bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database
Authors: Tataris Katie L , Mercer Mary P , Govindarajan Prasanthi 
Published: February 2015

IntroductionNational practice guidelines recommend early aspirin administration to reduce mortality in acute coronary syndrome (ACS). Although timely administration of aspirin has been shown to reduce mortality in ACS by 23%, prior regional Emergency Medical Service (EMS) data have shown inadequate prehospital administration of aspirin in patients with suspected cardiac ischaemia.ObjectivesUsing the National EMS Information System (NEMSIS) database, we sought to determine (1) the proportion of patients with suspected cardiac ischaemia who received aspirin and (2) patient and prehospital characteristics that independently predicted administration of aspirin.MethodsAnalysis of the 2011 NEMSIS database targeted patients aged ≥40 years with a paramedic primary impression of ‘chest pain’. To identify patients with chest pain of suspected cardiac aetiology, we included those for whom an ECG or cardiac monitoring had been performed. Trauma-related chest pain and basic life support transports were excluded. The primary outcome was presence of aspirin administration. Patient (age, sex, race/ethnicity and insurance status) and regional characteristics where the EMS transport occurred were also obtained. Multivariate logistic regression was used to assess the independent association of patient and regional factors with aspirin administration for suspected cardiac ischaemia.ResultsOf the total 14 371 941 EMS incidents in the 2011 database, 198 231 patients met our inclusion criteria (1.3%). Of those, 45.4% received aspirin from the EMS provider. When compared with non-Hispanic white patients, several groups had greater odds of aspirin administration by EMS: non-Hispanic black patients (OR 1.49, 95% CI 1.44 to 1.55), non-Hispanic Asians (OR 1.62, 95% CI 1.21 to 2.18), Hispanics (OR 1.71, 95% CI 1.54 to 1.91) and other non-Hispanics (OR 1.27, 95% CI 1.07 to 1.51). Patients living in the Southern region of the USA (OR 0.59, 95% CI 0.57 to 0.62) and patients with governmental (federally administered such as Veteran's Health Care, but not Medicare or Medicaid) insurance (OR 0.67, 95% CI 0.57 to 0.78) had the lowest odds of receiving aspirin. Age and sex (OR 1.00, 95% CI 1.00 to 1.00) were not associated with aspirin administration.ConclusionsIt is likely that prehospital aspirin administration for patients with suspected cardiac ischaemia remains low nationally and could be improved. Reasons for disparities among the various groups should be explored.
Epigenetic regulation of Newborns’ imprinted genes related to gestational growth: patterning by parental race/ethnicity and maternal socioeconomic status
Authors: King Katherine , Murphy Susan , Hoyo Cathrine 
Published: February 2015

BackgroundChildren born to parents with lower income and education are at risk for obesity and later-life risk of common chronic diseases, and epigenetics has been hypothesised to link these associations. However, epigenetic targets are unknown. We focus on a cluster of well-characterised genomically imprinted genes because their monoallelic expression is regulated by DNA methylation at differentially methylated regions (DMRs), are critical in fetal growth, and DNA methylation patterns at birth have been associated with increased risk of birth weight extremes and overweight status or obesity in early childhood.MethodsWe measured DNA methylation at DMRs regulating genomically imprinted domains (IGF2/H19,DLK1/MEG3,NNATandPLAGL1) using umbilical cord blood leucocytes from 619 infants recruited in Durham, North Carolina in 2010–2011. We examined differences in DNA methylation levels by race/ethnicity of both parents, and the role that maternal socioeconomic status (SES) may play in the association between race/ethnic epigenetic differences.ResultsUnadjusted race/ethnic differences only were evident for DMRs regulatingMEG3andIGF2; race/ethnic differences persisted inIGF2/H19andNNATafter accounting for income and education.ConclusionsResults suggest that parental factors may not only influence DNA methylation, but also do so in ways that vary by DMR. Findings support the hypothesis that epigenetics may link the observed lower SES during the prenatal period and poor outcomes such as low birth weight; lower birth weight has previously been associated with adult-onset chronic diseases and conditions that include cardiovascular diseases, diabetes, obesity and some cancers.
Induction for senior house officers. Part II: The departmental programme
Authors: Ward Simon J , Stanley Paula 
Published: February 2015

Summary
This study was designed to examine the content and usefulness of departmental induction programmes to senior house officers (SHOs) and to explore perceptions of the usefulness of a range of topics to these trainees. A total of 64 SHOs, in five hospitals in the Anglia region, participated in semi-structured interviews up to 3 months after starting their post. The interviews investigated the content of any induction received and also examined what the trainees would have liked to have received. Almost half (29) of the SHOs also completed a questionnaire which examined the perceived usefulness of various induction topics for a trainee starting a new post. The results showed that, although a departmental induction programme is considered important and highly valued, a substantial minority of SHOs had not received one. Of this minority, 75% would have welcomed an induction. Where an induction had taken place, the focus was primarily upon timetables, tours and meeting people, however, a quarter of the questionnaire sample had not received a service timetable, a third had not met any consultants, two-thirds had received no introduction to clinical management, and two-thirds had received no information about how their consultants manage their patients. Thus, although many trainees receive an induction, important information may not be covered. A staged approach to departmental induction is recommended, using a short, high-quality, and comprehensive induction programme. Flexible and timely programmes, supported by comprehensive written information, will contribute to meeting the needs of trainees in an efficient and effective way.
Prospective audit of a respiratory sleep disorders service at District General Hospital level
Authors: Deegan Paul C , Cooper Brendan G , Britton John R , Jones Nicholas S , Kinnear William J M 
Published: February 2015

Summary
This study was designed to examine the organisation and outcomes of a District General Hospital respiratory sleep service, since data are lacking on the management of sleep-disordered breathing at this level. Questionnaires and case-notes review were used to assess the management of 119 consecutive patients referred with suspected sleep-disordered breathing. Patients diagnosed with sleep-disordered breathing were assigned nasal continuous positive airway pressure (nCPAP), ear/nose/throat (ENT) surgery or simple measures (eg, weight loss). There were six non-attenders. At 12 months follow-up, 33 patients had been assigned to nCPAP, 25 to ENT surgery, and 37 to simple measures. Of the remainder, nine had alternative diagnoses, two were still being assessed and seven were lost to follow-up. Patients prescribed nCPAP (81% compliance) had significant symptomatic improvements with low dissatisfaction rates (20%); patients on simple measures did not improve (33% dissatisfied); only half assigned surgery had it performed, with 42% awaiting surgery and dissatisfied. Interspecialty referral resulted in major delays (mean 16 weeks). Referral letters were generally unhelpful in deciding on the appropriateness of initial referral (respiratory physicianvs ENT). nCPAP was generally effective in improving symptoms, with a high level of patient satisfaction, while simple measures did not improve symptoms and were associated with lower satisfaction levels. Waiting times to ENT surgery can be long and patients express significant dissatisfaction. Referral letters are not useful in directing initial referral. Services should be co-ordinated between respiratory and ENT specialties to reduce waiting times and improve patient satisfaction.
Association of serum resistin with cystatin C and urinary albumin-to-creatinine ratio in elderly Chinese men with essential hypertension
Authors: Zhang Meng , Cui Hua , Zhu Bing-Po , Fu Shu-Hong 
Published: February 2015

ABSTRACT

Purpose of the study
Resistin, a recently discovered proinflammatory cytokine, has been strongly linked to kidney dysfunction. The aim of this study was to determine the relationship of serum resistin with serum cystatin C (sCysC) and albuminuria, two sensitive endogenous markers of renal function, in elderly male patients with essential hypertension (EH).

Study design
This was a cross-sectional study enrolling 296 Chinese men (age ≥60 years, mean age 81.42 years) diagnosed with EH between January 2008 and May 2011. Renal function was assessed by measurement of sCysC levels and albuminuria (calculated as the urine albumin-to-creatinine ratio (uACR)). Serum resistin and selected metabolic and cardiovascular markers were determined by serological testing. Relationships between serum resistin levels and sCysC levels and uACR were analysed using multiple regression analysis.

Results
Multiple linear regression analyses revealed that the serum resistin level was positively associated with the sCysC level and uACR (βuACR=0.132, puACR=0.002; βsCysC=0.015, psCysC=0.008).

Conclusions
Our findings demonstrated that a raised serum resistin level is a potential indicator of renal dysfunction in elderly patients with EH. Resistin may be explored as a potential biomarker in addition to sCysC and uACR to provide a more accurate diagnosis of renal damage in elderly men with EH.
Prognostic and Therapeutic Implications of Statin and Aspirin Therapy in Individuals With Nonobstructive Coronary Artery Disease
Authors: Chow Benjamin J.W. , Small Gary , Yam Yeung , Chen Li , McPherson Ruth , Achenbach Stephan , Al-Mallah Mouaz , Berman Daniel S. , Budoff Matthew J. , Cademartiri Filippo , Callister Tracy Q. , Chang Hyuk-Jae , Cheng Victor Y. , Chinnaiyan Kavitha , Cury Ricardo , Delago Augustin , Dunning Allison , Feuchtner Gundrun , Hadamitzky Martin , Hausleiter Jörg , Karlsberg Ronald P. , Kaufmann Philipp A. , Kim Yong-Jin , Leipsic Jonathon , LaBounty Troy , Lin Fay , Maffei Erica , Raff Gilbert L. , Shaw Leslee J. , Villines Todd C. , Min James K. 
Published: February 2015

Objective—
We sought to examine the risk of mortality associated with nonobstructive coronary artery disease (CAD) and to determine the impact of baseline statin and aspirin use on mortality.

Approach and Results—

Coronary computed tomographic angiography permits direct visualization of nonobstructive CAD. To date, the prognostic implications of nonobstructive CAD and the potential benefit of directing therapy based on nonobstructive CAD have not been carefully examined. A total of 27 125 consecutive patients who underwent computed tomographic angiography (12 enrolling centers and 6 countries) were prospectively entered into the COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry. Patients, without history of previous CAD or obstructive CAD, for whom baseline statin and aspirin use was available were analyzed. Each coronary segment was classified as normal or nonobstructive CAD (1%–49% stenosis). Patients were followed up for a median of 27.2 months for all-cause mortality. The study comprised 10 418 patients (5712 normal and 4706 with nonobstructive CAD). In multivariable analyses, patients with nonobstructive CAD had a 6% (95% confidence interval, 1%–12%) higher risk of mortality for each additional segment with nonobstructive plaque (
P
=0.021). Baseline statin use was associated with a reduced risk of mortality (hazard ratio, 0.44; 95% confidence interval, 0.28–0.68;
P
=0.0003), a benefit that was present for individuals with nonobstructive CAD (hazard ratio, 0.32; 95% confidence interval, 0.19–0.55;
P
<0.001) but not for those without plaque (hazard ratio, 0.66; 95% confidence interval, 0.30–1.43;
P
=0.287). When stratified by National Cholesterol Education Program/Adult Treatment Program III, no mortality benefit was observed in individuals without plaque. Aspirin use was not associated with mortality benefit, irrespective of the status of plaque.

Conclusions—
The presence and extent of nonobstructive CAD predicted mortality. Baseline statin therapy was associated with a significant reduction in mortality for individuals with nonobstructive CAD but not for individuals without CAD.

Clinical Trial Registration—

URL:
http://clinicaltrials.gov/
. Unique identifier NCT01443637
Assessing Large-Vessel Endothelial Permeability Using Near-Infrared Fluorescence Imaging—Brief Report
Authors: Lundeberg Erik , Van Der Does Anne M. , Kenne Ellinor , Soehnlein Oliver , Lindbom Lennart 
Published: February 2015

Objective—
Loss of endothelial barrier function in arterial blood vessels is characteristic of vascular pathologies, including atherosclerosis. Here, we present a near-infrared fluorescence (NIRF) imaging methodology for quantifying endothelial permeability and macromolecular uptake in large arteries in the mouse and evaluate its applicability for studying mechanisms of vascular inflammation.

Approach and Results—

To validate the NIRF methodology, macrovascular inflammation was induced in C57bl/6 mice by local tumor necrosis factor-α stimulation of the carotid artery or in apolipoprotein E–deficient mice by Western diet for 4 weeks. Evans blue dye, serving as plasma protein marker and fluorescent in the near-infrared spectrum, was given intravenously at different doses. Carotids and aorta were excised, and Evans blue dye fluorescence was assessed through whole vessel scan in an infrared imaging system. NIRF correlated to extraction–absorbance methodology for Evans blue dye quantification and was superior at discriminating plasma protein accumulation in tumor necrosis factor-α–stimulated carotids. NIRF allowed for focal quantification of increased arterial wall Evans blue dye uptake in

apolipoprotein E–deficient

mice. Importantly, NIRF left vessels intact for subsequent histological analysis or quantification of leukocyte subpopulations by flow cytometry.

Conclusions—
The described NIRF methodology provides a sensitive and rapid tool to locate and quantify macromolecular uptake in the wall of arterial blood vessels in vascular pathologies in mice.
Expression of Human Tissue Factor Pathway Inhibitor on Vascular Smooth Muscle Cells Inhibits Secretion of Macrophage Migration Inhibitory Factor and Attenuates Atherosclerosis in ApoE
−/−
Mice
Authors: Chen Daxin , Xia Min , Hayford Claudia , Tham El-Li , Semik Vikki , Hurst Stuart , Chen Ying , Tam Henry H. , Pan Jun , Wang Yucheng , Tan Xiaojin , Lan Hui-Yao , Shen Huahao , Kakkar Vijay V. , Xu Qingbo , McVey John H. , Dorling Anthony 
Published: February 2015

Background—
Tissue factor (TF) and coagulation proteases are involved in promoting atherosclerosis, but the molecular and cellular bases for their involvement are unknown.

Methods and Results—

We generated a new strain (ApX4) of apolipoprotein E–deficient mice expressing a membrane-tethered human tissue factor pathway inhibitor fusion protein on smooth muscle actin–positive cells, including vascular smooth muscle cells (SMCs). ApX4 mice developed little atherosclerosis on either a normal chow or high-fat diet. Lipid levels were similar to those in parental ApoE
−/−
mice, and there was no detectable difference in systemic (circulating) tissue factor pathway inhibitor levels or activity. The small lipid-rich lesions that developed had markedly reduced leukocyte infiltrates, and in contrast to ApoE
−/−
mice, SMCs did not express macrophage migratory inhibitory factor (MIF), including at sites distant from atheromatous lesions. Low levels of circulating MIF in ApX4 mice normalized to levels seen in ApoE
−/−
mice after injection of an inhibitory anti–human tissue factor pathway inhibitor antibody, which also led to MIF expression by tissue factor–positive medial SMCs. MIF production by SMCs in ApoE
−/−
mice in vitro and in vivo was shown to be dependent on tissue factor and protease-activated receptor signaling, which were inhibited in ApX4 mice.

Conclusions—

Our data indicate that tissue factor plays a hitherto unreported role in the generation of MIF by SMCs in atherosclerosis-prone ApoE
−/−
mice, inhibition of which significantly prevents the development of atherosclerosis, through inhibition of leukocyte recruitment. These data significantly enhance our understanding of the pathophysiology of this important pathology and suggest new potential translational strategies to prevent atheroma formation.
Gait Measures as Predictors of Poststroke Cognitive Function
Authors: Ben Assayag Einor , Shenhar-Tsarfaty Shani , Korczyn Amos D. , Kliper Efrat , Hallevi Hen , Shopin Ludmila , Auriel Eitan , Giladi Nir , Mike Anat , Halevy Anat , Weiss Aner , Mirelman Anat , Bornstein Natan M. , Hausdorff Jeffrey M. 
Published: February 2015

Background and Purpose—
Patients with stroke are at risk for developing cognitive impairment. We tested whether the assessment of balance and gait can enhance the prediction of long-term cognitive outcome in stroke survivors.

Methods—
Participants were patients with first-ever, mild-moderate ischemic stroke or transient ischemic attack from the Tel Aviv Brain Acute Stroke Cohort (TABASCO) study, a large prospective cohort study, who underwent 3-T MRI and were followed for ≥2 years using neurological, neuropsychological, and mobility examinations 6, 12, and 24 months after the index event.

Results—

Data were available for 298 patients (age: 66.7±9.6 years). Forty-six participants (15.4%) developed cognitive decline (CD) over the 2 years of follow-up. The CD group and cognitively intact group did not differ in their neurological deficits or in their infarct volume or location. Nonetheless, 6 months after stroke, the Timed Up and Go test took longer in those who later developed CD (
P
<0.001). Additionally, the CD group also had lower Berg Balance Scale scores (
P
<0.001), slower gait (
P
<0.001), and fewer correct answers during dual-task walking (
P
=0.006). Separate analyses of the patients with transient ischemic attack revealed similar results. Multivariate regression analysis showed that Timed Up and Go times >12 s at 6 months after stroke/transient ischemic attack was a significant independent risk marker of CD 24 months after stroke (odds ratio=6.07, 95% confidence interval: 1.36–27.15).

Conclusions—
These results suggest that measures of balance and gait are significant risk markers of cognitive status 2 years after stroke. Relatively simple, performance-based tests of mobility may enhance the identification of stroke/transient ischemic attack survivors who have an increased risk of developing CD.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01926691.
Tenecteplase–Tissue-Type Plasminogen Activator Evaluation for Minor Ischemic Stroke With Proven Occlusion
Authors: Coutts Shelagh B. , Dubuc Véronique , Mandzia Jennifer , Kenney Carol , Demchuk Andrew M. , Smith Eric E. , Subramaniam Suresh , Goyal Mayank , Patil Shivanand , Menon Bijoy K. , Barber Philip A. , Dowlatshahi Dar , Field Thalia , Asdaghi Negar , Camden Marie-Christine , Hill Michael D. 
Published: February 2015

Background and Purpose—
Minor stroke and transient ischemic attack with an intracranial occlusion are associated with neurological deterioration and disability. Tenecteplase (TNK–tissue-type plasminogen activator) compared with alteplase is easier to administer, has a longer half-life, higher fibrin specificity, possibly a lower rate of intracranial hemorrhage, and may be an ideal thrombolytic agent in this population.

Methods—
TNK–Tissue-Type Plasminogen Activator Evaluation for Minor Ischemic Stroke With Proven Occlusion (TEMPO-1) was a multicenter, prospective, uncontrolled, TNK–tissue-type plasminogen activator dose-escalation, safety, and feasibility trial. Patients with a National Institutes of Health Stroke Scale ≤5 within 12 hours of symptom onset, intracranial arterial occlusion on computed tomographic angiography and absence of well-evolved infarction were eligible. Fifty patients were enrolled; 25 patients at a dose of 0.1 mg/kg, and 25 patients at 0.25 mg/kg. Primary outcome was the rate of drug-related serious adverse events. Secondary outcomes included recanalization and 90-day neurological outcome (modified Rankin Scale, 0–1).

Results—

Median baseline National Institutes of Health Stroke Scale was 2.5 (interquartile range, 1), and median age was 71 (interquartile range, 22) years. There were no drug-related serious adverse events in tier 1. In tier 2, there was 1 symptomatic intracranial hemorrhage (4%; 95% confidence interval, 0.01–20.0). Stroke progression occurred in 6% of cases. Overall, 66% had excellent functional outcome (modified Rankin Scale, 0–1) at 90 days. Recanalization rates were high; 0.1 mg/kg (39% complete and 17% partial), 0.25 mg/kg (52% complete and 9% partial). Complete recanalization was significantly related to excellent functional outcome (modified Rankin Scale, 0–1) at 90 days (relative risk, 1.65; 95% confidence interval, 1.09–2.5;
P
=0.026).

Conclusions—
Administration of TNK–tissue-type plasminogen activator in minor stroke with intracranial occlusion is both feasible and safe. A larger randomized controlled trial is needed to prove that this treatment is efficacious.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01654445.
A Detailed Cloud Fraction Climatology of the Upper Indus Basin and Its Implications for Near-Surface Air Temperature*
Authors: Forsythe N. , Hardy A. J. , Fowler H. J. , Blenkinsop S. , Kilsby C. G. , Archer D. R. , Hashmi M. Z. 
Published: February 2015

Abstract
Clouds play a key role in hydroclimatological variability by modulating the surface energy balance and air temperature. This study utilizes MODIS cloud cover data, with corroboration from global meteorological reanalysis (ERA-Interim) cloud estimates, to describe a cloud climatology for the upper Indus River basin. It has specific focus on tributary catchments in the northwest of the region, which contribute a large fraction of basin annual runoff, including 65% of flow originating above Besham, Pakistan or 50 km3 yr−1 in absolute terms. In this region there is substantial cloud cover throughout the year, with spatial means of 50%–80% depending on the season. The annual cycles of catchment spatial mean daytime and nighttime cloud cover fraction are very similar. This regional diurnal homogeneity belies substantial spatial variability, particularly along seasonally varying vertical profiles (based on surface elevation).
Correlations between local near-surface air temperature observations and MODIS cloud cover fraction confirm the strong linkages between local atmospheric conditions and near-surface climate variability. These correlations are interpreted in terms of seasonal and diurnal variations in apparent cloud radiative effect and its influence on near-surface air temperature in the region. The potential role of cloud radiative effect in recognized seasonally and diurnally asymmetrical temperature trends over recent decades is also assessed by relating these locally observed trends to ERA-Interim-derived trends in cloud cover fraction. Specifically, reduction in nighttime cloud cover fraction relative to daytime conditions over recent decades appears to provide a plausible physical mechanism for the observed nighttime cooling of surface air temperature in summer months.