bluuebunny/crossref_metadata_2025_split huggingface dataset:
Individual Treatment Effect Estimation of 2 Doses of Dabigatran on Stroke and Major Bleeding in Atrial Fibrillation
Authors: Stam-Slob Manon C. , Connolly Stuart J. , van der Graaf Yolanda , van der Leeuw Joep , Dorresteijn Jannick A.N. , Eikelboom John W. , Peters Ron J.G. , Alings Marco , Visseren Frank L.J. 
Published: May 2019

Background:
We aimed to estimate absolute benefit and harm from treatment with dabigatran in individual patients with atrial fibrillation, and to select the optimal dose for each individual.

Methods:
We derived and validated a prediction model for ischemic stroke/systemic embolism and major bleeding in patients with atrial fibrillation from the 3 treatment arms of the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy With Dabigatran Etexilate) (n=11 955 in derivation cohort, n=6158 in validation cohort). Readily available patient characteristics were included in Fine and Gray competing risk models (sex, age, smoking, antiplatelet drugs, previous vascular disease, diabetes mellitus, blood pressure, estimated glomerular filtration rate, and hemoglobin). Five-year risks for ischemic stroke/systemic embolism and major bleeding were estimated without anticoagulation therapy, and compared with high- and low-dose dabigatran.

Results:
Model calibration was good, and discrimination was adequate with a c-statistic of 0.65 (95% CI, 0.62–0.70) for ischemic stroke/systemic embolism and 0.69 (95% CI, 0.66–0.71) for major bleeding. The 5-year absolute risk reduction for ischemic stroke/systemic embolism with dabigatran 150 mg twice daily ranged from <10% in 20% of patients to >25% in 14% of patients, and the 5-year absolute risk increase for major bleeding ranged from <5% in 53% of patients to 15% to 20% in 1% of patients. Comparing high-dose to low-dose dabigatran, the net benefit (absolute risk reduction minus absolute risk increase) was positive for 46% of patients.

Conclusions:
The absolute treatment benefits and harms of dabigatran in atrial fibrillation can be estimated based on readily available patient characteristics. Such treatment effect estimations can be used for shared decision making before starting dabigatran treatment and to determine the optimal dose.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00262600.
Incidence and Clinical Impact of Recurrent Takotsubo Syndrome: Results From the GEIST Registry
Authors: El‐Battrawy Ibrahim , Santoro Francesco , Stiermaier Thomas , Möller Christian , Guastafierro Francesca , Novo Giuseppina , Novo Salvatore , Mariano Enrica , Romeo Francesco , Romeo Fabiana , Thiele Holger , Guerra Federico , Capucci Alessandro , Giannini Irene , Brunetti Natale Daniele , Eitel Ingo , Akin Ibrahim 
Published: May 2019

Background

Current literature only reports variable information from single‐center studies on the recurrence rate, the complications, and the outcome of patients with Takotsubo syndrome (
TTS)
experiencing recurrent
TTS
. Therefore, a detailed description of clinical characteristics, predictors, and the prognostic impact of patients with TTS and recurrences in a multicenter registry is needed.

Methods and Results

We analyzed 749 patients with TTS from 9 European centers being part of the international, multicenter GEIST (German Italian Stress Cardiomyopathy) Registry. Patients were divided into the recurrence group and the nonrecurrence group. The recurrence rate at a median follow‐up of 830 days (interquartile range, 118–1701 days) was 4%. Most recurrences were documented in the first 5 years after the index
TTS
episode. Up to 2
TTS
recurrences were documented in 2 of 30 patients (6%). A variable ballooning pattern (n=6, 0.8%) with, in particular, involvement of the right ventricular occurred in 3 cases (0.4%) at the recurrence event. Except for the higher presence of arterial hypertension (86.7% versus 68.3%;
P
=0.03) in the recurrence group, no other baseline characteristics were different between groups. Observation of
TTS
complications during follow‐up, including stroke, thromboembolic events, in‐hospital death, and cardiogenic shock, revealed no significant differences between groups (
P
>0.05), except the higher presence of pulmonary edema in the recurrence group versus the nonrecurrence group (13.3% versus 4.9%;
P
=0.04).

Conclusions

The incidence of
TTS
recurrence is estimated to be 4% in this multicenter
TTS
registry. A variable
TTS
pattern at recurrence is common in up to 20% of recurrence cases.
Diffusivity-Factor Approximation for Spectral Outgoing Longwave Radiation
Authors: Feng Jing , Huang Yi 
Published: May 2019

Abstract
Accurate integration of directional radiance shows that the conventional diffusivity-factor approximation with a constant diffusivity angle results in an overestimation of the outgoing longwave radiation (OLR) in the window band and an underestimation in the absorption band. We propose an analytical estimation of a spectrally dependent diffusivity angle for clear-sky spectral OLR, considering actual atmospheric conditions and realistic optical path geometry. Beginning with the plane-parallel geometry, we present a new, physical explanation of the conventional diffusivity angle that applies to the gas absorption bands and derives an alternative solution for the window bands. Then a correction scheme is developed to account for the impact of the spherical Earth geometry on the diffusivity angle. The proposed method achieves higher accuracy, reducing biases to generally less than 2% in all spectral regions.
On the Relation between the Boreal Spring Position of the Atlantic Intertropical Convergence Zone and Atlantic Zonal Mode
Authors: Pottapinjara Vijay , Girishkumar M. S. , Murtugudde R. , Ashok K. , Ravichandran M. 
Published: May 2019

AbstractPrevious studies have talked about the existence of a relation between the Atlantic meridional mode (AMM) and Atlantic zonal mode (AZM) via the meridional displacement of the intertropical convergence zone (ITCZ) in the Atlantic during boreal spring and the resulting cross-equatorial zonal winds. However, why the strong relation between the ITCZ (or AMM) and zonal winds does not translate into a strong relation between the ITCZ and AZM has not been explained. This question is addressed here, and it is found that there is a skewness in the relation between ITCZ and AZM: while a northward migration of ITCZ during spring in general leads to a cold AZM event in the ensuing summer, the southward migration of the ITCZ is less likely to lead to a warm event. This is contrary to what the previous studies imply. The skewness is attributed to the Atlantic seasonal cycle and to the strong seasonality of the AZM. All those cold AZM events preceded by a northward ITCZ movement during spring are found to strictly adhere to typical timings and evolution of the different Bjerknes feedback components involved. It is also observed that the causative mechanisms of warm events are more diverse than those of the cold events. These results can be expected to enhance our understanding of the AZM as well as that of chronic model biases and contribute to the predictability of the Indian summer monsoon through the links between the two as shown in our earlier studies.
Changing Seasonal Predictability of Arctic Summer Sea Ice Area in a Warming Climate
Authors: Holland Marika M. , Landrum Laura , Bailey David , Vavrus Steve 
Published: May 2019

Abstract
We use a large ensemble set of simulations and initialized model forecasts to assess changes in the initial-value seasonal predictability of summer Arctic sea ice area from the late-twentieth to the mid-twenty-first century. Ice thickness is an important seasonal predictor of September ice area because early summer thickness anomalies affect how much melt out occurs. We find that the role of this predictor changes in a warming climate, leading to decadal changes in September ice area predictability. In January-initialized prediction experiments, initialization errors grow over time leading to forecast errors in ice thickness at the beginning of the melt season. The magnitude of this ice thickness forecast error growth for regions important to summer melt out decreases in a warming climate, contributing to enhanced predictability. On the other hand, the influence of early summer thickness anomalies on summer melt out and resulting September ice area increases as the climate warms. Given this, for the same magnitude ice thickness forecast error in early summer, a larger September ice area anomaly results in the warming climate, contributing to reduced predictability. The net result of these competing factors is that a sweet spot for predictability exists when the ice thickness forecast error growth is modest and the influence of these errors on melt out is modest. This occurs at about 2010 in our simulations. The predictability of summer ice area is lower for earlier decades, because of higher ice thickness forecast error growth, and for later decades because of a stronger influence of ice thickness forecast errors on summer melt out.
Ethnic Group Differences in Dietary Diversity of School-Aged Children in Indonesia: The Roles of Gender and Household SES
Authors: Kunto Yohanes Sondang , Bras Hilde 
Published: May 2019

Background: Despite the importance of dietary diversity for nutritional status, studies on issues surrounding ethnicity and dietary diversity in developing countries are limited. Objective: We analyzed cross-ethnic differences in dietary diversity and examined the roles of gender and household socioeconomic status (SES) in 3 Indonesian ethnic groups with different kinship systems: Javanese (bilateral), Batak (patrilineal), and Minangkabau (matrilineal). Methods: Data were from the Indonesian Family Life Survey 2000-2015 that consisted of 6478 school-aged children (7-12 years of age) born to 3878 mothers. The children’s dietary diversity was measured using a Berry-Index. We used cluster-robust multivariate linear regression models. Results: Gendered dietary diversity occurred for ethnic groups with unilineal kinship but was less evident for ethnic with bilateral kinship. Batak and Minangkabau girls, rather than boys, had higher dietary diversity because boys from these 2 ethnic groups consumed low-status foods (eg, tubers and vegetables) less often. Household SES influenced ethnic-related dietary diversity differently, perhaps because of food culture. Batak children from lower SES households consumed fruits and dairy products less often, most likely to enable them to consume the pricier but culturally preferable animal-source foods. This lowered their dietary diversity. Conclusion: The overall results indicate gendered and household SES-related effects of ethnicity on dietary diversity. Nutrition interventions targeting boys should be on policy-makers’ agendas. Boys should be advised to consume healthy low-status foods more often to improve their dietary diversity. The Batak case shows that children from lower SES backgrounds should depend less on the pricier foods to enable them varying their diet better.
A Functional Polymorphism (rs6265, G>A) of Brain-Derived Neurotrophic Factor Gene and Breast Cancer: An Association Study
Authors: Iqbal Mehir un Nisa , Yaqoob Tahniyat , Ali Syed Adnan , Khan Taseer Ahmed 
Published: May 2019

Purpose: The objective of this study was to evaluate the relationship between brain-derived neurotrophic factor (BDNF) gene (Val66Met, rs6265, G>A) polymorphism and breast cancer (BC) among females of Southern Pakistan. Methods: This case-control study consisted of 300 females (BC cases [n = 100] and controls [n = 200]) with age range of 18 to 45 years. All participants were recruited during January to December 2014 and were screened for depression using Zung depression scale. Isolation of genomic DNA (gDNA) followed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was done. All statistical analysis was carried out on IBM-SPSS version 22 at P-value <.05. Hardy-Weinberg equilibrium (HWE), Pearson chi-square, and odds ratios (ORs) with 95% confidence interval (95% CI) were calculated. Results: Genotype distribution of BDNF gene polymorphism lies in the goodness-of-fit model among controls. The statistical analyses reveal a significant association between genotype frequencies (χ2 = 12.709, P-value = .002) of BDNF and BC among cases and controls. The AA genotype (OR = 5.2, 95%CI = 0.632-42.804) increases the risk of having BC. Conclusions: Our results suggest that BDNF gene polymorphism may have an association with BC risk among Pakistani females. However, the present finding needs to be replicated with greater sample size with BC risk.
Practices of Care to HIV-Infected Children: Current Situation in Cameroon
Authors: Penda Calixte Ida , Ndongo Francis A , Bissek Anne-Cécile Z-K , Téjiokem Mathurin C , Sofeu Casimir , Moukoko Eboumbou Else C , Mindjouli Sandrine , Desmonde Sophie , Njock Louis R 
Published: May 2019

Background: To accelerate access to pediatric HIV care in Cameroon, operational challenges in implementing HIV pediatric care need to be identified. The aim of this study was to assess the knowledge, attitudes, and practices of health care workers regarding pediatric HIV infection in Cameroon. Methods: A descriptive cross-sectional study was conducted over a 4-month period (April to August 2014) in 12 health facilities in 7 regions of Cameroon selected using systematic random sampling. Data were collected from interviews with health care providers and managers using standardized self-administered questionnaires and stored in the ACCESS software. Results: In total, 103 health care providers were included in this study, of which 59 (57.3%) were health workers and 44 (42.7%) community agents. Most of the health workers in charge of HIV pediatric care were nurses, requiring effective medical task shifting that was institutionalized in Cameroon. The knowledge of health care providers in relation to pediatric HIV care was acceptable. Indications for prescription of test for early infant diagnosis were known (96.1%), but their attitudes and practices regarding initiating antiretroviral therapy (ART) in infants less than 2 years (5.2%) and first-line ART protocols (25.4%) were insufficient, due to little information about standard procedures. Conclusion: Capacity building of health care providers and large-scale dissemination of normative national documents are imperative to improve HIV pediatric care in the health care facilities.
Cost analysis of neonatal tele-homecare for preterm infants compared to hospital-based care
Authors: Rasmussen Maja K , Clemensen Jane , Zachariassen Gitte , Kidholm Kristian , Brødsgaard Anne , Smith Anthony C , Holm Kristina G 
Published: May 2019

Introduction Neonatal homecare (NH) can be used to provide parents the opportunity of bringing cardiopulmonary-stable preterm infants home for tube feeding and the establishment of breastfeeding supported by neonatal nurses visiting the home. However, home visits can be challenging for hospitals covering large regions, and, therefore, regular neonatal hospital care has remained the first choice in Denmark. As an alternative to home visits, telehealth may be used to deliver NH. Thus, neonatal tele-homecare (NTH) was developed. Positive infant outcomes and the optimization of family-centred care have been described, but the costs of telehealth in the context of NH remain unknown. This study aims to assess the costs of NTH compared to regular neonatal hospital care, from the health service perspective. Methods The cost analysis was based on an observational study of NTH in Denmark (run from November 2015 to December 2016) and followed the Consolidated Health Economic Evaluation Reporting Standards. The intervention group were the families of preterm infants receiving NTH ( n = 96). The control group comprised a historic cohort of families with preterm infants, receiving standard care in the neonatal intensive care unit (NICU) ( n = 278). NTH infants and the historical group were categorized according to gestational age at birth at/under and over 32 weeks. The outcomes were NTH resource utilization, in-NICU hospital bed days, re-admissions and total costs on average per infant. The time horizon was from birth to discharge. Results The costs of NTH resource utilization were, on average, €695 per infant, and the total costs per infant, on average, were €12,200 and €4200 for infants at/under and over 32 weeks, respectively. The corresponding costs of the control group were €14,300 and €4400. The difference in total costs showed statistical significance for the group of infants under 32 weeks ( p < 0.001). Discussion The cost analysis showed that NTH was less costly compared to regular hospital care, especially for infants born with gestational age at/under 32 weeks. NTH is an appropriate model of care for preterm infants and their families, is clinically effective and less expensive than similar services delivered in the hospital.
Increased erythrocyte- and platelet-derived microvesicles in newly diagnosed type 2 diabetes mellitus
Authors: Gkaliagkousi Eugenia , Nikolaidou Barbara , Gavriilaki Eleni , Lazaridis Antonios , Yiannaki Efthalia , Anyfanti Panagiota , Zografou Ioanna , Markala Dimitra , Douma Stella 
Published: May 2019

Aim: To investigate the thrombotic microenvironment in early stages of type 2 diabetes mellitus measuring platelet-derived, endothelial-derived and erythrocyte-derived microvesicles. Methods: We recruited 50 newly diagnosed type 2 diabetes mellitus patients who did not receive glucose-lowering treatment except for metformin and 25 matched non-type 2 diabetes mellitus volunteers. Microvesicles were measured with flow cytometry, glycated haemoglobin with high-performance liquid chromatography and advanced glycation end products with enzyme-linked immunosorbent assay. Results: Type 2 diabetes mellitus patients showed significantly higher levels of platelet-derived microvesicles [195/μL (115–409) vs 110/μL (73–150), p = 0.001] and erythrocyte-derived microvesicles [26/μL (9–100) vs 9/μL (4–25), p = 0.007] compared to non-type 2 diabetes mellitus individuals. Platelet-derived microvesicles were positively associated with fasting blood glucose ( p = 0.026) and glycated haemoglobin ( p = 0.002). Erythrocyte-derived microvesicles were also positively associated with fasting blood glucose ( p = 0.018) but not with glycated haemoglobin ( p = 0.193). No significant association was observed between platelet-derived microvesicles ( p = 0.126) or erythrocyte-derived microvesicles ( p = 0.857) and advanced glycation end products. Erythrocyte-derived microvesicles predicted the presence of type 2 diabetes mellitus, independently of platelet-derived microvesicles. Conclusion: In newly diagnosed type 2 diabetes mellitus, ongoing atherothrombosis is evident during the early stages as evidenced by increased microvesicles levels. Furthermore, the association with glycemic profile suggests that microvesicles represent not only a novel mechanism by which hyperglycemia amplifies thrombotic tendency in type 2 diabetes mellitus but also early markers of thrombosis highlighting the need for earlier management of hyperglycemia.
Minimally Invasive Pulmonary Artery Aneurysm Repair Through a Left Anterior Minithoracotomy—an Alternative Approach
Authors: Rahman Sana , Cook Gary , Zheng Jing , Rehman Atiq 
Published: May 2019

The purpose in this case was to repair a less invasive approach than a standard sternotomy. Workup of asymptomatic patient with computerized tomography scan of chest revealed pulmonary artery aneurysm and transesophageal echocardiography demonstrated flow stagnation in aneurysm. An alternative minimally invasive approach was performed to repair the pulmonary artery aneurysm with plication through a left anterior minithoracotomy using normothermic cardiopulmonary bypass with percutaneous peripheral cannulation, instead of median sternotomy. Post-repair transesophageal echocardiography demonstrated normal flow in the pulmonary artery. The patient had an uneventful postoperative course and was seen in the outpatient clinic with excellent recovery. Minimally invasive repair of pulmonary artery aneurysm through a left anterior minithoracotomy is a feasible alternative approach. Minimally invasive repair of pulmonary artery aneurysm through a left anterior minithoracotomy is a feasible alternative approach.
Successful Transition to Robotic-Assisted Lobectomy With Previous Proficiency in Thoracoscopic Lobectomy
Authors: Merritt Robert E. , Kneuertz Peter J. , D’Souza Desmond M. 
Published: May 2019

Objective The learning curve and the advantages of transitioning to robotic-assisted lobectomy by a surgeon who is proficient in thoracoscopic lobectomy is currently unknown. The cost of robotic lobectomy has been reported to be higher than thoracoscopic lobectomy and there is no significant decrease in hospital length of stay. Methods This is a retrospective review of 228 patients diagnosed with lung carcinoma who underwent minimally invasive lobectomy from March 2014 to May 2018. A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The data collected included patient demographics, tumor characteristics, morbidity, mortality, operative times, and hospital length of stay. Results A total of 114 patients underwent thoracoscopic lobectomy and 114 patients underwent robotic-assisted lobectomy. The patients in each group were similar in age, gender, smoking status, FEV-1, tumor histology, and pathologic stage. The mortality and complication rates were similar. The mean number of total lymph nodes and N2 lymph nodes were significantly higher in the robotic lobectomy group ( P < 0.0001). The mean operative time was shorter in the robotic group. The median hospital length of stay (4 days) was similar between the 2 groups ( P = 0.99). Conclusion The results of this report suggest that thoracoscopic and robotic-assisted lobectomy have similar outcomes when a surgeon proficient in the thoracoscopic technique completely transitions to the robotic-assisted technique. The learning curve was relatively accelerated in this single-surgeon experience. There may be an advantage for robotic-assisted lobectomy in the total number of lymph nodes harvested.