bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantifying Selection Bias in National Institute of Health Stroke Scale Data Documented in an Acute Stroke Registry
Authors: Thompson Michael P. , Luo Zhehui , Gardiner Joseph , Burke James F. , Nickles Adrienne , Reeves Mathew J. 
Published: May 2016

Background—
As a measure of stroke severity, the National Institutes of Health Stroke Scale (NIHSS) is an important predictor of patient- and hospital-level outcomes, yet is often undocumented. The purpose of this study is to quantify and correct for potential selection bias in observed NIHSS data.

Methods and Results—

Data were obtained from the Michigan Stroke Registry and included 10 262 patients with ischemic stroke aged ≥65 years discharged from 23 hospitals from 2009 to 2012, of which 74.6% of patients had documented NIHSS. We estimated models predicting NIHSS documentation and NIHSS score and used the Heckman selection model to estimate a correlation coefficient (ρ) between the 2 model error terms, which quantifies the degree of selection bias in the documentation of NIHSS. The Heckman model found modest, but significant, selection bias (ρ=0.19; 95% confidence interval: 0.09, 0.29;
P
<0.001), indicating that because NIHSS score increased (ie, strokes were more severe), the probability of documentation also increased. We also estimated a selection bias–corrected population mean NIHSS score of 4.8, which was substantially lower than the observed mean NIHSS score of 7.4. Evidence of selection bias was also identified using hospital-level analysis, where increased NIHSS documentation was correlated with lower mean NIHSS scores (
r
=–0.39;
P
<0.001).

Conclusions—
We demonstrate modest, but important, selection bias in documented NIHSS data, which are missing more often in patients with less severe stroke. The population mean NIHSS score was overestimated by >2 points, which could significantly alter the risk profile of hospitals treating patients with ischemic stroke and subsequent hospital risk–adjusted outcomes.
Is Isolated Low High-Density Lipoprotein Cholesterol a Cardiovascular Disease Risk Factor?
Authors: Bartlett Jacquelaine , Predazzi Irene M. , Williams Scott M. , Bush William S. , Kim Yeunjung , Havas Stephen , Toth Peter P. , Fazio Sergio , Miller Michael 
Published: May 2016

Background—
Although the inverse association between high-density lipoprotein cholesterol (HDL-C) and risk of cardiovascular disease (CVD) has been long established, it remains unclear whether low HDL-C remains a CVD risk factor when levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) are not elevated. This is a timely issue because recent studies have questioned whether HDL-C is truly an independent predictor of CVD.

Methods and Results—
3590 men and women from the Framingham Heart Study offspring cohort without known CVD were followed between 1987 and 2011. Low HDL-C (<40 mg/dL in men and <50 mg/dL in women) was defined as isolated if TG and LDL-C were both low (<100 mg/dL). We also examined higher thresholds for TG (150 mg/dL) and LDL-C (130 mg/dL) and compared low versus high HDL-C phenotypes using logistic regression analysis to assess association with CVD. Compared with isolated low HDL-C, CVD risks were higher when low HDL-C was accompanied by LDL-C ≥100 mg/dL and TG <100 mg/dL (odds ratio 1.3 [1.0, 1.6]), TG ≥100 mg/dL and LDL-C <100 mg/dL (odds ratio 1.3 [1.1, 1.5]), or TG and LDL-C ≥100 mg/dL (odds ratio 1.6, [1.2, 2.2]), after adjustment for covariates. When low HDL-C was analyzed with higher thresholds for TG (≥150 mg/dL) and LDL-C (≥130 mg/dL), results were essentially the same. In contrast, compared with isolated low HDL-C, high HDL-C was associated with 20% to 40% lower CVD risk except when TG and LDL-C were elevated.

Conclusions—
CVD risk as a function of HDL-C phenotypes is modulated by other components of the lipid panel.
Safety and Use of Anticoagulation After Aortic Valve Replacement With Bioprostheses
Authors: Riaz Haris , Alansari Shehab Ahmad Redha , Khan Muhammad Shahzeb , Riaz Talha , Raza Sajjad , Luni Faraz Khan , Khan Abdur Rahman , Riaz Irbaz Bin , Krasuski Richard A. 
Published: May 2016

Background—
The American College of Cardiology guidelines recommend 3 months of anticoagulation after replacement of the aortic valve with a bioprosthesis. However, there remains great variability in the current clinical practice and conflicting results from clinical studies. To assist clinical decision making, we pooled the existing evidence to assess whether anticoagulation in the setting of a new bioprosthesis was associated with improved outcomes or greater risk of bleeding.

Methods and Results—

We searched the PubMed database from the inception of these databases until April 2015 to identify original studies (observational studies or clinical trials) that assessed anticoagulation with warfarin in comparison with either aspirin or no antiplatelet or anticoagulant therapy. We included the studies if their outcomes included thromboembolism or stroke/transient ischemic attacks and bleeding events. Quality assessment was performed in accordance with the Newland Ottawa Scale, and random effects analysis was used to pool the data from the available studies.
I
2
testing was done to assess the heterogeneity of the included studies. After screening through 170 articles, a total of 13 studies (cases=6431; controls=18210) were included in the final analyses. The use of warfarin was associated with a significantly increased risk of overall bleeding (odds ratio, 1.96; 95% confidence interval, 1.25–3.08;
P
<0.0001) or bleeding risk at 3 months (odds ratio, 1.92; 95% confidence interval, 1.10–3.34;
P
<0.0001) compared with aspirin or placebo. With regard to composite primary outcome variables (risk of venous thromboembolism, stroke, or transient ischemic attack) at 3 months, no significant difference was seen with warfarin (odds ratio, 1.13; 95% confidence interval, 0.82–1.56;
P
=0.67). Moreover, anticoagulation was also not shown to improve outcomes at time interval >3 months (odds ratio, 1.12; 95% confidence interval, 0.80–1.58;
P
=0.79).

Conclusions—
Contrary to the current guidelines, a meta-analysis of previous studies suggests that anticoagulation in the setting of an aortic bioprosthesis significantly increases bleeding risk without a favorable effect on thromboembolic events. Larger, randomized controlled studies should be performed to further guide this clinical practice.
Subfractions of High-Density Lipoprotein-Cholesterol and Carotid Intima-Media Thickness
Authors: Tiozzo Eduard , Gardener Hannah , Hudson Barry I. , Dong Chuanhui , Della-Morte David , Crisby Milita , Goldberg Ronald B. , Elkind Mitchell S.V. , Cheung Ying Kuen , Wright Clinton B. , Sacco Ralph L. , Desvarieux Moise , Rundek Tatjana 
Published: May 2016

Background and Purpose—
Recent drug trials have challenged the high-density lipoprotein-cholesterol (HDL-C) antiatherosclerotic hypothesis, suggesting that total level of HDL-C may not be the best target for intervention. HDL-C subfractions may be better markers of vascular risk than total levels of HDL-C. The objective of this cross-sectional study was to investigate the relationship between HDL2-C and HDL3-C fractions and carotid intima-media thickness (cIMT) in the population-based Northern Manhattan Study.

Methods—
We evaluated 988 stroke-free participants (mean age, 66±8 years; 60% women; 66% Hispanic, and 34% non-Hispanic) with available data on HDL-C subfractions using precipitation method and cIMT assessed by a high-resolution carotid ultrasound. The associations between HDL-C subfractions and cIMT were analyzed by multiple linear regression models.

Results—

The mean HDL2-C was 14±8 mg/dL, HDL3-C 32±8 mg/dL, and the mean total HDL-C was 46±14 mg/dL. The mean cIMT was 0.90±0.08 mm. After controlling for demographics and vascular risk factors, HDL2-C and total HDL-C were inversely associated with cIMT (per 2 SDs, β=−0.017,
P
=0.001 and β=−0.012,
P
=0.03, respectively). The same inverse association was more pronounced among those with diabetes mellitus (per 2SDs, HDL2-C: β=−0.043,
P
=0.003 and HDL-C: β=−0.029,
P
=0.02). HDL3-C was not associated with cIMT.

Conclusions—
HDL2-C had greater effect on cIMT than HDL3-C in this large urban population. The effect of HDL2-C was especially pronounced among individuals with diabetes mellitus. More research is needed to determine antiatherosclerotic effects of HDL-C subfractions and their clinical relevance.
Crowdsourcing the El Reno 2013 Tornado: A New Approach for Collation and Display of Storm Chaser Imagery for Scientific Applications
Authors: Seimon Anton , Allen John T. , Seimon Tracie A. , Talbot Skip J. , Hoadley David K. 
Published: May 2016

Abstract
The 31 May 2013 El Reno, Oklahoma, tornado is used to demonstrate how a video imagery database crowdsourced from storm chasers can be time-corrected and georeferenced to inform severe storm research. The tornado’s exceptional magnitude (∼4.3-km diameter and ∼135 m s−1 winds) and the wealth of observational data highlight this storm as a subject for scientific investigation. The storm was documented by mobile research and fixed-base radars, lightning detection networks, and poststorm damage surveys. In addition, more than 250 individuals and groups of storm chasers navigating the tornado captured imagery, constituting a largely untapped resource for scientific investigation.
The El Reno Survey was created to crowdsource imagery from storm chasers and to compile submitted materials in a quality-controlled, open-access research database. Solicitations to storm chasers via social media and e-mail yielded 93 registrants, each contributing still and/or video imagery and metadata. Lightning flash interval is used for precise time calibration of contributed video imagery; when combined with georeferencing from open-source geographical information software, this enables detailed mapping of storm phenomena. A representative set of examples is presented to illustrate how this standardized database and a web-based visualization tool can inform research on tornadoes, lightning, and hail. The project database offers the largest archive of visual material compiled for a single storm event, accessible to the scientific community through a registration process. This approach also offers a new model for poststorm data collection, with instructional materials created to facilitate replication for research into both past and future storm events.
Simulated Response of the Pacific Decadal Oscillation to Climate Change
Authors: Zhang Liping , Delworth Thomas L. 
Published: May 2016

Abstract
The impact of climate change on the Pacific decadal oscillation (PDO) is studied using a fully coupled climate model. The model results show that the PDO has a similar spatial pattern in altered climates, but its amplitude and time scale of variability change in response to global warming or cooling. In response to global warming the PDO amplitude is significantly reduced, with a maximum decrease over the Kuroshio–Oyashio Extension (KOE) region. This reduction appears to be associated with a weakened meridional temperature gradient in the KOE region. In addition, reduced variability of North Pacific wind stress, partially due to reduced air–sea feedback, also helps to weaken the PDO amplitude by reducing the meridional displacements of the subtropical and subpolar gyre boundaries. In contrast, the PDO amplitude increases in response to global cooling.
In the control simulations the model PDO has an approximately bidecadal peak. In a warmer climate the PDO time scale becomes shorter, changing from ~20 to ~12 yr. In a colder climate the time scale of the PDO increases to ~34 yr. Physically, global warming (cooling) enhances (weakens) ocean stratification. The increased (decreased) ocean stratification acts to increase (reduce) the phase speed of internal Rossby waves, thereby altering the time scale of the simulated PDO.
Extreme Noise–Extreme El Niño: How State-Dependent Noise Forcing Creates El Niño–La Niña Asymmetry
Authors: Levine Aaron , Jin Fei Fei , McPhaden Michael J. 
Published: May 2016

Abstract
A major open question about El Niño–Southern Oscillation (ENSO) is what causes ENSO amplitude asymmetry, with strong El Niños generally larger than strong La Niñas. The authors examine a leading hypothesis—that the ENSO state modifies the fetch and/or wind speed of westerly wind bursts (WWBs) that create asymmetric forcing and an asymmetric ENSO response. Further, in El Niño forecasts, the number of WWBs expected increases in the month following a strong WWB when compared with the month preceding it. Using a conceptual model, a relationship is derived between the magnitude of the westerly wind burst state dependence on ENSO and ENSO asymmetry. It is found that this relationship between the magnitude of the state dependence and ENSO asymmetry holds in both the observations and 21 coupled climate models. Finally, it is found that because of state-dependent westerly wind burst forcing, extreme El Niño events tend to be of the eastern Pacific variety.
Impact of Middle versus Inferior Total Turbinectomy on Nasal Aerodynamics
Authors: Dayal Anupriya , Rhee John S. , Garcia Guilherme J. M. 
Published: May 2016

ObjectivesThis computational study aims to (1) use virtual surgery to theoretically investigate the maximum possible change in nasal aerodynamics after turbinate surgery, (2) quantify the relative contributions of the middle and inferior turbinates to nasal resistance and air conditioning, and (3) quantify to what extent total turbinectomy impairs the nasal air‐conditioning capacity.Study DesignVirtual surgery and computational fluid dynamics.SettingAcademic tertiary medical center.Subjects and MethodsTen patients with inferior turbinate hypertrophy were studied. Three‐dimensional models of their nasal anatomies were built according to presurgery computed tomography scans. Virtual surgery was applied to create models representing either total inferior turbinectomy (TIT) or total middle turbinectomy (TMT). Airflow, heat transfer, and humidity transport were simulated at a steady‐state inhalation rate of 15 L/min. The surface area stimulated by mucosal cooling was defined as the area where heat fluxes exceed 50 W/m2.ResultsIn both virtual total turbinectomy models, nasal resistance decreased and airflow increased. However, the surface area where heat fluxes exceed 50 W/m2 either decreased (TIT) or did not change significantly (TMT), suggesting that total turbinectomy may reduce the stimulation of cold receptors by inspired air. Nasal heating and humidification efficiencies decreased significantly after both TIT and TMT. All changes were greater in the TIT models than in the TMT models.ConclusionTIT yields greater increases in nasal airflow but also impairs the nasal air‐conditioning capacity to a greater extent than TMT. Radical resection of the turbinates may decrease the surface area stimulated by mucosal cooling.
MERS versus Standard Surgical Approaches for Porcine Vocal Fold Scarring with Adipose Stem Cell Constructs
Authors: Woo Joo Hyun , King Suzanne N. , Hoffman Henry , Dailey Seth , Wang Sarah , Christensen Michael B. , Thibeault Susan L. 
Published: May 2016

ObjectiveCells, scaffold, and surgical approaches are important for regeneration of the lamina propria of the scarred vocal fold (VF). Microendoscopy of Reinke’s space (MERS) is a surgical approach used to access the lamina propria. The present study evaluated MERS in the treatment of VF scarring as compared with standardized approaches for the treatment of VF scarring with adipose stem cell constructs.Study DesignAnimal study.SettingAcademic center.Subjects and MethodsVF injury was performed bilaterally to induce scarring in 20 pigs. Eight weeks after injury, pigs were classified into no treatment, minithyrotomy, VF injection, VF incision/dissection, and MERS. All groups (except control) were implanted with adipose stem cell and hyaluronan. Four weeks after treatment, histology for collagen, hyaluronan, and fibronectin; mRNA expression for α‐smooth muscle actin, tumor growth factor β1, collagen 1α1, collagen 3α1, matrix metalloproteinase 2, basic fibroblast growth factor, and hepatocyte growth factor; and tissue rheology were evaluated.ResultsDifferences were measured among surgical approaches for protein levels of collagen, hyaluronan, and fibronectin (P =. 0133, P <. 0001, and P =. 0025, respectively). Fibroblast growth factor, collagen 1α1, and matrix metalloproteinase 2 transcript levels were different among treatment groups (P =. 003, P =. 0086, and P =. 014, respectively), while no differences were measured for α‐smooth muscle actin, tumor growth factor β1, hepatocyte growth factor, and collagen 3α1. Rheologically, significant differences were not measured between groups.ConclusionMERS is a promising surgical approach for the treatment of VF scarring, optimizing the placement of implanted biomaterials.
Spatial Mapping in the Rat Olfactory Bulb by Odor and Direct Electrical Stimulation
Authors: Coelho Daniel H. , Costanzo Richard M. 
Published: May 2016

ObjectivesTo directly measure the spatial mapping in the olfactory bulb by odor presentation and by direct electrical stimulation.Study DesignExperimental (animal).SettingUniversity research laboratory.Subjects and MethodsOdor (n = 8) and electrical stimulation (n = 4) of the olfactory bulb in rats were used to demonstrate the spatial mapping of neural responses in the olfactory bulb. Both multiunit responses to odor stimulation and evoked potential responses to localized electrical stimulation were measured in different regions of the olfactory bulb.ResultsResponses that were recorded simultaneously from an array of 32 electrodes positioned at different locations within the olfactory bulb were mapped. Results show different spatial patterns of neural activity for different odors (odor maps). Direct stimulation of the olfactory bulb with electrical current pulses from electrodes positioned at different locations was also effective in generating spatial patterns of neural activity.ConclusionThese data suggest that by programming an array of stimulating electrodes, it should be possible to selectively activate different regions of the olfactory bulb, generating unique patterns of neural activity as seen in normal smell.
Pretreatment Hematologic Findings as Novel Predictive Markers for Facial Palsy Prognosis
Authors: Wasano Koichiro , Kawasaki Taiji , Yamamoto Sayuri , Tomisato Shuta , Shinden Seiichi , Ishikawa Toru , Minami Shujiro , Wakabayashi Takeshi , Ogawa Kaoru 
Published: May 2016

ObjectiveTo examine the relationship between prognosis of 2 different facial palsies and pretreatment hematologic laboratory values.Study DesignMulticenter case series with chart review.SettingThree tertiary care hospitals.Subjects and MethodsWe examined the clinical records of 468 facial palsy patients who were treated with an antiviral drug in combination with either oral or intravenous corticosteroids in participating hospitals between 2010 and 2014. Patients were divided into a Bell’s palsy group or a Hunt’s palsy group. We used the Yanagihara facial nerve grading system to grade the severity of facial palsy. “Recovery” from facial palsy was defined as achieving a Yanagihara score ≥36 points within 6 months of onset and having no accompanying facial contracture or synkinesis. We collected information about pretreatment hematologic findings, demographic data, and electrophysiologic test results of the Bell and Hunt group patients who recovered and those who did not. We then compared these data across the 2 palsy groups.ResultsIn the Bell’s palsy group, recovered and unrecovered patients differed significantly in age, sex, electroneuronography score, stapedial muscle reflex, neutrophil rate, lymphocyte rate, neutrophil‐to‐lymphocyte ratio, and initial Yanagihara score. In the Hunt’s palsy group, recovered and unrecovered patients differed in age, electroneuronography score, stapedial muscle reflex, monocyte rate, platelet count, mean corpuscular volume, and initial Yanagihara score.ConclusionsPretreatment hematologic findings, which reflect the severity of inflammation and bone marrow dysfunction caused by a virus infection, are useful for predicting the prognosis of facial palsy.
Functional Outcomes after Salvage Transoral Laser Microsurgery for Laryngeal Squamous Cell Carcinoma
Authors: Fink Daniel S. , Sibley Haley , Kunduk Melda , Schexnaildre Mell , Sutton Collin , Kakade‐Pawar Anagha , McWhorter Andrew J. 
Published: May 2016

ObjectivesTransoral laser microsurgery (TLM) has been increasingly used in lieu of total laryngectomy to treat malignancy after definitive radiation. There are few data in the literature regarding functional outcomes. We retrospectively reviewed voice and swallowing outcomes in patients who underwent TLM for recurrent laryngeal carcinoma.Study DesignCase series with chart review.SettingTertiary care center.Subjects and MethodsForty‐two patients were identified with recurrent squamous cell carcinoma of the larynx after definitive radiation therapy from 2001 to 2013: 28 patients with glottic recurrence and 14 with supraglottic recurrence. Swallowing outcomes were evaluated by gastrostomy tube dependence, the MD Anderson Dysphagia Inventory, and the Functional Oral Intake Scale. Voice outcomes were evaluated by the Voice Handicap Index and observer‐rated perceptual analysis.ResultsNo significant difference was noted between mean pre‐ and postoperative MD Anderson Dysphagia Inventory scores: 78.25 and 74.9, respectively (P =. 118, t = 1.6955). Mean Functional Oral Intake Scale scores after TLM for supraglottic and glottic recurrences were 6.4 and 6.6, respectively. Of 42 patients, 17 (40.5%) required a gastrostomy tube either during radiation or in conjunction with the salvage procedure. Of 17 patients, 15 resumed sufficient oral diet for tube removal. Patients’ mean Voice Handicap Index score did increase from 34.3 to 51.5 (P =. 047), and their mean perceptual score did decrease from 60.0 to 45.3 (P =. 005). However, at 1‐year follow‐up, there was no significant difference in perceptual score: 61.1 to 57.1 (P =. 722).ConclusionsTLM is a successful surgical option for recurrent laryngeal cancer with acceptable functional outcomes.
The Effectiveness of Auxiliary Prescription Labels: A Pilot Study
Authors: Wiederholt Joseph B. , Kotzan Jeffrey A. , Cooper James W. 
Published: May 2016

Affixed auxiliary prescription labels are widely used in the practice of pharmacy because they supposedly provide the patient with pertinent information that is not contained within the prescription signature. Yet, whether the labels are effective is not known, nor is it known whether the label's elements, such as color, form, and logo, affect perception of the written text. Sound scientific analyses of these questions are limited. Therefore, a pilot study involving a series of experiments was designed to determine whether individual perception of pertinent information is affected by the use of affixed auxiliary prescription labels. The second objective of this study was to evaluate how color and logo differences affected perception of the label's written text. Participants were selected for the experiments after being screened for color blindness, corrected vision, and, in some cases, previous pharmacy employment. Subjects viewed labels affixed to prescription vials via a two-channel tachistoscope. The tachistoscopic methodology measured perception, and its accuracy was verified through a forced-choice instrument. Results from the pilot study were threefold: (1) a sound scientific analysis found affixed auxiliary labels to be effective, (2) significant variance could be attributed to both individual and subject differences, and (3) the unique effects of color and logo could not be determined.