bluuebunny/crossref_metadata_2025_split huggingface dataset:
Familial Clustering of Cardiac Conduction Defects and Pacemaker Insertion
Authors: Kaess Bernhard M. , Andersson Charlotte , Duncan Meredith S. , Larson Martin G. , Aasbjerg Kristian , Gislason Gunnar H. , Torp-Pedersen Christian , Vasan Ramachandran S. 
Published: June 2019

Background:
The etiopathogenesis of electrocardiographic bundle branch and atrioventricular blocks is not fully understood. We investigated familial clustering of cardiac conduction defects and pacemaker insertion in the FHS (Framingham Heart Study). Additionally, we assessed familial clustering of pacemaker insertion in the Danish general population.

Methods:
In FHS, we used multivariable-adjusted logistic regression models to investigate the association of parental atrioventricular block (PR interval, ≥0.2 s), complete bundle branch block (QRS, ≥0.12 s), or pacemaker insertion with the occurrence of cardiac conduction abnormalities in their offspring. The Danish nationwide administrative registries were interrogated to assess the relations of parental pacemaker insertion with offspring pacemaker insertion.

Results:
In FHS (n=371 cases with first-degree atrioventricular block, complete bundle branch block, or pacemaker insertion, and 1471 age- and sex-matched controls), individuals with at least 1 affected parent with a conduction defect had a 1.65-fold odds (odds ratio, 95% CI, 1.32–2.07) for manifesting an atrioventricular block and a 1.62-fold odds (95% CI, 1.08–2.42) for developing a complete bundle branch block. If at least 1 parent had any electrocardiographic conduction defect or pacemaker insertion, the offspring had a 1.62-fold odds (95% CI, 1.31–2.00) for experiencing any of these conditions. In Denmark (n=2 824 199 individuals; 5397 incident pacemaker implantations), individuals with at least 1 first-degree relative with history of pacemaker insertion had a multivariable-adjusted 1.68-fold (incidence rate ratio, 95% CI, 1.49–1.89) risk of undergoing a pacemaker insertion. If the affected relative was ≤45 years of age, the incidence rate ratio was markedly increased to 51.0 (95% CI, 32.7–79.9).

Conclusions:
Cardiac conduction blocks and risk for pacemaker insertion cluster within families. A family history of conduction system disturbance or pacemaker insertion should trigger increased awareness of a similar propensity in other family members, especially so when the conduction system disease occurs at a younger age.
Machine Learning Prediction of Response to Cardiac Resynchronization Therapy
Authors: Feeny Albert K. , Rickard John , Patel Divyang , Toro Saleem , Trulock Kevin M. , Park Carolyn J. , LaBarbera Michael A. , Varma Niraj , Niebauer Mark J. , Sinha Sunil , Gorodeski Eiran Z. , Grimm Richard A. , Ji Xinge , Barnard John , Madabhushi Anant , Spragg David D. , Chung Mina K. 
Published: June 2019

Background:
Cardiac resynchronization therapy (CRT) has significant nonresponse rates. We assessed whether machine learning (ML) could predict CRT response beyond current guidelines.

Methods:
We analyzed CRT patients from Cleveland Clinic and Johns Hopkins. A training cohort was created from all Johns Hopkins patients and an equal number of randomly sampled Cleveland Clinic patients. All remaining patients comprised the testing cohort. Response was defined as ≥10% increase in left ventricular ejection fraction. ML models were developed to predict CRT response using different combinations of classification algorithms and clinical variable sets on the training cohort. The model with the highest area under the curve was evaluated on the testing cohort. Probability of response was used to predict survival free from a composite end point of death, heart transplant, or placement of left ventricular assist device. Predictions were compared with current guidelines.

Results:

Nine hundred twenty-five patients were included. On the training cohort (n=470: 235, Johns Hopkins; 235, Cleveland Clinic), the best ML model was a naive Bayes classifier including 9 variables (QRS morphology, QRS duration, New York Heart Association classification, left ventricular ejection fraction and end-diastolic diameter, sex, ischemic cardiomyopathy, atrial fibrillation, and epicardial left ventricular lead). On the testing cohort (n=455, Cleveland Clinic), ML demonstrated better response prediction than guidelines (area under the curve, 0.70 versus 0.65;
P
=0.012) and greater discrimination of event-free survival (concordance index, 0.61 versus 0.56;
P
<0.001). The fourth quartile of the ML model had the greatest risk of reaching the composite end point, whereas the first quartile had the least (hazard ratio, 0.34;
P
<0.001).

Conclusions:

ML with 9 variables incrementally improved prediction of echocardiographic CRT response and survival beyond guidelines. Performance was not improved by incorporating more variables. The model offers potential for improved shared decision-making in CRT (online calculator:
http://riskcalc.org:3838/CRTResponseScore
). Significant remaining limitations confirm the need to identify better variables to predict CRT response.
The Short Happy Life of the SADC Tribunal: the Perils of Regional Integration in Southern Africa
Authors: Nkhata Mwiza Jo 
Published: June 2019

AbstractUnder the Treaty Establishing the Southern African Development Community (the Treaty) one of the institutions of the Southern African Development Community (SADC) was the Southern African Development Community Tribunal (the Tribunal). The Tribunal was established as the sole judicial organ of SADC. The Tribunal was established as part of the reorganisation of regional integration efforts within Southern Africa. The global atmosphere prevailing at the time the Tribunal was established, together with the lofty statements in the SADC’s founding instruments, suggest that there was a regional commitment to the ideals of human rights, rule of law and democracy among SADC member States. The Tribunal’s life, however, was short-lived. This paper analyses the prospects and lessons for regional integration within the SADC region from the perspective of the disbanding of the Tribunal and attempts to decipher the implications of the disbanding for regional integration in Southern Africa.
Strengthening Rule of Law Enforcement in Sub-Saharan Africa: the Role of African Union
Authors: Gelaye Tsega Andualem 
Published: June 2019

AbstractRule of law violation is a chronic problem in sub-Saharan Africa. Yet the African Union (AU), which is the main regional organization in the continent, is not playing a significant role in ensuring the observance of rule of law in its member states compared to its counterparts such as the European Union. This paper argues that, beside the issue of lack of political will, the existing legal framework of the AU has contributed its part for the negligible rule of law monitoring involvement of the organization at the moment and underscores the need for urgent remedy to address these lacunas. In undertaking this investigation, the paper adopts a comparative approach relying heavily on the lessons from the experience of the European Union, which is assumed to have a better mechanism in this regard.
Atlantic-Origin Overflow Water in the East Greenland Current
Authors: Håvik Lisbeth , Almansi Mattia , Våge Kjetil , Haine Thomas W. N. 
Published: June 2019

AbstractDense water masses transported southward along the east coast of Greenland in the East Greenland Current (EGC) form the largest contribution to the Denmark Strait Overflow. When exiting Denmark Strait these dense water masses sink to depth and feed the deep circulation in the North Atlantic. Based on one year of mooring observations upstream of Denmark Strait and historical hydrographic profiles between Fram Strait and Denmark Strait, we find that a large part (75%) of the overflow water ( ≥ 27.8 kg m−3) transported by the EGC is of Atlantic origin (potential temperature θ > 0°C). The along-stream changes in temperature of the Atlantic-origin Water are moderate north of 69°N at the northern end of Blosseville basin, but southward from this point the temperature decreases more rapidly. We hypothesize that this enhanced modification is related to the bifurcation of the EGC taking place close to 69°N into the shelfbreak EGC and the separated EGC. This is associated with enhanced eddy activity and strong water mass modification reducing the intermediate temperature and salinity maxima of the Atlantic-origin Water. During periods with a large (small) degree of modification the separated current is strong (weak). Output from a high-resolution numerical model supports our hypothesis and reveals that large eddy activity is associated with an offshore shift of the surface freshwater layer that characterizes the Greenland shelf. The intensity of the eddy activity regulates the density and the hydrographic properties of the Denmark Strait Overflow Water transported by the EGC system.
A Cross-Sectional Examination of the Writing of Students with Visual Impairments
Authors: Savaiano Mackenzie E. , Hebert Michael 
Published: June 2019

Introduction: Not much is known about the writing skills of students with visual impairments, and this research is often limited to subgroups of the population or subskills. A more comprehensive approach to research on the writing skills of students with visual impairments is needed. Methods: Researchers used a cross-sectional design to examine the writing of students with visual impairments in Nebraska, attempting to include as many students as possible aged from 4 to 21 years. Fifty students participated. All students were given the Essay Composition subtest of the Wechsler Individualized Achievement Test (third edition), with modified instructions. Essays were scored on number of words, essay elements, and mechanics. Descriptive statistics and statistical comparisons of groups are provided. Results: Mean scores of the overall sample and subgroups fell within the average range when compared to normative samples. There were no statistical differences between students who were blind and students with low vision and no statistical differences between writing modality. There were statistical differences between students with multiple disabilities and others. Results suggest substantial heterogeneity in the sample. Discussion: Results suggest some students with visual impairments write as well as do their sighted peers. These results are complicated by heterogeneity and do not imply anything about the writing ability of individual students. Implications for practitioners: Teachers should avoid making assumptions about the writing potential of specific students. Students with visual impairments in this study scored comparably to a normative sample, and students with multiple disabilities may be able to participate in writing activities in a variety of ways.
Evaluation of lumbar multifidus muscle in patients with lumbar disc herniation: are complex quantitative MRI measurements needed?
Authors: Colakoglu Bulent , Alis Deniz 
Published: June 2019

Objective To assess the composition of lumbar multifidus muscle, in patients with unilateral lumbar disc herniation causing nerve compression, using quantitative and qualitative magnetic resonance imaging (MRI) measurement methods. Methods Two radiologists retrospectively measured MRI signal intensity of the multifidus muscle, as high intensity represents more fat, and visually graded the fat content using a 5-point grading system in patients with unilateral subarticular lumbar disc herniation. Findings from the herniated and contralateral sides were compared. The association between fat content and severity of nerve compression and symptom duration were also evaluated. Results Ninety patients (aged 24–70 years) were included. Signal intensity of the affected multifidus muscle was significantly higher versus the contralateral muscle for quantitative measurements and qualitative scoring for both investigators. Significant correlations were observed between the severity of nerve compression and symptom duration and the degree of fat content in the affected multifidus muscle. Conclusions Higher fat composition was observed in the multifidus muscle ipsilateral to the lumbar disc herniation versus the contralateral side. Straightforward visual grading of muscle composition regarding fat infiltration appeared to be as useful as quantitative measurement.
Role of interleukin-33 in the clinical pathogenesis of chronic apical periodontitis
Authors: Gegen Tana , Zhu Yanxia , Sun Qinnuan , Hou Benxiang 
Published: June 2019

Objective This study investigated interleukin (IL)-33 expression in chronic apical periodontitis (CAP) lesions and possible relationships with receptor activator of nuclear factor κ-Β ligand (RANKL) and osteoprotegerin (OPG). Methods Inflammatory cell infiltration in CAP lesions and samples of healthy periapical tissue (n = 30 each) was evaluated by hematoxylin and eosin staining. IL-33, RANKL, and OPG expression levels were assessed by immunohistochemistry and real-time PCR. In CAP lesions alone, relationships between mRNA level of IL-33 and mRNA levels of both RANKL and OPG were analyzed by Spearman rank correlation. Results Histological analysis revealed a large number of inflammatory cells in CAP lesions, and immunohistochemistry revealed IL-33-positive cells. There were more IL-33- and RANKL-positive cells in CAP lesions than in healthy periapical tissue, whereas there were fewer OPG-positive cells in CAP lesions than in healthy periapical tissue. In CAP lesions alone, IL-33 mRNA level was negatively correlated with mRNA level of RANKL and positively correlated with mRNA level of OPG. Conclusions IL-33 is highly expressed in CAP lesions, where it is negatively correlated with RANKL and positively correlated with OPG expression. IL-33 may protect against bone resorption via RANKL suppression and OPG induction, and constitutes a potential target for CAP treatment.
Main Barriers to Optimal Breastfeeding Practices in Armenia: A Qualitative Study
Authors: Demirchyan Anahit , Melkom Melkomian Dzovinar 
Published: June 2019

Background In 2015, the median duration of exclusive breastfeeding was 2.2 months in Armenia, and only 15% of 4–5-month-old children were exclusively breastfed, indicating an issue with breastfeeding knowledge and practices. Research aim To identify the main barriers to optimal breastfeeding practices in Armenia. Methods We used qualitative research methods via focus group discussions and in-depth interviews with four groups of providers from different levels of care, and mothers of young children, from Yerevan city and two provinces, Lori and Shirak. Overall, eight in-depth interviews and 13 focus group discussions were conducted with a total of 99 participants. Qualitative content analysis was applied, with elements of both inductive and deductive approaches. Results We identified two main categories of barriers to optimal breastfeeding—systemic barriers and knowledge deficiencies. The main themes within systemic barriers were lack of skilled breastfeeding support services and low motivation of providers—mainly related to inadequate recognition of their role in breastfeeding counseling and low remuneration. The main knowledge-related barriers were insufficient counseling of mothers, lack of reliable information sources about infant feeding, and misconceptions among both mothers and providers. Conclusion Optimal breastfeeding is crucial for the best start to an infant’s life; however, there were a number of barriers to optimal breastfeeding practices in Armenia. Our findings and recommendations could help policymakers apply effective strategies for improving breastfeeding rates in Armenia. Considering the similar historical backgrounds of the post-Soviet countries, our findings could also be applicable to other Commonwealth of Independent States countries.
Insights From a Short-Term Protein–Calorie Restriction Exploratory Trial in Elective Carotid Endarterectomy Patients
Authors: Kip Peter , Trocha Kaspar M. , Tao Ming , O’leary James J. , Ruske Jack , Giulietti Jennifer M. , Trevino-Villareal Jose H. , MacArthur Michael R. , Bolze Andrew , Burak M. Furkan , Patterson Suzannah , Ho Karen J. , Carmody Rachel N. , Guzman Raul J. , Mitchell James R. , Ozaki C. Keith 
Published: June 2019

Background: Open vascular surgery interventions are not infrequently hampered by complication rates and durability. Preclinical surgical models show promising beneficial effects in modulating the host response to surgical injury via short-term dietary preconditioning. Here, we explore short-term protein–calorie restriction preconditioning in patients undergoing elective carotid endarterectomy to understand patient participation dynamics and practicalities of robust research approaches around nutritional/surgical interventions. Methods: We designed a pilot prospective, multicenter, randomized controlled study in patients undergoing carotid endarterectomy. After a 3:2 randomization to a 3-day preoperative protein–calorie restriction regimen (30% calorie/70% protein restriction) or ad libitum group, blood, clinical parameters, and stool samples were collected at baseline, pre-op, and post-op days 1 and 30. Subcutaneous and perivascular adipose tissues were harvested periprocedurally. Samples were analyzed for standard chemistries and cell counts, adipokines. Bacterial DNA isolation and 16S rRNA sequencing were performed on stool samples and the relative abundance of bacterial species was measured. Results: Fifty-one patients were screened, 9 patients consented to the study, 5 were randomized, and 4 completed the trial. The main reason for non-consent was a 3-day in-hospital stay. All 4 participants were randomized to the protein–calorie restriction group, underwent successful endarterectomy, reported no compliance difficulties, nor were there adverse events. Stool analysis trended toward increased abundance of the sulfide-producing bacterial species Bilophila wadsworthia after dietary intervention ( P = .08). Conclusions: Although carotid endarterectomy patients held low enthusiasm for a 3-day preoperative inpatient stay, there were no adverse effects in this small cohort. Multidisciplinary longitudinal research processes were successfully executed throughout the nutritional/surgical intervention. Future translational endeavors into dietary preconditioning of vascular surgery patients should focus on outpatient approaches.
Cellular-Enabled Glucometers and Maternal Glucose Control: A Quality Improvement Initiative
Authors: Wernimont Sarah A. , Sheng Jessica S. , Fleener Diedre , Summers Karen M. , Syrop Craig , Andrews Janet I. 
Published: June 2019

Background: Management of diabetes in pregnancy is burdensome due to self-glucose monitoring, recording, and reporting demands. Cellular-enabled glucometers provide real-time transmission of glucose values independent of internet access and cell phone data plans. We describe a quality improvement (QI) intervention that introduced cellular-enabled glucometers for use during pregnancies complicated by diabetes. Methods: Our aim was to improve maternal glucose control in a cohort of insulin-requiring pregnant women enrolled in a telemedicine diabetes program. During initial establishment of a QI program, women were offered cellular-enabled glucometers but could elect to keep their standard meter. The primary outcome evaluated was glycosylated hemoglobin A1c (HbA1c) at delivery. Results: Baseline characteristics including initial HbA1c were similar between women using a standard glucometer (n = 45) and those using a cellular-enabled glucometer (n = 72). Women who used a cellular-enabled glucometer had a lower HbA1c at delivery compared to those using a standard glucometer (5.8% vs 6.3%, P = .03). This improvement was particularly notable for women with poor glucose control (defined as HbA1c >6.5%) at initial obstetric visit. Women with poor glucose control who used a cellular-enabled glucose monitor had significantly lower HbA1c at delivery (6.0% vs 6.8%, P = .03) and greater change from initial visit compared to those using a standard glucometer (−2.6% vs −1.4%, P = .02). No statistically significant differences were detected in tracked neonatal outcomes. Conclusion: For pregnancies complicated by insulin-requiring diabetes, use of cellular-enabled glucometers as part of a perinatal diabetes program improves glucose control at delivery with timely transmission of accurate values throughout gestation.
Relationship Between Nasal Cycle, Nasal Symptoms and Nasal Cytology
Authors: Pendolino Alfonso Luca , Scarpa Bruno , Ottaviano Giancarlo 
Published: June 2019

Background The nasal cycle is the spontaneous congestion and decongestion of nasal mucosa that happens during the day. Classically, 4 types of nasal cycle patterns have been described: (1) classic, (2) parallel, (3) irregular, and (4) acyclic. Hypothalamus has been considered as the central regulator even if several external factors may influence its activity. Objective The aim of the study was to evaluate the presence of a correlation between nasal cycle pattern, nasal cytology and nasal symptoms. Methods Thirty healthy volunteers have been enrolled in the study. All subjects completed a Sino-Nasal Outcome Test-22 questionnaire and a Visual Analog Scale (VAS) for nasal obstruction. The nasal cycle was studied by means of peak nasal inspiratory flow. Nasal cytology has been used to evaluate the presence of local nasal inflammation. Results Nineteen subjects showed a parallel nasal cycle pattern, while 11 showed a regular one. A parallel pattern was present in 60% of asymptomatic subjects and in 67% of the symptomatic one ( P = 1). VAS for nasal obstruction did not show a significant difference between the 2 patterns of the nasal cycle ( P = .398). Seventeen subjects had a normal rhinocytogram, while 13 volunteers showed a neutrophilic rhinitis; 53.8% of the subjects with a neutrophilic rhinitis showed a parallel pattern, while the remaining 46.2% had a regular one. In the case of a normal cytology, 70.6% of the volunteers had a parallel pattern and 29.4% had a regular one. Differences between the 2 groups were not statistically significant ( P = .575). Conclusion Rhinitis with neutrophils seems to not influence the nasal cycle pattern. Based on the present results, the pattern of nasal cycle does not influence subjective nasal obstruction sensation.