bluuebunny/crossref_metadata_2025_split huggingface dataset:
Empagliflozin Reduced Mortality and Hospitalization for Heart Failure Across the Spectrum of Cardiovascular Risk in the EMPA-REG OUTCOME Trial
Authors: Fitchett David , Inzucchi Silvio E. , Cannon Christopher P. , McGuire Darren K. , Scirica Benjamin M. , Johansen Odd Erik , Sambevski Steven , Kaspers Stefan , Pfarr Egon , George Jyothis T. , Zinman Bernard 
Published: January 2019

Background:
In the EMPA-REG OUTCOME trial (BI 10773 [Empagliflozin] Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) in patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease, in comparison with placebo, empagliflozin reduced the risks of 3-point major adverse cardiovascular events (3-point MACE), cardiovascular and all-cause death, and hospitalization for heart failure. We investigated whether these effects varied across the spectrum of baseline cardiovascular risk.

Methods:
Cardiovascular death, all-cause mortality, 3-point MACE, and hospitalization for heart failure in the pooled empagliflozin and placebo groups were analyzed in subgroups by prior myocardial infarction and stroke at baseline, and by estimated baseline cardiovascular risk based on the 10-point TIMI (Thrombolysis In Myocardial Infarction) Risk Score for Secondary Prevention.

Results:

Of 7020 patients who received the study drug, 65% had a prior myocardial infarction or stroke, and 12%, 40%, 30%, and 18% were at low, intermediate, high, and highest estimated cardiovascular risk according to TIMI Risk Score for Secondary Prevention (≤2, 3, 4, and ≥5 points, respectively). In the placebo group, 3-point MACE occurred during the trial in 7.3%, 9.4%, 12.6%, and 20.6% of patients at low, intermediate, high, and highest estimated baseline risk, respectively. Relative reductions in risk of cardiovascular death, all-cause mortality, 3-point MACE and hospitalization for heart failure with empagliflozin versus placebo were consistent in patients with and without prior myocardial infarction and/or stroke and across subgroups by TIMI Risk Score for Secondary Prevention at baseline (
P
>0.05 for randomized group-by-subgroup interactions).

Conclusions:
Despite all patients having atherosclerotic cardiovascular disease, patients in EMPA-REG OUTCOME demonstrated a broad risk spectrum for cardiovascular events. Reductions in key cardiovascular outcomes and mortality with empagliflozin versus placebo were consistent across the range of cardiovascular risk.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01131676.
Anti-Inflammatory Therapy With Canakinumab for the Prevention of Hospitalization for Heart Failure
Authors: Everett Brendan M. , Cornel Jan H. , Lainscak Mitja , Anker Stefan D. , Abbate Antonio , Thuren Tom , Libby Peter , Glynn Robert J. , Ridker Paul M 
Published: January 2019

Background:
Subclinical inflammation is associated with an increased risk of heart failure and with adverse prognosis in patients with established heart failure. Yet, treatments specifically directed at reducing inflammation in patients with heart failure have not yet shown improved clinical outcomes. We tested the hypothesis that the interleukin-1β inhibitor canakinumab would prevent hospitalization for heart failure (HHF) and the composite of HHF or heart failure–related mortality.

Methods:
We randomized 10 061 patients with prior myocardial infarction and high-sensitivity C-reactive protein ≥2 mg/L to canakinumab 50, 150, or 300 mg or placebo, given subcutaneously once every 3 months. In total, 2173 (22%) reported a history of heart failure at baseline. We tested the hypothesis that canakinumab prevents prospectively collected HHF events and the composite of HHF or heart failure–related mortality.

Results:

A total of 385 patients had an HHF event during a median follow-up of 3.7 years. Patients who had HHF were older, had higher body mass index, and were more likely to have diabetes mellitus, hypertension, and prior coronary bypass surgery. As anticipated, median (quartile 1, 3) baseline concentrations of high-sensitivity C-reactive protein were higher among those who had HHF during follow-up than those who did not (5.7 [3.5, 9.9] mg/L versus 4.2 [2.8, 6.9] mg/L, respectively;
P
<0.0001). The unadjusted hazard ratios for HHF with each dose of canakinumab compared with placebo were 1.04 (95% CI, 0.79–1.36) for 50 mg, 0.86 (95% CI, 0.65–1.13) for 150 mg, and 0.76 (95% CI, 0.57–1.01) for 300 mg (
P
for trend=0.025). The composite of HHF or heart failure–related mortality was also reduced by canakinumab, with unadjusted hazard ratios of 1.00 (95% CI, 0.78–1.29) for 50 mg, 0.88 (95% CI, 0.68–1.13) for 150 mg, and 0.78 (95% CI, 0.60–1.02) for 300 mg (
P
for trend=0.042).

Conclusions:
These randomized double-blind placebo-controlled data suggest that therapy with canakinumab, an interleukin-1β inhibitor, is related to a dose-dependent reduction in HHF and the composite of HHF or heart failure–related mortality in a population of patients with prior myocardial infarction and elevations in high-sensitivity C-reactive protein.

Clinical Trial Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01327846.
Hypoperfusion Symptoms Poorly Predict Hemodynamic Compromise and Stroke Risk in Vertebrobasilar Disease
Authors: Amin-Hanjani Sepideh , Stapleton Christopher J. , Du Xinjian , Rose-Finnell Linda , Pandey Dilip K. , Elkind Mitchell S.V. , Zipfel Gregory J. , Liebeskind David S. , Silver Frank L. , Kasner Scott E. , Caplan Louis R. , Derdeyn Colin P. , Gorelick Philip B. , Charbel Fady T. ,   on behalf of the VERiTAS Study Group
Published: January 2019

Background and Purpose—
Cerebral hypoperfusion symptoms (defined as symptoms related to change in position, effort or exertion, or recent change in antihypertensive medication) have been used in stroke studies as a surrogate for detecting hemodynamic compromise. However, the validity of these symptoms in identifying flow compromise in patients has not been well established. We examined whether hypoperfusion symptoms correlated with quantitative measurements of flow compromise in the prospective, observational VERiTAS study (Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke).

Methods—
VERiTAS enrolled patients with recent vertebrobasilar transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion in vertebral or basilar arteries. Hemodynamic status using vertebrobasilar large vessel flow was measured using quantitative magnetic resonance angiography, and patients were designated as low, borderline, or normal flow based on distal territory regional flow, incorporating collateral capacity. The presence of qualifying event hypoperfusion symptoms was assessed relative to the quantitatively determined flow status (normal versus borderline/low) and also examined as a predictor of subsequent stroke risk.

Results—

Of the 72 enrolled subjects, 66 had data on hypoperfusion symptoms available. On initial quantitative magnetic resonance angiography designation, 43 subjects were designated as normal flow versus 23 subjects designated as low flow (n=16) or borderline flow (n=7). Of these, 5 (11.6%) normal flow and 3 (13.0%) low/borderline flow subjects reported at least one qualifying event hypoperfusion symptom (
P
=0.99, Fisher exact test). Hypoperfusion symptoms had a positive predictive value of 37.5% and negative predictive value of 65.5% for low/borderline flow status. Compared with flow status, which strongly predicted subsequent stroke risk, hypoperfusion symptoms were not associated with stroke outcome (
P
=0.87, log-rank test).

Conclusions—
These results suggest that hypoperfusion symptoms alone correlate poorly with actual hemodynamic compromise as assessed by quantitative magnetic resonance angiography and subsequent stroke risk in vertebrobasilar disease, and are not a reliable surrogate for flow measurement.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00590980.
Telemedicine for Follow-Up of Rare Neurological Disease
Authors: Walsh Jessica , Markus Hugh S. 
Published: January 2019

Background and Purpose—
Providing ongoing care for rare neurological conditions is challenging. Telemedicine can reduce patient travel. We set up and evaluated a telemedicine service for patients with a genetic form of stroke and dementia cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Methods—
One hundred fourteen patients with mutation-positive cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (64 telemedicine and 50 face-to-face) were recruited. Patient and clinician satisfaction questionnaires rated the service to create a mean satisfaction score for both face-to-face and telemedicine follow-up appointments.

Results—

There was no difference in mean (SD) patient or clinician satisfaction scores between telemedicine and face-to-face appointments (patient: 4.57 [0.56] and 4.69 [0.42];
P
=0.99; clinician: 4.55 [0.49] and 4.60 [0.43];
P
=0.44).

Conclusions—
Telemedicine follow-up was suited to patients with stroke and dementia and offered satisfaction levels similar to that for face-to-face consultations.
Deep Learning Natural Language Processing Successfully Predicts the Cerebrovascular Cause of Transient Ischemic Attack-Like Presentations
Authors: Bacchi Stephen , Oakden-Rayner Luke , Zerner Toby , Kleinig Timothy , Patel Sandy , Jannes Jim 
Published: January 2019

Background and Purpose—
Triaging of referrals to transient ischemic attack (TIA) clinics is aided by risk stratification. Deep learning-based natural language processing, a type of machine learning, may be able to assist with the prediction of cerebrovascular cause of TIA-like presentations from free-text information.

Methods—
Consecutive TIA clinic notes were retrieved from existing databases. Texts associated with cerebrovascular and noncerebrovascular diagnoses were preprocessed before classification experiments, using a variety of classifier models, based on only the free-text description of the history of presenting complaint. The primary outcome was area under the curve (AUC) of the receiver operator curve. The model with the greatest AUC was then used in classification experiments in which it was provided with additional clinical information.

Results—
Of the classifier models trialed on the history of presenting complaint, the convolutional neural network achieved the greatest predictive capability (AUC±SD; 81.9±2.0). The effects of additional clinical information on AUC were variable. The greatest AUC was achieved when the convolutional neural network was provided with the history of presenting complaint and magnetic resonance imaging report (88.3±3.6).

Conclusions—
Deep learning-based natural language processing, in particular convolutional neural networks, based on medical free-text, may prove effective in prediction of the cause of TIA-like presentations. Future research investigating the role of the application of deep learning-based natural language processing to the automated triaging of clinic referrals in TIA, and potentially other specialty areas, is indicated.
Coastal Trapped Wave Propagation along the Southwest African Shelf as Revealed by Moored Observations
Authors: Junker Tim , Mohrholz Volker , Schmidt Martin , Siegfried Lydia , van der Plas Anja 
Published: January 2019

AbstractCoastal trapped waves (CTWs) that propagate poleward along the southwest African shelf potentially leak energy from lower latitudes into the Benguela Upwelling System (BUS). Thus, in addition to local winds, these waves provide an important remote forcing mechanism for the upwelling region. The present study aims at elucidating the nature of CTWs in the northern BUS. To this end, we make use of multisite velocity observations from the Namibian shelf (18°, 20°, 23°S) and examine the alongshore velocity signal for signatures of CTWs by means of wavelet methods. We found that a substantial amount of energy is concentrated within a submonthly to subseasonal frequency band (10–50 days). Based on the coherence and phase spectra of the alongshelf currents, we provide evidence for a predominantly southward phase propagation and establish typical time and length scales of CTWs in the region. It turns out that their properties differ significantly within a few hundred kilometers along the coast. A comparison of the results with theoretical dispersion curves shows that this difference may be explained by variations in the bottom topography. Finally, we investigate the coupling of the alongshore currents with the coastal and equatorial wind stress and highlight regions of potential wave generation.
The Treadport: Natural Gait on a Treadmill
Authors: Chesebrough Sam , Hejrati Babak , Hollerbach John 
Published: January 2019

Objective: To evaluate the differences between walking on an advanced robotic locomotion interface called the Treadport and walking overground with healthy subjects. Background: Previous studies have compared treadmill-based and overground walking in terms of gait parameters. The Treadport’s unique features including self-selected speed capability, large belt, kinesthetic force feedback, and virtual reality environment distinguish it from other locomotion interfaces and could provide a natural walking experience for the users. Method: Young, healthy subjects ( N = 17) walked 10 meters 10 times each for both overground and the Treadport environments. Comparison between walking conditions used spatiotemporal and kinematic parameters. In addition, electromyographic data was collected for five of the 17 subjects to compare muscle activity between the two conditions. Results: Gait on the Treadport was found to have no significant differences ( p > .05) with overground walking in terms of hip and knee joint angles, cadence and stride length and stride speed, and muscle activation of the four muscle groups measured. Differences ( p < .05) were observed in ankle dorsiflexion which was reduced by 2.47 ± 0.01 degrees on the Treadport. Conclusion: Walking overground and on the Treadport is highly correlated and not significantly different in 13 of 14 parameters. Application: This study suggests that the Treadport creates an environment for natural walking experience, where natural gait of users is almost preserved, with great potential to be useful for other applications, such as gait rehabilitation of individuals with walking impairments.
Aerosol generation rates for showerheads
Authors: Zhou Yang , Mui Kwok Wai , Wong Ling Tim , Tsui Pak Hei , Chan Wing Ki 
Published: January 2019

Aerosolization of water from discharging water appliances provides a transmission medium for Legionnaires’ disease. The quantity of aerosolized droplets influences the infection of Legionnaires’ disease. This study investigates the aerosol generation rates of four sample showerheads experimentally in a mechanically ventilated test chamber, assisted by computational fluid dynamics simulations. The results show that aerosol mass generation rate decreases with the showerhead resistance factor but increases with the water supply pressure, nozzle area ratio, flow rate, spray jet velocity, momentum and force. There is no significant correlation between aerosol mass generation rate and water spray uniformity ( p > 0.05, t-test). Furthermore, the aerosol mass generation rates and aerosol particle generation rates determined for the sample showerheads are in the ranges of 1.42 × 10−5 to 5.52 × 10−5 g s−1 and 0.35 × 106 to 1.35 × 106 particles s−1, respectively. Practical application: The proposed expression of aerosol generation rate can be the referenced guidance for future showerhead design to limit the aerosol generation rate.
Inpatient management of gamma-hydroxybutyrate withdrawal
Authors: Cappetta Merissa , Murnion Bridin P 
Published: January 2019

Objectives: To describe the baseline characteristics, treatment and retention in patients electively admitted for gamma-hydroxybutyrate (GHB) withdrawal management. Methods: All patients admitted between July 2010 to June 2016 who used GHB two or more times per week with a minimum duration of 3 months were identified and data extracted by file review. Results: Twelve cases satisfied the inclusion criteria, of whom 50% were female; 75% were using GHB daily, with an average daily amount of 16 ml. Average duration of use was 60 months. All subjects were using amphetamine type stimulants and nicotine. Psychiatric comorbidity and unintentional overdose were common; 50% completed treatment. Medications used included diazepam and neuroleptic. Two patients completed withdrawal with no medications. No subject using greater than 90 ml GHB in the preceding week completed treatment. Pattern of GHB use did not predict medication requirements during withdrawal management. Conclusions: There were low numbers attending for elective treatment for GHB use. Heavier GHB use predicted poor treatment retention. Polysubstance use and psychiatric co-morbidities need consideration in treatment planning.
Interobserver reliability of the classification of capitellar osteochondritis dissecans using magnetic resonance imaging
Authors: Bexkens Rens , Simeone F. Joseph , Eygendaal Denise , Bekerom Michel PJ van den , Oh Luke S ,   on behalf of Shoulder and Elbow Platform
Published: January 2019

Aim (1) To determine the interobserver reliability of magnetic resonance classifications and lesion instability criteria for capitellar osteochondritis dissecans lesions and (2) to assess differences in reliability between subgroups. Methods Magnetic resonance images of 20 patients with capitellar osteochondritis dissecans were reviewed by 33 observers, 18 orthopaedic surgeons and 15 musculoskeletal radiologists. Observers were asked to classify the osteochondritis dissecans according to classifications developed by Hepple, Dipaola/Nelson, Itsubo, as well as to apply the lesion instability criteria of DeSmet/Kijowski and Satake. Interobserver agreement was calculated using the multirater kappa (k) coefficient. Results Interobserver agreement ranged from slight to fair: Hepple (k = 0.23); Dipaola/Nelson (k = 0.19); Itsubo (k = 0.18); DeSmet/Kijowksi (k = 0.16); Satake (k = 0.12). When classifications/instability criteria were dichotomized into either a stable or unstable osteochondritis dissecans, there was more agreement for Hepple (k = 0.52; p = .002), Dipaola/Nelson (k = 0.38; p = .015), DeSmet/Kijowski (k = 0.42; p = .001) and Satake (k = 0.41; p < .001). Overall, agreement was not associated with the number of years in practice or the number of osteochondritis dissecans cases encountered per year (p > .05). Conclusion One should be cautious when assigning grades using magnetic resonance classifications for capitellar osteochondritis dissecans. When making treatment decisions, one should rather use relatively simple distinctions (e.g. stable versus unstable osteochondritis dissecans; lateral wall intact versus not intact), as these are more reliable.
Prediction of Hypoglycemia During Aerobic Exercise in Adults With Type 1 Diabetes
Authors: Reddy Ravi , Resalat Navid , Wilson Leah M. , Castle Jessica R. , El Youssef Joseph , Jacobs Peter G. 
Published: January 2019

Background: Fear of exercise related hypoglycemia is a major reason why people with type 1 diabetes (T1D) do not exercise. There is no validated prediction algorithm that can predict hypoglycemia at the start of aerobic exercise. Methods: We have developed and evaluated two separate algorithms to predict hypoglycemia at the start of exercise. Model 1 is a decision tree and model 2 is a random forest model. Both models were trained using a meta-data set based on 154 observations of in-clinic aerobic exercise in 43 adults with T1D from 3 different studies that included participants using sensor augmented pump therapy, automated insulin delivery therapy, and automated insulin and glucagon therapy. Both models were validated using an entirely new validation data set with 90 exercise observations collected from 12 new adults with T1D. Results: Model 1 identified two critical features predictive of hypoglycemia during exercise: heart rate and glucose at the start of exercise. If heart rate was greater than 121 bpm during the first 5 min of exercise and glucose at the start of exercise was less than 182 mg/dL, it predicted hypoglycemia with 79.55% accuracy. Model 2 achieved a higher accuracy of 86.7% using additional features and higher complexity. Conclusions: Models presented here can assist people with T1D to avoid exercise related hypoglycemia. The simple model 1 heuristic can be easily remembered (the 180/120 rule) and model 2 is more complex requiring computational resources, making it suitable for automated artificial pancreas or decision support systems.
Bad weed: synthetic cannabinoid–associated coagulopathy
Authors: Arepally Gowthami M. , Ortel Thomas L. 
Published: January 2019

Abstract
Recent multistate outbreaks of coagulopathy caused by brodifacoum-tainted synthetic cannabinoids or “fake weed” highlight the public health impact of long-acting anticoagulant rodenticides (LAARs). Patients presenting with this syndrome have had recent exposure to synthetic cannabinoids, evidence of isolated vitamin K antagonism with or without bleeding, and detectable levels of brodifacoum and other LAARs in circulation. This article will provide information on synthetic cannabinoids, LAARs, and coagulopathic manifestations arising from use of adulterated synthetic cannabinoids and their management.