bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio for the Assessment of Right Ventricular-Arterial Coupling in Severe Pulmonary Hypertension
Authors: Tello Khodr , Wan Jun , Dalmer Antonia , Vanderpool Rebecca , Ghofrani Hossein A. , Naeije Robert , Roller Fritz , Mohajerani Emad , Seeger Werner , Herberg Ulrike , Sommer Natascha , Gall Henning , Richter Manuel J. 
Published: September 2019

Background:
The ratios of tricuspid annular plane systolic excursion (TAPSE)/echocardiographically measured systolic pulmonary artery pressure (PASP), fractional area change/invasively measured mean pulmonary artery pressure, right ventricular (RV) area change/end-systolic area, TAPSE/pulmonary artery acceleration time, and stroke volume/end-systolic area have been proposed as surrogates of RV-arterial coupling. The relationship of these surrogates with the gold standard measure of RV-arterial coupling (invasive pressure-volume loop-derived end-systolic/arterial elastance [Ees/Ea] ratio) and RV diastolic stiffness (end-diastolic elastance) in pulmonary hypertension remains incompletely understood. We evaluated the relationship of these surrogates with invasive pressure-volume loop-derived Ees/Ea and end-diastolic elastance in pulmonary hypertension.

Methods:
We performed right heart echocardiography and cardiac magnetic resonance imaging 1 day before invasive measurement of pulmonary hemodynamics and single-beat RV pressure-volume loops in 52 patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. The relationships of the proposed surrogates with Ees/Ea and end-diastolic elastance were evaluated by Spearman correlation, multivariate logistic regression, and receiver operating characteristic analyses. Associations with prognosis were evaluated by Kaplan-Meier analysis.

Results:

TAPSE/PASP, fractional area change/mean pulmonary artery pressure, RV area change/end-systolic area, and stroke volume/end-systolic area but not TAPSE/pulmonary artery acceleration time were correlated with Ees/Ea and end-diastolic elastance. Of the surrogates, only TAPSE/PASP emerged as an independent predictor of Ees/Ea (multivariate odds ratio: 18.6; 95% CI, 0.8–96.1;
P
=0.08). In receiver operating characteristic analysis, a TAPSE/PASP cutoff of 0.31 mm/mm Hg (sensitivity: 87.5% and specificity: 75.9%) discriminated RV-arterial uncoupling (Ees/Ea <0.805). Patients with TAPSE/PASP <0.31 mm/mm Hg had a significantly worse prognosis than those with higher TAPSE/PASP.

Conclusions:
Echocardiographically determined TAPSE/PASP is a straightforward noninvasive measure of RV-arterial coupling and is affected by RV diastolic stiffness in severe pulmonary hypertension.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03403868.
Selective Citizenship: How the Court of Justice Linked Security of Residence to Integration
Authors: Ryan Bernard 
Published: September 2019

Abstract
This article examines the case-law of the Court of Justice concerning security of residence for EU citizens and family members under Directive 2004/38. The relevant provisions of the Directive confer a right of permanent residence, and enhanced protection against expulsion, upon longer-term residents. It is argued that, in interpreting these provisions from 2006 onwards, the Court of Justice adopted a discourse which conceived of the rights as dependent on an individual’s social integration. The initial effect of the Court’s ‘turn’ to integration was benign, as it supported the retrospective extension of permanent residence, and ensured the efficacy of enhanced protection against expulsion. Later, however, the Court would treat integration as a precondition, in ways which would limit the rights of long-term residents who were not economically active or self-sufficient, or who had been sentenced to periods of imprisonment. That Court’s integration discourse was presumably influenced by developments in policy concerning third-country nationals at the state level which had linked immigration status to integration tests. The result was a selective approach to security of residence, which tended to deny protection to persons whose presence was unlikely to be favoured by Member States.
The Concept of ‘Investment’ in the Digital Economy: The Case of Social Media Companies
Authors: Horváth Enikő , Klinkmüller Severin 
Published: September 2019

Abstract
The digitalization of commercial and private relations has seen the rise of companies – among the most valuable corporations in the global economy – that have operations in nearly every country in the world, while maintaining an almost exclusively digital (online) presence there. Using the example of social media companies, like Facebook and Twitter, this article argues that the component parts of companies’ digital operations, whether viewed as distinct assets or as an economic unit, may qualify as an “investment” in the countries where such companies offer their services, even though digital operations do not conform to conventional understandings of investment activity for purposes of international investment law.
A Two-Cool-Season Wind Profiler–Based Analysis of Westward-Directed Gap Flow through the Columbia River Gorge
Authors: Neiman Paul J. , Gottas Daniel J. , White Allen B. 
Published: September 2019

Abstract
This observational study of westward-directed gap flows through the Columbia River Gorge uses three radar wind profilers during two winter seasons between October 2015 and April 2017, with a focus on the gap-exit region at Troutdale, Oregon. Of the 92 gap-flow events identified at Troutdale, the mean duration was 38.5 h, the mean gap-jet speed was 12 m s−1, and the mean gap-flow depth was 570 m MSL. The mean gap-jet height and gap-flow depth were situated below the top of the inner gorge, while a maximum depth of 1087 m MSL was contained within the gorge’s outer-wall rim. The mean gap-flow depth was deepest in the cold-air source region east of the gorge and decreased westward to the coast. Strong gap-flow events were longer lived, deeper, and capped by stronger vertical shear than their weak counterparts, and strong (weak) events were forced primarily by a cold-interior anticyclone (offshore cyclone). Deep gap-flow events were longer lived, stronger, and had weaker capping vertical shear than shallow events, and represented a combination of gap-flow and synoptic forcing. Composite temporal analysis shows that gap-flow strength (depth) was maximized midevent (early event), freezing rain was most prevalent during the second half of the event, and accumulated precipitation was greatest late-event. Gap-flow events tended to begin (end) during the evening (morning) hours and were most persistent in January. Surface wind gusts and snow occurrences around Portland, Oregon, were associated primarily with the deepest gap flows, whereas freezing rain occurred predominantly during shallow gap flows.
Simulated Evolution and Severe Wind Production by the 25–26 June 2015 Nocturnal MCS from PECAN
Authors: Parker Matthew D. , Borchardt Brett S. , Miller Rachel L. , Ziegler Conrad L. 
Published: September 2019

AbstractThe 25–26 June 2015 nocturnal mesoscale convective system (MCS) from the Plains Elevated Convection at Night (PECAN) field project produced severe winds within an environment that might customarily be associated with elevated convection. This work incorporates both a full-physics real-world simulation and an idealized single-sounding simulation to explore the MCS’s evolution. Initially, the simulated convective systems were elevated, being maintained by wavelike disturbances and lacking surface cold pools. As the systems matured, surface outflows began to appear, particularly where heavy precipitation was occurring, with air in the surface cold pools originating from up to 4–5 km AGL. Via this progression, the MCSs exhibited a degree of self-organization (i.e., structures that are dependent upon an MCS’s particular history). The cold pools eventually became 1.5–3.5 km deep, by which point passive tracers revealed that the convection was at least partly surface based. Soon after becoming surface based, both simulations produced severe surface winds, the strongest of which were associated with embedded low-level mesovortices and their attendant outflow surges and bowing segments. The origin of the simulated mesovortices was likely the downward tilting of system-generated horizontal vorticity (from baroclinity, but also possibly friction) within the simulated MCSs’ outflow, as has been argued in a number of previous studies. Taken altogether, it appears that severe nocturnal MCSs may often resemble their cold pool-driven, surface-based afternoon counterparts.
Preanalytical potassium EDTA sample contamination: open versus closed phlebotomy systems
Authors: Asif Usama , Whitehead Simon J , Ford Clare , Gama Rousseau 
Published: September 2019

Background Potassium ethylenediaminetetraacetic acid (K-EDTA) contamination of serum samples is a common cause of spurious electrolyte results, which may adversely affect patient care. The source of K-EDTA sample contamination is unknown since it is not caused by reverse order of draw. Other possible mechanisms are either direct transfer of blood from K-EDTA containing tubes to other tubes or syringe needle/top contamination when delivering blood into EDTA sample tubes before other sample tubes, but these have not been studied in clinical practice. We report on a quality improvement programme aimed at identifying the source of K-EDTA-contaminated samples. Methods We routinely measure EDTA in all serum samples with a potassium ⩾6.0 mmol/L. We identified individuals responsible for K-EDTA-contaminated samples (EDTA >0.15 mmol/L) and in close-to-real-time discussed their phlebotomy methods for the collection of these samples. Results Over four months, we investigated 96 EDTA-contaminated samples. Of these, we identified and interviewed 64 (67%) individuals responsible for contaminated samples; 52 (81%) doctors, 9 (14%) phlebotomists and 3 (5%) nurses. Fifty-two individuals recalled taking the sample and the phlebotomy method used. All used open phlebotomy methods. Conclusions We report, for the first time, that K-EDTA sample contamination almost always, if not exclusively, occurs following open phlebotomy methods. Phlebotomy training and guidelines should, therefore, encourage use of closed systems as well as include and emphasize the importance of ‘order of blood sample tube fill’ when using open phlebotomy methods.
Testing a Theoretical Model of Perceived Audience Legitimacy: The Neglected Linkage in the Dialogic Model of Police–community Relations
Authors: Nix Justin , Pickett Justin T. , Wolfe Scott E. 
Published: September 2019

Objectives: Democratic policing involves an ongoing dialogue between officers and citizens about what it means to wield legitimate authority. Most of the criminological literature on police legitimacy has focused on citizens’ perceptions of this dialogue—that is, audience legitimacy. Consequently, we know little about how officers perceive their legitimacy in the eyes of the public and the antecedents of such perceptions. Pulling together separate strands of literature pertaining to citizen demeanor, hostile media perceptions, and danger perception theory, we propose and test a theoretical model of perceived audience legitimacy. Method: We conducted two separate studies: the first a survey of 546 officers working at a southern U.S. agency and the second a survey of a national probability sample of 665 executives and high-ranking officers. Results: Local violent crime rates, but not minority group size or growth, are associated with lower perceived audience legitimacy. Additionally, recent experiences with citizen disrespect and global perceptions of citizen animus are both inversely associated with perceived audience legitimacy. The perceived hostility of local, but not national, media coverage is also associated with lower perceived audience legitimacy. Conclusions: Our results suggest a need for additional research that explores whether the antecedents of audience legitimacy indirectly affect police behaviors, like the use of force.
Submental Island Flap versus Free Flap Reconstruction for Complex Head and Neck Defects
Authors: Jørgensen Mads Gustaf , Tabatabaeifar Siavosh , Toyserkani Navid Mohamadpour , Sørensen Jens Ahm 
Published: September 2019

ObjectiveComplex soft tissue reconstruction of the head and neck requires a viable, versatile, and dependable flap. Free flaps, such as the radial forearm and anterolateral thigh flap, have been the mainstay of complex head and neck reconstruction. However, a local pedicled flap, such as the submental island flap (SIF), could be a more effective and less demanding alternative. This systematic review and meta‐analysis aim to compare free tissue transfer (FTT) with the SIF for head and neck reconstruction.Data SourcesWe performed a systematic search in PubMed and EMBASE databases. Meta‐analysis was performed on outcomes reported in ≥3 studies.Review MethodsCandidate articles were assessed for eligibility by 2 authors. Three authors performed data extraction and methodological quality of the included studies using the Newcastle‐Ottawa Quality Assessment Form for Cohort Studies.ResultsThe search strategy resulted in 450 studies, of which 7 were included in the analysis, yielding 155 SIF and 198 FTT cases. Operating time and length of stay were significantly lower for the SIF than for FTT (P =. 05 and P =. 0008). There was no significant difference between the groups for complete flap loss, debulking revisions, and oncologic recurrence.ConclusionThese results suggest that the SIF reduces length of stay and operating time as compared with FTT in head and neck reconstruction. These findings suggest that the SIF can be considered an alternative reconstructive option to FTT when evaluating intraoral, lateral facial, skull base, and parotidectomy defects, given comparable defect size and tumor biology.
Intra-articular and meniscal pathology according to anterior cruciate ligament injury pattern: both-bundle tear or selective bundle tear
Authors: Park Jin Hee , Park Hee Jin , Lee So Yeon , Hong Hyun Pyo , Ham Soo Youn , Kang Kyung A , Ahn Jin Hwan 
Published: September 2019

Background Articular cartilage injury and meniscal tear are usually combined with anterior cruciate ligament injury. Purpose We investigated the incidence of cartilage injury and traumatic meniscal tear according to the type of combined anterior cruciate ligament tear (both-bundle versus selective bundle tear). Material and Methods This retrospective study included 103 patients diagnosed with anterior cruciate ligament tear after knee joint magnetic resonance imaging and who underwent knee joint arthroscopy. Two radiologists evaluated articular cartilage injuries and meniscal tear independently. We used the chi-square test to analyze the association between type of anterior cruciate ligament bundle tear and presence of cartilage or meniscal injury in each reader. Results Cartilage injury presented a significantly higher prevalence in both-bundle tear than did selective bundle tear in reader 1 ( P = 0.004). In reader 2, both-bundle tear had a tendency for higher risk of cartilage injury, but this was not statistically significant ( P = 0.178). In meniscal injury, there was a statistically significant increase in the risk of associated meniscal injury in both-bundle tear versus selective bundle anterior cruciate ligament injury ( P = 0.019 and 0.021). The risk of accompanying traumatic meniscal lesion was significantly higher in both-bundle tear ( P = 0.036 and 0.018). Conclusion The incidence of accompanying meniscal injury, especially traumatic tears, is higher in both-bundle anterior cruciate ligament tear than in selective bundle tear. There was no significant difference in incidence of cartilage injury between both-bundle tear and selective bundle tear, although one of two readers showed a higher incidence in both-bundle tear.
T2 mapping in orbital masses: preliminary study on differential diagnostic ability of T2 relaxation time
Authors: Zhou Yan , Xu Xiao-Quan , Hu Hao , Su Guo-Yi , Liu Hu , Wu Fei-Yun 
Published: September 2019

Background T2 mapping has been proven to be useful in tumor characterization. As to orbital masses, its diagnostic value needs to be investigated. Purpose To evaluate the usefulness of T2 mapping in orbital masses and the ability of T2 relaxation time in differentiating malignant from benign orbital masses. Material and Methods Forty-seven patients with solid orbital masses (33 benign and 14 malignant) who underwent T2 mapping examination for preoperative assessment were enrolled in the current study. T2 mapping was acquired using 16 TE values (range 12–192 ms; delta TE 12 ms). Mean T2 relaxation time was calculated based on the whole mass region of interest and compared between the malignant and benign groups using the unpaired t-test. Receiver operating characteristic curve analysis was adopted to calculate its diagnostic value. Results Malignant orbital masses showed significantly lower T2 relaxation time than benign masses (76.4 ± 13.0 ms vs. 119.1 ± 20.4 ms; P < 0.001). If setting a T2 relaxation time of 89.5 ms as the threshold value, optimal differentiating performance could be achieved (area under the curve 0.936; sensitivity 100.0%; specificity 87.9%; accuracy 91.5%; positive predictive value 77.8%; negative predictive value 100%). Conclusion T2 mapping and its derived T2 relaxation time could provide quantitative information and serve as a supplementary imaging marker for differentiating malignant from benign orbital masses.
Factors affecting retrieval of 12 or more lymph nodes in pT1 colorectal cancers
Authors: Son Seung-Myoung , Woo Chang Gok , Lee Ok-Jun , Lee Sang-Jeon , Lee Taek-Gu , Lee Ho-chang 
Published: September 2019

Objective The aim of this study was to identify clinicopathological factors that affect the number of lymph nodes (LNs) (12 or more) retrieved from patients with colorectal cancer (CRC), particularly those with pathologic T1 (pT1) disease. Methods From 429 CRC patients, 75 pT1 cancers were identified and digitally scanned. Binary logistic regression analysis was performed to identify the clinicopathological factors affecting the number of LNs retrieved from all 429 patients and from the subset of patients with pT1 CRC. Results For the 429 patients, the mean number of harvested LNs per specimen was 20 (median, 19). The number of retrieved LNs was independently associated with maximum tumor diameter > 2.3 cm and right-sided tumor location. The mean number of LNs retrieved from the 75 patients with pT1 CRC was 14 (median, 15); retrieval of 12 or more LNs from this group was independently associated with maximum tumor diameter > 14.1 mm. Conclusion The number of LNs retrieved from patients with CRC was associated with maximum tumor diameter and right-sided tumor location. For patients with pT1 CRC, maximum tumor diameter was independently associated with the harvesting of 12 or more LNs.
Correlation between malnutrition and health-related quality of life (HRQOL) in elderly Iranian adults
Authors: Khatami Fatemeh , Shafiee Gita , Kamali Koorosh , Ebrahimi Mehdi , Azimi Mahinsadat , Ahadi Zeinab , Sharifi Farshad , Tanjani Parisa Taheri , Heshmat Ramin 
Published: September 2019

Objectives We aimed to evaluate the association of nutritional status and health-related quality of life (HRQOL) among elderly Iranian residents. Methods We used the 36-item Short Form Health Survey (SF-36) to assess HRQOL among participants with normal nutrition status, at risk of malnutrition, and malnourished. Results Mean group scores for the Physical Component Summary (PCS) of the SF-36 were 44, 36.5, and 29.0 for normal, at-risk, and malnourished groups, respectively; for the Mental Component Summary (MCS), these were 47.1, 40.7, and 34.8, respectively. The PCS and MCS displayed significant positive correlation with malnutrition in three models: crude (I); age- and sex-adjusted (II); and adjusted for age, sex, education, occupation, marital status, and residence. Standardized beta coefficients of PCS in Models I–III were 1.35, 1.27, and 1.14, respectively; for MCS, these were 1.11 in all three models; all results were statistically significant. Estimated results of logistic regression were −6.023 for malnourished versus well-nourished and −2.652 for malnourished versus at risk of malnutrition. Conclusion Our analyses revealed the crucial impact of nutritional status on both mental and physical components of HRQOL.
Relationship Between Glenohumeral Internal Rotation Deficit and Medial Elbow Torque in High School Baseball Pitchers
Authors: Smith D. Grace , Swantek Alexander J. , Gulledge Caleb M. , Lizzio Vincent A. , Bermudez Angel , Schulz Brian M. , Makhni Eric C. 
Published: September 2019

Background: Alterations in throwing mechanics have been identified as a risk factor for overuse injuries in baseball players. Glenohumeral internal rotation deficit (GIRD) has been found to adversely affect throwing mechanics, but the effect of GIRD on medial elbow torque is unclear. Purpose: To investigate the relationship between GIRD and medial elbow torque in high school–aged baseball pitchers. Study Design: Descriptive laboratory study. Methods: High school baseball pitchers (14-18 years old) were recruited for participation in this study. Players’ height, weight, body mass index, and arm measurements were recorded as well as shoulder and elbow range of motion measurements. GIRD was calculated from the difference between dominant and nondominant shoulder internal rotation. Participants then pitched 5 fastballs at maximum effort while wearing a wireless sensor that recorded elbow torque, arm slot, arm speed, shoulder rotation, and ball velocity. Principal component analysis was performed to determine which variables were associated with elbow torque or ball velocity. Results: Twenty-three high school pitchers participated in this study; 35% (n = 8) of participants exhibited GIRD of at least 20°. The mean GIRD was 15.3°± 11.2° and was not a predictor of medial elbow torque ( P = .205) or ball velocity ( P = .333). Ball velocity, age, and height were predictors of medial elbow torque ( P = .012, P = .003, and P = .024, respectively). Conclusion: In high school baseball pitchers, GIRD was not associated with medial elbow torque during the pitching motion. Instead, ball velocity, player age, and player height carried greater significance. Clinical Relevance: This study suggests that high school pitchers with GIRD do not have an inherently greater risk for increased medial elbow torque during the throwing motion. It is recommended that pitchers instead assess their ball velocity to evaluate for relative differences in medial elbow torque.