bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relations between baseline burden, maximum duration, and relative reduction of atrial fibrillation: Insights from continuous monitoring in rhythm control
Authors: Lin Po‐Lin , Huang Chun‐Che , Wu Yih‐Jer , Su Min‐I , Chiou Wei‐Ru , Liu Lawrence Yu‐Min , Liao Feng‐Ching , Lai Edward , Chen Chun‐Yen , Kuo Jen‐Yuan , Lee Ying‐Hsiang 
Published: December 2018

AbstractIntroductionCardiac implantable electronic devices (CIEDs) can measure atrial fibrillation (AF) early; however, the timing for administering antiarrhythmic drugs (AADs) to suppress AF remains unclear. This study aimed to investigate the association between baseline values and changes after AAD in terms of relative reduction of AF burden (RRAB) and maximum AF duration (RRMD).MethodsThis multicenter retrospective study screened all patients with nonpermanent AF who had dual‐chamber pacemakers and only enrolled those receiving a naive AAD between September 2009 and December 2014. AF burden and maximum duration were calculated using CIED at 0 and 3 to 6 months after starting rhythm control. All the enrolled patients were divided into four groups according to baseline AF burden. RRAB and RRMD were monitored using CIEDs.ResultsOverall, 145 eligible subjects received a naive AAD for nonpermanent AF. The mean RRAB in the four groups (AF burden <1%, 1%‐4%, 4%‐18%, and ≥18%) were −65.3%, −46.4%, −34.7%, and −27.9% (P = 0.005), respectively. Mean RRMD were −26.8%, −12.4%, 4.2%, and 6.0%, respectively (
P = 0.006). Multivariate analysis revealed that the lowest baseline AF burden (<1%) was significantly associated with greater RRAB, which was not observed in the RRMD model.ConclusionsLower baseline AF burden was associated with greater RRAB by AADs. Our finding suggests that rhythm control should be started in the early stage to achieve better responses to AADs.
Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation
Authors: Mohanty Sanghamitra , Di Biase Luigi , Trivedi Chintan , Choudhury Fahim , Della Rocca Domenico G. , Romero Jorge , Gianni Carola , Sanchez Javier , Hranitzky Patrick , Gallinghouse G. Joseph , Al‐Ahmad Amin , Horton Rodney P. , Burkhardt David , Natale Andrea 
Published: December 2018

AbstractIntroductionIt is common to find residual stump after the amputation or clip exclusion of the left atrial appendage (LAA). We evaluated the arrhythmogenic and thrombogenic potential of LAA stumps in atrial fibrillation (AF) patients.MethodsConsecutive patients undergoing catheter ablation for AF recurrence with LAA stump detected at baseline transesophageal echocardiogram (TEE) were included in the analysis. Nonpulmonary vein (non‐PV) triggers were ablated based on operator's discretion.ResultsA total of 213 patients with LAA stump were included in the analysis. Firing from the LAA stump was detected in 186 cases, of which 145 received stump isolation (group I) and the stump was not targeted for isolation in 41 (group II) patients. In 27 patients with no firing from the stump (group III) only non‐PV triggers from sites other than the LAA stump were targeted for ablation. At 16.7 ± 8.5 months of follow‐up, 126 (86.9%) patients from group I, eight (19.5%) from group II, and eight (33.3%) from group III remained arrhythmia‐free off antiarrhythmic drugs (AAD) (P < 0.001). Sixty out of 70 patients underwent redo procedure; electrical isolation of the stump and ablation of other non‐PV triggers was done in all 60 cases. At 1 year after the repeat procedure, 55 (91.7%) patients remained arrhythmia‐free off‐AAD. A total of four (1.88%) thromboembolic (TE) events reported, three of which were transient ischemic attacks and all three patients had “smoke” detected in the left atrium.ConclusionLAA stump is arrhythmogenic and electrical isolation improves clinical outcome. TE events are rare and mostly associated with left atrial smoke in this subset of AF population.
Slow atrioventricular nodal pathway affecting fast pathway conduction
Authors: Prystowsky Eric N. 
Published: December 2018

AbstractA 15‐year‐old girl with a history of paroxysmal supraventricular tachycardia underwent an electrophysiology study (EPS) for diagnosis and ablation. Her baseline electrocardiogram and echocardiogram were normal. At EPS, she had dual atrioventricular nodal (AVN) conduction, but isoproterenol was needed to initiate the slow‐fast form of AVN reentry. Before ablation without any isoproterenol, she began to have a spontaneous block in the fast pathway with continuous conduction over the slow pathway. After ablation of the slow pathway, all complexes conducted over the fast pathway during a 25‐year follow‐up. Possible electrotonic interaction between the slow and fast pathways is proposed as the mechanism for this phenomenon.
Amiodarone is associated with adverse outcomes in patients with sustained ventricular arrhythmias upgraded to cardiac resynchronization therapy—defibrillators
Authors: Adelstein Evan C. , Althouse Andrew D. , Davis Lydia , Schwartzman David , Bazaz Raveen , Jain Sandeep , Wang Norman , Saba Samir 
Published: December 2018

AbstractIntroductionAmiodarone reduces recurrent ventricular tachyarrhythmias (VTA) but may worsen cardiovascular outcomes in heart failure (HF) patients. Cardiac resynchronization therapy (CRT) may also be antiarrhythmic. When patients with prior sustained VTA are upgraded to CRT defibrillators (CRT‐D) from conventional implantable cardioverter‐defibrillators (ICDs), should concomitant amiodarone be continued or is CRT’s antiarrhythmic potential sufficient?Methods and ResultsWe identified 67 patients from a prospective CRT registry with spontaneous sustained VTA, New York Heart Association (NYHA) II‐IV HF, and left bundle‐branch block (LBBB) who were upgraded to CRT defibrillators from conventional ICDs. We compared changes in QRS duration and left ventricular ejection fraction (LVEF) pre‐ and post‐CRT, time to death, transplant or ventricular assist device (VAD), and time to recurrent VTA therapies between 37 patients continuing amiodarone therapy and 30 amiodarone‐naïve patients. Amiodarone‐treated patients had worse renal function and a higher prevalence of prior VTA storm compared with amiodarone‐naïve patients. After CRT, amiodarone‐treated patients demonstrated less QRS narrowing (8 vs 20 ms; P = 0.021) and less LVEF improvement (−2.7 vs +5.2%; P = 0.006). Over 29 months, 31 (47%) patients died and 13 (20%) received transplant or VAD. Risk of death, transplant, or VAD was greater in amiodarone‐treated than ‐naïve patients (corrected hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.12‐4.11; P = 0.022). Appropriate CRT‐D therapies occurred in 37 (55%) patients; amiodarone use was not associated time to first therapy (HR, 1.13; 95% CI, 0.59‐2.16; P = 0.72).ConclusionIn patients with sustained VTA and LBBB upgraded from conventional ICDs to CRT defibrillators, concomitant amiodarone use is associated with less QRS narrowing, less LVEF improvement, greater risk of death, transplant, or VAD, and similar risk of recurrent VTA.
Ambient fine particulate matter (PM2.5) exposure is associated with idiopathic ventricular premature complexes burden: A cohort study with consecutive Holter recordings
Authors: Tsai Tsung‐Ying , Lo Li‐Wei , Liu Shin‐Huei , Cheng Wen‐Han , Chou Yu‐Hui , Lin Wei‐Lun , Shinya Yamada , Lin Yenn‐Jiang , Chang Shih‐Lin , Hu Yu‐Feng , Chung Fa‐Po , Liao Jo‐Nan , Chao Tze‐Fan , Tuan Ta‐Chuan , Chen Shih‐Ann 
Published: December 2018

AbstractBackgroundEpidemiological evidence has shown an association between ambient fine particulate matter (PM2.5) exposure and cardiovascular mortality. Increased ventricular premature complex (VPC) burden can cause left ventricular dilatation and dysfunction. We aimed to investigate the relationship between acute PM2.5 exposure and VPC burden in patients without structural heart disease.MethodsWe reviewed 26 820 patients who underwent 24‐hour Holter electrocardiogram (ECG) recordings between 1 Jan 2013 and 1 Dec 2016. We enrolled patients with significant idiopathic (structurally normal heart) VPC burden defined as ≥30 VPCs/h (Lown grade 2) who had at least two Holter ECG recordings. The VPC burden between the studies on high and low PM2.5 exposure dates was compared in 24 and 12 hours time periods.ResultSixty‐seven patients (31 men, 56.49 ± 18.35 years) were enrolled. Patients were exposed to 25.63 ± 11.47 and 14.66 ± 7.51 μg/m
3 of PM2.5 during the high and low study dates, respectively. The overall VPC counts (10,490.69 ± 10,681.63/day) and burden (10.22% ± 10.17%) were significantly higher on the days with higher PM2.5 exposure compared with low PM2.5 exposure dates (8293.31 ± 9009.09;
P = 0.014% and 9.14% ± 12.73%,
P = 0.012, respectively). Compared with low PM2.5 exposure dates, the VPC burden on high exposure dates was significantly higher from 9
am to 9
pm (5.85% ± 6.41% vs 4.84% ± 6.97%;
P = 0.025) but not at nocturnal periods.ConclusionOur study demonstrated a significantly higher VPC burden on high PM2.5 exposure date. The burden was increased in the daytime but not at nighttime. This result suggests that daytime PM2.5 exposure may be associated with ventricular arrhythmia burden in the healthy population.
Improving patient access to hepatitis C antiviral medicines in Switzerland: Understanding the financial risks for community pharmacies
Authors: Berger Jérôme , Bourdin Aline , Pires Fatima , Backes Claudine , Perraudin Clémence , Bugnon Olivier 
Published: December 2018

AbstractRationaleAs observed in other countries, some patients may experiment difficulties in obtaining their hepatitis C antiviral medicines (HCVm) in Swiss community pharmacies. There is a lack of data related to access to HCVm at the patient level and notably related to the potential financial risks for the community pharmacies.Aims(a) To evaluate the potential financial risks for community pharmacist associated with the delivery of HCVm in the Swiss healthcare system; (b) to explore the attitudes and experiences of community pharmacists related to these risks and their consequences for the patients.MethodA three‐step approach was chosen as follows: (a) estimation of costs, incomes, and gross financial results directly related to 3‐month treatment with Harvoni based on the drug delivery process (data from 68 patients over 2 years); (b) sensitivity analyses; (c) exploration of local community pharmacists' attitudes and experiences related to the delivery of HCVm in the canton of Vaud (Western Switzerland).ResultsTwo main risks were identified: (a) Incomes do not always cover costs; (b) reimbursement issues could lead to an increase in the requirement for working capital. According to the survey, 23% (14/60) of pharmacies refused to deliver HCVm to at least one patient, and these patients had to find a solution mostly on their own.ConclusionsThe scenario analysis clarifies the causes of the possible refusal to deliver HCVm. With the growing number of high‐priced medicines, the healthcare systems should have a clear strategy to encourage their delivery by community pharmacies by ensuring seamless and collaborative care for patients. The community pharmacists could be accountable to provide such services—if they get the education, training, and remuneration.
Evidence‐based medicine as science
Authors: Vere Joseph , Gibson Barry 
Published: December 2018

AbstractEvidence‐based medicine has claimed to be science on a number of occasions, but it is not clear that this status is deserved. Within the philosophy of science, four main theories about the nature of science are historically recognized: inductivism, falsificationism, Kuhnian paradigms, and research programmes. If evidence‐based medicine is science, knowledge claims should be derived using a process that corresponds to one of these theories. This paper analyses whether this is the case. In the first section, different theories about the nature of science are introduced. In the second section, the claim that evidence‐based medicine is science is reinterpreted as the claim that knowledge claims derived from randomized controlled trails and meta‐analyses are science. In the third section, the knowledge claims valued within evidence‐based medicine are considered from the perspective of inductivism, falsificationism, Kuhnian paradigms, and research programmes. In the final section, possible counter arguments are considered. It is argued that the knowledge claims valued by evidence‐based medicine are not justified using inductivism, falsificationism, Kuhnian paradigms, or research programmes. If these are the main criteria for evaluating if something is science or not, evidence‐based medicine does not meet these criteria.
Lessons and Outcomes of Mobile Acute Care for Elders Consultation in a Veterans Affairs Medical Center
Authors: Schubert Cathy C. , Parks Rebecca , Coffing Jessica M. , Daggy Joanne , Slaven James E. , Weiner Michael 
Published: December 2018

OBJECTIVEDescribe the implementation and effects of Mobile Acute Care for Elders (MACE) consultation at a Veterans Affairs Medical Center (VAMC).DESIGNRetrospective cohort analysis.INTERVENTIONVeterans aged 65 or older who were admitted to the medicine service between October 1, 2012, and September 30, 2014, were screened for geriatric syndromes via review of medical records within 48 hours of admission. If the screen was positive, the MACE team offered the admitting team a same‐day consultation involving comprehensive geriatric assessment and ongoing collaboration with the admitting team and supportive services to implement patient‐centric recommendations for geriatric syndromes.RESULTSVeterans seen by MACE (n = 421) were compared with those with positive screens but without consultation (n = 372). The two groups did not significantly differ in age, comorbidity, sex, or race. All outcomes (30‐day readmission, 30‐day mortality, readmission costs) were in the expected direction for patients receiving MACE but did not reach statistical significance. Patients receiving MACE had lower odds of 30‐day readmission (11.9% vs 14.8%; odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.54‐1.25; p = .360) and 30‐day mortality (5.5% vs 8.6%; OR = 0.64; CI = 0.36‐1.12; p = .115), and they had lower 30‐day readmission costs (MACE $15,502; CI = $12,242‐$19,631; comparison = $18,335; CI = $14,641‐$22,962; p = .316) than those who did not receive MACE after adjusting for age and Charlson Comorbidity Index.CONCLUSIONOur MACE consultation model for older veterans with geriatric syndromes leverages the limited supply of clinicians with expertise in geriatrics. Although not statistically significant in this study of 793 subjects, MACE patients had lower odds of 30‐day readmission and mortality, and lower readmission costs. J Am Geriatr Soc 67:818–824, 2019.
The Heterogeneous Responses of Consumption between Poor and Rich to Government Spending Shocks
Authors: MA EUNSEONG 
Published: December 2018

AbstractGovernment spending shocks have substantially different effects on consumers across the income distribution: consumption increases for the poor whereas it decreases for the rich in response to a rise in government expenditure. I shed light on this issue by incorporating a progressive tax scheme and productive public expenditure into a heterogeneous agent model economy with indivisible labor. The model economy is able to successfully match aggregate and disaggregate effects of government spending shocks on consumption. When the government increases its spending and accompanies it by a rise in tax progressivity, the poor are employed and increase their consumption since after‐tax wage rates increase while the rich decrease their consumption because of a fall in after‐tax wage rates.
Factors affecting prognosis in locoregional recurrence of oral squamous cell carcinoma
Authors: Borsetto Daniele , Higginson James A. , Aslam Adil , Al‐Qamachi Laith , Dhanda Jagtar , Marioni Gino , Franchella Sebastiano , Frigo Annachiara , Praveen Prav , Martin Tim , Parmar Sat , Nankivell Paul 
Published: December 2018

BackgroundRecurrence of oral squamous cell carcinoma (rOSCC) after primary treatment is associated with poor survival outcomes. Salvage treatment with further surgery, radiotherapy and chemotherapy has high morbidity, making patient selection crucial. However, in the recurrence setting, reliable stratification data are scarce. Decision‐making in this context is consequently complex. We investigated factors influencing overall survival after rOSCC.MethodsRetrospective cohort study of patients with rOSCC (n = 83) at the Queen Elizabeth Hospital Birmingham, UK between 2006 and 2016. Associations with overall survival were analysed using univariate and multivariate analyses to identify important clinical prognostic indicators.ResultsOverall survival at 1 year was 32.5% and at 5 years was 18.1% after a median follow‐up of 7.4 months. Multivariate analysis identified four independent predictors of overall survival following rOSCC: size of primary tumour (HR 2.077; 95% CI 1.034‐4.172), extent of recurrent disease (HR 3.286; 95% CI 1.545‐6.991), history of moderate alcohol consumption (HR 0.351; 95% CI 0.162‐0.763), and close or positive margins at primary resection (HR 1.955; 95% CI 1.063‐3.595).ConclusionsWe identified four key factors that help prognostication and risk stratification of rOSCC. Given the high morbidity associated with salvage treatment, we recommend that the multidisciplinary team (MDT) and the patient weigh these factors carefully when considering further treatment. Further investigation of the biology underlying these oncophenotypes may contribute to better patient stratification.
The Effect of Ad Skepticism and Celebrity Preference on Brand Attitude Change in Celebrity‐Endorsed Advertising
Authors: Kang Jungsuk 
Published: December 2018

AbstractThe use of a celebrity endorser who is well recognized and favorably evaluated by the target viewers is a common strategy used by advertisers to increase the persuasiveness of an advertisement. Yet, at the same time, being skeptical of the claim being made by the celebrity endorser is the typical response of the viewers to such persuasion attempts. The present research examines how these effects potentially counterbalance each other as viewers evaluate the advertised brand in a low‐involvement setting. The results show that the degree of ad skepticism and the relative allocation of attentional resources to celebrity and brand elements in advertisements determine how preference for a celebrity endorser is transferred to the advertised brand. The findings provide a more complete understanding of the psychological mechanisms by which celebrity preference influences brand attitude change than has previously been available. They indicate that ad skepticism may be the missing link in understanding the effectiveness of celebrity‐endorsed advertising.
Quality and microbial properties of symbiotic bread produced by straight dough and frozen part‐baking methods
Authors: Majzoobi Mahsa , Aghdam Mohammad Bagher Kamali , Eskandari Mohammad Hadi , Farahnaky Asgar 
Published: December 2018

AbstractSymbiotic bread was produced by straight dough and frozen part‐baking methods using inulin as a prebiotic (0–7.5% in straight dough method and 5% in frozen part baked bread) and GanedenBC 30 as a probiotic. With addition of inulin, dough water absorption and softening reduced, but dough development time and stability time increased. Inulin prevented excessive moisture loss during bread storage and enhanced crust darkness and crumb firmness while reduced bread volume. Increasing the frozen storage time (up to 56 days) had no effect on bread moisture content, but it reduced volume and increased firmness and crust lightness. Samples produced by straight dough method had acceptable levels of probiotic (7.45, 6.45, and 7.43 log cfu/g, respectively) complying with the WHO recommendation. Frozen storage had no effect on the probiotic content of the samples and it increased to 7.35 log cfu/g (above the minimum recommended level) after re‐baking and storage at room temperature.Practical applicationsSymbiotic foods are products that contain both probiotics (useful bacteria) and prebiotics (carbohydrate source for probiotics). Development of symbiotic bread is required to add variety to the existing types of functional breads and satisfy costumers particularly those avoiding dairy products which are traditionally enriched with probiotics. Part‐baked bread industry is growing rapidly around the world; however, to remain in the market it requires innovation to satisfy consumers' demand for healthy products. This research can find practical application for ordinary and part‐baked bread industry to produce bread with improved health benefits and acceptable quality.
Serum hepatitis B core‐related antigen is an effective tool to categorize patients with HBeAg‐negative chronic hepatitis B
Authors: Loggi Elisabetta , Vukotic Ranka , Conti Fabio , Grandini Elena , Gitto Stefano , Cursaro Carmela , Galli Silvia , Furlini Giuliano , Re Maria Carla , Andreone Pietro 
Published: December 2018

SummaryThe discrimination between active chronic hepatitis B (CHB) and the clinically quiescent infection (CIB) is not always easy, as a significant portion of patients falls in a “grey” zone. Hepatitis B core‐related antigen (HBcrAg) is a now quantifiable serological marker with potential applications in diagnosis and therapy monitoring. The aim of the present study was to evaluate the HBcrAg serum levels in HBeAg‐negative HBV infection, and its ability in identifying the clinical profile, in comparison with HBsAg serum levels. HBcrAg was retrospectively assessed on serum samples from a population of treatment‐naive HBeAg‐negative patients by ChemiLuminescent Enzyme Immunoassay (CLEIA). HBsAg and HBV‐DNA data were collected. Serological data were associated to clinical profile, defined in the subsequent follow‐up of at least 1 year. In the overall population of 160 HBeAg‐negative patients, HBcrAg results weakly correlated with qHBsAg levels (Spearman r = 0.471, P < 0.0001) and correlated closely with HBV‐DNA (Spearman r = 0.746, P < 0.0001). HBcrAg levels were significantly higher in 85 CHB patients relative to 75 CIB carriers. A value of 2.5 logU/mL produced the optimal cut‐off to identify CIB patients, with diagnostic accuracy comparable to HBsAg levels. In long‐term clinical evaluation, a single measurement of HBcrAg at the established cut‐off was optimally consistent with clinical outcome. Conversely, the HBsAg cut‐off performed well in the true quiescent phase and less in more difficult‐to‐categorize patients. In conclusion, single‐point use of HBcrAg serum levels provides an accurate identification of CIB and represents a useful tool for patient classification.