bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risks of stroke and mortality associated with suboptimal anticoagulation in atrial fibrillation patients
Authors: Gallagher Arlene , Setakis Efrosini , Plumb Jonathan , Clemens Andreas , van Staa Tjeerd-Pieter 
Published: September 2011

SummaryAtrial fibrillation (AF) carries an increased risk of ischaemic stroke, and oral anticoagulation with warfarin can reduce this risk. The objective of this study was to evaluate the association between time in therapeutic International Normalised Ratio (INR) range when receiving warfarin and the risk of stroke and mortality. The study cohort included AF patients aged 40 years and older included in the UK General Practice Research Database. For patients treated with warfarin we computed the percentage of follow-up time spent within therapeutic range. Cox regression was used to assess the association between INR and outcomes while controlling for patient demographics, health status and concomitant medication. The study population included 27,458 warfarintreated (with at least 3 INR measurements) and 10,449 patients not treated with antithrombotic therapy. Overall the warfarin users spent 63% of their time within therapeutic range (TTR). This percentage did not vary substantially by age, sex and CHA2DS2-VASc score. Patients who spent at least 70% of time within therapeutic range had a 79% reduced risk of stroke compared to patients with ≤30% of time in range (adjusted relative rate of 0.21; 95% confidence interval 0.18–0.25). Mortality rates were also significantly lower with at least 70% of time spent within therapeutic range. In conclusion, good anticoagulation control was associated with a reduction in the risk of stroke.
Feasibility of a Heart Failure Disease Management Program in Eastern Europe: Tbilisi, Georgia
Authors: Hebert Kathy , Quevedo Henry C. , Gogichaishvili Ilia , Nozadze Nino , Sagirashvili Ekaterine , Trahan Patrick , Kipshidze Nicholas , Arcement Lee M. 
Published: September 2011

Background—
Little is known about the importation of a heart failure disease management program (HFDMP) into low- and middle-income countries. We examined the feasibility of importing a HFDMP into the country of Georgia, located in the Caucuses.

Methods and Results—

Patients with ejection fraction ≤40% were enrolled into a prospective, observational study consisting of a new HFDMP staffed by local cardiologists. Medications, emergency department use, hospital admissions, and mortality were assessed by interviews with patients or their families. Screening resulted in 400 patients who were followed for 10.2±3.5 months. β-Blocker prescriptions increased from 7.4–80.7% (
P
<0.001), angiotensin-converting enzyme inhibitor prescriptions increased from 18.4–92.6% (
P
<0.001), and mean systolic blood pressure declined from 145 to 114 mm Hg (
P
<0.001). Patients visiting the emergency department and hospitalizations were lowered by 40.7% and 52.5%, respectively, but were also influenced by the outbreak of war, during which 17.5% (n=70) of patients received follow-up in refugee tents. All-cause mortality extended to 7% of patients, with 12 of 28 deaths caused by war-related events.

Conclusions—
Importation of a Western HFDMP was demonstrated to be feasible, with a 5-fold increase in the use of recommended therapies, reduction of blood pressure, decrease of emergency department visits, and hospitalizations for heart failure. These measures could result in substantial cost savings in resource-limited settings, but assessment is complicated in unstable areas. Translating effective interventions to low- and middle-income countries requires sensitivity to regional cultures and flexibility to adapt both clinical goals and strategies to unexpected conditions.
Isoflavone Soy Protein Supplementation and Atherosclerosis Progression in Healthy Postmenopausal Women
Authors: Hodis Howard N. , Mack Wendy J. , Kono Naoko , Azen Stanley P. , Shoupe Donna , Hwang-Levine Juliana , Petitti Diana , Whitfield-Maxwell Lora , Yan Mingzhu , Franke Adrian A. , Selzer Robert H. ,   for the Women's Isoflavone Soy Health Research Group
Published: September 2011

Background and Purpose—
Although epidemiological and experimental studies suggest that dietary intake of soy may be cardioprotective, use of isoflavone soy protein (ISP) supplementation as a primary preventive therapy remains unexplored. We determined whether ISP reduces subclinical atherosclerosis assessed as carotid artery intima-media thickness progression.

Methods—
In a double-blind, placebo-controlled trial, 350 postmenopausal women 45 to 92 years of age without diabetes and cardiovascular disease were randomized to 2 evenly divided daily doses of 25 g soy protein containing 91 mg aglycon isoflavone equivalents or placebo for 2.7 years.

Results—

Overall, mean (95% CI) carotid artery intima-media thickness progression rate was 4.77 (3.39–6.16) μm/year in the ISP group and 5.68 (4.30–7.06) μm/year in the placebo group. Although carotid artery intima-media thickness progression was reduced on average by 16% in the ISP group relative to the placebo group, this treatment effect was not statistically significant (
P
=0.36). Among the subgroup of women who were randomized within 5 years of menopause, ISP participants had on average a 68% lower carotid artery intima-media thickness progression rate than placebo participants 2.16 (−1.10 to 5.43) versus 6.79 (3.56–10.01) μm/year (
P
=0.05). ISP supplementation had a null effect on women who were >5 years beyond menopause when randomized. There were no major adverse events from ISP supplementation.

Conclusions—
ISP supplementation did not significantly reduce subclinical atherosclerosis progression in postmenopausal women. Subgroup analysis suggests that ISP supplementation may reduce subclinical atherosclerosis in healthy young (median age, 53 years) women at low-risk for cardiovascular disease who were <5 years postmenopausal. These first trial results of their kind warrant further investigation.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00118846.
Temporal and Spatial Variability of Great Lakes Ice Cover, 1973–2010*
Authors: Wang Jia , Bai Xuezhi , Hu Haoguo , Clites Anne , Colton Marie , Lofgren Brent 
Published: September 2011

Abstract
In this study, temporal and spatial variability of ice cover in the Great Lakes are investigated using historical satellite measurements from 1973 to 2010. The seasonal cycle of ice cover was constructed for all the lakes, including Lake St. Clair. A unique feature found in the seasonal cycle is that the standard deviations (i.e., variability) of ice cover are larger than the climatological means for each lake. This indicates that Great Lakes ice cover experiences large variability in response to predominant natural climate forcing and has poor predictability. Spectral analysis shows that lake ice has both quasi-decadal and interannual periodicities of ~8 and ~4 yr. There was a significant downward trend in ice coverage from 1973 to the present for all of the lakes, with Lake Ontario having the largest, and Lakes Erie and St. Clair having the smallest. The translated total loss in lake ice over the entire 38-yr record varies from 37% in Lake St. Clair (least) to 88% in Lake Ontario (most). The total loss for overall Great Lakes ice coverage is 71%, while Lake Superior places second with a 79% loss. An empirical orthogonal function analysis indicates that a major response of ice cover to atmospheric forcing is in phase in all six lakes, accounting for 80.8% of the total variance. The second mode shows an out-of-phase spatial variability between the upper and lower lakes, accounting for 10.7% of the total variance. The regression of the first EOF-mode time series to sea level pressure, surface air temperature, and surface wind shows that lake ice mainly responds to the combined Arctic Oscillation and El Niño–Southern Oscillation patterns.
Observing Local-Scale Variability of Near-Surface Temperature and Humidity Using a Wireless Sensor Network
Authors: Lengfeld Katharina , Ament Felix 
Published: September 2011

AbstractIn this paper the influence of surface type, wind speed, and other environmental conditions on near-surface air temperature, specific humidity, and surface temperature is studied. A wireless sensor network consisting of 13 low-cost meteorological stations was set up as a 2.3-km-long double transect in western Germany during the Fluxes and Patterns in the Soil–Vegetation–Atmosphere Scheme (FLUXPAT2009) campaign. This deployment covered various surface types, including a small river. It was found that the air temperature was mainly influenced by the distance to the river and that its variability is controlled by the wind speed. During the night, a pool of cold air formed in the valley close to the water. The specific humidity is also governed by proximity to the river, especially during the night and for low wind speeds. In contrast, the differences in surface temperature were caused by different land cover. These results can be confirmed by a cluster analysis. Setting up 13 stations in a relatively small area is not always feasible. In this study, an estimation of the error that is made by considering the effect of a reduced number of stations is given. Use of only a single station results in an error of 0.86 K in air temperature, 0.67 g kg−1 in specific humidity, and 1.4 K in surface temperature.
Routes of Transport across the Antarctic Polar Vortex in the Southern Spring
Authors: de la Cámara Alvaro , Mancho Ana M. , Ide Kayo , Serrano Encarna , Mechoso Carlos R. 
Published: September 2011

Abstract
Transport in the lower stratosphere over Antarctica has been studied in the past by means of several approaches, such as contour dynamics or Lyapunov exponents. This paper examines the problem by means of a new Lagrangian descriptor, which is referred to as the function M. The focus is on the southern spring of 2005, which allows for a comparison with previous analyses based on Lyapunov exponents. With the methodology based on the function M, a much sharper depiction of key Lagrangian features is achieved and routes of large-scale horizontal transport across the vortex edge are captured. These results highlight the importance of lobe dynamics as a transport mechanism across the Antarctic polar vortex.
Tropical Oceanic Hot Towers: Need They Be Undilute to Transport Energy from the Boundary Layer to the Upper Troposphere Effectively? An Answer Based on Trajectory Analysis of a Simulation of a TOGA COARE Convective System
Authors: Fierro Alexandre O. , Zipser Edward J. , LeMone Margaret A. , Straka Jerry M. , Simpson Joanne (Malkus) 
Published: September 2011

AbstractThis paper addresses questions resulting from the authors’ earlier simulation of the 9 February 1993 Tropical Ocean Global Atmosphere Coupled Ocean–Atmosphere Research Experiment (TOGA COARE) squall line, which used updraft trajectories to illustrate how updrafts deposit significant moist static energy (in terms of equivalent potential temperature θe) in the upper troposphere, despite dilution and a θe minimum in the midtroposphere. The major conclusion drawn from this earlier work was that the “hot towers” that Riehl and Malkus showed as necessary to maintain the Hadley circulation need not be undilute. It was not possible, however, to document how the energy (or θe) increased above the midtroposphere. To address this relevant scientific question, a high-resolution (300 m) simulation was carried out using a standard 3-ICE microphysics scheme (Lin–Farley–Orville).Detailed along-trajectory information also allows more accurate examination of the forces affecting each parcel’s vertical velocity W, their displacement, and the processes impacting θe, with focus on parcels reaching the upper troposphere. Below 1 km, pressure gradient acceleration forces parcels upward against negative buoyancy acceleration associated with the sum of (positive) virtual temperature excess and (negative) condensate loading. Above 1 km, the situation reverses, with the buoyancy (and thermal buoyancy) acceleration becoming positive and nearly balancing a negative pressure gradient acceleration, slightly larger in magnitude, leading to a W minimum at midlevels. The W maximum above 8 km and concomitant θe increase between 6 and 8 km are both due to release of latent heat resulting from the enthalpy of freezing of raindrops and riming onto graupel from 5 to 6.5 km and water vapor deposition onto small ice crystals and graupel pellets above that, between 7 and 10 km.
Zonal Jets as Meridional Transport Barriers in the Subtropical and Polar Lower Stratosphere
Authors: Beron-Vera Francisco J. , Olascoaga María J. , Brown Michael G. , Koçak Huseyin 
Published: September 2011

Abstract
Applications of recent results from dynamical systems theory to the study of transport and mixing in incompressible two-dimensional flows lead to the expectation that, independent of the background potential vorticity (PV) distribution, weakly perturbed zonal jets are associated with barriers that inhibit meridional transport. Here the authors provide evidence in support of this expectation based on the analysis of isentropic winds in the lower stratosphere as produced by the Canadian Middle Atmosphere Model (CMAM), a comprehensive general circulation model. Specifically, barriers to meridional transport are found to be associated with the (eastward) austral polar night jet, for which the meridional gradient of background PV is large, and also for the (westward) boreal summer subtropical jet, for which the background PV gradient is quite small. The identification of the meridional transport barriers is based on the computation of finite-time Lyapunov exponents (FTLEs), which characterize the amount of stretching about fluid particle trajectories. Being composed of regular fluid particle trajectories lying on invariant tori, the meridional transport barriers are identified with topologically circular, local minimizing curves or trenches of the backward-plus-forward FTLE field. Results from explicit passive tracer advection experiments and flux computations are also presented, which are consistent with results inferred using the FTLE diagnostic.
MJO Modulation on 2009/10 Winter Snowstorms in the United States*
Authors: Moon Ja-Yeon , Wang Bin , Ha Kyung-Ja 
Published: September 2011

Abstract
During the winter of 2009/10, a number of record-breaking snowfall events registered in the eastern United States are shown to have been modulated by the pulsation of tropical MJO through an atmospheric teleconnection pattern. The intraseasonal variability over the eastern subtropical Pacific near Mexico (the equatorial central Pacific) had reached the maximum (second largest) strength since 1979/80. From late December to mid-February, the convection over these two regions experienced a remarkable wet–dry–wet cycle; correspondingly, the daily snowfall over the eastern United States also exhibited a wet–dry–wet cycle. As the MJO convection reached the central Pacific, a teleconnection pattern extended to North America, resulting in a westward-tilted deep anomalous trough anchored over the eastern United States, producing a low-level pressure dipole anomaly with an anticyclone (cyclone) centered at the U.S. West (East) Coast. The convection over the Indian Ocean varied in phase with the central Pacific convection, reinforcing the extratropical atmospheric teleconnection pattern. As a result, the enhanced high-latitude cold air penetrated southward, affecting the central and eastern United States. Meanwhile, warmer moist air was transported from the tropical central Pacific by the existing El Niño through Mexico to the southern United States along with the upper-level subtropical westerly jet, which extended from the subtropical Pacific to the Atlantic Ocean. As such, the eastern United States was located in a convergence zone between the enhanced cold air from the high latitude and the warm, moist air supplied from the subtropics, resulting in favorable conditions for extremely heavy snowfall.
Impacts of SST Anomalies in the Agulhas Current System on the Regional Climate Variability
Authors: Nakamura Mototaka 
Published: September 2011

Abstract
The potential impact of the variability in the Agulhas Current system on the large-scale atmospheric state in the Southern Hemisphere is examined, using the monthly near-surface baroclinicity as the key parameter, for the period between September 1980 and August 2002. Dominant patterns of anomalous near-surface baroclinicity found from empirical orthogonal function (EOF) analyses in the region that includes most of the Agulhas Current system show a wide variety of anomaly patterns: some of which indicate spatial shifts in the position of the Agulhas Retroflection and/or Agulhas Return Current. Composited anomalies in various atmospheric fields, sea surface temperature, and the net surface heat flux at the air–sea boundary based on the signals in the EOFs suggest that sea surface temperature anomalies in the Agulhas Current system thermally force the atmosphere on the synoptic scale via modification of the near-surface baroclinicity in March and April and possibly in January and February as well.
Children in Beardslee’s family intervention: Relieved by understanding of parental mental illness
Authors: Pihkala Heljä , Sandlund Mikael , Cederström Anita 
Published: September 2011

Background: Beardslee’s family intervention (FI), which is a family-based preventive method for children of mentally ill parents, has been implemented on a national level in Sweden. Material: Fourteen children and parents from nine families were interviewed about how the FI was for the children. Data were analysed by qualitative content analysis. Discussion: A central finding was children’s sense of relief and release from worry because of more knowledge and openness about the parent’s illness in the family. Conclusion: The results indicating relief for the children are encouraging.
Do Silicone Nasal Septal Splints with Integral Airway Reduce Postoperative Eustachian Tube Dysfunction?
Authors: Yilmaz M. Sinan , Guven Mehmet , Buyukarslan Deniz Gin , Kaymaz Recep , Erkorkmaz Unal 
Published: September 2011

ObjectiveThis study aims to compare the effects of Merocel nasal packs and silicone nasal septal splints with integral airway on the ventilation and pressure of the middle ear when applied intranasally after septoplasty for isolated septal deviation.Study DesignA prospective, randomized trial.SettingA tertiary referral center.Subjects and MethodsFifty‐one patients who underwent septoplasty for nasal respiratory impairment caused by septal deviation were randomized into 2 groups. After septoplasty, bilateral anterior Merocel nasal packs were applied in one group, while silicone nasal septal splints with integral airway were applied in the other group. Middle ear pressures were compared using preoperative and post‐operative tympanometry.ResultsPathological decrease in the middle ear pressure in at least 1 ear was determined in 17 patients (73.9%) in the Merocel group compared with only 6 patients (21.4%) in the silicone nasal septal splint group at the 48th postoperative hour. In the first 24 hours following surgery, decreases in tympanometric pressures were seen in both groups, but more in the Merocel group. After 24 hours, middle ear pressures continued to decrease in the Merocel group but started to increase in the silicone nasal septal splint group.ConclusionBecause they allow inhalation through the nose and cause less Eustachian tube dysfunction than Merocel, using silicone nasal septal splints with integral airway instead of packing after septoplasty seems a more reasonable option.
Articular Cartilage Treatment in High-Level Male Soccer Players
Authors: Kon Elizaveta , Filardo Giuseppe , Berruto Massimo , Benazzo Francesco , Zanon Giacomo , Della Villa Stefano , Marcacci Maurilio 
Published: September 2011

Background: Soccer is a highly demanding sport for the knee joint, and chondral injuries can cause disabling symptoms that may jeopardize an athlete’s career. Articular cartilage lesions are difficult to treat, and the increased mechanical stress produced by this sport makes their management even more complex. Hypothesis: To evaluate whether the regenerative cell-based approach allows these highly demanding athletes a better functional recovery compared with the bone marrow stimulation approach. Study Design: Cohort study; Level of evidence, 2. Methods: Forty-one professional or semiprofessional male soccer players were treated from 2000 to 2006 and evaluated prospectively at 2 years and at a final 7.5-year mean follow-up (minimum, 4 years). Twenty-one patients were treated with arthroscopic second-generation autologous chondrocyte implantation (Hyalograft C) and 20 with the microfracture technique. The clinical outcome of all patients was analyzed using the cartilage standard International Cartilage Repair Society (ICRS) evaluation package. The sport activity level was evaluated with the Tegner score, and the recovery time was also recorded. Results: A significant improvement in all clinical scores from preoperative to final follow-up was found in both groups. The percentage of patients who returned to competition was similar: 80% in the microfracture group and 86% in the Hyalograft C group. Patients treated with microfracture needed a median of 8 months before playing their first official soccer game, whereas the Hyalograft C group required a median time of 12.5 months ( P = .009). The International Knee Documentation Committee (IKDC) subjective score showed similar results at 2 years’ follow-up but significantly better results in the Hyalograft C group at the final evaluation ( P = .005). In fact, in the microfracture group, results decreased over time (from 86.8 ± 9.7 to 79.0 ± 11.6, P < .0005), whereas the Hyalograft C group presented a more durable outcome with stable results (90.5 ± 12.8 at 2 years and 91.0 ± 13.9 at the final follow-up). Conclusion: Despite similar success in returning to competitive sport, microfracture allows a faster recovery but present a clinical deterioration over time, whereas arthroscopic second-generation autologous chondrocyte implantation delays the return of high-level male soccer players to competition but can offer more durable clinical results.
Validating a Self-Report Screen for ADHD in Early Adulthood Using Childhood Parent and Teacher Ratings
Authors: Brownlie E. B. , Lazare Kim , Beitchman Joseph 
Published: September 2011

Objective: This article evaluates the diagnostic utility of a self-report screening tool for adults based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD criteria. Method: Children with speech/language (S/L) impairment and typically developing controls had ADHD symptoms rated by parents and teachers at ages 5 and 12. At age 19, participants completed the Adult Attention Problems Scale (AAPS), an 18-item screen. Receiver operative characteristic curve analyses were used to assess the efficiency of this instrument in screening for ADHD. Results: The AAPS had moderate sensitivity and high specificity, but only for adults without a history of communication disorders. Conclusion: The AAPS provides clinicians with the only self-report scales for ADHD in adulthood, validated with childhood ADHD symptoms assessed by multiple raters. However, scale characteristics were poor for the S/L-impaired cohort. Given the overlap between language impairment and ADHD, adult ADHD measures validated in S/L-impaired samples are needed.