bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention Therapy
Authors: Navar Ann Marie , Wang Tracy Y. , Li Shuang , Mi Xiaojuan , Li Zhuokai , Robinson Jennifer G. , Virani Salim S. , Peterson Eric D. 
Published: January 2021

Background:
Cardiovascular prevention guidelines use estimated 10-year atherosclerotic cardiovascular disease (CVD) risk based on the pooled cohort equations to guide treatment decisions and engage patients in shared decision-making. We sought to determine patient perceived versus actual risk of atherosclerotic CVD and associations with willingness for preventive therapy.

Methods:
We evaluated calculated and perceived CVD risk among 4187 patients across 124 sites in the Patient and Provider Assessment of Lipid Management Registry. Ten-year risk was assessed using the pooled cohort equations; risk relative-to-peers was determined based on age-, sex-, and race-based percentiles; and patient estimates of risk were assessed using patient surveys. Poisson regression models evaluated associations between risk estimates, statin use, and willingness to take prevention therapy.

Results:

Overall, there was no correlation between patients’ estimates of their 10-year CVD risk and calculated 10-year risk (ρ=−0.01,
P
correlation
=0.46), regardless of age, sex, race, or socioeconomic status. The majority (72.2%) overestimated their 10-year CVD risk relative to the pooled cohorts equation (mean perceived 33.3% versus mean calculated 17.1%,
P
difference
<0.01). Patients’ perceptions of their risk relative-to-peers were slightly correlated with standardized risk percentiles (ρ=0.19,
P
<0.01), although most had overly optimistic views of how risk compared with their peers. Increasing perceived risk was not associated with current statin use (
P
=0.18) but was associated with willingness to consider future prevention therapy (
P
<0.01). Perceived risk relative-to-peers was associated with increased prevalent statin use (risk ratio 1.04 per category increase [95% CI, 1.02–1.06]) and reported willingness for prevention therapy (risk ratio 1.11 [95% CI, 1.07–1.16]).

Conclusions:
When asked, most patients overestimate their 10-year risk but hold an optimistic bias of their risk relative to age-, race-, and sex-matched peers. Providing accurate absolute risk assessments to patients without proper context may paradoxically decrease many patients’ perceived risk of CVD, thereby disincentivizing initiation of CVD risk reduction therapy.
Clinical Efficacy and Safety of Alirocumab After Acute Coronary Syndrome According to Achieved Level of Low-Density Lipoprotein Cholesterol
Authors: Schwartz Gregory G. , Gabriel Steg Philippe , Bhatt Deepak L. , Bittner Vera A. , Diaz Rafael , Goodman Shaun G. , Jukema J. Wouter , Kim Yong-Un , Li Qian H. , Manvelian Garen , Pordy Robert , Sourdille Timothée , White Harvey D. , Szarek Michael ,   For the ODYSSEY OUTCOMES Committees and Investigators
Published: January 2021

Background:
Recent international guidelines have lowered recommended target levels of low-density lipoprotein cholesterol (LDL-C) for patients at very high risk for major adverse cardiovascular events (MACE). However, uncertainty persists whether additional benefit results from achieved LDL-C levels below the conventional targets. Inferences from previous analyses are limited because patients who achieve lower versus higher LDL-C on lipid-lowering therapy differ in other characteristics prognostic for MACE and because few achieved very low LDL-C levels. To overcome these limitations, we performed a propensity score–matching analysis of the ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) which compared alirocumab with placebo in 18 924 patients with recent acute coronary syndrome receiving intensive or maximum-tolerated statin treatment.

Methods:
Patients on alirocumab were classified in prespecified strata of LDL-C achieved at 4 months of treatment: <25 (n=3357), 25 to 50 (n=3692), or >50 mg/dL (n=2197). For each stratum, MACE (coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or hospitalization for unstable angina) after month 4 was compared in patients receiving placebo with similar baseline characteristics and adherence by using 1:1 propensity score matching.

Results:
Across achieved LDL-C strata of the alirocumab group, patients differed by baseline LDL-C, lipoprotein(a), use of intensive statin therapy, study medication adherence, and other demographic, medical history, biometric, and laboratory criteria. After propensity score matching, characteristics were similar in corresponding patients of the alirocumab and placebo groups. Treatment hazard ratio, 95% CI, and absolute risk reduction (number per 100 patient-years) for MACE were similar in those with achieved LDL-C <25 mg/dL (hazard ratio, 0.74 [95% CI, 0.62–0.89]; absolute risk reduction, 0.92) or 25 to 50 mg/dL (hazard ratio, 0.74 [95% CI, 0.64–0.87]; absolute risk reduction, 1.05). Patients with achieved LDL-C >50 mg/dL had poorer adherence and derived less benefit (hazard ratio, 0.87 [95% CI, 0.73–1.04]; absolute risk reduction, 0.62). No safety concerns were associated with a limited period of LDL-C levels <15 mg/dL.

Conclusions:
After accounting for differences in baseline characteristics and adherence, patients treated with alirocumab who achieved LDL-C levels <25 mg/dL had a reduction in the risk of MACE that was similar to that of patients who achieved LDL-C levels of 25 to 50 mg/dL.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01663402.
Regional Energy and Water Budget of a Precipitating Atmosphere over Ocean
Authors: Kato Seiji , Loeb Norman G. , Fasullo John T. , Trenberth Kevin E. , Lauritzen Peter H. , Rose Fred G. , Rutan David A. , Satoh Masaki 
Published: January 2021

AbstractEffects of water mass imbalance and hydrometeor transport on the enthalpy flux and water phase on diabatic heating rate in computing the regional energy and water budget of the atmosphere over ocean are investigated. Equations of energy and water budget of the atmospheric column that explicitly consider the velocity of liquid and ice cloud particles, and rain and snow are formulated by separating water variables from dry air. Differences of energy budget equations formulated in this study from those used in earlier studies are that 1) diabatic heating rate depends on water phase, 2) diabatic heating due to net condensation of nonprecipitating hydrometeors is included, and 3) hydrometeors can be advected with a different velocity from the dry-air velocity. Convergence of water vapor associated with phase change and horizontal transport of hydrometeors is to increase diabatic heating in the atmospheric column where hydrometeors are formed and exported and to reduce energy where hydrometeors are imported and evaporated. The process can improve the regional energy and water mass balance when energy data products are integrated. Effects of enthalpy transport associated with water mass transport through the surface are cooling to the atmosphere and warming to the ocean when the enthalpy is averaged over the global ocean. There is no net effect to the atmosphere and ocean columns combined. While precipitation phase changes the regional diabatic heating rate up to 15 W m−2, the dependence of the global mean value on the temperature threshold of melting snow to form rain is less than 1 W m−2.
The Evolution and Arrest of a Turbulent Stratified Oceanic Bottom Boundary Layer over a Slope: Upslope Regime and PV Dynamics
Authors: Ruan Xiaozhou , Thompson Andrew F. , Taylor John R. 
Published: January 2021

AbstractThe influence of a sloping bottom and stratification on the evolution of an oceanic bottom boundary layer (BBL) in the presence of a mean flow is explored. As a complement to an earlier study by Ruan et al. (https://doi.org/10.1175/JPO-D-18-0079.1) examining Ekman arrest in a downslope regime, this paper describes turbulence and BBL dynamics during Ekman arrest in the upslope regime. In the upslope regime, an enhanced stratification develops in response to the upslope Ekman transport and suppresses turbulence. Using a suite of large-eddy simulations, we show that the BBL evolution can be described in a self-similar framework based on a nondimensional number X/Xa. This nondimensional number is defined as the ratio between the lateral displacement of density surfaces across the slope X and a displacement Xa required for Ekman arrest; the latter can be predicted from external parameters. Additionally, the evolution of the depth-integrated potential vorticity is considered in both upslope and downslope regimes. The PV destruction rate in the downslope regime is found to be twice the production rate in the upslope regime, using the same definition for the bottom mixed layer thickness. It is shown that this asymmetry is associated with the depth scale over which turbulent stresses are active. These results are a step toward improving parameterizations of BBL properties and evolution over sloping topography in coarse-resolution ocean models.
Is Postextracapsular Tonsillectomy Bleeding More Common on the Side of the Surgeon’s Nondominant Hand?
Authors: Masalha Muhamed , DeRowe Are , Landsberg Roee , Mazzawi Salim , Shlizerman Lev , Kassem Firas , Fadel Adam 
Published: January 2021

ObjectivesTo determine the difference in bleeding when extracapsular tonsillectomy with electrocautery is performed on the dominant and nondominant side of the surgeon’s hands.Study DesignRetrospective cohort study.SettingAcademic university hospital.MethodsMedical record data of patients who were admitted with posttonsillectomy bleeding from January 1, 2000, to July 31, 2017, were reviewed. Included were age, sex, surgical indication, side of posttonsillectomy bleeding, and time of bleeding. Information on the surgeon’s dominant hand was also collected. All patients underwent total extracapsular resection with electrocautery.ResultsOf 280 patients, 186 met the inclusion criteria, 116 (62.3%) males and 70 (37.7%) females. Ages ranged from 2 to 74 years (mean ± SD, 17 ± 13 years; median, 13 years). In 136 cases (73.1%), bleeding was on the side of the surgeon’s nondominant hand (P <. 0001). In 50 (26.9%) cases, bleeding was on the side of the surgeon’s dominant hand. The odds ratio of bleeding on the side of the surgeon’s nondominant hand compared to the dominant hand was 8.99.ConclusionThe risk of bleeding following extracapsular tonsillectomy with electrocautery on the side of the surgeon’s nondominant hand is significantly higher than on the side of the dominant hand. Thus, additional caution is required when operating on the nondominant side of the oral cavity in extracapsular tonsillectomy using electrocautery. These findings raise questions regarding dexterity as a risk factor for posttonsillectomy bleeding.
Tracheotomy in COVID‐19 Patients: A Systematic Review and Meta‐analysis of Weaning, Decannulation, and Survival
Authors: Benito Daniel A. , Bestourous Daniel E. , Tong Jane Y. , Pasick Luke J. , Sataloff Robert T. 
Published: January 2021

ObjectivesA systematic review and meta‐analysis was conducted to determine the cumulative incidences of decannulation and mechanical ventilation weaning in patients with coronavirus disease 2019 (COVID‐19) who have undergone a tracheotomy. Weighted average mean times to tracheotomy, to decannulation, and to death were calculated from reported or approximated means.Data SourcesPubMed, SCOPUS, CINAHL, and the Cochrane library.Review MethodsStudies were screened by 3 investigators independently. Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines were followed. Studies including patients with COVID‐19 who underwent a tracheotomy were identified. Studies without reported mechanical ventilation weaning or decannulation were excluded. Data were pooled using a random‐effects model.ResultsAfter identifying 232 unique studies, 18 articles encompassing outcomes for 3234 patients were ultimately included for meta‐analysis, with a weighted mean follow‐up time of 28.6 ± 6.2 days after tracheotomy. Meta‐analysis revealed that 55.0% of tracheotomized patients were weaned successfully from mechanical ventilation (95% CI, 47.4%‐62.2%). Approximately 34.9% of patients were decannulated successfully, with a mean decannulation time of 18.6 ± 5.7 days after tracheotomy. The pooled mortality in tracheotomized patients with COVID‐19 was 13.1%, with a mean time of death of 13.0 ± 4.0 days following tracheotomy.ConclusionAt the current state of the coronavirus pandemic, over half of patients who have required tracheotomies are being weaned off of mechanical ventilation. While 13.1% patients have died prior to decannulation, over a third of all tracheotomized patients with COVID‐19 reported in the literature have undergone successful decannulation.
Overnight radiology resident discrepancies at a large pediatric hospital: categorization by year of training, program, imaging modality, and report type
Authors: Dinh Mary L , Yazdani Rana , Godiyal Nikhil , Pfeifer Cory M 
Published: January 2021

Background Overnight radiology resident discrepancies have been described in multiple studies; however, study of resident discrepancies specific to pediatric radiology is limited. Purpose To examine radiology resident discrepancies as they pertain to a large pediatric hospital system. Material and Methods A total of 21,560 preliminary reports issued by 39 residents over a one-year period were scored as agreement, minor discrepancy, or major discrepancy by faculty members using a modification of the 2009 RADPEER scoring system. Residents were trainees of three different diagnostic radiology programs: large university-based, medium-sized community-based, or small community-based. Discrepancy rates were evaluated based on resident postgraduate year, program, and imaging modality. The effect of a general pediatric radiology report versus pediatric neuroradiology report of a CT scan was also tested. CT was the only modality in which there were comparable numbers of studies scored by both general pediatric radiologists and neuroradiologists. Results The rate of major resident to faculty assessment discrepancies was 1.01%, and the rate of minor resident to faculty assessment discrepancies was 4.47%. Major discrepancy rates by postgraduate years 3-5 were 1.08%, 0.75%, and 1.59%, respectively. Major discrepancy rates were highest for MR (11.22%), followed by CT (1.82%), radiographs (0.91%), and ultrasound (0.56%). There was no significant difference in discrepancy rate between residency programs and general pediatric radiology report of a CT versus pediatric neuroradiology report of a CT. Conclusion Radiology discrepancy rates for residents issuing preliminary reports at a large children’s hospital system are similar to those reported for adult procedures.
Use of Disproportionality Analysis to Identify Previously Unknown Drug-Associated Causes of Cardiac Arrhythmias Using the Food and Drug Administration Adverse Event Reporting System (FAERS) Database
Authors: Moreland-Head Lindsay N. , Coons James C. , Seybert Amy L. , Gray Matthew P. , Kane-Gill Sandra L. 
Published: January 2021

Introduction: Drug-induced QTc-prolongation is a well-known adverse drug reaction (ADR), however there is limited knowledge of other drug-induced arrhythmias. Purpose: The objective of this study is to determine the drugs reported to be associated with arrhythmias other than QTc-prolongation using the FAERS database, possibly identifying potential drug causes that have not been reported previously. Methods: FAERS reports from 2004 quarter 1 through 2019 quarter 1 were combined to create a dataset of approximately 11.6 million reports. Search terms for arrhythmias of interest were selected from the Standardized MedDRA Queries (SMQ) Version 12.0. Frequency of the cardiac arrhythmias were determined for atrial fibrillation, atrioventricular block, bradyarrhythmia, bundle branch block, supraventricular tachycardia, and ventricular fibrillation and linked to the reported causal medications. Reports were further categorized by prior evidence associations using package inserts and established drug databases. A reporting odds ratio (ROR) and confidence interval (CI) were calculated for the ADRs for each drug and each of the 6 cardiac arrhythmias. Results: Of the 11.6 million reports in the FAERS database, 68,989 were specific to cardiac arrhythmias of interest. There were 61 identified medication-reported arrhythmia pairs for the 6 arrhythmia groups with 33 found to have an unknown reported association. Rosiglitazone was the most frequently medication reported across all arrhythmias [ROR 6.02 (CI: 5.82-6.22)]. Other medications with significant findings included: rofecoxib, digoxin, alendronate, lenalidomide, dronedarone, zoledronic acid, adalimumab, dabigatran, and interferon beta-1b. Conclusion: Upon retrospective analysis of the FAERS database, the majority of drug-associated arrhythmias reported were unknown suggesting new potential drug causes. Cardiac arrhythmias other than QTc prolongation are a new area of focus for pharmacovigilance and medication safety. Consideration of future studies should be given to using the FAERS database as a timely pharmacovigilance tool to identify unknown adverse events of medications.
Unleashing the power of immunotherapy and targeted therapy combinations: Advancing cancer care or discovering unknown toxicities?
Authors: Przybylski Daniel J , Bergsbaken Jason J , Piccolo Jennifer K 
Published: January 2021

Objective The purpose of this review was to summarize the triumphs and pitfalls of tyrosine kinase inhibitor (TKI) and immune checkpoint inhibitor (ICI) combinations. Data sources: A literature review of PubMed was conducted and studies were included if they were classified as a clinical trial and assessed TKI and ICI combinations for solid tumor malignancies. Dates of literature search included January 1, 1988 through September 22, 2019. Data summary: In the past decade, TKI and ICI monotherapy strategies have changed the management of many advanced solid tumors through their unique mechanisms of action. Preclinical data suggests that TKIs may be able to sensitize tumors to ICI therapy via direct and indirect pathways; however, optimal mechanisms to support various TKI and ICI combinations have yet to be determined. The FDA recently approved TKI and ICI combinations for renal cell carcinoma, endometrial carcinoma, and melanoma. Several other tumor types currently have TKI and immunotherapy combinations under investigation with mixed results. Dual therapy with TKIs and immunotherapy have the potential to be synergistic and improve patient outcomes; however, careful consideration will need to be taken in regard to what TKI and immunotherapy are combined. Conclusions Future research will be needed to determine appropriate sequencing of TKIs and ICIs after progression on combination therapy. Continued research is necessary to determine optimal dual TKI and immunotherapy options.
Feline abdominal ultrasonography: what’s normal? what’s abnormal? The adrenal glands
Authors: Griffin Sally 
Published: January 2021

Practical relevance: Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism. Clinical challenges: Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging. Aim: This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. Equipment: Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. Evidence base: Information provided in this article is drawn from the published literature and the author’s own clinical experience.
Comparative responsiveness of the health utilities index and the RAND-12 for multiple sclerosis
Authors: Marrie Ruth Ann , Leung Stella , Cutter Gary R , Fox Robert J , Salter Amber 
Published: January 2021

Background: Outcome measures need to be valid and have good test–retest reliability and responsiveness. We compared the responsiveness of the RAND-12 and the Health Utilities Index—mark III (HUI3) in persons with multiple sclerosis (MS). Methods: In Spring 2018 and 2019, North American Research Committee on Multiple Sclerosis (NARCOMS) registry participants completed the HUI3, the RAND-12, and reported disability (Patient Determined Disease Steps (PDDS)) and employment status (full-time, part-time, and no). We used changes in PDDS and employment status as anchors. We assessed responsiveness using effect size, standardized response mean, and the responsiveness index. We used relative efficiency (RE) to compare the responsiveness of the health-related quality of life (HRQOL) scores, adjusting for sociodemographic factors. Results: We included 4769 participants in the analysis. They had a mean (standard deviation (SD)) age of 60.9 (10.1) years, and 3826 participants (80.2%) were women. RE was highest for the HUI3 for changes in in disability status (HUI3: 1.0, Physical Component Score-12 (PCS-12): 0.80, and Mental Component Score-12 (MCS-12): 0.41) and for changes in employment status (HUI3: 1.0, PCS-12: 0.70, and MCS-12: 0.17). Conclusion: The HUI3 was more responsive to changes in disability and employment status than the PCS-12 or MCS-12. Given the HUI3’s other strong psychometric properties, it may be the preferred generic measure of HRQOL in MS.
Early age of onset predicts severity of visual impairment in patients with neuromyelitis optica spectrum disorder
Authors: Macaron Gabrielle , Khoury Jean , Bena James , Seay Meagan , Bermel Robert A , Cohen Jeffrey A , Rensel Mary R 
Published: January 2021

Background: Severe residual visual loss (SRVL) is frequent in neuromyelitis optica spectrum disorders (NMOSD). Identifying higher-risk patients at onset is important to prevent disability accumulation. Objective: To determine predictors of SRVL in a large NMOSD cohort. Methods: Patient characteristics at last visual acuity (VA) evaluation were retrospectively collected. VA was scored 0: better than 20/40, 1: 20/40–20/99, 2: 20/100–20/200, and 3: worse than 20/200. SRVL was defined as a combined score (VA worst + best eye) ⩾ 4. Descriptive statistics were used to compare groups and logistic regression to evaluate predictors of VA. Results: 106 patients (mean age at disease onset (AO): 35.8 ± 16.5 years) were included. Patients with SRVL had earlier AO (mean: 26.7 vs 38.0 years) compared to non-SRVL group ( p = 0.005). Patients with AO < 21 years were more likely to have SRVL, be blind, present with binocular optic neuritis, have recurrent optic neuritis, and receive oral therapy first-line than those with AO ⩾ 21. After adjusting for race, sex, and disease duration, the odds of SRVL were 4.68 times higher in patients < 21 at disease onset (95% CI: 1.53–14.34, p = 0.007). Conclusion: Early AO predicts SRVL in NMOSD, independent of disease duration. High-efficacy therapies should be considered for first-line treatment in this group.