bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities between Prescribing of Secondary Prevention Therapies for Stroke and Coronary Artery Disease in General Practice
Authors: Heeley Emma , Anderson Craig , Patel Anushka , Cass Alan , Peiris David , Weekes Andrew , Chalmers John 
Published: October 2011

Background Extensive evidence exists regarding the effectiveness of secondary prevention measures in patients with cardiovascular disease. Aim We aimed to examine the management and risk perceptions of cardiovascular events in people with established cardiovascular disease. Methods We analyzed data on 1453 patients, ≥55 year old, with a history of cardiovascular disease, from the Australian Hypertension and Absolute Risk Study. Results Compared with those 533 patients with stroke/transient ischemic attack, the 743 patients with coronary artery disease were twice as likely to have been prescribed secondary prevention therapies even after adjustment for potential confounding variables (adjusted relative risks 1·85; 95% confidence interval 1·56–2·19, 42% vs. 73% for use of the combination of blood pressure-lowering, lipid-lowering and antiplatelet therapies) and to have better control of lipid and blood pressure levels. General practitioners estimated that only 27% of patients with stroke/transient ischemic attack – 38% of those with coronary artery disease and 41% of those with both conditions – were at a high risk (≥15%) of a recurrent event. Patients similarly underestimated their risk of recurrent cardiovascular events, with only 8% of stroke/transient ischemic attack, 11% of coronary and 15% of combination disease patients rating themselves at ‘high’ or‘very-high’ risk. Conclusions This study reaffirms the large treatment gap in the uptake of secondary prevention for cardiovascular disease in primary care settings, being much greater for patients with cerebral compared with cardiac cardiovascular disease. This appears to be related to differential perceptions of cardiovascular risk across different vascular territories in both patients and doctors.
The Transforming Growth Factor-β Receptor Genes and the Risk of Intracranial Aneurysms
Authors: Ruigrok Ynte M. , Baas Annette F. , Medic Jelena , Wijmenga Cisca , Rinkel Gabriel J.E. 
Published: October 2011

Background Mutations in the receptor genes of the transforming growth factor β pathway, TGFBR1 and TGFBR2, cause syndromes with thoracic aortic aneurysms, while genetic variants in TGFBR1 and TGFBR2 are associated with abdominal aortic aneurysms. The transforming growth factor-β pathway may be involved in aneurysm development in general. Aims To analyze whether genetics variants in TGFBR1 and TGFBR2 are also involved in the pathogenesis of intracranial aneurysms. Methods Using tag single nucleotide polymorphisms, we analyzed all common genetic variants in TGFBR1 (five single nucleotide polymorphisms) and TGFBR2 (26 single nucleotide polymorphisms) in a Dutch intracranial aneurysm case-control population approach using a two-stage genotyping approach. Results In stage 1, on analyzing 481 patients and 648 controls, two of the five single nucleotide polymorphisms in TGFBR1 were associated with intracranial aneurysm with P<0·10. In an independent cohort of 310 intracranial aneurysm patients and 376 controls, a predominance of the allele of the two single nucleotide polymorphisms found more frequently in patients in stage 1 was also observed in patients of stage 2 but the associations were not statistically significant. On combined analyses of both stages, there was a statistically significant association of both single nucleotide polymorphisms with intracranial aneurysm (single nucleotide polymorphism rs1626340, odds ratio 1·24, 95% confidence intervals 1·05–1·46, P = 0·01; single nucleotide polymorphism rs10819634, odds ratio 1·23, 95% confidence intervals 1·03–1·46, P = 0·02) but these associations did not hold after multiple testing correction (i.e., P<0·0016, 0·05/31). Also, no differences in the single nucleotide polymorphism frequency were observed for TGFBR2 between patients and controls. Conclusions We found no evidence for TGFBR1 and TGFBR2 as susceptibility genes for intracranial aneurysm in the Dutch population.
Very Early Poststroke Aphasia Therapy: A Pilot Randomized Controlled Efficacy Trial
Authors: Godecke Erin , Hird Kathryn , Lalor Erin E. , Rai Tapan , Phillips Michael R. 
Published: October 2011

Background and purpose Early stroke rehabilitation has shown benefits over spontaneous recovery. Insufficient evidence exists to determine the benefits of early aphasia intervention. We hypothesized that daily aphasia therapy would show better communication outcomes than usual care (UC) in early poststroke recovery. Method This prospective, randomized, single-blinded, controlled trial was conducted in three acute-care hospitals in Perth, Australia, each with over 200 stroke admissions annually. Patients with acute stroke causing moderate to severe aphasia were recruited at a median of three-days (range: 0–10 days) to receive daily aphasia therapy or usual care therapy. Individually tailored, impairment-based intervention was provided for the acute hospital stay or intervention phase (median: 19 days; range: 5–76). Primary outcome measures were the aphasia quotient and functional communication profile at acute hospital discharge or four-weeks poststroke, whichever came first. A random-number generator and sealed envelopes were used to randomize participants. Assessments were completed by a blinded assessor. Results Fifty-nine participants were recruited, with six withdrawals (10%) and seven deaths (12%) at six-months. Ninety percent had ischemic strokes, with 56·5% experiencing a total anterior circulation stroke. The group mean (±SD) age was 69·1 (±13·9) years. Six participants (18·75%) in the daily aphasia therapy group did not complete the minimum (150 min) therapy required for this study. The daily aphasia therapy intervention phase mean therapy session time was 45 min (range: 30–80) and the total mean amount of therapy for the daily aphasia therapy participants was 331 min (range: 30–1415). Four (15%) participants in the usual care group received therapy. The collective total therapy provided to these participants was 295 min over seven sessions. Usual care participants received an average of 10·5 min of therapy per week during the intervention phase. At the primary end point, a generalized estimating equations model demonstrated that after controlling for initial aphasia severity, participants receiving daily aphasia therapy scored 15·1 more points ( P = 0·010) on the aphasia quotient and 11·3 more points ( P = 0·004) on the functional communication profile than those receiving usual care therapy. Conclusions Daily aphasia therapy in very early stroke recovery improved communication outcomes in people with moderate to severe aphasia.
Co‐oximetry in clinically healthy dogs and effects of time of post sampling on measurements
Authors: Kuleš J. , Mayer I. , Rafaj R. Barić , Matijatko V. , Kiš I. , Kučer N. , Brkljačić M. , Mrljak V. 
Published: October 2011

Objectives: Co‐oximetry is a complex and valuable laboratory method that measures haemoglobin species and oxygenation status by multi‐wavelength spectrophotometry. The purpose of this study was to establish reference intervals for clinically healthy dogs and to determine the effect of time of analyses and sex of animals on the accuracy of results.Methods: Blood was collected from 27 healthy adult dogs of various breeds and sex. Co‐oximetry was performed on a CCX co‐oximeter that measures eight haemoglobin and oxygen transport related parameters: carboxyhaemoglobin (COHb), deoxyhaemoglobin (HHb), oxyhaemoglobin (O2Hb), methaemoglobin (MetHb), total haemoglobin (tHb), oxygen saturation (SO2%), oxygen content (O2Ct) and oxygen capacity (O2Cap).Results: Results obtained after 2 and 4 hours were not significantly different from those obtained immediately after sampling. But after 48 hours, the results for total haemoglobin, oxygen saturation, oxyhaemoglobin, oxygen content and oxygen capacity were significantly lower, and carboxyhaemoglobin and deoxyhaemoglobin values were significantly higher than determination immediately after sampling. Gender had no significant impact on co‐oximetry values.Clinical Significance: Co‐oximetry offers several advantages compared with other methods, including ease of use, increased accuracy and greater differentiation among haemoglobin species.
Impact of Temporal Resolution of Flow‐Duration Curve on Sediment Load Estimation1
Authors: Chen Li , Schumer Rina , Knust Anna , Forsee William 
Published: October 2011

Chen, Li, Rina Schumer, Anna Knust, and William Forsee, 2011. Impact of Temporal Resolution of Flow‐Duration Curve on Sediment Load Estimation. Journal of the American Water Resources Association (JAWRA) 48(1): 145‐155. DOI: 10.1111/j.1752‐1688.2011.00602.xAbstract:  Estimates of a channel’s annual sediment transport capacity typically incorporate annualized flow‐duration curves. Average daily flow data, commonly used to develop flow‐duration curves, may not adequately describe sediment‐transporting flows in arid and semiarid ephemeral streams. In this study, we examined impacts of varied temporal resolution flow data on annual sediment load estimation. We derived flow‐duration curves for eight sites in the Southwestern United States based on both 15‐min and daily‐averaged flow data. We then estimated sediment loads for both flow‐duration curves using the Sediment Impact Analysis Method, implemented in HEC‐RAS. When average daily flow is used to generate flow‐duration curves, sediment load estimation is lower by up to an order of magnitude. This trend is generally unaffected by uncertainty associated with sediment particle size or hydraulic roughness. The ratio of sediment loads estimated by 15‐min versus daily‐averaged flow‐duration curves is strongly correlated with channel slope, being greater on steep‐slope channels. Sediment loads estimated by the two types of flow‐duration curves are closely correlated, suggesting possible relationships for improving predictions when high‐temporal resolution data are unavailable. Results also suggest that the largest flow contributes significantly to total sediment load, and thus will greatly impact ephemeral stream geomorphology in arid and semiarid regions.
Demonstration of quality of care measurement using the Japanese liver cancer registry
Authors: Higashi Takahiro , Hasegawa Kiyoshi , Kokudo Norihiro , Makuuchi Masatoshi , Izumi Namiki , Ichida Takafumi , Kudo Masatoshi , Ku Yonson , Sakamoto Michiie , Nakashima Osamu , Matsui Osamu , Matsuyama Yutaka , Sobue Tomotaka ,   the Liver Cancer Study Group of Japan
Published: October 2011

Aim:  Despite advances in medical therapy, studies have reported gaps between current evidence and actual practice in many areas of medicine. Process‐of‐care quality indicators (QIs) are tools to measure the evidence–practice gap. This study aims to examine the feasibility of applying QIs for liver cancer care to the national registry database operated by the Liver Cancer Study Group of Japan.Methods:  Prior research developed a set of process‐of‐care QIs developed on the basis of the Japanese Clinical Practice Guidelines for hepatocellular carcinoma. Each QI describes target patients and care processes indicated for such patients. Among the 25 developed QIs, six appeared scorable using the information contained in the dataset from the 17th Nationwide Survey of Primary Liver Cancer.Results:  In total, 16 187 patients were eligible for the six QIs for 34 599 times, among which the indicated care was provided 83.9% times. The scores ranged from 64.4% (surgical therapy in patients with HCC 3–5 cm in diameter) to 91.1% (indocyanine green checkup before surgical resection). The information was generally available to determine eligibility (78.3%–100%) and pass/fail (91.9%–99.9%) for the QIs.Conclusions:  Applying QIs to the liver cancer registry, the quality of hepatocellular carcinoma care can be measured. In future, providing feedback regarding the results to the participating society may improve the quality of liver cancer care nationwide.
Akt/mTOR Counteract the Antitumor Activities of Cixutumumab, an Anti-Insulin–like Growth Factor I Receptor Monoclonal Antibody
Authors: Shin Dong Hoon , Min Hye-Young , El-Naggar Adel K. , Lippman Scott M. , Glisson Bonnie , Lee Ho-Young 
Published: October 2011

Abstract
Recent reports have shown limited anticancer therapeutic efficacy of insulin-like growth factor receptor (IGF-1R)-targeted monoclonal antibodies (mAb), but the resistance mechanisms have not been completely identified. Because cooperation between epidermal growth factor receptor (EGFR) and IGF-IR could cause resistance to inhibitors of individual receptor tyrosine kinases, we investigated the involvement of EGFR signaling in resistance to IGF-1R mAb and the underlying mechanisms of action. Most head and neck squamous cell carcinoma (HNSCC) tissues had coexpression of total and phosphorylated IGF-1R and EGFR at high levels compared with paired adjacent normal tissues. Treatment with cixutumumab (IMC-A12), a fully humanized IgG1 mAb, induced activation of Akt and mTOR, resulting in de novo synthesis of EGFR, Akt1, and survivin proteins and activation of the EGFR pathway in cixutumumab-resistant HNSCC and non–small cell lung cancer (NSCLC) cells. Targeting mTOR and EGFR pathways by treatment with rapamycin and cetuximab (an anti-EGFR mAb), respectively, prevented cixutumumab-induced expression of EGFR, Akt, and survivin and induced synergistic antitumor effects in vitro and in vivo. These data show that resistance to IGF-1R inhibition by mAbs is associated with Akt/mTOR-directed enhanced synthesis of EGFR, Akt1, and survivin. Our findings suggest that Akt/mTOR might be effective targets to overcome the resistance to IGF-1R mAbs in HNSCC and NSCLC. Mol Cancer Ther; 10(12); 2437–48. ©2011 AACR.
Epidemiology and Outcomes of Fever Burden Among Patients With Acute Ischemic Stroke
Authors: Phipps Michael S. , Desai Rani A. , Wira Charles , Bravata Dawn M. 
Published: October 2011

Background and Purpose—
Although fever following ischemic stroke is common and has been associated with poor patient outcomes, little is known about which aspects of fever (eg, frequency, severity, or duration) are most associated with outcomes.

Methods—

We used data from a retrospective cohort of acute ischemic stroke patients who were admitted to 1 of 5 hospitals (1998–2003). A fever event was defined as a period with a temperature ≥100.0°F (37.8°C). Fever burden was defined as the maximum temperature (T
max
) minus 100.0°F, multiplied by the number of days with a fever. Fever burden (in degree-days) was categorized as low (0.1–2.0), medium (2.1–4.0), or high (≥4.0). Logistic regression was used to evaluate the adjusted association of any fever episode and fever burden with the combined outcome of in-hospital mortality or discharge to hospice.

Results—

Among 1361 stroke patients, 483 patients (35.5%) had ≥1 fever event. Among febrile patients, the median T
max
was 100.9°F (range, 100.0–106.6°F), 87% had ≤2 events and median total fever days was 2. Patients with any fever event had higher combined outcome rates after adjusting for demographics, stroke severity, and clinical characteristics: adjusted odds ratio (aOR), 2.7 (95% CI, 1.6–4.4). Higher fever burden was also associated with the combined outcome: high burden aOR, 6.7 (95% CI, 3.6–12.7); medium burden aOR, 3.9 (95% CI, 1.9–8.2); and low burden aOR, 1.2 (95%CI, 0.6–2.3) versus no fever.

Conclusions—
This study confirms that poststroke fever occurs commonly and demonstrates that patients with high fever burden have a 6-fold increased odds of death or discharge to hospice.
Age and Outcomes After Carotid Stenting and Endarterectomy
Authors: Voeks Jenifer H. , Howard George , Roubin Gary S. , Malas Mahmoud B. , Cohen David J. , Sternbergh W. Charles , Aronow Herbert D. , Eskandari Mark K. , Sheffet Alice J. , Lal Brajesh K. , Meschia James F. , Brott Thomas G. ,   for the CREST Investigators
Published: October 2011

Background and Purpose—
High stroke event rates among carotid artery stenting (CAS)-treated patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) lead-in registry generated an a priori hypothesis that age may modify the relative efficacy of CAS versus carotid endarterectomy (CEA). In the primary CREST report, we previously noted significant effect modification by age. Here we extend this investigation by examining the relative efficacy of the components of the primary end point, the treatment-specific impact of age, and contributors to the increasing risk in CAS-treated patients at older ages.

Methods—
Among 2502 CREST patients with high-grade carotid stenosis, proportional hazards models were used to examine the impact of age on the CAS-to-CEA relative efficacy, and the impact of age on risk within CAS-treated and CEA-treated patients.

Results—

Age acted as a treatment effect modifier for the primary end point (
P interaction
=0.02), with the efficacy of CAS and CEA approximately equal at age 70 years. For CAS, risk for the primary end point increased with age (
P
<0.0001) by 1.77-times (95% confidence interval, 1.38–2.28) per 10-year increment; however, there was no evidence of increased risk for CEA-treated patients (
P
=0.27). Stroke events were the primary contributor to the overall effect modification (
P interaction
=0.033), with equal risk at ≈64 years. The treatment-by-age interaction for CAS and CEA was not altered by symptomatic status (
P
=0.96) or by sex (
P
=0.45).

Conclusions—
Outcomes after CAS versus CEA were related to patient age, attributable to increasing risk for stroke after CAS at older ages. Patient age should be an important consideration when choosing between the 2 procedures for treating carotid stenosis.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00004732.
Representativeness of the Get With The Guidelines–Stroke Registry
Authors: Reeves Mathew J. , Fonarow Gregg C. , Smith Eric E. , Pan Wenqin , Olson DaiWai , Hernandez Adrian F. , Peterson Eric D. , Schwamm Lee H. 
Published: October 2011

Background and Purpose—
Get With The Guidelines (GWTG)—Stroke is a large quality improvement-based registry of acute stroke; however, its generalizability is unclear. We used fee-for-service Medicare claims to ascertain the representativeness of ischemic stroke admissions in GWTG-Stroke.

Methods—
All 228 815 ischemic stroke admissions aged ≥65 years enrolled in GWTG-Stroke between April 2003 and December 2007 were linked to 926 756 unique fee-for-service Medicare patients with ischemic stroke (primary International Classification of Diseases, 9th Revision discharge code 434 or 436) from the same period. Patient characteristics and in-hospital outcomes were compared between the linked GWTG-Stroke Medicare cohort and the remaining unlinked Medicare cohort. Characteristics of GWTG-Stroke hospitals were compared with non-GWTG-Stroke hospitals.

Results—
A total of 144 344 of the 228,815 GWTG-Stroke admissions (63.1%) were successfully linked to the 926 756 Medicare ischemic stroke beneficiaries, leaving 782 412 unlinked Medicare patients. Differences in patient characteristics, including age, race, gender, and comorbidities, between the linked and unlinked Medicare cohorts were minimal. Length of stay and rate of discharge home were almost identical between the linked and unlinked groups; however, in-hospital mortality was slightly lower in the linked Medicare cohort (6.3%) compared with the unlinked cohort (7.0%). There were large differences in hospital characteristics between GWTG-Stroke and non-GWTG-Stroke hospitals; GWTG-Stroke hospitals tended to be larger, urban, teaching centers.

Conclusions—
Despite substantial differences between GWTG-Stroke and non-GWTG-Stroke hospitals, Medicare beneficiaries with acute ischemic stroke entered in the GWTG-Stroke program were similar to other Medicare beneficiaries. These data suggest that the Medicare-aged GWTG-Stroke ischemic stroke admissions are generally representative of the national fee-for-service Medicare ischemic stroke population.
Influence of Socioeconomic Status on Distance Traveled and Care After Stroke
Authors: Ahuja Christopher , Mamdani Muhammad , Saposnik Gustavo ,   for the Stroke Outcomes Research Canada working group
Published: October 2011

Background and Purpose—
Vital to maintaining an efficient delivery of services is an understanding of patient travel patterns during an acute ischemic stroke. Socioeconomic status may influence access to stroke care, including transportation and admission to different facility types.

Methods—
We analyzed all acute ischemic stroke admissions between 2003 and 2007 through the Discharge Abstract Database, a national database containing patient-level sociodemographic, diagnostic, procedural, and administrative information across Canada. Socioeconomic status was defined in neighborhood quintiles according to Statistics Canada. Distances between patients and facilities were derived from postal codes. A principal diagnosis of ischemic stroke was identified using the International Classification of Diseases (versions 9 and 10). Analysis of variance and regression analyses were performed with adjustment for demographic characteristics.

Results—
Admitted to acute care institutions were 243 410 patients with ischemic stroke. Mean patient age was 72.8 and 49.5% were male; 44.2% traveled beyond their closest center, amounting to an average 7.2 km additional distance traveled. Socioeconomic status quintile had minimal effect on travel patterns, with the lowest socioeconomic status accessing the closest center most frequently (odds ratio, 1.19; 95% confidence interval [CI], 1.13–1.16). Increased utilization of the closest hospital occurred with academic (odds ratio, 6.90; 95% CI, 6.69–7.11) or high-volume (odds ratio, 1.93; 95% CI, 1.88–1.98) facilities. Older patients (β=0.28; 95% CI, 0.27–0.28), expert destination facility (β=0.13; 95% CI, 0.12–0.14), and ambulance use increased travel beyond the closest center.

Conclusions—
Patients tend to choose care facilities based on hospital expertise; investment promoting improved regional facilities may be of greatest benefit to patients. Socioeconomic status has little bearing on travel patterns associated with stroke in Canada. These findings may assist in allocating funding to centers and improving patient care.