bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burden of hospitalisation among older people in the Brazilian public health system: a big data analysis from 2009 to 2015
Authors: Dias Roger Daglius , Barros Jacson Venancio de 
Published: February 2019

BackgroundThe world’s population is progressively ageing, and this trend imposes several challenges to society and governments. The aim of this study was to investigate the burden generated by the hospitalisation of older (>60 years) compared with non-older population, as well as the epidemiology of these hospital admissions.MethodsUsing the Brazilian Unified Health System (known as ‘Sistema Único de Saúde’ (SUS)), an analysis of all hospital admissions of adult patients in the SUS from 2009 to 2015 was undertaken. The following indicators were used: hospital admission rate, intensive care unit (ICU) admission rate, average length of hospital and ICU stay, hospital mortality and average reimbursement per hospitalisation.ResultsA total of 61 958 959 admissions during the 7-year period, were analysed, encompassing 17 893 392 (28.9%) older patients. Elderly represent 15% (n=21 294 950) of the Brazilian adult population, but are responsible for 29% (n=17 893 392) of hospitalisations, 52% (n=1 731 299) of ICU admissions and 66% (n=1 885 291) of hospital mortality. Among the adults, elderly represents 39% of the total reimbursement made related to admission/hospitalisation. For 2009 to 2015, while the older population increased 27%, ICU admission rate increased 20%; the average length of ICU stay was 12% higher in 2015 (6.5 days) compared with 2009 (5.8 days); and the hospital mortality increased from 9.8% to 11.2%.ConclusionThese findings illustrate the current panorama of the burden due to hospitalisation of older people in the Brazilian public health system, and evidence the consolidation of the epidemiological transition toward the predominance of non-communicable diseases as the main cause of hospitalisation among the elderly in Brazil.
Impact of blood pressure levels within first 24 hours after mechanical thrombectomy on clinical outcome in acute ischemic stroke patients
Authors: Cernik David , Sanak Daniel , Divisova Petra , Kocher Martin , Cihlar Filip , Zapletalova Jana , Veverka Tomas , Prcuchova Andrea , Ospalik Dusan , Cerna Marie , Janousova Petra , Kral Michal , Dornak Tomas , Prasil Vojtech , Franc David , Kanovsky Petr 
Published: February 2019

IntroductionDespite early management and technical success of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), not all patients reach a good clinical outcome. Different factors may have an impact and we aimed to evaluate blood pressure (BP) levels in the first 24 hours after MT.MethodsConsecutive AIS patients treated with MT were enrolled in the retrospective bi-center study. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and functional outcome after 3 months with modified Rankin scale (mRS) with a score 0–2 for good outcome. The presence of symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS–MOST criteria.ResultsOf 703 treated patients, completed BP levels were collected in 690 patients (350 males, mean age 71±13 years) with median of admission NIHSS 17 points. Patients with mRS 0–2 had a lower median of systolic BP (SBP) compared with those with poor outcome (131 vs 140 mm Hg, P<0.0001). The rate of SICH did not differ between the patients with a median of SBP <140 mm Hg and ≥140 mm Hg. (5.1% vs 5.1%, P=0.980). Multivariate regression analysis with adjustment for potential confounders showed a median of distolic BP (P=0.024, OR: 0.977, 95% CI: 0.957 to 0.997) as a predictor of good functional outcome after MT, and a median of maximal SBP (P=0.038; OR: 0.990, 95% CI: 0.981 to 0.999) in the patients with achieved recanalization.ConclusionLowering of BP within the first 24 hours after MT may have a positive impact on clinical outcome in treated patients.
National estimates of the use and outcomes of extracorporeal membrane oxygenation after acute trauma
Authors: Hu Parker J , Griswold Lauren , Raff Lauren , Rodriguez Rachel , McGwin Jr Gerald , Kerby Jeffrey David , Bosarge Patrick 
Published: February 2019

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe acute respiratory distress syndrome is gaining greater acceptance among trauma intensivists. The objective of this study was to review ECMO usage in trauma patients in the USA.MethodsThe National Inpatient Sample (NIS) from years 2002 to 2012 was queried for patients aged 15 and older treated with ECMO who had one or more acute traumatic injuries as defined by the International Diagnostic Codes, Ninth Edition (ICD-9). The primary outcomes of interest were incidence of ECMO and overall inpatient mortality.ResultsA total of 1347 patients were identified in the NIS database who had both ECMO performed and ICD-9 codes consistent with trauma. Patients were predominantly aged 15 to 29 years (31.4%) and were male (65.5%). The incidence of ECMO for patients after traumatic injuries has increased 66-fold during the 10-year period. In-hospital mortality was 48.0% overall, with a decreasing trend during the study period that approached statistical significance (p=0.06).DiscussionAlthough ECMO use in patients in the post-trauma setting remains controversial, there is an increasing trend to use ECMO nationwide, suggesting an increasing acceptance and/or increased availability at trauma centers. Given the decrease in mortality during the study period, ECMO as a salvage method in trauma patients remains a potentially viable option. Evaluation in a prospective manner may clarify risks and benefits.Level of evidenceLevel IV, epidemiological.
Water-assisted production of late-orogenic trondhjemites at magmatic and subsolidus conditions
Authors: Fiannacca Patrizia , Basei Miguel A. S. , Cirrincione Rosolino , Pezzino Antonino , Russo Damiano 
Published: February 2019

Abstract

Peraluminous granites and trondhjemites make up small plutonic bodies intruded into high-grade paragneisses in the Peloritani Mountains, marking the beginning of late Variscan granitoid magmatism in southernmost Italy. The granites range from low-Ca monzogranites to alkali feldspar granites, while the trondhjemites vary from trondhjemites
s.s
. to low-Ca trondhjemites. Relatively high radiogenic (
87
Sr/
86
Sr)
i
ratios (mostly from 0.7073 to 0.7125) and negative
ε
Nd values (mostly from −5.66 to −8.73) point to crustal sources for all the granitoids. Major and trace element compositions indicate an absence of genetic relationships between the trondhjemites
s.s
. and the low-Ca granitoids, but possible relationships between the low-Ca trondhjemites and the granites. All of the studied granitoids have near-pure melts compositions, consistent with H
2
O-fluxed and dehydration melting of metasediments for the trondhjemites and the granites, respectively. However, the unusual compositions of the low-Ca trondhjemites and microstructural evidence in these rocks for pervasive subsolidus replacement of magmatic feldspars by secondary sodic plagioclase indicate that they were derived instead from metasomatic alteration of the granites. Thus, water may be involved in the production of trondhjemites in two different ways, driving water-fluxed melting in the magma source and driving alkali metasomatism at the sites of granite emplacement in the upper crust.
Dopamine D1 receptor activation reduces local inner retinal inhibition to light-adapted levels
Authors: Mazade Reece E. , Flood Michael D. , Eggers Erika D. 
Published: February 2019

During adaptation from dim to bright environments, changes in retinal signaling are mediated, in part, by dopamine. Dopamine is released with light and can modulate retinal receptive fields, neuronal coupling, inhibitory receptors, and rod pathway inhibition. However, it is unclear how dopamine affects inner retinal inhibition to cone bipolar cells, which relay visual information from photoreceptors to ganglion cells and are important signal processing sites. We tested the hypothesis that dopamine (D)1 receptor activation is sufficient to elicit light-adapted inhibitory changes. Local light-evoked inhibition and spontaneous activity were measured from OFF cone bipolar cells in dark-adapted mouse retinas while stimulating D1 receptors, which are located on bipolar, horizontal, and inhibitory amacrine cells. The D1 agonist SKF38393 reduced local inhibitory light-evoked response magnitude and increased response transience, which mimicked changes measured with light adaptation. D1-mediated reductions in local inhibition were more pronounced for glycinergic than GABAergic inputs, comparable with light adaptation. The effects of D1 receptors on light-evoked input were similar to the effects on spontaneous input. D1 receptor activation primarily decreased glycinergic spontaneous current frequency, similar to light adaptation, suggesting mainly a presynaptic amacrine cell site of action. These results expand the role of dopamine to include signal modulation of cone bipolar cell local inhibition. In this role, D1 receptor activation, acting primarily through glycinergic amacrine cells, may be an important mechanism for the light-adapted reduction in OFF bipolar cell inhibition since the actions are similar and dopamine is released during light adaptation. NEW & NOTEWORTHY Retinal adaptation to different luminance conditions requires the adjustment of local circuits for accurate signaling of visual scenes. Understanding mechanisms behind luminance adaptation at different retinal levels is important for understanding how the retina functions in a dynamic environment. In the mouse, we show that dopamine pathways reduce inner retinal inhibition similar to increased background luminance, suggesting the two are linked and highlighting a possible mechanism for light adaptation at an early retinal processing center.
Immune-Checkpoint Blockade Opposes CD8+ T-cell Suppression in Human and Murine Cancer
Authors: Pfannenstiel Lukas W. , Diaz-Montero C. Marcela , Tian Ye F. , Scharpf Joseph , Ko Jennifer S. , Gastman Brian R. 
Published: February 2019

AbstractImmune-checkpoint blockade enhances antitumor responses against cancers. One cancer type that is sensitive to checkpoint blockade is squamous cell carcinoma of the head and neck (SCCHN), which we use here to study limitations of this treatment modality. We observed that CD8+ tumor-infiltrating lymphocytes (TILs) in SCCHN and melanoma express excess immune checkpoints components PD-1 and Tim-3 and are also CD27−/CD28−, a phenotype we previously associated with immune dysfunction and suppression. In ex vivo experiments, patients' CD8+ TILs with this phenotype suppressed proliferation of autologous peripheral blood T cells. Similar phenotype and function of TILs was observed in the TC-1 mouse tumor model. Treatment of TC-1 tumors with anti–PD-1 or anti–Tim-3 slowed tumor growth in vivo and reversed the suppressive function of multi-checkpoint+ CD8+ TIL. Similarly, treatment of both human and mouse PD-1+ Tim-3+ CD8+ TILs with anticheckpoint antibodies ex vivo reversed their suppressive function. These suppressive CD8+ TILs from mice and humans expressed ligands for PD-1 and Tim-3 and exerted their suppressive function via IL10 and close contact. To model therapeutic strategies, we combined anti–PD-1 blockade with IL7 cytokine therapy or with transfer of antigen-specific T cells. Both strategies resulted in synergistic antitumor effects and reduced suppressor cell function. These findings enhance our understanding of checkpoint blockade in cancer treatment and identify strategies to promote synergistic activities in the context of other immunotherapies.
INSULIN RESISTANCE IN PATIENTS WITH NEWLY DIAGNOSED PULMONARY TUBERCULOSIS WITH DIFFERENT TREATMENT OUTCOME
Authors: Yasinskyi R. N. 
Published: February 2019

The aim of the study – to evaluate fasting glucose, insulin levels and homeostasis model assessment (HOMA-IR) index in patients with newly diagnosed pulmonary tuberculosis treatment failure (TFT) compared to data of patients who have successfully completed course of treatment (NDT).
Materials and methods. 49 newly diagnosed pulmonary tuberculosis patients were examined. Patients were divided into 2 groups. Group 1 included 28 patients with TFT. Group 2 (comparison group) included 21 NDT patients. Blood sampling in the patients was done before treatment, after 3 months of the treatment start and after 2–3 months of treatment of patients in the group 1. Fasting plasma glucose level was determined by the hexokinase method by using Beckman Coulter AU640 biochemical analyzer, Japan. Fasting serum insulin level was determined by electrochemiluminescence method on Cobas e411 analyzer, Switzerland. Insulin resistance index was calculated by HOMA-IR by Matthews et al., 1985.
Results. Fasting glucose levels were normal and almost similar in both groups before and after treatment, p˃0.05. Fasting insulin levels were also normal, but they were higher in patients of the group 1 than in the group 2, p˂0.05. It means there was a relative slight hyperinsulinemia in TFT patients. HOMA-IR index was also significantly greater among patients in the group 1, p˂0.05. Fasting glucose levels increase was in 10.7 % of patients in the group 1 and in 4.8 % patient in the group 2. Decrease of glucose levels was in 4.8 % of patients from the group 2. Fasting insulin levels increase was determined in 1 case among the group 1 patients and there were not cases with increased insulin levels among the patients of the group 2; fasting insulin levels reduction was identified in 14.3 % of patients from the group 1 only, p˃0.05. There was HOMA-IR index increase among patients of the group 1 mostly: 9 cases (33.3 %) versus 1 case (4.8 %) in the group 2, p˂0.05. Thus, a relative slight hyperinsulinemia in normal glucose levels and HOMA-IR index increase could be a signs of preclinical disorders of carbohydrate metabolism in patients with TFT.
Conclusion. It may indicate negative impact of virulent mycobacteria and more severe clinical and radiological changes on carbohydrate metabolism or/and negative impact of such disorders to prognosis of tuberculosis.
Real-World Treatment Trends in Endovascular Stroke Therapy
Authors: Saber Hamidreza , Navi Babak B. , Grotta James C. , Kamel Hooman , Bambhroliya Arvind , Vahidy Farhaan S. , Chen Peng Roc , Blackburn Spiros , Savitz Sean I. , McCullough Louise , Sheth Sunil A. 
Published: February 2019

Background and Purpose—
Recent landmark trials provided overwhelming evidence for effectiveness of endovascular stroke therapy (EST). Yet, the impact of these trials on clinical practice and effectiveness of EST among lower volume centers remains poorly characterized. Here, we determine population-level patterns in EST performance in US hospitals and compare EST outcomes from higher versus lower volume centers.

Methods—
Using validated diagnosis codes from data on all discharges from hospitals and Emergency Rooms in Florida (2006–2016) and the National Inpatient Sample (2012–2016) we identified patients with acute ischemic stroke treated with EST. The primary end point was good discharge outcome defined as discharge to home or acute rehabilitation facility. Multivariate regressions adjusted for medical comorbidities, intravenous tPA (tissue-type plasminogen activator) usage and annual hospital stroke volume were used to evaluate the likelihood of good outcome over time and by annual hospital EST volume.

Results—
A total of 3890 patients (median age, 73 [61–82] years, 51% female) with EST were identified in the Florida cohort and 42 505 (median age, 69 [58–79], 50% female) in the National Inpatient Sample. In both Florida and the National Inpatient Sample, the number of hospitals performing EST increased continuously. Increasing numbers of EST procedures were performed at lower annual EST volume hospitals over the studied time period. In adjusted multivariate regression, there was a continuous increase in the likelihood of good outcomes among patients treated in hospitals with increasing annual EST procedures per year (odds ratio, 1.1; 95% CI, 1.1–1.2 in Florida and odds ratio, 1.3; 95% CI, 1.2–1.4 in National Inpatient Sample).

Conclusions—
Analysis of population-level datasets of patients treated with EST from 2006 to 2016 demonstrated an increase in the number of centers performing EST, resulting in a greater number of procedures performed at lower volume centers. There was a positive association between EST volume and favorable discharge outcomes in EST-performing hospitals.
Improving Climate Change Literacy and Promoting Outreach in an Undergraduate Atmospheric Sciences Program
Authors: Hanrahan Janel , Shafer Jason 
Published: February 2019

AbstractMitigation of human-caused climate change is essential to lessen the extent of future negative impacts, but many people are not aware of the urgency of the situation. For meaningful climate change action to be realized, accurate information must be conveyed by experts to nonexperts. Improved climate change literacy may thus be achieved in two ways. First, we must increase the number of scientists who are knowledgeable about climate change, and second, we must encourage these experts to engage with nonexperts and provide them with adequate resources to do so. Such efforts are currently being implemented in the undergraduate Atmospheric Sciences/Meteorology program (ATM) at Northern Vermont University–Lyndon. To increase knowledge, all ATM students regardless of career pathway are required to take courses that cover the science of human-caused climate change. They are then encouraged to communicate this knowledge to the public. Students are creating informational content for a department-run website and are regularly given opportunities to engage with the public at local schools and events. The results of these curricular and extracurricular changes are promising. Student interest in the topic of climate change has increased and they have demonstrated a heighted sense of responsibility to engage with the public about this challenging topic.
The Eddy-Driven Jet and Storm-Track Responses to Boundary Layer Drag: Insights from an Idealized Dry GCM Study
Authors: Mbengue Cheikh O. , Woollings Tim 
Published: February 2019

Abstract
Simulations using a dry, idealized general circulation model (GCM) are conducted to systematically investigate the eddy-driven jet’s sensitivity to the location of boundary layer drag. Perturbations of boundary layer drag solely within the baroclinic zone reproduce the eddy-driven jet responses to global drag variations. The implications for current theories of eddy-driven jet shifts are discussed. Hemispherically asymmetric drag simulations in equinoctial and solstitial thermal conditions show that perturbations of surface drag in one hemisphere have negligible effects on the strength and latitude of the eddy-driven jet in the opposite hemisphere. Jet speed exhibits larger sensitivities to surface drag in perpetual winter simulations, while sensitivities in jet latitude are larger in perpetual summer simulations. Near-surface drag simulations with an Earthlike continental profile show how surface drag may facilitate tropical–extratropical teleconnections by modifying waveguides through changes in jet latitude. Longitudinally confined drag simulations demonstrate a novel mechanism for localizing storm tracks. A theoretical analysis is used to show that asymmetries in the Bernoulli function within the baroclinic zone are important for the eddy-driven jet latitude responses because they directly modulate the sensitivity of the zonal-mean zonal wind to drag in the boundary layer momentum balance. The simulations contained herein provide a rich array of case studies against which to test current theories of eddy-driven jet and storm-track shifts, and the results affirm the importance of correct, well-constrained locations and intensities of boundary layer drag in order to reduce jet and storm-track biases in climate and forecast models.
Sensible Heat Fluxes in the Nearly Neutral Boundary Layer: The Impact of Frictional Heating within the Surface Layer
Authors: Edwards J. M. 
Published: February 2019

Abstract
The effect of frictional dissipative heating on the calculation of surface fluxes in the atmospheric boundary layer using bulk flux formulas is considered. Although the importance of frictional dissipation in intense storms has been widely recognized, it is suggested here that its impact is also to be seen at more moderate wind speeds in apparently enhanced heat transfer coefficients and countergradient fluxes in nearly neutral conditions. A simple modification to the bulk flux formula can be made to account for its impact within the surface layer. This modification is consistent with an interpretation of the surface layer as one across which the flux of total energy is constant. The effect of this modification on tropical cyclones is assessed in an idealized model, where it is shown to reduce the predicted maximum wind speed by about 4%. In numerical simulations of three individual storms, the impacts are more subtle but indicate a reduction of the sensible heat flux into the storm and a cooling of the surface layer.
Disturbed thalamocortical connectivity in unaffected relatives of schizophrenia patients with a high genetic loading
Authors: Cho Kang Ik K , Kim Minah , Yoon Youngwoo Bryan , Lee Junhee , Lee Tae Young , Kwon Jun Soo 
Published: February 2019

Objectives: Alterations in thalamocortical anatomical connectivity, specifically the connection between the orbitofrontal cortex and thalamus, have been frequently reported in schizophrenia and are suggested to contribute to the pathophysiology of schizophrenia. The connectivity of the thalamocortical white matter in unaffected relatives of schizophrenia patients was compared to that of healthy controls. Methods: The unaffected relative group was defined as asymptomatic family members who had at least one first-degree relative with schizophrenia and one or more other affected first- to third-degree relatives. A total of 35 unaffected relatives and 34 healthy controls underwent diffusion-weighted and T1-weighted magnetic resonance imaging to examine the white matter connectivity between the thalamus and orbitofrontal cortex using probabilistic tractography. Results: After controlling for age and sex, the unaffected relatives exhibited significantly reduced fractional anisotropy values for the left thalamo-orbitofrontal tract compared to that of healthy controls, F(1, 65) = 6.93, p = 0.011, effect size partial η2 = 0.10. However, there was no association between the Genetic Liability Score and fractional anisotropy in the left thalamo-orbitofrontal tracts. Conclusion: Our findings in the unaffected relatives of schizophrenia patients, which are in line with the alterations reported in schizophrenia, first-episode psychosis and clinical high risk for psychosis, highlight a possible genetic contribution to the proposed biomarker of altered thalamocortical connectivity.