bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use and Outcomes Associated With Perioperative Amiodarone in Cardiac Surgery
Authors: Atreya Auras R. , Priya Aruna , Pack Quinn R. , Pekow Penelope S. , Stefan Mihaela , Lagu Tara , Lotfi Amir S. , Lindenauer Peter K. 
Published: August 2019

Background

In randomized controlled trials, perioperative administration of amiodarone has been shown to reduce the incidence of postoperative atrial arrhythmias and length of stay (
LOS
) among patients undergoing coronary bypass surgery. However, little is known about the use or effectiveness of perioperative amiodarone in routine clinical practice.

Methods and Results

We studied patients ≥18 years old without a previous history of atrial or ventricular arrhythmias who underwent elective coronary bypass surgery between 2013 and 2014 within a network of 235
US
hospitals. Perioperative amiodarone was defined as receipt of amiodarone either on the day of or the day preceding surgery. We used covariate‐adjusted modeling and instrumental variable methods to examine the association between receipt of amiodarone and the development of atrial arrhythmias, in‐hospital mortality, readmission,
LOS
, and cost. Of 12 758 patients, 2195 (17.2%) received perioperative amiodarone, 3330 (26.1%) developed atrial arrhythmias postoperatively, and the average
LOS
was 6.4 days (±2.6 days). Instrumental variable analysis showed that receipt of perioperative amiodarone was associated with lower risk of atrial arrhythmias (risk difference −11 percentage points, 95%
CI
−19 to −4 percentage points;
P
=0.002) and a shorter
LOS
(−0.7 day, 95%
CI
−1.39 to −0.01 days;
P
=0.048). There was no association between receipt of perioperative amiodarone and in‐hospital mortality, cost, or readmission.

Conclusions

Among patients undergoing coronary bypass surgery without previous arrhythmias, perioperative amiodarone is associated with a lower risk of atrial arrhythmias and shorter
LOS
. These findings are consistent with previous randomized trials and lend support to current guideline recommendations.
Arterial Stiffness Can Be Modulated by Pressure‐Independent Mechanisms in Hypertension
Authors: Faconti Luca , Farukh Bushra , McNally Ryan , Webb Andrew , Chowienczyk Phil 
Published: August 2019

Background

Effects of short‐term interventions on large‐artery stiffness assessed by pulse wave velocity (
PWV
) have mainly been explained by concomitant changes in blood pressure (
BP
). However, lower body negative pressure, which increases sympathetic activity and has other hemodynamic effects, has a specific effect on
PWV
in healthy volunteers.

Methods and Results

We examined effects of lower‐limb venous occlusion (
LVO
), a similar intervention to lower‐body negative pressure that reduces
BP
but increases sympathetic activity and device‐guided breathing (
DGB
), which reduces both
BP
and sympathetic activity, on
PWV
in patients with essential hypertension (n=70 after
LVO
, n=45 after
DGB
and
LVO
in random order). The short‐acting calcium channel antagonist nifedipine was used as a control for changes in
BP
.
LVO
produced a small but significant reduction in mean arterial pressure of 1.8 (95%
CI
0.3–3.4) mm Hg. Despite this, aortic and carotid‐femoral
PWV
increased during
LVO
by 0.8 (0.2–1.4) m/s and 0.7 (0.3–1.05) m/s, respectively.
DGB
reduced
PWV
by 1.2 (0.9–1.4) m/s, to a greater extent than did nifedipine 10 mg (reduction of 0.7 [0.1–1.3] m/s,
P
<0.05 compared with reduction during
DGB
). This occurred despite a greater decrease in
BP
with nifedipine compared with
DGB
.

Conclusions

Arterial stiffness can be modulated independently of
BP
over the short term. The mechanism could involve alterations in sympathetic activity or other as yet uncharacterized effects of
LVO
and
DGB
.
A Role for Barotropic Eddy–Mean Flow Feedbacks in the Zonal Wind Response to Sea Ice Loss and Arctic Amplification
Authors: Ronalds Bryn , Barnes Elizabeth A. 
Published: August 2019

Abstract
Previous studies have suggested that, in the zonal mean, the climatological Northern Hemisphere wintertime eddy-driven jet streams will weaken and shift equatorward in response to Arctic amplification and sea ice loss. However, multiple studies have also pointed out that this response has strong regional differences across the two ocean basins, with the North Atlantic jet stream generally weakening across models and the North Pacific jet stream showing signs of strengthening. Based on the zonal wind response with a fully coupled model, this work sets up two case studies using a barotropic model to test a dynamical mechanism that can explain the differences in zonal wind response in the North Pacific versus the North Atlantic. Results indicate that the differences between the two basins are due, at least in part, to differences in the proximity of the jet streams to the sea ice loss, and that in both cases the eddies act to increase the jet speed via changes in wave breaking location and frequency. Thus, while baroclinic arguments may account for an initial reduction in the midlatitude winds through thermal wind balance, eddy–mean flow feedbacks are likely instrumental in determining the final total response and actually act to strengthen the eddy-driven jet stream.
Are Sudden Stratospheric Warmings Preceded by Anomalous Tropospheric Wave Activity?
Authors: Cámara Alvaro de la , Birner Thomas , Albers John R. 
Published: August 2019

AbstractA combination of 240 years of output from a state-of-the-art chemistry–climate model and a twentieth-century reanalysis product is used to investigate to what extent sudden stratospheric warmings are preceded by anomalous tropospheric wave activity. To this end we study the fate of lower tropospheric wave events (LTWEs) and their interaction with the stratospheric mean flow. These LTWEs are contrasted with sudden stratospheric deceleration events (SSDs), which are similar to sudden stratospheric warmings but place more emphasis on the explosive dynamical nature of such events. Reanalysis and model output provide very similar statistics: Around one-third of the identified SSDs are preceded by wave events in the lower troposphere, while two-thirds of the SSDs are not preceded by a tropospheric wave event. In addition, only 20% of all anomalous tropospheric wave events are followed by an SSD in the stratosphere. This constitutes statistically robust evidence that the anomalous amplification of wave activity in the stratosphere that drives SSDs is not necessarily due to an anomalous amplification of the waves in the source region (i.e., the lower troposphere). The results suggest that the dynamics in the lowermost stratosphere and the vortex geometry are essential, and should be carefully analyzed in the search for precursors of SSDs.
A Climatological Analysis of Tropical Cyclone Rapid Intensification in Environments of Upper-Tropospheric Troughs
Authors: Fischer Michael S. , Tang Brian H. , Corbosiero Kristen L. 
Published: August 2019

AbstractTropical cyclone (TC)–trough interactions are a common occurrence in the North Atlantic basin and lead to a variety of TC intensity changes, from rapid intensification (RI) to rapid weakening. To test whether certain TC–trough configurations are more favorable for RI than others, the upper-tropospheric troughs involved in such interactions were objectively classified into one of three clusters through the implementation of a machine-learning, dimensionality-reduction technique in conjunction with a k-means clustering algorithm. Through composite analyses, the upper-tropospheric potential vorticity structure, the TC convective structure, and the TC environment were examined for both rapidly intensifying TCs and nonrapidly intensifying (non-RI) TCs. As a whole, RI episodes were associated with upper-tropospheric troughs of shorter zonal wavelengths and greater upstream TC–trough displacements than non-RI episodes. RI was found to occur most frequently when an upper-tropospheric cutoff low was located approximately 500–1000 km southwest of the TC location. RI occurred preferentially in environments associated with less ventilation of the TC warm core with low-entropy environmental air. An examination of potential trough-induced forcing for convection revealed little relationship between RI and eddy flux convergence of angular momentum. Nonetheless, RI episodes were associated with anomalously vigorous convective activity within the TC inner core, as diagnosed by infrared and passive microwave satellite imagery.
Involuntary admission of psychiatric patients: Referring physicians’ perceptions of competence
Authors: Hotzy Florian , Marty Silvan , Moetteli Sonja , Theodoridou Anastasia , Hoff Paul , Jaeger Matthias 
Published: August 2019

Background: Involuntary admissions can be detrimental for patients. Due to legal, ethical and clinical considerations, they are also challenging for referring physicians. Nevertheless, not much is known about the subjective perceptions of those who have to decide whether to conduct an involuntary admission or not. Aims: This study aimed at answering the question whether psychiatrists’ perceptions of confidence during psychiatric emergency situations and consecutive involuntary admissions differ from those of physicians without a psychiatric training. Method: We assessed the professional background and subjective perceptions during psychiatric emergency situations in physicians who executed involuntary admissions to the University Hospital of Psychiatry Zurich. We used one-way analysis of variance (ANOVA) with Bonferroni-adjusted post hoc tests and chi-square tests to compare the responses of 43 psychiatrists with those of 64 other physicians. Results: Psychiatrists felt less time constraints compared with non-psychiatric residents. The latter also had more doubts on the necessity of the involuntary admission issued. Psychiatrists considered themselves significantly more experienced in handling psychiatric emergency situations and in handling the criteria for involuntary admissions than other physicians. Psychiatrists and other physicians did not differ in their satisfaction concerning course and results of psychiatric emergency situations which was overall high. About half of all participants felt pressure from third parties. Conclusion: Psychiatric emergency situations are challenging situations not only for patients but also for the involved physicians. Physicians with a specialized training might be more confident in the handling of psychiatric emergency situations and exertion of involuntary admissions. Non-psychiatric physicians might benefit from specialized training programs.
‘I Gave You More’: Discretionary Power in a Corruption Experiment
Authors: Czap Hans J. , Czap Natalia V. 
Published: August 2019

Bribes are gifts that are given with an expectation of favourable treatment from a public official or an authority figure. In some cultures, gift giving is a widely accepted part of social interaction and the rejection of gifts may be frowned upon. The purpose of this article is to investigate whether and how the (in)ability to reject gifts/bribes impacts corrupt behaviour. We present the results of an economic experiment in which two agents (firms) are competing for governmental funds. The firms may choose to bribe a public official, who is responsible for distributing the funds. We find that if there is an option to reject bribes, then the average funds allocated to the bribers are lower than in case there is no such option. This holds regardless of whether the bribe was, in fact, accepted or rejected. We also find that if the bribe was rejected, the bribers receive less governmental funds on average. Our results shed some light on the persistence of corruption in cultures in which giving gifts and expecting gifts in return is a deeply rooted custom. Prevalence of this practice in the social context spills over into the business context and leads to higher corruption levels, and more economic distortion than when bribing is just a form of business transaction. JEL: D01, D02, D73, D90
Minimal invasive extracorporeal circulation preserves platelet function after cardiac surgery: a prospective observational study
Authors: Argiriadou Helena , Antonitsis Polychronis , Gkiouliava Anna , Papapostolou Evangelia , Deliopoulos Apostolos , Anastasiadis Kyriakos 
Published: August 2019

Introduction: Cardiac surgery on conventional cardiopulmonary bypass induces a combination of thrombocytopenia and platelet dysfunction which is strongly related to postoperative bleeding. Minimal invasive extracorporeal circulation has been shown to preserve coagulation integrity, though effect on platelet function remains unclear. We aimed to prospectively investigate perioperative platelet function in a series of patients undergoing cardiac surgery on minimal invasive extracorporeal circulation using point-of-care testing. Methods: A total of 57 patients undergoing elective cardiac surgery on minimal invasive extracorporeal circulation were prospectively recruited. Anticoagulation strategy was based on individualized heparin management and heparin level–guided protamine titration performed in all patients with a specialized point-of-care device (Hemostasis Management System – HMS Plus; Medtronic, Minneapolis, MN, USA). Platelet function was evaluated with impedance aggregometry using the ROTEM platelet (TEM International GmbH, Munich, Germany). ADPtest and TRAPtest values were assessed before surgery and after cardiopulmonary bypass. Results: ADPtest value was preserved during surgery on minimal invasive extracorporeal circulation (58.2 ± 20 U vs. 53.6 ± 21 U; p = 0.1), while TRAPtest was found significantly increased (90 ± 27 U vs. 103 ± 38 U; p = 0.03). Postoperative ADPtest and TRAPtest values were inversely related to postoperative bleeding (correlation coefficient: −0.29; p = 0.03 for ADPtest and correlation coefficient: −0.28; p = 0.04 for TRAPtest). The preoperative use of P2Y12 inhibitors was identified as the only independent predictor of a low postoperative ADPtest value (OR = 15.3; p = 0.02). Conclusion: Cardiac surgery on minimal invasive extracorporeal circulation is a platelet preservation strategy, which contributes to the beneficial effect of minimal invasive extracorporeal circulation in coagulation integrity.
Enhanced recovery after surgery in pediatric gastrointestinal surgery
Authors: Gao Ruyue , Yang Heying , Li Yanan , Meng Lingbing , Li Yaping , Sun Beibei , Zhang Guofeng , Yue Ming , Guo Fei 
Published: August 2019

Objective Enhanced recovery after surgery (ERAS) protocols help optimize inpatient care and minimize discomfort. This study was performed to explore the safety, feasibility, and clinical and social value of ERAS in pediatric gastrointestinal surgery. Methods This study included all children (n = 125) who underwent appendectomy, pyloromyotomy, transabdominal Soave’s procedure, Meckel’s diverticulum resection, or reduction of intussusception in our institution from January to September 2018. We compared surgical outcomes between children who underwent surgery under conventional perioperative regimens (control group, n = 57) and those who were treated with ERAS protocols (ERAS group, n = 68). Results There were no significant intergroup differences in demographic or surgical data. However, the bowel function recovery time, postoperative intravenous nutrition time, duration of postoperative hospital stay, and hospital costs were significantly lower in the ERAS group than control group. There was no significant intergroup difference in the complication rate. Conclusions Our results indicate that implementation of ERAS protocols is safe and feasible in pediatric gastrointestinal surgery. They can improve patient comfort, shorten the duration of the postoperative hospital stay, reduce hospital costs, and accelerate postoperative rehabilitation without increasing the risk of postoperative complications. Therefore, ERAS protocols deserve wider implementation and promotion.
Intervention for burnout among postgraduate chemistry education students
Authors: Ezeudu Florence Obiageli , Attah Florence Oboochi , Onah Anthonia Ebere , Nwangwu Tochukwu Longinus , Nnadi Ekwutosi Monica 
Published: August 2019

Objective This study investigated the efficacy of a group rational emotive behavioural intervention for burnout among postgraduate chemistry education students in Nigeria. Method Participants were 36 postgraduate chemistry education students with high burnout symptoms; 18 students were randomly assigned to an experimental group and 18 to a control group. The Oldenburg Burnout Inventory – Student Version was used to assess burnout. Results There was no significant difference between the experimental group and control group in pretest mean burnout scores. However, experimental group posttest scores showed a significant improvement compared with both experimental group pretest scores and with control group posttest scores, indicating that the group rational emotive behavioural intervention was effective in enabling postgraduate chemistry education students to manage burnout. Experimental group follow-up scores showed a significantly sustained improvement compared with both experimental group posttest scores and with control group follow-up scores, indicating that the effect of the intervention was maintained at follow-up. Conclusion The group rational emotive behavioural intervention was an effective treatment modality for burnout in postgraduate chemistry education students.
Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials
Authors: Deabate Luca , Previtali Davide , Grassi Alberto , Filardo Giuseppe , Candrian Christian , Delcogliano Marco 
Published: August 2019

Background:Injury-to-surgery time has been identified as a key point in anterior cruciate ligament (ACL) reconstruction, with early versus delayed treatment remaining a debated and controversial topic in the management of ACL tears.Purpose/Hypothesis:The aim was to quantitatively synthesize the best literature evidence by including only randomized controlled trials (RCTs) comparing early versus delayed ACL reconstruction, with a clear and univocal definition of cutoffs of early or delayed surgery. The hypothesis was that early treatment would lead to similar final clinical results compared with the delayed approach while providing a faster recovery without an increase in complications after ACL reconstruction.Study Design:Meta-analysis.Methods:A systematic literature search was performed on February 12, 2019, using PubMed, Web of Science, Cochrane Library, and gray literature databases. According to previous literature, 2 analyses with different cutoffs for injury-to-surgery time (3 weeks and 10 weeks) were performed to distinguish early and delayed reconstruction. The influence of timing was analyzed through meta-analyses in terms of patient-reported outcome measures (PROMs), risk of complications, range of motion (ROM) limitation, risk of retears, and residual laxity. Risk of bias and quality of evidence were assessed following the Cochrane guidelines.Results:Eight studies (5 in 3-week cutoff analysis and 3 in 10-week cutoff analysis) were included. No differences were found in terms of PROMs, risk of complications, ROM limitation, risk of retears, and residual laxity either in the 3-week cutoff analysis or in the 10-week cutoff analysis ( P > .05). The level of evidence was moderate to low for the outcomes of the 3-week cutoff analysis and low to very low for the outcomes of the 10-week cutoff analysis.Conclusion:This meta-analysis did not confirm the previously advocated benefits of delaying ACL surgery to avoid the acute posttraumatic phase. In fact, RCTs demonstrated that timing of surgery after ACL tears has no influence on the final functional outcome, risk of retears, or residual instability. While no data were available about the recovery time, literature results showed that early ACL reconstruction could be performed without increasing the risk of complications.Study Registration:CRD42019119319 (PROSPERO).
Single-Stage Multiple-Ligament Knee Reconstructions for Sports-Related Injuries: Outcomes in 194 Patients
Authors: LaPrade Robert F. , Chahla Jorge , DePhillipo Nicholas N. , Cram Tyler , Kennedy Mitchell I. , Cinque Mark , Dornan Grant J. , O’Brien Luke T. , Engebretsen Lars , Moatshe Gilbert 
Published: August 2019

Background: Outcomes after sports-related multiple-ligament knee reconstructions are limited. Purpose: To evaluate outcomes after single-stage surgical treatment of sports-related multiple-ligament knee injuries and to compare outcomes after anterior cruciate ligament (ACL)–based and posterior cruciate ligament (PCL)–based multiple-ligament knee reconstructions. Study Design: Case series; Level of evidence, 4. Methods: Skeletally mature patients with at least 2 major knee ligaments torn during a sporting activity that required surgery with a minimum of 2 years’ follow-up were included. The Lysholm score, Tegner activity scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-Item Short Form Health Survey Physical Component Summary were collected preoperatively and at a minimum of 2 years’ follow-up. Clinical data, including range of motion and knee stability, were also recorded at final follow-up. Results: A total of 276 patients with multiple-ligament knee injuries incurred during sport participation from 2010 to 2016 were identified. Of the 276 patients, 194 (70.5%) had complete follow-up at a mean 3.5 years (range, 2-8 years). There was a significant improvement in all outcome scores as compared with the preoperative scores ( P < .001 for all scores). The median (first and third quartiles) Tegner activity score improved from 1 (0, 2) preoperatively to 6 (4, 7) postoperatively. Significant improvements were from 41 (22, 57) to 90 (78, 95) and 44 (24, 60) to 3 (1, 8) for median Lysholm and WOMAC scores, respectively. There was no significant difference in postoperative outcome scores between patients treated in the acute and chronic phases. Furthermore, there was no significant difference between PCL- and ACL-based multiple-ligament knee injuries. Eighteen (9.3%) patients developed arthrofibrosis requiring reintervention surgery. Conclusion: These results demonstrated that single-stage anatomic-based knee ligament reconstructions with immediate postoperative rehabilitation in the setting of sports-related multiligament injuries yielded significantly improved outcomes irrespective of the ligament injury pattern. In addition, there was no difference in outcomes between ACL- and PCL-based injuries in the setting of sports-related multiligament injuries.