bluuebunny/crossref_metadata_2025_split huggingface dataset:
Missed Strokes Using Computed Tomography Imaging in Patients With Vertigo
Authors: Grewal Keerat , Austin Peter C. , Kapral Moira K. , Lu Hong , Atzema Clare L. 
Published: December 2014

Background and Purpose—
The purpose of this study was to determine the proportion of emergency department (ED) patients with a diagnosis of peripheral vertigo who received computed tomography (CT) head imaging in the ED and to examine whether strokes were missed using CT imaging.

Methods—
This population-based retrospective cohort study assessed patients who were discharged from an ED in Ontario, Canada, with a diagnosis of peripheral vertigo, April 2006 to March 2011. Patients who received CT imaging (exposed) were matched by propensity score methods to patients who did not (unexposed). If performed, CT imaging was presumed to be negative for stroke because brain stem/cerebellar stroke would result in hospitalization. We compared the incidence of stroke within 30, 90, and 365 days subsequent to ED discharge between groups, to determine whether the exposed group had a higher frequency of early strokes than the matched unexposed group.

Results—
Among 41 794 qualifying patients, 8596 (20.6%) received ED head CT imaging, and 99.8% of these patients were able to be matched to a control. Among exposed patients, 25 (0.29%) were hospitalized for stroke within 30 days when compared with 11 (0.13%) among matched nonexposed patients. The relative risk of a 30- and 90-day stroke among exposed versus unexposed patients was 2.27 (95% confidence interval, 1.12–4.62) and 1.94 (95% confidence interval, 1.10–3.43), respectively. There was no difference between groups at 1 year. Strokes occurred at a median of 32.0 days (interquartile range, 4.0–33.0 days) in exposed patients, compared with 105 days (interquartile range, 11.5–204.5) in unexposed patients.

Conclusions—
One fifth of patients diagnosed with peripheral vertigo in Ontario received imaging that is not recommended in guidelines, and that imaging was associated with missed strokes.
Regional Assessments of Low Clouds against Large-Scale Stability in CAM5 and CAM-CLUBB Using MODIS and ERA-Interim Reanalysis Data
Authors: Kubar Terence L. , Stephens Graeme L. , Lebsock Matthew , Larson Vincent E. , Bogenschutz Peter A. 
Published: December 2014

Abstract
Daily gridded cloud data from MODIS and ERA-Interim reanalysis have been assessed to examine variations of low cloud fraction (CF) and cloud-top height and their dependence on large-scale dynamics and a measure of stability. To assess the stratocumulus (Sc) to cumulus (Cu) transition (STCT), the observations are used to evaluate two versions of the NCAR Community Atmosphere Model version 5 (CAM5), both the base model and a version that has implemented a new subgrid low cloud parameterization, Cloud Layers Unified by Binormals (CLUBB).
The ratio of moist static energy (MSE) at 700–1000 hPa (MSEtotal) is a skillful predictor of median CF of screened low cloud grids. Values of MSEtotal less than 1.00 represent either conditionally or absolutely unstable layers, and probability density functions of CF suggest a preponderance of either trade Cu (median CF &lt; 0.4) or transitional Sc clouds (0.4 &lt; CF &lt; 0.9). With increased stability (MSEtotal &gt; 1.00), an abundance of overcast or nearly overcast low clouds exists. While both MODIS and ERA-Interim indicate a fairly smooth transition between the low cloud regimes, CAM5-Base simulates an abrupt shift from trade Cu to Sc, with trade Cu covering both too much area and occurring over excessively strong stabilities. In contrast, CAM-CLUBB simulates a smoother trade Cu to Sc transition (CTST) as a function of MSEtotal, albeit with too extensive coverage of overcast Sc in the primary northeastern Pacific subsidence region. While the overall CF distribution in CAM-CLUBB is more realistic, too few transitional clouds are simulated for intermediate MSEtotal compared to observations.
Book Review: National Archives of India, Imperial Records Department, Calendar of Persian Correspondence: Being Letters, referring mainly to Affairs in Bengal, which passed between some of the Company’s Servants and Indian Rulers and Notables, Vols I-V
Authors: Arafath P.K. Yasser 
Published: December 2014

National Archives of India, Imperial Records Department, Calendar of Persian Correspondence: Being Letters, referring mainly to Affairs in Bengal, which passed between some of the Company’s Servants and Indian Rulers and Notables, Vol. 1, 1759–1767, Delhi: Primus Books, 2013, pp. 509; National Archives of India, Imperial Records Department, Calendar of Persian Correspondence: Being Letters which passed between some of the Company’s Servants and Indian Rulers and Notables, Vol. II, 1767–1769, Delhi: Primus Books, 2013, pp. 470 + supplement; National Archives of India, Imperial Records Department, Calendar of Persian Correspondence: Being Letters which passed between some of the Company’s Servants and Indian Rulers and Notables, Vol. III, 1770–1772, Delhi: Primus Books, 2013, pp. 285; National Archives of India, Imperial Records Department, Calendar of Persian Correspondence: Being Letters which passed between some of the Company’s Servants and Indian Rulers and Notables, Vol. IV, 1772–1775, Delhi: Primus Books, 2013, pp. 365; National Archives of India, Imperial Records Department, Calendar of Persian Correspondence: Being Letters which passed between some of the Company’s Servants and Indian Rulers and Notables, Vol. V, 1776–1780, Delhi: Primus Books, 2013, pp. 507.
Long-term outcomes of patients on the 1988 West of Scotland renal transplant waiting list
Authors: Murray Eleanor C , McMillan Margaret 
Published: December 2014

Background The prevalent population with established renal failure continues to grow. Method Using the Renal Electronic Patient Record, we assess the long-term outcomes of the adult population in the West of Scotland who were awaiting kidney transplantation in 1988 ( n = 219), and compare the demographics to the 2011 transplant waiting list ( n = 409). Results Comparing the 2011 transplant waiting list, there are now more patients, but they are older, more likely to be female, and are more likely to have diabetes as a cause of renal failure. Seventy-four percent received a transplant; of these, 41% of the transplants ultimately failed and the patient returned to dialysis; 39% of patients died with a functioning graft and 20% remain alive with continuing transplant function. Life expectancy for those with renal failure was less than 60 years, significantly lower than the general population, though 29% survived for 20 years, half of these with a functioning kidney transplant and half having returned to dialysis. Conclusion As survival with a transplant improves, attention is required to reduce the causes of mortality, in particular cardiovascular disease, and malignancy and infection associated with immunosuppression.
Screening and management of gestational diabetes mellitus in Scottish obstetric units: a national survey
Authors: Stirrat Laura I , Denison Fiona C , Love Corinne DB , Lindsay Robert S , Reynolds Rebecca M 
Published: December 2014

Background and aims The last study of screening practices for gestational diabetes (GDM) in the UK concluded that a lack of consensus about screening was due to a lack of clinical guidelines. We aimed to determine current practices in Scotland since new guidelines recommended that diagnosis should be made at a lower level of hyperglycaemia. Method and results An online questionnaire designed to investigate the screening and management of GDM was distributed to all maternity units in Scotland managing women with GDM ( n = 15) for completion by relevant clinical team members. The response rate was 100%. Considerable variation in clinical practice existed between units. Thirteen units (86.7%) had adopted the lower glucose tolerance values for diagnosis of GDM (fasting ≥5.1 mmol/L; 2-h ≥8.5 mmol/L) recommended by the Scottish Intercollegiate Guidelines Network in 2010. Available data from units using this guideline ( n = 3) revealed a significant increase in the percentage of women diagnosed with GDM between 2010 and 2012 (2010: 1.28%, 2012: 2.54%; p < 0.0001). Conclusion Despite provision of clinical guidelines, there are still inconsistencies in screening and management of GDM in Scotland. If a similar increase in the prevalence of GDM is experienced across Scotland, there will be major implications for health care provision and resource allocation.
Objectively measured physical activity in obese women with and without migraine
Authors: Bond Dale S , Thomas J Graham , O’Leary Kevin C , Lipton Richard B , Peterlin B Lee , Roth Julie , Rathier Lucille , Wing Rena R 
Published: December 2014

Aim The aim of this article is to cross-sectionally compare objectively measured physical activity (PA) levels and their association with migraine characteristics in obese women with and without migraine. Methods Obese women seeking weight loss treatment were divided into migraine ( n = 25) and control ( n = 25) groups matched by age and body mass index (BMI). Participants wore the SenseWear Armband monitor for seven days to objectively evaluate daily light-(LPA) and moderate-to-vigorous intensity PA (MVPA). Migraine diagnosis was confirmed by a neurologist using ICHD-3-beta criteria. Migraine characteristics were tracked daily using a smartphone-based diary over a four-week period immediately preceding the objective PA assessment. Results Migraine participants spent 57.9 fewer minutes/day in LPA (141.1 ± 56.4 vs. 199.1 ± 87.7, p = 0.019) and 24.5 fewer minutes/day in MVPA (27.8 ± 17.0 vs. 52.3 ± 26.0, p < 0.001), compared to controls. Migraine participants reported 4.8 ± 3.1 migraine days/month (mean duration = 17.1 ± 8.9 hours; mean maximum pain severity = 6.4 ± 1.7 on a 0–10 scale). Higher BMI ( p < 0.05), but not migraine characteristics, were related to lower total PA. Additionally, total objectively measured PA was not associated with how often PA was reported to exacerbate migraine attacks during the four-week diary assessment. Conclusions Obese women with migraine spent nearly 1.5 hours/day less in PA compared to controls; however, lower PA was not related to migraine characteristics. Further research is needed to identify PA barriers and effective interventions in obese women with migraine.
Secondary Data Analyses From Published Descriptive Statistics
Authors: Nimon Kim 
Published: December 2014

The Problem The need for human resource development (HRD) to develop theory that will lead to improved practice was recognized in published literature in 2002. Two years after Holton’s initial mandate for theory in HRD, Torraco identified the need for researchers to “interpret old data in new ways” as a core role for theory development in HRD research. Yet over a decade later, few scholarly articles published in journals dedicated to HRD report on secondary data analyses (i.e., interpret old data in new ways). Even fewer have considered how quantitative analysis of secondary data can be used to inform theory. The Solution A three-pronged solution is provided to address the void of secondary data analyses reported in HRD literature. First, this article demonstrates how secondary data analyses can be conducted using only published descriptive statistics as data. Second, it presents user-friendly software to aid scholars and scholar-practitioners in their pursuit of such analyses. Third, it reviews the concept of the general linear model (GLM) as the technique presented is limited to supporting quantitative statistical analyses that fall within the GLM. The Stakeholders Stakeholders include scholars and scholar-practitioners who are interested in conducting quantitative data analyses to inform HRD theory. In addition, scholars and scholar-practitioners who conduct scholarly reviews of academic literature will see why it is important for authors to comply with reporting guidelines that call for relevant descriptive statistics such as means, standard deviations, and correlation matrices to be included in quantitative research reports.
Mediating Analysis Approaches
Authors: Song Ji Hoon , Lim Doo Hun 
Published: December 2014

The Problem In HRD research, while mediation research is receiving more attention, less is known about to what extent it has been used and what methodological approaches have been adopted by HRD researchers. Also, several critical methodological issues such as the common method variance (CMV) are often indicated by researchers who utilize mediational analysis in their studies. These issues have been known to hinder sound theory-building efforts among HRD researchers. The Solution In addressing the problems, the purpose of this research is to examine the mediation studies conducted in the HRD discipline and to identify the general trends of mediation research and the frequently used analytical approaches supporting theory-building efforts of HRD researchers. The Academy of Human Resource Development (AHRD) journals between 2000 and 2014 were the primary research sample. Also, this study identifies various threats to conducting reliable and valid mediation studies through a thorough review of existing mediation studies from the AHRD journals. The Stakeholders Stakeholders include researchers conducting mediation studies in the HRD discipline currently and in the future, and practitioners who utilize mediation study findings for improving workplace performance. Based on the study findings, statistical and theoretical implications for future HRD research are discussed, and practical recommendations are drawn for HRD practitioners for workplace application.
Unsuccessful trial accrual and human subjects protections: An empirical analysis of recently closed trials
Authors: Carlisle Benjamin , Kimmelman Jonathan , Ramsay Tim , MacKinnon Nathalie 
Published: December 2014

Background Ethical evaluation of risk–benefit in clinical trials is premised on the achievability of resolving research questions motivating an investigation. Objective To determine the fraction and number of patients enrolled in trials that were at risk of not meaningfully addressing their primary research objective due to unsuccessful patient accrual. Methods We used the National Library of Medicine clinical trial registry to capture all initiated phases 2 and 3 intervention clinical trials that were registered as closed in 2011. We then determined the number that had been terminated due to unsuccessful accrual and the number that had closed after less than 85% of the target number of human subjects had been enrolled. Five factors were tested for association with unsuccessful accrual. Results Of 2579 eligible trials, 481 (19%) either terminated for failed accrual or completed with less than 85% expected enrolment, seriously compromising their statistical power. Factors associated with unsuccessful accrual included greater number of eligibility criteria (p = 0.013), non-industry funding (25% vs 16%, p < 0.0001), earlier trial phase (23% vs 16%, p < 0.0001), fewer number of research sites at trial completion (p < 0.0001) and at registration (p < 0.0001), and an active (non-placebo) comparator (23% vs 16%, p < 0.001). Conclusion A total of 48,027 patients had enrolled in trials closed in 2011 who were unable to answer the primary research question meaningfully. Ethics bodies, investigators, and data monitoring committees should carefully scrutinize trial design, recruitment plans, and feasibility of achieving accrual targets when designing and reviewing trials, monitor accrual once initiated, and take corrective action when accrual is lagging.
The Accuracy of Diagnostic and Haemodynamic Data Obtained by Transthoracic Echocardiography in Critically Ill Adults: A Systematic Review
Authors: Colebourn Claire , Barber Vikki , Salmon Jon B , Young Duncan 
Published: December 2014

We systematically assessed the utility of diagnostic data and the accuracy of haemodynamic data obtained by transthoracic echocardiography in critically ill adults, by examination of prospective studies in unselected adult intensive care patients. Of the ten studies identified, three examined the diagnostic utility of transthoracic echocardiography. Thirty-eight percent of clinical questions were answered by a single transthoracic echocardiogram. The weighted mean percentage of clinical findings yielded by transoesophageal echocardiography not found by the transthoracic approach was 33% (range 28–50%). Four studies examined the correlation between transthoracic echocardiographic estimation of pulmonary artery occlusion pressure and pulmonary artery catheter-derived measurement. Correlation was strong in all studies: for example in one study r=0.98, p<0.001, with a mean difference of 0.0 (2.5) mm Hg by the Bland-Altman technique. Three studies examined the correlation between transthoracic echocardiography and thermodilution-derived cardiac output measurement. Correlation varied with the echocardiographic technique used and correlated best with Dopplerderived measurement: r=0.93, p<0.0001, mean difference of 0.2 (0.82) litres per minute. The diagnostic utility of transthoracic echocardiography compared with transoesophageal echocardiography in the critically ill cannot be reliably assessed from the available studies. More relevantly designed studies are required. Transthoracic echocardiography can accurately estimate pulmonary artery occlusion pressure, but the technique requires the patient to be in sinus rhythm. Transthoracic echocardiography can also accurately estimate cardiac output in the critically ill. Further studies should concentrate on Doppler-based assessments. The scene is now set for the development of this valuable non-invasive tool.
Patient Confidentiality and the Intensivist
Authors: Kotak Dee , Lawson Andrew 
Published: December 2014

Confidentiality is a patient's right and is central to trust between doctors and patients. Any disclosure and use of confidential patient information needs to be both lawful and ethical. The duty of confidentiality arises out of the common law of confidentiality, the Human Rights Act, General Medical Council guidelines, NHS staff employment contracts and ethical mores. Breaches of confidence, inappropriate use of health records or abuse of computer systems may lead to disciplinary measures, bringing into question professional registration and possibly resulting in legal proceedings. Whilst law and ethics in this area are largely in step, the law provides a minimum standard that does not always reflect the appropriate ethical standards that the government and the professional regulatory bodies require. The duty to preserve confidentiality can present intensivists with ethical and/or legal dilemmas. This article summarises the general principles of confidentiality and reviews the legal and professional requirements that intensivists need to be cognisant of when dealing with third party requests for patient information.
A Protocol Mandating a Daily Interruption of Sedatives and Spontaneous Breathing Trial Improves Patient Outcome
Authors: Irvine Michael , Cairns Chris 
Published: December 2014

In critically ill, mechanically ventilated, non-surgical patients, a protocol pairing daily mandatory sedation breaks (spontaneous awakening trials – SAT) with spontaneous breathing trials (SBT) results in earlier extubation, shorter ICU stay, shorter hospital stay and lower mortality at one year (NNT=7) compared to standard care. Level of evidence: 1++ (RCT with a low risk of bias)
Low Dose Epoetin Alfa in Critically Ill Patients
Authors: Tanner Oona , Cairns Chris 
Published: December 2014

Use of low dose epoetin alfa in the critically ill does not reduce the number of patients requiring blood transfusion, or units of red blood cells transfused. There may be a mortality benefit in trauma patients. Epoetin alfa is associated with an increased risk of thrombotic events. Level of evidence: 1++ (RCT with a very low risk of bias)
Special Section – Sedation in Intensive Care Seminar
Authors: Gunning Kevin 
Published: December 2014

Sedation is one of the commonest therapies that we use in intensive care. An international survey of 3,500 patients in 2005 showed that 68% of patients who were ventilated for more than 12 hours received sedation at some time during their stay in intensive care. Although we prescribe sedation on a daily basis, we do not always do so well, or give it the attention it deserves. It is only over the last ten years that we have begun to be aware of the importance of sedation and its impact on the way we care for our patients. We are more aware of the potential harm resulting from the way in which we sedate patients and the drugs that we use. Hopefully we have moved away from the scenario Thomas Petty described in 1998, “I am troubled today when I make rounds in critical care…., but what I see these days are paralysed, sedated patients lying without motion appearing to be dead.” Patients today are more likely to be awake and comfortable on a ventilator. We have begun to investigate the consequences of over sedation, such as delirium and post traumatic stress disorder. There is still a long way to go however, before we can say that we have implemented the current evidence base into our daily clinical practice. The three articles on sedation in this edition of JICS are based on talks given at a one day ICS Symposium in July of this year which was sponsored by GSK who have also supported the publication of these articles. The feedback from the seminar was very positive and shows there is a real interest in the subject. We hope to repeat the seminar next year to coincide with the publication of the ICS guidelines on sedation and analgesia.
Low dose Vasopressin in Septic Shock
Authors: Docking Robert , Rooney Kevin , Cairns Chris 
Published: December 2014

The addition of low-dose vasopressin to the treatment of septic shock does not reduce mortality compared to the use of norepinephrine alone, but allows a rapid reduction in norepinephrine requirements. Level of evidence: 1+ (RCT with a very low risk of bias)
Prone Positioning has no Effect on Mortality in ARDS
Authors: Puxty Alex , Cairns Chris , Daniel Malcolm 
Published: December 2014

In patients with acute respiratory distress syndrome (ARDS), prone positioning improves oxygenation but has no impact on mortality, except perhaps in those with Simplified Acute Physiology Score (SAPS) II >50. Level of evidence: 1+ (SR based on small RCTs, conducted prior to ARDSNet – subsequent change in practice)
Silver-Coated Endotracheal Tubes and the Incidence of Ventilator-Associated Pneumonia
Authors: Bongale Santosh , Cairns Chris 
Published: December 2014

The use of silver coated endotracheal (ET) tubes leads to statistically significant reduction in ventilator associated pneumonia (VAP) during the first 10 days of intubation. However methodological flaws lead to doubts over the clinical validity of this result. Level of evidence: 1− (RCT with a high risk of bias)