bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Effectiveness of Endovascular Thrombectomy in Elderly Stroke Patients
Authors: Malhotra Ajay , Wu Xiao , Payabvash Seyedmehdi , Matouk Charles C. , Forman Howard P. , Gandhi Dheeraj , Sanelli Pina , Schindler Joseph 
Published: March 2019

Background and Purpose—
Strokes in patients aged ≥80 years are common, and advanced age is associated with relatively poor poststroke functional outcome. The current guidelines do not recommend an upper age limit for endovascular thrombectomy (EVT). The purpose of this study is to evaluate the effectiveness of EVT in acute stroke because of large vessel occlusion for elderly patients >age 80 years.

Methods—
A Markov decision analytic model was constructed from a societal perspective to evaluate health outcomes in terms of quality-adjusted life years (QALYs) after EVT for acute ischemic stroke because of large vessel occlusion in patients above age 80 years. Age-specific input parameters were obtained from the most recent/comprehensive literature. Good outcome was defined as a modified Rankin Scale score ≤2. Probabilistic, 1-way, and 2-way sensitivity analyses were performed for both healthy patients and patients with disability at baseline.

Results—
Base case calculation showed in functionally independent patients at baseline, intravenous thrombolysis (IVT) with tPA (tissue-type plasminogen activator) only to be the better strategy with 3.76 QALYs compared to 2.93 QALYs for patients undergoing EVT. The difference in outcome is 0.83 QALY (equivalent to 303 days of life in perfect health). For patients with baseline disability, IVT only yields a utility of 1.92 QALYs and EVT yields a utility of 1.65 QALYs. The difference is 0.27 QALYs (equivalent to 99 days of life in perfect health). Multiple sensitivity analyses showed that the effectiveness of EVT is significantly determined by the morbidity and mortality after both IVT and EVT strategies, respectively.

Conclusions—
Our study demonstrates the impact of relevant factors on the effectiveness of EVT in patients above 80 years of age. Morbidity and mortality after both IVT and EVT strategies significantly influence the outcomes in both healthy and disabled patients at baseline. Better identification of patients not benefiting from IVT would optimize the selective use of EVT thereby improving its effectiveness.
The 2018 Agreement to Prevent Unregulated High Seas Fisheries in the Central Arctic Ocean: A Critical Analysis
Authors: Schatz Valentin J. , Proelss Alexander , Liu Nengye 
Published: March 2019

Abstract
Following almost ten years of negotiations, the Agreement to Prevent Unregulated High Seas Fisheries in the Central Arctic Ocean (CAOF Agreement) was concluded on 3 October 2018 in Ilulissat, Greenland. The CAOF Agreement is the first regional fisheries agreement adopted prior to the initiation of fishing in a specific area, and it has already been lauded as a science-based measure and a manifestation of the precautionary approach by representatives of States and Non-Governmental Organizations. This article provides a critical analysis of the content of the CAOF Agreement. It gives an overview of the negotiations which led to the conclusion of the CAOF Agreement and discusses its spatial and substantive scope. Particular attention is paid to the extent that the CAOF Agreement adopts a precautionary approach to conservation and management of high seas fisheries, and to the issue of participation in this regional fisheries treaty.
Variability and Predictability of North Atlantic Hurricane Frequency in a Large Ensemble of High-Resolution Atmospheric Simulations
Authors: Mei Wei , Kamae Youichi , Xie Shang-Ping , Yoshida Kohei 
Published: March 2019

AbstractVariability of North Atlantic annual hurricane frequency during 1951–2010 is studied using a 100-member ensemble of climate simulations by a 60-km atmospheric general circulation model that is forced by observed sea surface temperatures (SSTs). The ensemble mean results well capture the interannual-to-decadal variability of hurricane frequency in best track data since 1970, and suggest that the current best track data might underestimate hurricane frequency prior to 1966 when satellite measurements were unavailable. A genesis potential index (GPI) averaged over the main development region (MDR) accounts for more than 80% of the SST-forced variations in hurricane frequency, with potential intensity and vertical wind shear being the dominant factors. In line with previous studies, the difference between MDR SST and tropical mean SST is a useful predictor; a 1°C increase in this SST difference produces 7.05 ± 1.39 more hurricanes. The hurricane frequency also exhibits strong internal variability that is systematically larger in the model than observations. The seasonal-mean environment is highly correlated among ensemble members and contributes to less than 10% of the ensemble spread in hurricane frequency. The strong internal variability is suggested to originate from weather to intraseasonal variability and nonlinearity. In practice, a 20-member ensemble is sufficient to capture the SST-forced variability.
Evapotranspiration Partitioning in CMIP5 Models: Uncertainties and Future Projections
Authors: Berg Alexis , Sheffield Justin 
Published: March 2019

AbstractEvapotranspiration (ET) is a key process affecting terrestrial hydroclimate, as it modulates the land surface carbon, energy, and water budgets. Evapotranspiration mainly consists of the sum of three components: plant transpiration, soil evaporation, and canopy interception. Here we investigate how the partitioning of ET into these three main components is represented in CMIP5 model simulations of present and future climate. A large spread exists between models in the simulated mean present-day partitioning; even the ranking of the different components in the global mean differs between models. Differences in the simulation of the vegetation leaf area index appear to be an important cause of this spread. Although ET partitioning is not accurately known globally, existing global estimates suggest that CMIP5 models generally underestimate the relative contribution of transpiration. Differences in ET partitioning lead to differences in climate characteristics over land, such as land–atmosphere fluxes and near-surface air temperature. On the other hand, CMIP5 models simulate robust patterns of future changes in ET partitioning under global warming, notably a marked contrast between decreased transpiration and increased soil evaporation in the tropics, whereas transpiration and evaporation both increase at higher latitudes and both decrease in the dry subtropics. Idealized CMIP5 simulations from a subset of models show that the decrease in transpiration in the tropics largely reflects the stomatal closure effect of increased atmospheric CO2 on plants (despite increased vegetation from CO2 fertilization), whereas changes at higher latitudes are dominated by radiative CO2 effects, with warming and increased precipitation leading to vegetation increase and simultaneous (absolute) increases in all three ET components.
Deterministic Sea Waves Prediction Using Mixed Space–Time Wave Radar Data
Authors: Al-Ani M. , Christmas J. , Belmont M. R. , Duncan J. M. , Duncan J. , Ferrier B. 
Published: March 2019

AbstractA number of maritime operations can benefit from a short-term deterministic sea wave prediction (DSWP). Conventional X-band radars have recently been shown to provide a low-cost convenient source of two-dimensional wave profile information for DSWP purposes. However, such rotating radars typically introduce temporal smearing into the data, which introduces errors when traditional Fourier transform–based wave prediction methods are used. The authors report on a new approach for DSWP that avoids such errors. Furthermore, it is not susceptible to the condition number problems that arise with any form of direct or indirect inversion-based approaches. Extensive numerical analyses are conducted to illustrate the effect of the mixed space–time nature of the data on DSWP and the efficiency of the proposed technique to handle it.
Outcomes of Evans Versus Hintermann Calcaneal Lengthening Osteotomy for Flexible Flatfoot
Authors: Ettinger Sarah , Mattinger Tim , Stukenborg-Colsman Christina , Yao Daiwei , Claassen Leif , Daniilidis Kiriakos , Plaass Christian 
Published: March 2019

Background: Evans (E) and Hintermann (H) lateral lengthening calcaneal osteotomies (LLCOTs) are commonly used to correct flexible flatfoot deformities. Both methods are well accepted and produce good clinical results. The aim of this study was to compare the postoperative outcomes of both osteotomies. Methods: We retrospectively examined 53 patients with flatfoot deformities, who received surgery between October 2008 and March 2014. Seventeen E-LLCOT and 36 H-LLCOT procedures were performed during this time period, with a mean follow-up of 67.7 ± 20.6 and 40 ± 12.9 months, respectively. Data were collected using clinical and radiological examination, as well as clinical scores (Foot and Ankle Outcome Score [FAOS], University of California at Los Angeles [UCLA] activity score, numerical rating scale [NRS], and the Short-Form 36-item Health Survey [SF-36]) during regular follow-up. Results: For both groups of patients, the FAOS score, pain-NRS, and SF-36 improved significantly following surgery ( P < .05). The talus–second metatarsal angle, talonavicular coverage, and naviculocuneiform overlap showed significant correction ( P < .05). Postoperatively, radiographic degenerative changes were detected in the calcaneocuboid (CC) and subtalar joint in both groups of patients: 41% and 18% after E-LLCOT compared with 25% and 14% after H-LLCOT, although these changes did not have any clinical relevance ( P < .05). No secondary arthrodesis was necessary. There were no significant differences in the clinical or radiological outcome parameters when compared between the 2 groups. Conclusion: Both surgical techniques resulted in a significant improvement of clinical outcome scores and led to good radiological correction of flatfoot deformities. It appears that the CC joint develops less degenerative changes following the H-LLCOT procedure. Level of Evidence: Level III, comparative series.
Emergence of OXA-48 Carbapenemase Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit in Marrakech, Morocco
Authors: Taoufik Lahoucine , Amrani Hanchi Asma , Fatiha Bennaoui , Nissrine Slitine , Mrabih Rabou Maouainine Fadl , Nabila Soraa 
Published: March 2019

Goal: This work aims to describe and explore the circumstances of appearance of Klebsiella pneumoniae producing OXA-48 carbapenemase, which has occurred in a neonatal intensive care service at the Mohammed VI University Hospital of Marrakech. Results: During February 2015, the alert was triggered by the isolation of 6 isolates of K pneumoniae with the same antibiotic susceptibility profile in the neonatal intensive care service, suggesting a possible outbreak. Blood cultures represented the main site of isolation of these isolates. The phenotypic study of the isolates made it possible to identify a strain of K pneumoniae susceptible to third-generation cephalosporins, ciprofloxacin, and aminoglycosides, and resistant to ertapenem, β-lactamases inhibitors (ticarcillin-clavulanate, piperacillin-tazobactam; amoxicillin-clavulanic acid), and cotrimoxazole. The genotypic study of the epidemic isolate revealed the presence of the blaOXA-48 gene. The action to be taken was the establishment of corrective measures to stop this epidemic to a multi-resistant germ transmitted by hand transmission. The reinforcement of hygiene measures and the awareness of the staff made it possible to put an end to the epidemic at March 30, 2015, without closing the service. The outcome of 6 infected newborns was fatal due to the fragile terrain and the inappropriate probabilistic antibiotic therapy. Conclusion: The production of carbapenemase in K pneumoniae is an emerging resistance mechanism that must be suspected and identified to offer targeted therapy and to limit its spread. The implementation of a local policy to control multidrug-resistant germs is essential to limit their dissemination in hospitals.
The relationship between physical activity and appetite in patients with heart failure: A prospective observational study
Authors: Andreae Christina , Årestedt Kristofer , Evangelista Lorraine , Strömberg Anna 
Published: March 2019

Introduction:Physical activity and appetite are important components for maintaining health. Yet, the association between physical activity and appetite in heart failure (HF) populations is not completely understood. The aim of the present study was to investigate the relationship between physical activity, functional capacity, and appetite in patients with HF.Methods:This was a prospective observational study. In total, 186 patients diagnosed with HF, New York Heart Association (NYHA) class II–IV (mean age 70.7, 30% female), were included. Physical activity was measured using a multi-sensor actigraph for seven days and with a self-reported numeric rating scale. Physical capacity was measured by the six-minute walk test. Appetite was measured using the Council on Nutrition Appetite Questionnaire. Data were collected at inclusion and after 18 months. A series of linear regression analyses, adjusted for age, NYHA class, and B-type natriuretic peptide were conducted.Results:At baseline, higher levels of physical activity and functional capacity were significantly associated with a higher level of appetite in the unadjusted models. In the adjusted models, number of steps ( p = 0.019) and the six-minute walk test ( p = 0.007) remained significant. At the 18-month follow-up, all physical activity variables and functional capacity were significantly associated with appetite in the unadjusted regression models. In the adjusted models, number of steps ( p = 0.001) and metabolic equivalent daily averages ( p = 0.040) remained significant.Conclusion:A higher level of physical activity measured by number of steps/day was associated with better self-reported appetite, both at baseline and the 18-month follow-up. Further research is needed to establish causality and explore the intertwined relationship between activity and appetite in patients with HF.
Descending thoracic endovascular aortic repair does not require cardiothoracic surgery support
Authors: Chait Jesse , Kibrik Pavel , Alsheekh Ahmad , Marks Natalie , Rajaee Sareh , Hingorani Anil , Ascher Enrico 
Published: March 2019

Objective Descending thoracic endovascular aneurysm repair (D-TEVAR) is often performed by vascular surgeons. At many institutions, cardiothoracic surgery support is required for an elective TEVAR to take place. Oftentimes, this means a dedicated cardiopulmonary bypass team must be available. This study aims to investigate that TEVAR is a safe procedure that does not require such a resource-intensive “back-up plan.” Methods This is a retrospective analysis of data collected from March 2014 to January 2018 of 18 patients who underwent TEVAR at a tertiary care facility with a level I trauma center. There were 11 males and 7 females with an average age of 68.8 years old (range 19–97; SD ± 19.52). The average body mass index (BMI) was 24.7 kg/m2 (range 16.8–35; SD ±4.67). Nine were never smokers, four were former smokers, and five were currently smoking at the time of the procedure. The most common presenting symptom prior to intervention was chest pain ( n = 10), followed by cough/dyspnea ( n = 5), back pain ( n = 3), and trauma ( n = 2). Results The average maximum diameter of the thoracic aortic aneurysms (TAA) treated with TEVAR was 5.49 cm ( n = 7; range 4.3–6.7; SD ± 0.855). Six patients had Stanford Type B aortic dissections. Two patients with TAAs had concomitant, rapidly expanding aortic ulcers. Two patients had traumatic pseudoaneurysms, one of which ruptured prior to TEVAR. One patient had an expanding 1.9 × 1.8 cm saccular pseudoaneurysm of the aortic arch. The mean follow-up time was 69.2 weeks ( n = 17; range 3–166; SD ± 62.67), and one patient did not follow up following their initial TEVAR procedure. Of the 18 patients who received TEVAR, there were no major complications. Two patients experienced a type II endoleak. No patients required conversion to an open procedure, nor did any patients necessitate intervention by cardiothoracic surgery or cardiopulmonary bypass support. Conclusion These data suggest that cardiothoracic surgery support is not required for descending thoracic endovascular aneurysm repair (D-TEVAR). Further research is warranted on the risk factors associated with open conversion during these procedures.
Improving pragmatic clinical trial design using real-world data
Authors: Shortreed Susan M , Rutter Carolyn M , Cook Andrea J , Simon Gregory E 
Published: March 2019

Background Pragmatic clinical trials often use automated data sources such as electronic health records, claims, or registries to identify eligible individuals and collect outcome information. A specific advantage that this automated data collection often yields is having data on potential participants when design decisions are being made. We outline how this data can be used to inform trial design. Methods Our work is motivated by a pragmatic clinical trial evaluating the impact of suicide-prevention outreach interventions on fatal and non-fatal suicide attempts in the 18 months after randomization. We illustrate our recommended approaches for designing pragmatic clinical trials using historical data from the health systems participating in this study. Specifically, we illustrate how electronic health record data can be used to inform the selection of trial eligibility requirements, to estimate the distribution of participant characteristics over the course of the trial, and to conduct power and sample size calculations. Results Data from 122,873 people with patient health questionnaire (PHQ) responses, recorded in their electronic health records between 1 July 2010 and 31 March 2012, were used to show that the suicide attempt rate in the 18 months following completion of the questionnaire varies by response to item nine of the PHQ. We estimated that the proportion of individuals with a prior recorded elevated PHQ (i.e. history of suicidal ideation) would decrease from approximately 50% at the beginning of a trial to about 5%, 50 weeks later. Using electronic health record data, we conducted simulations to estimate the power to detect a 25% reduction in suicide attempts. Simulation-based power calculations estimated that randomizing 8000 participants per randomization arm would allow 90% power to detect a 25% reduction in the suicide attempt rate in the intervention arm compared to usual care at an alpha rate of 0.05. Conclusions Historical data can be used to inform the design of pragmatic clinical trials, a strength of trials that use automated data collection for randomizing participants and assessing outcomes. In particular, realistic sample size calculations can be conducted using real-world data from the health systems in which the trial will be conducted. Data-informed trial design should yield more realistic estimates of statistical power and maximize efficiency of trial recruitment.
The Paisley Pattern Breast Reduction
Authors: Becker Devra B. 
Published: March 2019

Background: Skin resection patterns inform the shape and scars after breast reduction. The 2 most commonly performed skin resection patterns, the Wise pattern and vertical pattern, each have limitations. The most common challenge is addressing excess lateral skin while avoiding medial scars. The Paisley Pattern breast reduction addresses this by incorporating lateral dogear excision in the skin resection design. Methods: Thirty consecutive patients received a Paisley Pattern breast reduction. After institutional review board approval, a chart review was performed to evaluate resection weight, operative time, American Society of Anesthesiologists class, flap necrosis, and seroma. Results: Operative times were comparable to published times for the Wise and vertical pattern techniques. No patients had lateral flap necrosis, and no patients required a return to the operating room during the follow-up period. One patient developed a unilateral seroma that was drained by interventional radiology. Conclusions: This report of a novel skin resection design demonstrates a proof of concept that the skin resection pattern can be performed safely in a wide variety of patients. Although there is a learning curve to the technique to prevent over-resection laterally, it provides efficient and aesthetically acceptable alternative to the Wise and vertical skin resection patterns for both large and small reductions.
Exploring the Score Equivalence of the English and Chinese Versions of the Brief Assessment Scale for Caregivers
Authors: Yang Grace Meijuan , Hui-Shan Neo Shirlyn , Teo Irene , Lee Geok Ling , Thumboo Julian , Chia John , Lau Annie , Koh Audrey , Qu Debra , Che William Wai Lam , Wee Hwee Lin , Glajchen Myra , Cheung Yin Bun 
Published: March 2019

Background: Multilingual outcome measures are used so that research studies are more generalizable across language contexts. Objective: To determine the score equivalence of the English and Chinese versions of Brief Assessment Scale for Caregivers (BASC) in Singapore. Method: Caregivers of patients with advanced cancer completed the BASC in either English or Chinese. Multivariable linear regression analysis was used to compare the mean BASC total and factor scores between the 2 language versions, with adjustment for possible confounding variables. Equivalence was declared if the 90% confidence interval of the mean scores fell entirely within an equivalence zone of ±0.5 standard deviation. Results: There were 521 ethnic Chinese participants, of whom 214 answered the English version and 307 answered the Chinese version. The BASC total and factor scores met the criteria for equivalence. Cronbach α coefficients were similar and exploratory factor analysis showed similar 2-factor structures for both language versions. Conclusion: The English and Chinese versions of the BASC were found to be equivalent in terms of similar adjusted mean scores, Cronbach α, and factor structures.