bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship Between the Ambulatory Arterial Stiffness Index and the Lower Limit of Cerebral Autoregulation During Cardiac Surgery
Authors: Obata Yurie , Barodka Viachaslau , Berkowitz Dan E. , Gottschalk Allan , Hogue Charles W. , Steppan Jochen 
Published: February 2018

Background

Pulse pressure, the ambulatory arterial stiffness index (
AASI
), and the symmetric
AASI
are established predictors of adverse cardiovascular outcomes. However, little is known about their relationship to cerebral autoregulation. This study evaluated whether these markers of vascular properties relate to the lower limit of cerebral autoregulation (
LLA
).

Methods and Results

The
LLA
was determined during cardiac surgery with transcranial Doppler ultrasonography in 181 patients. All other variables were calculated from continuous intraoperative readings obtained before cardiopulmonary bypass. The
LLA
varied directly with the
AASI
(β=3.12 per 0.1 change in
AASI
,
P
<0.001) and to a lesser extent the symmetric
AASI
(β=2.02 per 0.1 change in symmetric
AASI
,
P
≤0.022), while peripheral pulse pressure was not significantly related (β=0.0,
P
>0.99). Logistic regression revealed that the likelihood of
LLA
being >65 mm Hg increased by 50% (95% confidence interval, 11%–102%,
P
=0.008) for every 0.1 increase in the
AASI
. The
AASI
was able to predict a
LLA
above certain thresholds (area under the curve receiver operating characteristic for
AASI
predicting an
LLA
>65 mm Hg: 0.60; 95% confidence interval, 0.51%–0.68%,
P
=0.043). Incorporating additional variables improved the model's predictive ability (area under the curve for
AASI
predicting a
LLA
>65 mm Hg: 0.75; 95% confidence interval, 0.68–0.82,
P
=0.036).

Conclusions

These data indicate that the
LLA
is related to the mechanical properties of the vasculature as represented by the
AASI
. The
AASI
can be used to predict
LLA
threshold levels during cardiac surgery. It is now possible to link elevations in the
LLA
with an increased
AASI
as determined from readily accessible intraoperative variables.
Conventional and Ambulatory Blood Pressure as Predictors of Diastolic Left Ventricular Function in a Flemish Population
Authors: Wei Fang‐Fei , Yang Wen‐Yi , Thijs Lutgarde , Zhang Zhen‐Yu , Cauwenberghs Nicholas , Van Keer Jan , Huang Qi‐Fang , Mujaj Blerim , Kuznetsova Tatiana , Allegaert Karel , Verhamme Peter , Staessen Jan A. 
Published: February 2018

Background

No longitudinal study compared associations of echocardiographic indexes of diastolic left ventricular function studies with conventional (
CBP
) and daytime ambulatory (
ABP
) blood pressure in the general population.

Methods and Results

In 780 Flemish (mean age, 50.2 years; 51.7% women), we measured left atrial volume index (
LAVI
), peak velocities of the transmitral blood flow (E) and mitral annular movement (e′) in early diastole and E/e′ 9.6 years (median) after
CBP
and
ABP
. In adjusted models including
CBP
and
ABP
, we expressed associations per 10/5‐mm Hg systolic/diastolic blood pressure increments.
LAVI
and E/e′ were 0.65/0.40 mL/m
2
and 0.17/0.09 greater with higher systolic/diastolic
ABP
(
P
≤0.028), but not with higher baseline
CBP
(
P
≥0.086). e′ was lower (
P
≤0.032) with higher diastolic
CBP
(−0.09 cm/s) and
ABP
(−0.19 cm/s). When we substituted baseline
CBP
by
CBP
recorded concurrently with echocardiography,
LAVI
and E/e′ remained 0.45/0.38 mL/m
2
and 0.15/0.08 greater with baseline
ABP
(
P
≤0.036), while
LAVI
(+0.53 mL/m
2
) and E/e′ (+0.19) were also greater (
P
<0.001) in relation to concurrent systolic
CBP
. In categorized analyses of baseline data, sustained hypertension or masked hypertension compared with normotension or white‐coat hypertension was associated with greater
LAVI
(24.0 versus 22.6 mL/m
2
) and E/e′ (7.35 versus 6.91) and lower e′ (10.7 versus 11.6 cm/s;
P
≤0.006 for all) with no differences (
P
≥0.092) between normotension and white‐coat hypertension or between masked hypertension and sustained hypertension.

Conclusions

ABP
is a long‐term predictor of diastolic left ventricular function, statistically outperforming distant but not concurrent
CBP
. Masked hypertension and sustained hypertension carry equal risk for deterioration of diastolic left ventricular function.
Antiplatelet Therapy Changes for Patients With Myocardial Infarction With Recurrent Ischemic Events: Insights Into Contemporary Practice From the TRANSLATE‐ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) Study
Authors: Fanaroff Alexander C. , Kaltenbach Lisa A. , Peterson Eric D. , Akhter Mohammed W. , Effron Mark B. , Henry Timothy D. , Wang Tracy Y. 
Published: February 2018

Background

Guidelines recommend P2Y
12
inhibitor therapy for 1 year after myocardial infarction (
MI
), yet little guidance is provided on antiplatelet management for patients with recurrent ischemic events during that year. We describe changes in P2Y
12
inhibitor type among patients with recurrent ischemic events in the first year after
MI
.

Methods and Results

The
TRANSLATE
‐
ACS
(Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study enrolled 12 365 patients with MI treated with percutaneous coronary intervention. We examined whether P2Y
12
inhibitor choice changed among patients with recurrent
MI
, stent thrombosis, and/or unplanned revascularization during the first year after
MI
, and modeled factors associated with P2Y
12
inhibitor intensification (changing clopidogrel to prasugrel or ticagrelor). In the first year after
MI
, 1414 patients (11%) had a total of 1740 recurrent ischemic events (771 recurrent
MI
s, 969 unplanned revascularizations, and 165 stent thromboses). Median time to the first recurrent ischemic event was 154 days (25th–75th percentiles, 55–287 days). Of those with recurrent ischemic events, 101 of 1092 (9.3%) occurring in clopidogrel‐treated patients led to P2Y
12
inhibitor intensification. Recurrent events involving stent thrombosis or
MI
were the strongest factors associated with P2Y
12
inhibitor intensification, yet only 40% of patients with stent thrombosis and 14% of patients with recurrent
MI
had P2Y
12
inhibitor intensification. Increasing age and longer time from the index
MI
were associated with lower likelihood for intensification.

Conclusions

Few patients after
MI
with a recurrent ischemic event who were taking clopidogrel switched to a more potent P2Y
12
inhibitor, even after stent thrombosis events. Specific guidance is needed for patients who have recurrent ischemic events, particularly when closely spaced.

Clinical Trial Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier:
NCT
01088503.
Characteristics of Randomized Trials Focusing on Stroke due to Intracerebral Hemorrhage
Authors: Tamborska Arina , Poon Michael T.C. , Al-Shahi Salman Rustam 
Published: February 2018

Background and Purpose—
The absence of treatments for intracerebral hemorrhage with significant consistent benefit in randomized controlled trials (RCTs) could be because of lack of treatment efficacy or the design of RCTs.

Methods—
We searched the Cochrane Stroke Group Trials Register in December 2015 for completed and published RCTs reporting clinical outcome in adults with intracerebral hemorrhage. We collected data on publication year and language, study characteristics, and effect size. We regarded RCTs to be at lower risk of bias if they performed ≥2 of describing randomization, using blinding, or specifying the primary outcome. We registered this systematic review (PROSPERO, international prospective register of systematic reviews CRD42016051103).

Results—

We found 136 eligible RCTs: 57% were phase II, 76% were single center, 98% studied acute treatments, 49% involved drug interventions, 24% were placebo-controlled, the primary outcome was death or disability in 30%, and median sample size was 77 (interquartile range, 47–160). Forty-six percent explained randomization, 24% blinded treatment allocation, and 24% specified the primary outcome such that 38 (28%) were at lower risk of bias. RCTs at lower risk of bias were more likely to use multicenter recruitment (adjusted odds ratio, 6.95; 95% confidence interval, 2.2–21.5) and be published in English (adjusted odds ratio, 12.9, 95% confidence interval, 2.7–62.5). RCTs with larger sample sizes were independently more likely to be phase III/IV (
P
<0.01) and use multicenter recruitment (
P
<0.01). RCTs at lower risk of bias had smaller pooled treatment effects on death/disability (
P
=0.02).

Conclusions—
Intracerebral hemorrhage RCTs have often been at high risk of bias, and these RCTs have been characterized by small sample sizes and larger effect sizes.
A New Research Approach for Observing and Characterizing Land–Atmosphere Feedback
Authors: Wulfmeyer Volker , Turner David D. , Baker B. , Banta R. , Behrendt A. , Bonin T. , Brewer W. A. , Buban M. , Choukulkar A. , Dumas E. , Hardesty R. M. , Heus T. , Ingwersen J. , Lange D. , Lee T. R. , Metzendorf S. , Muppa S. K. , Meyers T. , Newsom R. , Osman M. , Raasch S. , Santanello J. , Senff C. , Späth F. , Wagner T. , Weckwerth T. 
Published: February 2018

AbstractForecast errors with respect to wind, temperature, moisture, clouds, and precipitation largely correspond to the limited capability of current Earth system models to capture and simulate land–atmosphere feedback. To facilitate its realistic simulation in next-generation models, an improved process understanding of the related complex interactions is essential. To this end, accurate 3D observations of key variables in the land–atmosphere (L–A) system with high vertical and temporal resolution from the surface to the free troposphere are indispensable.Recently, we developed a synergy of innovative ground-based, scanning active remote sensing systems for 2D to 3D measurements of wind, temperature, and water vapor from the surface to the lower troposphere that is able to provide comprehensive datasets for characterizing L–A feedback independently of any model input. Several new applications are introduced, such as the mapping of surface momentum, sensible heat, and latent heat fluxes in heterogeneous terrain; the testing of Monin–Obukhov similarity theory and turbulence parameterizations; the direct measurement of entrainment fluxes; and the development of new flux-gradient relationships. An experimental design taking advantage of the sensors’ synergy and advanced capabilities was realized for the first time during the Land Atmosphere Feedback Experiment (LAFE), conducted at the Atmospheric Radiation Measurement Program Southern Great Plains site in August 2017. The scientific goals and the strategy of achieving them with the LAFE dataset are introduced. We envision the initiation of innovative L–A feedback studies in different climate regions to improve weather forecast, climate, and Earth system models worldwide.
On the Use of Ocean Dynamic Temperature for Hurricane Intensity Forecasting
Authors: Balaguru Karthik , Foltz Gregory R. , Leung L. Ruby , Hagos Samson M. , Judi David R. 
Published: February 2018

Abstract
Sea surface temperature (SST) and tropical cyclone heat potential (TCHP) are metrics used to incorporate the ocean’s influence on hurricane intensification into the National Hurricane Center’s Statistical Hurricane Intensity Prediction Scheme (SHIPS). While both SST and TCHP serve as useful measures of the upper-ocean heat content, they do not accurately represent ocean stratification effects. Here, it is shown that replacing SST within the SHIPS framework with a dynamic temperature Tdy, which accounts for the oceanic negative feedback to the hurricane’s intensity arising from storm-induced vertical mixing and sea surface cooling, improves the model performance. While the model with SST and TCHP explains about 41% of the variance in 36-h intensity changes, replacing SST with Tdy increases the variance explained to nearly 44%. These results suggest that representation of the oceanic feedback, even through relatively simple formulations such as Tdy, may improve the performance of statistical hurricane intensity prediction models such as SHIPS.
Training peers to treat Ebola centre workers with anxiety and depression in Sierra Leone
Authors: Waterman Samantha , Hunter Elaine Catherine Margaret , Cole Charles L , Evans Lauren Jayne , Greenberg Neil , Rubin G James , Beck Alison 
Published: February 2018

Background: Following the 2014 Ebola virus disease (EVD) outbreak in West Africa, the UK Department for International Development funded South London and Maudsley National Health Service (NHS) to develop a psychological intervention that ex-Ebola Treatment Centre (ETC) staff could be trained to deliver to their peers to improve mental health in Sierra Leone. Aim: The two key aims were to assess the feasibility of training a national team to deliver a cognitive behavioural therapy (CBT)–based group intervention, and to evaluate the effectiveness of the overall intervention within this population. Methods: UK clinicians travelled to Sierra Leone to train a small team of ex-ETC staff in a three-phased CBT-based intervention. Standardised clinical measures, as well as bespoke measures, were applied with participants through the intervention to assess changes in mental health symptomology, and the effectiveness of the intervention. Results: The results found improvements across all factors of mental health in the bespoke measure from phase 1 to phase 3. Additionally, the majority of standardised clinical measures showed improvements between phase 2 and the start of phase 3, and pre- and post-phase 3. Conclusion: Overall, the findings suggest that it is possible to train staff from ETCs to deliver effective CBT interventions to peers. The implications of these results are discussed, including suggestions for future research and clinical intervention implementation within this population. The limitations of this research are also addressed.
Preliminary design of the internal geometry in a minimally invasive left ventricular assist device under pulsatile-flow conditions
Authors: Smith P Alex , Wang Yaxin , Metcalfe Ralph W , Sampaio Luiz C , Timms Daniel L , Cohn William E , Frazier OH 
Published: February 2018

Purpose: A minimally invasive, partial-assist, intra-atrial blood pump has been proposed, which would unload the left ventricle with a flow path from the left atrium to the arterial system. Flow modulation is a common strategy for ensuring washout in the pump, but it can increase power consumption because it is typically achieved through motor-speed variation. However, if a pump’s performance curve had the proper gradient, flow modulation could be realized passively. To achieve this goal, we propose a pump performance operating curve as an alternative to the more standard operating point. Methods and results: Mean-line theory was employed to generate an initial set of geometries that were then tested on a hydraulic test rig at ~20,000 r/min. Experimental results show that the intra-atrial blood pump performed below the operating region; however, it was determined that smaller hub diameter and longer chord length bring the performance of the intra-atrial blood pump device closer to the operating curve. Conclusion: We found that it is possible to shape the pump performance curve for specifically targeted gradients over the operating region through geometric variations inside the pump.
Intermediate Care Units: A Survey of Organization Practices Across the United States
Authors: Wendlandt Blair , Bice Thomas , Carson Shannon , Chang Lydia 
Published: February 2018

Purpose: Intermediate care units (IMCUs) represent an alternative care setting with nurse staffing levels between those of the general ward and the intensive care unit (ICU). Despite rising prevalence, little is known about IMCU practices across US hospitals. The purpose of this study is to characterize utilization patterns and assess for variation. Materials and Methods: A 14-item survey was distributed to a random nationwide sample of pulmonary and critical care physicians between January and April 2017. Results: A total of 51 physicians from 24 different states completed the survey. Each response represented a unique institution, the majority of which were public (59%), academic (73%), and contained at least 1 IMCU (65%). Of the IMCUs surveyed, 58% operated as 1 mixed unit that admitted medical, cardiac, and surgical patients as opposed to having separate subspecialty units. Ninety-one percent of units admitted step-down patients from the ICU, but 39% of units accepted a mix of step-up patients, step-down patients, postoperative patients, and patients from the emergency department. Intensivists managed care in 21% of units whereas 36% had no intensivist involvement. Conclusion: Organization practices vary considerably between IMCUs across institutions. The impact of different organization practices on patient outcomes should be assessed.
Patency of the arterial pedal–plantar arch in patients with chronic kidney disease or diabetes mellitus
Authors: Haine Axel , Haynes Alan G. , Limacher Andreas , Sebastian Tim , Saengprakai Wuttichai , Fuss Torsten , Baumgartner Iris 
Published: February 2018

Background: Patency of the pedal-plantar arch limits risk of amputation in peripheral artery disease (PAD). We examined patients without chronic kidney disease (CKD)/diabetes mellits (DM) [PAD-control], those with DM without CKD, and those with CKD without DM. Method: Uni- and multivariate logistic regression was used to assess association of CKD with loss of patency of the pedal–plantar arch and presence of tibial or peroneal vessel occlusion. Multivariate models adjusted for age, sex, hypertension, hyperlipidemia and smoking. Results: A total of 419 patients were included [age 75.2 ± 10.3 years, 288 (69%) male]. CKD nearly doubled the unadjusted odds ratio (OR) for loss of patency of the pedal–plantar arch. After adjustment, association remained significant for severe CKD [estimated glomerular filtration rate (eGFR) ≤ 29 ml/min compared with eGFR ≥ 60 ml/min, adjusted (adj.) OR 8.24 (95% confidence interval {CI} 0.99–68.36, p = 0.05)]. CKD was not related to risk of tibial or peroneal artery occlusion [PAD-control versus CKD, adj. OR 1.09 (95% CI 0.49–2.44, p = 0.83)] in contrast to DM [PAD–control versus DM, adj. OR 2.41 (95% CI 1.23–4.72, p = 0.01), CKD versus DM, adj. OR 2.21 (95% CI 0.93–5.22); p = 0.07)]. Conclusions: Below the knee (BTK) vascular pattern differs in patients with either DM or CKD alone. Severe CKD is a risk factor for loss of patency of the pedal–plantar arch.
Anti-Inflammatory Effects of Intra-Articular Hyaluronic Acid: A Systematic Review
Authors: Altman Roy , Bedi Asheesh , Manjoo Ajay , Niazi Faizan , Shaw Peter , Mease Philip 
Published: February 2018

Objective Osteoarthritis (OA) is one of the leading causes of disability in the adult population. Common nonoperative treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids, and intra-articular injections of hyaluronic acid (HA). HA is found intrinsically within the knee joint providing viscoelastic properties to the synovial fluid. HA therapy provides anti-inflammatory relief through a number of different pathways, including the suppression of pro-inflammatory cytokines and chemokines. Methods We conducted a systematic review to summarize the published literature on the anti-inflammatory properties of hyaluronic acid in osteoarthritis. Included articles were categorized based on the primary anti-inflammatory responses described within them, by the immediate cell surface receptor protein assessed within the article, or based on the primary theme of the article. Key findings aimed to describe the macromolecules and inflammatory-mediated responses associated with the cell transmembrane receptors. Results Forty-eight articles were included in this systematic review that focused on the general anti-inflammatory effects of HA in knee OA, mediated through receptor-binding relationships with cluster determinant 44 (CD44), toll-like receptor 2 (TLR-2) and 4 (TLR-4), intercellular adhesion molecule-1 (ICAM-1), and layilin (LAYN) cell surface receptors. Higher molecular weight HA (HMWHA) promotes anti-inflammatory responses, whereas short HA oligosaccharides produce inflammatory reactions. Conclusions Intra-articular HA is a viable therapeutic option in treating knee OA and suppressing inflammatory responses. HMWHA is effective in suppressing the key macromolecules that elicit the inflammatory response by short HA oligosaccharides.
Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery
Authors: Childers Christopher P. , Siletz Anaar E. , Singer Emily S. , Faltermeier Claire , Hu Q. Lina , Ko Clifford Y. , Golladay Gregory J. , Kates Stephen L. , Wick Elizabeth C. , Maggard-Gibbons Melinda 
Published: February 2018

Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). Study Design: This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Results: Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/ Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. Conclusion: This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.