bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Hemodynamic Ramp Test-Guided HVAD Speed and Medication Adjustments on Clinical Outcomes
Authors: Uriel Nir , Burkhoff Daniel , Rich Jonathan D. , Drakos Stavros G. , Teuteberg Jeffrey J. , Imamura Teruhiko , Rodgers Daniel , Raikhelkar Jayant , Vorovich Esther E. , Selzman Craig H. , Kim Gene , Sayer Gabriel 
Published: April 2019

Background:
Hemodynamic ramp (HR) tests can guide the optimization of left ventricular assist device (LVAD) speed and direct medical therapy. We investigated the effects of HR-guided LVAD management.

Methods and Results:

This prospective, multicenter, randomized, pilot study compared outcomes in LVAD patients using an HR-guided (HR group) versus a standard transthoracic echocardiography-guided (control group) management strategy. Patients were enrolled and randomized 1 to 3 months post-HVAD implantation and followed for 6 months. Twenty-two patients (57±10 years, 73% male) were randomized to the HR group and 19 patients (51±13 years, 63% male) to the control group. HR group patients had double the number of LVAD speed changes (1.68 versus 0.84 changes/patient,
P
=0.09 with an incidence rate ratio 2.0, 95% CI, 0.9–4.7) with twice the magnitude of rotations per minute changes (130 versus 60 rotations per minute/patient,
P
=0.004) during the study. The HR group also had 2-fold greater heart failure medication changes (4.32 versus 2.53 changes/patient,
P
=0.072, incidence rate ratio 1.7 with 95% CI, 0.8–3.5) predominantly because of changes in diuretic dose (40 versus 0 mg/patient,
P
<0.001). The HR group had numerically but not statistically higher event-free survival (62% versus 46%,
P
=0.087; hazard ratio, 0.46 with 95% CI, 0.2–1.2), with numerically but not statistically lower events per patient-year (
P
=0.084). There were no significant differences in the 6-minute walk or Kansas City Cardiomyopathy Questionnaire tests at 6 months.

Conclusions:
In this randomized pilot study of LVAD patient management we demonstrated the feasibility of standardized HR testing at multiple institutions and that a strategy guided by hemodynamics was associated with more LVAD speed and medication adjustments and a nonsignificant reduction in adverse events. A pivotal study to demonstrate the clinical benefit of HR testing is warranted.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03021239.
North Atlantic Rossby Wave Breaking during the Hurricane Season: Association with Tropical and Extratropical Variability
Authors: Zhang Gan , Wang Zhuo 
Published: April 2019

Abstract
This study explores the connection of Rossby wave breaking (RWB) with tropical and extratropical variability during the Atlantic hurricane season. The exploration emphasizes subtropical anticyclonic RWB events over the western North Atlantic, which strongly affect tropical cyclone (TC) activity. The first part of the study investigates the link between RWB and tropical sea surface temperature (SST) variability. Tropical SST variability affects tropical precipitation and modulates the large-scale atmospheric circulation over the subtropical Atlantic, which influences the behaviors of Rossby waves and the frequency of RWB occurrence. Meanwhile, RWB regulates surface heat fluxes and helps to sustain SST anomalies in the western North Atlantic. The second part of the study explores the connections between RWB and extratropical atmosphere variability by leveraging weather regime analysis. The weather regimes over the North Atlantic are closely associated with RWB over the eastern North Atlantic and western Europe, but show weak associations with RWB over the western North Atlantic. Instead, RWB over the western basin is closely related to the weather regimes in the North Pacific–North America sector. The finding helps clarify why the correlation between the Atlantic TC activity and the summertime North Atlantic Oscillation is tenuous. The relations between the extratropical weather regimes and tropical climate modes are also discussed. The findings suggest that both tropical and extratropical variability are important for understanding variations of RWB events and their impacts on Atlantic TC activity.
Northwest Pacific Anticyclonic Anomalies during Post–El Niño Summers Determined by the Pace of El Niño Decay
Authors: Jiang Wenping , Huang Gang , Huang Ping , Wu Renguang , Hu Kaiming , Chen Wei 
Published: April 2019

Abstract
This study investigates the characteristics and maintaining mechanisms of the anomalous northwest Pacific anticyclone (NWPAC) following different El Niño decaying paces. In fast decaying El Niño summers, the positive SST anomalies in the tropical central-eastern Pacific (TCEP) have transformed to negative, and positive SST anomalies appear around the Maritime Continent (MC), whereas in slow decaying El Niño summers, positive SST anomalies are present in the TCEP and in the tropical Indian Ocean (TIO). During fast decaying El Niño summers, the cold Rossby wave in response to the negative TCEP SST anomalies has a primary contribution to maintaining the NWPAC anomalies. The warm Kelvin wave response and enhanced Hadley circulation anomalies forced by the positive MC SST anomalies also facilitate developing the NWPAC anomalies. During slow decaying El Niño summers, the warm Kelvin wave anchored over the TIO plays a crucial role in sustaining the NWPAC anomalies, while the warm Rossby wave triggered by the positive TCEP SST anomalies weakens the western part of the NWPAC anomalies. The southwesterly anomalies of the NWPAC anomalies during fast decaying El Niño summers can reach to higher latitudes than those during slow decaying El Niño summers. Correspondingly, positive rainfall anomalies appear in northern China and the Yangtze River basin in fast decaying El Niño summers but are only distributed in the Yangtze River basin in slow decaying El Niño summers. This study implies that the El Niño decaying pace is a key factor in East Asian summer climate.
Development, concurrent validity and internal consistency of a simulator tool for assessing continued car driving after a brain injury/disease
Authors: Samuelsson Kersti , Tropp Maria , Lundqvist Anna , Wressle Ewa 
Published: April 2019

Introduction Beyond relevant cognitive tests, a simulated driving activity could be useful to observe performance and behaviour in a standardized ‘driving-like’ situation and provide information on attention, reaction time and information processing speed when evaluating the ability to continue driving after a brain injury or disease. The aim was to develop and evaluate concurrent validity and internal consistency of a computerized simulated driving task tool. Methods Results from a new tool (CyberSiM, including three subtests and four result variables) were compared with results from the Trail Making Test, Useful Field of View test and Nordic Stroke Driver Screening Assessment. There were 126 healthy adults included in the study. Results The correlation analysis showed significant correlations ( p<0.001) for CyberSiM reaction time and all cognitive tests except for Useful Field of View 1. The CyberSiM showed good internal consistency, with Cronbach’s alpha=0.85. Conclusion The analysis of concurrent validity showed conformity to most cognitive tests. CyberSiM might be a useful complement to cognitive testing with the opportunity to observe some behaviours ‘in a driving-like activity’. Further studies on clinical groups are needed to confirm its usefulness.
Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation
Authors: Wang Ann A , Tapia Christopher , Bhanji Yasin , Campbell Christopher , Larsen Daniel , Gross Derick , Ganatra Seema , Qodsi Melad , Tellez Claudia , Jain Shikha 
Published: April 2019

Introduction Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. Methods This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. Results Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0–109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. Conclusion Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.
Risk factors for femoral stem breakage: an analysis of the AOANJRR results
Authors: Rickman Mark S , Lewis Peter L , Chou Daud TS , Donnelly William , Graves Stephen E , Lorimer Michelle 
Published: April 2019

Introduction: Breakage of the femoral stem component of a total hip replacement is now uncommon but continues to be seen with certain stem designs and in certain patient groups. Data previously published on this topic has been limited, either gathered from a single surgeon or centre, or included only a single stem design. Methods: We reviewed the data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), identified and analysed 143 stem breakages over a period of 16 years, covering 44 different stem designs. Results: Our data confirms previously published findings that risk factors for stem breakage include patient age at implantation of under 70, male gender, as well as the use of exchangeable necks. We found no association with initial diagnosis, or type of acetabular component implanted. We did however also find, excluding exchangeable neck designs, that after 4.5 years a cemented stem had a significantly higher risk of breakage then a cementless stem. Discussion: To our knowledge this is the 1st paper to suggest cemented fixation as a specific risk factor for stem breakage. The analysis of rare complications such as stem breakage is only possible through large data collection systems such as the AOANJRR. Whilst there have been recent advances in materials and manufacturing techniques, we recommend that surgeons are aware of all the specific risks when considering implant choices for individual patients.
Mid-term follow-up after all-size acetabular revision and proposal for a stability classification system
Authors: Walter Sebastian G , Thomas Tom S , Kenndoff Daniel , Thomas Wolfram 
Published: April 2019

Background: There is a trend for using jumbo cups/oblong devices for acetabular reconstruction as alternative to biological solutions. We report about a spectrum of reconstruction methods and their mid-term results. Methods: Inclusion of 214 consecutive patients undergoing total hip arthroplasty revision surgery. Patients were examined using the Harris Hip Score (HHS). Based on the intraoperative acetabular defect situation, cases were classified into 1 of 5 possible categories of a stability classification for acetabular replacement (SCAR). Results: Mean HHS improved from 42 preoperatively (range 12–62) to 77 (range 54–90; p < 0.05) 6 months after operation. There were significant differences of the pre-and postoperative HHS between SCAR subgroups ( p < 0.05). Inter-observer reliability of the SCAR was high (kappa 0.94 (95% CI, 0.90–0.98)). Re-revision was performed in 15 cases (7%). Conclusion: The SCAR classification is a practicable tool for intraoperative decision-making as it provides standardised treatment recommendations.
Implementation of Active Learning Approach to Teach Biorisk Management and Dual-Use Research of Concern in Egypt
Authors: Elhadidy Mohamed , El-Tholoth Mohamed , Brocard Anne-Sophie 
Published: April 2019

Introduction: Frequent reports of laboratory- and hospital-acquired infection in Egypt suggested a deficiency in handling hazardous samples and microorganisms among different researchers and professionals. The most common cause of laboratory incidents and potential exposure is often identified as a lack of biosafety training. Methods: In this study, we designed and implemented an effective laboratory biorisk management (BRM) training. Two workshops were delivered to 42 faculty members working in laboratories handling biological material in Egypt. The workshop modules were based on the global biorisk management curriculum developed by Sandia National Laboratories, with some modifications. The content was delivered to actively engaging participants in the learning process that included group work, case studies and scenarios, short presentations, demonstrations, hands-on activities, and questions and answers that created analytical thinking situations. These workshops introduced the concept of biorisk management, which combines risk assessment, risk mitigation, and performance systems and dual-use research of concern. Results: Results of pre-tests/post-tests revealed significant ( P < .001) improvement in knowledge acquisition among participants. Course evaluation surveys indicate that most participants felt that these teaching methods met their needs and that their personal laboratory practices would change as a result of the training course. Conclusion: We conclude that using varied hands-on strategies in teaching biorisk management provided the participants with the skills, tools, and confidence to guide their laboratory staff and colleagues on sustainable biorisk management to reduce the risks associated with infectious disease research in a laboratory setting.
Adoption and adherence to chronic obstructive pulmonary disease GOLD guidelines in a primary care setting
Authors: Surani Salim , Aiyer Akshar , Eikermann Stephen , Murphy Timothy , Anand Pranav , Varon Joseph , Vanderheiden David , Khan Alamgir , Guzman Antonio 
Published: April 2019

Objectives: Over 380 million people in the world live with chronic obstructive pulmonary disease, and it is the third leading cause of death in the United States. Despite updated guidelines, there may be significant variations in diagnosis and management of chronic obstructive pulmonary disease at a primary care level. The aim of the study was to examine primary care physician management of chronic obstructive pulmonary disease in two community clinics. Methods: After approval from the Institutional Review Board, a retrospective chart review was done among all patients with the diagnosis of chronic obstructive pulmonary disease in two community clinics. Baseline demographics, utilization of spirometry, exacerbation history and home oxygen use were also obtained. Results: Chart reviews of 101 patients were completed (52 male and 49 female) in two outpatient primary care provider offices (Office A: 66 patients and Office B: 35 patients). None of the patients had validated measures of dyspnoea such as CAT or mMRC scores. Only 21% (22/101) of the patients had formal pulmonary function test testing done, and of those who had pulmonary function tests, 31.5% of patients were incorrectly diagnosed and mislabelled as chronic obstructive pulmonary disease. Pharmacotherapy for chronic obstructive pulmonary disease was not in alignment with GOLD guidelines, with only 42% of patients on an inhaler regimen that included a long-acting muscarinic antagonist. Conclusion: There is suboptimal use of pulmonary function test in a primary care setting for diagnosis of chronic obstructive pulmonary disease and substantial errors in diagnosis. There is virtually no use routinely of validated symptom scales for diagnosis of chronic obstructive pulmonary disease. There is substantial variance in pharmacotherapy, and regimens routinely do not follow GOLD guidelines.
Intratumoral platelet aggregate formation in a murine preclinical glioma model depends on podoplanin expression on tumor cells
Authors: Costa Barbara , Eisemann Tanja , Strelau Jens , Spaan Ingrid , Korshunov Andrey , Liu Hai-Kun , Bugert Peter , Angel Peter , Peterziel Heike 
Published: April 2019

Abstract
Binding of the sialomucin-like transmembrane glycoprotein podoplanin (PDPN) to the platelet receptor C-type lectin-like receptor 2 induces platelet activation and aggregation. In human high-grade gliomas, PDPN is highly expressed both in tumor cells and in tumor-associated astrocytes. In glioma patients, high expression of PDPN is associated with worse prognosis and has been shown to correlate with intratumoral platelet aggregation and an increased risk of venous thromboembolism (VTE). To functionally assess the role of PDPN in platelet aggregation in vivo, we established a syngeneic orthotopic murine glioma model in C57/Bl6 mice, based on transplantation of p53- and Pten-deficient neural stem cells. This model is characterized by the presence of intratumoral platelet aggregates and by the upregulation of PDPN both in glioma cells and in astrocytes, reflecting the characteristics of human gliomas. Deletion of PDPN either in tumor cells or in astrocytes resulted in glioma formation with similar penetrance and grade compared with control mice. Importantly, only the lack of PDPN in tumor cells, but not in astrocytes, caused a significant reduction in intratumoral platelet aggregates, whereas in vitro, both cell types have similar platelet aggregation-inducing capacities. Our results demonstrate a causative link between PDPN and platelet aggregation in gliomas and pinpoint the tumor cells as the major players in PDPN-induced platelet aggregation. Our data indicate that blocking PDPN specifically on tumor cells could represent a novel strategy to prevent platelet aggregation and thereby reduce the risk of VTE in glioma patients.
Randomized trial comparing standard vs sequential high-dose chemotherapy for inducing early CR in adult AML
Authors: Bassan Renato , Intermesoli Tamara , Masciulli Arianna , Pavoni Chiara , Boschini Cristina , Gianfaldoni Giacomo , Marmont Filippo , Cavattoni Irene , Mattei Daniele , Terruzzi Elisabetta , De Paoli Lorella , Cattaneo Chiara , Borlenghi Erika , Ciceri Fabio , Bernardi Massimo , Scattolin Anna M. , Todisco Elisabetta , Campiotti Leonardo , Corradini Paolo , Cortelezzi Agostino , Ferrero Dario , Zanghì Pamela , Oldani Elena , Spinelli Orietta , Audisio Ernesta , Cortelazzo Sergio , Bosi Alberto , Falini Brunangelo , Pogliani Enrico M. , Rambaldi Alessandro 
Published: April 2019

Abstract
Here we evaluated whether sequential high-dose chemotherapy (sHD) increased the early complete remission (CR) rate in acute myelogenous leukemia (AML) compared with standard-intensity idarubicin-cytarabine-etoposide (ICE) chemotherapy. This study enrolled 574 patients (age, 16-73 years; median, 52 years) who were randomly assigned to ICE (n = 286 evaluable) or sHD (2 weekly 3-day blocks with cytarabine 2 g/m2 twice a day for 2 days plus idarubicin; n = 286 evaluable). Responsive patients were risk-stratified for a second randomization. Standard-risk patients received autograft or repetitive blood stem cell-supported high-dose courses. High-risk patients (and standard-risk patients not mobilizing stem cells) underwent allotransplantation. CR rates after 2 induction courses were comparable between ICE (80.8%) and sHD (83.6%; P = .38). sHD yielded a higher single-induction CR rate (69.2% vs 81.5%; P = .0007) with lower resistance risk (P &lt; .0001), comparable mortality (P = .39), and improved 5-year overall survival (39% vs 49%; P = .045) and relapse-free survival (36% vs 48%; P = .028), despite greater hematotoxicity delaying or reducing consolidation blocks. sHD improved the early CR rate in high-risk AML (odds ratio, 0.48; 95% confidence interval [CI], 0.31-0.74; P = .0008) and in patients aged 60 years and less with de novo AML (odds ratio, 0.46; 95% CI, 0.27-0.78; P = .003), and also improved overall/relapse-free survival in the latter group (hazard ratio, 0.70; 95% CI, 0.52-0.94; P = .01), in standard-risk AML, and postallograft (hazard ratio, 0.61; 95% CI, 0.39-0.96; P = .03). sHD was feasible, effectively achieved rapid CR, and improved outcomes in AML subsets. This study is registered at www.clinicaltrials.gov as #NCT00495287.
How dangerousness evolves after court-ordered compulsory psychiatric admission: explorative prospective observational cohort study
Authors: de Jong Mark H. , Wierdsma André I. , van Baars Antonius W. B. , Van Gool Arthur R. , Mulder Cornelis L. 
Published: April 2019

BackgroundCompulsory admission is commonly regarded as necessary and justified for patients whose psychiatric condition represents a severe danger to themselves and others. However, while studies on compulsory admissions have reported on various clinical and social outcomes, little research has focused specifically on dangerousness, which in many countries is the core reason for compulsory admission.AimsTo study changes in dangerousness over time in adult psychiatric patients admitted by compulsory court order, and to relate these changes to these patients' demographic and clinical characteristics.MethodIn this explorative prospective observational cohort study of adult psychiatric patients admitted by compulsory court order, demographic and clinical data were collected at baseline. At baseline and at 6 and 12 month follow-up, dangerousness was assessed using the Dangerousness Inventory, an instrument based on the eight types of dangerousness towards self or others specified in Dutch legislation on compulsory admissions. We used descriptive statistics and logistic regression to analyse the data.ResultsWe included 174 participants with a court-ordered compulsory admission. At baseline, the most common dangerousness criterion was inability to cope in society. Any type of severe or very severe dangerousness decreased from 86.2% at baseline to 36.2% at 6 months and to 28.7% at 12 months. Being homeless at baseline was the only variable which was significantly associated with persistently high levels of dangerousness.ConclusionsDangerousness decreased in about two-thirds of the patients after court-ordered compulsory admission. It persisted, however, in a substantial minority (approximately one-third).Declaration of interestNone.