bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol Consumption at Midlife and Risk of Stroke During 43 Years of Follow-Up
Authors: Kadlecová Pavla , Andel Ross , Mikulík Robert , Handing Elizabeth P. , Pedersen Nancy L. 
Published: January 2015

Background and Purpose—
Although alcohol–stroke association is well known, the age-varying effect of alcohol drinking at midlife on subsequent stroke risk across older adulthood has not been examined. The effect of genetic/early-life factors is also unknown. We used cohort and twin analyses of data with 43 years of follow-up for stroke incidence to help address these gaps.

Methods—
All 11 644 members of the population-based Swedish Twin Registry born 1886 to 1925 with alcohol data aged ≤60 years were included. The interaction of midlife alcohol consumption by age at stroke was evaluated in Cox-regression and analyses of monozygotic twins were used. Covariates were baseline age, sex, cardiovascular diseases, diabetes mellitus, stress reactivity, depression, body mass index, smoking, and exercise.

Results—

Altogether 29% participants developed stroke. Compared with very-light drinkers (<0.5 drink/d), heavy drinkers (>2 drinks/d) had greater risk of stroke (hazard ratio, 1.34;
P
=0.02) and the effect for nondrinkers approached significance (hazard ratio, 1.11;
P
=0.08). Age increased stroke risk for nondrinkers (
P
=0.012) and decreased it for heavy drinkers (
P
=0.040). Midlife heavy drinkers were at high risk from baseline until the age of 75 years when hypertension and diabetes mellitus grew to being the more relevant risk factors. In analyses of monozygotic twin-pairs, heavy drinking shortened time to stroke by 5 years (
P
=0.04).

Conclusions—
Stroke-risk associated with heavy drinking (>2 drinks/d) in midlife seems to predominate over well-known risk factors, hypertension and diabetes, until the age of ≈75 years and may shorten time to stroke by 5 years above and beyond covariates and genetic/early-life factors. Alcohol consumption should be considered an age-varying risk factor for stroke.
Factors Influencing Sex Differences in Poststroke Functional Outcome
Authors: Lisabeth Lynda D. , Reeves Mathew J. , Baek Jonggyu , Skolarus Lesli E. , Brown Devin L. , Zahuranec Darin B. , Smith Melinda A. , Morgenstern Lewis B. 
Published: January 2015

Background and Purpose—
Our objective was to identify factors that contribute to or modify the sex difference in poststroke functional outcome.

Methods—
Ischemic strokes (n=439) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2008–2011). Data were ascertained from interviews (baseline and 90 days post stroke) and medical records. Functional outcome was measured as an average of 22 activities of daily living (ADL)/instrumental ADL items (range, 1–4; higher scores worse function). Tobit regression was used to estimate sex differences and to identify confounding and modifying factors.

Results—

Fifty-one percent were women. Median age was 71 (interquartile range, 59–80) years in women and 64 (interquartile range, 56–77) years in men. Median ADL/instrumental ADL score at 90 days was 2.7 (interquartile range, 1.8–3.6) in women and 2.0 (interquartile range, 1.3–3.1) in men (
P
<0.01); this difference remained after age-adjustment (
P
<0.001). Factors contributing to higher ADL/instrumental ADL scores in women included prestroke function, marital status, prestroke cognition, nursing home residence, stroke severity, history of stroke/transient ischemic attack, and body mass index; prestroke function was the largest contributor. Stroke severity modified the sex difference in outcome such that differences were apparent for mild to moderate but not severe strokes. After adjustment, women still had significantly worse functional outcome than men.

Conclusions—
These findings yield insight into possible strategies and subgroups to target to reduce the sex disparity in stroke outcome; demographics and prestroke and clinical factors explained only 41% of the sex difference in stroke outcome highlighting the need for future research to identify modifiable factors that contribute to sex differences.
Improved Prehospital Triage of Patients With Stroke in a Specialized Stroke Ambulance
Authors: Wendt Matthias , Ebinger Martin , Kunz Alexander , Rozanski Michal , Waldschmidt Carolin , Weber Joachim E. , Winter Benjamin , Koch Peter M. , Freitag Erik , Reich Jenrik , Schremmer Daniel , Audebert Heinrich J. 
Published: January 2015

Background and Purpose—
Specialized management of patients with stroke is not available in all hospitals. We evaluated whether prehospital management in the Stroke Emergency Mobile (STEMO) improves the triage of patients with stroke.

Methods—
STEMO is an ambulance staffed with a specialized stroke team and equipped with a computed tomographic scanner and point-of-care laboratory. We compared the prehospital triage of patients with suspected stroke at dispatcher level who either received STEMO care or conventional care. We assessed transport destination in patients with different diagnoses. Status at hospital discharge was used as short-term outcome.

Results—

From May 2011 to January 2013, 1804 of 6182 (29%) patients received STEMO care and 4378 of 6182 (71%) patients conventional care. Two hundred forty-five of 2110 (11.6%) patients with cerebrovascular events were sent to hospitals without Stroke Unit in conventional care when compared with 48 of 866 (5.5%;
P
<0.01%) patients in STEMO care. In patients with ischemic stroke, STEMO care reduced transport to hospitals without Stroke Unit from 10.1% (151 of 1497) to 3.9% (24 of 610;
P
<0.01). The delivery rate of patients with intracranial hemorrhage to hospitals without neurosurgery department was 43.0% (65 of 151) in conventional care and 11.3% (7 of 62) in STEMO care (
P
<0.01). There was a slight trend toward higher rates of patients discharged home in neurological patients when cared by STEMO (63.5% versus 60.8%;
P
=0.096).

Conclusions—
The triage of patients with cerebrovascular events to specialized hospitals can be improved by STEMO ambulances.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01382862.
Variability and Trends of Global Atmospheric Frontal Activity and Links with Large-Scale Modes of Variability
Authors: Rudeva Irina , Simmonds Ian 
Published: January 2015

AbstractPresented here is a global analysis of frontal activity variability derived from ERA-Interim data over the 34-yr period of January 1979–March 2013 using a state-of-the-art frontal tracking scheme. In December–February over that epoch, there is a northward shift of frontal activity in the Pacific in the Northern Hemisphere (NH). In the Southern Hemisphere (SH), the largest trends are identified in the austral summer and are manifested by a southward shift of frontal activity over the Southern Ocean.Variability of frontal behavior is found to be closely related to the main modes of atmospheric circulation, such as the North Atlantic Oscillation (NAO) for the Atlantic–European sector in the NH and the southern annular mode (SAM) in the middle and high latitudes of the SH. A signal associated with El Niño and hence emanating from the tropics is also apparent in the behavior of frontal systems over the Pacific by a reduction in the number of fronts in the middle South Pacific and intensification of frontal activity in high and low latitudes throughout the year. It is shown in general that the associations of the large-scale modes with frontal variability are much stronger than with cyclones. This indicates that the quantification of the behavior of fronts is an important component of understanding the climate system. At the very high latitudes, it is also shown here that, in the recent years of rapid sea ice reduction in the Arctic, there have been fewer summer fronts observed over the Canadian Arctic.
Probabilistic Concepts in a Changing Climate: A Snapshot Attractor Picture
Authors: Drótos Gábor , Bódai Tamás , Tél Tamás 
Published: January 2015

AbstractThe authors argue that the concept of snapshot attractors and of their natural probability distributions are the only available tools by means of which mathematically sound statements can be made about averages, variances, etc., for a given time instant in a changing climate. A basic advantage of the snapshot approach, which relies on the use of an ensemble, is that the natural distribution and thus any statistics based on it are independent of the particular ensemble used, provided it is initiated in the past earlier than a convergence time. To illustrate these concepts, a tutorial presentation is given within the framework of a low-order model in which the temperature contrast parameter over a hemisphere decreases linearly in time. Furthermore, the averages and variances obtained from the snapshot attractor approach are demonstrated to strongly differ from the traditional 30-yr temporal averages and variances taken along single realizations. The authors also claim that internal variability can be quantified by the natural distribution since it characterizes the chaotic motion represented by the snapshot attractor. This experience suggests that snapshot-attractor-based calculations might be appropriate to be evaluated in any large-scale climate model, and that the application of 30-yr temporal averages taken along single realizations should be complemented with this more appealing tool for the characterization of climate changes, which seems to be practically feasible with moderate ensemble sizes.
Managing the crises – how did local governments react to the financial crisis in 2008 and what explains the differences? The case of Swiss municipalities
Authors: Ladner Andreas , Soguel Nils 
Published: January 2015

Swiss municipalities are, to a large extent, responsible for their financial resources. Since these resources primarily depend on income and property taxes from individuals and enterprises, municipality budgets are likely to be directly affected by the current crisis in the financial sector and the economy. This article investigates how municipalities perceived this threat and how they reacted to it. In a nationwide survey conducted at the end of 2009 in all 2596 Swiss municipalities, we asked local secretaries which measures had been launched in order to cope with expected losses in tax income and a possible increase in welfare spending. Did the municipalities rely on Keynesian measures increasing public spending and accepting greater deficits, or did they try to avoid further deficits by using austerity measures and a withdrawal of planned investments? Our results show that only a few municipalities – mainly the bigger ones – expected to be greatly affected by the crisis. Their reactions, however, did not reveal any clear patterns that theory would lead one to expect. Preferences for austerity measures and deficit spending become visible but many municipalities took measures from both theories. The strongest explanatory factors for determining how/why municipalities react are: the municipality’s level of affectedness followed by whether or not the municipality belongs to the French-speaking part of the country. Size also has an impact, whereas the strength of the Social Democrat party is negligible. Explaining what kind of measures municipalities are likely to take is more difficult. However, the more a municipality is affected, the more likely it is to stick to austerity measures. Points for practitioners How to react to a financial crisis is not only a challenging question to answer for the scientific community but also for practitioners being confronted with the crucial decisions to be taken. This contribution shows that the theoretical debates stipulating the exclusiveness of deficit spending or austerity measures is hardly reflecting reality, at least not at the local level. Policymakers are well advised to cut down expenditure and to invest where necessary. This is, at least, what can be learned from the practices of the Swiss municipalities after the 2008 crisis.
End-of-life care in the intensive care unit: A patient-based questionnaire of intensive care unit staff perception and relatives’ psychological response
Authors: Hartog Christiane S , Schwarzkopf Daniel , Riedemann Niels C , Pfeifer Ruediger , Guenther Albrecht , Egerland Kati , Sprung Charles L , Hoyer Heike , Gensichen Jochen , Reinhart Konrad 
Published: January 2015

Background: Communication is a hallmark of end-of-life care in the intensive care unit. It may influence the impact of end-of-life care on patients’ relatives. We aimed to assess end-of-life care and communication from the perspective of intensive care unit staff and relate it to relatives’ psychological symptoms. Design: Prospective observational study based on consecutive patients with severe sepsis receiving end-of-life care; trial registration NCT01247792. Setting/participants: Four interdisciplinary intensive care units of a German University hospital. Responsible health personnel (attendings, residents and nurses) were questioned on the day of the first end-of-life decision (to withdraw or withhold life-supporting therapies) and after patients had died or were discharged. Relatives were interviewed by phone after 90 days. Results: Overall, 145 patients, 610 caregiver responses (92% response) and 84 relative interviews (70% response) were analysed. Most (86%) end-of-life decisions were initiated by attendings and only 2% by nurses; 41% of nurses did not know enough about end-of-life decisions to communicate with relatives. Discomfort with end-of-life decisions was low. Relatives reported high satisfaction with decision-making and care, 87% thought their degree of involvement had been just right. However, 51%, 48% or 33% of relatives had symptoms of post-traumatic stress disorder, anxiety or depression, respectively. Predictors for depression and post-traumatic stress disorder were patient age and relatives’ gender. Relatives’ satisfaction with medical care and communication predicted less anxiety ( p = 0.025). Conclusion: Communication should be improved within the intensive care unit caregiver team to strengthen the involvement of nurses in end-of-life care. Improved communication between caregivers and the family might lessen relatives’ long-term anxiety.
What’s in a name? A qualitative exploration of what is understood by “palliative care” in the emergency department
Authors: Weil Jennifer , Weiland Tracey J , Lane Heather , Jelinek George A , Boughey Mark , Marck Claudia H , Philip Jennifer 
Published: January 2015

Background: The understanding of what palliative care is, and which patients may benefit from palliative care, has important implications for optimal patient care in all areas of health provision. Aim: To explore the understanding of palliative care by healthcare professionals caring for patients with advanced cancer attending emergency departments. Design: Qualitative study, with two phases: the first, a series of focus groups with healthcare professionals from various disciplines and settings caring for patients with advanced cancer presenting to emergency departments; the second, semi-structured telephone interviews with emergency healthcare professionals across Australian States and Territories, including outside metropolitan centers. The data were audio-recorded and transcribed, with analysis undertaken using a qualitative thematic analysis. Setting/participants: Saturation of themes was reached after 8 focus groups (22 emergency nurses, 21 emergency physicians, 6 oncologists, 6 hospital palliative care clinicians, and 28 community palliative care clinicians) and 11 telephone interviews (8 emergency physicians and 3 emergency nurses), a total of 94 participants. Results: The overarching theme was that healthcare professionals held contradictory understandings of palliative care and its application in the emergency department; subthemes highlighted these inconsistencies when the term “palliative” is used, in understandings of and engagement with palliative care services and in perceptions about the practical utility of palliative care. Conclusion: There are entrenched contradictions and tensions surrounding the term “palliative care”; confronting these is likely to require more than re-branding, and will promote better care for this vulnerable patient group in the emergency department.
Hospital rapid response team and patients with life-limiting illness: A multicentre retrospective cohort study
Authors: Sulistio Merlina , Franco Michael , Vo Amanda , Poon Peter , William Leeroy 
Published: January 2015

Background: Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered. Aims: We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness. Design/Setting: A 3-month retrospective cohort study of all rapid response team consultations was conducted. The sample population included all adult inpatients in a major teaching hospital network. Results: We identified 351 patients – including 139 with a life-limiting illness – receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 years), more likely to come from a residential aged-care facility (29.5% vs 4.1%) and had a shorter hospital stay (10 vs 13 days). Rapid response team consultations resulted in a change to more palliative goals of care in 28.5% of patients, of whom two-thirds had a life-limiting illness. Conclusion: Patients with a life-limiting illness had worse outcomes post–rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.
Life-and-death decision-making in the acute phase after a severe stroke: Interviews with relatives
Authors: de Boer Marike E , Depla Marja , Wojtkowiak Joanna , Visser Marieke C , Widdershoven Guy AM , Francke Anneke L , Hertogh Cees MPM 
Published: January 2015

Background: Decision-making in the acute phase after a severe stroke is complex and may involve life-and-death decisions. Apart from the medical condition and prognosis, quality of life and the deliberation of palliative care should be part of the decision-making process. Relatives play an important role by informing physicians about the patient’s values and preferences. However, little is known about how the patients’ relatives experience the decision-making process. Aim: To elicit the perspective of relatives of severe stroke patients with regard to the decision-making process in the acute phase in order to understand how they participate in treatment decisions. Design: An exploratory qualitative interview approach guided by the principles of grounded theory. Settings/participants: Relatives of severe stroke patients ( n = 15) were interviewed about their experiences in the decision-making process in the acute phase. Results: Four categories reflecting relatives’ experiences were identified: (1) making decisions under time pressure, (2) the feeling of ‘who am I’ to decide, (3) reluctance in saying ‘let her die’ and (4) coping with unexpected changes. Following the treatment proposal of the physician was found to be the prevailing tendency of relatives in the decision-making process. Conclusion: A better understanding of the latent world of experiences of relatives that influence the decision-making process may help physicians and other health-care providers to better involve relatives in decision-making and enhance the care, including palliative care, for patients with severe stroke in line with their values and preferences. Communication between physician and relatives seems vital in this process.
Characteristics of episodic breathlessness as reported by patients with advanced chronic obstructive pulmonary disease and lung cancer: Results of a descriptive cohort study
Authors: Weingärtner Vera , Scheve Christine , Gerdes Verena , Schwarz-Eywill Michael , Prenzel Regina , Otremba Burkhard , Mühlenbrock Juliane , Bausewein Claudia , Higginson Irene J , Voltz Raymond , Herich Lena , Simon Steffen T 
Published: January 2015

Background: Episodic breathlessness is one form of refractory breathlessness. Better understanding of the symptom is necessary for effective management. Aim: The aim was to describe the characteristics of episodic breathlessness in patients with advanced chronic obstructive pulmonary disease or lung cancer. Design: This is a longitudinal cohort study. Outcomes were assessed monthly by up to 13 telephone interviews: peak severity (modified Borg scale: 0–10), duration, frequency, and timing of breathlessness episodes. Data from each episode were pooled and analyzed using descriptive statistics. Associations between outcomes were explored by correlation coefficients. Setting/participants: Patients with chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease classification stage III or IV) or primary lung cancer (any stage) were recruited in two inpatient units (internal medicine) and two outpatient clinics in Oldenburg, Germany. Results: A total of 82 patients (50 chronic obstructive pulmonary disease, 32 lung cancer), mean age (standard deviation) 67 years (8 years) and 36% female, were included reporting on 592 breathlessness episodes (chronic obstructive pulmonary disease: 403, lung cancer: 189). Peak severity was perceived significantly higher in chronic obstructive pulmonary disease patients than in lung cancer patients (mean (standard deviation) Borg scale: 6.2 (2.1) vs 4.2 (1.9); p < 0.001). Episodes described by chronic obstructive pulmonary disease patients were longer than those described by lung cancer patients (median (range): 7 min (0–600) vs 5 min (0.3–120), p = 0.002)). Frequency was similar and most often daily in both groups. Severity and frequency of episodes were correlated in lung cancer patients (r = 0.324, p = 0.009). Conclusion: Most breathlessness episodes are short (minutes) and severe with significant differences between chronic obstructive pulmonary disease and lung cancer patients. Effective management strategies are warranted to improve symptom relief and coping.