bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variability in the Internal Wave Field Induced by the Atlantic Deep Western Boundary Current at 16°N
Authors: Köhler Janna , Mertens Christian , Walter Maren , Stöber Uwe , Rhein Monika , Kanzow Torsten 
Published: October 2013

Abstract
Five years of continuous mooring data combined with conductivity–temperature–depth (CTD)/lowered acoustic Doppler current profiler (LADCP) measurements from five cruises are used to investigate the influence of the deep western boundary current (DWBC) on the internal wave field and associated vertical mixing at the continental slope at 16°N in the western Atlantic. The mooring data include 2-hourly rotor current-meter measurements and temperature/conductivity time series with a high temporal resolution of 5–20 min. Thus, the data resolve time scales ranging from the low-frequency variability of the large-scale DWBC that generates internal waves due to interactions with the topography to frequencies greater than that of internal waves that are associated with vertical mixing. Estimates of the vertical mixing induced by the breaking of the observed internal waves show elevated diapycnal diffusivities of up to 10−3 ± 0.4 × 10−3 m2 s−1 in the bottommost 1500 m during times of a strong DWBC (maximum velocities at the mooring site up to 50 cm s−1) whereas vertical mixing rates are about an order of magnitude lower (1.6 × 10−4 ± 0.6 × 10−4 m2 s−1) during weak flow. During periods of a strong DWBC, spectra of horizontal velocity and internal wave available potential energy change substantially at depths below 1200 m and show a strong increase in variance particularly in the near-inertial frequency band. Low-frequency, near-inertial waves generated by topography/DWBC interaction on the slope to the west of the moorings can potentially cause this observed wave intensification; ray paths estimated for these waves agree well with the observed spectral changes at different depths. Variability in the high-frequency range, considered as a proxy for turbulent mixing, is significantly correlated with the DWBC strength above the continental slope.
Computer-Based Programmed Instruction Did Not Improve the Knowledge Retention of Medication Instructions of Individuals With Type 2 Diabetes Mellitus
Authors: Ruiz Jorge G. , Andrade Allen D. , Anam Ramanakumar , Lisigurski Miriam , Karanam Chandana , Sharit Joseph 
Published: October 2013

Purpose The purpose of this study was to investigate whether computer-based programmed instruction (CPI) with a dynamic avatar (DA) improves retention of medication information better than text (controls) or better than CPI with text (T-CPI), CPI with voice (V-CPI), or CPI with static avatar with text (SA-CPI). Methods Participants with type 2 diabetes mellitus were enrolled in a randomized controlled trial comparing TDS with CPI in 4 conditions (T-CPI, V-CPI, SA-CPI, and DA-CPI). CPI sequentially delivers segmented information in text or voice followed by a multiple-choice question. Immediately after the user selects an option, CPI delivers elaborated feedback. Satisfaction was measured immediately after the interventions, and medication knowledge was measured at 2 weeks. Results One-hundred fifty individuals (30 per group) with a mean age 62 years (standard deviation [SD] 7.99 years) participated. There were no baseline differences in race, body mass index, education, and health literacy. Medication knowledge retention at 2 weeks was not significantly different between the groups, df(4), F = 0.17, P = .95 (TDS, mean = 25.43, SD = 5.11; T-CPI, mean = 25.07, SD = 4.98; V-CPI, mean = 25.77, SD = 4.89; SA-CPI, mean = 25.83, SD = 5.31; and DA-CPI, mean = 24.93, SD = 6.25). Satisfaction scores were significantly lower for TDS, df(4), F = 3.11, P = .01. Conclusions CPI did not improve medication knowledge retention at 2 weeks. CPI led to higher patient satisfaction compared with controls.
Digital Photography as an Educational Food Logging Tool in Obese Patients With Type 2 Diabetes
Authors: Ehrmann Brett J. , Anderson Robert M. , Piatt Gretchen A. , Funnell Martha M. , Rashid Hira , Shedden Kerby , Douyon Liselle 
Published: October 2013

Purpose The purpose of this pilot study is to investigate the utility of, and areas of refinement for, digital photography as an educational tool for food logging in obese patients with type 2 diabetes (T2DM). Methods Thirty-three patients aged 18 to 70 with T2DM, body mass index at least 30 kg/m2, and A1C 7.5% to 9% were recruited from an endocrinology clinic and randomized to a week of food logging using a digital camera (DC) or paper diary (PD), crossing over for week 2. Patients then viewed a presentation about dietary effects on blood glucose, using patient DC and blood glucose entries. Outcomes of adherence (based on number of weekly entries), changes in mean blood glucose and frequency of blood glucose checks, and patient satisfaction were compared between methods. Patient feedback on the DC intervention and presentation was also analyzed. Results Thirty patients completed the study. Adherence was identical across methods. The mean difference in number of entries was not significant between methods. This difference increased and neared statistical significance (favoring DC) among patients who were adherent for at least 1 week (21 entries, with 2 entries per day for 5 of 7 days, n = 25). Mean blood glucose did not significantly decrease in either method. Patient satisfaction was similar between interventions. Feedback indicated concerns over photograph accuracy, forgetting to use the cameras, and embarrassment using them in public. Conclusion Although the DC method was comparable to PD in adherence, blood glucose changes, and patient satisfaction in this pilot trial, patient feedback suggested specific areas of refinement to maximize utility of DC-based food logging as an educational tool in T2DM.
AAO‐HNSF CORE Grant Acquisition Is Associated with Greater Scholarly Impact
Authors: Eloy Jean Anderson , Svider Peter F. , Folbe Adam J. , Setzen Michael , Baredes Soly 
Published: October 2013

ObjectiveTo determine whether receiving funding from the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO‐HNSF) Centralized Otolaryngology Research Efforts (CORE) grant program is associated with career choice (in terms of practice setting) and scholarly impact.Study Design and SettingExamination of bibliometrics among academic otolaryngologists, including CORE grants funding history.MethodsAn Internet search was conducted to determine the current practice setting and, for academic otolaryngologists, academic rank of individuals receiving CORE grants since 1985. The Scopus database was used to determine scholarly impact, as measured by the h‐index, and publication experience (in years) of these practitioners along with a “control” cohort of nonfunded academic otolaryngologists.ResultsOf 432 unique individuals receiving CORE grant funding since 1985, 44.4% are currently academicians. This cohort had a higher h‐index (mean, 11.9; median, 10; interquartile range [IQR], 6‐18) than their non–CORE grant–funded academic peers (mean, 9.2; median, 7; IQR, 3‐13; P =. 002) and colleagues who are not currently in academic practice (mean, 4.4; median, 3; IQR, 0‐6; P <. 001). CORE grant–funded academic otolaryngologists had a statistically higher scholarly impact on controlling for academic rank and among practitioners with greater than 10 years of publication experience. No statistical differences in academic promotion patterns were noted between those with and those without a CORE grant funding history.ConclusionsProcurement of an AAO‐HNSF CORE grant is associated with greater scholarly impact, as measured by the h‐index. This relationship persists among practitioners with more than 10 years of publication experience, as well as upon comparison of CORE grant–funded and non–CORE grant–funded otolaryngologists at all academic ranks. Practitioners awarded these grants may be more likely to go into and remain in academic practice.
Impact of aortic prosthesis-patient mismatch on left ventricular mass regression
Authors: Alassal Mohamed A , Ibrahim Bedir M , Elsadeck Nabil 
Published: October 2013

Background Prostheses used for aortic valve replacement may be small in relation to body size, causing prosthesis-patient mismatch and delaying left ventricular mass regression. This study examined the effect of prosthesis-patient mismatch on regression of left ventricular mass after aortic valve replacement. Methods We prospectively studied 96 patients undergoing aortic valve replacement between 2007 and 2012. Mean and peak gradients and indexed effective orifice area were measured by transthoracic echocardiography at 3 and 6 months postoperatively. Patient-prosthesis mismatch was defined as indexed effective orifice area ≤0.85 cm2·m−2. Results Moderate prosthesis-patient mismatch was present in 25% of patients. There were no significant differences in demographic and operative data between patients with and without prosthesis-patient mismatch. Left ventricular dimensions, posterior wall thickness, transvalvular gradients, and left ventricular mass decreased significantly after aortic valve replacement in both groups. The interventricular septal diameter and left ventricular mass index regression, and left ventricular ejection fraction were better in patients without prosthesis-patient mismatch. There was a significant positive correlation between the postoperative indexed effective orifice area of each valve prosthesis and the rate of left ventricular mass regression. Conclusions Prosthesis-patient mismatch leads to higher transprosthetic gradients and impaired left ventricular mass regression. A small-sized valve prosthesis does not necessarily result in prosthesis-patient mismatch, and may be perfectly adequate in patient with small body size.
Perioperative predictors of midterm survival after aortic valve replacement
Authors: Grau Juan B , Mak Andrew WC , Ferrari Giovanni , Johnson Christopher K , Shaw Richard E , Sperling Jason , Brizzio Mariano E , Zapolanski Alex 
Published: October 2013

Background Elderly patients with aortic stenosis are under-referred for aortic valve replacement surgery. This study investigated the perioperative factors associated with midterm outcomes in a consecutive series of patients undergoing aortic valve replacement with or without coronary artery bypass graft surgery. Methods From 2006 to 2010, 509 patients having aortic valve replacement or aortic valve replacement with coronary artery bypass were grouped according to age (<80 years and ≥80 years) and procedure (aortic valve replacement ± coronary artery bypass). Patient survival was followed up for 5 years (mean 2.6 years). Midterm survival was evaluated using Kaplan-Meier and Cox proportional hazards regression model statistics. Results and conclusions 5-year survival among octogenarians was 59.2% with an observed 30-day mortality of 1% for aortic valve replacement and 3% for aortic valve replacement with coronary artery bypass. Kaplan-Meier survival analysis showed that age ≥80 years, New York Heart Association functional class III/IV, and left ventricular ejection fraction <35% were significantly associated with increased midterm mortality. Cox regression modeling demonstrated that age ≥80 years was the only significant independent factor associated with midterm mortality; older patients had a 3-fold increase in mortality (adjusted hazard ratio = 3.231, 95% confidence interval: 1.764–5.920, p < 0.0001). While hospital and 30-day mortality were not statistically different between age groups, age ≥80 years was the most powerful predictor of midterm death. These results support early aortic valve replacement with or without coronary artery bypass in aortic stenosis management.
Treatment for stable HIV patients in England: can we increase efficiency and improve patient care?
Authors: Adams Elisabeth , Ogden David , Ehrlich Alice , Hay Phillip 
Published: October 2013

Objectives To estimate the costs and potential efficiency gains of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients compared to the costs of hospital pharmacy dispensing and home delivery. Methods We estimated the annual costs per patient (HIV clinic visits and either first-line treatment or a common second-line regimen, with some patients switching to a second-line regimen during the year). The cost of three-, four- and six-monthly clinic appointments and drug supply was estimated assuming hospital dispensing (incurring value-added tax) and home delivery. Three-monthly appointments and hospital drug dispensing (baseline) were compared to other strategies. Results The baseline was the most costly option (£10,587 if first-line treatment and no switch to second-line regimen). Moving to six-monthly appointments and home delivery yielded savings of £1883 per patient annually. Assuming patients start on different regimens and may switch to second-line therapies, six-monthly appointments and three-monthly home delivery of drugs is the least expensive option and could result in nearly £2000 savings per patient. This translates to annual cost reduction of about £8 million for the estimated 4000 eligible patients not currently on home delivery in London, England. Conclusions Different appointment schedules and drug supply options should be considered for stable HIV patients based on efficiency gains. However, this should be assessed for individual patients to meet their needs, especially around adherence and patient support.
Considerations in the surgical use of the flexor sheath and pulley system
Authors: Lowrie A. G. , Lees V. C. 
Published: October 2013

The use of the digital flexor sheath to reconstruct damaged structures in the fingers is an intriguing but under-investigated subject. The sheath is anchored firmly to the phalanges and palmar plates and has well-vascularized outer and synovial inner layers. The middle layer is strong and fibrous and not all of it is required for its main biomechanical function of maintaining the moment arm of the flexor tendons. These characteristics have led to several descriptions of different reconstructive uses. In sheath reconstruction, flaps can be used to repair damaged A2 and A4 pulleys. As an anchor, the sheath is useful for tenodeses and tendon transfers. It has been used in the correction of ulnar claw and swan neck deformities. In ligament reconstruction, the A1 pulley has been used to reconstruct the transverse intermetacarpal ligament in cleft hand and ray amputations. The sheath has also been used to cover tendon repairs and periosteal defects with the aim of decreasing adhesions. There is potential for further use of the flexor sheath in reconstructive surgery. The digital flexor sheath can be used to restore various finger functions providing its physiological roles are recognized and preserved. This review considers the different techniques described and their potential uses.
Orbital phlebography in idiopathic intracranial hypertension and chronic tension-type headache
Authors: Hannerz Jan , Ericson Kaj , Greitz Dan , Skejo Pernille Hanne Bro , Edman Gunnar 
Published: October 2013

Background Pathologic signs in orbital phlebographies have been reported in various neurological diseases. Purpose To study if pathologic signs in orbital phlebography may be markers of inflammation primarily affecting intracranial capillaries, which would cause intracranial hypertension. Material and Methods Two groups with different intracranial cerebrospinal fluid pressures (Pcsf) were compared as to inflammatory markers in serum and pathologic signs in orbital phlebographies. Nine consecutive patients with idiopathic intracranial hypertension (IIH) with bilateral papilledema and eight consecutive patients with chronic tension-type headache (CTTH) were investigated prospectively with fibrinogen, orosomucoid, haptoglobin in serum, and invasive orbital phlebograms. The angiograms were evaluated by two skilled neuroradiologists, independent of each other and without knowledge of the diagnoses or aim of the study, as to the following pathologic signs: (i) narrowing of superior ophthalmic veins; (ii) caliber changes of intraorbital veins; (iii) collaterals of intraorbital veins; (iv) flow to cavernous sinus; and (v) asymmetric drainage of cavernous sinus. Results Mean body mass index was >30 kg/m2 in both groups. Pcsf was >200 < 250 mm H2O in 50% of the CTTH and >350 mm H2O in all IIH patients. No difference in inflammatory markers in blood was found. The phlebographies of the IIH patients had more pathologic signs and were considered pathologic significantly more often than the ones of the CTTH patients ( P < 0.001). Conclusion The difference as to phlebographic pathologic signs between the IIH and the CTTH patients with different Pcsf supports the hypothesis that such phlebographic signs are markers of inflammation primarily affecting intracranial capillaries, which would disturb cerebrospinal fluid regulation causing intracranial hypertension.
Three-year efficacy, safety, and survival findings from COMFORT-II, a phase 3 study comparing ruxolitinib with best available therapy for myelofibrosis
Authors: Cervantes Francisco , Vannucchi Alessandro M. , Kiladjian Jean-Jacques , Al-Ali Haifa Kathrin , Sirulnik Andres , Stalbovskaya Viktoriya , McQuitty Mari , Hunter Deborah S. , Levy Richard S. , Passamonti Francesco , Barbui Tiziano , Barosi Giovanni , Harrison Claire N. , Knoops Laurent , Gisslinger Heinz 
Published: October 2013

Key Points
Long-term analysis of the COMFORT-II Trial shows that ruxolitinib treatment results in durable reductions in splenomegaly and is well tolerated. Patients randomized to ruxolitinib showed longer overall survival than those receiving the BAT.
Meta-analysis to compare the accuracy of GeneXpert, MODS and the WHO 2007 algorithm for diagnosis of smear-negative pulmonary tuberculosis
Authors: Walusimbi Simon , Bwanga Freddie , De Costa Ayesha , Haile Melles , Joloba Moses , Hoffner Sven 
Published: October 2013

Abstract

Background
Smear-negative pulmonary tuberculosis (SN-PTB), which is common in HIV-infected patients, is difficult to diagnose using smear microscopy alone. In 2007, the WHO developed an algorithm to improve the diagnosis and management of smear-negative tuberculosis in HIV prevalent and resource constrained settings. Implementation of the algorithm required individuals with presumptive TB to be initially evaluated using two sputum microscopy examinations followed by clinical diagnosis that may include chest X-ray and antibiotic treatment in smear-negative individuals. Since that time, the WHO has endorsed several new tests for diagnosis of tuberculosis. However, it is unclear how the new tests perform when compared to the WHO 2007 algorithm in diagnosis of SN-PTB. Using meta-analysis study design, we summarized and compared the accuracy of Xpert® MTB/Rif assay (GeneXpert) and Microscopic Observation Drug Susceptibility assay (MODS), with the WHO 2007 algorithm in the diagnosis of SN-PTB.

Methods
A systematic review and meta-analysis of publications on GeneXpert, or MODS, or the WHO 2007 algorithm for diagnosis of SN-PTB, using culture as reference test was performed. Meta-Disc software was used to obtain pooled sensitivity and specificity of the diagnostic methods. Heterogeneity in the accuracy estimates was tested by reviewing the generated forest plots, sROC curves and the Spearman correlation coefficient of the logit of true positive rate versus the logit of false positive rate.

Results
Twenty-four publications on all three diagnostic methods were meta-analyzed. The pooled sensitivity and specificity for detection of smear-negative pulmonary tuberculosis were 67% and 98% for GeneXpert, 73% and 91% for MODS, and 61% and 69% for WHO 2007 algorithm, respectively. The sensitivity of GeneXpert reduced from 67% to 54% when sub-group analysis of studies with patient HIV prevalence ≥30% was performed.

Conclusion
The GeneXpert, MODS, and the WHO algorithm have moderate to high accuracy for the diagnosis of SN-PTB. However, the accuracy of the tests is extremely variable. The setting and context under which the tests are conducted in addition to several other factors could explain this variability. There is therefore need to investigate these factors further. The information from these studies would inform the adoption and placement of these new tests.
DNA extraction from long-term stored urine
Authors: Hilhorst Marc , Theunissen Ruud , van Rie Henk , van Paassen Pieter , Tervaert Jan Willem Cohen 
Published: October 2013

Abstract

Background
Traditionally, for DNA analyses, DNA is recovered from buffy coats. Since DNA in urine has been reported to deteriorate quickly, this option is often not considered. To complete our DNA database in patients with ANCA-associated vasculitis, we aimed to extract DNA from stored urine.

Methods
Urine was stored at the time of kidney biopsy from patients included in our regional kidney biopsy database, who had given informed consent for further study. Urine was subsequently filtered, dialyzed, concentrated and freeze dried and finallyresolubilized and centrifuged. DNA was extracted using the high pure PCR template preparation kit (Roche Diagnostics). Next, concentration and purity were determined by Nanodrop analysis and by Quant-iT analysis.

Results
One hundred and eighty-one patients with ANCA-associated vasculitis were included. Of 114 patients (63%), DNA was available. From 53 of the remaining 67 patients, stored urine was available. Of the 53 samples that were processed, 46 (86.8%) yielded DNA with a mean concentration of 258.7 ng/μL (range 33.2-529) with a mean purity ratio of 1.81 (λ 260/280).

Conclusion
DNA extraction from fresh urine has been described before, yielding DNA usable for PCR analysis in healthy subjects. Storage of fresh urine at 4°C or lower temperatures results in significant degradation of the DNA, making recovery of DNA more difficult with longer periods of storage. In the current study, we demonstrated that DNA could be retrieved from subsequently filtered, dialyzed, concentrated and freeze dried urine that was stored at room temperature. In addition, we demonstrated tthat this DNA could be used for PCR analysis. This method is useful when no other material from these patients is available.