bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acupuncture Effect on Thermal Tolerance and Electrical Pain Threshold: A Randomised Controlled Trial
Authors: Amand Marc , Nguyen-Huu Florence , Balestra Costantino 
Published: December 2010

Objective The aim of this study was to test whether acupuncture could modify the threshold of tolerance to thermal and electrical stimuli. Methods A randomised placebo-controlled single-blind trial was conducted in 36 healthy volunteers randomly distributed to control (no treatment), conventional acupuncture and sham acupuncture groups. The subjects were blind to the group allocation. The authors measured before and after treatment the pain threshold with the Painmatcher (Cefar Medical AB, Lund, Sweden) and the cold tolerance with the cold pressor test, together with the Visual Analogue Scale pain score. Results Electrical stimulation threshold and cold pressor tolerance both increased significantly in the control and the true acupuncture groups, but not the sham group. The changes in the true acupuncture group were highly statistically significant and amounted to 24% (pain threshold) and 44% (cold tolerance) increases in threshold. The changes in the true group were significantly greater than the control group but not significantly different from the sham group. The changes in the sham and control groups were not significantly different from each other. Conclusion Acupuncture at true, appropriate points was more effective than no intervention in raising pain threshold and tolerance in volunteers, and acupuncture at inappropriate points had an intermediate effect which was not significantly different from either. Thus acupuncture analgesia may not be a point specific effect.
Electronic nicotine delivery systems: is there a need for regulation?
Authors: Trtchounian Anna , Talbot Prue 
Published: December 2010

PurposeElectronic nicotine delivery systems (ENDS) purport to deliver nicotine to the lungs of smokers. Five brands of ENDS were evaluated for design features, accuracy and clarity of labelling and quality of instruction manuals and associated print material supplied with products or on manufacturers' websites.MethodsENDS were purchased from online vendors and analysed for various parameters.ResultsWhile the basic design of ENDS was similar across brands, specific design features varied significantly. Fluid contained in cartridge reservoirs readily leaked out of most brands, and it was difficult to assemble or disassemble ENDS without touching nicotine-containing fluid. Two brands had designs that helped lessen this problem. Labelling of cartridges was very poor; labelling of some cartridge wrappers was better than labelling of cartridges. In general, packs of replacement cartridges were better labelled than the wrappers or cartridges, but most packs lacked cartridge content and warning information, and sometimes packs had confusing information. Used cartridges contained fluid, and disposal of nicotine-containing cartridges was not adequately addressed on websites or in manuals. Orders were sometimes filled incorrectly, and safety features did not always function properly. Print and internet material often contained information or made claims for which there is currently no scientific support.ConclusionsDesign flaws, lack of adequate labelling and concerns about quality control and health issues indicate that regulators should consider removing ENDS from the market until their safety can be adequately evaluated.
On Properties of Solutions for Two Functional Equations Arising in Dynamic Programming
Authors: Liu Zeqing , Ume JeongSheok , Kang ShinMin 
Published: December 2010

AbstractWe introduce and study two new functional equations, which contain a lot of known functional equations as special cases, arising in dynamic programming of multistage decision processes. By applying a new fixed point theorem, we obtain the existence, uniqueness, iterative approximation, and error estimate of solutions for these functional equations. Under certain conditions, we also study properties of solutions for one of the functional equations. The results presented in this paper extend, improve, and unify the results according to Bellman, Bellman and Roosta, Bhakta and Choudhury, Bhakta and Mitra, Liu, Liu and Ume, and others. Two examples are given to demonstrate the advantage of our results over existing results in the literature.
Immunobiomarkers in Small Cell Lung Cancer: Potential Early Cancer Signals
Authors: Chapman Caroline J. , Thorpe Alison J. , Murray Andrea , Parsy-Kowalska Celine B. , Allen Jared , Stafford Kelly M. , Chauhan Alok S. , Kite Thomas A. , Maddison Paul , Robertson John F. R. 
Published: December 2010

Abstract
Purpose: We investigated the presence of autoantibodies as immunobiomarkers to a panel of tumor-associated antigens in a group of individuals with small cell lung cancer (SCLC), a disease group that has a poor overall cancer prognosis and therefore may benefit most from early diagnosis.
Experimental Design: Sera from 243 patients with confirmed SCLC and normal controls matched for age, sex, and smoking history were analyzed for the presence of these early immunobiomarkers (i.e., autoantibodies to p53, CAGE, NY-ESO-1, GBU4-5, Annexin I, SOX2, and Hu-D) by ELISA.
Results: Autoantibodies were seen to at least 1 of 6 antigens in 55% of all the SCLC patients' sera tested, with a specificity of 90% compared with controls. Using a higher assay cutoff to achieve a specificity of 99%, autoantibodies were still detectable in 42% of SCLC patients (receiver operator characteristic area under the curve = 0.76). There was no significant difference in sensitivity when analyzed by stage of the cancer or by patient age or gender. The frequency of autoantibodies to individual antigens varied, ranging from 4% for GBU4-5 to 35% for SOX2. Levels of Annexin I autoantibodies were not elevated in patients with SCLC. Antibodies were also detected in 4 separate patients whose sera were taken up to 3 months before tumor diagnosis.
Conclusion: The presence of an autoantibody to one or more cancer-associated antigens may provide an important addition to the armamentarium available to the clinician to aid early detection of SCLC in high-risk individuals. Clin Cancer Res; 17(6); 1474–80. ©2011 AACR.
Physician and Patient Influences on Provider Performance
Authors: Funkhouser Ellen , Houston Thomas K. , Levine Deborah A. , Richman Joshua , Allison Jeroan J. , Kiefe Catarina I. 
Published: December 2010

Background—
Efforts to improve the quality of care for patients with cardiovascular disease frequently target the decrease of physician-level performance variability. We assessed how variability in providing β-blockers to ambulatory postmyocardial infarction (MI) patients was influenced by physician and patient level characteristics.

Methods and Results—
β-Blocker prescription and patient characteristics were abstracted from charts of post-MI patients treated by 133 primary care physicians between 2003 and 2007 and linked to physician and practice characteristics. Associations of β-blocker prescription with physician- and patient-level characteristics were examined using mixed-effects models, with physician-level effects as random. Mean physician-specific predicted probabilities and the intraclass correlations, which assessed the proportion of variance explainable at the physician level, were estimated. Of 1901 patients without major contraindication, 69.1% (range across physicians, 20% to 100%) were prescribed β-blockers. Prescription varied with comorbidity from 78.3% in patients with chronic kidney disease to 54.7% for patients with stroke. Although physician characteristics such as older physician age, group practice, and rural location were each positively associated with β-blocker prescription, physician factors accounted for only 5% to 8% of the variance in β-blocker prescription; the preponderance of the variance, 92% to 95%, was at the patient level. The mean physician-specific probability of β-blocker prescription (95% confidence interval) in the fully adjusted model was 63% (61% to 65%).

Conclusions—
β-Blocker prescription rates were surprisingly low. The contribution of physician factors to overall variability in β-blocker prescription, however, was limited. Increasing evidence-based use of β-blockers may not be accomplished by focusing mostly on differential performance across physicians.
Lifetime Costs of Medical Care After Heart Failure Diagnosis
Authors: Dunlay Shannon M. , Shah Nilay D. , Shi Qian , Morlan Bruce , VanHouten Holly , Hall Long Kirsten , Roger Véronique L. 
Published: December 2010

Background—
Heart failure (HF) care constitutes an increasing economic burden on the health care system, and has become a key focus in the health care debate. However, there are limited data on the lifetime health care costs for individuals with HF after initial diagnosis.

Methods and Results—

Olmsted County residents with incident HF from 1987 to 2006 were identified. Direct medical costs incurred from the time of HF diagnosis until death or last follow-up were obtained using population-based administrative data through 2007. Costs were inflated to 2008 US dollars using the general Consumer Price Index. Inpatient, outpatient, and total costs were estimated using a 2-part model with adjustment for right censoring of data. Predictors of total costs were examined using a similar model. A total of 1054 incident HF patients were identified (mean age, 76.8 years; 46.1% men). After a mean follow-up of 4.6 years, 765 (72.6%) patients had died. The estimated total lifetime costs were $109 541 (95% confidence interval, $100 335 to 118 946) per person, with the majority accumulated during hospitalizations (mean, $83 980 per person). After adjustment for age, year of diagnosis, and comorbidity, diabetes mellitus and preserved ejection fraction (≥50%) were associated with 24.8% (
P
=0.003) and 23.6% (
P
=0.041) higher lifetime costs, respectively. Higher costs were observed at initial HF diagnosis and in the months immediately before death in those surviving >12 months after diagnosis.

Conclusions—
HF imposes a significant economic burden, primarily related to hospitalizations. Variations in cost over a lifetime can help identify strategies for efficient management of patients, particularly at the end of life.
Cost-Effectiveness of Genetic Testing in Family Members of Patients With Long-QT Syndrome
Authors: Perez Marco V. , Kumarasamy Narmadan A. , Owens Douglas K. , Wang Paul J. , Hlatky Mark A. 
Published: December 2010

Background—
Family members of patients with established long-QT syndrome (LQTS) often lack definitive clinical findings, yet may have inherited an LQTS mutation and be at risk of sudden death. Genetic testing can identify mutations in 75% of patients with LQTS, but genetic testing of family members remains controversial.

Methods and Results—
We used a Markov model to assess the cost-effectiveness of 3 strategies for treating an asymptomatic 10-year-old, first-degree relative of a patient with clinically evident LQTS. In the genetic testing strategy, relatives undergo genetic testing only for the mutation identified in the index patient, and relatives who test positive for the mutation are treated with β-blockers. This strategy was compared with (1) empirical treatment of relatives with β-blockers and (2) watchful waiting, with treatment only after development of symptoms. The genetic testing strategy resulted in better survival and quality-adjusted life years at higher cost, with a cost-effectiveness ratio of $67 400 per quality-adjusted life year gained compared with watchful waiting. The cost-effectiveness of the genetic testing strategy improved to less than $50 000 per quality-adjusted life year gained when applied selectively either to (1) relatives with higher clinical suspicion of LQTS (pretest probability 65% to 81%), or to (2) families with a higher than average risk of sudden death, or to (3) larger families (2 or more first-degree relatives tested).

Conclusions—
Genetic testing of young first-degree relatives of patients with definite LQTS is moderately expensive, but can reach acceptable thresholds of cost-effectiveness when applied to selected patients.
Regional Variation in the Use of Implantable Cardioverter-Defibrillators for Primary Prevention
Authors: Matlock Dan D. , Peterson Pamela N. , Heidenreich Paul A. , Lucas F. Lee , Malenka David J. , Wang Yongfei , Curtis Jeptha P. , Kutner Jean S. , Fisher Elliott S. , Masoudi Frederick A. 
Published: December 2010

Background—
Although the use of implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden cardiac death varies by sex, race, and hospital, geographic variation in ICD use remains unexplored. Our objective was to quantify regional variations in the utilization of primary prevention ICDs in the United States, and to evaluate if an association exists between utilization and physician supply or the proportion of patients meeting the trial inclusion criteria.

Methods and Results—

This is a cross-sectional analysis among the Medicare, fee-for-service population from the National Cardiovascular Data Registry. Using hospital referral regions, we calculated the age-, sex-, and race-adjusted rates of ICD placement for each region and assessed the correlation between these rates and (1) physician supply and (2) the proportion of patients meeting trial inclusion criteria. Substantial variation was found across quintiles of rate ratios of ICD implantation, ranging from 0.39 to 1.77 (compared with a national mean rate of 1.0). This ratio was not correlated with the supply of cardiologists (
R
2
=0.01), electrophysiologists (
R
2
=0.01), or with the proportion of patients meeting trial inclusion criteria (
R
2
<0.01). Over all, 13% of all patients receiving ICDs did not meet trial criteria.

Conclusions—
Marked geographic variation in the use of primary prevention ICDs exists across the United States that is not correlated with physician supply. Although >1 in 10 patients received ICDs outside of trial criteria, this potential overuse did not explain the variation. Future studies should consider underuse or misuse of primary prevention ICDs as causes of geographic variation.
Predictability of Seasonal Sahel Rainfall Using GCMs and Lead-Time Improvements Through the Use of a Coupled Model
Authors: Ndiaye Ousmane , Ward M. Neil , Thiaw Wassila M. 
Published: December 2010

AbstractThe ability of several atmosphere-only and coupled ocean–atmosphere general circulation models (AGCMs and CGCMs, respectively) is explored for the prediction of seasonal July–September (JAS) Sahel rainfall. The AGCMs driven with observed sea surface temperature (SST) over the period 1968–2001 confirm the poor ability of such models to represent interannual Sahel rainfall variability. However, using a model output statistics (MOS) approach with the predicted low-level wind field over the tropical Atlantic and western part of West Africa yields good Sahel rainfall skill for all models. Skill is mostly captured in the leading empirical orthogonal function (EOF1), representing large-scale fluctuation in the regional circulation system over the tropical Atlantic. This finding has operational significance for the utility of AGCMs for short lead-time prediction based on persistence of June SST information; however, studies have shown that for longer lead-time forecasts, there is substantial loss of skill, relative to that achieved using the observed JAS SST.The potential of CGCMs is therefore explored for extending the lead time of Sahel rainfall predictions. Some of the models studied, when initialized using April information, show potential to at least match the levels of skill achievable from assuming persistence of April SST. One model [NCEP Climate Forecasting System (CFS)] was found to be particularly promising. Diagnosis of the hindcasts available for the CFS (from lead times up to six months for 1981–2008) suggests that, especially by applying the same MOS approach, skill is achieved through capturing interannual variations in Sahel rainfall (primarily related to El Niño–Southern Oscillation in the period of study), as well as the upward trend in Sahel rainfall that is observed over 1981–2008, which has been accompanied by a relative warming in the North Atlantic compared to the South Atlantic. At lead times up to six months (initialized forecasts in December), skill levels are maintained with the correlation between predicted and observed Sahel rainfall at approximately r = 0.6. While such skill levels at these long lead times are notably higher than previously achieved, further experiments, such as over the same period and with comparable AGCMs, are required for definitive attribution of the advance to the use of a coupled ocean–atmosphere modeling approach. Nonetheless, the detrended skill achieved here by the January–March initializations (r = 0.33) must require an approach that captures the evolution of the key ocean–atmosphere anomalies from boreal winter to boreal summer, and approaches that draw on persistence in ocean conditions have not previously been successful.
Evolution of the Arctic Ocean Salinity, 2007–08: Contrast between the Canadian and the Eurasian Basins
Authors: Lique Camille , Garric Gilles , Treguier Anne-Marie , Barnier Bernard , Ferry Nicolas , Testut Charles-Emmanuel , Girard-Ardhuin Fanny 
Published: December 2010

Abstract
The authors investigate the variability of salinity in the Arctic Ocean and in the Nordic and Labrador Seas over recent years to see how the freshwater balance in the Arctic and the exchanges with the North Atlantic have been affected by the recent important sea ice melting, especially during the 2007 sea ice extent minimum. The Global Ocean Reanalysis and Simulations (GLORYS1) global ocean reanalysis based on a global coupled ocean–sea ice model with an average of 12-km grid resolution in the Arctic Ocean is used in this regard. Although no sea ice data and no data under sea ice are assimilated, simulation over the 2001–09 period is shown to represent fairly well the 2007 sea ice event and the different components accounting for the ocean and sea ice freshwater budget, compared to available observations. In the reanalysis, the 2007 sea ice minimum is due to an increase of the sea ice export through Fram Strait (25%) and an important sea ice melt in the Arctic (75%). Liquid freshwater is accumulated in the Beaufort gyre after 2002, in agreement with recent observations, and it is shown that this accumulation is due to both the sea ice melt and a spatial redistribution of the freshwater content in the Canadian Basin. In the Eurasian Basin, a very contrasting situation is found with an increase of the salinity. The effect of the sea ice melt is counterbalanced by an increase of the Atlantic inflow and a modification of the circulation north of Fram Strait after 2007. The authors suggest that a strong anomaly of the atmospheric conditions was responsible for this change of the circulation.
Influence of Langmuir Circulation on the Deepening of the Wind-Mixed Layer
Authors: Noh Yign , Goh Gahyun , Raasch Siegfried 
Published: December 2010

Abstract
Analysis of large eddy simulation data reveals that Langmuir circulation (LC) induces a significant enhancement of the mixed layer deepening, only if the mixed layer depth (MLD) h is shallow and the buoyancy jump across it ΔB is small, when simulations are initiated by applying the wind stress to a motionless mixed layer with stratification. The difference in the entrainment rate between the cases with and without LC decreases with hΔB/υL2, where υL is the velocity scale of LC. The ratio of the mixing length scale l between the cases with and without LC is close to 1 for larger Rt [=(Nl0/q)2; Rt &gt; ∼1], but it increases to above 10 with the decrease of Rt, where N is the Brunt–Väisälä frequency and q and l0 are the velocity and length scales of turbulence in the homogeneous layer. It is also found that, in the presence of LC, the effect of stratification on vertical mixing should be parameterized in terms of Rt instead of Ri (=(N/S)2), because velocity shear S is no longer a dominant source of turbulence. The parameterization is provided by l/l0 = (1 + αRt)−1/2 with α ∼ 50, regardless of the presence of LC. However, LC makes l0 much larger than conventionally used for the boundary layer.
Effect of Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions on Pivot-Shift Kinematics in Anterior Cruciate Ligament– and Meniscus-Deficient Knees
Authors: Musahl Volker , Bedi Asheesh , Citak Musa , O’Loughlin Padhraig , Choi Daniel , Pearle Andrew D. 
Published: December 2010

Background: Recent laboratory and clinical studies report no difference between single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. Hypothesis: Anatomical DB ACL reconstruction would restore knee kinematics in a complex injury model of ACL–meniscus injury closer to the intact state when compared with 2 common SB ACL reconstructions. Study Design: Controlled laboratory study. Methods: Five fresh-frozen cadaveric hip-to-toe lower extremity specimens were used for this study (10 knees). A surgical navigation system recorded the 3-dimensional motion path of a tracked point at the center of the medial and lateral compartments during a 68-N Lachman test and a mechanized pivot-shift test. Testing was performed on the intact knee, after ACL, medial meniscus, and lateral meniscus resection and after 3 ACL reconstructions: anatomical anteromedial SB, nonanatomical SB (posterolateral tibia to anteromedial femur), and anatomical DB. Same-sized hamstring grafts were used for all reconstructions. Repeated-measures analysis of variance with a post hoc Tukey multiple-comparison test was used to compare the anterior tibial translations of the 3 grafts during laxity testing. Results: Regarding the Lachman test, there was no difference between the anatomical anteromedial SB and DB reconstructions. For the mechanized pivot shift, anatomical DB reconstruction restored anterior tibial translation to the intact state; however, significantly greater anterior tibial translation was detected after anatomical anteromedial SB and nonanatomical SB reconstruction, compared with the intact knee. In addition, there was no difference in medial compartment translations during the pivot shift between the intact and reconstructed states. Conclusion: Anatomical DB ACL reconstruction was able to restore intact knee kinematics during the pivot shift even in the severe injury model. Clinical Relevance: Double-bundle ACL reconstruction procedures may be preferred in cases of high-grade instability or meniscus deficiency.