bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes
Authors: Marston Nicholas A. , Giugliano Robert P. , Im KyungAh , Silverman Michael G. , O’Donoghue Michelle L. , Wiviott Stephen D. , Ference Brian A. , Sabatine Marc S. 
Published: September 2019

Background:
Randomized trials of therapies that primarily lowered triglycerides have not consistently shown reductions in cardiovascular events.

Methods:
We performed a systematic review and trial-level meta-regression analysis of 3 classes of lipid-lowering therapies that reduce triglycerides to a greater extent than they do low-density lipoprotein cholesterol (LDL-C): fibrates, niacin, and marine-derived omega-3 fatty acids. Key inclusion criteria were a randomized controlled trial that reported major vascular events. We also incorporated data from a previous meta-regression of 25 statin trials. The main outcome measure was the risk ratio (RR) for major vascular events associated with absolute reductions in lipid parameters.

Results:

A total of 197 270 participants from 24 trials of nonstatin therapy with 25 218 major vascular events and 177 088 participants from 25 trials of statin therapy with 20 962 major vascular events were included, for a total of 374 358 patients and 46 180 major cardiovascular events. Starting with non–high-density lipoprotein cholesterol, a surrogate for very-low-density lipoproteins and low-density lipoproteins, the RR per 1-mmol/L reduction in non–high-density lipoprotein cholesterol was 0.79 (95% CI, 0.76–0.82;
P
<0.0001; 0.78 per 40 mg/dL). In a multivariable meta-regression model that included terms for both LDL-C and triglyceride (surrogates for low-density lipoproteins and very-low-density lipoproteins, respectively), the RR was 0.80 (95% CI, 0.76–0.85;
P
<0.0001) per 1-mmol/L (0.79 per 40 mg/dL) reduction in LDL-C and 0.84 (95% CI, 0.75–0.94;
P
=0.0026) per 1-mmol/L (0.92 per 40 mg/dL) reduction in triglycerides. REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial) was a significant outlier and strongly influential trial in the meta-regression. When removed, the RRs became 0.79 (95% CI, 0.76–0.83;
P
<0.0001) per 1-mmol/L (0.78 per 40 mg/dL) reduction in LDL-C and 0.91 (95% CI, 0.81–1.006;
P
=0.06) per 1-mmol/L (0.96 per 40 mg/dL) reduction in triglycerides. In regard to omega-3 dose, each 1 g/d eicosapentaenoic acid administered was associated with a 7% relative risk reduction in major vascular events (RR, 0.93 [95% CI, 0.91–0.95];
P
<0.0001), whereas there was no significant association between the dose of docosahexaenoic acid and the relative risk reduction in major vascular events (RR 0.96 [95% CI, 0.89–1.03]).

Conclusions:
In randomized controlled trials, triglyceride lowering is associated with a lower risk of major vascular events, even after adjustment for LDL-C lowering, although the effect is less than that for LDL-C and attenuated when REDUCE-IT is excluded. Furthermore, the benefits of marine-derived omega-3 fatty acids, particularly high-dose eicosapentaenoic acid, appear to exceed their lipid-lowering effects.
How Tropical Pacific Surface Cooling Contributed to Accelerated Sea Ice Melt from 2007 to 2012 as Ice Is Thinned by Anthropogenic Forcing
Authors: Baxter Ian , Ding Qinghua , Schweiger Axel , L’Heureux Michelle , Baxter Stephen , Wang Tao , Zhang Qin , Harnos Kirstin , Markle Bradley , Topal Daniel , Lu Jian 
Published: September 2019

Abstract
Over the past 40 years, the Arctic sea ice minimum in September has declined. The period between 2007 and 2012 showed accelerated melt contributed to the record minima of 2007 and 2012. Here, observational and model evidence shows that the changes in summer sea ice since the 2000s reflect a continuous anthropogenically forced melting masked by interdecadal variability of Arctic atmospheric circulation. This variation is partially driven by teleconnections originating from sea surface temperature (SST) changes in the east-central tropical Pacific via a Rossby wave train propagating into the Arctic [herein referred to as the Pacific–Arctic teleconnection (PARC)], which represents the leading internal mode connecting the pole to lower latitudes. This mode has contributed to accelerated warming and Arctic sea ice loss from 2007 to 2012, followed by slower declines in recent years, resulting in the appearance of a slowdown over the past 11 years. A pacemaker model simulation, in which we specify observed SST in the tropical eastern Pacific, demonstrates a physically plausible mechanism for the PARC mode. However, the model-based PARC mechanism is considerably weaker and only partially accounts for the observed acceleration of sea ice loss from 2007 to 2012. We also explore features of large-scale circulation patterns associated with extreme melting periods in a long (1800 yr) CESM preindustrial simulation. These results further support that remote SST forcing originating from the tropical Pacific can excite significant warm episodes in the Arctic. However, further research is needed to identify the reasons for model limitations in reproducing the observed PARC mode featuring a cold Pacific–warm Arctic connection.
A Multiscale Alignment Method for Ensemble Filtering with Displacement Errors
Authors: Ying Yue 
Published: September 2019

AbstractHigh-resolution models nowadays simulate phenomena across many scales and pose challenges to the design of efficient data assimilation methods that reduce errors at all scales. Smaller-scale features experience rapid nonlinear error growth that gives rise to displacement errors, which cause suboptimal ensemble filter performance. Previous studies have started exploring methods that can reduce displacement errors. In this study, a multiscale alignment (MSA) method is proposed for ensemble filtering. The MSA method iteratively processes the model state from the largest to the smallest scales. At each scale, an ensemble filter is applied to update the state with observations, and the analysis increments are utilized to derive displacement vectors for each member that align the ensemble at smaller scales before the next iteration. The nonlinearity in smaller-scale priors is reduced by removing larger-scale displacement errors. Because the displacement vectors are derived from analysis increments in the state space rather than the nonlinear observation-space cost function formulated in previous studies, this method provides a less costly and more robust way to solve for the displacement vectors. Observing system simulation experiments using a two-layer quasigeostrophic model were conducted to provide a proof of concept of the MSA method. Results show that the MSA method significantly improves the accuracy of posteriors compared to the existing ensemble filter methods with or without multiscale localization. Advantage of the MSA method are more evident when the ensemble size is relatively small and the cycling period is comparable to the average eddy turnover time of the dynamical system.
A Giant Problem: The Influence of the Chicago School on Australian Competition Law, Economic Dynamism and Inequality
Authors: Triggs Adam , Leigh Andrew 
Published: September 2019

AbstractAustralia has a competition problem: there is not enough of it. Our industries are concentrated. Our markets show signs of weak competition. The way Australia’s courts, parliamentarians and regulators think about competition is partly to blame. Although it has been less influential in Australia than in the United States, the Chicago School’s views on competition have shaped our laws, policies and enforcement practices. The Chicago School views market concentration as a virtue more than a vice. The School contended that barriers to entry are negligible, market power is temporary, most mergers are good, vertical restraints and predatory pricing are either benign or efficient. The growing body of research and experience, however, shows that the Chicago School’s faith in the ability of markets to self-correct and deliver competitive outcomes was misplaced. There is a strong progressive case for repositioning how we think about competition. Focusing more on the competitive process, the structure of markets and the incentives those structures create for firms will play an important role in reducing inequality.
Changes in sleep predict changes in depressive symptoms in depressed subjects receiving vortioxetine: An open-label clinical trial
Authors: Cao Bing , Park Caroline , Rosenblat Joshua D , Chen Yan , Iacobucci Michelle , Subramaniapillai Mehala , Mansur Rodrigo B , Zuckerman Hannah , Lee Yena , McIntyre Roger S 
Published: September 2019

Background Sleep disturbances are frequently reported in patients with major depressive disorder. We aimed to investigate the effects of vortioxetine on sleep quality and association between changes in sleep and treatment response. Methods: This study is a post-hoc analysis of a clinical trial that sought to evaluate the sensitivity to cognitive change of THINC-integrated tool in patients with major depressive disorder. In total, 92 patients (aged 18 to 65) meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for moderate or severe major depressive disorder and 54 healthy controls were included. All patients received open-label vortioxetine (10–20 mg/day, flexibly dosed) for 8 weeks. Herein, the primary outcomes of interest were changes in sleep, as measured by the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Insomnia Severity Index, between weeks 0, 2, and 8. The association between changes in sleep and depressive symptom severity was secondarily assessed. Results: We observed that sleep, as indicated by scores of Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Insomnia Severity Index, was significantly poorer in patients with major depressive disorder compared to healthy controls at weeks 0, 2, and 8 ( p < 0.05). Among patients with major depressive disorder, we observed significant improvements on the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Insomnia Severity Index between weeks 0 and 8 ( p < 0.05). We observed a significant association between improvements on the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Insomnia Severity Index and improvement of depressive symptoms. Conclusion: Improvement of depressive symptoms in major depressive disorder patients treated with vortioxetine was associated with significant improvements in sleep. Furthermore, improvements in sleep were predictive of antidepressant response and were linearly correlated with improvement in overall depressive symptom severity.
Peer assessment platform of clinical skills in undergraduate medical education
Authors: Chen Liling , Chen Hong , Xu Di , Yang Yan , Li Huiming , Hua Dong 
Published: September 2019

Objective The study objective was to enhance clinical skills among undergraduate students majoring in clinical medicine in performing physical examination by establishing a novel platform for peer assessment of clinical skills. Methods A total 126 Year 2012 students majoring in medicine and receiving traditional training were assigned to the control group, and 126 Year 2013 students receiving instruction via the peer assessment platform of clinical skills were allocated to the study group. Scores of the physical examination, paper exam, and peer assessment were compared using a t-test, and we performed linear correlation analysis of the data. Results Scores of the physical examination and peer assessment among Year 2013 students (the study group) were significantly higher than those in the control group. Paper exam scores in the study group were also significantly higher than those in the controls. The three assessment scores did not differ significantly according to sex. Conclusions The peer assessment platform can not only improve medical students’ skills and capabilities in physical examination, it can also enhance their theoretical knowledge of basic clinical principles. We determined that sex was not related to the assessment scores obtained by medical students.
Influence of dry weight reduction on anemia in patients undergoing hemodialysis
Authors: Deng Yinghui , Liu Hua , Lin Na , Ma Lina , Fu Wenjing 
Published: September 2019

Objective Volume load in patients undergoing hemodialysis correlates with renal anemia, with reductions in volume load significantly improving hemoglobin levels. We performed a prospective controlled study to assess the effect of post-dialysis dry weight reduction, resulting from the gradual enhancement of ultrafiltration, on renal anemia in this patient population. Methods Sixty-four patients with renal anemia on maintenance hemodialysis were randomized to an ultrafiltration group, in which dry weight was gradually reduced by slightly increasing the ultrafiltration volume while maintaining routine hemodialysis, and a control group, in which patients underwent conventional dialysis while routine ultrafiltration was maintained. After 28 weeks, post-dialysis weight and levels of hematocrit, hemoglobin, C-reactive protein, serum albumin, serum ferritin, and transferrin saturation were compared. Results All parameters were similar at baseline between the two groups and remained unchanged at week 28 in the control group compared with baseline. In contrast, the ultrafiltration group showed a significant reduction in post-dialysis weight and C-reactive protein concentration and a significant increase in hematocrit, hemoglobin, albumin, serum ferritin, and transferrin saturation. Conclusions Dry weight reduction resulting from enhanced ultrafiltration may improve renal anemia in patients undergoing hemodialysis.
Factors associated with outcomes of septic shock patients receiving high dose noradrenaline according to three primary infection sites
Authors: Wu Kang-song , Gu Dan-yan , Wang Ting-ting , Yu Bu-wen , Pan Kong-han , Zhou Jian-cang 
Published: September 2019

Objective To identify factors associated with outcome of septic shock patients receiving high dose noradrenaline according to three primary infection sites. Methods This retrospective study was based on data from a publicly available ICU database (Medical Information Mart for Intensive Care [MIMIC] III. Septic shock patients receiving high dose (≥1 μg/kg per min) noradrenaline and ≥18 years were identified and their characteristics and outcomes were compared according to three primary infection sites (abdominal, respiratory and urinary tract). Results 154 septic shock patients who received high doses of noradrenaline were identified; (89 [58%] had a respiratory infection, 41 [27%] an abdominal infection and 24 [16%] a urinary infection). There were no differences among the three infection groups in duration/maximum dosage of noradrenaline, length of stay in the ICU/hospital, do not resuscitate (DNR) rates, hypertension and adequate antimicrobial therapy. Patients with urinary infections had a lower risk of death at 28-days compared with those with abdominal or respiratory infections. Conclusions The prognosis for septic shock patients receiving high dose noradrenaline is poor. Patients with abdominal or respiratory infections are at higher risk of death compared with those with urinary infections.
The power of crowds: Grand challenges in the Asia-Pacific region
Authors: Cai Cynthia Weiyi , Gippel Jennifer , Zhu Yushu , Singh Abhay Kumar 
Published: September 2019

Technology is enabling organizations across the globe – large and small, for-profit and not-for-profit, governments and scientific groups – to harness the resources, knowledge, talent and creativity of crowds, in their effort to find innovative solutions to vexing problems. As contributors to solving grand challenges, crowds are providing data and funds, generating novel ideas and evaluating and developing concrete solutions. This article proposes a conceptual model for understanding the utility of crowdsourcing in the context of grand challenges. The article further identifies some boundary conditions where crowdsourcing may not be useful and discusses significant barriers to applying crowdsourcing in the Asia-Pacific region. We conclude by recognizing some empirical considerations and avenues for future research. JEL Classification: O31, O35
Brain state monitoring for the future prediction of migraine attacks
Authors: Martins Isabel P , Westerfield Marissa , Lopes Marco , Maruta Carolina , Gil-da-Costa Ricardo 
Published: September 2019

Background Migraine attacks are unpredictable, precluding preemptive interventions and leading to lack of control over individuals' lives. Although there are neurophysiological changes 24–48 hours before migraine attacks, so far, they have not been used in patients' management. This study evaluates the applicability and the ability to identify pre-attack changes of daily “at home” electroencephalography obtained with a portable system for migraine patients. Methods Patients with episodic migraine fulfilling ICHD-3 beta criteria used a mobile system composed of a wireless EEG device (BrainStation®, Neuroverse®, Inc., USA) and mobile application (BrainVitalsM®, Neuroverse®, Inc., USA) to self-record their neural activity daily at home while resting and while performing an attention task, over the course of 2 weeks. Standard EEG spectral analysis and event-related brain potentials (ERP) methods were used and recordings were grouped by time from migraine attacks (i.e. “Interictal day”, “24 h Before Migraine”, “Migraine day” and “Post Migraine”). Results Twenty-four patients (22 women) recorded an average of 13.3 ± 1.9 days and had 2 ± 0.9 attacks. Twenty-four hours before attack onset, there was a statistically significant modulation of relative power in the delta (decrease) and beta (increase) frequency bands, at rest, and a significant reduction of the amplitude and inter-trial coherence measures of an attention event-related brain potential (P300). Conclusions This proof-of-concept study shows that brain state monitoring, utilising an easy-to-use wearable EEG system to track neural modulations at home, can identify physiological changes preceding a migraine attack enabling valuable pre-symptom prediction and subsequent early intervention.
Perspectives of Quebec Primary Health Care Nurse Practitioners on Their Role and Challenges in Chronic Disease Management: A Qualitative Study
Authors: Guillaumie Laurence , Therrien Dominique , Bujold Mathieu , Pelletier Jérôme , Bujold Louise , Lauzier Sophie 
Published: September 2019

Background Primary health care nurse practitioners (PHCNPs) can play a key role in chronic disease management. However, little is known about the challenges they face. Purpose The study aimed to describe PHCNPs’ perspectives on their role for patients with chronic health conditions, the barriers they face, and facilitating factors. Methods A qualitative descriptive exploratory study was conducted with 24 PHCNPs in the Canadian province of Quebec. Results PHCNPs believe that they are in an optimal position to address the needs of patients with chronic health conditions, especially in providing self-management support. However, PHCNPs reported feeling pressured to practice according to a biomedical model and to constantly defend their role in chronic disease management. They feel that they are frequently being diverted from their role to compensate for the lack of family doctors. PHCNPs made concrete recommendations to optimize their autonomous practice and quality of care: promoting strong interprofessional communication skills, genuine mentoring relationships between PHCNPs and partner physicians, managers upholding the full scope of PHCNPs’ practice, and a more flexible legislative framework. Conclusions The original conception of PHCNPs as health professionals with unique characteristics is at stake. The factors that should be targeted to support the autonomy of PHCNPs were identified.
Indigenous mental health: the limits of medicalised solutions
Authors: Hunter Ernest 
Published: September 2019

Objective: The excess burden of mental disorders experienced by Indigenous Australians is complexly overdetermined. Social and political factors contributing to the intransigence of vulnerability are reviewed, and the wider arena of neoliberal political change considered. Conclusions: The dynamic relationship between disadvantage and mental health vulnerability requires that practitioners should be attuned to both the ‘big picture’ and ‘modest and practical ways’ to contribute to reducing the developmental embedding of social disadvantage and transgenerational vulnerability.
Comparison of Positive Screening for Obstructive Sleep Apnea in Patients With and Without Cleft Lip and Palate
Authors: Gorucu-Coskuner Hande , Saglam-Aydinatay Banu , Aksu Muge , Ozgur Fatma Figen , Taner Tulin 
Published: September 2019

Objective: To compare the prevalence of increased risk of obstructive sleep apnea (OSA) in children with and without cleft lip and/or palate using a previously validated questionnaire and to examine the clinical and demographic variables that may lead to increased OSA risk. Design: Prospective, cross-sectional study. Participants: One hundred fifty-five cleft lip palate and 155 noncleft children between 2 and 18 years old. Interventions: The Pediatric Sleep Questionnaire (PSQ): Sleep Related Breathing Disorder Scale was used for screening of increased OSA risk. Age, body mass index (BMI), gender, breast-feeding, and bottle-feeding durations were recorded for all patients. Cleft type, lip and palate operation times, nasoalveolar molding, or nutrition plaque usage was documented for the cleft lip palate group. Pearson χ2 or Fisher exact test was used for the evaluation of the qualitative variables and independent samples t test or Mann Whitney U test for quantitative variables. P < .05 was accepted as statistically significant. Results: The mean ages were 7.52 ± 3.91 and 7.50 ± 3.89 years for cleft lip palate and control groups, respectively. No significant differences were observed between the groups for age, gender, or BMI. Breast-feeding duration was significantly higher, and bottle-feeding duration was lower in the control group ( P < .05). Mean PSQ score was significantly higher in cleft lip palate group (0.18 ± 0.12) than in control group (0.13 ± 0.1, P < .001); and prevalence of increased OSA risk was significantly higher in patients with both cleft lip and palate ( P = .020). Conclusions: Positive OSA screening ratio of children with cleft lip and palate (12.2%) was significantly higher than the controls (4.5%).