bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of the Simplified Stroke-Thrombolytic Predictive Instrument to Predict Functional Outcomes in Chinese Patients
Authors: Wang Chunjuan , Yang Yingying , Pan Yuesong , Liao Xiaoling , Huo Xiaochuan , Miao Zhongrong , Wang Yongjun , Wang Yilong 
Published: October 2018

Background and Purpose—
The simplified stroke-thrombolytic predictive instrument (s-Stroke-TPI) is useful for predicting the outcomes in thrombolysis-treated patients in Western populations. We aimed to validate its predictive value in Chinese patients.

Methods—
Data from thrombolysis implementation and monitor of acute ischemic stroke in China were analyzed. Patients with acute ischemic stroke and treated with thrombolysis within 4.5 hours of symptom onset were included. The 3-month functional outcomes were assessed with the modified Rankin Scale (mRS). Model discrimination was quantified by calculating the area under receiver operating characteristic curve. s-Stroke-TPI was compared with dense artery sign, mRS score, age, glucose, onset to treatment time, and National Institutes of Health Stroke Scale or stroke prognostication using age and National Institutes of Health Stroke Scale.

Results—
A total of 1102 patients who received thrombolysis were enrolled. The area under receiver operating characteristic curve of s-Stroke-TPI for predicting a catastrophic outcome (mRS score, 5–6), a normal/near-normal outcome (mRS score, 0–1), and independent outcome (mRS score, 0–2) at 3 months were 0.80, 0.73, and 0.75, respectively, which were significantly higher than or similar to those of dense artery sign, mRS score, age, glucose, onset to treatment time, and National Institutes of Health Stroke Scale or stroke prognostication using age and National Institutes of Health Stroke Scale. The calibration analysis of the s-Stroke-TPI showed a high correlation between the predicted and observed probabilities of the functional outcomes at 3 months.

Conclusions—
The s-Stroke-TPI reliably predicted the 3-month functional outcomes, especially catastrophic outcomes, in Chinese stroke patients with thrombolysis. Further validation is needed to confirm outcome predictions in patients both with and without thrombolysis.
Higher Incidence of Ischemic Stroke in Patients Taking Novel Oral Anticoagulants
Authors: Shpak Max , Ramakrishnan Anurekha , Nadasdy Zoltan , Cowperthwaite Matthew , Fanale Christopher 
Published: October 2018

Background and Purpose—
The increased use of novel oral anticoagulants (NOACs) to control atrial fibrillation is largely driven by the assumption that they are equally effective as warfarin at preventing ischemic stroke while putting patients at lower risk of hemorrhages. To test this hypothesis, a retrospective study of the relative incidence of strokes among patients taking NOACs versus those taking warfarin is performed.

Methods—
Relative stroke incidence in the 2 groups of patients was compared using odds ratios and Fisher exact tests for significance using a data set of 71 365 on NOACs and 59 546 patients on warfarin. In addition, the 7033 patients with a record of both warfarin and NOAC use were analyzed as a separate cohort.

Results—
There is a significantly higher (odds ratio=1.29, <0.001) frequency of ischemic strokes among patients prescribed NOACs compared with those on warfarin. The relative frequency of ischemic strokes was also higher for every individual NOAC compared with warfarin (these higher frequencies are statistically significant for dabigatran and apixaban, though not for edoxaban and rivaroxaban). There is a lower incidence of intracranial hemorrhages and nontraumatic hemorrhages in general among patients taking NOACs, consistent with the published literature. Comparisons of the demographic and clinical profiles of the patients taking NOACs to those on warfarin do not show significantly higher background stroke risk in NOAC patients; in fact, patients on NOACs tend to be at lower background risk overall for ischemic strokes.

Conclusions—
Because NOAC use is associated with higher ischemic stroke risk together with a lower risk of hemorrhages than warfarin use, it can be concluded that patients on warfarin are more strongly anticoagulated. The observed effect could be a secondary consequence of dosage control or alternatively a result of different anticoagulant effects among the different medications.
Genetically Determined FXI (Factor XI) Levels and Risk of Stroke
Authors: Gill Dipender , Georgakis Marios K. , Laffan Mike , Sabater-Lleal Maria , Malik Rainer , Tzoulaki Ioanna , Veltkamp Roland , Dehghan Abbas 
Published: October 2018

Background and Purpose—
FXI (factor XI) is involved in thrombus propagation and stabilization. It is unknown whether lower FXI levels have a protective effect on risk of ischemic stroke (IS) or myocardial infarction. This study investigated the effect of genetically determined FXI levels on risk of IS, myocardial infarction, and intracerebral hemorrhage.

Methods—
Two-sample Mendelian randomization analysis was performed. Instruments and genetic association estimates for FXI levels were obtained from a genome-wide association study of 16 169 individuals. Genetic association estimates for IS and its etiological subtypes were obtained from a study of 16 851 cases and 32 473 controls. For myocardial infarction, estimates were obtained from a study of 43 676 cases and 123 504 controls and for intracerebral hemorrhage from a study of 1545 cases and 1481 controls.

Results—

After applying a Bonferroni correction for multiple testing, the Mendelian randomization analysis supported a causal effect of higher, genetically determined FXI levels on risk of any IS (odds ratio [OR] per 1-unit increase in natural logarithm-transformed FXI levels, 2.54; 95% CI, 1.68–3.84;
P
=1×10
−5
) but not myocardial infarction (OR, 1.01; 95% CI, 0.76–1.34;
P
=0.94) or intracerebral hemorrhage (OR, 1.81; 95% CI, 0.44–7.38;
P
=0.41). Examining IS subtypes, the main results supported an effect of higher, genetically determined FXI levels on risk of cardioembolism (OR, 4.23; 95% CI, 1.94–9.19;
P
=3×10
−4
) and IS of undetermined cause (OR, 3.44; 95% CI, 1.79–6.60;
P
=2×10
−4
) but not large artery atherosclerosis (OR, 2.73; 95% CI, 1.15–6.45;
P
=0.02) or small artery occlusion (OR, 1.19; 95% CI, 0.50–2.82;
P
=0.69). However, the statistically significant result for IS of undetermined cause was not replicated in all sensitivity analyses.

Conclusions—
We find Mendelian randomization evidence supporting FXI as a possible target to reduce risk of the cardioembolic subtype of IS.
Endovascular Thrombectomy
Authors: Wu Yuefei , Yin Congguo , Yang Jianhong , Jiang Lin , Parsons Mark W. , Lin Longting 
Published: October 2018

Background and Purpose—
This study aimed to explore safety of tirofiban in endovascular treatment of acute ischemic stroke.

Methods—

Two hundred eighteen ischemic stroke patients receiving endovascular thrombectomy were prospectively recruited, with 94 treated with intra-arterial tirofiban and 124 were not. The 2 groups were compared in terms of symptomatic intracranial hemorrhage (ICH) and fatal ICH rate by the χ
2
test and logistic regression.

Results—

Patients treated with tirofiban compared with those without tirofiban had significantly higher rate of symptomatic ICH (14.6% versus 5.7%;
P
=0.027) and fatal ICH (8.8% versus 1.6%;
P
=0.014). Tirofiban-treated patients had increased odds of symptomatic ICH by 2.9-fold (95% CI, 1.1–7.5), and odds of fatal ICH increased by 5.9-fold (95% CI, 1.2–28.4).

Conclusions—
Tirofiban treatment increases risk of major ICH after endovascular thrombectomy for acute ischemic stroke in this nonrandomized study.
Decline in Regional Trends in Mortality of Stroke Subtypes in Germany From 1998 to 2015
Authors: Rücker Viktoria , Wiedmann Silke , O’Flaherty Martin , Busch Markus A. , Heuschmann Peter U. 
Published: October 2018

Background and Purpose—
Data on recent time trends in stroke mortality by subtypes and regions are lacking for Germany. We investigated sex- and age-standardized trends in stroke mortality in Germany for different stroke subtypes from 1998 to 2015 and assessed potential regional variations between the former Eastern and former Western part of Germany.

Methods—
Mortality and population data from the German Federal Statistical Office were used to calculate sex- and age-standardized mortality rates for hemorrhagic stroke, ischemic stroke, and total strokes from 1998 to 2015 for all age groups. Joinpoint regression was used to examine trends and its changes. Estimations were stratified for Eastern and Western part of Germany.

Results—
From 1998 to 2015, age-standardized total stroke mortality decreased by >50% in men (from 78.0 to 34.1 per 100 000) and women (from 62.1 to 28.4 women per 100 000). The decrease was more pronounced for ischemic stroke mortality (rate change: men, −66%; women, −63%) than for hemorrhagic stroke mortality (men, −40%; women, −31%). Total and ischemic stroke mortality declined more in Eastern than in Western part of Germany. From 1998 to 2015, there were no differences in the decline between the regions in hemorrhagic stroke mortality. Total stroke mortality was higher in Eastern compared with Western part of Germany throughout the study period. Differences in subtype- and sex-specific mortality between the regions decreased from 1998 to 2015.

Conclusions—
Between 1998 and 2015, stroke mortality declined substantially in Germany with differing time trends in stroke subtypes between sexes and regions. Differences in stroke mortality rates between East and West Germany are negligible 24 years after the German reunification.
Vertical Velocity Dynamics and Mixing in an Anticyclone near the Canary Islands
Authors: Estrada-Allis S. N. , Barceló-Llull B. , Pallàs-Sanz E. , Rodríguez-Santana A. , Souza J. M. A. C. , Mason E. , McWilliams J. C. , Sangrà P. 
Published: October 2018

AbstractThe complex structure of the vertical velocity field inside an anticyclonic eddy located just south of the Canary Islands is analyzed through a high-resolution ocean model. Based on the flow divergence, vertical velocity is decomposed into various forcing components. The analysis reveals that advection and stretching of vorticity are the most important forcing contributions to the vertical velocity within the eddy. In the mixed layer, a small-scale multipolar vertical velocity pattern dominates. This is the result of vertical mixing effects that enhance the surface vertical velocity by increasing the ageostrophic velocity profile. As a result, an ageostrophic secondary circulation arises that acts to restore thermal-wind balance, inducing strong vertical motions. Nonlinear Ekman pumping/suction patterns resemble the small-scale vertical velocity field, suggesting that nonlinear Ekman effects are important in explaining the complex vertical velocity, despite an overestimate of its magnitude. In the eddy thermocline, the vertical velocity is characterized by a dipolar pattern, which experiences changes in intensity and axisymmetrization with time. The dipolar vertical velocity distribution arises from the imbalance between the advection and stretching of the vorticity forcing terms. A vertical velocity dipole is also obtained by solving a generalized omega equation from density and horizontal velocity fields, which also shows a preponderance of the ageostrophic term. The ubiquity of dipolar vertical velocity distributions inside isolated anticyclones is supported by recent observational findings in the same oceanic region.
Multisensory Influences on Driver Steering During Curve Navigation
Authors: Macuga Kristen L. 
Published: October 2018

Objective: The effects of inertial (vestibular and somatosensory) information on driver steering during curve navigation were investigated, using an electric four-wheel mobility vehicle outfitted with a steering wheel and a portable virtual reality system. Background: When driving, multiple sources of perceptual information are available. Researchers have focused on visual information, which plays a critical role in steering control. However, it is not yet well established how inertial information might contribute. Methods: I biased inertial cues by varying visual/inertial gains (doubled, halved, reversed), as drivers negotiated curving paths, and measured steering accuracy and efficiency. I also assessed whether being exposed to inertial biases had an impact on postbias steering by comparing pre- and posttest session performance measures. Results: Doubling or halving inertial cues had little effect on steering performance. Inertial information only disrupted steering when it was reversed with respect to visual information. Over time, the influence of this extreme inertial bias was reduced though not eliminated. Postbias curve navigation performance was not impacted, likely because participants had learned to disregard, rather than integrate, biased inertial cues. Conclusion: Results suggest that biased inertial information has little influence on curve navigation performance when visual information is available. Application: Though inertial cues may be important for open-loop steering, when visual cues are unavailable, their role in closed-loop steering seems less influential. This has implications for driving simulation and suggests that inertial discrepancies due to limitations in motion-cuing capabilities may not be all that problematic for the simulation of closed-loop curve steering tasks.
‘Just trying to talk to people … It’s the hardest’: Perspectives of adolescents with high-functioning autism spectrum disorder on their social communication skills
Authors: Kelly Rachel , O’Malley Mary-Pat , Antonijevic Stanislava 
Published: October 2018

Difficulty with social communication is the most pervasive difficulty experienced by individuals with high-functioning autism spectrum disorder (HF-ASD). Communication difficulties are often magnified in adolescence as social demands become more intricate. This puts adolescents with HF-ASD at increased risk of social isolation and depression, as they have difficulty developing positive social identity. Yet, there is a dearth of literature addressing the communication issues of this population and even fewer studies including the voice of adolescents with HF-ASD themselves. This study aimed to (1) explore the perspectives of adolescents with HF-ASD as to their social communication skills, (2) explore what (if any) difficulties they perceive themselves as having when talking with their peers, (3) explore if they would like help with social communication skills and (4) determine what kind of help they think may be useful to them and establish if they already use self-initiated strategies. This study was qualitative in nature, using thematic analysis to analyse data collected from 10 semi-structured interviews with 5 adolescents with HF-ASD. Qualitative research underpins the idea that one must understand the significance and explanation that people give to situations, experiences, their own actions and to the actions of others, for one to comprehend human behaviours and actions. A qualitative design allowed us to gain the most in depth insight into how adolescents with HF-ASD understand and perceive their experiences. Three themes emerged revealing the participants’ perceptions of their difficulties communicating, challenging feelings that they experience about communication, and their perspectives about the support for developing communication skills. The participants indicated a need for support to aid their desire to improve communication skills and interactions with typically developing peers. In educational settings, adolescents with HF-ASD may benefit from a peer mentor system to give them opportunities to practice social communication skills with typically developing peers and to encourage inclusion amongst their classmates.
Acute ingestion of rosemary water: Evidence of cognitive and cerebrovascular effects in healthy adults
Authors: Moss Mark , Smith Ellen , Milner Matthew , McCready Jemma 
Published: October 2018

Background: The use of herbal extracts and supplements to enhance health and wellbeing is increasing in western society. Aims: This study investigated the impact of the acute ingestion of a commercially available water containing an extract and hydrolat of rosemary ( Rosmarinus officinalis L. syn. Salvia rosmarinus Schleid.). Aspects of cognitive functioning, mood and cerebrovascular response measured by near-infrared spectroscopy provided the dependent variables. Methods: Eighty healthy adults were randomly allocated to consume either 250 mL of rosemary water or plain mineral water. They then completed a series of computerised cognitive tasks, followed by subjective measures of alertness and fatigue. Near-infrared spectroscopy monitored levels of total, oxygenated and deoxygenated haemoglobin at baseline and throughout the cognitive testing procedure. Results: Analysis of the data revealed a number of statistically significant, small, beneficial effects of rosemary water on cognition, consistent with those found previously for the inhalation of the aroma of rosemary essential oil. Of particular interest here are the cerebrovascular effects noted for deoxygenated haemoglobin levels during cognitive task performance that were significantly higher in the rosemary water condition. This represents a novel finding in this area, and may indicate a facilitation of oxygen extraction at times of cognitive demand. Conclusion: Taken together the data suggest potential beneficial properties of acute consumption of rosemary water. The findings are discussed in terms of putative metabolic and cholinergic mechanisms.
Effect of simultaneous surgical treatment of severe coronary artery disease and lung cancer
Authors: Li Zhi , Liu Ban , Ge Wen , Zhang Wei , Gu Chang , Liu Jingjing , Ke Xianting , Zhang Yangyang 
Published: October 2018

Objective The co-incidence of lung cancer and coronary artery disease (CAD) is increasing in patients of advanced age. This study was performed to demonstrate the efficiency and safety of simultaneous coronary artery bypass grafting and lung cancer surgery in a selected group of older patients. Methods Twenty patients with severe CAD and coexisting lung cancer underwent simultaneous surgical interventions (Group A), and 20 patients with lung cancer underwent an isolated lung cancer operation (Group B). In Group A, the combined operations were carried out through 2 incisions in 3 patients, a single incision in 14 patients, and median sternotomy for heart surgery and thoracoscopic lobectomy for lung cancer in 3 patients. The single-incision approach was used in all patients in Group B. Results The operation time was longer and the blood loss volume was larger in Group A than B. No significant between-group differences were found in the 5-year relapse-free survival rate or 5-year survival rate. Conclusions The simultaneous performance of lung cancer surgery and cardiac surgery was effective and evidently safe in Group A. This treatment approach enabled earlier lung cancer resection and avoidance of the eventual complications associated with further surgical procedures.
Child-onset systemic lupus erythematosus is associated with a higher incidence of myopericardial manifestations compared to adult-onset disease
Authors: Chang J C , Xiao R , Mercer-Rosa L , Knight A M , Weiss P F 
Published: October 2018

Objectives There are no population-based estimates of the incidence or risk factors for acute cardiac manifestations in children with systemic lupus erythematosus (SLE) to guide screening and diagnostic imaging practices. We estimated the incidence and prevalence of acute cardiac manifestations of child-onset SLE compared to adult-onset SLE and identified factors associated with cardiac diagnoses. Methods We identified children (5–17 years) and adults (18–64 years) with incident SLE (≥3 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code 710.0, > 30 days apart) using Clinformatics® DataMart (OptumInsight, Eden Prairie, MN) deidentified United States administrative claims (2000–2013). We calculated incidence and prevalence of three outcomes: ≥ 1 diagnosis code for (1) pericarditis and/or myocarditis, (2) endocarditis, or (3) valvular insufficiency. Negative binomial regression was used to identify characteristics associated with cardiac diagnoses in children and determine whether SLE onset in childhood vs adulthood was independently associated with cardiac involvement. Results There were 297 children and 6927 adults with new-onset SLE. A total of 17.8% of children had ICD-9 CM codes for acute cardiac diagnoses, the incidence of which were highest in the first year after SLE diagnosis (12.2 per 100 person-years). African American race (incidence rate ratio (IRR) 6.6, 95% confidence interval (CI) (2.9, 15.0), p < 0.01) and nephritis (IRR 7.0, 95% CI (2.6, 18.6), p < 0.01) were associated with acute cardiac diagnoses in children. Child-onset disease was independently associated with a 4.4-fold higher rate of pericarditis or myocarditis compared to adult-onset SLE after adjustment for other disease and demographic characteristics (95% CI (2.4, 8.0), p < 0.01). Conclusion This study establishes baseline estimates of the incidence and prevalence of pericarditis and myocarditis in child-onset SLE, which is substantially higher than that of adult-onset SLE. Prospective echocardiographic evaluations are needed to validate incidence measures and characterize the natural history of acute cardiac manifestations in child-onset SLE, as well as identify risk factors for poor cardiac outcomes to inform screening and management.
Caregivers’ perception of dignity in teenagers with autism spectrum disorder
Authors: Mohammadi Fatemeh , Rakhshan Mahnaz , Molazem Zahra , Zareh Najaf , Gillespie Mark 
Published: October 2018

Introduction: Maintaining dignity is one of patients is one of the main ethical responsibilities of caregivers. However, in many cases, the dignity of patients, especially autistic teenagers is not maintained. The extent to which dignity needs are met for this group within the Iranian care system is difficult to determine as dignity is an abstract concept, and there are few related research studies reported. Objectives: The objective of this study is to find out caregivers perspectives on dignity in teenagers with autistic spectrum disorder. Research design: This study uses a qualitative research design. The data were collected through individual, semi-structured interviews and field notes developed during the interviews. In order to analyze the data, qualitative conventional content analysis was used. Participants and research context: In all, 16 professional caregivers for autistic teenagers working in public hospitals were recruited based on a targeted sampling method to reach data saturation from February 2016 to July 2017. Findings: The findings of this study were presented in three main themes, “privacy,” “respecting individual identity,” and “comprehensive support,” and 11 categories. Ethical consideration: This study’s protocol was approved by the Research Ethics Committee of medical universities located in Southeast of Iran and the required ethical principles were followed throughout. Discussion and conclusion: Based on the findings of this study from the perspective of caregivers, autistic teenagers need to be cared for and educated in a respectful environment where their privacy is maintained, their individual identities are respected, and they receive comprehensive familial, social, and financial support. These conditions would maintain the dignity of such teenagers and would result in appropriate behavioral outcomes. Therefore, it is suggested that a cultural, professional and institutional background in which all components of the autistic teenager’s dignity are protected and emphasized be provided.