with SLNOf the 965 patients identified, the overall SLNRetrospective study.SLN

Published
2023

17. Longitudinal associations between β-amyloid and cortical thickness in mild cognitive impairment

Author

Mak, Elijah, Zhang, Liwen, Tan, Chin Hong, Reilhac, Anthonin, Shim, Hee Youn, Wen, Marcus Ong Qin, Wong, Zi Xuen, Chong, Eddie Jun Yi, Xu, Xin, Stephenson, Mary, Venketasubramanian, Narayanaswamy, Zhou, Juan Helen, O’Brien, John T, Chen, Christopher Li-Hsian, Mak, Elijah [0000-0002-6437-8024], O’Brien, John T [0000-0002-0837-5080], and Apollo - University of Cambridge Repository

Subjects
2 Aetiology, Aging, FOS: Clinical medicine, 5202 Biological Psychology, Neurosciences, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD), Neurodegenerative, Alzheimer's Disease, Brain Disorders, Mental Health, Clinical Research, 52 Psychology, Behavioral and Social Science, Neurological, Acquired Cognitive Impairment, 2.1 Biological and endogenous factors, Dementia
Abstract

How beta-amyloid accumulation influences brain atrophy in Alzheimer's disease remains contentious with conflicting findings. We aimed to elucidate the correlations of regional longitudinal atrophy with cross-sectional regional and global amyloid in individuals with mild cognitive impairment and no cognitive impairment. We hypothesized that greater cortical thinning over time correlated with greater amyloid deposition, particularly within Alzheimer’s disease characteristic regions in mild cognitive impairment, and weaker or no correlations in those with no cognitive impairment. 45 patients with mild cognitive impairment and 12 controls underwent a cross-sectional [11C]-Pittsburgh Compound B PET and two retrospective longitudinal structural imaging (follow-up: 23.65 ± 2.04 months) to assess global/regional amyloid and regional cortical thickness, respectively. Separate linear mixed models were constructed to evaluate relationships of either global or regional amyloid with regional cortical thinning longitudinally. In patients with mild cognitive impairment, regional amyloid in the right banks of the superior temporal sulcus was associated with longitudinal cortical thinning in the right medial orbitofrontal cortex (p = 0.04 after False Discovery Rate correction). In the mild cognitive impairment group, greater right banks amyloid burden and less cortical thickness in the right medial orbitofrontal cortex showed greater visual and verbal memory decline over time, which was not observed in controls. Global amyloid was not associated with longitudinal cortical thinning in any locations in either group. Our findings indicate an increasing influence of amyloid on neurodegeneration and memory along the preclinical to prodromal spectrum. Future multimodal studies that include additional biomarkers will be well-suited to delineate the interplay between various pathological processes and amyloid and memory decline, as well as clarify their additive or independent effects along the disease deterioration.

Published
2023
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18. Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Appendicitis

Author

Deborah B. Diercks, Eric J. Adkins, Nicholas Harrison, Peter E. Sokolove, Heemun Kwok, Stephen J. Wolf, John D. Anderson, Richard Byyny, Christopher R. Carpenter, Benjamin Friedman, Seth R. Gemme, Charles J. Gerardo, Steven A. Godwin, Sigrid A. Hahn, Benjamin W. Hatten, Jason S. Haukoos, Amy Kaji, Bruce M. Lo, Sharon E. Mace, Maggie Moran, Susan B. Promes, Kaushal H. Shah, Richard D. Shih, Scott M. Silvers, Andrea Slivinski, Michael D. Smith, Molly E.W. Thiessen, Christian A. Tomaszewski, Stacy Trent, Jonathan H. Valente, Stephen P. Wall, Lauren M. Westafer, Yanling Yu, Stephen V. Cantrill, John T. Finnell, Travis Schulz, and Kaeli Vandertulip

Subjects
Emergency Medicine
Published
2023

22. Patient's expectations of surgery for lumbar degenerative spondylolisthesis: analysis by type of surgery and patient factors from the Canadian Spine Outcomes and Research Network (CSORN)

Author

Charlotte Dandurand, Jennifer Urquhart, Christopher S. Bailey, Tamir Ailon, Raphaele Charest-Morin, Nicolas Dea, Marcel Dvorak, Andrew Glennie, Brian K. Kwon, Scott Paquette, Y. Raja Rampersaud, John T. Street, Celine Hounjet, Mohammad Sadegh Mashayekhi, and Charles G. Fisher

Subjects
Surgery, Orthopedics and Sports Medicine, Neurology (clinical)
Published
2023

24. Clinical and radiographic outcomes following anatomic total shoulder arthroplasty utilizing an inset glenoid component at 2-year minimum follow-up: a dual center study

Author

Peter S. Johnston, John T. Strony, Jessica L. Churchill, Roma Kankaria, Benjamin W. Sears, Grant E. Garrigues, and Robert J. Gillespie

Subjects
Orthopedics and Sports Medicine, Surgery, General Medicine
Abstract

Anatomic total shoulder arthroplasty (aTSA) is a successful and reproducible treatment for patients with painful glenohumeral arthritis. However, long-term outcomes using traditional onlay glenoid components have been tempered by glenoid loosening. Inset components have been proposed to minimize glenoid loosening by reducing edge-loading and opposite-edge lift-off forces with humeral translation. Successful short and long-term outcomes have been reported while using inset glenoid implants. The current study is the largest study presenting a minimum of two-year follow-up data following aTSA with an all-polyethylene inset glenoid component (Shoulder Innovations, Holland, MI).A dual center, retrospective review of patients undergoing aTSA using an Inset glenoid component by two fellowship-trained shoulder surgeons at two separate institutions from August, 2016 to August, 2019 was performed. Minimum follow up was two years. Range of motion (ROM), Visual Analog Pain Scores (VAS), Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) scores were obtained. Radiographic outcomes, including central peg lucency and glenoid loosening, were assessed by three independent reviewers on the postoperative Grashey and axillary radiographs obtained at the final follow-up.Seventy-five shoulders were included for final analysis. The mean age of the entire cohort was 64 (±11.4) years. Twenty-one (28%) glenoids were type A1, 10 (13.3%) were type A2, 13 (17.3%) were type B1, 22 (29.3%) were type B2, six (8%) were type B3 and three (4%) were type D. At a minimum follow-up of 24 months (mean 28.7 months), a significant improvement in ROM in all planes was observed. Significant improvements in VAS (5.1 to 0.9, p0.001), SANE (39.5 to 91.2, p0.001) and ASES (43.7 to 86.6, p0.001) scores were observed. There were four (5.3%) cases of central peg lucency about the inset glenoid component and one (1.3%) cases of glenoid loosening. No revisions were performed for glenoid loosening.At a minimum of two years postoperatively, there were significant improvements in ROM and VAS, SANE, and ASES scores with very low rates of central peg lucency and glenoid loosening in patients undergoing aTSA with an inset glenoid component. Further work is needed to determine the long-term benefit of this novel implant.

Published
2023

25. The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes

Author

Adam Boissonneault, Nathan O Hara, David Pogorzelski, Lucas Marchand, Thomas Higgins, Leah Gitajn, Mark J. Gage, Roman M. Natoli, Ishani Sharma, Sarah Pierrie, Robert V O’Toole, Sheila Sprague, Gerard Slobogean, Gerard P. Slobogean, Jeffrey Wells, Mohit Bhandari, Anthony D. Harris, C. Daniel Mullins, Lehana Thabane, Amber Wood, Gregory J. Della Rocca, Joan Hebden, Kyle J. Jeray, Lucas S. Marchand, Lyndsay M. O'Hara, Robert Zura, Christopher Lee, Joseph Patterson, Michael J. Gardner, Jenna Blasman, Jonah Davies, Stephen Liang, Monica Taljaard, PJ Devereaux, Gordon H. Guyatt, Diane Heels-Ansdell, Debra Marvel, Jana Palmer Jeffrey Wells, Jeff Friedrich, Nathan N. O'Hara, Frances Grissom, I. Leah Gitajn, Saam Morshed, Robert V. O'Toole, Bradley A. Petrisor, Franca Mossuto, Manjari G. Joshi, Jean-Claude D'Alleyrand, Justin Fowler, Jessica Rivera, Max Talbot, Shannon Dodds, Silvia Li, Alejandra Rojas, Gina Del Fabbro, Olivia Paige Szasz, Paula McKay, Alexandra Minea, Andrea Howe, Haley Demyanovich, Michelle Medeiros, Genevieve Polk, Eric Kettering, Nirmen Mahal, Andrew Eglseder, Aaron Johnson, Christopher Langhammer, Christopher Lebrun, Jason Nascone, Raymond Pensy, Andrew Pollak, Marcus Sciadini, Yasmin Degani, Haley K. Demyanovich, Heather Phipps, Eric Hempen, Christine Holler, Brad A. Petrisor, Herman Johal, Bill Ristevski, Dale Williams, Matthew Denkers, Krishan Rajaratnam, Jamal Al-Asiri, Jodi Gallant, Kaitlyn Pusztai, Sarah MacRae, Sara Renaud, John D. Adams, Michael L. Beckish, Christopher C. Bray, Timothy R. Brown, Andrew W. Cross, Timothy Dew, Gregory K. Faucher, Richard W. Gurich, David E. Lazarus, S. John Millon, M. Christian Moody, M. Jason Palmer, Scott E. Porter, Thomas M. Schaller, Michael S. Sridhar, John L. Sanders, L. Edwin Rudisill, Michael J. Garitty, Andrew S. Poole, Michael L. Sims, Clark M. Walker, Robert Carlisle, Erin A. Hofer, Brandon Huggins, Michael Hunter, William Marshall, Shea B. Ray, Cory Smith, Kyle M. Altman, Erin Pichiotino, Julia C. Quirion, Markus F. Loeffler, Erin R. Pichiotino, Austin A. Cole, Ethan J. Maltz, Wesley Parker, T. Bennett Ramsey, Alex Burnikel, Michael Colello, Russell Stewart, Jeremy Wise, Matthew Anderson, Joshua Eskew, Benjamin Judkins, James M. Miller, Stephanie L. Tanner, Rebecca G. Snider, Christine E. Townsend, Kayla H. Pham, Abigail Martin, Emily Robertson, Emily Bray, J. Wilson Sykes, Krystina Yoder, Kelsey Conner, Harper Abbott, Todd O. McKinley, Walter W. Virkus, Anthony T. Sorkin, Jan P. Szatkowski, Brian H. Mullis, Yohan Jang, Luke A. Lopas, Lauren C. Hill, Courteney L. Fentz, Maricela M. Diaz, Krista Brown, Katelyn M. Garst, Emma W. Denari, Patrick Osborn, Maria Herrera, Theodore Miclau, Meir Marmor, Amir Matityahu, R. Trigg McClellan, David Shearer, Paul Toogood, Anthony Ding, Jothi Murali, Ashraf El Naga, Jennifer Tangtiphaiboontana, Tigist Belaye, Eleni Berhaneselase, Dmitry Pokhvashchev, William T Obremskey, Amir Alex Jahangir, Manish Sethi, Robert Boyce, Daniel J. Stinner, Phillip Mitchell, Karen Trochez, Elsa Rodriguez, Charles Pritchett, Natalie Hogan, A. Fidel Moreno, Jennifer E. Hagen, Matthew Patrick, Richard Vlasak, Thomas Krupko, Michael Talerico, Marybeth Horodyski, Marissa Pazik, Elizabeth Lossada-Soto, Joshua L. Gary, Stephen J Warner, John W. Munz, Andrew M. Choo, Timothy S. Achor, Milton L. 'Chip' Routt, Michael Kutzler, Sterling Boutte, Ryan J. Warth, Michael Prayson, Indresh Venkatarayappa, Brandon Horne, Jennifer Jerele, Linda Clark, Christina Boulton, Jason Lowe, John T. Ruth, Brad Askam, Andrea Seach, Alejandro Cruz, Breanna Featherston, Robin Carlson, Iliana Romero, Isaac Zarif, Niloofar Dehghan, Michael McKee, Clifford B Jones, Debra L Sietsema, Alyse Williams, Tayler Dykes, Ernesto Guerra-Farfan, Jordi Tomas-Hernandez, Jordi Teixidor-Serra, Vicente Molero-Garcia, Jordi Selga-Marsa, Juan Antonio Porcel-Vazquez, Jose Vicente Andres-Peiro, Ignacio Esteban-Feliu, Nuria Vidal-Tarrason, Jordi Serracanta, Jorge Nuñez-Camarena, Maria del Mar Villar-Casares, Jaume Mestre-Torres, Pilar Lalueza-Broto, Felipe Moreira-Borim, Yaiza Garcia-Sanchez, Francesc Marcano-Fernández, Laia Martínez-Carreres, David Martí-Garín, Jorge Serrano-Sanz, Joel Sánchez-Fernández, Matsuyama Sanz-Molero, Alejandro Carballo, Xavier Pelfort, Francesc Acerboni-Flores, Anna Alavedra-Massana, Neus Anglada-Torres, Alexandre Berenguer, Jaume Cámara-Cabrera, Ariadna Caparros-García, Ferran Fillat-Gomà, Ruben Fuentes-López, Ramona Garcia-Rodriguez, Nuria Gimeno-Calavia, Marta Martínez-Álvarez, Patricia Martínez-Grau, Raúl Pellejero-García, Ona Ràfols-Perramon, Juan Manuel Peñalver, Mònica Salomó Domènech, Albert Soler-Cano, Aldo Velasco-Barrera, Christian Yela-Verdú, Mercedes Bueno-Ruiz, Estrella Sánchez-Palomino, Vito Andriola, Matilde Molina-Corbacho, Yeray Maldonado-Sotoca, Alfons Gasset-Teixidor, Jorge Blasco-Moreu, Núria Fernández-Poch, Josep Rodoreda-Puigdemasa, Arnau Verdaguer-Figuerola, Heber Enrique Cueva-Sevieri, Santiago Garcia-Gimenez, Darius G. Viskontas, Kelly L. Apostle, Dory S. Boyer, Farhad O. Moola, Bertrand H. Perey, Trevor B. Stone, H. Michael Lemke, Ella Spicer, Kyrsten Payne, Robert A. Hymes, Cary C. Schwartzbach, Jeff E. Schulman, A. Stephen Malekzadeh, Michael A. Holzman, Greg E. Gaski, Jonathan Wills, Holly Pilson, Eben A. Carroll, Jason J. Halvorson, Sharon Babcock, J. Brett Goodman, Martha B. Holden, Wendy Williams, Taylor Hill, Ariel Brotherton, Nicholas M. Romeo, Heather A Vallier, Anna Vergon, Thomas F. Higgins, Justin M. Haller, David L. Rothberg, Zachary M. Olsen, Abby V. McGowan, Sophia Hill, Morgan K. Dauk, Patrick F. Bergin, George V. Russell, Matthew L. Graves, John Morellato, Sheketha L. McGee, Eldrin L. Bhanat, Ugur Yener, Rajinder Khanna, Priyanka Nehete, Dr. David Potter, Dr. Robert VanDemark, Kyle Seabold, Nicholas Staudenmier, Marcus Coe, Kevin Dwyer, Devin S. Mullin, Theresa A. Chockbengboun, Peter A. DePalo, Kevin Phelps, Michael Bosse, Madhav Karunakar, Laurence Kempton, Stephen Sims, Joseph Hsu, Rachel Seymour, Christine Churchill, Ada Mayfield, Juliette Sweeney, Todd Jaeblon, Robert Beer, Brent Bauer, Sean Meredith, Sneh Talwar, Christopher M. Domes, Rachel M. Reilly, Ariana Paniagua, JaNell Dupree, Michael J. Weaver, Arvind G. von Keudell, Abigail E. Sagona, Samir Mehta, Derek Donegan, Annamarie Horan, Mary Dooley, Marilyn Heng, Mitchel B. Harris, David W. Lhowe, John G. Esposito, Ahmad Alnasser, Steven F. Shannon, Alesha N. Scott, Bobbi Clinch, Becky Weber, Michael J. Beltran, Michael T. Archdeacon, Henry Claude Sagi, John D. Wyrick, Theodore Toan Le, Richard T. Laughlin, Cameron G. Thomson, Kimberly Hasselfeld, Carol A. Lin, Mark S. Vrahas, Charles N. Moon, Milton T. Little, Geoffrey S. Marecek, Denice M. Dubuclet, John A. Scolaro, James R. Learned, Philip K. Lim, Susan Demas, Arya Amirhekmat, and Yan Marco Dela Cruz

Subjects
General Earth and Planetary Sciences, General Environmental Science
Published
2023

26. Toward Operational Real-time Identification of Frontal Boundaries Using Machine Learning

Author

Andrew D. Justin, Colin Willingham, Amy McGovern, and John T. Allen

Abstract

We present and evaluate a deep learning first-guess front identification system that identifies cold, warm, stationary, and occluded fronts. Frontal boundaries play a key role in the daily weather around the world. Human-drawn fronts provided by the National Weather Service’s Weather Prediction Center, Ocean Prediction Center, Tropical Analysis & Forecast Branch, and Honolulu Forecast Office are treated as ground truth labels for training the deep learning models. The models are trained using ERA5 reanalysis data with variables known to be important to distinguishing frontal boundaries, including temperature, equivalent potential temperature, and wind velocity and direction at multiple heights. Using a 250 km neighborhood over the Continental United States domain, our best models achieve critical success index scores of 0.60 for cold fronts, 0.43 for warm fronts, 0.48 for stationary fronts, 0.45 for occluded fronts, and 0.71 using a binary classification system (front / no front), while scores over the full Unified Surface Analysis domain were lower. For cold and warm fronts and binary classification, these scores significantly outperform prior baseline methods that utilize 250 km neighborhoods. These first-guess deep learning algorithms can be used by forecasters to more effectively locate frontal boundaries and expedite the frontal analysis process.

Published
2023

28. Influence of polycyclic aromatic hydrocarbons on water storage capacity of two lichens species

Author

Anna Klamerus-Iwan, Rafał Kozłowski, Anna Sadowska-Rociek, Ewa Słowik-Opoka, Dawid Kupka, Paolo Giordani, Philipp Porada, and John T. Van Stan

Abstract

The wide variability in functional traits that enable the cosmopolitan distribution of lichens often includes the water storage capacity, S, of their thallus. Lichen S in forest canopies can be large enough to intercept and evaporate significant amounts of rainwater, contributing to the runoff-reduction ecosystem services provided by urban forests; however, S is likely influenced by the presence of air pollutants (polycyclic aromatic hydrocarbons, PAHs) in urban areas. PAHs, being both chemically hydrophobic and damaging to lichen thalli, are expected to reduce lichens’ S and, thereby, limit their contribution to hydrologic ecoservices of urban forests. Hence, the relationship between PAH accumulation and rainwater uptake was examined for two lichen species, common in urban forests around the world – Platismatia glauca and Pseudevernia furfuracea. Samples were collected from an area of low air pollution and another area in a highly urbanized city centre with high air pollution exposure (Kraków, Poland). Lichen S was determined using laboratory-simulated rainfall. PAH bioaccumulation differed between species and among the samples from clean and polluted environments. After exposure to polluted air, the concentration of PAHs was higher in P. glauca than P. furfuracea. Samples from the non-urban setting, however, showed no differences between the two species. In the case of P. glauca, S decreased from 35.8% in samples from clean environment to 8.3% after six months of exposure in the urban setting. The respective S values for P. furfuracea were 25.4% and 12.4%. Results strongly suggest that PAH exposure reduces S in both lichen species. The obtained results are important both in ecohydrology and microclimatology and are part of the research on the condition of urban forests.

Published
2023

29. Visualization of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale Results

Author

Jaimie Hixson, Jorge E. Quintero, Ashley Guiliani, Tritia R. Yamasaki, Greg A. Gerhardt, John T. Slevin, and Craig G. van Horne

Subjects
Cellular and Molecular Neuroscience, Neurology (clinical)
Abstract

We sought to design a data visualization platform to represent the Movement Disorder Society- Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) item scores in an easy-to-use display without modification of the raw data or summary scores. Score items for Parts I, II, and IV were arranged as separate inline blocks, while Part III item blocks were arranged in an anatomical fashion. A color scale was created to represent symptom severity and changes observed from one exam to another. We have found the visualization helpful for quickly defining the most troublesome symptoms and their anatomical location enabling communication of the results and interpretations.

Published
2023

34. Validity of self‐reported migraine in adolescents and children

Author

Danielle J. Kellier, Blanca Marquez de Prado, Dana Haagen, Philip Grabner, Nichelle Raj, Lara Lechtenberg, Gerardo Velasquez, Jesse Y. Hsu, John T. Farrar, Andrew D. Hershey, and Christina L. Szperka

Subjects
Neurology, Neurology (clinical)
Published
2023

36. Dupilumab in patients with prurigo nodularis: two randomized, double-blind, placebo-controlled phase 3 trials

Author

Gil Yosipovitch, Nicholas Mollanazar, Sonja Ständer, Shawn G. Kwatra, Brian S. Kim, Elizabeth Laws, Leda P. Mannent, Nikhil Amin, Bolanle Akinlade, Heribert W. Staudinger, Naimish Patel, George D. Yancopoulos, David M. Weinreich, Sheldon Wang, Genming Shi, Ashish Bansal, and John T. O’Malley

Subjects
General Medicine, General Biochemistry, Genetics and Molecular Biology
Abstract

Prurigo nodularis (PN) is a chronic inflammatory skin disease with intensely pruritic nodules. The LIBERTY-PN PRIME and PRIME2 phase 3 trials enrolled adults with PN with ≥20 nodules and severe itch uncontrolled with topical therapies. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin (IL)-4 and IL-13. Patients were randomized 1:1 to 300 mg dupilumab or placebo subcutaneously every 2 weeks for 24 weeks. The primary endpoint was pruritus improvement, measured by proportion of patients with a ≥4-point reduction in Worst Itch Numeric Rating Scale (WI-NRS) from baseline at week 24 (PRIME) or week 12 (PRIME2). Key secondary endpoints included nodule number reduction to ≤5 at week 24. PRIME and PRIME2 enrolled 151 and 160 patients, respectively. Both trials met all the pre-specified primary and key secondary endpoints. A ≥4-point WI-NRS reduction at week 24 in the dupilumab and placebo arms was achieved by 60.0% and 18.4% of patients, respectively, in PRIME (95% confidence interval (CI), 27.8–57.7 for the difference, P P = 0.022). Dupilumab demonstrated clinically meaningful and statistically significant improvements in itch and skin lesions versus placebo in PN. Safety was consistent with the known dupilumab safety profile.ClinicalTrials.gov identifiers: NCT04183335 and NCT04202679.

Published
2023

37. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Mild Traumatic Brain Injury

Author

Jonathan H. Valente, John D. Anderson, William F. Paolo, Kelly Sarmiento, Christian A. Tomaszewski, Jason S. Haukoos, Deborah B. Diercks, Richard Byyny, Christopher R. Carpenter, Benjamin Friedman, Seth R. Gemme, Charles J. Gerardo, Steven A. Godwin, Sigrid A. Hahn, Benjamin W. Hatten, Amy Kaji, Heemun Kwok, Bruce M. Lo, Sharon E. Mace, Maggie Moran, Susan B. Promes, Kaushal H. Shah, Richard D. Shih, Scott M. Silvers, Andrea Slivinski, Michael D. Smith, Molly E.W. Thiessen, Stacy Trent, Stephen P. Wall, Lauren M. Westafer, Yanling Yu, Stephen V. Cantrill, John T. Finnell, Travis Schulz, and Kaeli Vandertulip

Subjects
Emergency Medicine
Published
2023

41. What really matters in play?

Author

Kateri Thunder, John Hattie, John T. Almarode, Douglas Fisher, Nancy Frey, and Alisha Demchak

Subjects
Education
Published
2023

43. Opportunities for Achieving the Cancer Moonshot Goal of a 50% Reduction in Cancer Mortality by 2047

Author

Meredith S. Shiels, Stanley Lipkowitz, Nicole G. Campos, Mark Schiffman, John T. Schiller, Neal D. Freedman, and Amy Berrington de González

Subjects
Oncology
Abstract

On February 2, 2022, President Biden and First Lady Dr. Biden reignited the Cancer Moonshot, setting a new goal to reduce age-standardized cancer mortality rates by at least 50% over the next 25 years in the United States. We estimated trends in U.S. cancer mortality during 2000 to 2019 for all cancers and the six leading types (lung, colorectum, pancreas, breast, prostate, liver). Cancer death rates overall declined by 1.4% per year from 2000 to 2015, accelerating to 2.3% per year during 2016 to 2019, driven by strong declines in lung cancer mortality (−4.7%/year, 2014 to 2019). Recent declines in colorectal (−2.0%/year, 2010–2019) and breast cancer death rates (−1.2%/year, 2013–2019) also contributed. However, trends for other cancer types were less promising. To achieve the Moonshot goal, progress against lung, colorectal, and breast cancer deaths needs to be maintained and/or accelerated, and new strategies for prostate, liver, pancreatic, and other cancers are needed. We reviewed opportunities to prevent, detect, and treat these common cancers that could further reduce population-level cancer death rates and also reduce disparities. Significance: We reviewed opportunities to prevent, detect, and treat common cancers, and show that to achieve the Moonshot goal, progress against lung, colorectal, and breast cancer deaths needs to be maintained and/or accelerated, and new strategies for prostate, liver, pancreatic, and other cancers are needed. See related commentary by Bertagnolli et al., p. 1049. This article is highlighted in the In This Issue feature, p. 1027

Published
2023

47. Sentinel lymph node biopsy status improves adjuvant therapy decision-making in patients with clinical stage IIB/C melanoma: A population-based analysis

Author

Cimarron E, Sharon, Richard J, Straker, Phyllis A, Gimotty, Emily Y, Chu, Tara C, Mitchell, John T, Miura, Michael A, Marchetti, Edmund K, Bartlett, and Giorgos C, Karakousis

Subjects
Dermatology
Abstract

Given the results of the recent KEYNOTE-716 trial, the performance of sentinel lymph node (SLN) biopsy for patients with clinical stage IIB/C melanoma has been questioned.Determine the utility of SLN status in guiding the recommendations for adjuvant therapy.Patients with clinical stage IIB/C cutaneous melanoma who underwent wide local excision and SLN biopsy between 2004-2011 were identified from the Surveillance, Epidemiology, and End Results database. Two prognostic models, with and without SLN status, were developed predicting risk of Melanoma specific death (MSD). The primary outcome was net benefit at treatment thresholds of 20-40% risk of 5-year MSD RESULTS: For the 4,391 patients included, the 5-year MSD rate was 46%. The model estimating 5-year MSD risk that included SLN status provided greater net benefit at treatment thresholds from 30-78% compared to the model without SLN status. The added net benefit for the SLN biopsy-containing model persisted in subgroup analysis of patients in different age groups and with various T stages.Retrospective study.A prognostic model with SLN status estimating patient risk for 5-year MSD provides superior net benefit compared to a model with primary tumor staging factors alone for threshold mortality rates ≥30%.

Published
2023

48. Generic versus disease-specific adverse event reporting: a comparison of the NSQIP and SAVES databases for the identification of acute care adverse events in adult spine surgery

Author

Eryck Moskven, Christopher D. Daly, Jennifer Nevin, Étienne Bourassa-Moreau, Tamir Ailon, Raphaële Charest-Morin, Nicolas Dea, Marcel F. Dvorak, Charles G. Fisher, Brian K. Kwon, Scott Paquette, and John T. Street

Subjects
General Medicine
Abstract

OBJECTIVE The accurate identification and reporting of adverse events (AEs) is crucial for quality improvement. A myriad of AE systems are utilized. There is a lack of understanding of the differences between prospective versus retrospective, disease-specific versus generic, and point-of-care versus chart-abstracted systems. The objective of this study was to compare the benefits and limitations between the prospective, disease-specific, point-of-care Spine Adverse Events Severity System (SAVES) and the retrospective, generic, and chart-abstracted National Surgical Quality Improvement Program (NSQIP) for the identification and reporting of AEs in adult patients undergoing spinal surgery. METHODS The authors conducted an observational ambidirectional cohort study of adult patients undergoing spine surgery other than for trauma between 2011 and 2019 in a quaternary spine center. Patients were identified using Current Procedural Terminology codes in the NSQIP database and matched using unique medical record numbers to their corresponding record in SAVES. The incidence of AEs and per-patient AEs as recorded in NSQIP and SAVES was the primary outcome of interest. Comparable AEs were identified by matching NSQIP AEs to equivalent ones in SAVES. Chi-square tests were used to test for significant differences in the incidence of overall and comparable AEs between the databases. RESULTS There were 2198 patients identified in NSQIP, of whom 2033 also had complete records in SAVES. SAVES identified 5342 individual AEs in 1484 patients (73%) compared with 1291 individual AEs in 807 patients (39.7%) with the NSQIP database (p < 0.001). SAVES identified 250 intraoperative and 422 postoperative spine-specific AEs that NSQIP did not record. NSQIP captured a greater number of AEs beyond 30 days, including prolonged length of stay > 30 days, unplanned readmission, unplanned reoperation, and death later than 30 days after surgery compared with SAVES. CONCLUSIONS SAVES captures a greater incidence of peri- and intraoperative spine-specific AEs than NSQIP, while NSQIP identifies a greater number of AEs beyond 30 days. While a prospective, disease-specific, point-of-care AE system such as SAVES is specific for guiding quality improvement in spine surgery, it incurs greater time and financial costs. Conversely, a retrospective, generic, and chart-abstracted system such as NSQIP provides equivocal cross-institutional comparability with reduced time and financial costs. Specific contextual and aim-specific needs should guide the choice and implementation of an AE system.

Published
2023

49. Risk Factors Associated with Spinal Cord Ischemia During Aortic Aneurysm Repair

Author

Faraz Behzadi, Joshua E. Simon, Tara J. Zielke, John T. Cook, Renzo A. Costa, Carlos F. Bechara, and Vikram C. Prabhu

Subjects
Surgery, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

The risk of spinal cord injury (SCI) with aortic aneurysm repair can cause significant neurological morbidity. Prevention of SCI is critical. We sought to identify risk factors that predispose to SCI that may guide strategies to mitigate the occurrence of SCI during and following these procedures.This study includes all adults who underwent atraumatic, unruptured, thoracic and supra-renal aortic aneurysm repairs (endovascular or open) at our institution over 11 years (2010-2020). Our database included patient demographics, aneurysm anatomic features, and operative characteristics and an extreme gradient boost (XGB) machine method was used to develop a predictive model for SCI. The model was trained on a 80% randomly stratified cohort of the data and tested on the remaining 20% testing cohort. Shapley values were used to determine the most important predictive factors of SCI and decision trees were used to identify risk factor threshold values and highest risk factor combinations.Information was collected for 174 adult patients undergoing thoracic and supra-renal aortic repair from 2010-2020. Fifty-eight percent of the patients were male. Ninety-seven (55.7%) patients had Open Aortic Repair and 87 (44.3%) had endovascular repair. Twenty-seven (15%) of all patients had major complications and were considered to have SCI. The XGB model converged over the training cohort with a testing cohort accuracy of 0.841 [Sensitivity = 75%, Specificity = 68%] and AUC of ROC of 0.774. The XGB model identified older age (65), history of neurologic disease, hyperlipidemia, diabetes, coronary artery disease, heart failure, poor renal function,6 months since last aortic repair, chronic anticoagulant use, preoperational anemia (Hgb9), thrombocytopenia (Plt90,000), coagulopathy (PT15s and aPTT40s), hypotension (MAP70 mmHg), longer operations (100 minutes), aneurysms longer than 5 cm, and anatomic location of aneurysm caudal to T-11 as risk factors for SCI in all types of aortic repair. Diabetic and heart failure patients undergoing longer operations (100 minutes) with thrombocytopenia or aneurysms longer than 5 cm were at the highest risk.The XGB model accurately identified risk factors of SCI with aortic aneurysm repair that may guide patient selection, timing of surgery, and strategies to minimize the risk of SCI.

Published
2023

50. Spring Snowpack Influences on the Volume and Timing of Spring and Peak-Season Overnight Visitation to Yosemite Wilderness

Author

Jeffrey S. Jenkins, John T. Abatzoglou, and Brian A. Peterson

Subjects
Atmospheric Science, Global and Planetary Change, Social Sciences (miscellaneous)
Abstract

Wilderness visitation, particularly overnight use, is reactive to climate variability because backpackers face greater exposure to and dependence on environmental conditions. This study examines the effect that spring snowpack had on the timing and volume of permits issued for overnight use of the Yosemite Wilderness during peak and shoulder-season months (April–October) from 2002 to 2019. We categorize 1 April snowpack at Tuolumne Meadows into snow drought (125%), and near-average snowpack (75%–125%). Results confirm wilderness-wide differences between snowpack categories, including change in spring overnight visitors (April–June: +20% snow drought and −28% high snowpack). Our findings confirm that snow drought allows for more access to high-elevation trailheads when seasonal roads are open earlier in spring (May–June: +74% Tioga Road and +81% Tuolumne Meadows). Mid- to high-elevation trailheads experience a sustained increase in use during high-snowpack years (June–October: +12% Yosemite Valley and Big Oak Flat; +15% Glacier Point Road and Wawona; +32% Hetch Hetchy) because a narrower seasonal access window leads to filled permit quotas in the high country and displaces use to lower-elevation trailheads. These findings have implications for wilderness stewards, including biophysical and experiential impacts on wilderness character from earlier and longer seasons, especially at higher elevation and in fragile alpine and subalpine areas, as snow drought in mountain-protected areas becomes more common. Recommendations to address greater early-season use and its attendant impacts include adaptively managing permits for different types of snowpack years, including potential changes in the number, timing, and destination of select trailhead quotas.

Published
2023

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