bluuebunny/crossref_metadata_2025_split huggingface dataset:
Importance of Clinical Worsening of Heart Failure Treated in the Outpatient Setting
Authors: Okumura Naoki , Jhund Pardeep S. , Gong Jianjian , Lefkowitz Martin P. , Rizkala Adel R. , Rouleau Jean L. , Shi Victor C. , Swedberg Karl , Zile Michael R. , Solomon Scott D. , Packer Milton , McMurray John J.V. 
Published: June 2016

Background—
Many episodes of worsening of heart failure (HF) are treated by increasing oral therapy or temporary intravenous treatment in the community or emergency department (ED), without hospital admission. We studied the frequency and prognostic importance of these episodes of worsening in the Prospective Comparison of ARNI (angiotensin-receptor-neprilysin inhibitor) with ACEI (angiotensin-converting enzyme inhibitor) to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial (PARADIGM-HF).

Methods and Results—
Outpatient intensification of HF therapy was added to an expanded composite outcome with ED visits, HF hospitalizations, and cardiovascular deaths. In an examination of first nonfatal events, 361 of 8399 patients (4.3%) had outpatient intensification of HF therapy without a subsequent event (ie, ED visit/HF hospitalizations) within 30 days; 78 of 8399 (1.0%) had an ED visit without previous outpatient intensification of HF therapy or a subsequent event within 30 days; and 1107 of 8399 (13.2%) had HF hospitalizations without a preceding event. The risk of death (in comparison with no-event patients) was similar after each manifestation of worsening: outpatient intensification of HF therapy (hazard ratio, 4.8; 95% confidence interval, 3.9–5.9); ED visit (hazard ratio, 4.5; 95% confidence interval, 3.0–6.7); HF hospitalizations (hazard ratio, 5.9; 95% confidence interval, 5.2–6.6). The expanded composite added 14% more events and shortened time to accrual of a fixed number of events. The benefit of sacubitril/valsartan over enalapril was similar to the primary outcome for the expanded composite (hazard ratio, 0.79; 95% confidence interval, 0.73–0.86) and was consistent across the components of the latter.

Conclusions—
Focusing only on HF hospitalizations underestimates the frequency of worsening and the serious implications of all manifestations of worsening. For clinical trials conducted in an era of heightened efforts to avoid HF hospitalizations, inclusion of episodes of outpatient treatment intensification (and ED visits) in a composite outcome adds an important number of events and shortens the time taken to accrue a target number of end points in an event-driven trial.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01035255.
A Substantial Change in the Approach to the Zoroastrian Long Liturgy
Authors: Cantera Alberto 
Published: June 2016

Between 2006 and 2013 J. Kellens published in five volumes (the last one together with C. Redard) a corrected version of the text edited by K.F. Geldner of the longest and most important Zoroastrian ritual usually known by the name of one of its variants as the Yasna. The text accompanies an experimental translation and both are followed by a commentary. J. Kellens is pioneering in translating and studying, not only the standard daily variant of the liturgy, but also its more solemn version. Furthermore, his work is the first attempt to read the complete text of the liturgy as the coherent text (although produced at different times) of an old and meaningful liturgy, although it has been traditionally understood as a late composition. As it appears in the manuscripts and is celebrated still today in India, the liturgy is the result of a series of conscious interpretations, reinterpretations and rearrangements of older versions. Despite of this, it is a coherent text and ritual in which each section of the liturgy plays a concrete role that J. Kellens has tried to bring to light for the first time. In the present review, I try to highlight the extraordinary importance of Kellens’ new approach to the Zoroastrian Long Liturgy and to expose his main achievements. At the same time, I expose the main weaknesses of this monumental work: 1. its dependence on the text edited by Geldner, which hides part of the ritual variety of the Long Liturgy; 2. the conscious disregard of the meta-ritual information provided by the Zoroastrian tradition about the performance of the liturgy; 3. J. Kellens’s Yasna-centrism that prevents him to recognize the close connections between the Long Liturgy and other minor rituals and the participation within the Long Liturgy of many short rituals that can be celebrated independently.
WOOD ANATOMY AND TRAIT-BASED ECOLOGY
Authors: Beeckman Hans 
Published: June 2016

The largest part of forest biomass consists of wood. A global estimate of carbon stored in lignified tissues rises up to 400 Pg. Given these quantities, there is a growing interest of implementing wood research in diagnoses and evaluations of the carrying capacity of the global ecosystem and its forests. The question arises how disciplines like wood anatomy could respond to the increasing demands of a trait-based ecology, understood as a paradigmatic shift in addressing global changes. Dendrochronology and ecological wood anatomy, traditionally operating within the paradigm of species-based ecology, developed robust methods to address ecological questions. However, sampling strategies and database design will likely be different when wood traits are to be used to study individual tree performance, including responses to stress.
Aiming at optimally involving wood research in trait-based ecology, some trait concepts are analysed. The value of the IAWA standard lists of wood anatomical features as starting points for trait databases is recognized. A summary of the functionality of wood is given to inform the trait-research community of basic aspects of tree performance. The time dimension is highlighted, as well as the foundations for understanding bio-hydraulics, bio-mechanics and metabolism of wood and relevant traits.
Guidelines are given for sampling strategies and database concepts. Prospects of time axis construction and system integration are discussed, as well as the importance of standardizing for size.
EARLYWOOD VESSELS IN RING-POROUS TREES BECOME FUNCTIONAL FOR WATER TRANSPORT AFTER BUD BURST AND BEFORE THE MATURATION OF THE CURRENT-YEAR LEAVES
Authors: Kitin Peter , Funada Ryo 
Published: June 2016

This paper reviews the development of xylem vessels in ring-porous dicots and the corresponding leaf phenology. Also included are our original observations on the time-course of vessel element growth, secondary wall deposition, and end wall perforation in the deciduous hardwood Kalopanax septemlobus. Different patterns of xylem growth and phenology serve different strategies of the species for adaptation to seasonal climates. Trees with ring-porous xylem form wide earlywood vessels (EWV) in spring and narrow latewood vessels in summer. The wide EWV become embolized or blocked with tyloses by the end of the growing season while the narrow vessels may remain functional for many years. The co-occurrence of wide and narrow vessels provides both efficiency and safety of the water transport as well as a potentially longer growing season. It has for a long time been assumed that EWV in ring-porous hardwoods are formed in early spring before bud burst in order to supply sap to growing leaves and shoots.
However, the full time-course of development of EWV elements from initiation of growth until maturation for water transport has not been adequately studied until recently. Our observations clarify a crucial relationship between leaf maturation and the maturation of earlywood vessels for sap transport. Accumulated new evidence shows that EWV in branches and upper stem parts develop earlier than EWV lower in the stem. The first EWV elements are fully expanded with differentiated secondary walls by the time of bud burst. In lower stem parts, perforations in vessel end walls are formed after bud burst and before the new leaves have achieved full size. Therefore, the current-year EWV network becomes functional for water transport only by the time when the first new leaves are mature.
Conflict about Climate Change at the American Meteorological Society: Meteorologists’ Views on a Scientific and Organizational Controversy
Authors: Stenhouse Neil , Harper Allison , Cai Xiaomei , Cobb Sara , Nicotera Anne , Maibach Edward 
Published: June 2016

Abstract
This article analyzes open-ended survey responses to understand how members of the American Meteorological Society (AMS) perceive conflict within the AMS over global warming. Of all survey respondents, 53% agreed that there was conflict within the AMS; of these individuals who perceived conflict, 62% saw it as having at least some productive aspects, and 53% saw at least some unproductive aspects. Among members who saw a productive side to the conflict, most agreed as to why it was productive: debate and diverse perspectives enhance science. However, among members who saw an unproductive side, there was considerable disagreement as to why. Members who are convinced of largely human-caused climate change expressed that debate over global warming sends an unclear message to the public. Conversely, members who are unconvinced of human-caused climate change often felt that their peers were closed-minded and suppressing unpopular views. These two groups converged, however, on one point: politics was seen as an overwhelmingly negative influence on the debate. This suggests that scientific organizations faced with similar conflict should understand that there may be a contradiction between legitimizing all members’ views and sending a clear message to the public about the weight of the evidence. The findings also reinforce the conclusion that attempts by scientific societies to directly address differences in political views may be met with strong resistance by many scientists.
Evaluation of Variation in Surface Solar Irradiance and Clustering of Observation Stations in Japan
Authors: Watanabe Takeshi , Takamatsu Takahiro , Nakajima Takashi Y. 
Published: June 2016

AbstractVariation in surface solar irradiance is investigated using ground-based observation data. The solar irradiance analyzed in this paper is scaled by the solar irradiance at the top of the atmosphere and is thus dimensionless. Three metrics are used to evaluate the variation in solar irradiance: the mean, standard deviation, and sample entropy. Sample entropy is a value representing the complexity of time series data, but it is not often used for investigation of solar irradiance. In analyses of solar irradiance, sample entropy represents the manner of its fluctuation; large sample entropy corresponds to rapid fluctuation and a high ramp rate, and small sample entropy suggests weak or slow fluctuations. The three metrics are used to cluster 47 ground-based observation stations in Japan into groups with similar features of variation in surface solar irradiance. This new approach clarifies regional features of variation in solar irradiance. The results of this study can be applied to renewable-energy engineering.
Atmospheric Response to a Midlatitude SST Front: Alongfront Winds
Authors: Kilpatrick Thomas , Schneider Niklas , Qiu Bo 
Published: June 2016

AbstractSatellite observations and modeling studies show that midlatitude SST fronts influence the marine atmospheric boundary layer (MABL) and atmospheric circulation. Here, the Weather Research and Forecasting (WRF) mesoscale model is used to explore the atmospheric response to a midlatitude SST front in an idealized, dry, two-dimensional configuration, with a background wind oriented in the alongfront direction.The SST front excites an alongfront wind anomaly in the free atmosphere, with peak intensity just above the MABL. This response is nearly quasigeostrophic, in contrast to the inertia–gravity wave response seen for cross-front background winds. The free-atmosphere response increases with the background wind , in contrast to previously proposed SST frontal MABL models.The MABL winds are nearly in Ekman balance. However, a cross-front wind develops in the MABL as a result of friction and rotation such that the MABL cross-front Rossby number ε ≈ 0.2. The MABL vorticity balance and scaling arguments indicate that advection plays an important role in the MABL dynamics. Surface wind convergence shows poor agreement with MABL depth-integrated convergence, indicating that the MABL mixed-layer assumption may not be appropriate for SST frontal zones with moderate to strong surface winds.
Lower-Tropospheric Mixing as a Constraint on Cloud Feedback in a Multiparameter Multiphysics Ensemble
Authors: Kamae Youichi , Shiogama Hideo , Watanabe Masahiro , Ogura Tomoo , Yokohata Tokuta , Kimoto Masahide 
Published: June 2016

Abstract
Factors and possible constraints to extremely large spread of effective climate sensitivity (ECS) ranging about 2.1–10.4 K are examined by using a large-member ensemble of quadrupling CO2 experiments with an atmospheric general circulation model (AGCM). The ensemble, called the multiparameter multiphysics ensemble (MPMPE), consists of both parametric and structural uncertainties in parameterizations of cloud, cumulus convection, and turbulence based on two different versions of AGCM. The sum of the low- and middle-cloud shortwave feedback explains most of the ECS spread among the MPMPE members. For about half of the perturbed physics ensembles (PPEs) in the MPMPE, variation in lower-tropospheric mixing intensity (LTMI) corresponds well with the ECS variation, whereas it does not for the other half. In the latter PPEs, large spread in optically thick middle-cloud feedback over the equatorial ocean substantially affects the ECS, disrupting the LTMI–ECS relationship. Although observed LTMI can constrain uncertainty in the low-cloud feedback, total uncertainty of the ECS among the MPMPE cannot solely be explained by the LTMI, suggesting a limitation of single emergent constraint for the ECS.
DiAs User Interface: A Patient-Centric Interface for Mobile Artificial Pancreas Systems
Authors: Keith-Hynes Patrick , Guerlain Stephanie , Mize Benton , Hughes-Karvetski Colleen , Khan Momin , McElwee-Malloy Molly , Kovatchev Boris P. 
Published: June 2016

Background: Recent in-hospital studies of artificial pancreas (AP) systems have shown promising results in improving glycemic control in patients with type 1 diabetes mellitus. The next logical step in AP development is to conduct transitional outpatient clinical trials with a mobile system that is controlled by the patient. In this article, we present the user interface (UI) of the Diabetes Assistant (DiAs), an experimental smartphone-based mobile AP system, and describe the reactions of a round of focus groups to the UI. This work is an initial inquiry involving a relatively small number of potential users, many of whom had never seen an AP system before, and the results should be understood in that light. Methods: We began by considering how the UI of an AP system could be designed to make use of the familiar touch-based graphical UI of a consumer smartphone. After developing a working prototype UI, we enlisted a human factors specialist to perform a heuristic expert analysis. Next we conducted a formative evaluation of the UI through a series of three focus groups with N = 13 potential end users as participants. The UI was modified based upon the results of these studies, and the resulting DiAs system was used in transitional outpatient AP studies of adults in the United States and Europe. Results: The DiAs UI was modified based on focus group feedback from potential users. The DiAs was subsequently used in JDRF- and AP@Home-sponsored transitional outpatient AP studies in the United States and Europe by 40 subjects for 2400 h with no adverse events. Conclusions: Adult patients with type 1 diabetes mellitus are able to control an AP system successfully using a patient-centric UI on a commercial smartphone in a transitional outpatient environment.
DiAs Web Monitoring: A Real-Time Remote Monitoring System Designed for Artificial Pancreas Outpatient Trials
Authors: Place Jérôme , Robert Antoine , Ben Brahim Najib , Keith-Hynes Patrick , Farret Anne , Pelletier Marie-Josée , Buckingham Bruce , Breton Marc , Kovatchev Boris , Renard Eric 
Published: June 2016

Background: Developments in an artificial pancreas (AP) for patients with type 1 diabetes have allowed a move toward performing outpatient clinical trials. “Home-like” environment implies specific protocol and system adaptations among which the introduction of remote monitoring is meaningful. We present a novel tool allowing multiple patients to monitor AP use in home-like settings. Methods: We investigated existing systems, performed interviews of experienced clinical teams, listed required features, and drew several mockups of the user interface. The resulting application was tested on the bench before it was used in three outpatient studies representing 3480 h of remote monitoring. Results: Our tool, called DiAs Web Monitoring (DWM), is a web-based application that ensures reception, storage, and display of data sent by AP systems. Continuous glucose monitoring (CGM) and insulin delivery data are presented in a colored chart to facilitate reading and interpretation. Several subjects can be monitored simultaneously on the same screen, and alerts are triggered to help detect events such as hypoglycemia or CGM failures. In the third trial, DWM received approximately 460 data per subject per hour: 77% for log messages, 5% for CGM data. More than 97% of transmissions were achieved in less than 5 min. Conclusions: Transition from a hospital setting to home-like conditions requires specific AP supervision to which remote monitoring systems can contribute valuably. DiAs Web Monitoring worked properly when tested in our outpatient studies. It could facilitate subject monitoring and even accelerate medical and technical assessment of the AP. It should now be adapted for long-term studies with an enhanced notification feature.
In Silico Optimization of Basal Insulin Infusion Rate during Exercise: Implication for Artificial Pancreas
Authors: Schiavon Michele , Man Chiara Dalla , Kudva Yogish C. , Basu Ananda , Cobelli Claudio 
Published: June 2016

Background: Several clinical trials have been performed to assess safety and efficacy of closed-loop control. Some included physical activity (PA), with the goal of challenging the control algorithms with a rapid change in insulin sensitivity while reducing the risk of hypoglycemia. However, the question remains as to the necessity to inform the control algorithm on the imminent PA. The aim here is to assess in silico (i) if it is necessary to announce upcoming PA and (ii) if this is the case, what is the safest strategy of basal insulin reduction in the context of the closed-loop control. Methods: We modified the University of Virginia/Padova type 1 diabetes simulator to incorporate the effect of PA based on a study in healthy subjects that demonstrated an almost doubling of insulin sensitivity during PA versus rest. Two in silico experiments, including a PA session, have been simulated on the virtual adult population: One in the absence of and one with different degrees of reductions and durations of basal insulin infusion rates. Results: Most in silico subjects experienced hypoglycemia in the absence of basal insulin adjustment. We show that, in the absence of patient-specific information, a safe and effective strategy is to reduce basal insulin by 50% starting 90 min before exercise and by 30% during exercise. Conclusions: Our results suggest that control algorithms could benefit by knowing an upcoming PA. Ideally, the control algorithm should be informed about the patient-specific basal insulin reduction pattern. An alternative strategy that has been proposed here has been deemed safe and effective in in silico experiments.
Artificial Pancreas: Model Predictive Control Design from Clinical Experience
Authors: Toffanin Chiara , Messori Mirko , Di Palma Federico , De Nicolao Giuseppe , Cobelli Claudio , Magni Lalo 
Published: June 2016

Background: The objective of this research is to develop a new artificial pancreas that takes into account the experience accumulated during more than 5000 h of closed-loop control in several clinical research centers. The main objective is to reduce the mean glucose value without exacerbating hypo phenomena. Controller design and in silico testing were performed on a new virtual population of the University of Virginia/Padova simulator. Methods: A new sensor model was developed based on the Comparison of Two Artificial Pancreas Systems for Closed-Loop Blood Glucose Control versus Open-Loop Control in Patients with Type 1 Diabetes trial AP@home data. The Kalman filter incorporated in the controller has been tuned using plasma and pump insulin as well as plasma and continuous glucose monitoring measures collected in clinical research centers. New constraints describing clinical knowledge not incorporated in the simulator but very critical in real patients (e.g., pump shutoff) have been introduced. The proposed model predictive control (MPC) is characterized by a low computational burden and memory requirements, and it is ready for an embedded implementation. Results: The new MPC was tested with an intensive simulation study on the University of Virginia/Padova simulator equipped with a new virtual population. It was also used in some preliminary outpatient pilot trials. The obtained results are very promising in terms of mean glucose and number of patients in the critical zone of the control variability grid analysis. Conclusions: The proposed MPC improves on the performance of a previous controller already tested in several experiments in the AP@home and JDRF projects. This algorithm complemented with a safety supervision module is a significant step toward deploying artificial pancreases into outpatient environments for extended periods of time.
Accuracy of a First-Generation Intravenous Blood Glucose Monitoring System in Subjects with Diabetes Mellitus: A Multicenter Study
Authors: Bailey Timothy , Gulino Angela , Higgins Michael J. , Leach Jacob , Kamath Apurv , Simpson Peter C. 
Published: June 2016

Background: Hyperglycemia and hypoglycemia in hospitalized patients have been associated with increased morbidity and mortality. Improvements in glucose monitoring technology may be helpful in the clinical management of critically ill patients with abnormal glucose levels. A first-generation intravenous blood glucose monitoring (IVBG) system was developed to facilitate glycemic control therapy in hospitalized patients. A nonrandomized, single-arm, multicenter study was performed to evaluate the safety and accuracy of the IVBG system in insulin-treated subjects with diabetes mellitus. Methods: The IVBG system is a bedside monitor that automatically measures venous blood glucose (BG) concentration. In this study, BG was measured every 7.5 min by the IVBG system. Reference samples [venous blood samples measured on the Yellow Springs Instruments (YSI) glucose analyzer] were drawn every 15 min during inpatient studies on days 1, 2, and 3. Fifty insulin-treated healthy volunteers with diabetes were studied, and a maximum of 72 reference samples were collected. Effectiveness was primarily evaluated by assessing the proportion of IVBG BG measurements within the 15 mg/dl or 20% criterion [15 mg/dl (for YSI <75 mg/dl) or 20% (for YSI ≥75 mg/dl)] compared with YSI. Adverse events and adverse device effects were evaluated. Results: A total of 95% of all IVBG values were within the 15 mg/dl or 20% criterion. The IVBG system BG measurement showed significant linear relationship with the laboratory YSI standard. Catheter insertion site irritation was mild and infrequent. No serious adverse events were reported. A total of 33% of the sensors were replaced during the 3-day use due to problematic IV lines or sensor/system errors. Conclusions: This clinical performance evaluation demonstrates that the IVBG system provides accurate and safe continuous BG measurements in healthy insulin-treated patients with diabetes.