bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recognition and Significance of Pathological T-Wave Inversions in Athletes
Authors: Schnell Frédéric , Riding Nathan , O’Hanlon Rory , Axel Lentz Pierre , Donal Erwan , Kervio Gaelle , Matelot David , Leurent Guillaume , Doutreleau Stéphane , Chevalier Laurent , Guerard Sylvain , Wilson Mathew G. , Carré François 
Published: November 2014

Background—
Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations.

Methods and Results—
Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease.

Conclusions—
PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.
New Perspectives on Observed and Simulated Antarctic Sea Ice Extent Trends Using Optimal Fingerprinting Techniques*
Authors: Hobbs William Richard , Bindoff Nathaniel L. , Raphael Marilyn N. 
Published: November 2014

Abstract
Using optimal fingerprinting techniques, a detection analysis is performed to determine whether observed trends in Southern Ocean sea ice extent since 1979 are outside the expected range of natural variability. Consistent with previous studies, it is found that for the seasons of maximum sea ice cover (i.e., winter and early spring), the observed trends are not outside the range of natural variability and in some West Antarctic sectors they may be partially due to tropical variability. However, when information about the spatial pattern of trends is included in the analysis, the summer and autumn trends fall outside the range of internal variability. The detectable signal is dominated by strong and opposing trends in the Ross Sea and the Amundsen–Bellingshausen Sea regions. In contrast to the observed pattern, an ensemble of 20 CMIP5 coupled climate models shows that a decrease in Ross Sea ice cover would be expected in response to external forcings. The simulated decreases in the Ross, Bellingshausen, and Amundsen Seas for the autumn season are significantly different from unforced internal variability at the 95% confidence level. Unlike earlier work, the authors formally show that the simulated sea ice response to external forcing is different from both the observed trends and simulated internal variability and conclude that in general the CMIP5 models do not adequately represent the forced response of the Antarctic climate system.
Three-Dimensional Circulation Structure of Summer Heavy Rainfall in Central North China
Authors: Sun Wei , Yu Rucong , Li Jian , Yuan Weihua 
Published: November 2014

Abstract
Based on daily rainfall observations and Japanese 25-year Reanalysis Project data during ~1981–2010, a three-dimensional circulation structure that formed before heavy summer rainfall in central north China (CNC) is revealed in this study. Composite analyses of circulation in advance of 225 heavy rain days show that the circulation structure is characterized by a remarkable upper-tropospheric warm anomaly (UTWA), which covers most of northern China with a center at ~300 hPa. Under hydrostatic and geostrophic equilibriums, the UTWA contributes to the generation of an anticyclonic (cyclonic) anomaly above (below). The anticyclonic anomaly strengthens (weakens) westerly winds to the north (south) of the warm center and pushes the high-level westerly jet to the north. The cyclonic anomaly deepens the trough upstream of CNC and intensifies lower southwesterly winds to the mideast of the warm center. As a result, the northerly stretched high-level jet produces upper divergence in its right-front side and the intensified southwesterly winds induce lower moisture convergence in its left-front side, causing heavy rainfall in CNC. Correlation analyses further confirm the close connections between UTWA and circulation in the upper and lower troposphere. The correlation coefficients between UTWA and the upper geopotential height, upper westerly jet, and lower southerly flow reach 0.95, 0.70, and 0.39, implying that the two critical factors leading to intense rainfall in CNC, the high-level jet and the low-level southerly flow, are closely connected with the UTWA. Consequently, in the future analyses and forecasts of heavy rainfall over northern China, more attention should be paid to the temperature in the upper troposphere.
Outcomes of Recurrent Facial Palsy in Melkersson Rosenthal Syndrome
Authors: Wang Junying , Li Peizhong , Jin Xin , Xu Yu , Zhang Xin 
Published: November 2014

Objective: The objective of the study was to investigate outcomes of recurrent facial palsy in Melkersson Rosenthal syndrome (MRS). Methods: We carried out a prospective investigation on patients who had recurrent facial palsy in MRS and visited an outpatient department of otolaryngology from January 2002 to January 2012, focusing on their facial nerve outcomes. They were followed up for 12 months. The patients who visited our department due to recurrent Bell’s palsy during the same period were selected as controls. Oral prednisolone alone was given to each patient. Results: A total of 22 patients with recurrent facial palsy in MRS and 73 patients with recurrent Bell’s palsy were included in the study. Twelve months later, only 3 of 22 patients (13.6%) who had recurrent facial palsy in MRS recovered to House-Brackmann grade I, whereas 52 of 73 patients (71.2%) who had recurrent Bell’s palsy recovered completely. The difference was statistically significant ( P < .01). Conclusion: Compared to recurrent Bell’s palsy, recurrent facial palsy in MRS had much worse prognosis.
The Utility of the Sino-Nasal Outcome Test (SNOT) as a Treatment Outcome Measure in Nonsinogenic Facial Pain Syndrome
Authors: Leong Samuel C. , Tsang Hoo K. , Banhegyi Gyorgy 
Published: November 2014

Introduction: The purpose of this study was to assess the strength of correlation between the Sino-Nasal Outcome Test (SNOT) subdomains to determine which bore the greatest disease burden so that it could be used as a suitable measure of clinical response. Methods: Prospective clinical audit of patients attending the Liverpool Multi-Disciplinary Facial Pain Clinic. The Brief Pain Inventory–Facial (BPI-F) was used as a comparator and surrogate measure of quality of life. Results: Fifty patients (38 female) were reviewed, of whom 66% had midfacial segment pain. The total SNOT score was highly correlated with the BPI-F. Both the sleep function and psychological issues were the most highly correlated SNOT subdomains with the BPI-F, followed by ear-facial symptoms. The rhinologic symptom subdomain had a weak correlation with the BPI-F. The total SNOT score was most significantly correlated with the sleep function and psychological issues subdomains. Conclusion: This study supports the utility of the SNOT questionnaire as a measure of clinical outcome for nonsinogenic facial pain. The total SNOT score is highly correlated with the BPI-F, which has been used as a surrogate measure of quality of life. In addition, the sleep function and psychological issues subdomains are suitable variables to measure response to treatment.
‘What happened next’: a study of outcomes for maltreated children following care proceedings
Authors: Mulcahy Gerry , Badger Julia , Wright Hannah , Erskine Catherine 
Published: November 2014

This is the first report from a study of outcomes for 114 children from 49 families assessed in an expert multi-disciplinary service during care proceedings. The study investigated the extent of children’s adaptation following judicial decisions made in the proceedings and what factors might be involved in changes in the children’s adaptation and well-being. We also aimed to investigate the reliability of the expert placement and treatment recommendations made to the court. The original assessment reports for the court were independently coded using a comprehensive child adaptation measure (Target and Fonagy, 1992). At follow-up, mean time of 26 months after their assessment, the researchers re-employed the child adaptation measure in semi-structured interviews with carers in birth, adoptive, foster and kinship placements. The data were independently coded and the results compared with the child’s original score as a measure of change in adaptation post proceedings in their substitute family or birth family. Researchers also collected information about the children’s placement(s) and any support or treatment received. The study found that children’s well-being significantly improved by an average of +6.7 points between initial assessment ( M = 68.13; SD = 9.86) and follow-up ( M = 74.82; SD = 7.84), ( t (67) = −5.0, p < .001, d = 0.76). Children whose global adjustment scores were clinically concerning at the time of assessment hardly improved their scores (.44), compared to children whose global adjustment scores were within the normal range at the time of assessment. Interestingly, the majority (88%) of expert placement recommendations had been accepted and implemented. However, less than 50% of the children and only 30% of parents received the support and treatment recommended in the experts’ reports in the proceedings. The implications for both policy and practice in working with children and their families during and after care proceedings are explored.
Knee Chondrolysis by Infusion of Bupivacaine With Epinephrine Through an Intra-Articular Pain Pump Catheter After Arthroscopic ACL Reconstruction
Authors: Buchko Jordan Z. , Gurney-Dunlop Tanner , Shin Jason J. 
Published: November 2014

Background: Postoperative knee chondrolysis caused by continuous intra-articular pain pumps infusing bupivacaine with epinephrine is a rare but serious complication. Purpose: To determine the association between postoperative intra-articular infusion of bupivacaine with epinephrine and the development of knee chondrolysis in patients who have undergone arthroscopic anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that the development of knee chondrolysis after ACLR is associated with postoperative high-dose intra-articular bupivacaine with epinephrine infusion. Study Design: Cohort study; Level of evidence, 3. Methods: In this retrospective cohort study, the charts of all patients treated with arthroscopic ACLR by a single surgeon between January 1, 2004, and December 31, 2006, were reviewed. Patients with severe articular cartilage damage at the time of the index procedure, with known knee joint infection, inflammatory arthritis, multiligament knee injury, bilateral knee injury, or any previous knee surgery, were excluded. Patients were grouped into 2 cohorts: the exposure group (those who had postoperative infusion of bupivacaine with epinephrine via an intra-articular pain pump [IAPP]) and the nonexposure group (those without postoperative infusion). Results: A total of 105 patients met the inclusion and exclusion criteria. There were 57 male and 48 female patients with a mean age at surgery of 25.5 ± 8.6 years (range, 13-52 years). The exposure group consisted of 46 patients and the control group of 59 patients. Thirteen of 46 patients (28.3%) who received an IAPP developed chondrolysis. There were no cases of chondrolysis in the control group. Of those in the exposure group, 32 patients were exposed to 0.5% bupivacaine with epinephrine and 12 developed chondrolysis (37.5%), while 14 patients were exposed to 0.25% bupivacaine with epinephrine and 1 developed chondrolysis (7.1%). Patients exposed to 0.5% bupivacaine with epinephrine had a significantly higher incidence of chondrolysis compared with those exposed to 0.25% ( P = .03). Patients with chondrolysis had severe pain and limitations in daily activity. Conclusion: The development of knee chondrolysis was associated with the intra-articular infusion of bupivacaine with epinephrine postoperatively. Furthermore, the presented evidence suggests that this occurs in a dose-dependent manner. The risk of knee chondrolysis might be reduced by avoidance of intra-articular infusion of bupivacaine with epinephrine. We recommend against continuous intra-articular infusion of local anesthetic postoperatively.
Effect of Distal Ulnar Collateral Ligament Tear Pattern on Contact Forces and Valgus Stability in the Posteromedial Compartment of the Elbow
Authors: Hassan Sheref E. , Parks Brent G. , Douoguih Wiemi A. , Osbahr Daryl C. 
Published: November 2014

Background: It is not known whether the pattern of ulnar collateral ligament (UCL) tear affects elbow biomechanics. Hypothesis: There will be a significant change in elbow biomechanics with 50% proximal but not 50% distal simulated rupture of the UCL. Study Design: Controlled laboratory study. Methods: Pressure sensors in the posteromedial elbow joint of 25 male cadaveric elbows (average age, 54.9 years; range, 26-66 years) were used to measure contact area, pressure, and valgus torque at 90° and 30° of elbow flexion. Thirteen specimens were tested with the UCL intact, then with proximal-to-distal detachment of 50%, and then with proximal-to-distal detachment of 100% of the anterior band of the UCL from the ulnar attachment. This method was repeated in the remaining 12 specimens in a distal-to-proximal direction. Results: With 50% proximal-to-distal detachment, contact area decreased significantly versus intact at 90° (91.3 ± 23.6 vs 112.2 ± 26.0 mm2; P < .001) and 30° (69.3 ± 14.8 vs 83.1 ± 21.6 mm2; P < .001) of elbow flexion; the center of pressure (COP) moved significantly proximally versus intact at 90° (3.8 ± 2.5 vs 5.4 ± 2.3 mm; P < .001) and 30° (5.9 ± 2.8 vs 7.4±1.9 mm; P < .001). With 50% distal-to-proximal UCL detachment versus intact, no significant change was observed in contact area, movement of the COP, or valgus laxity at either flexion position. With 100% proximal-to-distal and distal-to-proximal detachment, significant change in contact area, movement of the COP, and valgus laxity versus intact was found at 90° and 30° of elbow flexion ( P < .05). No significant difference in contact pressure was observed in any test conditions. Conclusion: Significant change in contact area and proximal movement of the COP with 50% proximal UCL detachment and the lack of significant change with 50% distal UCL detachment suggest that the proximal half of the UCL ulnar footprint has a primary role in maintaining posteromedial elbow biomechanics. Clinical Relevance: The findings suggest that surgical reconstruction should aim to reestablish at least the proximal 50% of the UCL ulnar footprint.
Comparison of Two Fixation Methods for Arthrodesis of the Calcaneocuboid Joint
Authors: Milshteyn Michael A. , Dwyer Mark , Andrecovich Christopher , Bir Cynthia , Needleman Richard L. 
Published: November 2014

Background: The traditional fixation for a calcaneocuboid (CC) arthrodesis in triple arthrodesis is with a 6.5-mm cancellous screw. This procedure can be technically challenging. Fixation with a locking compression plate (LCP) may be easier to perform while achieving compression perpendicular to the fusion site. The purpose of this study was to compare the load to failure and the stiffness for each fixation method. Methods: Five matched-pair cadaver feet had an arthrodesis of the CC joint. For each matched pair, one was fixed with a screw and the other with an LCP. Surface bead markers were applied. Each specimen was then secured to a material testing machine through the calcaneus. The plantar surface of the cuboid faced the hydraulic ram to simulate weightbearing. A force was applied while the specimen was recorded with a high-resolution camera. The endpoint was maximal force at 2-mm separation between the calcaneus and cuboid measured along a horizontal axis. Results: The average force to failure and the average stiffness in the screw group were significantly less than the LCP group ( P < .05). The screw construct failed in pullout from the cuboid; the LCP construct failed by plastic deformation of the plate. Conclusion: Calcaneocuboid joint fixation with the LCP withstood a higher load until failure and demonstrated greater stiffness than with a 6.5-mm cancellous lag screw. Clinical Relevance: The use of LCP fixation can be considered as an alternative to oblique lag screw fixation for CC arthrodesis in a triple arthrodesis. It remains to be determined if LCP fixation leads to better clinical outcomes.
Operative Treatment of Primary Hyperparathyroidism in Daycare Surgery
Authors: Dulfer R. R. , van Ginhoven T. M. , Geilvoet W. , de Herder W. W. , van Eijck C. H. J. 
Published: November 2014

Objective: The standard of care for primary hyperparathyroidism is surgical removal of hyperfunctional parathyroid tissue. Here, we describe 20 patients with primary hyperparathyroidism who were treated surgically in the setting of daycare surgery. Design: Prospective observational study. Methods: A total of 20 patients with primary hyperparathyroidism were operated between March 2005 and May 2010. The follow-up period had a median of 41 weeks (5–245 weeks). Results are presented as mean (± standard deviation) or median (minimum–maximum). Results: A total of 20 patients (15 women, mean age 54 ± 14 years) were included. Nine patients were provided with post-operative calcium supplementation. One of the patients visited the emergency department the next day with paresthesia and normocalcemia; this patient was sent home. Four patients, without prophylaxis, also reported themselves to the emergency department. Only one had mild hypocalcemia (2.09 mmol/L) and was supplemented. Comparing the emergency department group (n = 5) with the others, we found that pre-operative calcium levels were similar (p = 0.40); however, the emergency department group had significantly lower post-operative calcium levels (2.27 ± 0.14 vs 2.55 ± 0.25, p = 0.008) and the decrease-percentage was significantly higher (17.5% ± 5.4% vs 10.5% ± 6.4%, p = 0.21). Conclusion: Parathyroidectomy in the daycare setting is feasible and safe. However, many patients return to the emergency department. This could be related to the strict information that is provided or due to a large decrease in their calcium levels, albeit normocalcemia. Calcium supplementation is cheap and safe, so we will provide all future patients with calcium supplementation and herewith aim to reduce the amount of emergency department visits.
Reducing the rates of prescribing high-dose antipsychotics and polypharmacy on psychiatric inpatient and intensive care units: results of a 6-year quality improvement programme
Authors: Mace Shubhra , Taylor David 
Published: November 2014

Background: There is no conclusive evidence that either high doses or combinations of antipsychotics are more effective than standard doses or monotherapy alone. Nonetheless, prescription of both remains prevalent in the UK. In 2006 the South London and Maudsley NHS Foundation Trust (SLAM) participated in a national survey of prescription of antipsychotic medications, organized by the Prescribing Observatory for Mental Health. Over half of the patients on SLAM inpatient or psychiatric intensive care units were prescribed a high-dose antipsychotic or a combination of antipsychotics. Prescribing high-dose antipsychotics and polypharmacy in SLAM was found to be among the highest in the UK. Aim: To assess the impact of a 6-year quality improvement programme aimed at reducing the rates of prescribing high-dose antipsychotics and polypharmacy on SLAM inpatients and psychiatric intensive care units. Results: There was a significant reduction between baseline and final survey in the rates of prescription of both high-dose antipsychotics and polypharmacy on SLAM inpatients and intensive care units (58% versus 10% p < 0.0001 and 57% versus 16%, p < 0.0001 respectively). The proportion of patients at final survey prescribed a high-dose antipsychotic and a combination was substantially lower in SLAM than in the national sample (10% versus 28%, p < 0.0001 and 16% versus 38%, p < 0.0001 respectively). Clinical implications: A sustained change in the prescribing culture of an organization can be achieved through a targeted improvement programme.
“Barcelona or die”: understanding illegal migration from Senegal
Authors: Mbaye Linguère Mously 
Published: November 2014

Abstract
Fatalities from illegal immigration from Africa to Europe are a grave reality. The phenomenon represents a major challenge for both home and host countries. Nonetheless, almost nothing is known about how the motivations of potentially illegally migrating individuals are formed. This paper aims to explain the factors behind the formation of the willingness to migrate illegally knowing that death might occur during the trip. I focus on the role of expectations, friends and relatives who have migrated and host countries policies. By using an original survey among Senegalese residing in Dakar in 2006-2007, I show that potential illegal migrants are willing to accept a substantial risk of death. I find that high expectations and migrant networks are positively related with illegal migration motivations. Surprisingly, I find that stricter immigration policies deter potential legal migrants much more than potential illegal migrants.
Finally, I find that the price of illegal migration is negatively correlated with the willingness to migrate illegally.

JEL Code: F22, O15