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Purpose: Prone transpsoas fusion (PTP) is a minimally invasive technique that maximizes the benefit of lateral access interbody surgery and the prone positioning for surgically significant adjacent segment disease. The authors describe the feasibility, reproducibility and radiographic efficacy of PTP when performed for cases of lumbar ASD. Methods: Adult patients undergoing PTP for treatment of lumbar ASD at three institutions were retrospectively enrolled. Demographic information was recorded, as was operative data such as adjacent segment levels, operative time, blood loss, laterality of approach, open versus percutaneous pedicle screw instrumentation and need for primary decompression. Radiographic measurements including segmental and global lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope and sagittal vertical axis were recorded both pre- and immediately post-operatively. Results: Twenty-four patients met criteria for inclusion. Average age was 60.4 ± 10.4 years and average BMI was 31.6 ± 5.0 kg/m2. Total operative time was 204.7 ± 83.3 min with blood loss of 187.9 ± 211 mL. Twenty-one patients had pedicle screw instrumentation exchanged percutaneously and 3 patients had open pedicle screw exchange. Two patients suffered pulmonary embolism that was treated medically with no long-term sequelae. One patient had transient lumbar radicular pain and all patients were discharged home with an average length of stay of 3.0 days (range 1–6). Radiographically, global lumbar lordosis improved by an average of 10.3 ± 9.0 degrees, segmental lordosis by 10.1 ± 13.3 degrees and sagittal vertical axis by 3.2 ± 3.2 cm. Conclusion: Single-position prone transpsoas lumbar interbody fusion is a clinically reproducible minimally invasive technique that can effectively treat lumbar adjacent segment disease. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted surgery is becoming more widely applied in surgical subspecialties due to its intraoperative and postoperative advantages such as minimally invasive approach, reduced blood loss, shorter hospital stay, and decreased incidence of postoperative complications. However, robotic devices were only recently introduced in the field of spinal surgery. Specifically, percutaneous approaches involving computer-assisted image guidance are relatively new in iliac screw fixation. Previous methods focused on the use of S2-alar-iliac (S2AI) screw fixation which allows for pelvic fixation without a need for side connectors. However, for patients with destructive lesions of the sacrum, placement of these S2AI screws may not be feasible. The purpose of this technical note is to illustrate the implementation of robotic-assisted percutaneous iliac screw fixation in two cases which allows for minimally invasive attachment to the proximal lumbar screws without a side connector and eliminates a potential source of instrumentation failure. Methods: Robotic-assisted percutaneous iliac screw fixation was performed on two patients. The robotics system was used to merge the fluoroscopic images with intraoperative computed tomography (CT) images to plan the trajectories for placement of bilateral pedicle and iliac screws. Intraoperative CT scan was again performed to confirm proper placement of all screws. Rods were then engaged bilaterally with the pedicle and iliac screws without the use of side connectors. Results: The patients did not experience immediate postoperative complications and had stable hardware at one-month follow-up. Our cases demonstrate the surgical efficiency of robotic-assisted lumbo-iliac instrumentation which obviates the need to use a side connector, which is commonly used in iliac fixation. This eliminates a step, which can reduce the possibility of instrumentation failure. Conclusion: Robotic-assisted percutaneous iliac screw fixation is a safe and feasible technique to improve operative and clinical outcomes in complex spinal instrumentation surgeries. [ABSTRACT FROM AUTHOR]

The Missouri River Basin (MRB) encompasses one of the most important agricultural regions in the world. Three decadal climate variability (DCV) phenomena — the Pacific Decadal Oscillation (PDO), the tropical Atlantic sea surface temperature (SST) gradient variability (TAG), and the West Pacific Warm Pool (WPWP) variability — substantially influence hydro-meteorology and, consequently, spring and winter wheat yields in the MRB as indicated by data from 1961 to 2010. We applied the Soil and Water Assessment Tool (SWAT) to simulate DCV impacts on wheat yields in response to realistic values of the DCV indices in approximately 13,500 hydrologic unit areas covering the MRB. SWAT, driven by scenarios of past hydro-meteorological anomalies associated with positive and negative phases of the PDO and TAG, indicated major impacts on wheat yields, as much as ± 40% of the average in many locations, with smaller impacts of the WPWP variability. SWAT showed much larger wheat yield increases when the positive phase of the PDO and the negative phase of the TAG are superposed, and an equivalent decrease in yields when opposite phases of the two DCV phenomena are superposed. Thus, combined effects of DCV phenomena on wheat yields in the MRB can be dramatic with important consequences for food production and security. The usefulness of this inter-disciplinary study to farmers and other stakeholders for adapting MRB agriculture to DCV, and the applicability of the methodology to other agricultural regions are described. The results’ implications for detection and attribution of climatic change impacts are also described. [ABSTRACT FROM AUTHOR]

Unruptured intracranial saccular aneurysms occur in 3–5% of the general population. As the use of diagnostic medical imaging has steadily increased over the past few decades with the increased availability of computed tomography (CT) and magnetic resonance imaging (MRI), so has the detection of incidental aneurysms. The management of an unruptured intracranial saccular aneurysm is challenging for both patients and physicians, as the decision to intervene must weigh the risk of rupture and resultant subarachnoid hemorrhage against the risk inherent to the surgical or endovascular procedure. The purpose of this paper is to provide an overview of factors to be considered in the decision to offer treatment for unruptured intracranial aneurysms in adults. In addition, we review aneurysm and patient characteristics that favor surgical clipping over endovascular intervention and vice versa. Finally, the authors propose a novel, simple, and clinically relevant algorithm for observation versus intervention in unruptured intracranial aneurysms based on the PHASES scoring system. [ABSTRACT FROM AUTHOR]

Data from decadal hindcast experiments conducted under CMIP5 were used to assess the ability of CM2.1, HadCM3, MIROC5, and CCSM4 Earth System Models (ESMs) to hindcast sea-surface temperature (SST) indices of the Pacific Decadal Oscillation (PDO), the tropical Atlantic SST gradient (TAG) variability, and the West Pacific Warm Pool (WPWP) SST variability from 1961 to 2010. The ESMs were initialized at specific times with observed data to make 10- and 30-year hindcasts/forecasts. Deterministic and probabilistic skill estimates show predictability of detrended WPWP index to 5 years' lead time and of non-detrended WPWP index to 10 years' lead time. These estimates also show atypical skill dependence of PDO and TAG indices on lead times, with increasing skill in the middle to end of 10-year hindcasts. The skill of ESMs to hindcast an observed DCV index (signal skill) is surprisingly greater than the skill to hindcast their own DCV index (noise skill) at some lead times. All ESMs hindcast occurrence frequencies of positive and negative phases of the indices, and probabilities of same-phase transitions from one year to the next reasonably well. Four, major, low-latitude volcanic eruptions are associated with phase transitions of all observed and some of the ensemble-average hindcast indices. All ESMs' WPWP index hindcasts respond correctly to all eruptions as do three observed PDO phase transitions. No one of the ESMs' hindcasts of the TAG index responds correctly to these eruptions. Some of the ESMs hindcast correct phase transitions in the absence of eruptions also, implying that initializations with observed data are beneficial in predicting phase transitions. The skills of DCV indices' phase prediction up to at least two years in advance can be used to inform societal impacts adaptation decisions in water resources management and agriculture. The Atlantic region's responses in these ESMs appear to be fundamentally incorrect. [ABSTRACT FROM AUTHOR]

The ability of four Earth System Models (ESMs) to simulate major attributes of sea-surface temperature (SST) manifestations of the Pacific Decadal Oscillation (PDO), the tropical Atlantic SST gradient (TAG) variability, and the West Pacific Warm Pool (WPWP) SST variability was assessed. Data from simulation experiments conducted under the CMIP5 with the CM2.1, HadCM3, MIROC5, and CCSM4 ESMs from 1861 to 2005 were used. A Multi-Model Ensemble was also formed by combining data from the four ESMs. Aerosol optical depths and solar radiation were specified in these experiments. The simulation of PDO spatial pattern, annual cycle, and preferred timescales is the closest to observed attributes in these ESMs. The simulated and observed TAG SST patterns are generally similar, but their average annual cycles are very different and simulated TAG variability does not have a preferred decadal timescale unlike observed variability. No one of the ESMs is able to simulate the WPWP SST pattern. Simulated and observed average annual cycles of the WPWP SST are similar, and the dominant timescale of WPWP variability is close to 8 years in all ESMs and observations. Simulation skills of the three phenomena fluctuate from decade to decade in all ESMs. Major volcanic eruptions substantially influence observed and simulated indices and simulation skills of the three phenomena. The mixing of net surface heat flux anomalies to 200 m depth in the tropical and mid-latitude Pacific, and the WPWP region causes a delayed and multiyear response of the PDO and WPWP indices to volcanic eruptions. [ABSTRACT FROM AUTHOR]

This study estimates economic value and management adaptations associated with decadal climate variability (DCV) information. We develop a stylized model to illustrate the value of climate information where agricultural decisions are conditional to different sets of DCV information. The decision maker can adjust management given such information where the economic value and associated adaptations are of interest. The framework is implemented within a stochastic programming model that simulates market activities and welfare changes under different probability distributions on DCV phase occurrence in the Missouri River Basin (MRB), the largest river basin in the USA. This basin produces approximately 46 % of the wheat, 33 % of the cattle, and 26 % of the grain corn in the USA. The results show that a conditional DCV information generates net benefits of $28.84 million annually, while the perfect information results in net benefits of $82.30 million. In addition, crop acreage shifts and the extent of irrigation vary with different DCV information. This study shows that the benefits gained from accurate climate information may address the producers' needs across a range of DCV scenarios characterized by the persistence of the impacts. Most notably, this is the first economic study to our knowledge to investigate the combined occurrence of three DCV phenomena, and the joint and persistent impacts over crop yields. Our results provide compelling evidence for long-term planning of crop mix selection, and infrastructure related to water irrigation mechanisms. [ABSTRACT FROM AUTHOR]

This paper presents results of a study of long term trends in the characteristics of the within-season temporal profile of southwest monsoon rainfall over western India during the last five decades in relation to global warming induced regional climate change. In contrast to recent climate change analyses and projections, no significant long-term trends have been observed in this study. Slow decadal scale variations observed are analysed in relation to Pacific Decadal Oscillations (PDO). Daily variations in rainfall anomaly show opposite characteristics during negative and positive phases of PDO. The above-normal rainfall (>25%) is found during the starting phase of monsoon in negative PDO. Over the last decade, i.e., during 2000-2007, the seasonal rainfall amount, as well as seasonal span of southwest monsoon over western India is indicative of a gradual increase. [ABSTRACT FROM AUTHOR]

In this paper we study the extension of structure group of principal bundles with a reductive algebraic group as structure group on a smooth projective variety defined over an algebraically closed field. Our main result is to show that given a finite-dimensional representation ρ of a reductive algebraic group G, there exists an integer N which is quantifiable in terms of G and ρ such that any semistable G-bundle whose first N Frobenius pullbacks are semistable induces a semistable bundle on extension of structure group via ρ. We do this by quantifying the fields of definition of the instability parabolics associated to various parabolic reductions of the induced bundle. [ABSTRACT FROM AUTHOR]

Current in vivo models of arterial lesions often lead to unpredictable results in terms of lesion anatomy and hemodynamical significance. This study aimed to evaluate the impact of coronary stenosis using a novel in vivo adjustable stenosis model capable of mimicking advanced human coronary lesions. We developed a series of balloon expandable covered coronary stents with a central restriction, mimicking different intermediate to severe stenosis, and implanted them percutaneously in coronary arteries of eight healthy hybrid Landrace pigs. Optical coherence tomography (OCT) pullbacks and fractional flow reserve (FFR) were acquired along the artery after implantation of the stenotic stents for precise evaluation of anatomy and functional impact. Diameter and area stenosis after deployment of the stenosis implant were, on average, respectively, 54.1 ± 5.9 and 78.4 ± 5.8 % and average FFR value was 0.83 (SD 0.13). There was a low correlation between FFR and MLA evaluated by OCT ( r = 0.02, p = 0.94), improved with percentage area stenosis ( r = −0.55, p = 0.12), or OCT volumetric evaluation of the stenosis taking into account not only the MLA but also the length of the lesion ( r = −0.78, p = 0.01). This study presents a method and proof of concept for percutaneously introducing, and removing, anatomical stenosis of predetermined severity in vivo. Such in vivo model may be used to create and evaluate the impact of focal stenoses on physiological parameters such as FFR. [ABSTRACT FROM AUTHOR]

Let Y be a normal and projective variety over an algebraically closed field k and V a vector bundle over Y. We prove that if there exist a k-scheme X and a finite surjective morphism g : X → Y that trivializes V then V is essentially finite. [ABSTRACT FROM AUTHOR]

We show that simply connected projective manifolds in characteristic p>0 have no nontrivial stratified bundles. This gives a positive answer to a conjecture by D. Gieseker (Ann. Sc. Norm. Super. Pisa, 4 Sér. 2(1):1–31, ). The proof uses Hrushovski’s theorem on periodic points. [ABSTRACT FROM AUTHOR]

Responses of global ocean circulation and temperature to freshwater runoff from major rivers were studied by blocking regional runoff in the global ocean general circulation model (OGCM) developed at the Massachusetts Institute of Technology. Runoff into the tropical Atlantic, the western North Pacific, and the Bay of Bengal and northern Arabian Sea were selectively blocked. The blocking of river runoff first resulted in a salinity increase near the river mouths (2 practical salinity units). The saltier and, therefore, denser water was then transported to higher latitudes in the North Atlantic, North Pacific, and southern Indian Ocean by the mean currents. The subsequent density contrasts between northern and southern hemispheric oceans resulted in changes in major ocean currents. These anomalous ocean currents lead to significant temperature changes (1°C −2°C) by the resulting anomalous heat transports. The current and temperature anomalies created by the blocked river runoff propagated from one ocean basin to others via coastal and equatorial Kelvin waves. This study suggests that river runoff may be playing an important role in oceanic salinity, temperature, and circulations; and that partially or fully blocking major rivers to divert freshwater for societal purposes might significantly change ocean salinity, circulations, temperature, and atmospheric climate. Further studies are necessary to assess the role of river runoff in the coupled atmosphere-ocean system. [ABSTRACT FROM AUTHOR]

In this paper we study the sheaf of differential operators on a flag manifold X in characteristic p>0. We generalize the non-vanishing theorem of Haastert on the associated filtration of . We make use of the lifting of X to characteristic zero and the complex geometry of X. [ABSTRACT FROM AUTHOR]

Meridional, linear, and free modes of global, primitive-equation, ocean-atmosphere models were analyzed to see if they contain multi-year, especially decadal (∼ 10-30 years), oscillation time scale modes. A two-layer model of the global ocean and a two-level model of the global atmosphere were formulated. Both models were linearized around axially-symmetric basic states containing mean meridional circulations. The linearized perturbation system was solved as an eigenvalue problem. The operator matrix was discretized in the north-south direction with centered finite differences. Uncoupled, meridional modes of oscillation of the ocean and the atmosphere models were calculated. Calculations were performed at three grid spacings (5°, 2.5° and 1.25°) and for two types of basic states (symmetric and asymmetric). Uncoupled, free oceanic modes in the presence of mean meridional circulations have oscillation time scales ranging from two years to several centuries. Such low frequency meridional modes do not exist in the ocean model if there are no mean meridional circulations. A large number of oceanic modes are grouped around decadal oscillation time scales. All the oceanic modes have neutral growth rates. The spatial structures of some of the oceanic modes are comparable to observed spatial structures of sea surface temperature variations in the Pacific Ocean. Most years to decades variability of meridional modes of the ocean model is contained in tropical and midlatitude modes. Some oceanic modes with years to decades periods have standing oscillations in the tropics and poleward propagation of zonal velocity and layer thickness outside the tropics. Uncoupled, free atmospheric modes in the presence of mean meridional circulations have oscillation time scales ranging from a week to several decades. Such low-frequency meridional modes do not exist in the atmospere model if there are no mean meridional circulations. A large number of modes are grouped around intraseasonal time scales. Unlike the oceanic modes, the atmospheric modes are weakly unstable. Most of the intraseasonal variability of atmospheric modes is contained in tropical, midlatitude, and polar modes. Atmospheric modes with oscillation periods longer than about one year have global extent. Meridional ocean-atmospheric modes exist in the models wherever there are mean meridional circulations, i.e., tropical, midlatitude, polar, and global. Oceanic and atmospheric eigenvectors have symmetric (assymetric) latitudinal structures if their basic states are symmetric (asymmetric) around the equator. For both models, models calculated at coarser than 2.5° grid spacing do not accurately represent low-frequency variability. Scale analysis shows taht advection by tge basic state meridional velocities is the primary cause of the meridional oscillations on time scales longer than two years in the ocean model and longer than a few weeks in the atmosphere model. Meridional modes of the coupled ocean-atmosphere models are the subject of a subsequent paper. [ABSTRACT FROM AUTHOR]

We will produce a smooth projective scheme X over ℤ, a rank 2 vector bundle V on X with a line subbundle L having the following property. For a prime p, let F be the absolute Fobenius of X, and let L ⊂ V be the restriction of L ⊂ V. Then for almost all primes p, and for all t ≥ 0, $(F_p^*)^t L_P \subset (F_p^*)^t V_p$ is a non-split Harder-Narasimhan filtration. In particular, $(F_p^*)^t V_p$ is not a direct sum of strongly semistable bundles for any t. This construction works for any full flag veriety G/ B, with semisimple rank of G ≥ 2. For the construction, we will use Borel-Weil-Bott theorem in characteristic 0, and Frobenius splitting in characteristic p. [ABSTRACT FROM AUTHOR]