bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Department Volume and Outcomes for Patients After Chest Pain Assessment
Authors: Ko Dennis T. , Dattani Neil D. , Austin Peter C. , Schull Michael J. , Ross Joseph S. , Wijeysundera Harindra C. , Tu Jack V. , Eberg Maria , Koh Maria , Krumholz Harlan M. 
Published: October 2018

Background:
Chest pain is one of the most common reasons for emergency department (ED) visits in developed countries. Whether higher volume EDs have better outcomes, specifically for patients with chest pain, is unknown and pertinent.

Methods and Results:
We conducted a study using population-based data on 498 291 patients ≥40 years old, presenting to ED in Ontario, Canada from 2008 to 2014, with chest pain and were discharged after assessment. We evaluated processes of care after discharge from ED. The primary outcome was a composite of all-cause death or hospitalization for acute coronary syndrome. Hierarchical logistic regression models adjusting for potential confounding variables were used to evaluate the association of annual ED chest pain volume and outcome. We also determined if there was a volume threshold above which an increased ED volume was not associated with a lower adverse outcome. The mean age of our patients was 59 years, 46.7% were men, and 20% had diabetes mellitus. Patients discharged from higher volume EDs had higher rates of cardiologist consultations, cardiac medication use, and cardiac testing within 30 days of ED assessment. Higher ED volume was associated with significantly lower adjusted odds ratio for mortality or acute coronary syndrome (odds ratio, 0.87; 95% CI, 0.82–0.92 per each unit increase in the log of volume) at 30 days and at 1 year (odds ratio, 0.92; 95% CI, 0.88–0.92). Once the annual ED chest pain volume reached 1400 cases (95% CI, 910–1900), an increase of annual chest pain volume of 100 was associated with relative decrease in the odds of the composite outcome at 30 days of <1%.

Conclusions:
Evaluations of chest pain in EDs with higher chest pain volume had lower rates of death or hospitalizations for acute coronary syndrome. There was a volume threshold above which an increase in volume was no longer associated with reduced outcomes.
God of Abraham, God of Aristotle: Soloveitchik’s Reading of The Guide of the Perplexed
Authors: Sztuden Alex 
Published: October 2018

Abstract
R. Joseph Soloveitchik’s profound engagement with The Guide of the Perplexed is amply attested by Lawrence Kaplan’s recent publication of Soloveitchik’s lectures on this classic work of Jewish philosophy, delivered in 1950–1951 during a year-long course on the Guide. Soloveitchik’s reading is situated outside the boundaries of the Guide’s usual interpretations, and his lectures offer an entirely new view of the essence of the Guide. For Maimonides, hesed, or loving-kindness, is the foundation of the world. Soloveitchik’s lectures offer an elaborate working out of this fundamental insight.
“The East within Us”: Leo Strauss’s Reinterpretation of Heidegger
Authors: McIlwain David 
Published: October 2018

Abstract
Leo Strauss’s grand theme, the theological-political problem, has its basis in the predicament of being a philosopher in a political society. As a Jew and a philosopher, Strauss also faced the entanglement of Judaism and German philosophy culminating in Heidegger’s historicism. These related challenges prompted Strauss’s recognition of the first steps for philosophy in a global epoch. Strauss reinterpreted Heidegger’s religious anticipation of a “meeting of East and West” as a philosophical re-encounter with the Bible as “the East within us.” Whereas the Bible challenges the rationality of the philosophical way of life, this “Bible as Eastern” challenges rationalism itself.
The Evolution and Modernisation of Treaty Regimes
Authors: Bewley-Taylor David R. , Fitzmaurice Malgosia 
Published: October 2018

Abstract
The UN based framework for international drug control, described as the global drug prohibition regime, has displayed some capacity to evolve. This is the case both in terms of formal structures and accompanying norms. Recent moves by a small number of jurisdictions towards the legal regulation of cannabis for non-medical and non-scientific purposes has, however, highlighted the existence of systemic inertia in the face of unprecedented challenge. The resultant obstacles and accompanying recourse by states to creative legal argumentation contrasts with approaches found within the regime for environmental regulation and its underpinning Multilateral Environmental Agreements (MEAs). In this case a variety of structures and bodies characterise a more dynamic and responsive framework. It is argued here that while we should be alert to issue area specificity, much can be learned from MEAs and their regime evolution, in relation to governance structures and the use of Conferences of the Parties.
Interannual Agulhas Leakage Variability and Its Regional Climate Imprints
Authors: Cheng Yu , Beal Lisa M. , Kirtman Ben P. , Putrasahan Dian 
Published: October 2018

AbstractWe investigate the interannual variability of Agulhas leakage in an ocean-eddy-resolving coupled simulation and characterize its influence on regional climate. Many observational leakage estimates are based on the study of Agulhas rings, whereas recent model studies suggest that rings and eddies carry less than half of leakage transport. While leakage variability is dominated by eddies at seasonal time scales, the noneddy leakage transport is likely to be constrained by large-scale forcing at longer time scales. To investigate this, leakage transport is quantified using an offline Lagrangian particle tracking approach. We decompose the velocity field into eddying and large-scale fields and then recreate a number of total velocity fields by modifying the eddying component to assess the dependence of leakage variability on the eddies. We find that the resulting leakage time series show strong coherence at periods longer than 1000 days and that 50% of the variance at interannual time scales is linked to the smoothed, large-scale field. As shown previously in ocean models, we find Agulhas leakage variability to be related to a meridional shift and/or strengthening of the westerlies. High leakage periods are associated with east–west contrasting patterns of sea surface temperature, surface heat fluxes, and convective rainfall, with positive anomalies over the retroflection region and negative anomalies within the Indian Ocean to the east. High leakage periods are also related to reduced inland convective rainfall over southeastern Africa in austral summer.
Intraseasonal Variability of the Equatorial Undercurrent in the Indian Ocean
Authors: Chen Gengxin , Han Weiqing , Li Yuanlong , Yao Jinglong , Wang Dongxiao 
Published: October 2018

AbstractBy analyzing in situ observations and conducting a series of ocean general circulation model experiments, this study investigates the physical processes controlling intraseasonal variability (ISV) of the Equatorial Undercurrent (EUC) of the Indian Ocean. ISV of the EUC leads to time-varying water exchanges between the western and eastern equatorial Indian Ocean. For the 2001–14 period, standard deviations of the EUC transport variability are 1.92 and 1.77 Sv (1 Sv ≡ 106 m3 s−1) in the eastern and western basins, respectively. The ISV of the EUC is predominantly caused by the wind forcing effect of atmospheric intraseasonal oscillations (ISOs) but through dramatically different ocean dynamical processes in the eastern and western basins. The stronger ISV in the eastern basin is dominated by the reflected Rossby waves associated with intraseasonal equatorial zonal wind forcing. It takes 20–30 days to set up an intraseasonal EUC anomaly through the Kelvin and Rossby waves associated with the first and second baroclinic modes. In the western basin, the peak intraseasonal EUC anomaly is generated by the zonal pressure gradient force, which is set up by radiating equatorial Kelvin and Rossby waves induced by the equatorial wind stress. Directly forced and reflected Rossby waves from the eastern basin propagate westward, contributing to intraseasonal zonal current near the surface but having weak impact on the peak ISV of the EUC.
A New Hurricane Wind Direction Retrieval Method for SAR Images without Hurricane Eye
Authors: Gao Yuan , Guan Changlong , Sun Jian , Xie Lian 
Published: October 2018

AbstractThis study presents a new approach for hurricane wind direction retrieval utilizing rainband streaks contained in synthetic aperture radar (SAR) images without hurricane eye information, based on the hurricane inflow angle. To calculate the wind direction field, a method for estimating the location of the hurricane center is given. In this paper, four Sentinel-1A (S-1A) images with a hurricane eye are used to clarify the center estimation method. Three S-1A SAR images without a hurricane eye are studied to evaluate the accuracy of the new method. The estimated locations of hurricane centers show good agreement with hurricane track data provided by the National Oceanic and Atmospheric Administration (NOAA)’s Atlantic Oceanographic and Meteorological Laboratory (AOML) Hurricane Research Division (HRD), HurricaneCity, and the National Institute of Informatics (NII). To validate the estimated wind directions, the NOAA HRD dropwindsonde observations for Tropical Storm Karl are collected and compared. The wind directions retrieved by our approach are more consistent with visual inspection than the fast Fourier transform (FFT) method in subimages. Moreover, the retrieved wind speeds utilizing C-band model 5.N (CMOD5.N) are compared with wind speed estimations observed by Stepped Frequency Microwave Radiometer (SFMR). The results suggest that the proposed method has good potential to retrieve hurricane wind direction from SAR images without a hurricane eye and external data.
Incidence, Epidemiology, and Outcomes of Pediatric Tracheostomy in the United States from 2000 to 2012
Authors: Muller R. Grant , Mamidala Madhu P. , Smith Samuel H. , Smith Aaron , Sheyn Anthony 
Published: October 2018

ObjectivesTo investigate national and regional variations in pediatric tracheostomy rates, epidemiology, and outcomes from 2000 to 2012.Study DesignRetrospective cohort analysis.SettingPrevious research with the 1997 edition of the Kids’ Inpatient Database (KID), a national database of pediatric hospital discharge data, demonstrated that rates and outcomes of pediatric tracheostomy vary among US geographic regions. The KID has since been released an additional 5 times, increasing in size with successive editions.Subjects and MethodsPatients ≤18 years old with procedure codes for permanent or temporary tracheostomy from 2000 to 2012 were included. Primary outcome was a weighted population‐based rate of tracheostomy stratified by year. Secondary analysis included epidemiologic characteristics and outcomes stratified by year and geographic region.ResultsA weighted total of 24,354 cases was analyzed. Population‐based tracheostomy rates decreased from 6.8 ± 0.2 (mean ± SD) tracheostomies per 100,000 child‐years in 2000 to 6.0 ± 0.2 in 2012. Minorities increased from 53.3% in 2000 to 56.4% in 2012. Patients experienced increased procedures, diagnoses, length of stay, and hospital charges with time. From 2000 to 2012, rates and outcomes varied by US geographic region. Mortality during hospitalization (8%) did not vary by year, patient age, region, or sex.ConclusionsPediatric tracheostomy is associated with variation in incidence, epidemiology, and hospitalization outcomes in the United States from 2000 to 2012. While rates of pediatric tracheostomy decreased, patients became increasingly medically complicated and ethnically diverse with outcomes varying according to geographic region.
Surgical management of early and late esophageal perforation
Authors: Fattahi Masoom Seyed Hossein , Nouri Dalouee Marziyeh , Fattahi Asieh Sadat , Hajebi Khaniki Saeedeh 
Published: October 2018

Introduction Esophageal perforation is a rare and life-threating problem with a 10%–40% mortality rate. Early diagnosis and treatment are important for prevention of complications. Strategies for treatment of esophageal perforation have been controversial for many years, especially in cases of late presentation. Methods We prospectively studied 27 patients (12 male, 17 female, mean age 42.7 ± 17.8 years) who presented with esophageal perforation from 1996 to 2015, and evaluated the results of surgical treatment. The patients were divided into 3 groups according to time of presentation: early (<24 h), intermediate (24–72 h), and late (>72 h). We also considered the etiology and site of esophageal perforation, complications, and mortality. Results Surgery was performed in 5 patients in the early group, 7 in the moderate group, and 15 in the late group. Primary repair was carried out in 5 cases, primary repair and reinforcement with a flap in 10, esophageal resection and reconstruction in 8, and a T-tube stent was used in 4. Four patients developed a fistula postoperatively, and there was one death due to respiratory failure. No relationship was found between complications and the cause of perforation, time of presentation, or type of treatment. Conclusion In patients without sepsis, primary repair can be an option even in those presenting late after esophageal perforation, with an acceptable result.
Comparing polymer-filled versus self-expanding endografts in Chinese patients
Authors: Law Yuk , Chan Yiu Che , Cheng Stephen Wing-Keung 
Published: October 2018

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.
The effects of 12-month administration of tofogliflozin on electrolytes and dehydration in mainly elderly Japanese patients with type 2 diabetes mellitus
Authors: Higashikawa Toshihiro , Ito Tomohiko , Mizuno Takurou , Ishigami Keiichirou , Kohori Masaru , Mae Kunihiro , Sangen Ryusho , Usuda Daisuke , Saito Atsushi , Iguchi Masaharu , Kasamaki Yuji , Fukuda Akihiro , Saito Hitoshi , Kanda Tsugiyasu , Okuro Masashi 
Published: October 2018

Objective To assess the effect of 12 months of treatment with tofogliflozin on electrolytes and dehydration in Japanese patients with type 2 diabetes mellitus (T2DM) Methods This retrospective study involved mainly elderly patients with T2DM who had received tofogliflozin for 12 months. Data on glycated haemoglobin (HbA1c), serum electrolytes (sodium, potassium, chloride), haematocrit, estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN)/creatinine ratio were retrieved and analysed. Results Data from 69 patients (77% of whom were ≥65 years) showed that there was a significant reduction in HbA1c over the 12-month treatment period with tofogliflozin. However, the drug had no significant effect on levels of haematocrit, electrolytes, eGFR or BUN/creatinine ratio. Conclusion This retrospective analysis of data from mainly elderly Japanese patients with T2DM showed that 12-month administration of tofogliflozin exhibited glucose-lowering capabilities with accompanying low risk of electrolyte abnormalities and dehydration.
Prospective Associations Between Play Environments and Pediatric Obesity
Authors: Fitzpatrick Caroline , Alexander Stephanie , Henderson Melanie , Barnett Tracie A. 
Published: October 2018

Purpose: To identify school typologies based on the availability of play equipment and installations. We also examined the associations between availability of play items and child adiposity. Design: Secondary analysis of longitudinal data. Setting: Elementary schools in Montreal, Canada. Participants: We used data from the Quebec Adipose and Lifestyle Investigation in Youth study (QUALITY), an ongoing investigation of the natural history of obesity and type 2 diabetes in Quebec children of Caucasian descent. Measures: The presence of play items was assessed in each child’s school. A trained nurse directly assessed child anthropometric measurements to derive body mass index and waist circumference. Body fat composition was measured using DEXA Prodigy Bone Densitometer System. Analyses: The final analytic sample comprised 512 students clustered in 296 schools (81% response). We used K-cluster analyses to identify school typologies based on the variety of play items on school grounds. Generalized estimation equations were used to estimate associations between school clusters and outcomes. Results: We identified 4 distinct school typologies. Children in schools with the most varied indoor play environments had lower overall body fat, B = −1.26 cm (95% confidence interval [CI], −2.28 to −0.24 cm), and smaller waist circumference, B = −4.42 cm (95% CI, −7.88 to −0.96 cm), compared to children with the least varied indoor play environment. Conclusion: Our results suggest that policies regulating the availability of play items in schools may enrich comprehensive school-based obesity prevention strategies. Extending research in this area to diverse populations is warranted.
Utility of neutrophil gelatinase-associated lipocalin in the management of acute kidney injury: A prospective, observational study
Authors: Işıkkent Ali , Yılmaz Serkan , Özturan İbrahim Ulaş , Doğan Nurettin Özgür , Yaka Elif , Gültekin Haldun , Kum Tuğba , Pekdemir Murat 
Published: October 2018

Background:Utilization of renal biomarkers such as neutrophil gelatinase-associated lipocalin in the management of acute kidney injury may be useful as a diagnostic tool in the emergency department.Objective:The aim of this study is to determine the relationship between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury based on the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification, and to investigate the role of the serum neutrophil gelatinase-associated lipocalin level in differentiating the etiology and predicting the 30-day mortality rate and need for dialysis.Methods:This prospective, observational study was conducted from March 2015 to 2016. Adult patients with acute kidney injury in the emergency department were enrolled in the study. Demographic and clinical features such as hypovolemic state, nephrotoxic substance exposure, renal functions, and serum neutrophil gelatinase-associated lipocalin level were evaluated. After the etiology of the acute kidney injury was ascertained, the severity of the acute kidney injury was determined according to RIFLE criteria. Primary outcome was defined as the correlation between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury according to RIFLE classification. Secondary outcomes were defined as the relationship between the serum neutrophil gelatinase-associated lipocalin level and the etiology of the acute kidney injury; need for dialysis and 30-day mortality were defined as poor outcomes.Results:A total of 87 patients were included in the study. Mean serum neutrophil gelatinase-associated lipocalin levels were 380.14 ± 276.65 ng/mL in RIFLE-R, 425.80 ± 278.99 ng/mL in RIFLE-I, and 403.60 ± 293.15 ng/mL in RIFLE-F groups. There was no statistically significant relationship between the severity of acute kidney injuries and serum neutrophil gelatinase-associated lipocalin level. Initial serum neutrophil gelatinase-associated lipocalin levels in the emergency department did not indicate a statistically significant ability to predict the etiology of acute kidney injury, 30-day mortality rates, or need for dialysis.Conclusion:Initial serum neutrophil gelatinase-associated lipocalin level in the emergency department is not a determinant tool for predicting the severity, etiology, 30-day mortality rates, or need for dialysis in cases of acute kidney injuries.
Heightened anxiety state among parents of sick children attending emergency department using State‐Trait Anxiety Inventory
Authors: Embong Hashim , Ting Chiew Yuen , Ramli Muhamad Supi , Harunarashid Husyairi 
Published: October 2018

Background:The anxiety and stress level of both parent and child seeking treatment at the emergency department is assumed to be high. However, it is rarely quantified as to ascertain any need for intervention.Objective:The study seeks to quantify anxiety of parents accompanying sick children presenting acutely to the emergency department and to explore possible pre‐visit factors that may contribute to anxiety.Methods:A 12‐month cross‐sectional study was conducted at the Emergency Department, Universiti Kebangsaan Malaysia Medical Centre. All parents accompanying a child presenting to the study location, fitting the inclusion and exclusion criteria, were invited to participate. Parents required to fill a self‐administered questionnaire on anxiety, State‐Trait Anxiety Inventory and any related factors that can influence anxiety.Results:A total of 233 subjects were recruited. The mean state anxiety score was 53.48 ± 11.36, compared to the mean score for trait anxiety of 39.85 ± 7.66, suggesting a heightened state of anxiety. Majority of subjects (65.7%) had reported clinically detected anxiety as defined by state anxiety score above 49. There was no significant association between parental anxiety level with pre‐visit factors: children's age, duration of illness, the presence of co‐morbidities, time of presentation, prior medical contact and primary care referral. The child's state of illness was the dominant psychosocial factor associated with parental anxiety reported by the subjects.Conclusion:Parental anxiety upon arrival appeared to be significantly higher than expected, suggesting intervention may be needed.