bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provoked Right-to-Left Shunt in Patent Foramen Ovale Associates With Ischemic Stroke in Posterior Circulation
Authors: Kim Bum Joon , Kim Na-Young , Kang Dong-Wha , Kim Jong S. , Kwon Sun U. 
Published: October 2014

Background and Purpose—
Right-to-left shunt (RLS) via the patent foramen ovale is an important cause of cryptogenic stroke. The Valsalva maneuver provokes or enhances RLS, but RLS can also occur during normal respiration. This study examined whether the ischemic lesion pattern differs depending on the character of RLS.

Methods—
All consecutive patients with a patent foramen ovale (diagnosed by transesophageal echocardiography) who had a cryptogenic stroke and underwent transcranial Doppler–patent foramen ovale test (monitoring of microbubbles in the right middle cerebral artery by transcranial Doppler after hand-agitated saline injection) were divided according to whether RLS was constant (microbubbles detected both at baseline and after the Valsalva maneuver) or provoked (microbubbles detected only after the Valsalva maneuver). The groups were compared in terms of clinical and imaging characteristics.

Results—

Seventy-six patients met the eligibility criteria: 50 had constant RLS and 26 had provoked RLS. Provoked RLS patients were significantly younger. The ischemic lesions in provoked RLS patients were located predominantly in the vertebro-basilar circulation (73.1% versus 28.0%;
P
=0.002), whereas constant RLS patients were more likely to have multicirculatory lesions (16.0% versus 0.0%;
P
=0.045). After adjusting for confounders, provoked RLS associated independently with a vertebro-basilar lesion location (OR=3.306;
P
=0.03).

Conclusions—
The predominance of posterior-circulatory infarction in provoked RLS patients suggests that the Valsalva maneuver may promote RLS and paradoxical embolization to the posterior circulation.
Dominance of the Southern Ocean in Anthropogenic Carbon and Heat Uptake in CMIP5 Models
Authors: Frölicher Thomas L. , Sarmiento Jorge L. , Paynter David J. , Dunne John P. , Krasting John P. , Winton Michael 
Published: October 2014

Abstract
The authors assess the uptake, transport, and storage of oceanic anthropogenic carbon and heat over the period 1861–2005 in a new set of coupled carbon–climate Earth system models conducted for the fifth phase of the Coupled Model Intercomparison Project (CMIP5), with a particular focus on the Southern Ocean. Simulations show that the Southern Ocean south of 30°S, occupying 30% of global surface ocean area, accounts for 43% ± 3% (42 ± 5 Pg C) of anthropogenic CO2 and 75% ± 22% (23 ± 9 × 1022 J) of heat uptake by the ocean over the historical period. Northward transport out of the Southern Ocean is vigorous, reducing the storage to 33 ± 6 Pg anthropogenic carbon and 12 ± 7 × 1022 J heat in the region. The CMIP5 models, as a class, tend to underestimate the observation-based global anthropogenic carbon storage but simulate trends in global ocean heat storage over the last 50 years within uncertainties of observation-based estimates. CMIP5 models suggest global and Southern Ocean CO2 uptake have been largely unaffected by recent climate variability and change. Anthropogenic carbon and heat storage show a common broad-scale pattern of change, but ocean heat storage is more structured than ocean carbon storage. The results highlight the significance of the Southern Ocean for the global climate and as the region where models differ the most in representation of anthropogenic CO2 and, in particular, heat uptake.
Continuum Power CCA: A Unified Approach for Isolating Coupled Modes
Authors: Swenson Erik 
Published: October 2014

AbstractVarious multivariate statistical methods exist for analyzing covariance and isolating linear relationships between datasets. The most popular linear methods are based on singular value decomposition (SVD) and include canonical correlation analysis (CCA), maximum covariance analysis (MCA), and redundancy analysis (RDA). In this study, continuum power CCA (CPCCA) is introduced as one extension of continuum power regression for isolating pairs of coupled patterns whose temporal variation maximizes the squared covariance between partially whitened variables. Similar to the whitening transformation, the partial whitening transformation acts to decorrelate individual variables but only to a partial degree with the added benefit of preconditioning sample covariance matrices prior to inversion, providing a more accurate estimate of the population covariance. CPCCA is a unified approach in the sense that the full range of solutions bridges CCA, MCA, RDA, and principal component regression (PCR). Recommended CPCCA solutions include a regularization for CCA, a variance bias correction for MCA, and a regularization for RDA. Applied to synthetic data samples, such solutions yield relatively higher skill in isolating known coupled modes embedded in noise. Provided with some crude prior expectation of the signal-to-noise ratio, the use of asymmetric CPCCA solutions may be justifiable and beneficial. An objective parameter choice is offered for regularization with CPCCA based on the covariance estimate of O. Ledoit and M. Wolf, and the results are quite robust. CPCCA is encouraged for a range of applications.
Rapid Generation of Upwelling at a Shelf Break Caused by Buoyancy Shutdown
Authors: Benthuysen Jessica , Thomas Leif N. , Lentz Steven J. 
Published: October 2014

AbstractModel analyses of an alongshelf flow over a continental shelf and slope reveal upwelling near the shelf break. A stratified, initially uniform, alongshelf flow undergoes a rapid adjustment with notable differences onshore and offshore of the shelf break. Over the shelf, a bottom boundary layer and an offshore bottom Ekman transport develop within an inertial period. Over the slope, the bottom offshore transport is reduced from the shelf’s bottom transport by two processes. First, advection of buoyancy downslope induces vertical mixing, destratifying, and thickening the bottom boundary layer. The downward-tilting isopycnals reduce the geostrophic speed near the bottom. The reduced bottom stress weakens the offshore Ekman transport, a process known as buoyancy shutdown of the Ekman transport. Second, the thickening bottom boundary layer and weakening near-bottom speeds are balanced by an upslope ageostrophic transport. The convergence in the bottom transport induces adiabatic upwelling offshore of the shelf break. For a time period after the initial adjustment, scalings are identified for the upwelling speed and the length scale over which it occurs. Numerical experiments are used to test the scalings for a range of initial speeds and stratifications. Upwelling occurs within an inertial period, reaching values of up to 10 m day−1 within 2 to 7 km offshore of the shelf break. Upwelling drives an interior secondary circulation that accelerates the alongshelf flow over the slope, forming a shelfbreak jet. The model results are compared with upwelling estimates from other models and observations near the Middle Atlantic Bight shelf break.
Management of Chronic Laryngopharyngeal Neuropathy in the United States and Europe
Authors: DePietro Joseph D. , Jang Minyoung , Sjogren Elisabeth V. , Dikkers Frederik G. , Cohen Seth M. , Noordzij J. Pieter 
Published: October 2014

Objective: This study aimed to analyze differences in the evaluation of laryngopharyngeal neuropathy by laryngologists in the United States and Europe. Methods: Members of the American Laryngological Association (ALA) and the European Laryngological Society (ELS) were surveyed. Questionnaires were emailed to all 179 members of the ALA and all 324 members of the ELS. Results: Of the ALA members surveyed, 40 (23.3%) responded, compared to 72 members (22.2%) of the ELS group. Of the ALA respondents, 79.5% identified laryngology as their primary area of practice, whereas 56.9% of ELS respondents identified devoting more than 50% of their practice to laryngology. Of ELS laryngologists, 81.1% received training in laryngology or associated subspecialties. For diagnosing laryngopharyngeal neuropathy, the average comfort level on the Likert scale was significantly greater for ALA members than ELS members ( P < .01). Furthermore, ALA laryngologists were less likely to consider laryngopharyngeal reflux as an overdiagnosed condition compared to ELS laryngologists ( P < .05). Conclusion: Laryngologists in the United States and Europe vary significantly in their familiarity with laryngopharyngeal neuropathy. This could reflect either differences in awareness concerning this condition or a more critical perspective of European providers regarding the chronic laryngopharyngeal neuropathy (CLPN) diagnosis. As CLPN is still lacking definitive proof, the addition of European researchers could aid in validating CLPN and determining its overall effect on the chronic cough population.
Intraoperative Narrow Band Imaging Better Delineates Superficial Resection Margins During Transoral Laser Microsurgery for Early Glottic Cancer
Authors: Garofolo Sabrina , Piazza Cesare , Del Bon Francesca , Mangili Stefano , Guastini Luca , Mora Francesco , Nicolai Piero , Peretti Giorgio 
Published: October 2014

Objective: The high rate of positive margins after transoral laser microsurgery (TLM) remains a matter of debate. This study investigates the effect of intraoperative narrow band imaging (NBI) examination on the incidence of positive superficial surgical margins in early glottic cancer treated by TLM. Methods: Between January 2012 and October 2013, 82 patients affected by Tis-T1a glottic cancer were treated with TLM by type I or II cordectomies. Intraoperative NBI evaluation was performed using 0-degree and 70-degree rigid telescopes. Surgical specimens were oriented by marking the superior edge with black ink and sent to a dedicated pathologist. Comparison between the rate of positive superficial margins in the present cohort and in a matched historical control group treated in the same way without intraoperative NBI was calculated by chi-square test. Results: At histopathological examination, all surgical margins were negative in 70 patients, whereas 7 had positive deep margins, 2 close, and 3 positive superficial margins. The rate of positive superficial margins was thus 3.6% in the present group and 23.7% in the control cohort ( P < .001). Conclusion: Routine use of intraoperative NBI increases the accuracy of neoplastic superficial spreading evaluation during TLM for early glottic cancer.
Subjective well-being in adolescence and teacher connectedness: A health asset analysis
Authors: García-Moya Irene , Brooks Fiona , Morgan Antony , Moreno Carmen 
Published: October 2014

Objectives: Teacher connectedness is an important factor for young people’s well-being. The aim of this paper was to examine teacher connectedness in detail and its potential association with emotional well-being. More specifically, we set out to analyse whether teacher connectedness acted as a universal asset for boys and girls of different ages and countries as well as across adolescents with differing perceptions of their performance at school. Methods: The study sample consisted of 9,444 young people aged 11, 13 and 15 years who had taken part in the World Health Organization (WHO) collaborative survey Health Behaviour in School-aged Children in Spain and England. After examining differences in teacher connectedness associated with demographic factors, we used general linear models to analyse the relationship between teacher connectedness and emotional well-being (including interaction teacher connectedness by country) across different age and performance-derived groups. Results: Results indicated some significant differences in teacher connectedness associated with age, country and perceived performance, but a consistent positive association between teacher connectedness and emotional well-being regardless of demographic factors, country and perceptions of school performance. Older adolescents and low achievers reported lower level of connectedness to their teachers, but the association between teacher connectedness and emotional well-being operated irrespective of adolescents’ age and perceived performance at school. Conclusion: Results support the perspective that teacher connectedness can act as a significant health asset that operates irrespective of key demographic factors, while they point to some inequalities in teacher connectedness associated with age and performance at school. These findings have significant implications for health promotion interventions.
The emergency physician’s assessment of suicide risk in intentional self-poisoning using the modified SAD PERSONS scale versus standard psychiatric evaluation in a general hospital in South India: A cross-sectional study
Authors: Chandramouleeswaran Susmita , Edwin Natasha Catherine , Victor Peter John , Tharyan Prathap 
Published: October 2014

Introduction The reliable identification, by emergency physicians, of those with intentional self-poisoning at risk of repeating attempts is crucial, particularly in countries with a shortfall of mental health professionals. Methods This cross-sectional study of intentional self-poisoning in India compared an emergency physician’s assessment for the need for psychiatric referral, using the modified SAD PERSONS Scale (MSPS) as an interview guide, with a standard psychiatric interview. Results In 67 consecutive adults with intentional self-poisoning, MSPS cut-off scores of 5 or more best approximated psychiatric assessments for the need for psychiatric referral (positive likelihood ratio 2.9, 95% confidence interval [CI] 0.8–10.2; negative likelihood ratio 0.5, 95% CI 0.3–0.8). Conclusions MSPS-guided emergency physicians’ assessments after self-poisoning showed modest concordance with psychiatric assessments of suicide-risk. Concordance with psychiatric assessments may improve if risk factors prevalent in different settings are identified and incorporated in the MSPS.
Analysis of “Hidden Lesions” of the Extra-articular Biceps After Subpectoral Biceps Tenodesis
Authors: Moon Seong Cheol , Cho Nam Su , Rhee Yong Girl 
Published: October 2014

Background: In biceps tenodesis for intra-articular tears, determining the distal extension of the lesions through the biceps groove is important in choosing the optimal tenodesis site. Purpose: To determine the optimal tenodesis site by analyzing the extension and delamination of an extra-articular lesion, or a “hidden lesion,” in the retrieved biceps after subpectoral biceps tenodesis. Study Design: Case series; Level of evidence, 4. Methods: A total of 36 subpectoral tenodeses were performed, and the retrieved biceps were analyzed. The biceps lesions were divided into zones according to their location as follows: the proximal intra-articular (zone A), middle intragroove (zone B), and distal extra-articular portions (zone C); the lesions in zones B and C were called “hidden lesions.” The length and delamination depth of the biceps tears were examined, and the severity of the accompanying tenosynovitis and degeneration was assessed. Results: Tears invaded zone B in all the cases and extended to zone C in 28 cases (77.8%). Tenosynovitis was observed along the tear in 28 cases (77.8%) and extended to zone C in 26 cases (72.2%). The mean tear length in the hidden lesions, including the tear and tenosynovitis, was 34.2 mm. Degenerative changes in the proximal intra-articular and middle intragroove portions were observed in all the cases and up to the distal extra-articular portion in 29 cases (80.6%). Conclusion: In approximately 80% of the intra-articular biceps tears evaluated in this study, a “hidden lesion” was observed going beyond the bicipital groove and extending to the distal extra-articular portion. Therefore, the subpectoral portion may be considered the optimal tenodesis site for the complete removal of all hidden biceps lesions.
Investigating the role of angiogenesis in systemic lupus erythematosus
Authors: Liu J , Wang X , Yang X , Yan Q , Wang S , Han W 
Published: October 2014

Objective We aimed to elucidate the roles of six pro-angiogenic factors, namely, basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), placental growth factor (PlGF), hepatocyte growth factor (HGF), transforming growth factor-beta (TGF-beta) and tumor necrosis factor-alpha (TNF-alpha), in the pathogenesis of systemic lupus erythematosus (SLE). Methods A group of 75 patients with SLE and a control group of 40 healthy volunteers were recruited. Angiogenic factors were tested through enzyme-linked immunosorbent assay (ELISA) measurement. The angiogenic activities of the patients with SLE and the healthy controls were assessed and a correlation analysis of these angiogenic factors was conducted. Results A much higher level of angiogenic activity was shown in the serum of patients with SLE than that of the healthy controls, yet no statistically significant difference was found in the angiogenic activities of active SLE and inactive SLE. Serum VEGF level in the active SLE group was significantly higher than that in the control group and the inactive SLE group, and serum HGF level was strongly positively correlated with VEGF in all SLE groups; meanwhile, there was also a statistically significant positive correlation between TNF-alpha and VEGF in all SLE groups. There was a statistically significant positive correlation between serum VEGF level and bFGF level in the active SLE group. There was a slightly negative correlation between serum HGF level and TGF-beta level in the SLE group, but this negativity did not reach the significance level. Likewise, positive correlation was also shown in the serum VEGF level and PlGF level, yet not in bFGF with PlGF. Conclusion Circulating serum angiogenic cytokines may be disease markers of SLE activity. Anti-angiogenic agents such as thalidomide and endogenous angiogenesis inhibitors such as endostatin are potentially effective and promising therapies in the treatment of SLE.
Comparison of Perioperative Complications and Hospitalization Outcomes After Ankle Arthrodesis Versus Total Ankle Arthroplasty From 2002 to 2011
Authors: Jiang Jimmy J. , Schipper Oliver N. , Whyte Noelle , Koh Jason L. , Toolan Brian C. 
Published: October 2014

Background: The aim of this study was to analyze a validated, nationally representative admissions database in order to compare perioperative complications and hospitalization outcomes associated with ankle arthrodesis (AAD) versus ankle arthroplasty (TAA). Methods: Using the Nationwide Inpatient Sample (NIS) database from 2002 to 2011, 12 250 patients who underwent AAD and 3002 patients who underwent TAA were identified based on International Classification of Diseases, Ninth Revision (ICD-9) codes. The demographics, comorbidities, and perioperative outcomes during the index hospital stay were compared between patients who underwent AAD and TAA. Multivariate analysis was performed to adjust for differences in demographics and comorbidities between the 2 groups. Results: Multivariate analysis demonstrated that TAA was independently associated with a decreased risk of blood transfusion (relative risk [RR] = 0.53, P < .001), non–home discharge (RR = 0.70, P < .001), and overall complication (RR = 0.79, P = .03). There were similar rates of pneumonia, deep vein thrombosis, pulmonary embolus, cerebrovascular accident, myocardial infarction, and mortality. TAA was independently associated with a significantly higher hospital charge (difference = $24 431, P < .001). There was no significant difference in the adjusted length of stay between the 2 groups ( P = .13). Conclusion: TAA was independently associated with a lower risk of blood transfusion, non–home discharge, and overall complication when compared to AAD during the index hospitalization period. TAA was also independently associated with a higher hospitalization charge, but length of stay was similar between the 2 groups. Until long-term comparative studies are performed, the optimal treatment for end-stage ankle arthritis remains controversial, this study provides greater clarity with regard to hospitalization outcomes after the 2 procedures and shows no significant difference in risk for the majority of medical perioperative complications. Level of Evidence: Level III, comparative series.
Impact of case-mix on comparisons of patient-reported experience in NHS acute hospital trusts in England
Authors: Raleigh Veena , Sizmur Steve , Tian Yang , Thompson James 
Published: October 2014

Objectives To examine the impact of patient-mix on National Health Service (NHS) acute hospital trust scores in two national NHS patient surveys. Methods Secondary analysis of 2012 patient survey data for 57,915 adult inpatients at 142 NHS acute hospital trusts and 45,263 adult emergency department attendees at 146 NHS acute hospital trusts in England. Changes in trust scores for selected questions, ranks, inter-trust variance and score-based performance bands were examined using three methods: no adjustment for case-mix; the current standardization method with weighting for age, sex and, for inpatients only, admission method; and a regression model adjusting in addition for ethnicity, presence of a long-term condition, proxy response (inpatients only) and previous emergency attendances (emergency department survey only). Results For both surveys, all the variables examined were associated with patients’ responses and affected inter-trust variance in scores, although the direction and strength of impact differed between variables. Inter-trust variance was generally greatest for the unadjusted scores and lowest for scores derived from the full regression model. Although trust scores derived from the three methods were highly correlated (Kendall’s tau coefficients 0.70–0.94), up to 14% of trusts had discordant ranks of when the standardization and regression methods were compared. Depending on the survey and question, up to 14 trusts changed performance bands when the regression model with its fuller case-mix adjustment was used rather than the current standardization method. Conclusions More comprehensive case-mix adjustment of patient survey data than the current limited adjustment reduces performance variation between NHS acute hospital trusts and alters the comparative performance bands of some trusts. Given the use of these data for high-impact purposes such as performance assessment, regulation, commissioning, quality improvement and patient choice, a review of the long-standing method for analysing patient survey data would be timely, and could improve rigour and comparability across the NHS. Performance comparisons need to be perceived as fair and scientifically robust to maintain confidence in publicly reported data, and to support their use by both the public and the NHS.