bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Female Sex on Clinical Outcomes in the FIRE AND ICE Trial of Catheter Ablation for Atrial Fibrillation
Authors: Kuck Karl-Heinz , Brugada Josep , Fürnkranz Alexander , Chun K.R. Julian , Metzner Andreas , Ouyang Feifan , Schlüter Michael , Elvan Arif , Braegelmann Kendra M. , Kueffer Fred J. , Arentz Thomas , Albenque Jean-Paul , Kühne Michael , Sticherling Christian , Tondo Claudio ,   on behalf of the FIRE AND ICE Investigators*
Published: April 2018

Background:
Data on predictors of long-term clinical outcomes after catheter ablation of atrial fibrillation (AF) are limited. We sought to assess the association of baseline covariates with clinical outcomes in the 750 patients with drug-refractory paroxysmal AF enrolled in FIRE AND ICE.

Methods:
In a 2-part analysis, univariate and multivariable Cox regression models were first used to identify baseline patient characteristics predictive of catheter ablation efficacy determined by the clinical end points of (1) atrial arrhythmia recurrence (primary efficacy failure), (2) cardiovascular rehospitalization, and (3) repeat ablation. Propensity score stratification methods were then used to account for differences in baseline characteristics between sexes.

RESULTS:

Female sex (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.08–1.73;
P
=0.010) and prior direct current cardioversion (HR, 1.40; 95% CI, 1.07–1.82;
P
=0.013) were independently associated with atrial arrhythmia recurrence. Female sex (HR, 1.36; 95% CI, 1.02–1.80;
P
=0.035) and hypertension (HR, 1.48; 95% CI, 1.09–2.00;
P
=0.013) independently predicted cardiovascular rehospitalization. A longer history of AF (HR, 1.03; 95% CI, 1.00–1.06;
P
=0.039) increased the rate of repeat ablation. Women continued to have higher rates of primary efficacy failure and cardiovascular rehospitalization after propensity score adjustment, with adjusted HRs of 1.51 (95% CI, 1.16–2.18;
P
<0.05) and 1.40 (95% CI, 1.15–2.17;
P
<0.05), respectively.

Conclusions:
After catheter ablation of paroxysmal AF, female sex was associated with an almost 40% increase in the risks of primary efficacy failure and cardiovascular rehospitalization. Primary efficacy failure was also adversely impacted by a history of direct current cardioversion, whereas hypertension had a negative impact on cardiovascular rehospitalization. History of AF was the only predictor of repeat ablation.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01490814.
Defining the Boundaries of Legally Binding Treaties – Some Aspects of Japan’s Practice in Treaty-Making in Light of State Practice
Authors: Nakanishi Yusuke 
Published: April 2018

Abstract
The boundaries between legally binding treaties and non-legally binding instruments have long been a subject of dispute. The ICJ judgments suggest focus on ‘the actual terms and to the particular circumstances in which it was drawn up’ in order to determine the legal nature of an instrument. This article explores some aspects of Japan’s practice in treaty-making in light of State practice, aiming at uncovering the approach and thinking behind State practice in treaty-making.
Clouds over the Southern Ocean as Observed from the R/V Investigator during CAPRICORN. Part I: Cloud Occurrence and Phase Partitioning
Authors: Mace Gerald G. , Protat Alain 
Published: April 2018

AbstractThe properties of clouds derived using a suite of remote sensors on board the Australian research vessel (R/V) Investigator during the 5-week Clouds, Aerosols, Precipitation, Radiation, and Atmospheric Composition over the Southern Ocean (CAPRICORN) voyage south of Australia during March and April 2016 are examined and compared to similar measurements collected by CloudSat and CALIPSO (CC) and from data collected at Graciosa Island, Azores (GRW). In addition, we use depolarization lidar data to examine the thermodynamic phase partitioning as a function of temperature and compare those statistics to similar information reported from the CALIPSO lidar in low-Earth orbit. We find that cloud cover during CAPRICORN was 76%, dominated by clouds based in the marine boundary layer. This was lower than comparable measurements collected by CC during these months, although the CC dataset observed significantly more high clouds. In the surface-based data, approximately 2/3 (1/2) of all low-level layers observed had a reflectivity below −20 dBZ in the CAPRICORN data (GRW) with 30% (20%) of the layers observed only by the lidar. The phase partitioning in layers based in the lower 4 km of the atmosphere was similar in the two surface-based datasets, indicating a greater occurrence of the ice phase in subfreezing low clouds than what is reported from analysis of CALIPSO data.
Assessment of Conditional Symmetric Instability from Global Reanalysis Data
Authors: Chen Ting-Chen , Yau M. K. , Kirshbaum Daniel J. 
Published: April 2018

Abstract
Slantwise convection, the process by which moist symmetric instability is released, has often been linked to banded clouds and precipitation, especially in frontal zones within extratropical cyclones. Studies also suggest that the latent heat release associated with slantwise convection can lead to a spinup of surface frontogenesis, which can enhance the rapid intensification of extratropical cyclones. However, most of these studies considered only local areas or short time durations. In this study, we provide a novel statistical investigation of the global climatology of the potential occurrence of slantwise convection, in terms of conditional symmetric instability, and its relationship with precipitating systems. Using the 6-hourly ERA-Interim, two different indices are calculated, namely, slantwise convective available potential energy (SCAPE) and vertically integrated extent of realizable symmetric instability (VRS), to assess the likelihood of occurrence of slantwise convection around the globe. The degree of association is quantified between these indices and the observed surface precipitation as well as the cyclone activity. The susceptibility of midlatitude cyclones to slantwise convection at different stages of their life cycle is also investigated. As compared to the nonexplosive cyclone cases, the time evolution of SCAPE and VRS within rapidly deepening cyclones exhibit higher values before, and a more significant drop after, the onset of rapid intensification, supporting the idea that the release of symmetric instability might contribute to the intensification of storms.
False-negative results in the immunoassay analysis of drugs of abuse: can adulterants be detected by sample check test?
Authors: Matriciani Barbara , Huppertz Bernd , Keller Ruprecht , Weiskirchen Ralf 
Published: April 2018

Background The dilution or adulteration of urine is a serious problem in drugs of abuse testing. Tests to identify adulteration are currently available. This study investigated the ability of the CEDIA® sample check to detect adulteration. Methods Eight different drugs of abuse were added to a urine sample obtained from a healthy, drug-free subject: 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), 3,4-methylenedioxyamphetamine, benzoylecgonine, D-amphetamine sulphate, ethyl-D-glucuronide, morphine sulphate, oxazepam, (-)-11-nor-9-carboxy-Δ9-tetrahydrocannabinol. Urine samples were diluted to yield three samples of drugs of abuse concentrations close to general cut-offs as used in methadone treatment centres, by health authorities for psychological tests and in traffic medicine. Aspirin, citric acid, CrO3, H2O2, soap, sodium metaborate, vitamin C were added in three, HCl and NaOH in one, and NaN3 in two concentrations. All samples were measured with commercially available immunological assays shortly after sample preparation and 24 h later. All samples were further analysed with the CEDIA® sample check reaction which may identify adulteration. Results Oxidizing reagents (H2O2 or CrO3) are most effective in interfering in the measurement of benzoylecgonine, EDDP, ethyl-D-glucuronide and morphine sulphate. The measurement of (-)-11-nor-9-carboxy-Δ9-tetrahydrocannabinol is affected by many adulterants. Adulteration with HCl and NaOH was identified with the sample check reaction. NaN3 generated false negative results for a number of drugs of abuse. Conclusions Urine samples with drugs of abuse concentrations above cut-offs can be successfully tampered with adulterants in a way which cannot be detected with the CEDIA® sample check assay.
Diagnostic specificity and sensitivity of PIVKAII, GP3, CSTB, SCCA1 and HGF for the diagnosis of hepatocellular carcinoma in patients with alcoholic liver cirrhosis
Authors: Unić Adriana , Derek Lovorka , Duvnjak Marko , Patrlj Leonardo , Rakić Mislav , Kujundžić Milan , Renjić Vesna , Štoković Nikola , Dinjar Petra , Jukic Anita , Grgurević Ivica 
Published: April 2018

Introduction Despite some new treatment possibilities, the improvement in survival rate for hepatocellular carcinoma (HCC) patients is still poor due to late diagnosis. The aim of this study was to investigate the diagnostic sensitivity and specificity of protein induced by vitamin K absence or antagonist-II (PIVKAII), Glypican-3 (GP3), Cystatin B (CSTB), squamous cell carcinoma antigen 1 (SCCA1) and hepatocyte growth factor (HGF) as potential tumour markers for HCC in patients with alcoholic liver cirrhosis (ALC) using imaging techniques (MSCT and MRI) as reference standards. Patients and methods Eighty-three participants were included: 20 healthy volunteers, 31 patients with ALC and 32 patients with HCC. Peripheral blood sampling was performed for each participant, and serum concentrations of PIVKAII, GP3, CSTB, SCCA1 and HGF were determined using commercial ELISA kits. Results Only serum concentrations of PIVKAII were significantly higher in HCC patients as compared with ALC and healthy controls (cut-off: 2.06  µg/L; AUC: 0.903), whereas individual diagnostic performance of other individual compounds was inadequate. The ‘best’ combination of tumour markers in our study includes all tested markers with AUC of 0.967. Conclusion While novel diagnostic tumour markers are urgently needed, the examined potential tumour markers, with the exception of PIVKAII seem to be inadequate for diagnosing HCC in ALC. Furthermore, probably the future is in finding the best optimal combination of tumour markers for diagnosing HCC based on cost-effectiveness.
Cortical spreading depression as a site of origin for migraine: Role of CGRP
Authors: Close Liesl N , Eftekhari Sajedeh , Wang Minyan , Charles Andrew C , Russo Andrew F 
Published: April 2018

Premise Migraine is a complex neurologic disorder that leads to significant disability, yet remains poorly understood. Problem One potential triggering mechanism in migraine with aura is cortical spreading depression, which can activate the trigeminal nociceptive system both peripherally and centrally in animal models. A primary neuropeptide of the trigeminal system is calcitonin gene-related peptide, which is a potent vasodilatory peptide and is currently a major therapeutic target for migraine treatment. Despite the importance of both cortical spreading depression and calcitonin gene-related peptide in migraine, the relationship between these two players has been relatively unexplored. However, recent data suggest several potential vascular and neural connections between calcitonin gene-related peptide and cortical spreading depression. Conclusion This review will outline calcitonin gene-related peptide-cortical spreading depression connections and propose a model in which cortical spreading depression and calcitonin gene-related peptide act at the intersection of the vasculature and cortical neurons, and thus contribute to migraine pathophysiology.
Development of the layered structure in a double-gated glass fiber-reinforced polypropylene injection molding: Experimental and simulated results
Authors: Quintana MC , Frontini MP 
Published: April 2018

The present study aims to experimentally validate numerical simulation of fiber orientation distribution performed by molding simulation software Moldex3D in a double-gated injection-molded glass fiber-filled (40 wt%) polypropylene box, by making a detailed comparison of predicted and experimentally measured fiber orientation distribution data. The modeling approach evaluated in this work consists in the implementation of the Folgar–Tucker rotary diffusion model with the invariant-based optimal fitting closure approximation for the fourth-order orientation tensor. The specimen used has a weld line in the center and sharp corners. This investigation characterizes in detail the development of the through-thickness layered structure at distinctive locations of the specimen. The sensitivity of fiber orientation distribution and the layered structure to changes upon injection time and melt temperature is also evaluated. The boxes display the typical layered laminate structure, with fibers aligned in the main flow direction near the walls (shell layer) and less oriented in the middle plane (core layer). The boxes injected at the lowest melt temperature display an additional skin layer. Unfortunately, simulation fails in predicting the five layers structure developed under these latter conditions. The grade of fiber orientation is deemed to be independent of process parameters but not the layered structure.
Efficacy and Safety of Atypical Antipsychotics for Behavioral and Psychological Symptoms of Dementia Among Community Dwelling Adults
Authors: Trinkley Katy E. , Sturm Allison M. , Porter Kyle , Nahata Milap C. 
Published: April 2018

Introduction: Options for the treatment of the behavioral and psychological symptoms of dementia (BPSD) are limited. Atypical antipsychotics are often used but have questionable efficacy and are generally considered high risk. Therefore, the objective of this study is to evaluate the efficacy and safety of using any atypical antipsychotic for the treatment of BPSD among outpatients. Methods: Retrospective observational study of an academic outpatient memory disorders clinic. Participants included any community-dwelling patient with a diagnosis of dementia, not trauma induced, with documented BPSD treated with an atypical antipsychotic for at least 2 weeks. Medical records were reviewed from January 1, 1990 to March 23, 2010. Safety outcomes were documented from the time of antipsychotic initiation, and behavioral/psychological efficacy outcomes were documented beginning 2 weeks after antipsychotic therapy was initiated, until the last documentation available. Results: A total of 87 distinct antipsychotic treatment periods for 81 unique patients were included. Antipsychotic treatment was continued for more than a year in 33% of patients and only 17% of patients discontinued antipsychotic treatment over the entire period. The behavioral/psychological outcomes improved for 24 (28%) treatments, remained stable for 17 (20%) treatments, and worsened for 46 (53%) treatments. Adverse events were reported by 53% of patients, with the most common adverse events being metabolic, fall related, type, and vascular. Few adverse events were severe. The odds ratio of adverse events per every 90-day increase in duration of treatment was 1.20 ( P = 0.02). Conclusion: Antipsychotic treatment improved behavioral/psychological symptoms for less than one-third of patients and increased the potential risk of adverse events for more than half of patients.
Effect of complexing agents on desulphurization and deashing of coal by H2O2/H2SO4 leaching
Authors: Sana Hafiza , Haider Rizwan , Rahim Muhammad Usman , Munir Shahid 
Published: April 2018

The present study was aimed at investigating the effect of the addition of complexing agents on the removal efficiency of sulphur and ash contents during chemical leaching by acidified hydrogen peroxide. Representative coal sample from Lakhra was subjected to chemical leaching under various conditions of the parameters including time (60 and 120 min), temperature (25 and 50°C), complexing agents (citric acid and phosphoric acid) and the concentration of complexing agents (100 and 1000 ppm). The addition of complexing agents, i.e. citric acid and phosphoric acid imparted significant effects on improving the removal efficiency of sulphur and ash contents. Under optimized conditions, it was found out that the addition of citric acid improved the removal efficiency for sulphur from 63.88 to 83.47% and from 33.12 to 66.25% for ash. In case of phosphoric acid, the removal in sulphur and ash contents was increased from 63.77 to 80.77% and from 33.12 to 59.18%, respectively. Apparently, citric acid happened to be the most effective complexing agent, as compared to phosphoric acid. These results warrant subsequent detailed studies for further optimization of the process, including the use of some other complexing agents, as well.
Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations
Authors: Matusik P S , Matusik P T , Stein P K 
Published: April 2018

Aim The aim of this review was to summarize current knowledge about the scientific findings and potential clinical utility of heart rate variability measures in patients with systemic lupus erythematosus. Methods PubMed, Embase and Scopus databases were searched for the terms associated with systemic lupus erythematosus and heart rate variability, including controlled vocabulary, when appropriate. Articles published in English and available in full text were considered. Finally, 11 publications were selected, according to the systematic review protocol and were analyzed. Results In general, heart rate variability, measured in the time and frequency domains, was reported to be decreased in patients with systemic lupus erythematosus compared with controls. In some systemic lupus erythematosus studies, heart rate variability was found to correlate with inflammatory markers and albumin levels. A novel heart rate variability measure, heart rate turbulence onset, was shown to be increased, while heart rate turbulence slope was decreased in systemic lupus erythematosus patients. Reports of associations of changes in heart rate variability parameters with increasing systemic lupus erythematosus activity were inconsistent, showing decreasing heart rate variability or no relationship. However, the low/high frequency ratio was, in some studies, reported to increase with increasing disease activity or to be inversely correlated with albumin levels. Conclusions Patients with systemic lupus erythematosus have abnormal heart rate variability, which reflects cardiac autonomic dysfunction and may be related to inflammatory cytokines but not necessarily to disease activity. Thus measurement of heart rate variability could be a useful clinical tool for monitoring autonomic dysfunction in systemic lupus erythematosus, and may potentially provide prognostic information.
Effect of moral empowerment program on moral distress in intensive care unit nurses
Authors: Abbasi Safura , Ghafari Somayeh , Shahriari Mohsen , Shahgholian Nahid 
Published: April 2018

Background: Moral distress has been experienced by about 67% of critical care nurses which causes many complications such as job dissatisfaction, loss of capacity for caring, and turnover for nurses and poor quality of care for patients as well as health system. Objective: The purpose of this research was to provide a moral empowerment program to nursing directors, school of nursing, and the heads of hospitals to reduce moral distress in nurses and improve the quality of care. Methods: This research was a randomized clinical trial conducted in two groups and three stages before, after 2 weeks, and 1 month after the intervention in order to evaluate the changes in moral distress of 60 nurses working in adults’ intensive care unit wards of Al-Zahra teaching hospital of Isfahan University of Medical Sciences. Data were collected using the standard Hamric’s Moral Distress Scale (2012) and analyzed using SPSS software version 22. Ethical considerations: This study was approved by the Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran. Results: Results showed that in the three stages, there was no significant difference between the mean score of moral distress before (4.12 ± 2.70), 2 weeks after (4.23 ± 2.70), and 1 month after the intervention (4.04 ± 2.54) in the control group (p > 0.05), while in the experimental group, there was a significant difference between the three stages (p < 0.05). The mean score of moral distress in the experimental group before intervention (4.05 ± 2.26) and 2 weeks after the intervention (3.38 ± 2.11) was not significant (p > 0.05). However, this score significantly decreased 1 month after the intervention (2.64 ± 2.23; p < 0.05). Conclusion: In this research, it was observed that moral empowerment program has been effective in reducing the mean score of moral distress. Therefore, it is recommended that nursing managers and hospital directors implement empowerment program, in order to reduce the moral distress of nurses and improve the quality of care.
The paradoxical body: A glimpse of a deeper truth through relatives’ stories
Authors: Lorentsen Vibeke Bruun , Nåden Dagfinn , Sæteren Berit 
Published: April 2018

Background: People with progressive cancer experience that their bodies change due to disease and/or treatment. The body is integral to the unity of the human being, a unity that must be perceived as whole if dignity shall be experienced. Relatives are in touch with the suffering bodies of their dear ones, physically, socially, mentally, and existentially, and thus the relatives’ experiences of the bodies of their dear ones might yield insight into the concept of dignity. Aim: The aim of this study is to explore relatives’ experiences of the patients’ bodily changes from a perspective of dignity. Research design and method: A total of 12 relatives from a hospice in Norway were interviewed. Gadamer’s ontological hermeneutics inspired the interpretation. Ethical considerations: The principles of voluntariness, confidentiality, withdrawal, and anonymity were respected during the whole research process. The Norwegian Social Science Data Services approved the study. Results and conclusion: The conversations about the body were conversations about ambivalent or paradoxical matters that shed light on the concept of dignity. The results show that the relatives got in touch with elements that otherwise would have remained tacit and unspoken, and which gave glimpses of a deeper truth, which might reveal the core of dignity. Furthermore, the relatives’ confirmation of the ambivalence might be understood as a strong ethical obligation to treat the other with dignity. The confirmation may also reveal the relatives’ unselfish love of the other, which can be understood as the core of ethics and ethos. Finally, the results reveal the relatives’ limited insight into their dear ones’ bodily changes, and we discuss the challenges of truly seeing the other. Body knowledge and the relationship between body and dignity as phenomena cannot be ignored and needs more attention and articulation in clinical nursing practice and in nursing research.