bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes With Various Drug-Eluting or Bare Metal Stents in Patients With ST-Segment–Elevation Myocardial Infarction
Authors: Bangalore Sripal , Amoroso Nicholas , Fusaro Mario , Kumar Sunil , Feit Frederick
Published: August 2013

Background—

The efficacy and safety of drug-eluting stents (DES) in patients with ST-segment–elevation myocardial infarction (STEMI) is controversial. Consequently, DES implantation has a class IIa indication in the American College of Cardiology/American Heart Association and the European Society of Cardiology STEMI guidelines.

Methods and Results—

PUBMED, EMBASE, and CENTRAL were searched for randomized clinical trials, until March 2013, comparing any of the 5 Food and Drug Administration–approved durable stent and polymer DES (sirolimus eluting stent, paclitaxel eluting stent, everolimus-eluting stent [EES], zotarolimus-eluting stent, and zotarolimus-eluting stent resolute), against each other or bare metal stents (BMS), and enrolling ≥50 patients with STEMI. Efficacy (target vessel revascularization) and safety (death, myocardial infarction, and stent thrombosis) outcomes at the longest reported follow-up times were evaluated. Twenty-eight randomized clinical trials with 34 068 patient-years of follow-up on subjects with STEMI fulfilled the inclusion criteria. When compared with BMS (reference rate ratio [RR] of 1), sirolimus eluting stent (RR, 0.46; 95% credibility interval [CrI], 0.36–0.56), paclitaxel eluting stent (RR, 0.69; 95% CrI, 0.53–0.87), and EES (RR, 0.42; 95% CrI, 0.26–0.62) were associated with a statistically significant reduction in rate of target vessel revascularization, with the point estimate for zotarolimus-eluting stent resolute trending in a similar direction. There was no increase in the risk of death, myocardial infarction, or stent thrombosis with any DES compared with BMS. Moreover, EES was associated with a statistically significant reduction in the rate of stent thrombosis when compared with sirolimus eluting stent (RR, 0.38; 95% CrI, 0.21–0.74), paclitaxel eluting stent (RR, 0.39; 95% CrI, 0.21–0.73), and even BMS (RR, 0.42; 95% CrI, 0.23–0.76). There was a 74% probability that EES had the lowest rate of any stent thrombosis when compared with all other stent types (no data on zotarolimus-eluting stent resolute). There was no increase in very late stent thrombosis with EES versus BMS (RR, 0.89; 95% CrI, 0.09–8.67).

Conclusions—

In patients with STEMI, DES versus BMS was associated with substantial decrease in the risk of target vessel revascularization without compromising safety. EES had the added advantage of substantial reduction in the risk of stent thrombosis when compared with first-generation DES and BMS with no increase in very late stent thrombosis.
Endovascular Repair of Type B Aortic Dissection
Authors: Nienaber Christoph A. , Kische Stephan , Rousseau Hervé , Eggebrecht Holger , Rehders Tim C. , Kundt Guenther , Glass Aenne , Scheinert Dierk , Czerny Martin , Kleinfeldt Tilo , Zipfel Burkhart , Labrousse Louis , Fattori Rossella , Ince Hüseyin
Published: August 2013

Background—

Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown.

Methods and Results—

A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%;
P
=0.13), aorta-specific mortality (6.9% versus 19.3%;
P
=0.04), and progression (27.0% versus 46.1%;
P
=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%;
P
=0.0003), aorta-specific mortality (0% versus 16.9%;
P
=0.0005), and for progression (4.1% versus 28.1%;
P
=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (
P
<0.0001).

Conclusions—

In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01415804.
Higher Persistence in Newly Diagnosed Nonvalvular Atrial Fibrillation Patients Treated With Dabigatran Versus Warfarin
Authors: Zalesak Martin , Siu Kimberly , Francis Kevin , Yu Chen , Alvrtsyan Hasmik , Rao Yajing , Walker David , Sander Stephen , Miyasato Gavin , Matchar David , Sanchez Herman
Published: August 2013

Background—

Oral anticoagulation therapy is the primary tool in reducing stroke risk in patients with nonvalvular atrial fibrillation but is underused. Patients nonpersistent with therapy contribute to this underuse. The objective of this study was to compare persistence rates in newly diagnosed nonvalvular atrial fibrillation patients treated with warfarin versus dabigatran as their oral anticoagulation.

Methods and Results—

US Department of Defense administrative claims were used to identify patients receiving warfarin or dabigatran between October 28, 2010, and June 30, 2012. Patient records were examined for a minimum of 12 months before index date to restrict the analyses to those newly diagnosed with nonvalvular atrial fibrillation and naive-to-treatment, identifying 1775 on warfarin and 3370 on dabigatran. Propensity score matching was used to identify 1745 matched pairs. Persistence was defined as time on therapy to discontinuation. Kaplan–Meier curves were used to depict persistence over time. Cox proportional hazards model was used to determine the factors significantly associated with persistence. Using a 60-day permissible medication gap, the persistence rates were higher for dabigatran than for warfarin at both 6 months (72% versus 53%) and 1 year (63% versus 39%). Patients on dabigatran with a low-to-moderate risk of stroke (CHADS
2
<2) or with a higher bleed risk (HEMORR
2
HAGES>3) had a higher likelihood of nonpersistence (hazard ratios, 1.37; 95% confidence interval, 1.17–1.60;
P
<0.001; and hazard ratios, 1.24; 95% confidence interval, 1.04–1.47;
P
=0.016).

Conclusions—

Patients who initiated dabigatran treatment were more persistent than patients who began warfarin treatment. Within each cohort, patients with lower stroke risk were more likely to discontinue therapy.
Human Enterovirus in the Gastrocnemius of Patients With Peripheral Arterial Disease
Authors: Kim Julian K. S. , Zhu Zhen , Casale George , Koutakis Panagiotis , McComb Rodney D. , Swanson Stanley , Thompson Jonathan , Miserlis Dimitrios , Johanning Jason M. , Haynatzki Gleb , Pipinos Iraklis I.
Published: August 2013

Background

Peripheral arterial disease (
PAD
) is characterized by myofiber degeneration and loss of function in muscles of the lower limbs. Human enterovirus (
HEV
) infection has been implicated in the pathogenesis of a number of muscle diseases. However, its association with
PAD
has not been studied. In this study, we tested the hypothesis that infectious
HEV
is present in skeletal muscle of patients with
PAD
and is associated with severity of disease.

Methods and Results

Gastrocnemius biopsies from 37 patients with
PAD
and 14 controls were examined for the presence of
HEV RNA
, viral capsid protein, viral
RNA
copy number, and viral infectivity.
HEV RNA
was detected in 54% of the biopsies from patients with
PAD
but was not detected in muscle biopsies from control patients. This difference in prevalence among
PAD
and control patients was significant at
P
<0.001. Viral
RNA
copy numbers were increased significantly at the later stages of disease; Fontaine Stage IV (10
5.50
 copies/mg muscle wet weight, at
P
<0.005) and Stage III (10
4.87
 copies/mg, at
P
<0.010) compared to Stage II (10
2.50
 copies/mg). Viral replication was confirmed by the presence of the negative‐strand of viral
RNA
in all specimens positive for
HEV RNA
. Cultures of HeLa and human skeletal muscle cells treated with muscle homogenates showed
HEV
replication and the presence of
HEV
capsid protein.

Conclusion

Our data identified infectious
HEV
in the gastrocnemius of
PAD
patients but not in controls. Viral copy number and prevalence of infection were higher in the later stages of disease. Our data point to the need for further studies to determine the contribution of
HEV
infection to the pathophysiology of
PAD
.
Brain Imaging and Cognitive Predictors of Stroke and Alzheimer Disease in the Framingham Heart Study
Authors: Weinstein Galit , Beiser Alexa S. , DeCarli Charles , Au Rhoda , Wolf Philip A. , Seshadri Sudha
Published: August 2013

Background and Purpose—

Exposure to vascular risk factors has a gradual deleterious effect on brain MRI and cognitive measures. We explored whether a pattern of these measures exists that predicts stroke and Alzheimer disease (AD) risk.

Methods—

A cognitive battery was administered to 1679 dementia and stroke-free Framingham offspring (age, >55 years; mean, 65.7±7.0) between 1999 and 2004; participants were also free of other neurological conditions that could affect cognition and >90% also had brain MRI examination. We related cognitive and MRI measures to risks of incident stroke and AD ≤10 years of follow-up. As a secondary analysis, we explored these associations in The Framingham Heart Study original cohort (mean age, 67.5±7.3 and 84.8±3.3 years at the cognitive assessment and MRI examination, respectively).

Results—

A total of 55 Offspring participants sustained strokes and 31 developed AD. Offspring who scored <1.5 SD below predicted mean scores, for age and education, on an executive function test, had a higher risk of future stroke (hazard ratio [HR], 2.27; 95% confidence interval [CI], 1.06–4.85) and AD (HR, 3.60; 95% CI, 1.52–8.52); additional cognitive tests also predicted AD. Participants with low (<20 percentile) total brain volume and high (>20 percentile) white matter hyperintensity volume had a higher risk of stroke (HR, 1.97; 95% CI, 1.03–3.77 and HR, 2.74; 95% CI, 1.51–5.00, respectively) but not AD. Hippocampal volume at the bottom quintile predicted AD in the offspring and original cohorts (HR, 4.41; 95% CI, 2.00–9.72 and HR, 2.37; 95% CI, 1.12–5.00, respectively). A stepwise increase in stroke risk was apparent with increasing numbers of these cognitive and imaging markers.

Conclusions—

Specific patterns of cognitive and brain structural measures observed even in early aging predict stroke risk and may serve as biomarkers for risk prediction.
Imaging of Contrast Medium Extravasation in Anticoagulation-Associated Intracerebral Hemorrhage With Dual-Energy Computed Tomography
Authors: Won Sae-Yeon , Schlunk Frieder , Dinkel Julien , Karatas Hulya , Leung Wendy , Hayakawa Kazuhide , Lauer Arne , Steinmetz Helmuth , Lo Eng H. , Foerch Christian , Gupta Rajiv
Published: August 2013

Background and Purpose—

Contrast medium extravasation (CE) in intracerebral hemorrhage (ICH) is a marker of ongoing bleeding and a predictor of hematoma expansion. The aims of the study were to establish an ICH model in which CE can be quantified, characterized in ICH during warfarin and dabigatran anticoagulation, and to evaluate effects of prothrombin complex concentrates on CE in warfarin-associated ICH.

Methods—

CD1-mice were pretreated orally with warfarin, dabigatran, or vehicle. Prothrombin complex concentrates were administered in a subgroup of warfarin-treated mice. ICH was induced by stereotactic injection of collagenase VIIs into the right striatum. Contrast agent (350 μL Isovue 370 mg/mL) was injected intravenously after ICH induction (2–3.5 hours). Thirty minutes later, mice were euthanized, and CE was measured by quantifying the iodine content in the hematoma using dual-energy computed tomography.

Results—

The optimal time point for contrast injection was found to be 3 hours after ICH induction, allowing detection of both an increase and a decrease of CE using dual-energy computed tomography. CE was higher in the warfarin group compared with the controls (
P
=0.002). There was no significant difference in CE between dabigatran-treated mice and controls. CE was higher in the sham-treated warfarin group than in the prothrombin complex concentrates–treated warfarin group (
P
<0.001).

Conclusions—

Dual-energy computed tomography allows quantifying CE, as a marker of ongoing bleeding, in a model of anticoagulation-associated ICH. Dabigatran induces less CE in ICH than warfarin and consequently reduces risks of hematoma expansion. This constitutes a potential safety advantage of dabigatran over warfarin. Nevertheless, in case of warfarin anticoagulation, prothrombin complex concentrates reduce this side effect.
Population-Based Study of Disability and Institutionalization After Transient Ischemic Attack and Stroke
Authors: Luengo-Fernandez Ramon , Paul Nicola L.M. , Gray Alastair M. , Pendlebury Sarah T. , Bull Linda M. , Welch Sarah J.V. , Cuthbertson Fiona C. , Rothwell Peter M.
Published: August 2013

Background and Purpose—

Long-term outcome information after transient ischemic attack (TIA) and stroke is required to help plan and allocate care services. We evaluated the impact of TIA and stroke on disability and institutionalization over 5 years using data from a population-based study.

Methods—

Patients from a UK population-based cohort study (Oxford Vascular Study) were recruited from 2002 to 2007 and followed up to 2012. Patients were followed up at 1, 6, 12, 24, and 60 months postevent and assessed using the modified Rankin scale. A multivariate regression analysis was performed to assess the predictors of disability postevent.

Results—

A total of 748 index stroke and 440 TIA cases were studied. For patients with TIA, disability levels increased from 14% (63 of 440) premorbidly to 23% (60 of 256) at 5 years (
P
=0.002), with occurrence of subsequent stroke being a major predictor of disability. For stroke survivors, the proportion disabled (modified Rankin scale >2) increased from 21% (154 of 748) premorbidly to 43% (273 of 634) at 1 month (
P
<0.001), with 39% (132 of 339) of survivors disabled 5 years after stroke. Five years postevent, 70% (483 of 690) of patients with stroke and 48% (179 of 375) of patients with TIA were either dead or disabled. The 5-year risk of care home institutionalization was 11% after TIA and 19% after stroke. The average 5-year cost per institutionalized patient was $99 831 (SD, 67 020) for TIA and $125 359 (SD, 91 121) for stroke.

Conclusions—

Our results show that 70% of patients with stroke are either dead or disabled 5 years after the event. Thus, there remains considerable scope for improvements in acute treatment and secondary prevention to reduce postevent disability and institutionalization.
External Validation of the Secondary Intracerebral Hemorrhage Score in The Netherlands
Authors: van Asch Charlotte J.J. , Velthuis Birgitta K. , Greving Jacoba P. , van Laar Peter Jan , Rinkel Gabriël J.E. , Algra Ale , Klijn Catharina J.M.
Published: August 2013

Background and Purpose—

We aimed to validate externally in a setting outside the United States the secondary intracerebral hemorrhage (ICH) score that was developed to predict the probability of macrovascular causes in patients with nontraumatic ICH.

Methods—

Patients with nontraumatic ICH admitted to the University Medical Center Utrecht, the Netherlands, between 2003 and 2011 were included if an angiographic examination, neurosurgical inspection, or pathological examination had been performed. Secondary ICH score performance was assessed by calibration (agreement between predicted and observed outcomes) and discrimination (separation of those with and without macrovascular cause).

Results—

Forty-eight of 204 patients (23.5%) had a macrovascular cause. The secondary ICH score showed modest calibration (
P
=0.06) and modest discriminative ability (
c
-statistic 0.73; 95% confidence interval, 0.65–0.80). Discrimination improved slightly using only noncontrast computed tomography categorization (
c
-statistic 0.79; 95% confidence interval, 0.72–0.86).

Conclusions—

The discriminative ability and calibration of the secondary ICH score are moderate in a university hospital setting outside the United States. Clues on noncontrast computed tomography are the strongest predictor of a macrovascular cause in patients with ICH.
Custody Regulations in the United Arab Emirates: Legal Reforms and Social Realities
Authors: Möller Lena-Maria
Published: August 2013

Abstract

One major area of discussion during the 2005 process of initially codifying Muslim personal status law in the United Arab Emirates (UAE) were regulations regarding the divorced mother’s right to custody of her minor children. The new rules regarding the allocation and duration of female custodianship are the outcome of fiery debates amongst various actors involved in the codification process. The new codified custody rules differ from traditional Islamic law and concede large discretionary powers to the judiciary. The courts’ discretion in allocating custody is verbalized in the term “maṣ laḥat al-maḥḍūn” (the welfare of the child under custody). At the same time, courts in the UAE have thus far refrained from defining in clear terms what actually constitutes the child’s welfare. While one of the major aims of the codification of Muslim personal status law in the UAE was to guarantee legal certainty, the reformed custody regulations do not serve this purpose. They rather point towards the legislator’s will to put in force more flexible rules on custody which allow for the accommodation of changing societal needs and values.
Offended Christians, Anti-Mission Churches and Colonial Politics: One Man’s Story of the Messy Birth of the African Orthodox Church in Kenya
Authors: Black Joseph William
Published: August 2013

Abstract

Thomas Nganda Wangai’s personal account of the beginnings of the Orthodox Church in Kenya gives a first-hand narrative of the Kikuyu resistance to mission Christianity and mission-imposed education that led to the break with the mission churches and colonial-approved mission schools. The subsequent creation of the Kikuyu Independent Schools Association and the Kikuyu Karing’a Education Association as well as independent churches attempted to create a new identity outside the mission church establishment in colonial Kenya. This desire to remain Christian while throwing off the yoke of Western versions of Christianity led Nganda and other early leaders to seek out a nonmission form of Christianity that reflected the ancient purity of the early church. Nganda tells the story of how a schismatic archbishop of the African Orthodox Church provided the initial leadership for the nascent Orthodox movement. Nganda charts the interrelatedness of the search for an ecclesiastical identity and the decision to align with the Alexandrian Patriarchate and the growing political conflict with the Kenyan colonial authorities. The paper concludes with Nganda’s description of the Orthodox Church’s response to the declaration of Emergency in 1953, along with the hardship and suffering that the subsequent ten years of proscription imposed.
Taxonomic revision of Croton section Cleodora (Euphorbiaceae)
Authors: CARUZO MARIA BEATRIZ ROSSI , CORDEIRO INÊS
Published: August 2013

Croton section Cleodora is a Neotropical section disjunctly distributed in Mexico and Central America, northern and northwestern South America, and eastern Brazil. Eighteen species are recognized as belonging to the section, which is characterized mainly by an arborescent or shrubby habit, presence of clear or reddish latex, leaves with a pair of basilaminar or acropetiolar glands, pistillate flowers sepals with some degree of overlap, and 4-fid or multifid styles united at the base or above, usually forming a crown. We conduct a critical revision of Croton section Cleodora, congruent with the current understanding of its evolutionary history. We provide here an identification key for the two recognized subsections (Croton subsection Sphaerogyni and C. subsection Spruceani) and their species. Descriptions, illustrations, comments about taxonomy, habitat, geographic distribution and phenological information are provided for each species. Six lectotypes are here designated.
The identity of Damatris pudica and typification of Arctotis breviscapa (Asteraceae, Arctotideae)
Authors: MCKENZIE ROBERT JAMES , BARKER NIGEL P.
Published: August 2013

The Arctotidinae, a subtribe of the Arctotideae, comprises approximately 90–100 species predominantly confined to southern and eastern Africa. The species are presently classified into five genera: Arctotheca Vaillant (1754: 604), Arctotis Linnaeus (1753: 922), Cymbonotus Cassini (1825: 397), Dymondia Compton (1953: 110) and Haplocarpha Lessing (1831: 90) (Karis et al. 2009). Cassini (1817) published the genus Damatris Cassini (1817: 139) and described a single species, D. pudica Cassini (1817: 140), for a species of Arctotidinae collected from ‘le Cap de Bonne-Espérance’ (Cape of Good Hope, South Africa). Cassini (1819) stated that Damatris pudica was described from material in the Herbier de Jussieu (P-JU). However, the identity of Damatris pudica has always been uncertain. Initially, most authors listed the genus as either poorly known or of dubious status (e.g. Lessing 1832, Candolle 1838b, Harvey 1865). Bentham (1873) tentatively considered that Damatris might be congeneric with Haplocarpha and subsequently Beauverd (1915) made the combination for D. pudica in Haplocarpha without comment on the species’ identity (although marked with a question mark to indicate a degree of uncertainty). In the most recent monograph of Arctotidinae, Lewin (1922) followed Bentham in citing Damatris as a synonym of Haplocarpha but curiously did not cite D. pudica, either as an accepted species or in the synonymy of another species. Damatris has nomenclatural priority over Haplocarpha, therefore resolution of the identity of D. pudica may have nomenclatural implications for the generic taxonomy of Arctotidinae.
A new species of lizard in the genus Caledoniscincus (Reptilia: Scincidae) from southern New Caledonia and a review of Caledoniscincus atropunctatus (Roux)
Authors: SADLIER ROSS A. , BAUER AARON M. , WOOD PERRY Jr. L. , SMITH SARAH A. , JACKMAN TODD R.
Published: August 2013

A new species of skink, Caledoniscincus notialis sp. nov., is described from the ultramafic ranges in southern New Caledonia. It is most similar to, and has previously been referred to Caledoniscincus atropunctatus (Roux), a species with a widespread distribution throughout the Grand Terre and Loyalty Islands. The new species is distinct genetically from all other Caledoniscincus and can be distinguished by a unique pattern of dorsal coloration in males. Its range extends over much of the extensive ultramafic block in the south of the island, including the Goro Plateau and the mountain ranges at the southern edge of the Chaine Centrale north to Mt. Humboldt. It occurs mainly in humid forest habitat, much of which is now present only as isolated fragments in southern New Caledonia. Its preference for a habitat that has undergone a significant reduction in area of extent in a region under pressure from a range of anthropogenic threats suggests this new species is of conservation concern, and could be ranked as Vulnerable under IUCN listing. The genetic relationships of a redefined Caledoniscincus atropunctatus identifies two major subgroups, one located mainly in the northern and central-east regions of Grand Terre and the other in the southern and central-west regions and also including the population on the Loyalty Islands.
Aradidae from Vietnam I. Two new genera of micropterous Mezirinae (Hemiptera: Heteroptera: Aradidae)
Authors: HEISS ERNST
Published: August 2013

Two new micropterous genera and three species of micropterous Mezirinae are described and illustrated. Although of similar habitual appearance as the Oriental genus Hutanicoris Heiss 1993, the two new genera are distinguished at once by the unique structures of their metathoracic evaporatoria.
Neotype designation for Sinonamuropteris ningxiaensis Peng, Hong et Zhang, 2005 (Grylloblattida: Sinonamuropteridae)
Authors: CUI YINGYING , REN DONG
Published: August 2013

In contrast to the Permian period, grylloblattidan insects represent a small portion of the Carboniferous entomofaunas (Cui et al. 2011; Béthoux et al. 2010; Storozhenko 2002). The Xiaheyan locality (Tupo Formation; Ningxia, China) is no exception. The nine species of the family Sinonamuropteridae described by Peng et al. (2005) based on material from this locality, and each represented by a single isolated forewing, actually belong to a single species, namely Sinonamuropteris ningxiaensis Peng, Hong et Zhang, 2005 (Cui et al. 2011). To date, this is the only grylloblattidan species from the corresponding fauna, which is dominated by stem-Orthoptera (e.g., Prokop et al. 2007; Gu et al. 2011; Béthoux et al. 2012) and by a few other speciose groups, such as stem-Odonata (e.g., Li et al. 2013).
Theory and Observations of Controls on Lightning Flash Size Spectra
Authors: Bruning Eric C. , MacGorman Donald R.
Published: August 2013

Previous analyses of very high frequency (VHF) Lightning Mapping Array (LMA) observations relative to the location of deep convective updrafts have noted a systematic pattern in flash characteristics. In and near strong updrafts, flashes tend to be smaller and more frequent, while flashes far from strong vertical drafts exhibit the opposite tendency. This study quantitatively tests these past anecdotal observations using LMA data for two supercell storms that occurred in Oklahoma in 2004. The data support a prediction from electrostatics that frequent breakdown and large flash extents are opposed. An energetic scaling that combines flash rate and flash area exhibits a power-law scaling regime on scales of a few kilometers and a maximum in flash energy at about 10 km. The spectral shape is surprisingly consistent across a range of moderate to large flash rates. The shape of this lightning flash energy spectrum is similar to that expected of turbulent kinetic energy spectra in thunderstorms. In line with the hypothesized role of convective motions as the generator of thunderstorm electrical energy, the correspondence between kinematic and electrical energy spectra suggests that advection of charge-bearing precipitation by the storm’s flow, including in turbulent eddies, couples the electrical and kinematic properties of a thunderstorm.
A Diagnostic Evaluation of Precipitation in CORDEX Models over Southern Africa
Authors: Kalognomou Evangelia-Anna , Lennard Christopher , Shongwe Mxolisi , Pinto Izidine , Favre Alice , Kent Michael , Hewitson Bruce , Dosio Alessandro , Nikulin Grigory , Panitz Hans-Jürgen , Büchner Matthias
Published: August 2013

The authors evaluate the ability of 10 regional climate models (RCMs) to simulate precipitation over Southern Africa within the Coordinated Regional Climate Downscaling Experiment (CORDEX) framework. An ensemble of 10 regional climate simulations and the ensemble average is analyzed to evaluate the models' ability to reproduce seasonal and interannual regional climatic features over regions of the subcontinent. All the RCMs use a similar domain, have a spatial resolution of ~50 km, and are driven by the Interim ECMWF Re-Analysis (ERA-Interim; 1989–2008). Results are compared against a number of observational datasets.

In general, the spatial and temporal nature of rainfall over the region is captured by all RCMs, although individual models exhibit wet or dry biases over particular regions of the domain. Models generally produce lower seasonal variability of precipitation compared to observations and the magnitude of the variability varies in space and time. Model biases are related to model setup, simulated circulation anomalies, and moisture transport. The multimodel ensemble mean generally outperforms individual models, with bias magnitudes similar to differences across the observational datasets. In the northern parts of the domain, some of the RCMs and the ensemble average improve the precipitation climate compared to that of ERA-Interim. The models are generally able to capture the dry (wet) precipitation anomaly associated with El Niño (La Niña) events across the region. Based on this analysis, the authors suggest that the present set of RCMs can be used to provide useful information on climate projections of rainfall over Southern Africa.
Broadening the Spatial Applicability of Paleoclimate Information—A Case Study for the Murray–Darling Basin, Australia
Authors: Ho Michelle , Verdon-Kidd Danielle C. , Kiem Anthony S. , Drysdale Russell N.
Published: August 2013

Recent advances in the collection and analysis of paleoclimate data have provided significant insights into preinstrumental environmental events and processes, enabling a greater understanding of long-term environmental change and associated hydroclimatic risks. Unfortunately, it is often the case that there is a dearth of readily available paleoclimate data from regions where such insights and long-term data are most needed. The Murray–Darling basin (MDB), known as Australia’s “food bowl,” is an example of such a region where currently there are very limited in situ paleoclimate data available. While previous studies have utilized paleoclimate proxy records of large-scale climate mechanisms to infer preinstrumental MDB hydroclimatic variability, there is a lack of studies that utilize Australian terrestrial proxy records to garner similar information. Given the immediate need for improved understanding of MDB hydroclimatic variability, this paper identifies key locations in Australia where existing and as yet unrealized paleoclimate records will be most useful in reconstructing such information. To identify these key locations, rainfall relationships between MDB and non-MDB locations were explored through correlations and principal component analysis. An objective analysis using optimal interpolation was then used to pinpoint the most strategic locations to further develop proxy records and gain insights into the benefits of obtaining this additional information. The findings reveal that there is potential for the future assembly of high-resolution paleoclimate records in Australia capable of informing MDB rainfall variability, in particular southeast Australia and central-northern Australia. This study highlights the need for further investment in the development of these potential proxy sources to subsequently enable improved assessments of long-term hydroclimatic risks.
Comparing Limited-Area 3DVAR and Hybrid Variational-Ensemble Data Assimilation Methods for Typhoon Track Forecasts: Sensitivity to Outer Loops and Vortex Relocation
Authors: Schwartz Craig S. , Liu Zhiquan , Huang Xiang-Yu , Kuo Ying-Hwa , Fong Chin-Tzu
Published: August 2013

The Weather Research and Forecasting Model (WRF) “hybrid” variational-ensemble data assimilation (DA) algorithm was used to initialize WRF model forecasts of three tropical cyclones (TCs). The hybrid-initialized forecasts were compared to forecasts initialized by WRF's three-dimensional variational (3DVAR) DA system. An ensemble adjustment Kalman filter (EAKF) updated a 32-member WRF-based ensemble system that provided flow-dependent background error covariances for the hybrid. The 3DVAR, hybrid, and EAKF configurations cycled continuously for ~3.5 weeks and produced new analyses every 6 h that initialized 72-h WRF forecasts with 45-km horizontal grid spacing. Additionally, the impact of employing a TC relocation technique and using multiple outer loops (OLs) in the 3DVAR and hybrid minimizations were explored.

Model output was compared to conventional, dropwindsonde, and TC “best track” observations. On average, the hybrid produced superior forecasts compared to 3DVAR when only one OL was used during minimization. However, when three OLs were employed, 3DVAR forecasts were dramatically improved but the mean hybrid performance changed little. Additionally, incorporation of TC relocation within the cycling systems further improved the mean 3DVAR-initialized forecasts but the average hybrid-initialized forecasts were nearly unchanged.
An Early Performance Evaluation of the NEXRAD Dual-Polarization Radar Rainfall Estimates for Urban Flood Applications
Authors: Cunha Luciana K. , Smith James A. , Baeck Mary Lynn , Krajewski Witold F.
Published: August 2013

Dual-polarization radars are expected to provide better rainfall estimates than single-polarization radars because of their ability to characterize hydrometeor type. The goal of this study is to evaluate single- and dual-polarization radar rainfall fields based on two overlapping radars (Kansas City, Missouri, and Topeka, Kansas) and a dense rain gauge network in Kansas City. The study area is located at different distances from the two radars (23–72 km for Kansas City and 104–157 km for Topeka), allowing for the investigation of radar range effects. The temporal and spatial scales of radar rainfall uncertainty based on three significant rainfall events are also examined. It is concluded that the improvements in rainfall estimation achieved by polarimetric radars are not consistent for all events or radars. The nature of the improvement depends fundamentally on range-dependent sampling of the vertical structure of the storms and hydrometeor types. While polarimetric algorithms reduce range effects, they are not able to completely resolve issues associated with range-dependent sampling. Radar rainfall error is demonstrated to decrease as temporal and spatial scales increase. However, errors in the estimation of total storm accumulations based on polarimetric radars remain significant (up to 25%) for scales of approximately 650 km2.
The Obesity Paradox in Patients With Acute Coronary Syndrome
Authors: Shehab Abdulla , Al-Dabbagh Bayan , AlHabib Khalid , Alsheikh-Ali Alawi , Almahmeed Wael , Sulaiman Kadhim , Al-Motarreb Ahmed , Suwaidi Jassim Al , Hersi Ahmad , AlFaleh Hussam , Asaad Nidal , AlSaif Shukri , Amin Haitham , Alanbaei Muath , Nagelkerke Nicolaas , Abdulle Abdishakur
Published: August 2013

We investigated the association between in-hospital and peri-hospital mortality and body mass index (BMI)/waist circumference (WC) in a prospective acute coronary syndrome (ACS) registry in the Arabian Gulf. No significant associations with in-hospital mortality were found. Normal BMI had highest peri-hospital mortality, notably those with high WC. In logistic regression of mortality on obesity measures and potential confounders, the effects of obesity measures were no longer significant. In-hospital death increased by 5% with age and decreased by 42% in males. Mortality increased 3.7-fold with ST-elevation myocardial infarction (STEMI) and 3.0-fold with heart failure (HF) but decreased by 33% with dyslipidemia. Peri-hospital death increased by 4% with age and decreased by 30% in males. Mortality increased 2.8-fold with STEMI and 2.4-fold with HF. In- and peri-hospital mortality in ACS is significantly associated with age, gender, STEMI, HF, and dyslipidemia but not obesity measures.
Impact of blood collection method on first-trimester dried blood free Beta hCG and PAPP-A
Authors: Krantz David A , Carmichael Jonathan B
Published: August 2013

Background

Analysis of dried blood specimens has been an integral part of laboratory medicine dating back to the early 1960s when they were introduced as part of neonatal screening programs. More recently, they have been used in Down syndrome screening programmes. Dried blood spot specimens can be collected either by finger-stick or by traditional venipuncture and spotted onto filter paper. We sought to evaluate whether first-trimester free Beta hCG and PAPP-A multiples of the median (MoMs) were different in dried blood specimens collected via finger-stick compared to specimens collected via venipuncture.

Methods

A total of 2786 consecutive dried blood specimens were evaluated including 2144 collected using finger-stick and 644 specimens collected using venipuncture and spotted onto filter paper. Linear regression was used to assess the overall impact of collection method on dried blood free Beta hCG and PAPP-A and the impact of collection method on the trend of dried blood free Beta hCG and PAPP-A with transport time.

Results

For finger-stick and venipuncture, the median for free Beta hCG MoM was 0.99 and 1.04, respectively while the median PAPP-A MoM was 1.00 and 1.01, respectively. The regression formula for free Beta hCG was ln(MoM) = −0.00918 + 0.05112×Venipuncture + 0.00299×Days −0.00983×Days×Venipuncture and for PAPP-A the formula was ln(MoM) = −0.01000 + 0.04779×Venipuncture −0.00051×Days −0.02117×Days×Venipuncture. None of the coefficients were significant.

Conclusions

Collection method does not impact MoM values. Thus, centres have flexibility in the collection method utilized while being able to use a single reference database for all dried blood specimens.
Conversion to Twelver Shi‘ism among American and Canadian women
Authors: Inloes Amina , Takim Liyakat
Published: August 2013

Little research has been done on Western women who convert to Shi‘i Islam. To fill this gap, this study was conducted on American and Canadian women who have converted to Shi‘i Islam. Most of the research subjects in this study reported a moderate to severe sense of social marginalization after conversion. This marginalization resulted from membership in multiple minority groups (Shi‘i, Muslim, convert, and female); Black converts reported the most severe sense of marginalization due to the added pressure of being a racial minority in North America. Most of the research subjects also experienced a sense of social exclusion from other Shi‘i Muslims. Therefore, the question arises as to why these women continued to adhere to Shi‘i Islam despite these difficulties. This article will attempt to answer this question through an analysis of the data provided by the research subjects.
A Strategically Timed Verbal Task Improves Performance and Neurophysiological Alertness During Fatiguing Drives
Authors: Atchley Paul , Chan Mark , Gregersen Sabrina
Published: August 2013

Objective:

The objective of this study was to investigate if a verbal task can improve alertness and if performance changes are associated with changes in alertness as measured by EEG.

Background:

Previous research has shown that a secondary task can improve performance on a short, monotonous drive. The current work extends this by examining longer, fatiguing drives. The study also uses EEG to confirm that improved driving performance is concurrent with improved driver alertness.

Method:

A 90-min, monotonous simulator drive was used to place drivers in a fatigued state. Four secondary tasks were used: no verbal task, continuous verbal task, late verbal task, and a passive radio task.

Results:

When engaged in a secondary verbal task at the end of the drive, drivers showed improved lane-keeping performance and had improvements in neurophysiological measures of alertness.

Conclusion:

A strategically timed concurrent task can improve performance even for fatiguing drives.

Application:

Secondary-task countermeasures may prove useful for enhancing driving performance across a range of driving conditions.
Canada, NATO, and the Berlin Crisis, 1961–1962: “Slow-boil” or “pressure cooker?”
Authors: Sayle Timothy Andrews
Published: August 2013

Historians of Canadian foreign affairs have argued that Canada played an important role in influencing allied policy during the Berlin Crisis of 1961–1962. Newly declassified documents reveal the opposite. Canada opposed much of the North Atlantic Treaty Organization (NATO) contingency planning during the crisis, especially plans calling for the demonstrative use of nuclear weapons. Despite Canada’s efforts to modify NATO’s Berlin Contingency plans (BERCONs), Canadian diplomats found themselves isolated in the North Atlantic Council (NAC) and accepted plans they considered to be dangerous. Canada had no significant influence on NATO military planning during one of the most serious crises of the Cold War.
Frequency and nature of testicular and paratesticular lesions in forensic autopsies
Authors: de la Grandmaison Geoffroy Lorin , Marchaut Jéhanne , Watier Laurence , Médiouni Zakia , Charlier Philippe
Published: August 2013

The aim of our study was to determine the frequency and nature of testicular and paratesticular lesions in forensic autopsies. A retrospective study was carried out on 495 adult male cases that underwent forensic autopsy from January 2008 to December 2011 in our Department. For each case, the following parameters were reported: age, body mass index, nature of testicular and paratesticular lesions, associated lesions in external genitalia, testicle weight, cause of death, manner of death, resuscitation attempts and prior medical history. Mean age of the studied population was 47.8 years (range 18–96). Mean body mass index was 25.3 kg/m2 (range 15–46.2). Testicular lesions and/or paratesticular were found in 16.4% of the cases ( n = 81). The most frequent lesions were, respectively, testicular atrophy ( n = 38) and trauma ( n = 28). In three cases showing traumatic lesions, associated traumatic lesions were found in external genitalia. Most frequent cause of death was blunt trauma (19.9% of the cases). Manner of death most frequently associated with testicular trauma was, respectively, road traffic accident ( n = 11) and suicidal fall ( n = 6). Mean testicular weight was, respectively, 17.9 g for the right and 20.8 g for the left (range 2–38). Atrophy was associated with testicular weight less than 10 g. A significant association between testicular atrophy and age was found, the risk of atrophy increasing quite linearly with age. No significant statistical link between prior medical history and testicular pathology was found. There was also no influence of body mass index. Resuscitation attempts were not statistically associated with testicular traumatic lesions.
Neck pseudo-bruising secondary to acute aortic dissection
Authors: Advenier Anne-Sophie , Marchaut Jéhanne , de la Grandmaison Geoffroy Lorin
Published: August 2013

We report a case of lethal acute aortic dissection revealed by a large ecchymotic area at the root of the neck; the subject was an 86-year-old man who died suddenly in his hospital room. His medical history included ischemic heart disease with pacemaker implantation and an aortic surgical prosthesis. Forensic autopsy showed a major subcutaneous hemorrhage in the neck and large left pleural and pericardial adhesions secondary to thoracic surgery. The cause of death was an acute aortic dissection. Large adhesions led to an extensive mediastinal hemorrhage, spreading to the subcutaneous tissues of the neck. This case report highlights the difficulties in differentiating between traumatic and pseudo-bruising during a death scene investigation. The etiologies of pseudo-bruising are reviewed.
Applying the European Spatial Development Perspective in Low-density Regions: A Methodology Based on Mobility and Labour Market Structure
Authors: Pillet Félix , Cañizares M. Carmen , Ruiz A. Raúl , Martínez Héctor , Plaza Julio , Santos Jesús F.
Published: August 2013

The paper reflects on how ESDP (European Spatial Development Perspective) principles can be applied in territories with weak population patterns in quantitative terms. The ESDP defines a functional urban area (FUA) as the influence area of a city and sets a minimum threshold of 15,000 inhabitants for the city and 40,000 for the entire FUA. These thresholds are taken as guidelines to explore the concept of functional regions, adding more information from several sources. Hence the paper starts under the normative background given by EU spatial policy and proposes a methodology of analysis combining several techniques, including an application for the Castilla–La Mancha autonomous region (ES42 in NUTS 2). The approaches used in the method proposed include data from mobility, commuting, accessibility and qualitative analyses of services. The outcome shows how ESDP principles could be applied in practice in places with low-density settlement.
Optimising heating system structure using exergy Branch and Bound
Authors: Fisk DJ
Published: August 2013

To reduce work in assessing alternative system structures in low-energy design, a Branch and Bound method is proposed. The bound is based on exploiting the thermodynamic constraint of exergy destruction along a heat flow path. A novel derivation of exergy in a flow system is provided and used to show its fundamental relationship with temperature and primary energy. The method is applied to two simple systems.

Practical application: In novel low-energy design, there can be many structural solutions that meet the client brief, especially at early stages in design, before full simulation/optimisation can be efficiently applied. The technique presented offers an application of the Branch and Bound algorithm that can be implemented on a spread sheet and which usually reduces the number of full structural solutions that have to be produced. It relies on working in exergy as the metric rather than temperature, and the work explains why this approach, common in optimising services components, can be applied to heating systems.
Novel modulated flow, self configuring, siphonic roof drainage system
Authors: Campbell DP
Published: August 2013

Siphonic roof drainage systems are an efficient method of removing rainwater rapidly from roofs. Siphonic roof drainage systems are designed to run full-bore, resulting in sub-atmospheric system pressures, higher driving heads and higher system flow velocities. Hence, siphonic roof drainage systems normally require far fewer downpipes, and the depressurised conditions also mean that much of the collection pipework can be routed at high level, thus reducing the extent of any underground pipework. But, they work properly at only one roof run-off rate and therefore suffer from sizing and operational problems that limit their performance. Climate change is creating situations where normal ranges of rainfall intensity are being frequently exceeded, and this may have an impact on the performance of siphonic roof drainage systems. A multiple parallel pipe siphonic roof drainage system appears to offer benefits and avoids sizing problems associated with current siphonic roof drainage systems. A movable cap covering the inlet to a small bank of parallel pipes has the potential to avoid noise associated with making and breaking siphonic action through flow modulation. Laboratory scale tests demonstrate the basic feasibility of the multiple parallel pipe system and indicate that handover of flow between pipes occurs smoothly and that the flow modulation cap functions reliably. This technology includes moving parts and smaller diameters (19 mm ID) than are currently accepted (32 mm ID) in the British Standards and product development will be required.

Practical application: Original research detailing an innovative development of a multi-pipe siphonic roof drainage system. This provides a wide design flow rate range and flow modulation caps reduce noise significantly by avoiding priming failure. Potentially extends the technique to a smaller building size than with current siphonic systems and offers climate change resilience potential.