bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes of Plavix and Generic Clopidogrel for Patients Hospitalized With an Acute Coronary Syndrome
Authors: Ko Dennis T. , Krumholz Harlan M. , Tu Jack V. , Austin Peter C. , Stukel Therese A. , Koh Maria , Chong Alice , de Melo Jose Francisco , Jackevicius Cynthia A. 
Published: March 2018

Background:
Clopidogrel is one of the most commonly prescribed medications because of its ability to improve clinical outcomes for a broad range of cardiovascular conditions. After patent protection expired for Plavix in 2012, many healthcare systems adopted generic clopidogrel as a strategy to reduce healthcare costs.

Methods and Results:

We conducted a population-based observational study to determine whether generic clopidogrel was noninferior to Plavix. Patients who were hospitalized with an acute coronary syndrome (ACS) from 2009 to 2014 in Ontario, Canada, >65 years, survived ≥7 days after discharge, were eligible for inclusion. The primary outcome was a composite of death and recurrent ACS at 1 year. The noninferiority margin was prespecified at a relative hazard difference of 10%. Inverse propensity of treatment weighting of the propensity score was used to account for differences in baseline characteristics between the treatment groups. The effect of clopidogrel on the hazard of clinical outcomes was estimated using a Cox proportional hazards model within the propensity-weighted cohort using Plavix as a reference. Our study included 24 530 patients with ACS, 12 643 were prescribed Plavix and 11  887 were prescribed generic clopidogrel at hospital discharge. The mean age was 77 years, 57% were men, and 21% had an ST-segment–elevation myocardial infarction. At 1 year, 17.6% of patients prescribed Plavix and 17.9% of patients prescribed clopidogrel experienced the primary outcome (hazard ratio, 1.02; 95% confidence interval, 0.96–1.08;
P
=0.005 for noninferiority). No significant differences between rates of death, all-cause readmission, ACS, stroke or transient ischemic attack, or bleeding were observed.

Conclusions:
Generic clopidogrel was noninferior to Plavix with respect to the composite end point of death and recurrent hospitalization for ACS at 1 year among adults >65 years after an ACS hospitalization. Our findings support generic clopidogrel in ACS, which could lead to substantial healthcare cost savings.
Prognostic Impact of Statin Intensity in Heart Failure Patients With Ischemic Heart Disease: A Report From the CHART‐2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2) Study
Authors: Oikawa Takuya , Sakata Yasuhiko , Nochioka Kotaro , Miura Masanobu , Tsuji Kanako , Onose Takeo , Abe Ruri , Kasahara Shintaro , Sato Masayuki , Shiroto Takashi , Takahashi Jun , Miyata Satoshi , Shimokawa Hiroaki ,   the CHART‐2 invesigators
Published: March 2018

Background

The beneficial prognostic impact of statins has been established in patients with ischemic heart disease but not in those with heart failure (
HF
). In addition, it is still unclear whether patients benefit from statins regardless of low‐density lipoprotein cholesterol levels.

Methods and Results

We examined 2444 consecutive stage C or D
HF
patients with ischemic heart disease registered in CHART‐2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2), a multicenter, prospective, observational cohort study in Japan. Patients were divided into 3 groups according to the Japanese standard doses of statins and statin‐intensity categories defined by the 2013 American College of Cardiology and American Heart Association guidelines: higher (moderate‐high)‐intensity (n=868), lower (low)‐intensity (n=526), and no statin (n=1050). The median follow‐up period was 6.4 years (13929 person‐years). Analysis with the inverse probability of treatment weighted using a propensity score for multiple treatment revealed that both the higher‐intesity group (hazard ratio [
HR
]: 0.68;
P
<0.001) and the lower‐intensity group (
HR
: 0.82;
P
<0.001) had significantly lower incidence of the primary end point—a composite of all‐cause death and
HF
admission—compared with the no statin group. The higher‐intensity statin group had significantly lower incidence of the primary end point (
HR
: 0.82;
P
<0.001), all‐cause death (
HR
: 0.83;
P
<0.001), and
HF
admission (
HR
: 0.78;
P
<0.001) than the lower‐intensity statin group. Moreover, the use of statins, either higher‐ or lower‐intensity, was associated with reduced incidence of the primary end point, regardless of low‐density lipoprotein cholesterol levels.

Conclusions

These results suggest that statin use, particularly the use of higher‐intensity statins, has a beneficial prognostic impact in
HF
patients with ischemic heart disease, regardless of low‐density lipoprotein cholesterol levels.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
00418041.
High‐Density Lipoprotein Subspecies Defined by Apolipoprotein C‐III and Subclinical Atherosclerosis Measures: MESA (The Multi‐Ethnic Study of Atherosclerosis)
Authors: Aroner Sarah A. , Koch Manja , Mukamal Kenneth J. , Furtado Jeremy D. , Stein James H. , Tattersall Matthew C. , McClelland Robyn L. , Jensen Majken K. 
Published: March 2018

Background

Apolipoprotein C‐
III
(apoC‐
III
), a small proinflammatory protein present on 6% to 7% of high‐density lipoprotein (
HDL
) particles, defines a subspecies of
HDL
adversely associated with coronary heart disease in primarily white cohorts. In a multi‐ethnic population free of clinical cardiovascular disease, we evaluated the relationship between apoC‐
III
–defined
HDL
subspecies and subclinical markers of atherosclerotic pathology.

Methods and Results

We investigated cross‐sectional associations between apolipoprotein A‐I concentrations of apoC‐
III
–defined
HDL
subspecies, measured via
ELISA
and imaging measures of subclinical atherosclerosis, among 4659 participants in the MESA (The Multi‐Ethnic Study of Atherosclerosis) at baseline (2000–2002).
HDL
particles containing and lacking apoC‐
III
were divergently associated with coronary artery calcification in women (
P
‐heterogeneity=0.002) but not in men (
P
‐heterogeneity=0.31) and with carotid plaque score (
P
‐heterogeneity=0.02) and intima‐media thickness (
P
‐heterogeneity=0.06) in the overall study population.
HDL
lacking apoC‐
III
was inversely associated with all outcome measures (coronary artery calcification, women: odds ratio per
SD
=0.81 [95% confidence interval [CI], 0.73–0.90]; carotid plaque, overall: odds ratio per
SD
=0.92 [95% CI, 0.84–1.00]; intima‐media thickness, overall: mean difference per
SD
=−14.0 µm [95% CI, −21.1 to −6.7 μm]), whereas
HDL
containing apoC‐
III
was positively associated (coronary artery calcification, women: odds ratio=1.10 [95% CI, 0.99–1.22]; plaque, overall: odds ratio=1.10 [95% CI, 1.01–1.19]) or unassociated. Neither total
HDL
nor
HDL
subspecies was associated with changes in subclinical atherosclerosis measures up to 10 years later.

Conclusions

The presence of apoC‐
III
defined a subspecies of
HDL
not inversely associated with baseline measures of subclinical atherosclerosis, supporting a role of apoC‐
III
in the pathophysiology of cardiovascular disease.
Residential Proximity to Major Roadways and Risk of Incident Ischemic Stroke in NOMAS (The Northern Manhattan Study)
Authors: Kulick Erin R. , Wellenius Gregory A. , Boehme Amelia K. , Sacco Ralph L. , Elkind Mitchell S. 
Published: March 2018

Background and Purpose—
The evidence supporting the deleterious cardiovascular health effects of living near a major roadway is growing, although this association is not universal. In primary analyses, we hypothesized that residential proximity to a major roadway would be associated with incident ischemic stroke and that cardiovascular risk factors would modify that association.

Methods—
NOMAS (The Northern Manhattan Study) is an ongoing, population-based cohort study designed to measure cardiovascular risk factors, stroke incidence, and other outcomes in a multiethnic urban population. Recruitment occurred from 1993 to 2001 and participants are followed-up annually by telephone. Residential addresses at baseline were geocoded and Euclidean distance to nearest major roadway was estimated and categorized as in prior studies. We used Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals for the association of this distance to incidence of stroke and other outcomes, adjusting for sociodemographic and cardiovascular risk factors, year at baseline, and neighborhood socioeconomic status. We assessed whether these associations varied by age, sex, smoking status, diabetes mellitus, and hypertension.

Results—
During a median follow-up period of 15 years (n=3287), 11% of participants were diagnosed with ischemic stroke. Participants living <100 m from a roadway had a 42% (95% confidence interval, 1.01–2.02) higher rate of ischemic stroke versus those living >400 m away. This association was more pronounced among noncurrent smokers (hazard ratio, 1.54; 95% confidence interval, 1.05–2.26) and not evident among smokers (hazard ratio, 0.69; 95% confidence interval, 0.23–2.06). There was no clear pattern of association between proximity to major roadways and other cardiovascular events including myocardial infarction, all-cause death, or vascular death.

Conclusions—
In this urban multiethnic cohort, we found evidence supporting that within-city variation in residential proximity to major roadway is associated with higher risk of ischemic stroke. An individual’s smoking history modified this association, with the association remaining only among participants not currently smokers.
Rates and Risk Factors for Arterial Ischemic Stroke Recurrence in Children
Authors: Stacey Arthur , Toolis Claire , Ganesan Vijeya 
Published: March 2018

Background and Purpose—
Recurrent ischemic events are common in children with arterial ischemic stroke (AIS) and put patients at risk for further neurological impairment. This study sought to identify rates and risk factors for recurrent AIS or transient ischemic attack in a cohort of children seen after index AIS and uniformly investigated and managed using contemporary clinical guidelines.

Methods—
Case note and radiology review of children >28 days and <18 years of age who presented to Great Ormond Street Hospital from 2005 to 2015 with index AIS. Demographic characteristics, medical history, index AIS features, radiological findings, and neurological outcome were examined. Recurrence was identified from clinical records and coded as AIS (if there was associated new cerebral infarction) or transient ischemic attack.

Results—
Eighty-four children (43 girls; median age at index AIS, 4.1 years) were identified. Cumulative AIS recurrence was 5% at 1 month, 10% at 3 months, 12% at 6 months, 12% at 12 months, and 15% at 60 months after index event. Factors that independently predicted AIS recurrence were referral to Great Ormond Street Hospital from outside the catchment area, a prior relevant diagnosis, bilateral arteriopathy, and AIS CASCADE category 3A or 3B (Childhood AIS Standardized Classification and Diagnostic Evaluation). Multiple infarcts and evidence of mature, as well as acute, infarcts on first brain imaging, although independently associated with AIS recurrence, were also associated with bilateral arteriopathy. Only CASCADE categories 3A and 3B (bilateral cerebral arteriopathy with or without collaterals) remained significant in multivariate analysis. AIS recurrence was not associated with poor neurological outcome.

Conclusions—
AIS recurrence remains a significant problem, despite the wide use of antithrombotic medications. AIS subtypes should direct clinicians and future trials to use stratified management strategies and durations of treatment. Bilateral cerebral arteriopathies are especially sinister, and consensus criteria should be developed to improve consistency of management.
Laudato Si
Authors: Holden William N. , Mansfield William O. 
Published: March 2018

Abstract
This article examines the highly influential Papal encyclical Laudato Si issued by Pope Francis in June 2015. The scientific basis behind climate change is discussed, as are the consequences of climate change, which will be disproportionately borne by the poor countries and poor peoples of the world. The Pope’s prescriptions for coping with climate change are reviewed and the article concludes with a discussion of how Laudato Si exemplifies the simultaneous, and frequently intersecting, themes of protecting the environment and protecting the poor in Catholic social thought. In many ways, Laudato Si is the product of the church of the poor confronting climate change.
Fitting a Square Peg into a Round Hole: Categorizing Works of Jewish Historiography of the Second Temple Period
Authors: Finkelstein Ari 
Published: March 2018

AbstractThe categories of Jewish historiography of the Second Temple Period frame how scholars and their students approach crucial texts of this era and therefore shape our understanding of history. Yet, these categories are fraught with difficulties. This article explores this issue by examining Daniel R. Schwartz’s categorization of Second Temple historiography as either Palestinian or diasporan works. While these categories provide interesting insights, they also leave far too many exceptions. This article demonstrates that such efforts of categorization warp our understanding of Second Temple historiography. Rather than categorize Second Temple historiography I suggest that each work ought to be considered from the point of view of its author’s aims.
The Untouchable Nature of the ‘EU Seal Regime’—Is the European Union Liable for the Damages Suffered by the Canadian Inuit Due to the Violation of WTO Law in EC—Seal Products?
Authors: Hennig Martin 
Published: March 2018

Abstract
In this article, the author assesses whether Canadian Inuit sealers, who have suffered economic damage in the wake of the introduction of the European Union (EU) ban on seal products, can bring an action for damages against the EU before the European Court of Justice. The author reviews why the EU ban on seal hunting violates World Trade Office (WTO) law and discusses if, and why, Canadian Inuit sealers can rely on a violation of the WTO Agreements as a legal basis in a potential claim for damages under EU law. Moreover, the author criticizes the current state of EU law, which does not grant reparation of the economic damage suffered by indigenous communities when carrying out their traditional seal hunts that are protected under UN human rights law.
The Role of the ‘al-Ġobn’ Imbalance in Strengthening Arab Consumers: The Significance of the European Approach
Authors: Ibrahim Mohammed Ali 
Published: March 2018

Abstract
The concept of imbalance, al-ġobn, is a decisive factor in protecting consumers. In addition to consumer protection regulations, imbalance as a traditional defect in contracts (not in will) in Egypt and Syria is a cornerstone of increasing protection. However, the concept has not been developed and remains limited to certain occasions, mainly exploitation. Therefore, it is useful to examine imbalance in modern consumer laws in developed countries (e.g. in European consumer law). We first compare the perspectives of both traditional and European laws. Then we examine the interrelationship between both perspectives by demonstrating how the traditional defects of will became a source of imbalance rather than being limited to exploitation only. The conclusion thus reconsiders the concept of imbalance shifting to increase consumer protection in Arab countries, even though it may not be included in any separate legal instrument (e.g. in consumer-protection acts).
A Bird’s-Eye View: Development of an Operational ARM Unmanned Aerial Capability for Atmospheric Research in Arctic Alaska
Authors: de Boer Gijs , Ivey Mark , Schmid Beat , Lawrence Dale , Dexheimer Darielle , Mei Fan , Hubbe John , Bendure Albert , Hardesty Jasper , Shupe Matthew D. , McComiskey Allison , Telg Hagen , Schmitt Carl , Matrosov Sergey Y. , Brooks Ian , Creamean Jessie , Solomon Amy , Turner David D. , Williams Christopher , Maahn Maximilian , Argrow Brian , Palo Scott , Long Charles N. , Gao Ru-Shan , Mather James 
Published: March 2018

AbstractThorough understanding of aerosols, clouds, boundary layer structure, and radiation is required to improve the representation of the Arctic atmosphere in weather forecasting and climate models. To develop such understanding, new perspectives are needed to provide details on the vertical structure and spatial variability of key atmospheric properties, along with information over difficult-to-reach surfaces such as newly forming sea ice. Over the last three years, the U.S. Department of Energy (DOE) has supported various flight campaigns using unmanned aircraft systems [UASs, also known as unmanned aerial vehicles (UAVs) and drones] and tethered balloon systems (TBSs) at Oliktok Point, Alaska. These activities have featured in situ measurements of the thermodynamic state, turbulence, radiation, aerosol properties, cloud microphysics, and turbulent fluxes to provide a detailed characterization of the lower atmosphere. Alongside a suite of active and passive ground-based sensors and radiosondes deployed by the DOE Atmospheric Radiation Measurement (ARM) program through the third ARM Mobile Facility (AMF-3), these flight activities demonstrate the ability of such platforms to provide critically needed information. In addition to providing new and unique datasets, lessons learned during initial campaigns have assisted in the development of an exciting new community resource.
Un foro nella realtà. Dai circumvisionisti al neo realismo di Carlo Bernari
Authors: Panico Angelo 
Published: March 2018

Negli anni ‘30 del Novecento nasce nell’Italia Meridionale un movimento culturale ctonio che, operando al di sotto della censura fascista, tenta di restituire all’arte la libertà di espressione – e ispirazione – necessaria a rappresentare la nuova realtà delle cose. Così, nella clandestinità che il momento storico imponeva, si sviluppa una vera e propria avanguardia (testimoniata dal manifesto dell’U.D.A.) orientata verso una nuova forma di realismo ben distante dalle formule canonizzate della retorica naturalistica. Spinti dalla volontà di fondare una nuova arte che riacquisti il rapporto dialettico con il reale e affascinati dal pensiero materialistico, i circumvisionisti, collegandosi alla situazione sociale meridionale e ai grandi eventi della vita contemporanea, elaboravano, come un magma germinativo, gli studi sulla nuova “grammatica della visione” (Maria Corti Principi della comunicazione letteraria), volti a fornire una precisa descrizione della realtà emersa a ridosso della Liberazione. Quanto più profonde si fanno le ricerche nel terreno culturale della clandestinità e quanto più diventano aderenti i percorsi critici alla rete di passaggi sotterranei, tanto più risulta essere opportuno soffermarsi sulla mostra di Capri nel 1928 del primo circumvisionismo, sul manifesto Uda del 1929 di Carlo Bernari, Paolo Ricci e Guglielmo Pierce come punto di partenza del primo neorealismo napoletano, al fine di delineare una macrocategoria estetica (come preciserà Bernari) non ancora cristallizzata in una vera e propria etichetta, ma aperta alle sperimentazioni avanguardistiche europee.
Talking to children about parental mental illness: The experiences of well parents
Authors: Ballal Divya , Navaneetham Janardhana 
Published: March 2018

Background: Children of parents with mental illness are not routinely included in psychoeducational and supportive family interventions provided by adult mental health systems. The family, therefore, is an important and, sometimes, the only source of information and support for them. Aim: To understand the experiences of well parents in talking to their children about parental mental illness. Method: This article presents the findings of a qualitative study of the experiences of well parents in talking to their children about parental mental illness. Ten well parents whose spouses were diagnosed with a severe mental illness participated in the study. Socio-demographic information, family details and history of the spouse’s mental illness along with their experiences of talking to children about parental mental illness, the perceived risks and benefits, challenges they faced and the role of others in the process were recorded. Qualitative data were analysed using interpretative phenomenological analysis. Findings: The themes of ‘distancing children from parental mental illness’, ‘avoiding conversations about the illness’, ‘giving and receiving emotional support’, ‘providing explanations of the illness’ and ‘regulating other sources of information’ show the complex ways in which well parents influence their children’s understanding of parental mental illness. The findings are examined in the background of what is known about this topic from the perspective of children or of the parent with illness. Possible ways to support well parents in families affected by parental mental illness are discussed. Conclusion: This study is a step forward in the understanding of how families talk to children about parental mental illness and provides the perspective of the well parent.
Assessment of thermal comfort in high-occupancy spaces with relevance to air distribution schemes: A case study of mosques
Authors: Samiuddin S , Budaiwi Ismail M 
Published: March 2018

In high-occupancy intermittently operated buildings such as mosques and auditoriums, maintaining an acceptable thermal environment may present a challenging task. Variations in the operation and the thermal loads can result in variable and non-uniform thermal comfort conditions when the HVAC system is not properly designed. Non-uniformity of the thermal environment is greatly influenced by the design and scheme of the air distribution system. Mosques, with their distinctive five intermittent short occupancies and the non-fixed posture of occupants, present a unique case for investigation. In this study, the effect of air distribution of various schemes of a ceiling-based system on the thermal comfort in mosques is investigated. Air diffusion performance index and Fanger’s PMV method are used to assess thermal comfort. Three air distribution schemes at four diffuser terminal velocities were studied using the EnergyPlus and computational fluid dynamics techniques. Results indicate major variations in air diffusion performance index with each air distribution scheme type and diffuser terminal velocity. The uniformity of the PMV was entirely dependent on the air diffusion performance index value and exhibited large variations when the air diffusion performance index value was low. In most cases, the space was overcooled with an average PMV of −0.66 or below. Practical application: The effect of air distribution system design on human thermal comfort has been very complex to understand, as it involves different schemes and different diffuser discharge velocities. This study will help engineers and designers in designing better thermal environment for the occupants.