bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation
Authors: Kern Karl B. , Radsel Peter , Jentzer Jacob C. , Seder David B. , Lee Kwan S. , Lotun Kapildeo , Janardhanan Rajesh , Stub Dion , Hsu Chiu-Hsieh , Noc Marko 
Published: September 2020

Background:
The benefit of emergency coronary angiography after resuscitation from out-of-hospital cardiac arrest is uncertain for patients without ST-segment elevation. The aim of this randomized trial was to evaluate the efficacy and safety of early coronary angiography and to determine the prevalence of acute coronary occlusion in resuscitated patients with out-of-hospital cardiac arrest without ST-segment elevation.

Methods:
Adult (>18 years) comatose survivors without ST-segment elevation after resuscitation from out-of-hospital cardiac arrest were prospectively randomized in a 1:1 fashion under exception to informed consent regulations to early coronary angiography versus no early coronary angiography in this multicenter study. Early angiography was defined as ≤120 minutes from arrival at the percutaneous coronary intervention–capable facility. The primary end point was a composite of efficacy and safety measures, including efficacy measures of survival to discharge, favorable neurologic status at discharge (Cerebral Performance Category score ≤2), echocardiographic measures of left ventricular ejection fraction >50%, and a normal regional wall motion score of 16 within 24 hours of admission. Adverse events included rearrest, pulmonary edema on chest x-ray, acute renal dysfunction, bleeding requiring transfusion or intervention, hypotension (systolic arterial pressure ≤90 mm Hg), and pneumonia. Secondary end points included the incidence of culprit vessels with acute occlusion.

Results:

The study was terminated prematurely before enrolling the target number of patients. A total of 99 patients were enrolled from 2015 to 2018, including 75 with initially shockable rhythms. Forty-nine patients were randomized to early coronary angiography. The primary end point of efficacy and safety was not different between the 2 groups (55.1% versus 46.0%;
P
=0.64). Early coronary angiography was not associated with any significant increase in survival (55.1% versus 48.0%;
P
=0.55) or adverse events (26.5% versus 26.0%;
P
=1.00). Early coronary angiography revealed a culprit vessel in 47%, with a total of 14% of patients undergoing early coronary angiography having an acutely occluded culprit coronary artery.

Conclusions:
This underpowered study, when considered together with previous clinical trials, does not support early coronary angiography for comatose survivors of cardiac arrest without ST elevation. Whether early detection of occluded potential culprit arteries leads to interventions that improve outcomes requires additional study.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02387398.
Unsteady Vortex Behavior in the Asian Monsoon Anticyclone
Authors: Siu Leong Wai , Bowman Kenneth P. 
Published: September 2020

AbstractThe Asian monsoon anticyclone (AMA), which is primarily driven by the latent heat released by monsoon precipitation, is one of the dominant features of the Northern Hemisphere summer circulation in the upper troposphere and lower stratosphere. Due to variations in the diabatic heating, interactions with Rossby waves propagating along the subtropical jet, and internal dynamics within the anticyclone, the circulation of the AMA is unsteady. Here we use the ERA-Interim dataset and trajectories computed with ERA-Interim winds to show that the AMA contains two or three distinct synoptic-scale subvortices 69% of the time, while a single circulation center is present only 23% of the time. More than three simultaneous subvortices are uncommon. Observed behaviors of the subvortices include 1) splitting of a single vortex into two vortices; 2) merger of two vortices into a single vortex; 3) vortex shedding in the eastward direction; 4) vortex shedding in the westward direction; and 5) formation, movement, and dissipation of a vortex. The evolution of the subvortices is closely tied to stirring and transport.
The Western Alboran Gyre: An Analysis of Its Properties and Its Exchange with Surrounding Water
Authors: Brett Genevieve Jay , Pratt Larry J. , Rypina Irina I. , Sánchez-Garrido José C. 
Published: September 2020

AbstractOne of the largest and most persistent features in the Alboran Sea is the Western Alboran Gyre (WAG), an anticyclonic recirculation bounded by the Atlantic Jet (AJ) to the north and the Moroccan coast to the south. Eulerian budgets from several months of a high-resolution model run are used to examine the exchange of water across the Eulerian WAG’s boundary and the processes affecting the salinity, temperature, and vorticity of the WAG. The volume transport across the sides of the WAG is found to be related to vertical isopycnal movement at the base of the gyre. Advection is found to drive a decay in the salinity minimum and anticyclonic vorticity of the Eulerian WAG. Given the large contributions of advection, a Lagrangian analysis is performed, revealing geometric aspects of the exchange that are hidden in an Eulerian view. In particular, stable and unstable manifolds identify a stirring region around the outer reaches of the gyre where water is exchanged with the WAG on a time scale of weeks. Its complement is an inner core that expands with depth and exchanges water with its surroundings on much longer time scales. The 3D evolution of one parcel, or lobe, of water as it enters the WAG is also described, identifying a general Lagrangian subduction pathway.
Shocking Escape: A Cardiac Escape Room for Undergraduate Nursing Students
Authors: Morrell Briyana , Eukel Heidi N 
Published: September 2020

Background. Cardiovascular content is challenging for students to master in the undergraduate nursing curriculum. Educational escape rooms have been shown to be useful in increasing student knowledge, immersing students in the learning process, and facilitating the growth of soft skills among learners. Aim. This article details a cardiovascular educational escape room in an undergraduate nursing course, including educational objectives, design considerations, and all materials for seamless transferability into other curricula. Methods. Faculty designed, implemented, evaluated, and revised a nursing cardiovascular escape room over three years. In this sequential-style escape room, junior-level students worked together in groups to complete nine puzzles and activities. The student teams solved puzzles during the allotted 60 minutes to save a fictional patient at risk for further clinical deterioration related to cardiogenic shock. Participants complete activities including drug dosage calculations, rebus puzzles, multiple choice items, and clinical reasoning activities based around course and licensing objectives for the content area in nursing education. Upon game conclusion, faculty lead a guided debriefing to close the loop of learning. The escape room has been implemented for groups ranging from 31 to 68 students in each cohort. Results. Previously published results on this topic indicate that student content knowledge improved after the event. Students also reflected growth in confidence, critical thinking, and teamwork and also appreciated the real-life nature of the activity. The educational game can be adapted and transferred to other schools of nursing or clinical sites.
Caregiver Speaks Study Protocol: A Technologically-Mediated Storytelling Intervention for Hospice Family Caregivers of Persons Living With Dementia
Authors: Rolbiecki Abigail J. , Oliver Debra Parker , Teti Michelle , Washington Karla T. , Benson Jacquelyn J. , Kruse Robin L. , Smith Jamie , Demiris George , Ersek Mary , Mehr David R. 
Published: September 2020

Objective: We present the protocol of a study aiming to examine the efficacy of a technologically-mediated storytelling intervention called Caregiver Speaks in reducing distress and grief intensity experienced by active and bereaved hospice family caregivers of persons living with dementia (PLWD). Design: The study is a mixed-method, 2-group, randomized controlled trial. Setting: This study takes place in 5 hospice agencies in the Midwest and Northeastern United States. Participants: Participants include hospice family caregivers of PLWD. Intervention: Participants are randomized to usual hospice care or the intervention group. In the Caregiver Speaks intervention, caregivers engage in photo-elicitation storytelling (sharing photos that capture their thoughts, feelings, and reactions to caregiving and bereavement) via a privately facilitated Facebook group. This intervention will longitudinally follow caregivers from active caregiving into bereavement. The usual care group continues to receive hospice care but does not participate in the online group. Outcomes Measured: We anticipate enrolling 468 participants. Our primary outcomes of interest are participant depression and anxiety, which are measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder screening (GAD-7). Our secondary outcomes of interest are participants’ perceived social support, measured by the Perceived Social Support for Caregiving (PSSC) scale, and grief intensity, which is measured by the Texas Revised Inventory of Grief Present Subscale (TRIG-Present).
Maxillary Protraction Therapy in Class III Patients With and Without Cleft Lip and Palate: An Interim Report of a Prospective Comparative Study
Authors: Lin Yifan , Fu Zhen , Guo Runzhi , Ma Lian , Li Weiran 
Published: September 2020

Objective: To investigate and compare the effects of maxillary protraction therapy on Class III patients with unilateral cleft lip and palate (UCLP) and Class III patients with noncleft. Design: Prospective controlled clinical trial. Patients: Twenty-six Class III patients with UCLP (mean age: 10.32 ± 1.29 years) and 26 Class III patients with noncleft (mean age: 9.82 ± 1.03 years) were included and treated with maxillary protraction therapy. Interventions: Maxillary protraction therapy was performed with an intraoral Hyrax appliance and extraoral facemask. Cone beam computed tomography scans were taken before and after treatment. Pretreatment skeletal and dental characteristics and treatment changes were analyzed and compared. Results: The average treatment duration was 18.44 ± 4.16 months in the UCLP group, which was substantially longer than the 12.46 ± 4.03-month average treatment duration in the noncleft group ( P < .001). No significant difference was found in the maxillary changes (length, advancement of point A, and SNA angle) and improvement of intermaxillary relationship (ANB angle) between the 2 groups. The UCLP group had 1.40° more mandibular clockwise rotation ( P = .034). Regarding dental changes, the UCLP group had more upper incisor proclination ( P = .006) and less lower incisor retroclination ( P = .023). Conclusions: Approximately extended maxillary protraction therapy in patients with UCLP could be as effective as in patients with noncleft. Further study is required to follow patients until completion of growth to elucidate the long-term stability of the treatment.
Long-term results of autologous plasma as adjuvant to pars plana vitrectomy in the treatment of high myopic full-thickness macular holes
Authors: Figueroa Marta S , Mora Cantallops Arnau , Virgili Gianni , Govetto Andrea 
Published: September 2020

Background: To analyse the feasibility and efficacy of a novel autologous plasma rich in growth factor (PRGF) preparation as adjuvant to pars plana vitrectomy and internal limiting membrane peel in high myopic full-thickness macular hole (FTMH). Methods: Single-centre, single-surgeon retrospective chart review of consecutive patients with high myopic FTMH who underwent surgery with a minimum follow-up of 12 months. Patients were divided in group 1 (naïve) and group 2 (persistent). Quantitative and qualitative variables were analysed, compared among groups and correlated with best corrected visual acuity (BCVA). Results: Postoperatively, FTMH resolved in 28/31 eyes in group 1 (90%) and in 10/11 eyes in group 2 (91%), without significant differences ( p = 0.954). None of the preoperative anatomical variables analysed showed significant association with preoperative BCVA. Intraoperatively, no significant complications were registered. Postoperatively, BCVA improved significantly in the studied population ( p < 0.001). Preoperative factors associated with better postoperative BCVA were the presence of intraretinal cystoid spaces ( p = 0.028) and elevated FTMH borders ( p = 0.005). Preoperative dome-shaped macula was associated with significantly worse postoperative BCVA ( p = 0.049). Conclusion: The use of PRGF as adjuvant to vitrectomy showed to be reproducible, straightforward and efficient, with primary anatomical success rate comparable to other surgical approaches and lower risk of complications.
Different risk factors are associated with vascular access patency after construction and percutaneous transluminal angioplasty in patients starting hemodialysis
Authors: Yoshida Mahoko , Doi Shigehiro , Nakashima Ayumu , Kyuden Yasufumi , Kawai Toru , Kawaoka Koichiro , Takahashi Shunsuke , Ueno Toshinori , Nishizawa Yoshiko , Masaki Takao 
Published: September 2020

Background: The objective of this multicenter, prospective observational study was to determine the factors related to patency rates after construction of vascular access (VA) and the first percutaneous transluminal angioplasty (PTA). Methods: The 24-month primary and secondary patency rates after construction of a radiocephalic arteriovenous fistula (RC-AVF) and arteriovenous graft (AVG) were evaluated using the Kaplan–Meier method and log-rank test. The 12-month post-PTA patency rate was also investigated. A Cox proportional hazard model was used to identify clinical parameters associated with the primary patency rate and the post-PTA patency rate. Results: A total of 611 patients were enrolled in the study. The primary patency rate after VA construction was lower in hemodialysis (HD) patients with an AVG than in those with an AVF. Aging (hazard ratio [HR], 1.02 per 1 year; p < 0.001), female sex (HR, 1.41; p = 0.03), diabetes mellitus (HR, 1.37; p = 0.03), low serum albumin (HR, 0.76 per 1-g/dL decrease; p = 0.02), and use of an erythropoietin-stimulating agent (HR, 1.62; p = 0.02) were risk factors for VA problems. The post-PTA patency rate was associated with aging (HR, 1.02; p < 0.001), diabetes mellitus (HR, 1.49; p = 0.02), polycystic kidney disease (HR, 2.14; p = 0.01), temporary catheter use for initiation of HD (HR, 1.60; p = 0.02), and period from VA construction to use (HR, 0.99; p = 0.04). Conclusion: Although a poor patency rate is commonly associated with advanced age and diabetes, different risk factors affect patency between VA construction and the first PTA.
Risk of orthostatic hypotension associated with sodium-glucose cotransporter-2 inhibitor treatment: A meta-analysis of randomized controlled trials
Authors: Rong Xi , Li Xinran , Gou Qiling , Liu Kai , Chen Xiaoping 
Published: September 2020

Objective: The aim of this study was to assess the association between sodium-glucose cotransporter-2 (SGLT2) inhibitors and the risk of orthostatic hypotension (OH) in patients with type 2 diabetes mellitus (T2DM). Method: A systematic literature retrieval was performed using PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception up to 16 October 2019. Data for study characteristics and outcomes of interest were extracted from each eligible study. Pooled risk ratios (RRs) with 95% confidence intervals (CI) for OH were calculated using a random-effects model. Result: A total of 16 studies ( n = 12,749) were included in our meta-analysis, with a result of 44 incident OH cases (29 in the SGLT2 inhibitor group, and 15 in the control group). The pooled RR was 1.17 (95% CI: 0.65–2.09). There was no evidence that receiving SGLT2 inhibitors increased the risk of OH, when stratified by age, duration of T2DM, or placebo-control or active-control and baseline blood pressure. Conclusion: This meta-analysis suggested that, in general, SGLPT2 inhibitors did not increase the risk of OH in patients with T2DM. The possibility of OH should be, therefore, considered on an individual basis, especially in patients with a history of OH, long duration of T2DM, or comorbidities.
Application of Community-Based Social Marketing (CBSM) to Increase Recycling Behavior (RB) in Primary Schools
Authors: Haghighatjoo Sahar , Tahmasebi Rahim , Noroozi Azita 
Published: September 2020

Background: Recycling and waste separation is one of the most important policies for the management of municipal solid waste, and notwithstanding the importance of recycling especially at the school age, little research have been conducted in this field. Focus of the Article: In this quasi-experimental study, five steps of community-based social marketing (CBSM) were used for changing of the recycling behavior (RB). Research Question: Do CBSM strategies increase use of recycling containers versus the sole availability of containers? Program Design/Approach: The intervention was implemented in five steps and through seven CBSM strategies that include communication, social diffusion, convenience, incentives, social norms, commitment, and prompts. Importance to the Social Marketing Field: Since the RB will be influenced by environmental context, it cannot be assumed that application of CBSM theory is effective in school field. Therefore, the findings of this study are used to determine the effectiveness of environmental changes based on CBSM theory in the school field. Method: One thousand four hundred fifty-three male and female students from fourth to sixth grade in Bushehr, Iran, were evaluated in intervention and control groups from December 2018 to May 2019. In intervention group, CBSM steps were implemented, and in the control group, only blue bins and containers for recyclable materials were provided. To assess behavior change, a questionnaire consisting of three sections of demographic information, knowledge, and barrier questions was used. RB was evaluated by daily weighing waste and recyclable materials (separated) in two groups from 10 days before to 4 months after intervention. The data were analyzed using Statistical Package for Social Sciences (Version 16.0). Results: Results reveal that CBSM based strategies increased knowledge in the intervention group versus the control group. Also, CBSM strategies significantly increased the amount of recycling and reduced the waste in the intervention group. The results of this study showed that the sole availability of containers does not increase RB and reduce waste; applying CBSM based strategies is very useful and effective in removing barriers and increasing RB in schools. Recommendation for Research: It is recommended to compare the effectiveness of the application of only some CBSM strategies such as social norms, incentives, and diffusion versus all CBSM strategies for changing of RB in school setting. Limitation: A limitations of this study is that the number of students in the two groups is not the same due to the random selection of schools. Additionally, we could not control for students’ textbook content on recycling.
Patient-Related Risk Factors Associated With Surgical Site Complications After Elective Hand Surgery
Authors: Youngman Tyler , Del Core Michael , Benage Timothy , Koehler Daniel , Sammer Douglas , Golden Ann 
Published: September 2020

Background: The purpose of this study was to identify independent risk factors associated with an increased rate of surgical site complications after elective hand surgery. Methods: This study is a retrospective review of all patients who underwent elective hand, wrist, forearm, and elbow surgery over a 10-year period at a single institution. Electronic medical records were reviewed, and information regarding patient demographics, past medical and social history, perioperative laboratory values, procedures performed, and surgical complications was collected. Surgical site complications included surgical site infections, seromas or hematomas, and delayed wound healing or wound dehiscence. A univariate analysis was then performed to identify potential risk factors, which were then included in a multivariate regression analysis. Results: A total of 3261 patients who underwent elective hand surgery and met the above inclusion and exclusion criteria were included in this study. The mean age was 57 years, with 65% female and 35% male patients. The overall surgical complication rate was 2.2%. Univariate analysis of patient factors identified male sex; number of procedures >1; history of drug, alcohol, or smoking use; American Society of Anesthesiologists (ASA) class III and IV; and serum albumin <3.5 mg/dL to be significantly associated with complications. However, multivariate regression analysis identified that only ASA class III and IV (odds ratio = 3.27) was significantly associated with surgical complications. Conclusions: Patients classified as ASA class III or IV were identified to be at a significantly increased risk of complications following elective hand surgery. Health factors which triage patients into these 2 groups may represent potentially modifiable factors to mitigate perioperative risk in the elective hand surgery population.
Determinants of uterine rupture among mothers who gave birth in Jinka and Arba Minch General Hospitals, institution-based case–control study, Southern Ethiopia, Ethiopia, 2019
Authors: Girmay Goitom , Gultie Teklemariam , Gebremichael Gebrekiros , Afework Bezawit , Temesgen Gebremariam 
Published: September 2020

Background: Uterine rupture is a major public health problem in low-income countries including Ethiopia. In Ethiopia, its prevalence is low, but it results in devastative health problems of the mother and her baby. Even though the Ethiopian government and nongovernmental organizations tried to strengthen the health care system, significant adverse maternal and fetal outcome is still associated with uterine rupture. The aim of this study was to identify determinants of uterine rupture in Jinka and Arba Minch General Hospitals. Methods: The study was conducted in Jinka and Arba Minch General Hospitals, and the data collection period was 15 to 30 November 2018. A case–control study design was used with simple random sampling of 1:4. Data were collected using data extraction sheets. Variables with p < 0.25 in bivariate logistic regression were entered into multivariable logistic regression. Variables with p < 0.05 in multivariable logistic regression were used to determine significant association between dependent and independent variables. Result: Uterine rupture occurred in 112 cases with 448 controls. Women referred from health facilities (adjusted odds ratio = 8.0, 95% confidence interval: 3.5–17.8), multiparous women (adjusted odds ratio = 12.7, 95% confidence interval: 4.2–39.0), duration of labor more than 18 h (adjusted odds ratio = 11.5, 95% confidence interval: 5.5–24.1), malpresentation (adjusted odds ratio = 3.5, 95% confidence interval: 1.0–8.0) and gestational age of ⩾37 weeks (adjusted odds ratio = 5.2, 95% confidence interval: 1.4–19.3) were independent factors associated with uterine rupture. Conclusion: Mothers referred from health facilities, multiparous women, duration of labor more than 18 h, gestational age of ⩾37 weeks and malpresentation were significantly associated with uterine rupture. Early referral, encouraging family planning, proper use of partograph, early identification and appropriate intervention for malpresentation are recommended.