bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal Function Trajectories and Clinical Outcomes in Acute Heart Failure
Authors: Givertz Michael M. , Postmus Douwe , Hillege Hans L. , Mansoor George A. , Massie Barry M. , Davison Beth A. , Ponikowski Piotr , Metra Marco , Teerlink John R. , Cleland John G.F. , Dittrich Howard C. , O’Connor Christopher M. , Cotter Gad , Voors Adriaan A. 
Published: November 2013

Background—
Prior studies have demonstrated adverse risk associated with baseline and worsening renal function in acute heart failure, but none has modeled the trajectories of change in renal function and their impact on outcomes.

Methods and Results—

We used linear mixed models of serial measurements of blood urea nitrogen and creatinine to describe trajectories of renal function in 1962 patients with acute heart failure and renal dysfunction enrolled in the Placebo-Controlled Randomized Study of the Selective A
1
Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function study. We assessed risk of 180-day mortality and 60-day cardiovascular or renal readmission and used Cox regression to determine association between renal trajectories and outcomes. Compared with patients alive at 180 days, patients who died were older, had lower blood pressure and ejection fraction, and higher creatinine levels at baseline. On average for the entire cohort, creatinine rose from days 1 to 3 and increased further after discharge, with the trajectory dependent on the day of discharge. Blood urea nitrogen, creatinine, and the rate of change in creatinine from baseline were the strongest independent predictors of 180-day mortality and 60-day readmission, whereas the rate of change of blood urea nitrogen from baseline was not predictive of outcomes. Baseline blood urea nitrogen >35 mg/dL and increase in creatinine >0.1 mg/dL per day increased the risk of mortality, whereas stable or decreasing creatinine was associated with reduced risk.

Conclusions—
Patients with acute heart failure and renal dysfunction demonstrate variable rise and fall in renal indices during and immediately after hospitalization. Risk of morbidity and mortality can be predicted based on baseline renal function and creatinine trajectory during the first 7 days.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT00328692 and NCT00354458.
Guideline Concordance of Testing for Hyperkalemia and Kidney Dysfunction During Initiation of Mineralocorticoid Receptor Antagonist Therapy in Patients With Heart Failure
Authors: Allen Larry A. , Shetterly Susan M. , Peterson Pamela N. , Gurwitz Jerry H. , Smith David H. , Brand David W. , Fairclough Diane L. , Rumsfeld John S. , Masoudi Frederick A. , Magid David J. 
Published: November 2013

Background—
Mineralocorticoid receptor antagonists (MRA) reduce morbidity and mortality in heart failure with reduced ejection fraction but can cause hyperkalemia and acute kidney injury. Guidelines recommend measurement of serum potassium (K) and creatinine (Cr) before and serially after MRA initiation, but the extent to which this occurs is unknown.

Methods and Results—

Using electronic data from 3 health systems 2005 to 2008, we performed a retrospective review of laboratory monitoring among 490 patients hospitalized for heart failure with reduced ejection fraction who were subsequently initiated on MRA therapy. Median age at time of MRA initiation was 73 years, and 37.1% were women. Spironolactone accounted for 99.4% of MRA use. Initial ambulatory MRA dispensing occurred at hospital discharge in 70.0% of cases. In the 30 days before MRA initiation, 94.3% of patients had a K or Cr measurement. Preinitiation K was >5.0 mmol/L in 1.4% and Cr >2.5 mg/dL in 1.7%. In the 7 days after MRA initiation among patients who remained alive and out of the hospital, 46.5% had no evidence of K measurement; by 30 days, 13.6% remained untested. Patient factors explained a small portion of postinitiation K testing (
c
-statistic, 0.67).

Conclusions—
Although laboratory monitoring before MRA initiation for heart failure with reduced ejection fraction is common, laboratory monitoring after MRA initiation frequently does not meet guideline recommendations, even in patients at higher risk for complications. Quality improvement efforts that encourage the use of MRA should also include mechanisms to address recommended monitoring.
Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents
Authors: Witzenbichler Bernhard , Maehara Akiko , Weisz Giora , Neumann Franz-Josef , Rinaldi Michael J. , Metzger D. Christopher , Henry Timothy D. , Cox David A. , Duffy Peter L. , Brodie Bruce R. , Stuckey Thomas D. , Mazzaferri Ernest L. , Xu Ke , Parise Helen , Mehran Roxana , Mintz Gary S. , Stone Gregg W. 
Published: November 2013

Background—
Prior small to modest-sized studies suggest a benefit of intravascular ultrasound (IVUS) guidance in noncomplex lesions. Whether IVUS guidance is associated with improved clinical outcomes after drug-eluting stent (DES) implantation in an unrestricted patient population is unknown.

Methods and Results—

Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter, nonrandomized “all-comers” study of 8583 consecutive patients at 11 international centers designed to determine the frequency, timing, and correlates of stent thrombosis and adverse clinical events after DES. Propensity-adjusted multivariable analysis was performed to examine the relationship between IVUS guidance and 1-year outcomes. IVUS was utilized in 3349 patients (39%), and larger-diameter devices, longer stents, and/or higher inflation pressures were used in 74% of IVUS-guided cases. IVUS guidance compared with angiography guidance was associated with reduced 1-year rates of definite/probable stent thrombosis (0.6% [18 events] versus 1.0% [53 events]; adjusted hazard radio, 0.40; 95% confidence interval, 0.21–0.73;
P
=0.003), myocardial infarction (2.5% versus 3.7%; adjusted hazard radio, 0.66; 95% confidence interval, 0.49–0.88;
P
=0.004), and composite adjudicated major adverse cardiac events (ie, cardiac death, myocardial infarction, or stent thrombosis) (3.1% versus 4.7%; adjusted hazard radio, 0.70; 95% confidence interval, 0.55–0.88;
P
=0.002). The benefits of IVUS were especially evident in patients with acute coronary syndromes and complex lesions, although significant reductions in major adverse cardiac events were present in all patient subgroups those with including stable angina and single-vessel disease.

Conclusions—
In ADAPT-DES, the largest study of IVUS use to date, IVUS guidance was associated with a reduction in stent thrombosis, myocardial infarction, and major adverse cardiac events within 1 year after DES implantation.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00638794.
Preadmission Oral Anticoagulant Treatment and Clinical Outcome Among Patients Hospitalized With Acute Stroke and Atrial Fibrillation
Authors: Johnsen Søren Paaske , Svendsen Marie Louise , Hansen Morten Lock , Brandes Axel , Mehnert Frank , Husted Steen Elkjær 
Published: November 2013

Background and Purpose—
Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further.

Methods—
We identified 11 356 patients with atrial fibrillation admitted to hospital with acute stroke (including ischemic stroke and intracerebral hemorrhage) between 2003 and 2009. Propensity score–matched analyses were used to compare stroke severity (Scandinavian Stroke Scale score) and mortality among 2175 patients with preadmission OAT and 2175 patients without preadmission OAT.

Results—
A total of 2492 (21.9%) patients received OAT at the time of their stroke. Preadmission OAT was associated with a lower risk of severe stroke (Scandinavian Stroke Scale score at time of admission, <30 point; propensity score–matched odds ratio, 0.74; 95% confidence interval, 0.63–0.86) and lower 30-day mortality rate (propensity score–matched adjusted odds ratio, 0.83; 95% confidence interval, 0.71–0.98).

Conclusions—
Only a minority of hospitalized patients with acute stroke with atrial fibrillation received OAT at the time of stroke. Preadmission OAT was associated with less severe stroke and lower 30-day mortality rate in a propensity score–matched analysis.
Design and Validation of a Prehospital Stroke Scale to Predict Large Arterial Occlusion
Authors: Pérez de la Ossa Natalia , Carrera David , Gorchs Montse , Querol Marisol , Millán Mònica , Gomis Meritxell , Dorado Laura , López-Cancio Elena , Hernández-Pérez María , Chicharro Vicente , Escalada Xavier , Jiménez Xavier , Dávalos Antoni 
Published: November 2013

Background and Purpose—
We aimed to develop and validate a simple prehospital stroke scale to predict the presence of large vessel occlusion (LVO) in patients with acute stroke.

Methods—
The Rapid Arterial oCclusion Evaluation (RACE) scale was designed based on the National Institutes of Health Stroke Scale (NIHSS) items with a higher predictive value of LVO on a retrospective cohort of 654 patients with acute ischemic stroke: facial palsy (scored 0–2), arm motor function (0–2), leg motor function (0–2), gaze (0–1), and aphasia or agnosia (0–2). Thereafter, the RACE scale was validated prospectively in the field by trained medical emergency technicians in 357 consecutive patients transferred by Emergency Medical Services to our Comprehensive Stroke Center. Neurologists evaluated stroke severity at admission and LVO was diagnosed by transcranial duplex, computed tomography, or MR angiography. Receiver operating curve, sensitivity, specificity, and global accuracy of the RACE scale were analyzed to evaluate its predictive value for LVO.

Results—

In the prospective cohort, the RACE scale showed a strong correlation with NIHSS (
r
=0.76;
P
<0.001). LVO was detected in 76 of 357 patients (21%). Receiver operating curves showed a similar capacity to predict LVO of the RACE scale compared with the NIHSS (area under the curve 0.82 and 0.85, respectively). A RACE scale ≥5 had sensitivity 0.85, specificity 0.68, positive predictive value 0.42, and negative predictive value 0.94 for detecting LVO.

Conclusions—
The RACE scale is a simple tool that can accurately assess stroke severity and identify patients with acute stroke with large artery occlusion at prehospital setting by medical emergency technicians.
Relative Cerebral Blood Volume as a Marker of Durable Tissue-at-Risk Viability in Hyperacute Ischemic Stroke
Authors: Cortijo Elisa , Calleja Ana Isabel , García-Bermejo Pablo , Mulero Patricia , Pérez-Fernández Santiago , Reyes Javier , Muñoz Mª Fe , Martínez-Galdámez Mario , Arenillas Juan Francisco 
Published: November 2013

Background and Purpose—
Selection of best responders to reperfusion therapies could be aided by predicting the duration of tissue-at-risk viability, which may be dependant on collateral circulation status. We aimed to identify the best predictor of good collateral circulation among perfusion computed tomography (PCT) parameters in middle cerebral artery (MCA) ischemic stroke and to analyze how early MCA response to intravenous thrombolysis and PCT-derived markers of good collaterals interact to determine stroke outcome.

Methods—
We prospectively studied patients with acute MCA ischemic stroke treated with intravenous thrombolysis who underwent PCT before treatment showing a target mismatch profile. Collateral status was assessed using a PCT source image–based score. PCT maps were quantitatively analyzed. Cerebral blood volume (CBV), cerebral blood flow, and Tmax were calculated within the hypoperfused volume and in the equivalent region of unaffected hemisphere. Occluded MCAs were monitored by transcranial Duplex to assess early recanalization. Main outcome variables were brain hypodensity volume and modified Rankin scale score at day 90.

Results—

One hundred patients with MCA ischemic stroke imaged by PCT received intravenous thrombolysis, and 68 met all inclusion criteria. A relative CBV (rCBV) >0.93 emerged as the only predictor of good collaterals (odds ratio, 12.6; 95% confidence interval, 2.9–55.9;
P
=0.001). Early MCA recanalization was associated with better long-term outcome and lower infarct volume in patients with rCBV<0.93, but not in patients with high rCBV. None of the patients with rCBV<0.93 achieved good outcome in absence of early recanalization.

Conclusions—
High rCBV was the strongest marker of good collaterals and may characterize durable tissue-at-risk viability in hyperacute MCA ischemic stroke.
Characteristics of Convective Processes and Vertical Vorticity from the Tropical Wave to Tropical Cyclone Stage in a High-Resolution Numerical Model Simulation of Tropical Cyclone Fay (2008)
Authors: Wang Zhuo 
Published: November 2013

Abstract
The statistics of convective processes and vertical vorticity from the tropical wave to tropical cyclone stage are examined in a high-resolution simulation of Tropical Cyclone Fay (2008). The intensity of vertical velocity follows approximately the truncated lognormal distribution in the model simulation, which is consistent with previous observational studies. The upward motion at the pregenesis stage is weaker compared to mature hurricanes or midlatitude thunderstorms. The relatively strong upward velocities occupying a small areal fraction make a substantial contribution to the upward mass and moisture fluxes and condensation.
It is also found that upward motion and downward motion both intensify with time, but the former is stronger than the latter, and the mean vertical motion and the mean vertical mass flux thus increase with time. By contrast, the maximum anticyclonic vorticity is comparable to the maximum cyclonic vorticity in magnitude. Both cyclonic vorticity and anticyclonic vorticity intensify with time, but the former covers a larger areal fraction in the lower and middle troposphere and becomes dominant throughout the troposphere after genesis.
Sensitivity tests with different model resolutions were carried out to test the robustness of the results. When the horizontal grid spacing is reduced, the size of updrafts decreases and the number of updrafts increases, but the areal fraction of updrafts, the mean vertical velocity, and the mean vertical mass flux are rather insensitive to the model resolution, especially in the lower troposphere and when the model resolution is 1 km or higher. This may explain why models with relatively coarse resolution can simulate tropical cyclogenesis reasonably well.
Response of the Ocean Natural Carbon Storage to Projected Twenty-First-Century Climate Change
Authors: Bernardello Raffaele , Marinov Irina , Palter Jaime B. , Sarmiento Jorge L. , Galbraith Eric D. , Slater Richard D. 
Published: November 2013

Abstract
The separate impacts of wind stress, buoyancy fluxes, and CO2 solubility on the oceanic storage of natural carbon are assessed in an ensemble of twentieth- to twenty-first-century simulations, using a coupled atmosphere–ocean–carbon cycle model. Time-varying perturbations for surface wind stress, temperature, and salinity are calculated from the difference between climate change and preindustrial control simulations, and are imposed on the ocean in separate simulations. The response of the natural carbon storage to each perturbation is assessed with novel prognostic biogeochemical tracers, which can explicitly decompose dissolved inorganic carbon into biological, preformed, equilibrium, and disequilibrium components. Strong responses of these components to changes in buoyancy and winds are seen at high latitudes, reflecting the critical role of intermediate and deep waters. Overall, circulation-driven changes in carbon storage are mainly due to changes in buoyancy fluxes, with wind-driven changes playing an opposite but smaller role. Results suggest that climate-driven perturbations to the ocean natural carbon cycle will contribute 20 Pg C to the reduction of the ocean accumulated total carbon uptake over the period 1860–2100. This reflects a strong compensation between a buildup of remineralized organic matter associated with reduced deep-water formation (+96 Pg C) and a decrease of preformed carbon (−116 Pg C). The latter is due to a warming-induced decrease in CO2 solubility (−52 Pg C) and a circulation-induced decrease in disequilibrium carbon storage (−64 Pg C). Climate change gives rise to a large spatial redistribution of ocean carbon, with increasing concentrations at high latitudes and stronger vertical gradients at low latitudes.
Students’ attitudes towards school-based sex and relationships education in Tanzania
Authors: Mkumbo Kitila AK 
Published: November 2013

Objective: The objective of this paper was to assess students’ attitudes towards school-based sex and relationships education (SRE). Design: This study featured a cross-sectional survey design. Method: A sample of 715 students from two districts in Tanzania completed a survey questionnaire assessing various aspects related to their attitudes towards SRE. Results: Results show that the overwhelming majority (more than 80%) of students supported the provision of SRE in schools and the inclusion of a wide range of SRE topics in the curriculum. The majority of students wanted the teaching of SRE in schools to begin early during primary education (ages 10–14). Nevertheless, the majority of students objected to the inclusion of some of the SRE topics that are commonly regarded as controversial, including homosexuality and masturbation. Students’ attitudes towards SRE and specific topics were associated with participants’ sex, age and religious affiliation. Conclusion: The results of this study should encourage policy makers and researchers in Tanzania to advocate for the provision of comprehensive sex education in schools.
Cilostazol decreases total atrial conduction time in patients with peripheral artery disease
Authors: Alizade E , Şahin M , Şimşek Z , Açar G , Bulut M , Güler A , Avcı A , Kalkan ME , Pala S , Akçakoyun M , Esen AM 
Published: November 2013

Objective: Total atrial conduction time (TACT) is the most important parameter in predicting the development of new-onset atrial fibrillation. We investigated the effect of cilostazol therapy on TACT in patients with peripheral artery disease. Methods: Thirty patients with peripheral artery disease were treated with cilostazol (200 mg/day) for 6 months. The baseline echocardiographic total atrial conduction time parameter was compared with the 6-month follow-up. Results: The TACT duration was decreased in all patients compared with the baseline after therapy (121.8 ± 19.3 vs. 109.1 ± 15.9 milliseconds, p<0.001). However, left atrial (LA) diameter was not changed with the therapy. The reduction of TACT duration was correlated with the increase in mitral E wave velocity/mitral A wave velocity ratio (r=-0.48, p<0.003). Conclusion: Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease, which may also prevent the development and/or recurrence of atrial fibrillation (AF).
Why do older people oppose physician-assisted dying? A qualitative study
Authors: Malpas Phillipa J , Wilson Maria KR , Rae Nicola , Johnson Malcolm 
Published: November 2013

Background: Physician-assisted dying at the end of life has become a significant issue of public discussion. While legally available in a number of countries and jurisdictions, it remains controversial and illegal in New Zealand. Aim: The study aimed to explore the reasons some healthy older New Zealanders oppose physician-assisted dying in order to inform current debate. Design: Recorded interviews were transcribed and analysed by the authors after some edits had been made by respondents. Setting/participants: In all, 11 older participants (over 65 years) who responded to advertisements placed in Grey Power magazines and a University of Auckland email list were interviewed for around 1 h and asked a number of open-ended questions. Results: Four central themes opposing physician-assisted dying were identified from the interviews: one’s personal experience with health care and dying and death, religious reasoning and beliefs, slippery slope worries and concern about potential abuses if physician-assisted dying were legalised. Conclusions: An important finding of the study suggests that how some older individuals think about physician-assisted dying is strongly influenced by their past experiences of dying and death. While some participants had witnessed good, well-managed dying and death experiences which confirmed for them the view that physician-assisted dying was unnecessary, those who had witnessed poor dying and death experiences opposed physician-assisted dying on the grounds that such practices could come to be abused by others.
The Paediatric Palliative Screening Scale: Further validity testing
Authors: Bergstraesser Eva , Paul Michaela , Rufibach Kaspar , Hain Richard D , Held Leonhard 
Published: November 2013

Background: Paediatric palliative care is still often introduced late in the illness trajectory of children with life-limiting diseases. Translating palliative care into practice continues to be a challenge. Aim: To validate the Paediatric Palliative Screening Scale further by defining attributes that predict the need for palliative care in children between 1 and 18 years. Design: Proportional-odds logistic regression analysis was performed to investigate the relationship between the attributes of the Paediatric Palliative Screening Scale and the experts’ assessment of case vignettes with various combinations of different attribute characteristics. Estimates from regression analysis were transformed to empirical weightings of the Paediatric Palliative Screening Scale attribute characteristics. Setting/participants: Online questionnaires with case vignettes were sent to 33 paediatric palliative care experts from Europe, the United States, Canada, Australia and New Zealand. Results: The highest weightings among the five previously defined attributes were estimated life expectancy <12 months (40% of maximum score) and preferences of the child/parents received (24%). Trajectory of disease and impact on daily activities of the child, expected outcome of treatment directed at the disease and burden of treatment, and symptom or problem burden were weighted less. Conclusions: According to this second step of psychometric testing of the Paediatric Palliative Screening Scale, the strongest and most urgent necessity indicators for a palliative care approach are life expectancy and child/family preferences. These results are somewhat discrepant with results from the previous validation of the instrument as well as previous research findings.