bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality Improvement in Coronary Care: Analysis of Sustainability and Impact on Adjacent Clinical Measures After a Swedish Controlled, Multicenter Quality Improvement Collaborative
Authors: Carlhed Rickard , Bellman Christina , Bojestig Mats , Bojö Leif , Peterson Anette , Lindahl Bertil ,   the Quality Improvement in Coronary Care (QUICC) Study Group
Published: September 2012

Background

Quality Improvement in Coronary Care, a Swedish multicenter, controlled quality‐improvement (
QI
) collaborative, has shown significant improvements in adherence to national guidelines for acute myocardial infarction, as well as improved clinical outcome. The objectives of this report were to describe the sustainability of the improvements after withdrawal of study support and a consolidation period of 3 months and to report whether improvements were disseminated to treatments and diagnostic procedures other than those primarily targeted.

Methods and Results

Multidisciplinary teams from 19 Swedish hospitals were educated in basic
QI
methodologies. Another 19 matched hospitals were included as blinded controls. All evaluations were made on the hospital level, and data were obtained from a national quality registry, Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS‐HIA). Sustainability indicators consisted of use of angiotensin‐converting enzyme inhibitors, lipid‐lowering therapy, clopidogrel, low‐molecular weight heparin, and coronary angiography. Dissemination indicators were use of echocardiography, stress tests, and reperfusion therapy; time delays; and length of stay. At the reevaluation period of 6 months, the improvements at the
QI
intervention hospitals were sustained in all indicators but 1 (angiotensin‐converting enzyme inhibitor). Between the 2 measurements, the control group improved significantly in all but 1 indicator (angiotensin‐converting enzyme inhibitor). However, at the second measurement, the absolute adherence rates of the intervention hospitals were still numerically higher in all 5 indicators, and significantly so in 1 (clopidogrel). No significant changes were observed for the dissemination indicators.

Conclusions

The combination of a systematic
QI
collaborative with a national, interactive quality registry might lead to substantial and sustained improvements in the quality of acute myocardial infarction care. However, to achieve disseminated improvements in adjacent clinical measures, those adjacent measures probably should be made explicit before any
QI
intervention.
Delay in Presentation After an Acute Stroke in a Multiethnic Population in South London: The South London Stroke Register
Authors: Addo Juliet , Ayis Salma , Leon Josette , Rudd Anthony G. , McKevitt Christopher , Wolfe Charles D.A. 
Published: September 2012

Background
Delayed presentation to hospital after an acute stroke is a major explanation given for low thrombolysis rates. This study aimed to investigate the factors associated with delays in presentation after an acute stroke and changes after a mass media campaign.

Methods and Results
Data were from a population‐based study involving 1392 patients with first‐ever strokes between 2002 and 2010 in a multiethnic South London population. Associations were determined between prehospital delay (≥3 hours) and variables of interest, including ethnicity, by using multivariate logistic regression analyses. Differences in prehospital delay and thrombolysis rates were determined for the period immediately before and after the FAST mass media campaign (2007/2008 versus 2009/2010).

The median (Q
1
to Q
3
) time to presentation was 4.73 (1.55 to 12.70) hours, and 550 (39.5%) presented within 3 hours of symptom onset. In multivariate analysis, patients of black ethnicity had increased odds of delay (odds ratio: 1.63; 95% confidence interval, 1.11 to 2.38), whereas those with more severe strokes characterized by a higher National Institutes of Health Stroke Scale score (odds ratio: 0.35; 95% confidence interval, 0.20 to 0.61) had reduced odds of delay. There was no difference in the proportion of patients who arrived within 3 hours (
P
=0.30) in the period immediately before and after the FAST campaign (40.7% in 2007/2008 versus 44.9% in 2009/2010). Among patients with ischemic stroke, 119 (11.0%) received thrombolysis between 2002 and 2010, with no difference observed between the pre‐ and postcampaign periods (16.9% versus 16.4%).

Conclusion

Significant delays in seeking care after stroke still occur in this population despite efforts to increase public awareness. Future educational programs must identify and specifically address factors that influence behavior and should target those at higher risk of delay.

(
J Am Heart Assoc
. 2012;1:e001685 doi

:
10.1161/JAHA.112.001685
.)
Peroxisome Proliferator–Activated Receptor‐α Agonism With Fenofibrate Does Not Suppress Inflammatory Responses to Evoked Endotoxemia
Authors: Mulvey Claire K. , Ferguson Jane F. , Tabita‐Martinez Jennifer , Kong Stephanie , Shah Rhia Y. , Patel Parth N. , Master Stephen R. , Usman M. Haris U. , Propert Kathleen J. , Shah Rachana , Mehta Nehal N. , Reilly Muredach P. 
Published: September 2012

Background

Data conflict with regard to whether peroxisome proliferator–activated receptor‐α agonism suppresses inflammation in humans. We hypothesized that in healthy adults peroxisome proliferator–activated receptor‐α agonism with fenofibrate would blunt the induced immune responses to endotoxin (lipopolysaccharide [
LPS
]), an in vivo model for the study of cardiometabolic inflammation.

Methods and Results

In the Fenofibrate and omega‐3 Fatty Acid Modulation of Endotoxemia (FFAME) trial, 36 healthy volunteers (mean age 26±7 years, mean body mass index 24±3 kg/m
2
, 44% female, 72% white) were randomized to fenofibrate 145 mg or placebo daily. After 6 to 8 weeks of treatment, subjects underwent a low‐dose
LPS
challenge. Clinical and blood measurements were collected at randomization, before
LPS
administration, and serially for 24 hours after
LPS
administration. We examined area under the curve for evoked responses by treatment group. Compared to placebo, but before
LPS
challenge, fenofibrate reduced total cholesterol and tended to decrease triglycerides, consistent with achieved therapeutic plasma levels of fenofibric acid. In the placebo group,
LPS
induced a modest inflammatory response with increased cytokines and chemokines (2‐ to 4‐hour post‐
LPS
8‐fold increase in tumor necrosis factor‐α, 9‐fold increase in interleukin‐6, 9‐fold increase in interleukin‐10, and 10‐fold increase in monocyte chemotactic protein‐1; all
P
<0.001) and acute‐phase reactants (24‐hour post‐
LPS
15‐fold increase in serum amyloid A and 9‐fold increase in C‐reactive protein; both
P
<0.001). Compared to placebo, however, fenofibrate did not significantly attenuate
LPS
‐induced levels of plasma cytokines, chemokines, or acute‐phase proteins.

Conclusions
These data suggest a lack of systemic antiinflammatory properties of fenofibrate at clinically relevant dosing in humans.

Clinical Trial Registration

URL:
http://clinicaltrials.gov/ct2/show/NCT01048502
. Unique identifier: NCT01048502.
Risk Factors for Intracranial Hemorrhage in Acute Ischemic Stroke Patients Treated With Recombinant Tissue Plasminogen Activator
Authors: Whiteley William N. , Slot Karsten Bruins , Fernandes Peter , Sandercock Peter , Wardlaw Joanna 
Published: September 2012

Background and Purpose—
Recombinant tissue plasminogen activator (rtPA) is an effective treatment for acute ischemic stroke but is associated with an increased risk of intracranial hemorrhage (ICH). We sought to identify the risk factors for ICH with a systematic review of the published literature.

Methods—
We searched for studies of rtPA-treated stroke patients that reported an association between a variable measured before rtPA infusion and clinically important ICH (parenchymal ICH or ICH associated with clinical deterioration). We calculated associations between baseline variables and ICH with random-effect meta-analyses.

Results—
We identified 55 studies that measured 43 baseline variables in 65 264 acute ischemic stroke patients. Post-rtPA ICH was associated with higher age (odds ratio, 1.03 per year; 95% confidence interval, 1.01–1.04), higher stroke severity (odds ratio, 1.08 per National Institutes of Health Stroke Scale point; 95% confidence interval, 1.06–1.11), and higher glucose (odds ratio, 1.10 per mmol/L; 95% confidence interval, 1.05–1.14). There was approximately a doubling of the odds of ICH with the presence of atrial fibrillation, congestive heart failure, renal impairment, previous antiplatelet agents, leukoaraiosis, and a visible acute cerebral ischemic lesion on pretreatment brain imaging. Little of the variation in the sizes of the associations among different studies was explained by the source of the cohort, definition of ICH, or degree of adjustment for confounding variables.

Conclusions—
Individual baseline variables were modestly associated with post-rtPA ICH. Prediction of post-rtPA ICH therefore is likely to be difficult if based on single clinical or imaging factors alone. These observational data do not provide a reliable method for the individualization of treatment according to predicted ICH risk.
Impact of Asymmetric Dynamical Processes on the Structure and Intensity Change of Two-Dimensional Hurricane-Like Annular Vortices
Authors: Menelaou Konstantinos , Yau M. K. , Martinez Yosvany 
Published: September 2012

AbstractIn this study, a simple two-dimensional (2D) unforced barotropic model is used to study the asymmetric dynamics of the hurricane inner-core region and to assess their impact on the structure and intensity change. Two sets of experiments are conducted, starting with stable and unstable annular vortices, to mimic intense mature hurricane-like vortices. The theory of empirical normal modes (ENM) and the Eliassen–Palm flux theorem are then applied to extract the dominant wave modes from the dataset and diagnose their kinematics, structure, and impact on the primary vortex.From the first experiment, it is found that the evolution and the lifetime of an elliptical eyewall, described by a stable annular vortex perturbed by an external wavenumber-2 impulse, may be controlled by the inviscid damping of sheared vortex Rossby waves (VRWs) or the decay of an excited quasimode. The critical radius and structure of the quasimode obtained by the ENM analysis are shown to be consistent with the predictions of a linear eigenmode analysis of small perturbations. From the second experiment, it is found that the outward-propagating VRWs that arise due to barotropic instability and the inward mixing of high vorticity in the unstable annular vortex affect the primary circulation and create a secondary ring of enhanced vorticity that contains a secondary wind maximum. Sensitivity tests performed on the spatial extent of the initial external impulse verifies the robustness of the results. That the secondary eyewall occurs close to the critical radius of some of the dominant modes emphasizes the important role played by the VRWs.
Electrospun poly(vinyl alcohol)/α-zirconium phosphate nanocomposite fibers
Authors: Wei Suying , Lizu Monira , Zhang Xi , Sampathi Jayanthi , Sun Luyi , Milner Matthew F. 
Published: September 2012

Poly(vinyl alcohol) (PVA)/α-zirconium phosphate (ZrP) polymer nanocomposite (PNC) fibers were successfully prepared by a simple and low-cost electrospinning process. ZrP nanoparticles with two different dimensions, that is, ZrP-500 with a lateral dimension of ∼320 nm and an aspect ratio of ∼500 and ZrP-1500 with a lateral dimension of ∼950 nm and an aspect ratio of ∼1500, were utilized to illustrate the size effect on the electrospun nanofibers. In order to obtain defect-free, uniform PNC fibers, a number of parameters including polymer concentration, feed rate, applied voltage and working distance between the needle tip and the fiber collecting substrate were investigated. Scanning electron microscopic morphological analysis showed smooth and nonwoven electrospun nanofiber mat. Strong intermolecular interactions between the PVA matrix and the included ZrP nanofillers were revealed by the attenuated total reflectance Fourier transform infrared spectroscopy. The incorporation of ZrP nanofillers drastically improved the thermal stability of the PNC fibers. Results of thermogravimetric analysis demonstrated a clear thermal stability dependence on the aspect ratio of the crystalline ZrP nanofillers. The degradation temperature was increased by 90°C for the ZrP-1500 and 60°C for ZrP-500, when the loading level was increased from 1 wt% to 5 wt%. Furthermore, the viscoelastic properties of the PNC solutions were studied by the rheometer. The solutions with higher loading of the nanofiller exhibited higher viscosity and demonstrated different fluid nature when compared with the solutions at lower loading level.
Work Effort, Productivity, and Compensation Trends in Members of the Society for Vascular Surgery
Authors: Satiani Bhagwan , Matthews Mika A.B. , Gable Dennis 
Published: September 2012

Objective: To survey the Society for Vascular Surgery (SVS) membership with regard to type of practice, employment status, work effort, and productivity criteria. Methods: A survey questionnaire was developed to gather information about member demographics, academic versus private practice, employment status, time in practice, measures of work, and productivity criteria. Results: Two-thirds of members were in private practice, 24% were employed by hospitals/health systems and 21% were in solo practice. Only 50.3% said they or their group kept record of relative value units/work relative value units (RVUs/WRVUs). Of those tracking RVUs, significantly greater number of private practice VS reported annual RVUs >10 000 compared to academic VS ( P < .01). Net collections were the most common measure of productivity (51%) followed by WRVUs (36%). Conclusions: With a changing environment and employment status of VS, tracking measures of productivity and proper benchmarking become vitally important. The SVS should consider positioning itself to collect, store, manage, and provide such information to assist members in practice transition.
Impact of an Assistant on the Technical Skills of the Primary Operator in Superficial Femoral Artery Angioplasty
Authors: Hseino Hazem , Nugent Emmeline , Cantwell Colin , Lee Michael J. , Given Mark , Hill Arnold D. K. , Moneley Daragh 
Published: September 2012

Objective: To assess the impact of an assistant on the technical skills of the operator performing superficial femoral artery (SFA) angioplasty on the vascular intervention simulation trainer (VIST) simulator. Methods: Eight experts performed 2 SFA angioplasties each on the VIST. Four experts had an assistant available. Experts’ video recordings were blindly evaluated using global and procedural rating scales. Results: Experts with assistants scored higher than the controls in the first: global rating scale (47.8 ± 0.5 vs 33.5 ± 5.1, P = .01); procedural rating scale (94.3 ± 2.2 vs 89 ± 2.5, P = .02) and the second procedure: global rating scale (47.8 ± 0.5 vs 38 ± 7, P = .03); procedural rating scale (95.3 ± 0.5 vs 89.5 ± 2.4, P = .02). Conclusions: The presence of an assistant had a positive influence on the technical skills of the operator performing SFA angioplasty on the VIST simulator.
How many dendritic cells are required to initiate a T-cell response?
Authors: Celli Susanna , Day Mark , Müller Andreas J. , Molina-Paris Carmen , Lythe Grant , Bousso Philippe 
Published: September 2012

Abstract
T-cell activation in lymph nodes relies on encounters with antigen (Ag)–bearing dendritic cells (DCs) but the number of DCs required to initiate an immune response is unknown. Here we have used a combination of flow cytometry, 2-photon imaging, and computational modeling to quantify the probability of T cell–DC encounters. We calculated that the chance for a T cell residing 24 hours in a murine popliteal lymph nodes to interact with a DC was 8%, 58%, and 99% in the presence of 10, 100, and 1000 Ag-bearing DCs, respectively. Our results reveal the existence of a threshold in DC numbers below which T-cell responses fail to be elicited for probabilistic reasons. In mice and probably humans, we estimate that a minimum of 85 DCs are required to initiate a T-cell response when starting from precursor frequency of 10−6. Our results have implications for the rational design of DC-based vaccines.
Differential infection properties of three inducible prophages from an epidemic strain of Pseudomonas aeruginosa
Authors: James Chloe E , Fothergill Joanne L , Kade Hannes , Hall Amanda J , Cottell Jennifer , Brockhurst Michael A , Winstanley Craig 
Published: September 2012

Abstract
Background
Pseudomonas aeruginosa is the most common bacterial pathogen infecting the lungs of patients with cystic fibrosis (CF). The Liverpool Epidemic Strain (LES) is transmissible, capable of superseding other P. aeruginosa populations and is associated with increased morbidity. Previously, multiple inducible prophages have been found to coexist in the LES chromosome and to constitute a major component of the accessory genome not found in other sequenced P. aerugionosa strains. LES phages confer a competitive advantage in a rat model of chronic lung infection and may, therefore underpin LES prevalence. Here the infective properties of three LES phages were characterised.

Results
This study focuses on three of the five active prophages (LESφ2, LESφ3 and LESφ4) that are members of the Siphoviridae. All were induced from LESB58 by norfloxacin. Lytic production of LESφ2 was considerably higher than that of LESφ3 and LESφ4. Each phage was capable of both lytic and lysogenic infection of the susceptible P. aeruginosa host, PAO1, producing phage-specific plaque morphologies. In the PAO1 host background, the LESφ2 prophage conferred immunity against LESφ3 infection and reduced susceptibility to LESφ4 infection. Each prophage was less stable in the PAO1 chromosome with substantially higher rates of spontaneous phage production than when residing in the native LESB58 host. We show that LES phages are capable of horizontal gene transfer by infecting P. aeruginosa strains from different sources and that type IV pili are required for infection by all three phages.

Conclusions
Multiple inducible prophages with diverse infection properties have been maintained in the LES genome. Our data suggest that LESφ2 is more sensitive to induction into the lytic cycle or has a more efficient replicative cycle than the other LES phages.
RETRACTED ARTICLE: MicroRNA expression profile of the hippocampus in a rat model of temporal lobe epilepsy and miR-34a-targeted neuroprotection against hippocampal neurone cell apoptosis post-status epilepticus
Authors: Hu Kai , Xie Yuan-Yuan , Zhang Chen , Ouyang Dong-Sheng , Long Hong-Yu , Sun Dan-Ni , Long Li-Li , Feng Li , Li Yi , Xiao Bo 
Published: September 2012

Abstract
Background
The expression pattern and function of miRNAs in the rat model of temporal lobe epilepsy have not been well defined. Profiling miRNA expression in the rat model of temporal lobe epilepsy and investigating the function of specific miRNAs in epilepsy offers the prospect of a deeper understanding of the mechanisms of epilepsy.

Methods
The lithium-pilocarpine-induced status epilepticus model and the temporal lobe epilepsy model were established in Sprague–Dawley rats. Samples were analysed to detect deregulated miRNAs in the hippocampal temporal lobe, and several of these deregulated miRNAs were confirmed by qPCR. The expression of the pro-apoptotic miR-34a was detected at 1 day, 7 days and 2 weeks post-status epilepticus and at 2 months after temporal lobe epilepsy. The antagomir of miR-34a was then utilised. The expression of miR-34a after targeting and the expression change of activated caspase-3 protein were examined. The effects of altering the expression of miR-34a and activated caspase-3 protein on neuronal survival and neuronal death or apoptosis post-status epilepticus were assessed.

Results
The miRNA microarray detected 9 up-regulated miRNAs (miR-146a, -211, -203, -210, -152, -31, -23a, -34a, -27a) and 15 down-regulated miRNAs (miR-138*, -301a, -136, -153, -19a, -135b, -325-5p, -380, -190, -542-3p, -33, -144, -542-5p, -543, -296*). Some of the deregulated miRNAs (miR-146a, miR-210, miR-27a, miR-135b and miR-33) were confirmed using qPCR. Furthermore, an increase in expression of the pro-apoptotic miR-34a was demonstrated in the post-status epilepticus rat hippocampus. miR-34a was significantly up-regulated at 1 day, 7 days and 2 weeks post-status epilepticus and at 2 months after temporal lobe epilepsy. Experiments with the miR-34a antagomir revealed that targeting miR-34a led to an inhibition of activated caspase-3 protein expression, which may contribute to increased neuronal survival and reduced neuronal death or apoptosis.

Conclusions
Our study showed the expression profile of miRNAs in the hippocampus in a rat model of temporal lobe epilepsy and an increase in the expression of the pro-apoptotic miR-34a in post-status epilepticus rats. The results show that miR-34a is up-regulated during seizure-induced neuronal death or apoptosis, and targeting miR-34a is neuroprotective and is associated with an inhibition of an increase in activated caspase-3 protein.
What determines the income gap between French male and female GPs - the role of medical practices
Authors: Dumontet Magali , Le Vaillant Marc , Franc Carine 
Published: September 2012

Abstract

Background
In many OECD countries, the gender differences in physicians’ pay favour male doctors. Due to the feminisation of the doctor profession, it is essential to measure this income gap in the French context of Fee-for-service payment (FFS) and then to precisely identify its determinants. The objective of this study is to measure and analyse the 2008 income gap between males and females general practitioners (GPs). This paper focuses on the role of gender medical practices differentials among GPs working in private practice in the southwest region of France.

Methods
Using data from 339 private-practice GPs, we measured an average gender income gap of approximately 26% in favour of men. Using the decomposition method, we examined the factors that could explain gender disparities in income.

Results
The analysis showed that 73% of the income gap can be explained by the average differences in doctors’ characteristics; for example, 61% of the gender income gap is explained by the gender differences in workload, i.e., number of consultations and visits, which is on average significantly lower for female GPs than for male GPs. Furthermore, the decomposition method allowed us to highlight the differences in the marginal returns of doctors’ characteristics and variables contributing to income, such as GP workload; we found that female GPs have a higher marginal return in terms of earnings when performing an additional medical service.

Conclusions
The findings of this study help to understand the determinants of the income gap between male and female GPs. Even though workload is clearly an essential determinant of income, FFS does not reduce the gender income gap, and there is an imperfect relationship between the provision of medical services and income. In the context of feminisation, it appears that female GPs receive a lower income but attain higher marginal returns when performing an additional consultation.