bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late Quaternary sea-level history of Saipan, Commonwealth of the Northern Mariana Islands, USA: A test of tectonic uplift and glacial isostatic adjustment models
Authors: Muhs Daniel R. , Schweig Eugene S. , Simmons Kathleen R. 
Published: September 2019

AbstractIn 1979, S. Uyeda and H. Kanamori proposed a tectonic model with two end members of a subduction-boundary continuum: the “Chilean” type (shallow dip of the subducting plate, great thrust events, compression, and uplift of the overriding plate) and a “Mariana” type (steep dip of the subducting plate, no great thrust events, tension, and no uplift). This concept has been used to explain variable rates of Quaternary uplift around the Pacific Rim, yet no uplift rates have been determined for the Mariana Islands themselves, one of the end members in this model. We studied the late Quaternary Tanapag Limestone, which rims much of the eastern and southern coasts of Saipan, Northern Mariana Islands, with elevations of ∼13 m to ∼30 m. Samples from 12 well-preserved corals (Acropora, Porites, and Goniastrea) yielded U-series ages ranging from ca. 134 ka to ca. 126 ka. These ages correlate the emergent reef of the Tanapag Limestone with the last interglacial period, when sea level was several meters above present. Ages and measured reef elevations from the Tanapag Limestone, along with paleo–sea-level data, yield relatively low late Quaternary uplift rates of 0.002–0.19 m/k.y., consistent with the Uyeda-Kanamori model. A review of data from other localities near subduction zones around the Pacific Basin, however, indicates that many coastlines do not fit the model. Uplift rates along the Chilean coast are predicted to be relatively high, but field studies indicate they are low. On some coastlines, relatively high uplift rates are better explained by subduction of seamounts or submarine ridges rather than subduction zone geometry. Despite the low long-term uplift rate on Saipan, the island also hosts an emergent, low-elevation (+3.9–4.0 m) reef with corals in growth position below a notch (+4.2 m). The corals are dated to 3.9–3.1 ka. The occurrence of this young, emergent reef is likely not due to tectonic uplift; instead, it is interpreted to be the result of glacial isostatic adjustment processes after the end of the last glacial period. Our findings are consistent with similar observations on tectonically stable or slowly uplifting islands elsewhere in the equatorial Pacific Ocean and agree with numerical models of a higher-than-present Holocene sea level in this region due to glacial isostatic adjustment processes.
Low-cost, smartphone-based frequency doubling technology visual field testing using a head-mounted display
Authors: Alawa Karam AlRahman , Nolan Ryan P , Han Elaine , Arboleda Alejandro , Durkee Heather , Sayed Mohamed S , Aguilar Mariela C , Lee Richard K 
Published: September 2019

BackgroundCurrent visual field screening machines are bulky and expensive, limiting their accessibility, affordability and use. We report the design and evaluation of a novel, portable, cost-effective system for glaucoma screening using smartphone-based visual field screening using frequency doubling technology (FDT) and a head-mounted display.MethodsNineteen eyes of 10 subjects with new-onset or chronic primary open angle glaucoma were tested and compared with the Humphrey Zeiss FDT and the newly developed Mobile Virtual Perimetry (MVP) FDT with the C-20 testing pattern. Mann-Whitney, Bland-Altman and linear regression analyses were performed to assess statistical difference, agreement and correlation, respectively, between the two devices.ResultsThe average age of the participants was 58±15 years. No statistically significant difference was found between the MVP FDT and the Humphrey Zeiss FDT (p>0.05). Bland-Altman and linear regression analyses demonstrated good agreement and correlation between the two devices.ConclusionThe MVP FDT is a low-cost, portable visual field screening device that produces comparable results to the Humphrey Zeiss FDT and may be used as an easily accessible screening tool for glaucoma.
Can clinical audits be enhanced by pathway simulation and machine learning? An example from the acute stroke pathway
Authors: Allen Michael , Pearn Kerry , Monks Thomas , Bray Benjamin D , Everson Richard , Salmon Andrew , James Martin , Stein Ken 
Published: September 2019

ObjectiveTo evaluate the application of clinical pathway simulation in machine learning, using clinical audit data, in order to identify key drivers for improving use and speed of thrombolysis at individual hospitals.DesignComputer simulation modelling and machine learning.SettingSeven acute stroke units.ParticipantsAnonymised clinical audit data for 7864 patients.ResultsThree factors were pivotal in governing thrombolysis use: (1) the proportion of patients with a known stroke onset time (range 44%–73%), (2) pathway speed (for patients arriving within 4 hours of onset: per-hospital median arrival-to-scan ranged from 11 to 56 min; median scan-to-thrombolysis ranged from 21 to 44 min) and (3) predisposition to use thrombolysis (thrombolysis use ranged from 31% to 52% for patients with stroke scanned with 30 min left to administer thrombolysis). A pathway simulation model could predict the potential benefit of improving individual stages of the clinical pathway speed, whereas a machine learning model could predict the benefit of ‘exporting’ clinical decision making from one hospital to another, while allowing for differences in patient population between hospitals. By applying pathway simulation and machine learning together, we found a realistic ceiling of 15%–25% use of thrombolysis across different hospitals and, in the seven hospitals studied, a realistic opportunity to double the number of patients with no significant disability that may be attributed to thrombolysis.ConclusionsNational clinical audit may be enhanced by a combination of pathway simulation and machine learning, which best allows for an understanding of key levers for improvement in hyperacute stroke pathways, allowing for differences between local patient populations. These models, based on standard clinical audit data, may be applied at scale while providing results at individual hospital level. The models facilitate understanding of variation and levers for improvement in stroke pathways, and help set realistic targets tailored to local populations.
Monthly variance in UK renal transplantation activity: a national retrospective cohort study
Authors: Lowe Marcus , Maidstone Robert , Poulton Kay , Worthington Judith , Durrington Hannah J , Ray David W , van Dellen David , Asderakis Argiris , Blaikley John , Augustine Titus 
Published: September 2019

ObjectiveTo identify whether renal transplant activity varies in a reproducible manner across the year.DesignRetrospective cohort study using NHS Blood and Transplant data.SettingAll renal transplant centres in the UK.ParticipantsA total of 24 270 patients who underwent renal transplantation between 2005 and 2014.Primary outcomeMonthly transplant activity was analysed to see if transplant activity showed variation during the year.Secondary outcomeThe number of organs rejected due to healthcare capacity was analysed to see if this affected transplantation rates.ResultsAnalysis of national transplant data revealed a reproducible yearly variance in transplant activity. This activity increased in late autumn and early winter (p=0.05) and could be attributed to increased rates of living (October and November) and deceased organ donation (November and December). An increase in deceased donation was attributed to a rise in donors following cerebrovascular accidents and hypoxic brain injury. Other causes of death (infections and road traffic accidents) were more seasonal in nature peaking in the winter or summer, respectively. Only 1.4% of transplants to intended recipients were redirected due to a lack of healthcare capacity, suggesting that capacity pressures in the National Health Service did not significantly affect transplant activity.ConclusionUK renal transplant activity peaks in late autumn/winter in contrast to other countries. Currently, healthcare capacity, though under strain, does not affect transplant activity; however, this may change if transplantation activity increases in line with national strategies as the spike in transplant activity coincides with peak activity in the national healthcare system.
Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study
Authors: Mooney John F , Croal Bernard L , Cassidy Sean , Lee Vincent W , Chow Clara K , Cuthbertson Brian H , Hillis Graham S 
Published: September 2019

ObjectiveRenal dysfunction predicts an increased risk of both early and long-term mortality after cardiac surgery. Cystatin C enables glomerular filtration rate (GFR) to be estimated accurately and may be superior in this regard to creatinine-based estimates. We hypothesised, therefore, that cystatin C and derived estimates of GFR would independently predict long-term survival after cardiac surgery and would be superior in this respect to traditional estimates of GFR. The current study tests this hypothesis in a large and well-characterised cohort of patients.DesignA prospective cohort study.SettingRegional cardiothoracic centre in Northeast Scotland.Participants1010 patients undergoing non-emergent cardiac surgery between 2004 and 2007. Serum creatinine and cystatin C levels were measured preoperatively and demographic and clinical variables were recorded.Primary outcome measureAll-cause mortality, established from the National Records of Scotland.ResultsThe median duration of follow-up after surgery was 9.7 years (IQR 8.9–10.6 years), during which 297 participants died. Preoperative creatinine and cystatin C levels and estimates of GFR derived from these were all strong predictors of death using Cox regression and remained independently predictive after adjustment for the logistic European System for Cardiac Operative Risk Evaluation, a well-validated clinical risk score and a range of other clinical predictors. Cystatin C-based measures were superior to creatinine-based estimates of GFR.ConclusionsCystatin C and creatinine derived eGFR are powerful and independent predictors of long-term mortality following cardiac surgery. Estimates of GFR derived from cystatin C convey superior prognostic information to conventional creatinine-based estimates, but the observed differences are modest.
Psychometric validation of Swedish and Arabic versions of two health literacy questionnaires, eHEALS and HLS-EU-Q16, for use in a Swedish context: a study protocol
Authors: Wangdahl Josefin M , Dahlberg Karuna , Jaensson Maria , Nilsson Ulrica 
Published: September 2019

IntroductionEquity in health and access to healthcare regardless of gender, ethnicity or social position is a major political issue worldwide. Regardless of an individual’s knowledge, motivation and competence, individuals are expected to be engaged and take responsibility of their own care. Migrants have been identified as a vulnerable population in healthcare, and an explanation for the inequity in health and in healthcare is limited health literacy. Furthermore, with increasing digitalisation in healthcare, it also puts demand on the individual to have digital or electronic health (eHealth) literacy.The overall aim of this study is to conduct a psychometric evaluation of the Swedish and Arabic versions of HLS-EU-Q16 and eHEALS and to compare Arabic and Swedish speakers’ Health literacy and eHealth literacy levels in Sweden.Methods and analysisThis is a prospective, psychometric evaluation study with the intent of including 300 Arabic-speaking and 300 Swedish-speaking participants. Questionnaires: The Health Literacy Survey European Questionnaire (HLS-EU-Q16) includes 16 items measuring perceived personal skills of finding, understanding, judging and applying health information to maintain and improve their health. The eHealth literacy scale (eHEALS) is an 8-item scale measuring health literacy skills in relation to online information and applications.This study will be conducted in four phases. Phase 1: Translation of HLS-EU-Q16 and eHEALS from English to Swedish and Arabic versions following the principles of translation of questionnaires. Phase 2: Content validity testing of eHEALS, including face validity and interpretability, conducted with five Arabic and five Swedish-speaking participants. Phase 3: Psychometric testing including construct validity, reliability, feasibility and floor ceiling effects. Phase 4: Distribution and comparison of eHealth and HLS-EU-Q16 analysed with χ2and Fisher’s exact test as appropriate. To assess associations between HLS-EU-Q16, eHEALS and demographic variables, binary logistic regression analyses will be performed.Ethics and disseminationThe project has been approved by the regional ethical review board in Stockholm, Sweden (2019/5:1) and will follow the principles outlined in the 1964 Helsinki Declaration and its later amendments. Results from this study will be disseminated in peer-reviewed journals, scientific conferences and social media.
Mortality and cause of death in South Korean patients with Parkinson’s disease: a longitudinal follow-up study using a national sample cohort
Authors: Choi Hyo Geun , Lim Jae-Sung , Lee Young Kyung , Sim Songyong , Kim Miyoung 
Published: September 2019

ObjectiveThe incidence rate of Parkinson’s disease (PD) is growing rapidly owing to the ageing population. We investigated the mortality rates and causes of death in South Korean patients with PD.DesignWe investigated a national cohort using the nationwide insurance database.SettingKorean Health Insurance Review and Assessment Service—National Sample Cohort database.ParticipantsWe included 3510 participants ≥60 years of age who were diagnosed with PD between 2002 and 2013, as well as 14 040 matched controls.InterventionsNonePrimary and secondary outcome measuresA stratified Cox proportional hazards model was used to evaluate patients with PD who were matched 1:4 with non-PD control subjects adjusted for age, sex, income and region of residence. The causes of death were grouped into 12 classifications.ResultsThe adjusted HR for mortality in the PD group was 2.09 (95% CI 1.94 to 2.24, p<0.001). Subgroup analysis according to age (<70 years, 70–79 years, and ≥80 years) and sex revealed that patients with PD showed higher adjusted HRs for mortality across all subgroups. Mortalities caused by metabolic, mental, neurologic, circulatory, respiratory, and genitourinary diseases, as well as trauma, were more common in the PD group than in the control group, with the highest OR observed in patients with neurologic disease.ConclusionsWe demonstrated that PD in South Korean patients ≥60 years of age was associated with increased mortality in both sexes regardless of age.
A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation
Authors: Mai Linlin , Wu Yu , Luo Jianjing , Liu Xinyue , Zhu Hailan , Zheng Haoxiao , Liang Guoquan , Zhang Yan , Huang Yuli 
Published: September 2019

ObjectiveTo examine the real-world patterns of oral anticoagulant (OAC) therapy in patients with acute coronary syndrome (ACS) and atrial fibrillation (AF) in Southern China undergoing percutaneous coronary intervention (PCI) and determine the clinical characteristics associated with OAC prescription.DesignA retrospective cohort study.SettingThis study was conducted in the Shunde Hospital, Southern Medical University and the second hospital of Zhaoqing, China, from January 2013 to 31 December 2018.ParticipantsPatients were aged ≥18 years, hospitalised for ACS and received PCI treatment.Outcome measuresAF was diagnosed based on an ECG recording or a Holter monitor. Prescription of OACs and antiplatelets were determined from the discharge medication list.ResultsA total of 3612 patients with ACS were included: 286 (7.9%) were diagnosed with AF, including 45 (1.2%) with paroxysmal AF, 227 (6.3%) with persistent/permanent AF and 14 (0.4%) with unclassified AF. Although 95.5% of patients with AF were at high risk (CHA2DS2-VASc score ≥2) of stroke, only 21.7% of them were discharged on OACs (10.5% received warfarin and 11.2% received non-vitamin K antagonist OACs). Patients with pre-admission use of OAC, a HAS-BLED score <3, with persistent/permanent AF were more likely to receive OAC treatment at discharge.ConclusionWe found that approximately 8% of patients who underwent PCI during ACS hospitalisation also demonstrated AF. Anticoagulant therapy was greatly underused. Patients with paroxysmal AF and an increased risk of bleeding were less likely to receive anticoagulant treatment. Further efforts should be made to increase the adherence to guideline recommendations for OACs.
Antibiotics for COPD exacerbations: does drug or duration matter? A primary care database analysis
Authors: Stolbrink Marie , Bonnett Laura J , Blakey John D 
Published: September 2019

IntroductionAntibiotics are routinely given to people with chronic obstructive pulmonary disease (COPD) presenting with lower respiratory tract infection (LRTI) symptoms in primary care. Population prescribing habits and their consequences have not been well-described.MethodsWe conducted a retrospective analysis of antibiotic prescriptions for non-pneumonic exacerbations of COPD from 2010 to 2015 using the UK primary care Optimum Patient Care Research Database. As a proxy of initial treatment failure, second antibiotic prescriptions for LRTI or all indications within 14 days were the primary and secondary outcomes, respectively. We derived a model for repeat courses using univariable and multivariable logistic regression analysis.ResultsA total of 8.4% of the 9042 incident events received further antibiotics for LRTI, 15.5% further courses for any indication. Amoxicillin and doxycycline were the most common index and second-line drugs, respectively (58.7% and 28.7%), mostly given for 7 days. Index drugs other than amoxicillin, cardiovascular disease, pneumococcal vaccination and more primary care consultations were statistically significantly associated with repeat prescriptions for LRTI (p<0.05). The ORs and 95% CIs were: OR 1.28, 95% CI 1.10 to 1.49; OR 1.37, 95% CI 1.13 to 1.66; OR 1.33, 95% CI 1.14 to 1.55 and OR 1.05, 95% CI 1.02 to 1.07, respectively. Index duration, inhaled steroid use and exacerbation frequency were not statistically significant. The derived model had an area under the curve of 0.61, 95% CI 0.59 to 0.63.DiscussionThe prescription of multiple antibiotic courses for COPD exacerbations was relatively common—one in twelve patients receiving antibiotics for LRTI had a further course within 2 weeks. The findings support the current preference for amoxicillin as index drug within the limitations of this observational study. Further clinical trials to determine best practice in this common clinical situation appear required.
Alternative to the finger in the dike: use of the vascular closure button to control postdialysis bleeding in a haemodialysis access conduit
Authors: Sacchetti Alfred , Hennessey Adam , Shannon Brian 
Published: September 2019

ObjectiveThe purpose of this case series is to describe the application of a vascular closure button (VCB) for the repair of haemodialysis access bleeding. The VCB’s main function is not to assist in bleeding control, but instead to provide easy access for removal of tightly placed sutures in the repair.MethodsA retrospective review of patients undergoing ED repair of persistent bleeding from puncture sites in haemodialysis access conduits (HACs) using a VCB was conducted. Study patients were collected from ED visits to Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, between May 2013 and August 2017. Patients were followed until the time of definitive repair of the underlying pathology or until the end of the study period.ResultsSeventeen VCBs were used to control persistent bleeding from HACs in the ED. Sixteen bleeds were the result of recent haemodialysis punctures, while one was from a bleeding site ulcer. All repairs were successful at controlling the bleeding with preserved HAC function in the ED and no delayed thrombosis. Follow-up time ranged from 1 day to 778 days.ConclusionVascular control buttons provide an effective means to control HAC postdialysis bleeding and allow for ease of suture removal without disruption of a repair with no long-term complications.
Endovascular management of acute postprocedural flow diverting stent thrombosis
Authors: Townsend Robert Kyle , Wolfe Stacey Q , Anadani Mohammad , Spiotta Alejandro , De Leacy Reade , Mocco J , Garner Rebecca M , Albuquerque Felipe C , Ducruet Andrew F , Kan Peter , Fargen Kyle M 
Published: September 2019

IntroductionPostprocedural thrombosis is a rare complication after flow diverting stent (FD) implantation for aneurysm treatment with few reported cases in the literature. Management strategies and outcomes associated with this complication have not been reported.MethodsA multicenter retrospective series of cases of acute postprocedural FD thrombosis were compiled and prevalence was calculated based on procedural volumes over a 7 year period. Acute postprocedural FD thrombosis was defined as the development of neurologic deficit with angiographic imaging demonstrating acute thrombus within the index FD stent at least 2 hours following completion of the implantation procedure.ResultsA total of 10 cases of postprocedural thrombosis were identified at five participating centers among a total of 768 patients treated (prevalence 1.3%). Thrombosis occurred a median of 5.5 days after implantation (range 0–83 days). 9/10 patients underwent emergent angiography with intent to perform endovascular reperfusion. A variety of different endovascular treatments were used, including aspiration thrombectomy, retrievable stent thrombectomy, balloon angioplasty, and intra-arterial thrombolytic infusion, without any procedural complications. There were no instances of FD migration, stent kinking, or aneurysm rupture. 90% of patients achieved Thrombolysis in Cerebral Infarction 2B or greater revascularization. Favorable clinical outcomes (modified Rankin Scale score of 0–2) at 3 months were achieved in 88% of patients.ConclusionAcute postprocedural thrombosis of an FD is a rare complication that occurs in approximately 1–2% of patients after aneurysm treatment. Patients presenting with acute postprocedural FD thrombosis should be aggressively managed using large vessel occlusion thrombectomy techniques, as good angiographic and clinical outcomes are possible.