bluuebunny/crossref_metadata_2025_split huggingface dataset:
Both High and Low HbA1c Predict Incident Heart Failure in Type 2 Diabetes Mellitus
Authors: Parry Helen M. , Deshmukh Harshal , Levin Daniel , Van Zuydam Natalie , Elder Douglas H.J. , Morris Andrew D. , Struthers Allan D. , Palmer Colin N.A. , Doney Alex S.F. , Lang Chim C. 
Published: January 2015

Background—
Type 2 diabetes mellitus is an independent risk factor for heart failure development, but the relationship between incident heart failure and antecedent glycemia has not been evaluated.

Methods and Results—

The Genetics of Diabetes Audit and Research in Tayside Study study holds data for 8683 individuals with type 2 diabetes mellitus. Dispensed prescribing, hospital admission data, and echocardiography reports were linked to extract incident heart failure cases from December 1998 to August 2011. All available HbA1c measures until heart failure development or end of study were used to model HbA1c time-dependently. Individuals were observed from study enrolment until heart failure development or end of study. Proportional hazard regression calculated heart failure development risk associated with specific HbA1c ranges accounting for comorbidities associated with heart failure, including blood pressure, body mass index, and coronary artery disease. Seven hundred and one individuals with type 2 diabetes mellitus (8%) developed heart failure during follow up (mean 5.5 years, ±2.8 years). Time-updated analysis with longitudinal HbA1c showed that both HbA1c <6% (hazard ratio =1.60; 95% confidence interval, 1.38–1.86;
P
value <0.0001) and HbA1c >10% (hazard ratio =1.80; 95% confidence interval, 1.60–2.16;
P
value <0.0001) were independently associated with the risk of heart failure.

Conclusions—
Both high and low HbA1c predicted heart failure development in our cohort, forming a U-shaped relationship.
Electrocardiographic Changes During Exercise in Acute Hypoxia and Susceptibility to Severe High-Altitude Illnesses
Authors: Coustet Baptiste , Lhuissier François J. , Vincent Renaud , Richalet Jean-Paul 
Published: January 2015

Background—
The goals of this study were to compare ECG at moderate exercise in normoxia and hypoxia at the same heart rate, to provide evidence of independent predictors of hypoxia-induced ECG changes, and to evaluate ECG risk factors of severe high-altitude illness.

Methods and Results—

A total of 456 subjects performed a 20-minute hypoxia exercise test with continuous recording of ECG and physiological measurements before a sojourn above 4000 m. Hypoxia did not induce any conduction disorder, arrhythmias, or change in QRS axis. The amplitude of the P wave in V
1
was lower in hypoxia than in normoxia. The amplitudes of the R, S, and T waves and the Sokolow index decreased in hypoxia. Under hypoxia, the amplitude of the ST segment decreased in II and V
6
and increased in V
1
, the ST slope rose in V
5
and V
6
, and the J point was lower in II, V
5
, and V
6
. Multivariate regression of hypoxic/normoxic ratios of electrophysiological parameters and clinical characteristics showed a correlation between the decrease in Sokolow index and T-wave amplitude in V
5
with desaturation at exercise. Trained status and low body mass index were associated with a smaller decrease in T-wave amplitude in V
5
and V
6
. Comparison of ECG between subjects suffering or not suffering from severe high-altitude illness failed to show any difference.

Conclusions—
During a hypoxia exercise test, a dose-dependent hypoxia-induced decrease in the amplitude of the P/QRS/T waves was observed. No standard ECG characteristic predicted the risk of developing severe high-altitude illness. Further studies are required to clarify the cause of these electric changes and their potential predictive role in cardiac events.
Evaluation of Effectiveness and Cost‐Effectiveness of a Clinical Decision Support System in Managing Hypertension in Resource Constrained Primary Health Care Settings: Results From a Cluster Randomized Trial
Authors: Anchala Raghupathy , Kaptoge Stephen , Pant Hira , Di Angelantonio Emanuele , Franco Oscar H. , Prabhakaran D. 
Published: January 2015

Background
Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings.

Methods and Results

We performed a cluster randomized trial to test the effectiveness and cost‐effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart‐based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow‐up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was −6.59 mm Hg (95% confidence interval: −12.18 to −1.42;
P
=0.021). The cost‐effective ratio for CBS and DSS groups was $96.01 and $36.57 per mm of SBP reduction, respectively.

Conclusion
Clinical DSS are effective and cost‐effective in the management of HTN in resource‐constrained PHC settings.

Clinical Trial Registration

URL:
http://www.ctri.nic.in
. Unique identifier: CTRI/2012/03/002476.
Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST‐Elevation Myocardial Infarction: A Nationwide Study in Denmark
Authors: Jabbari Reza , Engstrøm Thomas , Glinge Charlotte , Risgaard Bjarke , Jabbari Javad , Winkel Bo Gregers , Terkelsen Christian Juhl , Tilsted Hans‐Henrik , Jensen Lisette Okkels , Hougaard Mikkel , Chiuve Stephanie E. , Pedersen Frants , Svendsen Jesper Hastrup , Haunsø Stig , Albert Christine M. , Tfelt‐Hansen Jacob 
Published: January 2015

Background

We aimed to investigate the incidence and risk factors for ventricular fibrillation (
VF
) before primary percutaneous coronary intervention (
PPCI
) among patients with
ST
‐segment elevation myocardial infarction (
STEMI
) in a prospective nationwide setting.

Methods and Results

In this case‐control study, patients presenting within the first 12 hours of first
STEMI
who survived to undergo angiography and subsequent
PPCI
were enrolled. Over 2 years, 219 cases presenting with
VF
before
PPCI
and 441 controls without preceding
VF
were enrolled. Of the 219 case patients, 182 (83%) had
STEMI
with out‐of‐hospital cardiac arrest due to
VF
, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of
VF
before
PPCI
among
STEMI
patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with
VF
. Patients with a history of
atrial fibrillation
had a 2.80‐fold odds of experiencing
VF
before
PPCI
(95%
CI
1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (
OR) of
1.30 (95%
CI
, 0.80 to 2.20), 2.30 (95%
CI
, 1.20 to 4.20), or 3.30 (95%
CI
, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (
OR
0.46; 95%
CI
0.32 to 0.67), age of <60 years (
OR
1.75; 95%
CI
1.20 to 2.60), anterior infarction (
OR
2.10; 95%
CI
1.40 to 3.00), preprocedural
thrombolysis in myocardial infarction
flow grade 0 (
OR
1.65; 95%
CI
1.14 to 2.40), and family history of sudden death (
OR
1.60; 95%
CI
1.10 to 2.40) were all associated with
VF
.

Conclusion

Several easily assessed risk factors were associated with
VF
occurring out‐of‐hospital or on arrival at the emergency room before
PPCI
in
STEMI
patients, thus providing potential avenues for investigation regarding improved identification and prevention of life‐threatening ventricular arrhythmias.
Effect of Cardiogenic Shock Hospital Volume on Mortality in Patients With Cardiogenic Shock
Authors: Shaefi Shahzad , O'Gara Brian , Kociol Robb D. , Joynt Karen , Mueller Ariel , Nizamuddin Junaid , Mahmood Eitezaz , Talmor Daniel , Shahul Sajid 
Published: January 2015

Background

Cardiogenic shock (
CS
) is associated with significant morbidity, and mortality rates approach 40% to 60%. Treatment for
CS
requires an aggressive, sophisticated, complex, goal‐oriented, therapeutic regimen focused on early revascularization and adjunctive supportive therapies, suggesting that hospitals with greater
CS
volume may provide better care. The association between
CS
hospital volume and inpatient mortality for
CS
is unclear.

Methods and Results

We used the Nationwide Inpatient Sample to examine 533 179 weighted patient discharges from 2675 hospitals with
CS
from 2004 to 2011 and divided them into quartiles of mean annual hospital
CS
case volume. The primary outcome was in‐hospital mortality. Multivariate adjustments were performed to account for severity of illness, relevant comorbidities, hospital characteristics, and differences in treatment. Compared with the highest volume quartile, the adjusted odds ratio for inpatient mortality for persons admitted to hospitals in the lowest‐volume quartile (≤27 weighted cases per year) was 1.27 (95%
CI
1.15 to 1.40), whereas for admission to hospitals in the low‐volume and medium‐volume quartiles, the odds ratios were 1.20 (95%
CI
1.08 to 1.32) and 1.12 (95%
CI
1.01 to 1.24), respectively. Similarly, improved survival was observed across quartiles, with an adjusted inpatient mortality incidence of 41.97% (95%
CI
40.87 to 43.08) for hospitals with the lowest volume of
CS
cases and a drop to 37.01% (95%
CI
35.11 to 38.96) for hospitals with the highest volume of
CS
cases. Analysis of treatments offered between hospital quartiles revealed that the centers with volumes in the highest quartile demonstrated significantly higher numbers of patients undergoing coronary artery bypass grafting, percutaneous coronary intervention, or intra‐aortic balloon pump counterpulsation. A similar relationship was demonstrated with the use of mechanical circulatory support (ventricular assist devices and extracorporeal membrane oxygenation), for which there was significantly higher use in the higher volume quartiles.

Conclusions

We demonstrated an association between lower
CS
case volume and higher mortality. There is more frequent use of both standard supportive and revascularization techniques at the higher volume centers. Future directions may include examining whether early stabilization and transfer improve outcomes of patients with
CS
who are admitted to lower volume centers.
Subdiurnal Stratocumulus Cloud Fraction Variability and Sensitivity to Precipitation
Authors: Burleyson Casey D. , Yuter Sandra E. 
Published: January 2015

AbstractThis paper presents an analysis of subtropical marine stratocumulus cloud fraction variability using a 30-min and 3° × 3° cloud fraction dataset from 2003 to 2010. Each of the three subtropical marine stratocumulus regions has distinct diurnal characteristics, but the southeast (SE) Pacific and SE Atlantic are more similar to each other than to the northeast (NE) Pacific. The amplitude and season-to-season diurnal cycle variations are larger in the Southern Hemisphere regions than in the NE Pacific. Net overnight changes in cloud fraction on 3° × 3° scales are either positive or neutral >77% of the time in the NE Pacific and >88% of the time in the SE Pacific and SE Atlantic. Cloud fraction often increases to 100% by dawn when cloud fraction at dusk is >30%. In the SE Pacific and SE Atlantic, a typical decrease in cloud area (median ≤ −5.7 × 105 km2) during the day is equivalent to 25% or more of the annual-mean cloud deck area. Time series for 3° × 3° areas where cloud fraction was ≥90% sometime overnight and <60% at dawn, such as would result from nocturnal formation of pockets of open cells (POCs), only occur 1.5%, 1.6%, and 3.3% of the time in the SE Pacific, SE Atlantic, and NE Pacific, respectively. Comparison of cloud fraction changes to ship-based radar and satellite-derived precipitation intensity and area measurements shows a lack of sensitivity of cloud fraction to drizzle on time scales of 1–3 h and spatial scales of 100–300 km.
Calculating Crop Water Requirement Satisfaction in the West Africa Sahel with Remotely Sensed Soil Moisture
Authors: McNally Amy , Husak Gregory J. , Brown Molly , Carroll Mark , Funk Chris , Yatheendradas Soni , Arsenault Kristi , Peters-Lidard Christa , Verdin James P. 
Published: January 2015

Abstract
The Soil Moisture Active Passive (SMAP) mission will provide soil moisture data with unprecedented accuracy, resolution, and coverage, enabling models to better track agricultural drought and estimate yields. In turn, this information can be used to shape policy related to food and water from commodity markets to humanitarian relief efforts. New data alone, however, do not translate to improvements in drought and yield forecasts. New tools will be needed to transform SMAP data into agriculturally meaningful products. The objective of this study is to evaluate the possibility and efficiency of replacing the rainfall-derived soil moisture component of a crop water stress index with SMAP data. The approach is demonstrated with 0.1°-resolution, ~10-day microwave soil moisture from the European Space Agency and simulated soil moisture from the Famine Early Warning Systems Network Land Data Assimilation System. Over a West Africa domain, the approach is evaluated by comparing the different soil moisture estimates and their resulting Water Requirement Satisfaction Index values from 2000 to 2010. This study highlights how the ensemble of indices performs during wet versus dry years, over different land-cover types, and the correlation with national-level millet yields. The new approach is a feasible and useful way to quantitatively assess how satellite-derived rainfall and soil moisture track agricultural water deficits. Given the importance of soil moisture in many applications, ranging from agriculture to public health to fire, this study should inspire other modeling communities to reformulate existing tools to take advantage of SMAP data.
Technique for Reducing the Effects of Nonlinear Terms on Electric Field Measurements of Electric Field Sensor Arrays on Aircraft Platforms
Authors: Mach D. M. 
Published: January 2015

AbstractA generalized technique has been developed that reduces the contributions of nonlinear effects that occur during measurements of natural electric fields around thunderstorms by an array of field mills on an aircraft. The nonlinear effects can be due to nearby charge emitted by the aircraft as it acquires and sheds charge, but the nonlinear effects are not limited to such sources. The generalized technique uses the multiple independent measurements of the external electric field obtained during flight to determine and remove nonlinear contaminations in the external vector electric field. To demonstrate the technique, a simulated case with nonlinear contaminations was created and then corrected for the nonlinear components. In addition, data from two different field programs utilizing two different aircraft and field mill configurations, each containing observable and different nonlinear effects, were also corrected for the significant nonlinear effects found in the field mill outputs. The expanded independent measurements in this new technique allow for the determination and correction of components in the field mill outputs from almost any measurable source. Alternate utilization of the technique can include removing effects in the aircraft charging such as aircraft altitude, cloud properties, engine power settings, or aircraft flap deployment. This technique provides a way to make more precise measurements of the true external electric field for scientific studies of cloud electrification.
Pharyngeal Wall Floppiness
Authors: Qian Wei , Tang Jun‐xiang , Jiang Guo‐chang , Zhao Lin 
Published: January 2015

ObjectiveTo measure pharyngeal wall floppiness (PWF) under different pressures, a novel method and technique were introduced in the present study.Study DesignA prospective clinical study.Subjects and MethodsForty‐seven healthy subjects (32 male; mean age, 37.9 years) and 49 patients with obstructive sleep apnea syndrome (OSAS) (46 male; mean age, 41.45 years) were recruited. The pharyngeal cavity volume was measured by acoustic reflection under positive (10 cm H2O) and negative (−10 cm H2O) pressures. The pharyngeal cavity volume was detected from the segment of 10 to 20 cm from the incisor. Moreover, PWF was calculated from the difference of pharyngeal cavity volumes under positive and negative pressures divided by the sum of the volumes under positive and negative pressures. The measurements were conducted on a group of 7 subjects weekly over 3 consecutive weeks to evaluate test‐retest variability.ResultsThe mean PWF was 0.19 ± 0.11 in healthy subjects and 0.24 ± 0.07 in the OSAS group, with a significant difference (P <. 01). There was moderate positive correlation between PWF and age or body mass index in healthy subjects. In the 7 subjects, the mean measured interclass correlation coefficient was 0.9 (P <. 05) in 3 consecutive weekly measurements.ConclusionThe OSAS population had greater PWF compared to healthy subjects. The age dependency of PWF in healthy subjects implied which might play important roles in the development of OSAS. This noninvasive and reproducible technique might be a useful tool in OSAS clinical applications.
Acute Injuries in Track and Field Athletes
Authors: Opar David , Drezner Jonathan , Shield Anthony , Williams Morgan , Webner David , Sennett Brian , Kapur Rahul , Cohen Marc , Ulager James , Cafengiu Anna , Cronholm Peter F. 
Published: January 2015

Background: Few studies have examined acute injuries in track and field in both elite and subelite athletes. Purpose: To observe the absolute number and relative rates of injury in track and field athletes across a wide range of competition levels and ages during 3 years of the Penn Relays Carnival to assist with future medical coverage planning and injury prevention strategies. Study Design: Descriptive epidemiology study. Methods: Over a 3-year period, all injuries treated by the medical staff were recorded on a standardized injury report form. Absolute number of injuries and relative injury rates (number of injuries per 1000 competing athletes) were determined and odds ratios (ORs) of injury rates were calculated between sexes, competition levels, and events. Injuries were also broken down into major or minor medical or orthopaedic injuries. Results: Throughout the study period, 48,473 competing athletes participated in the Penn Relays Carnival, and 436 injuries were sustained. For medical coverage purposes, the relative rate of injury subtypes was greatest for minor orthopaedic injuries (5.71 injuries per 1000 participants), followed by minor medical injuries (3.42 injuries per 1000 participants), major medical injuries (0.69 injuries per 1000 participants), and major orthopaedic injuries (0.18 injuries per 1000 participants). College/elite athletes displayed the lowest relative injury rate (7.99 injuries per 1000 participants), which was significantly less than that of high school (9.87 injuries per 1000 participants) and masters athletes (16.33 injuries per 1000 participants). Male athletes displayed a greater likelihood of having a minor orthopaedic injury compared with female athletes (OR, 1.36 [95% CI, 1.06-1.75]; χ2 = 5.73; P = .017) but were less likely to sustain a major medical injury (OR, 0.33 [95% CI, 0.15-0.75]; χ2 = 7.75; P = .005). Of the 3 most heavily participated in events, the 4 × 400-m relay displayed the greatest relative injury rate (13.6 injuries per 1000 participants) compared with the 4 × 100-m and 4 × 200-m relays. Conclusion: Medical coverage teams for future large-scale track and field events need to plan for at least 2 major orthopaedic and 7 major medical injuries per 10,000 participants. Male track and field athletes, particularly masters male athletes, are at greater risk of injury compared with other sexes and competition levels.
Tibiotalocalcaneal Arthrodesis Using a Straight Intramedullary Nail
Authors: Lucas y Hernandez Julien , Abad Julien , Remy Stanislas , Darcel Veronique , Chauveaux Dominique , Laffenetre Olivier 
Published: January 2015

Background: Tibiotalocalcaneal (TTC) arthrodesis is a proven solution for severe hindfoot arthropathy that reestablishes stability for plantigrade gait and alleviates pain, while correcting deformity. Intramedullary nailing is an effective option for fixation. The aim of this study was to determine clinical outcome, analyze the fusion rate, and determine final hindfoot alignment in a consecutive series of patients using a single-design straight intramedullary nail. Methods: This study evaluated 63 patients treated between 2006 and 2010 with at least 36 months of follow-up. Ten patients were excluded because of study inclusion criteria, and 4 were lost to follow-up, leaving 49 patients available for review. The average follow-up was 70.7 ± 15.1 months. Results: The American Orthopaedic Foot and Ankle Society score improved from 29.7 ± 15.1 before arthrodesis to 65.8 ± 14.6 after ( P < .001) with 83.7% (41/49) of patients stating they were satisfied or very satisfied with the outcome. The hindfoot angle improved from −3 ± 15 degrees (varus) before the arthrodesis to 3.5 ± 4 degrees (valgus) after; the tibiotalar angle averaged 103 ± 4.2 degrees after the arthrodesis. Fusion occurred in both joints in 86% (42/49) of patients and in 93% (91/98) of all joints. The average time to fusion was 4.5 ± 2 months. Current smokers had a significantly ( P = .03) higher risk of complications. Use of an allograft, with or without bone morphogenetic protein 2, led to comparable results even in the presence of a large bone defect. Conclusion: These results are comparable to previously published studies using intramedullary nailing to achieve tibiotalocalcaneal arthrodesis. The complication concerns typically associated with straight nails were not found. We recommend using a retrograde intramedullary nail for the fixation of TTC arthrodesis and adding an allograft in cases of significant bone loss. Level of Evidence: Level IV, consecutive case series.