bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variations in Quality Indicators of Acute Stroke Care in 6 European Countries
Authors: Wiedmann Silke , Norrving Bo , Nowe Tim , Abilleira Sònia , Asplund Kjell , Dennis Martin , Hermanek Peter , Rudd Anthony , Thijs Vincent , Wolfe Charles D.A. , Heuschmann Peter U. 
Published: December 2011

Background and Purpose—
Quality indicators serve as standards of care by which performance of individual hospitals is measured. Although several audits for monitoring quality of stroke care have been established in Europe, there is currently no consensus on quality indicators for acute stroke care or for methodology for collecting information on these measures.

Methods—
An up-to-date inventory on European stroke audits in place in 2006 was performed in the course of a project funded by the European Union (European Implementation Score Collaboration [EIS]). Two regional (Flanders, Belgium; Catalonia, Spain) and 4 national (Germany, Scotland, Sweden, England/Wales/Northern Ireland) stroke audits took part. Between November 2009 and July 2010, 2 standardized surveys and a series of interviews were performed to determine characteristics, methods, and content of these quality initiatives. For quality purposes, all summarized information was validated by representatives of the respective audits.

Results—
Overall, 123 quality indicators (91 process, 24 outcome, and 8 structural indicators) were identified. Anticoagulants in patients with atrial fibrillation and brain imaging were the only quality indicators used in all, whereas another 13 indicators were used in at least 2 of the quality initiatives. Substantial variations were found across the audits in terms of the development process of quality indicators, inclusion criteria, participation, population coverage, data documentation, follow-ups, benchmarking, and feedback of results to participants.

Conclusions—
There is a huge variety in measuring performance of acute stroke care in Europe, hampering valid comparisons of acute stroke care. Common standards for defining quality indicators and collecting information required for these measures should be defined in Europe.
MoCA, ACE-R, and MMSE Versus the National Institute of Neurological Disorders and Stroke–Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Neuropsychological Battery After TIA and Stroke
Authors: Pendlebury Sarah T. , Mariz Jose , Bull Linda , Mehta Ziyah , Rothwell Peter M. 
Published: December 2011

Background and Purpose—
The Montreal Cognitive Assessment (MoCA) and Addenbrooke's Cognitive Examination–Revised (ACE-R) are proposed as short cognitive tests for use after stroke, but there are few published validations against a neuropsychological battery. We studied the relationship between MoCA, ACE-R, Mini-Mental State Examination (MMSE) and mild cognitive impairment (MCI) in patients with cerebrovascular disease and mild cognitive impairment (MCI).

Methods—
One hundred consecutive non-institutionalized patients had the MMSE, MoCA, ACE-R, and National Institute of Neurological Disorders and Stroke–Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Neuropsychological Battery ≥1 year after transient ischemic attack or stroke in a population-based study. MCI was diagnosed using modified Petersen criteria in which subjective cognitive complaint is not required (equivalent to cognitive impairment–no dementia) and subtyped by number and type of cognitive domains affected.

Results—
Among 91 nondemented subjects completing neuropsychological testing (mean/SD age, 73.4/11.6 years; 44% female; 56% stroke), 39 (42%) had MCI (amnestic multiple domain=10, nonamnestic multiple domain=9, nonamnestic single domain=19, amnestic single domain=1). Sensitivity and specificity for MCI were optimal with MoCA <25 (sensitivity=77%, specificity=83%) and ACE-R <94 (sensitivity=83%, specificity=73%). Both tests detected amnestic MCI better than nonamnestic single-domain impairment. MMSE only achieved sensitivity >70% at a cutoff of <29, mainly due to relative insensitivity to single-domain impairment.

Conclusions—
The MoCA and ACE-R had good sensitivity and specificity for MCI defined using the Neurological Disorders and Stroke–Canadian Stroke Network Vascular Cognitive Impairment Battery ≥1 year after transient ischemic attack and stroke, whereas the MMSE showed a ceiling effect. However, optimal cutoffs will depend on use for screening (high sensitivity) or diagnosis (high specificity). Lack of timed measures of processing speed may explain the relative insensitivity of the MoCA and ACE-R to single nonmemory domain impairment.
Sleep Apnea Risk Among Mexican American and Non-Hispanic White Stroke Survivors
Authors: Skolarus Lesli E. , Lisabeth Lynda D. , Morgenstern Lewis B. , Burgin William , Brown Devin L. 
Published: December 2011

Background and Purpose—
Sleep apnea is a modifiable independent stroke risk factor and is associated with poor stroke outcomes. Mexican Americans have a higher incidence of stroke than non-Hispanic whites. In a biethnic community, we sought to determine the frequency of screening, testing, and treatment of sleep apnea among stroke survivors and to compare self-perceived risk of sleep apnea with actual risk.

Methods—
A survey was mailed to ischemic stroke survivors in the Brain Attack Surveillance in Corpus Christi (BASIC) project. The survey included the validated sleep apnea screening tool, the Berlin questionnaire, and queried the frequency of sleep apnea screening by symptoms, formal sleep testing, and treatment. Self-perceived risk and actual high risk of sleep apnea were compared using McNemar's test.

Results—

Of the 193 respondents (49% response rate), 54% were Mexican American. Forty-eight percent of respondents had a high risk of sleep apnea based on the Berlin questionnaire, whereas only 19% thought they were likely to have sleep apnea (
P
<0.01). There was no difference in the proportion of respondents at high risk of sleep apnea between Mexican Americans and non-Hispanic whites (48% versus 51%,
P
=0.73). Less than 20% of respondents had undergone sleep apnea screening, testing, or treatment.

Conclusions—
Stroke survivors perceive their risk of sleep apnea to be lower than their actual risk. Despite a significant proportion of both Mexican American and non-Hispanic white stroke survivors at high risk of sleep apnea, few undergo symptom screening, testing, or treatment. Both stroke survivors and physicians may benefit from educational interventions.
An Efficient Way to Detect Poststroke Depression by Subsequent Administration of a 9-Item and a 2-Item Patient Health Questionnaire
Authors: de Man-van Ginkel Janneke M. , Hafsteinsdóttir Thóra , Lindeman Eline , Burger Huibert , Grobbee Diederick , Schuurmans Marieke 
Published: December 2011

Background and Purpose—
The early detection of poststroke depression is essential for optimizing recovery after stroke. A prospective study was conducted to investigate the diagnostic value of the 9-item and the 2-item Patient Health Questionnaire (PHQ-9, PHQ-2).

Methods—
One hundred seventy-one consecutive patients with stroke who could communicate adequately were included. In the 6th to 8th weeks after stroke, depression was measured using the PHQ-9 and PHQ-2 and diagnosed using the Composite International Diagnostic Interview.

Results—
Of the participating patients, 20 (12.2%) were depressed. The PHQ-9 performed best at a score ≥10, a sensitivity of 0.80 (95% CI, 0.62–0.98), and a specificity of 0.78 (95% CI, 0.72–0.85) and the PHQ-2 at a score ≥2 with a sensitivity of 0.75 (95% CI, 0.56–0.94) and a specificity of 0.76 (95% CI, 0.69–0.83). Administering the PHQ-9 only to patients who scored ≥2 on the PHQ-2 improved the identification of depression (sensitivity, 0.87; 95% CI, 0.69–1.04).

Conclusions—
The diagnostic value is acceptable to good for PHQ-9 scores ≥10 and PHQ-2 scores ≥2. Conducting a PHQ-9 only in patients with a PHQ-2 score ≥2 generates the best results.
Modeling Potential Equilibrium States of Vegetation and Terrestrial Water Cycle of Mesoamerica under Climate Change Scenarios*
Authors: Imbach Pablo , Molina Luis , Locatelli Bruno , Roupsard Olivier , Mahé Gil , Neilson Ronald , Corrales Lenin , Scholze Marko , Ciais Philippe 
Published: December 2011

Abstract
The likelihood and magnitude of the impacts of climate change on potential vegetation and the water cycle in Mesoamerica is evaluated. Mesoamerica is a global biodiversity hotspot with highly diverse topographic and climatic conditions and is among the tropical regions with the highest expected changes in precipitation and temperature under future climate scenarios. The biogeographic soil–vegetation–atmosphere model Mapped Atmosphere Plant Soil System (MAPSS) was used for simulating the integrated changes in leaf area index (LAI), vegetation types (grass, shrubs, and trees), evapotranspiration, and runoff at the end of the twenty-first century. Uncertainty was estimated as the likelihood of changes in vegetation and water cycle under three ensembles of model runs, one for each of the groups of greenhouse gas emission scenarios (low, intermediate, and high emissions), for a total of 136 runs generated with 23 general circulation models (GCMs). LAI is likely to decrease over 77%–89% of the region, depending on climate scenario groups, showing that potential vegetation will likely shift from humid to dry types. Accounting for potential effects of CO2 on water use efficiency significantly decreased impacts on LAI. Runoff will decrease across the region even in areas where precipitation increases (even under increased water use efficiency), as temperature change will increase evapotranspiration. Higher emission scenarios show lower uncertainty (higher likelihood) in modeled impacts. Although the projection spread is high for future precipitation, the impacts of climate change on vegetation and water cycle are predicted with relatively low uncertainty.
RBF Neural Networks Combined with Principal Component Analysis Applied to Quantitative Precipitation Forecast for a Reservoir Watershed during Typhoon Periods
Authors: Wei Chih-Chiang 
Published: December 2011

AbstractThe forecast of precipitations during typhoons has received much attention in recent years. It is important in meteorology and atmospheric sciences. Hence, the study on precipitation nowcast during typhoons is of great significance to operators of a reservoir system. This study developed an improved neural network that combines the principal component analysis (PCA) technique and the radial basis function (RBF) network. The developed methodology was employed to establish the quantitative precipitation forecast model for the watershed of the Shihmen Reservoir in northern Taiwan. The results obtained from RBF, multiple linear regression (MLR), PCA–RBF, and PCA–MLR models included the forecasts of L-ahead (L = 1, 3, 6) hourly accumulated precipitations. The deducted prediction results were compared in terms of four measures [mean absolute error (MAE), RMSE, coefficient of correlation (CC), and coefficient of efficiency (CE)] and four skill scores [percentage error (PE), area-weighted error score (AWES), bias score (BIAS), and equitable threat score (ETS)]. The results showed that predictions obtained using RBF and PCA–RBF were better than those produced by MLR and PCA–MLR. Although both RBF and PCA–RBF can provide good results on average, the network architecture and the learning speed of the PCA–RBF network are superior to those of the simple RBF network. This is because PCA technique could greatly reduce the input parameters and simplify concurrently the network structure. Consequently, the PCA–RBF neural networks can be regarded as a reliable model for predicting precipitation during typhoons.
Views on Applying RKW Theory: An Illustration Using the 8 May 2009 Derecho-Producing Convective System
Authors: Coniglio Michael C. , Corfidi Stephen F. , Kain John S. 
Published: December 2011

Abstract
This work presents an analysis of the vertical wind shear during the early stages of the remarkable 8 May 2009 central U.S. derecho-producing convective system. Comments on applying Rotunno–Klemp–Weisman (RKW) theory to mesoscale convective systems (MCSs) of this type also are provided. During the formative stages of the MCS, the near-surface-based shear vectors ahead of the leading convective line varied with time, location, and depth, but the line-normal component of the shear in any layer below 3 km ahead of where the strong bow echo developed was relatively small (6–9 m s−1). Concurrently, the midlevel (3–6 km) line-normal shear component had magnitudes mostly &gt;10 m s−1 throughout.
In a previous companion paper, it was hypothesized that an unusually strong and expansive low-level jet led to dramatic changes in instability, shear, and forced ascent over mesoscale areas. These mesoscale effects may have overwhelmed the interactions between the cold pool and low-level shear that modulate system structure in less complex environments. If cold pool–shear interactions were critical to producing such a strong system, then the extension of the line-normal shear above 3 km also appeared to be critical. It is suggested that RKW theory be applied with much caution, and that examining the shear above 3 km is important, if one wishes to explain the formation and maintenance of intense long-lived convective systems, particularly complex nocturnal systems like the one that occurred on 8 May 2009.
Effectiveness of the Women’s Lacrosse Protective Eyewear Mandate in the Reduction of Eye Injuries
Authors: Lincoln Andrew E. , Caswell Shane V. , Almquist Jon L. , Dunn Reginald E. , Clough Mark V. , Dick Randall W. , Hinton Richard Y. 
Published: December 2011

Background: In an effort to minimize the risk of catastrophic eye injury, US Lacrosse initiated mandatory use of protective eyewear in women’s lacrosse in the 2004-2005 season. Purpose: The authors compared eye injury rates in girls’ scholastic lacrosse before and after implementation of protective eyewear. They also compared head/face injury rates, concussion rates, and overall injury rates before and after the rule change to assess possible unintended consequences of the change. Study Design: Cohort study; Level of evidence, 3. Methods: The study group included female scholastic lacrosse players in the 25 public high schools in Fairfax County, Virginia, during the 2004-2009 spring seasons. Injury rates were compared with those from the same data source for the 2000-2003 seasons. Premandate versus postmandate injury rates were adjusted for athlete exposures, or total opportunities for injury throughout the season. Results: The rate of eye injuries was reduced from 0.10 injuries per 1000 athlete exposures (AEs) in 2000 through 2003 before the use of protective eyewear to 0.016 injuries per 1000 AEs in 2004 through 2009 (incident rate ratio [IRR], 0.16; 95% confidence interval [CI], 0.06-0.42). The rate ratio of head/face injuries excluding concussion also decreased (IRR, 0.44; 95% CI, 0.26-0.76). There was no change in the rate ratio of total injuries involving all body parts (IRR, 0.93; 95% CI, 0.82-1.1) after introduction of protective eyewear. However, the rate ratio of concussion increased (IRR, 1.6; 95% CI, 1.1-2.3). Conclusion: The use of protective eyewear in women’s lacrosse was associated with a reduction in the number of eye injuries. The number of head/face injuries decreased in this study group after introduction of protective eyewear, and there was no change in overall injury rates. The reason for the increase in concussion rate cannot be determined conclusively based on this study, but the authors speculate that this increase resulted largely from increased recognition and diagnosis because overall injury rates do not indicate rougher play with introduction of protective equipment.
Calcifying Tendinitis of the Shoulder
Authors: Balke Maurice , Bielefeld Rebecca , Schmidt Carolin , Dedy Nicolas , Liem Dennis 
Published: December 2011

Background: Calcifying tendinitis is a common and painful disorder of the shoulder characterized by the presence of calcific deposits in the tendons of the rotator cuff. When nonoperative treatment over a prolonged period of time fails, surgical treatment should be considered. Midterm success rates are inconsistent, and the role of subacromial decompression is still unclear. Hypothesis: Our hypotheses were that the rate of supraspinatus tears after arthroscopic treatment of calcifying tendinitis is comparable with that in the contralateral uninvolved shoulder and that subacromial decompression does not have beneficial effects compared with calcium removal alone. Study Design: Case series; Level of evidence, 4. Methods: In 70 shoulders of 62 patients with a mean age of 54 years, arthroscopic removal of calcium deposits of the supraspinatus tendon was performed. In 44 shoulders, additional subacromial decompression was performed. After a mean follow-up of 6 years (range, 2-13 years), patients were clinically investigated, and function was statistically evaluated using Constant and American Shoulder and Elbow Surgeons (ASES) scores. Affected and contralateral shoulders were examined by ultrasound in 48 shoulders, and rotator cuff tears were documented. Results: The mean Constant scores of the operated shoulders were significantly lower than those of the healthy shoulders ( P < .001). The ASES scores significantly ( P < .001) increased after surgery but were still lower than the ASES scores of the healthy shoulders ( P < .001). Concerning the additional subacromial decompression, there were no significant differences in the overall ASES and Constant scores; the subitem “pain” was significantly better in the subacromial decompression group ( P = .048). Ultrasound examination at last follow-up (48 shoulders) showed a partial supraspinatus tendon tear in 11 operated and 3 contralateral shoulders. Conclusion: Although the good clinical results after arthroscopic treatment of calcifying tendinitis of the shoulder persist midterm, the affected shoulders present significantly lower clinical scores than healthy shoulders. The rate of partial supraspinatus tendon tears seems to be higher after calcium removal. Additional subacromial decompression seems to reduce postoperative pain.
A small molecule screening strategy with validation on human leukemia stem cells uncovers the therapeutic efficacy of kinetin riboside
Authors: McDermott Sean P. , Eppert Kolja , Notta Faiyaz , Isaac Methvin , Datti Alessandro , Al-awar Rima , Wrana Jeff , Minden Mark D. , Dick John E. 
Published: December 2011

Abstract
Gene regulatory networks that govern hematopoietic stem cells (HSCs) and leukemia-initiating cells (L-ICs) are deeply entangled. Thus, the discovery of compounds that target L-ICs while sparing HSC is an attractive but difficult endeavor. Presently, most screening approaches fail to counter-screen compounds against normal hematopoietic stem/progenitor cells (HSPCs). Here, we present a multistep in vitro and in vivo approach to identify compounds that can target L-ICs in acute myeloid leukemia (AML). A high-throughput screen of 4000 compounds on novel leukemia cell lines derived from human experimental leukemogenesis models yielded 80 hits, of which 10 were less toxic to HSPC. We characterized a single compound, kinetin riboside (KR), on AML L-ICs and HSPCs. KR demonstrated comparable efficacy to standard therapies against blast cells in 63 primary leukemias. In vitro, KR targeted the L-IC–enriched CD34+CD38− AML fraction, while sparing HSPC-enriched fractions, although these effects were mitigated on HSC assayed in vivo. KR eliminated L-ICs in 2 of 4 primary AML samples when assayed in vivo and highlights the importance of in vivo L-IC and HSC assays to measure function. Overall, we provide a novel approach to screen large drug libraries for the discovery of anti–L-IC compounds for human leukemias.
B-cell depletion and remissions of malignancy along with cytokine-associated toxicity in a clinical trial of anti-CD19 chimeric-antigen-receptor–transduced T cells
Authors: Kochenderfer James N. , Dudley Mark E. , Feldman Steven A. , Wilson Wyndham H. , Spaner David E. , Maric Irina , Stetler-Stevenson Maryalice , Phan Giao Q. , Hughes Marybeth S. , Sherry Richard M. , Yang James C. , Kammula Udai S. , Devillier Laura , Carpenter Robert , Nathan Debbie-Ann N. , Morgan Richard A. , Laurencot Carolyn , Rosenberg Steven A. 
Published: December 2011

AbstractWe conducted a clinical trial to assess adoptive transfer of T cells genetically modified to express an anti-CD19 chimeric Ag receptor (CAR). Our clinical protocol consisted of chemotherapy followed by an infusion of anti–CD19-CAR–transduced T cells and a course of IL-2. Six of the 8 patients treated on our protocol obtained remissions of their advanced, progressive B-cell malignancies. Four of the 8 patients treated on the protocol had long-term depletion of normal polyclonal CD19+ B-lineage cells. Cells containing the anti-CD19 CAR gene were detected in the blood of all patients. Four of the 8 treated patients had prominent elevations in serum levels of the inflammatory cytokines IFNγ and TNF. The severity of acute toxicities experienced by the patients correlated with serum IFNγ and TNF levels. The infused anti–CD19-CAR–transduced T cells were a possible source of these inflammatory cytokines because we demonstrated peripheral blood T cells that produced TNF and IFNγ ex vivo in a CD19-specific manner after anti–CD19-CAR–transduced T-cell infusions. Anti–CD19-CAR–transduced T cells have great promise to improve the treatment of B-cell malignancies because of a potent ability to eradicate CD19+ cells in vivo; however, reversible cytokine-associated toxicities occurred after CAR–transduced T-cell infusions. This trial was registered with ClinicalTrials.gov as NCT00924326.