bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operator Radiation Exposure During Percutaneous Coronary Procedures Through the Left or Right Radial Approach
Authors: Sciahbasi Alessandro , Romagnoli Enrico , Trani Carlo , Burzotta Francesco , Sarandrea Alessandro , Summaria Francesco , Patrizi Roberto , Rao Sunil , Lioy Ernesto 
Published: May 2011

Background—
Transradial percutaneous coronary procedures may be effectively performed through the right radial approach (RRA) or the left radial approach (LRA), but data on radiation dose absorbed by operators comparing the two approaches are lacking. The aim of the present study was to evaluate radiation dose absorbed by operators during coronary procedures through the RRA and LRA.

Methods and Results—

Three operators were equipped with 5 different dosimeters (left wrist, shoulder, thorax outside the lead apron, thorax under the lead apron, and thyroid) during RRA or LRA for coronary procedures. Each month, the dosimeters were analyzed to determine the radiation dose absorbed. From February to December 2009, 390 patients were randomly assigned to the RRA (185 patients; age, 66±11 years) or the LRA (185 patients; age, 66±11 years). There were no significant differences in fluoroscopy time (for RRA, 369 seconds; interquartile range, 134 to 857 seconds; for LRA, 362 seconds; interquartile range, 142 to 885 seconds;
P
=0.58) between the 2 groups. There were no significant differences in monthly radiation dose at the thorax (0.85±0.46 mSv for RRA and 1.12±0.78 mSv for LRA,
P
=0.33), at the thyroid (0.36±0.2 mSv for RRA and 0.34±0.3 mSv for LRA,
P
=0.87), and at the shoulder (0.73±0.44 mSv for RRA and 0.94±0.42 mSv for LRA,
P
=0.27). The dose at the wrist was significantly higher for the RRA (2.44±1.12 mSv) compared with the LRA (1±0.8 mSv,
P
=0.002). In both radial approaches, the thoracic radiation dose under the lead apron was undetectable.

Conclusions—
Compared with RRA, LRA for coronary procedures is associated with similar radiation dose for operators at the body, shoulder, or thyroid level, with a possible significant advantage at the wrist. The cumulative radiation dose for both approaches is well under to the annual dose-equivalent limit.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00282646.
On the Factors Modulating the Stratocumulus to Cumulus Transitions
Authors: Sandu Irina , Stevens Bjorn 
Published: May 2011

Abstract
Large-eddy simulation (LES) is used to explore the role of various processes in regulating the stratocumulus to cumulus transition (SCT). Simulations are based on a composite case derived from a Lagrangian analysis of 2 yr of data from the northeastern Pacific. The simulations reproduce well the observed transition from a compact stratocumulus layer to more broken fields of cumulus, simply as a response to increasing sea surface temperatures (SSTs) along the transition. In so doing they support earlier theoretical work that argued that the SCT was a response of boundary layer circulations to increased forcing by surface latent heat fluxes. Although the basic features of the SCT imposed by the increase in SST are robust, a variety of other factors affect the detailed character of the SCT. For example, enhanced precipitation or increased downwelling longwave radiative fluxes can accelerate the reduction in cloud cover that accompanies the SCT, while a gradual decrease in the large-scale divergence can make changes in cloud cover that accompany the SCT relatively more modest. The simulations also demonstrate that the pace of the SCT is mainly set by the strength of the temperature inversion capping the initial stratocumulus-topped boundary layer.
Predictability of the Atlantic Overturning Circulation and Associated Surface Patterns in Two CCSM3 Climate Change Ensemble Experiments
Authors: Teng Haiyan , Branstator Grant , Meehl Gerald A. 
Published: May 2011

Abstract
Predictability of the Atlantic meridional overturning circulation (AMOC) and associated oceanic and atmospheric fields on decadal time scales in the Community Climate System Model, version 3 (CCSM3) at T42 resolution is quantified with a 700-yr control run and two 40-member “perfect model” climate change experiments. After taking into account both the mean and spread about the mean of the forecast distributions and allowing for the possibility of time-evolving modes, the natural variability of the AMOC is found to be predictable for about a decade; beyond that range the forced predictability resulting from greenhouse gas forcing becomes dominant. The upper 500-m temperature in the North Atlantic is even more predictable than the AMOC by several years. This predictability is associated with subsurface and sea surface temperature (SST) anomalies that propagate in an anticlockwise direction along the subpolar gyre and tend to be prominent during the 10 yr following peaks in the amplitude of AMOC anomalies. Predictability in the North Atlantic SST mainly resides in the ensemble mean signals after three to four forecast years. Analysis suggests that in the CCSM3 the subpolar gyre SST anomalies associated with the AMOC variability can influence the atmosphere and produce surface climate predictability that goes beyond the ENSO time scale. However, the resulting initial-value predictability in the atmosphere is very weak.
A Numerical Sensitivity Study on the Impact of Soil Moisture on Convection-Related Parameters and Convective Precipitation over Complex Terrain
Authors: Barthlott Christian , Kalthoff Norbert 
Published: May 2011

Abstract
The impact of soil moisture on convection-related parameters and convective precipitation over complex terrain is studied by numerical experiments using the nonhydrostatic Consortium for Small-Scale Modeling (COSMO) model. For 1 day of the Convective and Orographically Induced Precipitation Study (COPS) conducted during summer 2007 in southwestern Germany and eastern France, initial soil moisture is varied from −50% to +50% of the reference run in steps of 5%. As synoptic-scale forcing is weak on the day under investigation, the triggering of convection is mainly due to soil–atmosphere interactions and boundary layer processes. Whereas a systematic relationship to soil moisture exists for a number of variables (e.g., latent and sensible fluxes at the ground, near-surface temperature, and humidity), a systematic increase of 24-h accumulated precipitation with increasing initial soil moisture is only present in the simulations that are drier than the reference run. The time evolution of convective precipitation can be divided into two regimes with different conditions to initiate and foster convection. Furthermore, the impact of soil moisture is different for the initiation and modification of convective precipitation. The results demonstrate the high sensitivity of numerical weather prediction to initial soil moisture fields.
Evolving Multisensor Precipitation Estimation Methods: Their Impacts on Flow Prediction Using a Distributed Hydrologic Model
Authors: Kitzmiller David , Van Cooten Suzanne , Ding Feng , Howard Kenneth , Langston Carrie , Zhang Jian , Moser Heather , Zhang Yu , Gourley Jonathan J. , Kim Dongsoo , Riley David 
Published: May 2011

AbstractThis study investigates evolving methodologies for radar and merged gauge–radar quantitative precipitation estimation (QPE) to determine their influence on the flow predictions of a distributed hydrologic model. These methods include the National Mosaic and QPE algorithm package (NMQ), under development at the National Severe Storms Laboratory (NSSL), and the Multisensor Precipitation Estimator (MPE) and High-Resolution Precipitation Estimator (HPE) suites currently operational at National Weather Service (NWS) field offices. The goal of the study is to determine which combination of algorithm features offers the greatest benefit toward operational hydrologic forecasting. These features include automated radar quality control, automated Z–R selection, brightband identification, bias correction, multiple radar data compositing, and gauge–radar merging, which all differ between NMQ and MPE–HPE. To examine the spatial and temporal characteristics of the precipitation fields produced by each of the QPE methodologies, high-resolution (4 km and hourly) gridded precipitation estimates were derived by each algorithm suite for three major precipitation events between 2003 and 2006 over subcatchments within the Tar–Pamlico River basin of North Carolina. The results indicate that the NMQ radar-only algorithm suite consistently yielded closer agreement with reference rain gauge reports than the corresponding HPE radar-only estimates did. Similarly, the NMQ radar-only QPE input generally yielded hydrologic simulations that were closer to observations at multiple stream gauging points. These findings indicate that the combination of Z–R selection and freezing-level identification algorithms within NMQ, but not incorporated within MPE and HPE, would have an appreciable positive impact on hydrologic simulations. There were relatively small differences between NMQ and HPE gauge–radar estimates in terms of accuracy and impacts on hydrologic simulations, most likely due to the large influence of the input rain gauge information.
Automatic Detection of Cloud Cover over the Baltic Sea
Authors: Krężel Adam , Paszkuta Marcin 
Published: May 2011

Abstract
A simple detection method was proposed to increase the efficiency of automatic classification of a satellite image cell (clear/cloudy). A method is described on the basis of the Advanced Very High Resolution Radiometer (AVHRR) data, with a focus on highly active and highly reflecting targets (i.e., the Baltic Sea). Radiation input conditions and the dynamic threshold were used to reduce geometric influences of any daily scene supplied by the NOAA-17 and NOAA-18 platforms. They were carried out from statistic and histogram sequences of albedo and temperature maps. The presented approach is intended to primarily serve the activation of a nonsupervised system for oceanographic analyses (mainly SST), based on an accurate cloud mask.
A Hybrid Thresholding Algorithm for Cloud Detection on Ground-Based Color Images
Authors: Li Qingyong , Lu Weitao , Yang Jun 
Published: May 2011

Abstract
Cloud detection is the precondition for deriving other information (e.g., cloud cover) in ground-based sky imager applications. This paper puts forward an effective cloud detection approach, the Hybrid Thresholding Algorithm (HYTA) that fully exploits the benefits of the combination of fixed and adaptive thresholding methods. First, HYTA transforms an input color cloud image into a normalized blue/red channel ratio image that can keep a distinct contrast, even with noise and outliers. Then, HYTA identifies the ratio image as either unimodal or bimodal according to its standard deviation, and the unimodal and bimodal images are handled by fixed and minimum cross entropy (MCE) thresholding algorithms, respectively. The experimental results demonstrate that HYTA shows an accuracy of 88.53%, which is far higher than those of either fixed or MCE thresholding alone. Moreover, HYTA is also verified to outperform other state-of-the-art cloud detection approaches.
Temperature management and monitoring practices during adult cardiac surgery under cardiopulmonary bypass: results of a Canadian national survey
Authors: Belway D , Tee R , Nathan HJ , Rubens FD , Boodhwani M 
Published: May 2011

Background: Mild to moderate systemic hypothermia is commonly used as a cerebral protective strategy during adult cardiac surgery. The benefits of this strategy for routine cardiac surgery have been questioned and the adverse effects of hyperthermia demonstrated. The purpose of the present study was to examine current temperature management and monitoring practices during adult cardiac surgery using CPB in Canada. Methods: Web-based survey referring to adult cases undergoing cardiac surgery using CPB without the use of deep hypothermic circulatory arrest. Thirty-two questionnaires were completed, representing a 100% response rate. Results: The usual management is to cool patients during CPB at 30 (94%) centers for low-risk (isolated primary CABG) cases and at 31 (97%) centers for high-risk (all other) cases. The average nadir temperature at the target site achieved on CPB is 34°C (range 28°C - 36°C). At 26 (81%) centers, patients are typically rewarmed to a target temperature between 36°C and 37°C before separation from CPB. Only 6 (19%) centers reported that thermistors and coupled devices used to monitor blood temperature are checked for accuracy or calibrated according to the product operating directive’s schedule or more often. Conclusions: Contemporary management of adult cardiac surgery under CPB still involves induction of mild to moderate systemic hypothermia. Significant practice variation exists across the country with respect to target temperatures for cooling and rewarming, as well as the site for temperature monitoring. This probably reflects the lack of definitive evidence. There is a need for well-conducted clinical trials to provide more robust evidence regarding temperature management.
Healthcare financing reform in Turkey: context and salient features
Authors: Yıldırım Hasan Hüseyin , Yıldırım Türkan 
Published: May 2011

The health field is characterised by high uncertainties which can lead to large expenditures. One way to manage these uncertainties is to develop collectively-financed health care systems. Some countries create this collective financing through general taxes, whereas others rely on premiums set up through compulsory social health insurance. Turkey, a middle-income country, has historically used several mechanisms to extend health care to its population. However, inadequate financing and poor service quality have plagued this health care system. Recently, a transition from a system of multiple insurance schemes that cover only about two-thirds of the population to a single-payer system aiming to achieve universal coverage has been under way to overcome problems in the fragmented health financing system and ensure universal coverage. With the enactment of the General Health Insurance Scheme Law in 2006, the Turkish health care system has embarked on one of its most radical and far-reaching reforms since the socialization attempt of the 1960s. This paper focuses on the health care financing reform in Turkey, concentrating on its salient features in terms of financing functions and policies and explores the main differences between the old and new systems. The care and coverage aspects are also dealt with. Our results suggest that if well implemented, the GHIS reform can be a powerful engine for achieving universal coverage and enhancing equity and solidarity in the Turkish health care system. However, to reach this end, a transition process is required, as the success of the GHIS will depend on its ability to manage challenges during the implementation process.
Grey matter volume in a large cohort of MS patients: relation to MRI parameters and disability
Authors: Roosendaal Stefan D , Bendfeldt Kerstin , Vrenken Hugo , Polman Chris H , Borgwardt Stefan , Radue Ernst W , Kappos Ludwig , Pelletier Daniel , Hauser Stephen L , Matthews Paul M , Barkhof Frederik , Geurts Jeroen JG 
Published: May 2011

Background: Although grey matter damage in multiple sclerosis is currently recognized, determinants of grey matter volume and its relationship with disability are not yet clear. Objectives: The objectives of the study were to measure grey and white matter volumes across different disease phenotypes; identify MRI parameters associated with grey matter volume; and study grey and white matter volume as explanatory variables for clinical impairment. Methods: This is a cross-sectional study in which MRI data of 95 clinically isolated syndrome, 657 relapsing–remitting, 125 secondary-progressive and 50 primary-progressive multiple sclerosis patients from three centres were acquired. Grey and white matter volumes were determined, together with T2 and T1 lesion volumes. Physical disability was assessed with the Expanded Disability Status Scale, cognitive impairment with the Paced Auditory Serial Addition Task. Data were analysed using multiple regression. Results: Grey matter volume was lower in relapsing–remitting patients (mean [SD]: 0.80 [0.05] L) than in clinically isolated syndrome patients (0.82 [0.05] L), and even greater relative atrophy was found in secondary-progressive patients (0.77 [0.05] L). In contrast, white matter volume in secondary-progressive patients was comparable to that in relapsing–remitting patients. Grey matter volume was the strongest independent predictor of physical disability and cognitive impairment, and was associated with both T2 and T1 lesion volume. Conclusions: Our findings show that grey matter volume is lower in secondary-progressive than in relapsing–remitting disease. Grey matter volume explained physical and cognitive impairment better than white matter volume, and is itself associated with T2 and T1 lesion volume.
The association between perceived fatigue and actual level of physical activity in multiple sclerosis
Authors: Rietberg Marc B , van Wegen Erwin EH , Uitdehaag Bernard MJ , Kwakkel Gert 
Published: May 2011

Background: Both fatigue and reduced physical activity are important consequences of multiple sclerosis (MS). However, their mutual association is poorly understood. Objective: The objective of the study was to determine the relation between perceived fatigue and home-based recording of motor activity in patients with MS. Methods: Found associations were checked for confounding by age, Expanded Disability Status Scales (EDSS), disease duration, sub-type of MS, anxiety, and depression. Forty-three ambulatory patients with MS were recruited. Ambulatory physical activity was recorded for 24 hours. Fatigue was assessed with the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS) and the Checklist Individual Strength (CIS20R). Linear regression was applied after which potential confounding factors were introduced in a multivariate regression model. Results: No significant associations between physical activity and fatigue scores were found, except for the MFIS sub-scale ‘physical activity’ (ßphysical_activity [ßpa] = −0.044; SE = 0.020). The association between physical activity and the FSS score was distorted by age, MS-type, anxiety and depression and the association between physical activity and the MFIS score by age and depression. The inverse association between MFIS sub-scale ‘physical activity’ and physical activity was significantly strengthened by adjusting for age (ßpa = − 0.052; SE = 0.019), sub-type of MS (ßpa = − 0.048; SE = 0.020), anxiety (ßpa = − 0.070; SE = 0.023) and depression (ßpa = − 0.083; SE = 0.023). Conclusions: In MS, there is no, or at best a weak association between severity of perceived fatigue and physical activity. Depending on the fatigue questionnaire used, patient characteristics such as age, type of MS, depression and anxiety are factors that may affect this relationship.
Is the patient’s baseline inhaled steroid dose a factor for choosing the budesonide/formoterol maintenance and reliever therapy regimen?
Authors: Aubier Michel , Haughney John , Selroos Olof , van Schayck Onno C. P. , Ekström Tommy , Ostinelli Juliette , Buhl Roland 
Published: May 2011

Objective: Baseline inhaled corticosteroid (ICS) dose may be a factor for prescribers to consider when they select a budesonide/formoterol maintenance and reliever therapy regimen for symptomatic asthmatics. Methods: A 6-month randomized study compared two maintenance doses of budesonide/formoterol 160/4.5 µg, 1 × 2 and 2 × 2, plus as needed, in 8424 asthma patients with symptoms when treated with ICS ± an inhaled long-acting β2-agonist (LABA). In the total study population, 1339 (17%) were high-dose ICS (HD) users (≥1600 µg/day budesonide). This HD stratum was compared with the rest of the study population, divided into low-dose (LD; 400 µg/day) and medium-dose strata (MD; 401–1599 µg/day) with regard to severe asthma exacerbations and mean changes in five-item Asthma Control Questionnaire (ACQ5) scores from baseline. Results: In all three strata there were fewer exacerbations in the 2 × 2 treatment groups (yearly rates 0.268, 0.172 and 0.094) than in the 1 × 2 treatment groups (yearly rates 0.232, 0.138 and 0.764). In no stratum was the difference between the treatment groups statistically significant. There was no statistically significant difference in time to the first severe exacerbation between the treatments 2 × 2 and 1 × 2 in the HD group (hazard ratio 0.944, p = 0.75). The adjusted mean changes in ACQ5 scores in the HD, MD and LD strata were −0.89, −0.61 and −0.65, respectively, with 1 × 2 treatment and −0.90, −0.74 and −0.76, respectively, with 2 × 2 treatment. In the MD and LD strata, the difference between doses was significant in favour of 2 × 2 (MD p < 0.0001; LD p = 0.004), but not in the HD stratum ( p = 0.870). No difference in serious adverse events was seen. Conclusion: Compared with the LD and MD strata, the HD stratum patients had more exacerbations and a shorter time to first exacerbation. However, there were no differences in response between the 1 × 2 and 2 × 2 groups in any of the strata. This indicates that patients using budesonide/formoterol maintenance and reliever therapy, irrespective of baseline ICS dose, can be switched to 1 × 2 with its lower steroid load. ACQ5 scores improved more in the HD stratum than in the MD and LD strata indicating, among other things, that HD patients were not overtreated at baseline. ClinicalTrials.gov registration: NCT00463866
Outcomes after allogeneic hematopoietic cell transplantation for childhood cerebral adrenoleukodystrophy: the largest single-institution cohort report
Authors: Miller Weston P. , Rothman Steven M. , Nascene David , Kivisto Teresa , DeFor Todd E. , Ziegler Richard S. , Eisengart Julie , Leiser Kara , Raymond Gerald , Lund Troy C. , Tolar Jakub , Orchard Paul J. 
Published: May 2011

Abstract
Cerebral adrenoleukodystrophy (cALD) remains a devastating neurodegenerative disease; only allogeneic hematopoietic cell transplantation (HCT) has been shown to provide long-term disease stabilization and survival. Sixty boys undergoing HCT for cALD from 2000 to 2009 were analyzed. The median age at HCT was 8.7 years; conditioning regimens and allograft sources varied. At HCT, 50% demonstrated a Loes radiographic severity score ≥ 10, and 62% showed clinical evidence of neurologic dysfunction. A total of 78% (n = 47) are alive at a median 3.7 years after HCT. The estimate of 5-year survival for boys with Loes score < 10 at HCT was 89%, whereas that for boys with Loes score ≥ 10 was 60% (P = .03). The 5-year survival estimate for boys absent of clinical cerebral disease at HCT was 91%, whereas that for boys with neurologic dysfunction was 66% (P = .08). The cumulative incidence of transplantation-related mortality at day 100 was 8%. Post-transplantation progression of neurologic dysfunction depended significantly on the pre-HCT Loes score and clinical neurologic status. We describe the largest single-institution analysis of survival and neurologic function outcomes after HCT in cALD. These trials were registered at www.clinicaltrials.gov as #NCT00176904, #NCT00668564, and #NCT00383448.