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We present environmental and polarimetric radar observations of a long-lived December supercell that tracked approximately 750 km from Arkansas to northern Kentucky. The storm was associated with two long-track EF4 tornadoes, one of which was among the longest-tracked tornadoes recorded in the United States. The supercell's life cycle is documented from 2000 UTC 10 to 0700 UTC 11 December 2021, using data from five operational polarimetric weather radars. After convection initiation in central Arkansas, it took nearly 4 h for a supercell to develop. Afterward, the storm's ZDR column and arc became anomalously large leading up to genesis of the first EF4 tornado. During this time, the storm's environment had moderate convective available potential energy (CAPE) and strong deep-layer shear. A cell interaction at about 0200 UTC disrupted the supercell updraft, weakening the ZDR arc and column, and initiating the largest radar-implied hailfall event observed with this storm. The remnant circulation associated with the first EF4 tornado did not fully dissipate, and it appeared to merge with the low-level mesocyclone on the nose of a rear-flank downdraft surge likely initiated by the hailfall. It is hypothesized that this merger was important to the intensification of the storm's second EF4 tornado, which lasted nearly 3 h and traveled approximately 267 km. During the second EF4 tornado the storm experienced decreasing CAPE and increasing storm relative helicity. Increasing interactions with other cells eventually weakened the storm, and its original updraft was obscured before the storm's remnants dissipated in northern Kentucky. Significance Statement: In December 2021, a long-lived supercell thunderstorm produced two long-track, violent tornadoes, including one that produced historic damage across western Kentucky. Radar observations indicate that, once the storm became a supercell, its updraft became anomalously large relative to similar storms studied prior. Simultaneously its storm-relative inflow strengthened markedly, supporting the first long-lived tornado. Interactions with a developing thunderstorm disrupted the supercell's updraft, leading to hail fallout and updraft weakening. The remnant circulation associated with the first strong tornado merged with the supercell's updraft and became a rotation source for the second long-track tornado, which persisted for nearly 3 h. Eventually interactions with other thunderstorms weakened the supercell. [ABSTRACT FROM AUTHOR]

Category: Other Introduction/Purpose: Musculoskeletal consultations constitute a growing portion of primary care physician (PCP) referrals. Optimization of communication between PCPs and orthopaedists can potentially reduce the time PCPs spend in the electronic medical record (EMR). This, in turn, may help reduce burnout. However, little is known about the preferences of PCPs regarding communication from orthopaedic specialists. The current study therefore investigated the preferences of PCPs across a large health network regarding communication from orthopaedists. Methods: One hundred and seventy-five PCPs across 15 practices within our health network were surveyed. These providers universally used the Epic Systems EMR. PCPs were asked to report their years in practice, panel size, typical number of electronic clinical messages received each day, time spent in the EMR after normal clinical hours, and burnout level. Likert scales and top-box scores were used to assess the PCPs' perceived importance of communication from orthopedists in specific clinical scenarios. PCPs were further asked to report their preferred method of communication in each scenario and overall interest in communication from orthopaedists. Regression analyses were performed to determine if any PCP characteristics are associated with communication preferences and overall PCP interest in communication from orthopaedists. Results: A total of 107 (61%) PCPs completed the survey. PCPs most commonly rated communication from orthopaedists as highly important when the orthopaedist needed information from the PCP. In this scenario, PCPs preferred to receive an Epic Staff Message. Other scenarios rated as important included: the decision for surgery, hospitalization, and a major clinical change. In these scenarios, a CC'd Chart rather than Staff Message was preferred. Increased EMR use after-hours was associated with diminished odds of having high interest in communication from orthopaedists (odds ratio=0.65, 95% confidence interval: 0.48-0.88, P=0.005). Ninety-three PCPs (86.9%) reported spending at least 1 hour a day in Epic after normal clinical hours. Twenty-seven (25.2%) spent more than 3 hours. Forty-six PCPs (42.9%) reported experiencing at least one symptom of burnout. Conclusion: In the current study, there were distinct preferences among PCPs regarding clinical communication from orthopaedic surgeons. In addition, there was evidence of substantial burnout and after-hours work effort by PCPs. Our results may be helpful in optimizing communication between PCPs and orthopaedists, while also reducing time spent in the EMR by PCPs. [ABSTRACT FROM AUTHOR]