bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortic Valve Adaptation to Aortic Root Dilatation
Authors: Kim Dae-Hee , Handschumacher Mark D. , Levine Robert A. , Sun Byung Joo , Jang Jeong Yoon , Yang Dong Hyun , Kang Joon-Won , Song Jong-Min , Kang Duk-Hyun , Lim Tae-Hwan , Song Jae-Kwan 
Published: July 2014

Background—
The 3-dimensional relationship between aortic root and cusp is essential to understand the mechanism of aortic regurgitation (AR) because of aortic root dilatation (ARD). We sought to test the hypothesis that the stretched cusps in ARD enlarge to compensate for ARD.

Methods and Results—

Computed tomography imaged 92 patients (57 with ARD, 29 with moderate to severe AR, 28 without significant AR) and 35 normal controls. Specialized 3-dimensional software measured individual cusp surface areas relative to maximal mid-sinus cross-sectional area and minimal 3-dimensional annular area, coaptation area fraction, and asymmetry of sinus volumes and intercommissural distances. Total open cusp surface area increased (
P
<0.001) from 7.6±1.4 cm
2
/m
2
in normals to 12.9±2.2 cm
2
/m
2
in AR-negative and 15.2±3.3 cm
2
/m
2
in AR-positive patients. However, the ratio of closed cusp surface area to maximal mid-sinus area, reflecting cusp adaptation, decreased from normals to AR-negative to AR-positive patients (1.38±0.20, 1.15±0.15, 0.88±0.15;
P
<0.001), creating the lowest coaptation area fraction. Cusp distensibility (closed diastolic versus open area) decreased from 20% in controls and AR-negative patients to 5% in AR-positive patients (
P
<0.001). Multivariate determinants of AR and coaptation area fraction reflected both sinus size and cusp-to-annular adaptation. ARD was also progressively asymmetrical with root size, and individual cusp surface areas failed to match this asymmetry.

Conclusions—
Aortic cusp enlargement occurs in ARD, but cusp adaptation and distensibility become limited in prominent, asymmetrical ARD, leading to AR. Optimal AR repair tailored to individual patient anatomy can benefit from appreciating valve adaptation and 3-dimensional relationships; understanding cusp adaptation mechanisms may ultimately provide therapeutic opportunities to improve such compensation.
Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention
Authors: Herrmann Joerg , Lennon Ryan J. , Jaffe Allan S. , Holmes David R. , Rihal Charanjit S. , Prasad Abhiram 
Published: July 2014

Background—
There is controversy about the diagnostic and prognostic significance of percutaneous coronary intervention–related myocardial infarction, especially with the use of cardiac troponin T (cTnT). This analysis was designed to address the question of the presence and the level of a prognostic cTnT threshold.

Methods and Results—

We evaluated 5268 consecutive patients who underwent nonemergent percutaneous coronary intervention between 2000 and 2009 with a preprocedural cTnT level below the upper limit of normal (ULN, ≤0.01 ng/mL). Postprocedural cTnT and creatine kinase-MB mass levels (ULN, 6.7 ng/mL in men and 3.8 ng/mL in women) were found to be associated with 3-month mortality in Cox proportional hazard models (hazard ratio per doubling of cTnT, 1.24; 95% confidence interval, 1.08–1.43;
P
=0.003 and hazard ratio per doubling of creatine kinase-MB, 1.30; 95% confidence interval, 1.05–1.60;
P
=0.018), adjusted for the Mayo Clinic risk scores for in-hospital and postdischarge mortality. The optimal prognostic threshold for 3-month mortality was 25× ULN for cTnT (hazard ratio, 4.53; 99% confidence interval, 1.59–12.9;
P
<0.001), which provided similar information as a value of 5× ULN for creatine kinase-MB (hazard ratio, 4.31; 99% confidence interval, 1.27–14.6;
P
=0.002). The cumulative mortality rate was 0.6% at 91 days.

Conclusions—
A significant association of postpercutaneous coronary intervention cardiac biomarker elevation with a small number of postpercutaneous coronary intervention outcomes was noted for the early (first 91 days) follow-up period with an identifiable optimal threshold of 25× ULN (0.25, ng/mL) for cTnT, which provided similar early outcome information as a cutoff of 5× ULN for creatine kinase-MB.
Fetal Aortic Valvuloplasty for Evolving Hypoplastic Left Heart Syndrome
Authors: Freud Lindsay R. , McElhinney Doff B. , Marshall Audrey C. , Marx Gerald R. , Friedman Kevin G. , del Nido Pedro J. , Emani Sitaram M. , Lafranchi Terra , Silva Virginia , Wilkins-Haug Louise E. , Benson Carol B. , Lock James E. , Tworetzky Wayne 
Published: July 2014

Background—
Fetal aortic valvuloplasty can be performed for severe midgestation aortic stenosis in an attempt to prevent progression to hypoplastic left heart syndrome (HLHS). A subset of patients has achieved a biventricular (BV) circulation after fetal aortic valvuloplasty. The postnatal outcomes and survival of the BV patients, in comparison with those managed as HLHS, have not been reported.

Methods and Results—

We included 100 patients who underwent fetal aortic valvuloplasty for severe midgestation aortic stenosis with evolving HLHS from March 2000 to January 2013. Patients were categorized based on postnatal management as BV or HLHS. Clinical records were reviewed. Eighty-eight fetuses were live-born, and 38 had a BV circulation (31 from birth, 7 converted after initial univentricular palliation). Left-sided structures, namely aortic and mitral valve sizes and left ventricular volume, were significantly larger in the BV group at the time of birth (
P
<0.01). After a median follow-up of 5.4 years, freedom from cardiac death among all BV patients was 96±4% at 5 years and 84±12% at 10 years, which was better than HLHS patients (log-rank
P
=0.04). There was no cardiac mortality in patients with a BV circulation from birth. All but 1 of the BV patients required postnatal intervention; 42% underwent aortic or mitral valve replacement. On the most recent echocardiogram, the median left ventricular end-diastolic volume
z
score was +1.7 (range, −1.3 to +8.2), and 80% had normal ejection fraction.

Conclusions—
Short- and intermediate-term survival among patients who underwent fetal aortic valvuloplasty and achieved a BV circulation postnatally is encouraging. However, morbidity still exists, and ongoing assessment is warranted.
B‐type Natriuretic Peptides for the Prediction of Cardiovascular Events in Patients With Stable Coronary Heart Disease: The Heart and Soul Study
Authors: Mishra Rakesh K. , Beatty Alexis L. , Jaganath Rajesh , Regan Mathilda , Wu Alan H.B. , Whooley Mary A. 
Published: July 2014

Background

Brain‐type natriuretic peptide (
BNP
) and the amino‐terminal fragment of its prohormone (
NT
‐pro
BNP
) are known predictors of cardiovascular outcomes in patients with coronary heart disease; however, the relative prognostic value of these 2 biomarkers for secondary events remains unclear.

Methods and Results

In 983 participants with stable
coronary heart disease
, we evaluated the association of
BNP
and
NT
‐pro
BNP
with time to hospitalization for heart failure, nonfatal myocardial infarction, stroke or transient ischemic attack, cardiovascular death, and combined major adverse cardiovascular events (
MACE
). During an average follow‐up of 6.5±3.3 years, both
BNP
and
NT
‐pro
BNP
were associated with increased risk of
MACE
in a multivariable‐adjusted model (hazard ratio per standard deviation of log
BNP
: 1.58; 95% CI: 1.32 to 1.89; hazard ratio per standard deviation of log
NT
‐proBNP: 1.84; 95% CI: 1.52 to 2.24). When added to traditional risk factors,
NT
‐pro
BNP
predicted
MACE
better than
BNP
(C statistic: 0.76 versus 0.72,
P
<0.001). Similarly, the addition of
NT
‐pro
BNP
resulted in a greater net reclassification improvement for predicting
MACE
than the addition of
BNP
(65% for
NT
‐pro
BNP
, 56% for
BNP
).

Conclusions

Both
BNP
and
NT
‐pro
BNP
were significant predictors of
MACE
in stable
coronary heart disease
; however,
NT
‐pro
BNP
was superior to
BNP
for net risk reclassification for
MACE
.
Distal Single Subcortical Infarction Had a Better Clinical Outcome Compared With Proximal Single Subcortical Infarction
Authors: Zhang Changqing , Wang Yilong , Zhao Xingquan , Wang David , Liu Liping , Wang Chunxue , Pu Yuehua , Zou Xinying , Du Wanliang , Jing Jing , Pan Yuesong , Wong Ka Sing , Wang Yongjun 
Published: July 2014

Background and Purpose—
Single subcortical infarction (SSI) may be classified as proximal SSI (pSSI) or distal SSI (dSSI) according to its location within the middle cerebral artery territory. Few studies have examined the differences in clinical outcome between the two. Our study investigated such differences in patients with pSSI or dSSI and examined their baseline characteristics and indicators for small-vessel disease.

Methods—
We prospectively enrolled 400 patients with SSI (208 pSSI and 192 dSSI) who had no middle cerebral artery disease on MR angiography. Data compared included clinical information, lesion size, prevalence of lacune and leukoaraiosis at baseline, National Institutes of Health Stroke Scale score and modified Rankin Scale score at discharge, and any deterioration during admission or recurrence of ischemic stroke <1 year.

Results—
In multivariable logistic regression analysis, dSSI was independently associated with patient’s history of stroke, admission National Institutes of Health Stroke Scale score ≤3, Fazekas score ≥3, presence of lacune, but not hyperlipidemia. Patients with dSSI had shorter length of hospital stay, lower rate of functional dependence at discharge (modified Rankin Scale score ≥2), and lower deterioration or recurrence risk of ischemic stroke in 1 year. Multivariable logistic regression analysis showed that factors associated with higher deterioration or recurrence risk of ischemic stroke at 1 year included female sex, history of coronary heart disease, pSSI, and not on antithrombotics <48 hours of admission.

Conclusions—
Compared with pSSI, patients with dSSI likely had small-vessel diseases but better clinical outcome.
Numerical Computations of the Latitudinal Variation of Solar Radiation for an Atmosphere of Varying Opacity
Authors: Atwater Marshall A. , Brown Philip S. 
Published: July 2014

Abstract
A model for incoming solar radiation is developed for use with readily available meteorological data and is designed for efficiency and accuracy. Purameterizations are used to account for Rayleigh and Mie scattering and for absorption by permanent gases, water vapor and aerosols. Clouds are incorporated in the model by employing Manabe and Strickler's methods, and by including the transmission functions of Haurwitz. Results compare favorably with results of more sophisticated models and with observations taken during BOMEX and IFYGL. The latitudinal effects of various aerosol concentrations in the presence of clouds are examined. For a given aerosol opacity, it is found that the doily summer insolation has larger reductions near the poles than near the equator.
Assessing the Impact of L-Band Observations on Drought and Flood Risk Estimation: A Decision-Theoretic Approach in an OSSE Environment
Authors: Kumar Sujay V. , Harrison Kenneth W. , Peters-Lidard Christa D. , Santanello Joseph A. , Kirschbaum Dalia 
Published: July 2014

AbstractObserving system simulation experiments (OSSEs) are often conducted to evaluate the worth of existing data and data yet to be collected from proposed new missions. As missions increasingly require a broader “Earth systems” focus, it is important that the OSSEs capture the potential benefits of the observations on end-use applications. Toward this end, the results from the OSSEs must also be evaluated with a suite of metrics that capture the value, uncertainty, and information content of the observations while factoring in both science and societal impacts. This article presents a soil moisture OSSE that employs simulated L-band measurements and assesses its utility toward improving drought and flood risk estimates using the NASA Land Information System (LIS). A decision-theory-based analysis is conducted to assess the economic utility of the observations toward improving these applications. The results suggest that the improvements in surface soil moisture, root-zone soil moisture, and total runoff fields obtained through the assimilation of L-band measurements are effective in providing improvements in the drought and flood risk assessments as well. The decision-theory analysis not only demonstrates the economic utility of observations but also shows that the use of probabilistic information from the model simulations is more beneficial compared to the use of corresponding deterministic estimates. The experiment also demonstrates the value of a comprehensive modeling environment such as LIS for conducting end-to-end OSSEs by linking satellite observations, physical models, data assimilation algorithms, and end-use application models in a single integrated framework.
A Thermohaline Inverse Method for Estimating Diathermohaline Circulation and Mixing
Authors: Groeskamp Sjoerd , Zika Jan D. , Sloyan Bernadette M. , McDougall Trevor J. , McIntosh Peter C. 
Published: July 2014

Abstract
The thermohaline inverse method (THIM) is presented that provides estimates of the diathermohaline streamfunction , the downgradient along-isopycnal diffusion coefficient K, and the isotropic downgradient turbulent diffusion coefficient D of small-scale mixing processes. This is accomplished by using the water mass transformation framework in two tracer dimensions: here in Absolute Salinity SA and Conservative Temperature Θ coordinates. The authors show that a diathermal volume transport down a Conservative Temperature gradient is related to surface heating and cooling and mixing, and a diahaline volume transport down an Absolute Salinity gradient is related to surface freshwater fluxes and mixing. Both the diahaline and diathermal flows can be calculated using readily observed parameters that are used to produce climatologies, surface flux products, and mixing parameterizations for K and D. Conservation statements for volume, salt, and heat in (SA, Θ) coordinates, using the diahaline and diathermal volume transport expressed as surface freshwater and heat fluxes and mixing, allow for the formulation of a system of equations that is solved by an inverse method that can estimate the unknown diathermohaline streamfunction and the diffusion coefficients K and D. The inverse solution provides an accurate estimate of , K, and D when tested against a numerical climate model for which all these parameters are known.
Water Level and Wave Height Estimates at NOAA Tide Stations from Acoustic and Microwave Sensors
Authors: Park Joseph , Heitsenrether Robert , Sweet William 
Published: July 2014

Abstract
The National Oceanic and Atmospheric Administration (NOAA) is transitioning the primary water level sensor at the majority of tide stations in the National Water Level Observation Network (NWLON) from an acoustic ranging system to a microwave radar system. Field comparison of the acoustic and microwave systems finds statistically equivalent performance when temperature gradients between the acoustic sensor and water surface are small and when significant wave height is less than roughly 0.5 m. When significant wave height is greater than approximately 0.5–1 m, the acoustic system consistently reports lower water levels. An analysis of 2 months of acoustic and microwave water level data at Duck, North Carolina, finds that the majority of differences between the two sensors can be attributed to systemic errors in the acoustic system and that the microwave system captures water level variability with higher fidelity than the acoustic system. NWLON real-time data products include the water level standard deviation, a statistic that can serve as a proxy for significant wave height. This study identifies 29 coastal water level stations that are candidates for monitoring wave height based on water level standard deviation, potentially adding a significant source of data for the sparsely sampled coastal wave fields around the United States, and finds that the microwave sensor is better suited than the acoustic system for wave height estimates.
Dynamic Vibrotactile Signals for Forward Collision Avoidance Warning Systems
Authors: Meng Fanxing , Gray Rob , Ho Cristy , Ahtamad Mujthaba , Spence Charles 
Published: July 2014

Objective: Four experiments were conducted in order to assess the effectiveness of dynamic vibrotactile collision-warning signals in potentially enhancing safe driving. Background: Auditory neuroscience research has demonstrated that auditory signals that move toward a person are more salient than those that move away. If this looming effect were found to extend to the tactile modality, then it could be utilized in the context of in-car warning signal design. Method: The effectiveness of various vibrotactile warning signals was assessed using a simulated car-following task. The vibrotactile warning signals consisted of dynamic toward-/away-from-torso cues (Experiment 1), dynamic versus static vibrotactile cues (Experiment 2), looming-intensity- and constant-intensity-toward-torso cues (Experiment 3), and static cues presented on the hands or on the waist, having either a low or high vibration intensity (Experiment 4). Results: Braking reaction times (BRTs) were significantly faster for toward-torso as compared to away-from-torso cues (Experiments 1 and 2) and static cues (Experiment 2). This difference could not have been attributed to differential responses to signals delivered to different body parts (i.e., the waist vs. hands; Experiment 4). Embedding a looming-intensity signal into the toward-torso signal did not result in any additional BRT benefits (Experiment 3). Conclusion: Dynamic vibrotactile cues that feel as though they are approaching the torso can be used to communicate information concerning external events, resulting in a significantly faster reaction time to potential collisions. Application: Dynamic vibrotactile warning signals that move toward the body offer great potential for the design of future in-car collision-warning system.
Safe removal of long-term venous catheters in the neck
Authors: Light Duncan , Subramonia Sriram , Krishna Arun 
Published: July 2014

Aims Tunnelled venous catheters are a well-established method of long-term venous access for total parental nutrition, chemotherapy and antimicrobial treatment. Removal of these catheters is a simple procedure; however, there are some significant risks. Methods We report a case in which a serious complication occurred. A simple technique for the safe removal of long-term venous catheters is described. Conclusion A direct surgical removal is now generally favoured for safe line removal. However, this still carries the same complications and care must be taken in the technique.
The Cost and Inpatient Burden of Treating Mandible Fractures: A Nationwide Inpatient Sample Database Analysis
Authors: Pena Israel , Roberts Laura Evelyn , Guy W. Marshall , Zevallos Jose P. 
Published: July 2014

ObjectiveTo discuss patient demographics, hospitalization characteristics, and costs associated with the treatment of mandible fractures.Study DesignCross‐sectional study.SettingThe 2009 Nationwide Inpatient Sample (NIS) database.Subjects/MethodsPatient demographics, hospital characteristics, fracture locations, and common comorbidities for patients with isolated mandible fractures were analyzed, and variables associated with increased cost and length of hospitalization stay were ascertained.ResultsA total of 1481 patients were identified with isolated mandible fractures. The average age was 32, 85.4% were male, 39% were Caucasian, and 25% African American. Forty percent were from the lowest median household income quartile, and 77% were uninsured or government funded. The average length of stay (LOS) was 2.65 days, and average hospitalization cost was $35,804. A statistically significant increased LOS was associated with alcohol abuse, drug abuse, mental illness, diabetes mellitus type 2, cardiovascular disease, HIV, and age over 40. There was a statistically significant increased total cost associated with drug abuse, alcohol abuse, mental illness, cardiovascular disease, and age over 40.ConclusionThe average cost for treatment of mandible fractures was $35,804 per person with increased expenditures for older patients and those with a history of mental illness, cardiovascular disease, or substance abuse. To improve outcomes and reduce hospital charges, outpatient resources and inpatient protocols should be implemented to address the factors we identified as contributing to higher costs and increased hospital stay.
Cost Analysis of Mandibular Distraction versus Tracheostomy in Neonates with Pierre Robin Sequence
Authors: Runyan Christopher M. , Uribe‐Rivera Armando , Karlea Audrey , Meinzen‐Derr Jareen , Rothchild Dawn , Saal Howard , Hopkin Robert J. , Gordon Christopher B. 
Published: July 2014

ObjectiveTo evaluate costs associated with surgical treatment for neonates with Pierre Robin sequence (PRS).Study DesignRetrospective cohort study.SettingCincinnati Children's Hospital Medical Center.Subjects and MethodsWith Institutional Review Board approval, we retrospectively studied neonates with PRS treated from 2001 to 2009 with either tracheostomy (Trach), mandibular distraction (MD), or Trach with subsequent MD (Trach+MD). Actual charges over a 3‐year period associated with operative costs, hospital stay, imaging and sleep studies, clinic visits, and related emergency room visits were collected. Home tracheostomy care charges were estimated individually for each patient. Charges were compared using regression and appropriate statistical analyses.ResultsForty‐seven neonates were included in the study (MD, n = 26; Trach, n = 12; Trach+MD, n = 9). Trach group patients had 2.6‐fold higher charges than the MD group despite no difference in length of hospital stay. This difference increased to 7.3‐fold when including home trach care‐related costs. Trach+MD group patients had longer hospital lengths of stay and higher operation room (OR) fees, but no increased total charges compared with the Trach only group.ConclusionsFor patients with severe PRS, mandibular distraction provides significant cost savings over tracheostomy ($300,000 per patient over 3 years). Increased costs with tracheostomy come from greater hospital‐related charges, more frequent airway procedures, a higher incidence of gastrostomy tube feeds, and home trach care costs. A careful examination of long‐term outcomes will be critical as mandibular distraction continues to gain acceptance for treatment of PRS.