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Convergence in the lateral moisture flux resulting from this air mass ascending the coastal topography (sea-breeze phase) as well as colliding with air masses from the opposing coastline (land-breeze phase) further resulted in cumulous cloud formation and precipitation. ©2019. The Authors.We analyzed the interaction between the North American monsoon anticyclone (NAMA) and summertime cross-tropopause convective outflow by applying a trajectory analysis to a climatology of convective overshooting tops (OTs) identified in GOES satellite images, which covers the domain from 29°S to 68°N and from 205 to 1.25°W for the time period of May through September 2013. With this analysis we identified seasonally, geographically, and altitude-dependent variability in NAMA strength and in cross-tropopause convection that control their interaction. We find that the NAMA has the strongest impact on the circulation of convectively influenced air masses in August. Over the entire time period examined the intertropical convergence zone contributes the majority of OTs with a larger fraction of total OTs at 370 K (on average 70%) than at 400 K (on average 52%). During August at 370 K, the convectively influenced air masses within the NAMA circulation, as determined by the trajectory analysis, are primarily sourced from the intertropical convergence zone (monthly average of 66.1%), while at 400 K the Sierra Madres and the Central United States combined constitute the dominant source region (monthly average of 44.1%, compared to 36.6% of the combined Intertropical Convergence Zone regions). When evaluating the impact of cross-tropopause convection on the composition and chemistry of the upper troposphere and lower stratosphere, the effects of the NAMA on both the distribution of convective outflow and the residence time of convectively influenced air masses within the NAMA region must be considered. © 2019. The Authors.Infection-related glomerulonephritis (IRGN) is an immune complex-mediated glomerulonephritis (GN), often preceded by infection with subsequent recovery of renal function after the resolution of the infection. C3 deposition in the absence of immune complex deposits can be seen in patients with IRGN, but with the emergence of C3 glomerulonephritis (C3GN), the distinction is&nbsp;difficult as the clinical and pathological presentation may be similar. However, their treatment and clinical course vary significantly. A 64-year-old&nbsp;man&nbsp;with&nbsp;a history of&nbsp;hypertension and bioprosthetic aortic valve presented to the Emergency Department&nbsp;with left upper quadrant (LUQ)&nbsp;pain and a purpuric rash on bilateral lower extremities. The patient became septic, and further workup during the hospitalization revealed&nbsp;endocarditis secondary to Streptococcus viridans. On admission, the patient had acute kidney injury (AKI) with a serum creatinine of 3.79 mg/dl, which peaked at 5.72 mg/dl during the hospitalization. Renal biopsy demonstrated segmental necrotizing glomerulonephritis on light microscopy, predominant C3 deposition on immunofluorescence (IF) staining, and mesangial and paramesangial deposits on electron microscopy. This histologic picture can be seen both in IRGN and C3GN. The patient was treated with intravenous ceftriaxone for six weeks for endocarditis&nbsp;and the kidney injury was managed with supportive care. [https://www.selleckchem.com/products/gsk269962.html GSK269962A] The patient's renal function improved and complement levels normalized, supporting the diagnosis of IRGN retrospectively. IRGN can mimic C3GN, and evaluation for alternate pathways of the complement system may be warranted in patients with atypical presentation of IRGN. Copyright © 2020, Chamarthi et al.Introduction Miscommunication during patient handoff contributes to an estimated 80% of serious medical errors and, consequently, plays a key role in the estimated five million excess deaths annually from poor quality of care in low- and middle-income countries (LMICs). Objective The objective of this study was to assess signout communication during patient handoffs between prehospital personnel and hospital staff. Methods This is a cross-sectional study, with a convenience sample of 931 interfacility transfers for pregnant women across four states from November 7&nbsp;to December 13, 2016. A complete signout, as defined for this study, contains all necessary signout elements for patient care exchanged verbally or in written form between an emergency medical technician (EMT) and a physician or nurse. Results Enrollment of 786 cases from 931 interfacility transfers resulted in 1572 opportunities for signout. EMTs and a physician or nurse signed out in 1549 cases (98.5%). Signout contained all elements in 135 cases (8.6%). The mean percentage of signout elements included was 45.2% (95% CI, 43.9-46.6). Physician involvement was correlated with a higher mean percent (63.4% [95% CI, 62-64.8]) compared to nurse involvement (23.6% [95% CI, 22.5-24.8]). With respect to the frequency of signout communication, 63.1% of EMTs reported often or always giving signout, and 60.5% reported often or always giving signout; they reported feeling moderately to very comfortable with signout (73.7%)&nbsp;and 34.1% requested further training. Conclusions Physicians, nurses, and the EMTs conducted signout 99% of the time but often fell short of including all elements required for optimal patient care. Interventions aimed at improving the quality of patient care must include strengthening signout communication. Copyright © 2020, Janagama et al.Background Management of elderly patients with Non-ST Elevation Myocardial Infarction (NSTEMI) continues to be a source of controversy due to underrepresentation in large-scale clinical trials and the increased risk of adverse outcomes after both invasive (Percutaneous coronary intervention and Coronary artery bypass grafting) and non-invasive therapies. Recent randomized clinical trials have shown improved short term and intermediate term outcomes among high risk NSTEMI patients receiving early invasive management versus conservative medical management. However, how this is reflected in U.S. clinical practice for elderly patients has not been reported. Objective To identify the trend of invasive management in patients with NSTEMI, particularly among elderly population. Methods We used data from National Hospital Discharge Survey to identify all adult patients with an International Classification of Diseases,&nbsp;Ninth Revision, Clinical Modification (ICD-9-CM) code for NSTEMI from the years 2005 to 2009.&nbsp;The goal was to investigate the trends in time of invasive therapy for patients diagnosed with NSTEMI.