bluuebunny/crossref_metadata_2025_split huggingface dataset:
Slumped posture on chest X-ray—association with mortality and length of hospital stay in older hospitalised patients
Authors: Lloyd Aled , Thomas Elin , Haboubi Hasan 
Published: March 2019

Abstract

Introduction
frail, older patients are occasionally incapable of keeping their head out of the field of view of a chest radiograph (CXR) resulting in a ‘slumpogram’. This study aims to explore a possible link between a slumped appearance on a CXR; mortality and length of hospital stay.

Methods
the CXRs of patients aged over 65 admitted to a Health Board with a catchment area of approximately 300,000 were investigated in a retrospective analysis of all CXRs taken during the first week of January 2015. Slumped patients were compared to age matched controls. The degree of slumping was measured by the number of ribs covered and the MA/C factor (the shortest distance between the angle of the mandible and a line drawn between the heads of both acromion divided by the length of the patient’s clavicle). Outcomes investigated included length of hospital stay and 18-month mortality.

Results
806 CXRs were viewed with 53 slumped patients and 53 matched controls identified. In all patients aged over 65 there was a statistically significant correlation between the length of stay and the number of ribs covered by the patients’ head (P = 0.038). The MA/C factor was also associated with length of stay (P = 0.025). In patients over 80 there was a significant association between the number of ribs covered and death (P = 0.015).

Conclusion
a slumped CXR may be associated with longer hospitalisation or death. The results of this small study require further revalidation but if true could help inform clinical decision making.
Developing a Spatial Navigation Screening Tool Sensitive to the Preclinical Alzheimer Disease Continuum
Authors: Allison Samantha L , Rodebaugh Thomas L , Johnston Chiharu , Fagan Anne M , Morris John C , Head Denise 
Published: March 2019

Abstract

Objective
There remains a need for a non-invasive and cost-effective screening measure that could be administered prior to the provision of a lumbar puncture or positron emission tomography scan for the detection of preclinical Alzheimer disease (AD). Previous findings suggest that a hippocampally-based spatial navigation task may be effective for screening individuals for the preclinical AD continuum (i.e., low cerebrospinal fluid (CSF) Aβ42). Unfortunately, this task took 1.5–2 hours to administer, which would be time-prohibitive in a clinical setting. Therefore, the goal of this study was to compare psychometric properties of six spatial navigation-related tasks in order to take the next steps in developing a clinically appropriate screening measure.

Methods
Psychometric properties (i.e., reliability, diagnostic accuracy, validity) of a modified version of the cognitive mapping task, two binding tasks, a visual perspective taking task, and self- and informant report versions of a questionnaire were examined in a sample of 91 clinically normal (CN) individuals. CSF Aβ42 and ptau181 were available for 30 individuals.

Results
The learning phase of the cognitive mapping task and the self-report questionnaire were sensitive to identifying individuals in the preclinical AD continuum (93% and 87% sensitivity, 60% and 67% specificity, respectively). These two measures also demonstrated good test-retest stability (intraclass correlation coefficients = .719 and .838, respectively) and internal consistency (Cronbach’s αs = .825 and .965, respectively).

Conclusions
These findings suggest that a self-report questionnaire and aspects of a cognitive mapping task may be particularly appropriate for development as screening tools for identifying individuals in the preclinical AD continuum.
Permutation-based simultaneous confidence bounds for the false discovery proportion
Authors: Hemerik J , Solari A , Goeman J J 
Published: March 2019

SummaryWhen multiple hypotheses are tested, interest is often in ensuring that the proportion of false discoveries is small with high confidence. In this paper, confidence upper bounds for the false discovery proportion are constructed, which are simultaneous over all rejection cut-offs. In particular, this allows the user to select a set of hypotheses post hoc such that the false discovery proportion lies below some constant with high confidence. Our method uses permutations to account for the dependence structure in the data. So far only Meinshausen (2006) has developed an exact, permutation-based and computationally feasible method for obtaining simultaneous false discovery proportion bounds. We propose an exact method which uniformly improves that procedure. Further, we provide a generalization of the method that lets the user select the shape of the simultaneous confidence bounds; this gives the user more freedom in determining the power properties of the method. Interestingly, several existing permutation methods, such as significance analysis of microarrays and the maxT method of Westfall & Young (1993), are obtained as special cases.
A Brief Overview of HPLC–MS Analysis of Alkyl Methylphosphonic Acid Degradation Products of Nerve Agents
Authors: B’Hymer Clayton 
Published: March 2019

AbstractThe analysis of degradation products from the classic chemical warfare nerve agents by high-performance liquid chromatography–mass spectrometry has been of much interest in recent years owing to the possible use as a terrorist weapon, and the incidents of chemical weapon usage in recent years in war torn countries. The alkyl methylphosphonic acid degradation products are of a particular interest, and they represent a specific chromatographic technical challenge for use in typical separation systems. Various published methods are summarized in this review and some of the problems associated with the analysis of these compounds are discussed. Future trends of the analysis in this area of research are also considered.
2019 EACTS Expert Consensus on long-term mechanical circulatory support
Authors: Potapov Evgenij V , Antonides Christiaan , Crespo-Leiro Maria G , Combes Alain , Färber Gloria , Hannan Margaret M , Kukucka Marian , de Jonge Nicolaas , Loforte Antonio , Lund Lars H , Mohacsi Paul , Morshuis Michiel , Netuka Ivan , Özbaran Mustafa , Pappalardo Federico , Scandroglio Anna Mara , Schweiger Martin , Tsui Steven , Zimpfer Daniel , Gustafsson Finn 
Published: March 2019

AbstractLong-term mechanical circulatory support (LT-MCS) is an important treatment modality for patients with severe heart failure. Different devices are available, and many—sometimes contradictory—observations regarding patient selection, surgical techniques, perioperative management and follow-up have been published. With the growing expertise in this field, the European Association for Cardio-Thoracic Surgery (EACTS) recognized a need for a structured multidisciplinary consensus about the approach to patients with LT-MCS. However, the evidence published so far is insufficient to allow for generation of meaningful guidelines complying with EACTS requirements. Instead, the EACTS presents an expert opinion in the LT-MCS field. This expert opinion addresses patient evaluation and preoperative optimization as well as management of cardiac and non-cardiac comorbidities. Further, extensive operative implantation techniques are summarized and evaluated by leading experts, depending on both patient characteristics and device selection. The faculty recognized that postoperative management is multidisciplinary and includes aspects of intensive care unit stay, rehabilitation, ambulatory care, myocardial recovery and end-of-life care and mirrored this fact in this paper. Additionally, the opinions of experts on diagnosis and management of adverse events including bleeding, cerebrovascular accidents and device malfunction are presented. In this expert consensus, the evidence for the complete management from patient selection to end-of-life care is carefully reviewed with the aim of guiding clinicians in optimizing management of patients considered for or supported by an LT-MCS device.
Comparison of outcomes of pulmonary valve replacement in adult versus paediatric hospitals: institutional influence†
Authors: Fuller Stephanie , Ramachandran Abhinay , Awh Katherine , Faerber Jennifer A , Patel Prakash A , Nicolson Susan C , O’Byrne Michael L , Mascio Christopher E , Kim Yuli Y 
Published: March 2019

Abstract

OBJECTIVES
Controversy exists in ascertaining the ideal location for adults with congenital heart disease requiring surgical intervention. In this study, we sought to compare the perioperative management between our paediatric and adult hospitals and to determine how clinical factors and the location affect the length of stay after pulmonary valve replacement.

METHODS
A retrospective analysis of patients, ≥18 years of age, undergoing pulmonary valve replacement was conducted at our paediatric and adult hospitals between 1 January 2000 and 30 October 2014. Patients with previous Ross or concomitant left heart procedures were excluded. Descriptive statistics were used to assess demographics and clinical characteristics. Inverse probability weight-adjusted models were used to determine differences in the number of surgical complications, duration of mechanical ventilation and postoperative length of stay between paediatric and adult hospitals. Additional models were calculated to identify factors associated with prolonged length of stay.

RESULTS
There were altogether 98 patients in the adult (48 patients) and paediatric (50 patients) hospitals. Patients in the adult hospital were older with more comorbidities (arrhythmia, hypertension, depression and a history of cardiac arrest, all P < 0.05). Those at the paediatric hospital had better preoperative right ventricular function and less tricuspid regurgitation. The cardiopulmonary bypass time, the length of intubation and the length of stay were higher at the adult hospital, despite no difference in the number of complications between locations. Factors contributing to the increased length of stay include patient characteristics and postoperative management strategies. There were no deaths.

CONCLUSIONS
Pulmonary valve replacement may be performed safely with no deaths and with a comparable complication rate at both hospitals. Patients undergoing surgery at the adult hospital have longer intubation times and length of stay. Opportunities exist to streamline management strategies.
Open distal anastomosis in the frozen elephant trunk technique: initial experiences and preliminary results of arch zone 2 versus arch zone 3†
Authors: Leone Alessandro , Di Marco Luca , Coppola Giuditta , Amodio Ciro , Berardi Marianna , Mariani Carlo , Votano Daniela , Bacchi Reggiani Maria Letizia , Di Bartolomeo Roberto , Pacini Davide 
Published: March 2019

AbstractOBJECTIVESWe compared the results of 2 groups of patients who underwent aortic arch replacement with the frozen elephant trunk technique. In the first group, the distal anastomosis was performed in arch zone 2; in the second control group, the distal anastomosis was performed in arch zone 3.METHODSBetween January 2007 and April 2018, the frozen elephant trunk technique was used in 282 patients. The median age was 62 years (range 18–83 years), and 233 patients were men (82.6%). Two different frozen elephant trunk prostheses were used: the Jotec E-vita open prosthesis in 167 patients (59.2%) and the Vascutek Thoraflex hybrid prosthesis in 115 patients (40.8%). Patients were divided into 2 groups according to the distal anastomosis site: zone 2 group (69 patients) and zone 3 group (213 patients). The main indications were chronic aortic dissection (n = 164, 58.2%), degenerative aneurysm (n = 72, 25.5%) and acute aortic dissections (n = 45, 16%).RESULTSThe overall in-hospital mortality rate was 17%: 20% for the zone 2 group and 16% for the zone 3 group, without significant differences, also in terms of cardiopulmonary bypass and myocardial ischaemia times. However, the visceral ischaemia time was significantly shorter for the zone 2 group, whereas the antegrade selective cerebral perfusion time was significantly longer for the same group. Recurrent laryngeal nerve injury rate was lower in the zone 2 group. The overall postoperative paraplegia rate was 3.5%, whereas the occurrence of permanent neurological dysfunction and dialysis was 9% and 19%, respectively, with no significant differences between the groups.CONCLUSIONS‘Proximalization’ of the distal anastomosis can be used for arch reconstruction, especially in complex cases such as reoperations or acute aortic dissections. Furthermore, with the aid of branched hybrid grafts, a reduction of the visceral ischaemia time is achieved.
Differential clinical features and long-term prognosis of acute aortic syndrome according to disease entity
Authors: Ahn Jung-Min , Kim Hoyun , Kwon Osung , Om Sang Yong , Heo Ran , Lee Sahmin , Kim Dae-Hee , Kim Ho Jin , Kim Joon Bum , Jung Sung Ho , Choo Suk Jung , Song Jong-Min , Kang Duk-Hyun , Chung Cheol Hyun , Lee Jae Won , Song Jae-Kwan 
Published: March 2019

AbstractAimsTo evaluate the acute and long-term prognosis of acute aortic syndrome (AAS) according to the disease entity [intramural haematoma (IMH) vs. aortic dissection (AD)] and the anatomical location (type A vs. B).Methods and resultsA total of 1012 patients [672 with AD and 340 with IMH (33.6%)] were enrolled between 1993 and 2015. Compared with AD patients, IMH patients were older and had higher frequency of female sex and distal aorta involvement. The overall crude in-hospital mortality of AAS was 8.6%; type A AD [15.0%; adjusted hazard ratio (aHR) 30.4; 95% confidence interval (CI) 8.62–107.3; P < 0.001], type A IMH (8.0%; aHR 4.85; 95% CI 1.29–18.2; P = 0.019), type B AD (5.0%; aHR 3.51; 95% CI 1.00–12.4; P = 0.051), and type B IMH [1.5%; aHR 1.00 (reference)]. During a median follow-up duration of 8.5 years (interquartile range: 4.0–13.5 years), AD (aHR 2.78; 95% CI 1.87–4.14; P < 0.001) and type A (aHR 2.28; 95% CI 1.45–3.58; P < 0.001) was associated with a higher risk of aortic death. After 90 days, a risk of aortic death was no longer associated with anatomical location (aHR 0.74; 95% CI 0.40–1.36; P = 0.33), but remained associated with disease entity (aHR 1.83; 95% CI 1.10–3.04; P = 0.02).ConclusionThe clinical features, response to treatment strategy, and outcomes of IMH patients were distinct from those of AD patients. Both early and late survival was better for IMH than for AD. In addition to the anatomical location of AAS, the disease entity is an independent factor associated with both acute and long-term mortality in patients with AAS. Further investigation is necessary to confirm the prognostic implication of disease entity in different patient populations.
The association between vegetation size and surgical treatment on 6-month mortality in left-sided infective endocarditis
Authors: Fosbøl Emil L , Park Lawrence P , Chu Vivian H , Athan Eugene , Delahaye Francois , Freiberger Tomas , Lamas Cristiane , Miro Jose M , Strahilevitz Jacob , Tribouilloy Christophe , Durante-Mangoni Emanuele , Pericas Juan M , Fernández-Hidalgo Nuria , Nacinovich Francisco , Rizk Hussein , Barsic Bruno , Giannitsioti Efthymia , Hurley John P , Hannan Margaret M , Wang Andrew ,   ICE-PLUS Investigators
Published: March 2019

Abstract

Aims
In left-sided infective endocarditis (IE), a large vegetation &gt;10 mm is associated with higher mortality, yet it is unknown whether surgery during the acute phase opposed to medical therapy is associated with improved survival. We assessed the association between surgery and 6-month mortality as related to vegetation size.

Methods and results
Patients with definite, left-sided IE (2008–2012) from The International Collaboration on Endocarditis prospective, multinational registry were included. We compared clinical characteristics and 6-month mortality (by Cox regression with inverse propensity of treatment weighting) between patients with vegetation size ≤10 mm vs. &gt;10 mm in maximum length by surgical treatment strategy. A total of 1006 patients with left sided IE were included; 422 with a vegetation size ≤10 mm (median age 66.0 years, 33% women) and 584 (median age 58.4 years, 34% women) patients with a large vegetation &gt;10 mm. Operative risk by STS-IE score was similar between groups. Embolic events occurred in 28.4% vs. 44.3% (P &lt; 0.001), respectively. Patients with a vegetation &gt;10 mm was associated with higher 6-month mortality (25.1% vs. 19.4% for small vegetation, P = 0.035). However, after propensity adjustment, the association with higher mortality persisted only in patients with a large vegetation &gt;10 mm vs. ≤10 mm: hazard ratio (HR) 1.55 (1.27–1.90); but only in patients with large vegetation managed medically [HR 1.86 (1.48–2.34)] rather than surgically [HR 1.01 (0.69–1.49)].

Conclusion
Left-sided IE with vegetation size &gt;10 mm was associated with an increased mortality at 6 months in this observational study but was dependent on treatment strategy. For patients with large vegetation undergoing surgical treatment, survival was similar to patients with smaller vegetation size.
Parents survive longer after stroke than childless individuals: a prospective cohort study of Swedes over the age of 65
Authors: Meyer Anna C , Torssander Jenny , Talbäck Mats , Modig Karin 
Published: March 2019

AbstractBackgroundParents have lower mortality than childless individuals, and one possible explanation is support provided by adult children. Since stroke often results in functional limitations, support from children may be of particular importance. Here, we examine whether the presence of children matters for survival after stroke among older Swedish men and women.MethodsThis prospective cohort study linked data from several Swedish population registers. Individuals aged 65 years and older hospitalized for their first ischemic stroke between 1998 and 2002 (33 960 men and 36 189 women) were followed 12 years for survival. Hazard ratios for all-cause mortality were calculated by number of children using Cox proportional hazard regression stratified by sex and marital status and adjusted for education, income and comorbidities.ResultsChildlessness and having only one child was associated with higher mortality after stroke compared with having two children among men and women. The relative survival disadvantage of childless individuals was largest among married women [HR 1.28 (1.18–1.39)] and smallest among married men [1.09 (1.03–1.15)]. The differences in predicted median survival between childless individuals and those with two children were 4 and 7 months among married and unmarried men, and 15 and 9 months among married and unmarried women, respectively.ConclusionsHaving children is associated with a longer survival after stroke among men and women regardless of marital status. Our findings further suggest that the presence of children is especially connected to married women’s survival. These results may have implications for the improvement of informal care for childless older individuals.
Drug development against human adenoviruses and its advancement by Syrian hamster models
Authors: Wold William S M , Tollefson Ann E , Ying Baoling , Spencer Jacqueline F , Toth Karoly 
Published: March 2019

ABSTRACTThe symptoms of human adenovirus infections are generally mild and self-limiting. However, these infections have been gaining importance in recent years because of a growing number of immunocompromised patients. Solid organ and hematopoietic stem cell transplant patients are subjected to severe immunosuppressive regimes and cannot efficaciously eliminate virus infections. In these patients, adenovirus infections can develop into deadly multi-organ disseminated disease. Presently, in the absence of approved therapies, physicians rely on drugs developed for other purposes to treat adenovirus infections. As there is a need for anti-adenoviral therapies, researchers have been developing new agents and repurposing existing ones to treat adenovirus infections. There are several small molecule drugs that are being tested for their efficacy against human adenoviruses; some of these have reached clinical trials, while others are still in the preclinical phase. Besides these compounds, research on immunotherapy against adenoviral infection has made significant progress, promising another modality for treatment. The availability of an animal model confirmed the activity of some drugs already in clinical use while proving that others are inactive. This led to the identification of several lead compounds that await further development. In the present article, we review the current status of anti-adenoviral therapies and their advancement by in vivo studies in the Syrian hamster model.
A Phase I Randomized Clinical Trial of Evidence-Based, Pragmatic Interventions to Improve Functional Recovery After Hospitalization in Geriatric Patients
Authors: Deer Rachel R , Dickinson Jared M , Baillargeon Jacques , Fisher Steven R , Raji Mukaila , Volpi Elena 
Published: March 2019

Abstract

Background
Physical function declines during hospitalization in geriatric patients, increasing the risk of loss of independence. There is a need for evidence-based, pragmatic interventions to improve functional recovery of older adults following acute hospitalization. Here, we report the results of a Phase I randomized clinical trial designed to determine safety and effect size of protein supplementation, exercise, and testosterone interventions on 30-day post-discharge functional recovery and readmissions in geriatric patients.

Methods
A total of 100 patients admitted to the University of Texas Medical Branch hospital for an acute medical illness were randomized to one of five intervention groups: isocaloric placebo, whey protein supplement, in-home rehabilitation + placebo, in-home rehabilitation + whey protein, or testosterone. Primary outcome measure was the change from baseline in short physical performance battery score at 1 and 4 weeks post-discharge. Secondary outcomes were changes in body composition, activities of daily living, and 30-day readmissions. Comparisons were made across study groups and between placebo and all active intervention groups.

Results
Four weeks post-discharge, the short physical performance battery total score and balance score increased more in active intervention groups than placebo group (p < .05). There were no significant differences in change in body composition or activities of daily living across groups or between active intervention groups and placebo group. Readmission rates were highest in placebo (28%), followed by rehabilitation + placebo (15%), whey protein (12%), rehabilitation + whey protein (11%), and testosterone (5%). There was a trend for lower readmission rates in all active intervention groups (11%) versus placebo group (28%).

Conclusions
Findings from this Phase I clinical trial suggest that pragmatic, evidence-based interventions may accelerate recovery from acute hospitalization in geriatric patients. These data provide essential information to design larger randomized controlled trials to test the effectiveness of these interventions.