bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology
Authors: Paris Yvonne , Toro‐Salazar Olga H. , Gauthier Naomi S. , Rotondo Kathleen M. , Arnold Lucy , Hamershock Rose , Saudek David E. , Fulton David R. , Renaud Ashley , Alexander Mark E. ,   the New England Congenital Cardiology Association (NECCA)
Published: September 2018

Background

Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (
SCAMP
s).

Methods and Results

Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a
SCAMP
. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise‐related or more problematic symptoms. Guideline‐defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of
ECG
s and 11% of echocardiograms. The 10% returning for follow‐up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.

Conclusions

SCAMP
methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low‐severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.
Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis
Authors: Ekström Kaj , Lehtonen Jukka , Hänninen Helena , Kandolin Riina , Kivistö Sari , Kupari Markku 
Published: September 2018

Background
Cardiac magnetic resonance imaging has a key role in today's diagnosis of cardiac sarcoidosis. We set out to investigate whether cardiac magnetic resonance imaging also helps predict outcome in cardiac sarcoidosis.

Methods and Results

Our work involved 59 patients with cardiac sarcoidosis (38 female, mean age 46±10 years) seen at our hospital since February 2004 and followed up after contrast‐enhanced cardiac magnetic resonance imaging. The extent of myocardial late gadolinium enhancement (measured as percentage of left ventricular mass), the volumes and ejection fractions of the left and right ventricles, and the thickness of the basal interventricular septum were determined and analyzed for prognostic significance. By April 2015, 23 patients had reached the study's end point, consisting of a composite of cardiac death (n=3), cardiac transplantation (n=1), and occurrence of life‐threatening ventricular tachyarrhythmias (n=19; ventricular fibrillation in 5 and sustained ventricular tachycardia in 14 patients). In univariate analysis, myocardial extent of late gadolinium enhancement predicted event‐free survival, as did scar‐like thinning (<4 mm) of the basal interventricular septum and the ejection fraction of the right ventricle (
P
<0.05 for all). In multivariate Cox regression analysis, extent of late gadolinium enhancement was the only independent predictor of outcome events on cardiac magnetic resonance imaging, with a hazard ratio of 2.22 per tertile (95%
CI
1.07–4.59). An extent of late gadolinium enhancement >22% (third tertile) had positive and negative predictive values for serious cardiac events of 75% and 76%, respectively.

Conclusions
Findings on cardiac magnetic resonance imaging and the extent of myocardial late gadolinium enhancement in particular help predict serious cardiac events in cardiac sarcoidosis.
Diagnosing and Treating Sleep Apnea in Patients With Acute Cerebrovascular Disease
Authors: Bravata Dawn M. , Sico Jason , Vaz Fragoso Carlos A. , Miech Edward J. , Matthias Marianne S. , Lampert Rachel , Williams Linda S. , Concato John , Ivan Cristina S. , Fleck J. D. , Tobias Lauren , Austin Charles , Ferguson Jared , Radulescu Radu , Iannone Lynne , Ofner Susan , Taylor Stanley , Qin Li , Won Christine , Yaggi H. Klar 
Published: September 2018

Background

Obstructive sleep apnea (
OSA
) is common among patients with acute ischemic stroke and transient ischemic attack. We evaluated whether continuous positive airway pressure for
OSA
among patients with recent ischemic stroke or transient ischemic attack improved clinical outcomes.

Methods and Results

This randomized controlled trial among patients with ischemic stroke/transient ischemic attack compared 2 strategies (standard or enhanced) for the diagnosis and treatment of
OSA
versus usual care over 1 year. Primary outcomes were National Institutes of Health Stroke Scale and modified Rankin Scale scores. Among 252 patients (84, control; 86, standard; 82, enhanced),
OSA
prevalence was as follows: control, 69%; standard, 74%; and enhanced, 80%. Continuous positive airway pressure use occurred on average 50% of nights and was similar among standard (3.9±2.1 mean hours/nights used) and enhanced (4.3±2.4 hours/nights used;
P
=0.46) patients. In intention‐to‐treat analyses, changes in National Institutes of Health Stroke Scale and modified Rankin Scale scores were similar across groups. In as‐treated analyses among patients with OSA, increasing continuous positive airway pressure use was associated with improved National Institutes of Health Stroke Scale score (no/poor, −0.6±2.9; some, −0.9±1.4; good, −0.3±1.0;
P
=0.0064) and improved modified Rankin Scale score (no/poor, −0.3±1.5; some, −0.4±1.0; good, −0.9±1.2;
P
=0.0237). In shift analyses among patients with OSA, 59% of intervention patients had best neurological symptom severity (National Institutes of Health Stroke Scale score, 0–1) versus 38% of controls (
P
=0.038); absolute risk reduction was 21% (number needed to treat, 4.8).

Conclusions

Although changes in neurological functioning and functional status were similar across the groups in the intention‐to‐treat analyses, continuous positive airway pressure use was associated with improved neurological functioning among patients with acute ischemic stroke/transient ischemic attack with
OSA
.

Clinical Trial Registration

URL:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
01446913.
Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study
Authors: Gardener Hannah , Caunca Michelle , Dong Chuanhui , Cheung Ying Kuen , Alperin Noam , Rundek Tatjana , Elkind Mitchell S. V. , Wright Clinton B. , Sacco Ralph L. 
Published: September 2018

Background
The American Heart Association Life's Simple 7 metric defines ideal cardiovascular health (CVH) on 7 factors: smoking, diet, physical activity, body mass index, blood sugar, blood pressure, and cholesterol. This metric has been used to define optimal brain health, but data relative to subclinical imaging biomarkers of brain aging are lacking. This study examines the association between Life's Simple 7 with white matter hyperintensity volume, silent brain infarcts, and cerebral volume.

Methods and Results

A subsample of stroke‐free participants from the population‐based Northern Manhattan Study underwent brain magnetic resonance imaging an average of 7 years after baseline. Linear and logistic regression models were constructed to estimate associations between the number of ideal CVH metrics achieved with imaging biomarkers of brain aging, adjusting for sociodemographics. Among 1031 participants (mean age at magnetic resonance imaging=72±8, 40% men, 19% black, 16% white, and 65% Hispanic), no one had ideal status in all 7 factors, 1% had ideal status in 6 factors, 18% in 4 to 5 factors, 30% in 3 factors, 33% in 2 factors, and 18% in 0 to 1 factors. The number of ideal CVH factors achieved was inversely associated with white matter hyperintensity volume (beta per factor=−0.047;
P
=0.04) and silent brain infarct (odds ratio per factor=0.84; 95% confidence interval=0.72–0.97) and positively associated with cerebral volume (beta per factor=0.300;
P
=0.002).

Conclusions
An increasing ideal CVH score was associated with less white matter hyperintensity volume and silent brain infarcts and greater cerebral volumes, supporting the Life's Simple 7 metric as a useful measure to quantify optimal brain health. Monitoring and promoting achievement of Life's Simple 7 ideal CVH factors may improve subclinical and clinical brain health outcomes.
Determinants of Long‐Term Outcomes and Costs in the Management of Critical Limb Ischemia: A Population‐Based Cohort Study
Authors: Mustapha Jihad A. , Katzen Barry T. , Neville Richard F. , Lookstein Robert A. , Zeller Thomas , Miller Larry E. , Jaff Michael R. 
Published: September 2018

Background
The optimal treatment for critical limb ischemia remains controversial owing to conflicting conclusions from previous studies.

Methods and Results

We obtained administrative claims on Medicare beneficiaries with initial critical limb ischemia diagnosis in 2011. Clinical outcomes and healthcare costs over 4 years were estimated among all patients and by first treatment (endovascular revascularization, surgical revascularization, or major amputation) in unmatched and propensity‐score–matched samples. Among 72 199 patients with initial primary critical limb ischemia diagnosis in 2011, survival was 46% (median survival, 3.5 years) and freedom from major amputation was 87%. Among 9942 propensity‐score–matched patients (8% rest pain, 26% ulcer, and 66% gangrene), survival was 38% with endovascular revascularization (median survival, 2.7 years), 40% with surgical revascularization (median survival, 2.9 years), and 23% with major amputation (median survival, 1.3 years;
P
<0.001 for each revascularization procedure versus major amputation). Corresponding major amputation rates were 6.5%, 9.6%, and 10.6%, respectively (
P
<0.001 for all pair‐wise comparisons). The cost per patient year during follow‐up was $49 700, $49 200, and $55 700, respectively (
P
<0.001 for each revascularization procedure versus major amputation).

Conclusions
Long‐term survival and cost in critical limb ischemia management is comparable between revascularization techniques, with lower major amputation rates following endovascular revascularization. Primary major amputation results in shorter survival, higher risk of subsequent major amputation, and higher healthcare costs versus revascularization. Results from this observational research may be susceptible to bias because of the influence of unmeasured confounders.
Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization
Authors: Hussain Mohamad A. , Saposnik Gustavo , Raju Sneha , Salata Konrad , Mamdani Muhammad , Tu Jack V. , Bhatt Deepak L. , Verma Subodh , Al‐Omran Mohammed 
Published: September 2018

Background
Statins are commonly used for the prevention of cardiovascular events; however, statins are underutilized in patients with noncoronary atherosclerosis. We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and outcomes after carotid revascularization.

Methods and Results
In this population‐level retrospective cohort study, we identified all individuals aged ≥66 years who underwent carotid endarterectomy or stenting in Ontario, Canada (2002–2014). The primary outcome was a composite of 1‐year stroke, myocardial infarction, or death (major adverse cardiac and cerebrovascular events). Five‐year risks were also examined. Adjusted hazard ratios were computed using inverse probability of treatment weighting based on propensity scores. A total of 7893 of 10 723 patients (73.6%) who underwent carotid revascularization were on preprocedural statin therapy; moderate‐ or high‐dose therapy was utilized by 7384 patients (68.9%). The composite rate of 1‐year major adverse cardiac and cerebrovascular events was lower among statin users (adjusted hazard ratio: 0.76; 95% confidence interval, 0.70–0.83). Patients who were on persistent long‐term statin therapy after the carotid procedure continued to experience significantly lower risk of major adverse cardiac and cerebrovascular events at 5 years (adjusted hazard ratio: 0.75, 95% confidence interval, 0.71–0.80). The beneficial associations with statin use were observed regardless of type of carotid revascularization procedure, carotid artery symptom status, or statin dose.

Conclusions
Continuous statin therapy was associated with a 25% lower risk of long‐term adverse cardiovascular events in patients with significant carotid disease. Along with other supportive evidence, statins should be considered in patients undergoing carotid revascularization, and efforts are required to increase statin use in this undertreated population.
The Theory and Practice of Property in Premodern South Asia: Disparities and Convergences
Authors: Lubin Timothy 
Published: September 2018

AbstractThis article reviews the main scholastic norms relevant to property and land rights in ancient and medieval India, and then surveys a range of inscriptions that illustrate the contours of land law in practice. The evidence suggests that India developed a sophisticated concept of landed property from earliest history, with conceptual tools and legal instruments to define the rights of owners vis-à-vis rulers, rival claimants, and holders of subordinate interests (such as tenants, cultivators, mortgagees, etc.). It further shows that although earlier inscriptions deployed those tools and instruments in a narrow range of transfers between rulers and Brahmins or other religious groups, subsequent periods provide evidence of an increasingly wider application, including gifts by non-elite donors, ordinary contractual land transfers, and resolution of property disputes. In some cases, the implication seems to be that the legal framework was more widespread in practice but generated durable records (in metal or stone) only for elite actors; in many cases, it seems likely that elite legal resources became more widely available over time. This survey also notes how documents bring to the fore aspects of property law—the role of councils and arbitrators in administering the law (rather than the king or his officers), or the use of documents to carve out special rights—that are less prominent in scholastic treatments such as Dharmaśāstra.
Cross-Cultural Differences in Informal Argumentation: Norms, Inductive Biases and Evidentiality
Authors: Karaslaan Hatice , Hohenberger Annette , Demir Hilmi , Hall Simon , Oaksford Mike 
Published: September 2018

AbstractCross-cultural differences in argumentation may be explained by the use of different norms of reasoning. However, some norms derive from, presumably universal, mathematical laws. This inconsistency can be resolved, by considering that some norms of argumentation, like Bayes theorem, are mathematical functions. Systematic variation in the inputs may produce culture-dependent inductive biases although the function remains invariant. This hypothesis was tested by fitting a Bayesian model to data on informal argumentation from Turkish and English cultures, which linguistically mark evidence quality differently. The experiment varied evidential marking and informant reliability in argumentative dialogues and revealed cross-cultural differences for both independent variables. The Bayesian model fitted the data from both cultures well but there were differences in the parameters consistent with culture-specific inductive biases. These findings are related to current controversies over the universality of the norms of reasoning and the role of normative theories in the psychology of reasoning.
Receiver female body size and distances affect the claw-waving rate of signaller males in fiddler crabs (Brachyura, Ocypodidae)
Authors: Tina Fahmida W. , Jaroensutasinee M. , Jaroensutasinee K. 
Published: September 2018

AbstractWe tested for the first time howAustruca bengaliCrane, 1975 signaller males adjusted their waving rates based on receiver female body sizes and their distances. We video recorded the waving display of 46 males (9–12 mm carapace width) for 30 s, and counted their waving rate. Receiver females were categorised as small (8–10 mm carapace width) and large (>10 mm). Distances between males and females were categorised as short (⩽12 cm) and long (>12 cm) distances. Our results indicate that males are able to measure distances and female sizes, and adjust their waving display by actively reducing waving rate (1) towards small females, as usually small females have lower fecundity compared to large ones and (2) towards females at very close distance because at this point, the females would make their mating decision, and thus males start to lead/hit the females towards their burrow rather than waving vigorously.
Neutrality before Grotius: A City, a State and Seven Salt Ships in the Baltic (1564-1567)
Authors: Wubs-Mrozewicz Justyna 
Published: September 2018

Abstract
The article argues on the basis of a case from the 1560s in Danzig that prior to the formulation of the legal concept of neutrality by Hugo Grotius, there was a practice of neutrality. It was expressed in various terms and manners. This practice pertained to both cities and states, and the case discloses the first documented instance when the Netherlands explicitly strove for neutrality also by legal means. The choice for neutrality was rooted in political and economic interests and as such had advantages, but it was also fraught with difficulties. The analysis shows that the actual extent of neutrality depended on the acceptance (or lack thereof) of the warring parties. Also, by excluding the possibilities of the use of violence or economic means of pressure like blockades, neutrals were limited to diplomacy and law during conflicts. This lay the ground for the development of a legal concept of neutrality.
Features of Extreme Precipitation at Progress Station, Antarctica
Authors: Yu Lejiang , Yang Qinghua , Vihma Timo , Jagovkina Svetlana , Liu Jiping , Sun Qizhen , Li Yubin 
Published: September 2018

AbstractObserved daily precipitation data were used to investigate the characteristics of precipitation at Antarctic Progress Station and synoptic patterns associated with extreme precipitation events during the period 2003–16. The annual precipitation, annual number of extreme precipitation events, and amount of precipitation during the extreme events have positive trends. The distribution of precipitation at Progress Station is heavily skewed with a long tail of extreme dry days and a high peak of extreme wet days. The synoptic pattern associated with extreme precipitation events is a dipole structure of negative and positive height anomalies to the west and east of Progress Station, respectively, resulting in water vapor advection to the station. For the first time, we apply self-organizing maps (SOMs) to examine thermodynamic and dynamic perspectives of trends in the frequency of occurrence of Antarctic extreme precipitation events. The changes in thermodynamic (noncirculation) processes explain 80% of the trend, followed by the changes in the interaction between thermodynamic and dynamic processes, which account for nearly 25% of the trend. The changes in dynamic processes make a negative (less than 5%) contribution to the trend. The positive trend in total column water vapor over the Southern Ocean explains the change of thermodynamic term.
Mechanisms for Generation and Development of the Ningaloo Niño
Authors: Zhang Lei , Han Weiqing , Li Yuanlong , Shinoda Toshiaki 
Published: September 2018

AbstractGeneration and development mechanisms of the Ningaloo Niño are investigated using ocean and atmospheric general circulation model experiments. Consistent with previous studies, northerly wind anomalies off the West Australian coast are critical in generating warm sea surface temperature (SST) anomalies of the Ningaloo Niño, which induce SST warming through reduced turbulent heat loss toward the atmosphere (by decreasing surface wind speed), enhanced Leeuwin Current heat transport, and weakened coastal upwelling. Our results further reveal that northerly wind anomalies suppress the cold dry air transport from the Southern Ocean to the Ningaloo Niño region, which also contributes to the reduced turbulent heat loss. A positive cloud–radiation feedback is also found to play a role. Low stratiform cloud is reduced by the underlying warm SSTAs and the weakened air subsidence, which further enhances the SST warming by increasing downward solar radiation. The enhanced Indonesian Throughflow also contributes to the Ningaloo Niño, but only when La Niña co-occurs. Further analysis show that northerly wind anomalies along the West Australian coast can be generated by both remote forcing from the Pacific Ocean (i.e., La Niña) and internal processes of the Indian Ocean, such as the positive Indian Ocean dipole (IOD). Approximately 40% of the Ningaloo Niño events during 1950–2010 co-occurred with La Niña, and 30% co-occurred with positive IOD. There are also ~30% of the events independent of La Niña and positive IOD, suggesting the importance of other processes in triggering the Ningaloo Niño.
Benchmarking and Process Diagnostics of Land Models
Authors: Nearing Grey S. , Ruddell Benjamin L. , Clark Martyn P. , Nijssen Bart , Peters-Lidard Christa 
Published: September 2018

Abstract
We propose a conceptual and theoretical foundation for information-based model benchmarking and process diagnostics that provides diagnostic insight into model performance and model realism. We benchmark against a bounded estimate of the information contained in model inputs to obtain a bounded estimate of information lost due to model error, and we perform process-level diagnostics by taking differences between modeled versus observed transfer entropy networks. We use this methodology to reanalyze the recent Protocol for the Analysis of Land Surface Models (PALS) Land Surface Model Benchmarking Evaluation Project (PLUMBER) land model intercomparison project that includes the following models: CABLE, CH-TESSEL, COLA-SSiB, ISBA-SURFEX, JULES, Mosaic, Noah, and ORCHIDEE. We report that these models (i) use only roughly half of the information available from meteorological inputs about observed surface energy fluxes, (ii) do not use all information from meteorological inputs about long-term Budyko-type water balances, (iii) do not capture spatial heterogeneities in surface processes, and (iv) all suffer from similar patterns of process-level structural error. Because the PLUMBER intercomparison project did not report model parameter values, it is impossible to know whether process-level error patterns are due to model structural error or parameter error, although our proposed information-theoretic methodology could distinguish between these two issues if parameter values were reported. We conclude that there is room for significant improvement to the current generation of land models and their parameters. We also suggest two simple guidelines to make future community-wide model evaluation and intercomparison experiments more informative.