bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of a Screening Tool Improves Appropriate Referral to an Electrophysiologist for Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death
Authors: Gravelin Laura M. , Yuhas Jennifer , Remetz Michael , Radford Martha , Foley John , Lampert Rachel 
Published: February 2011

Background—
Despite data showing the benefits of implantable cardioverter-defibrillator (ICD) insertion for primary prevention in populations at risk for sudden death, professional society guidelines recommending primary prevention, and recognition by payers of the clinical value of ICDs in these populations, ICDs for primary prevention remain underused. We sought to determine whether implementing a screening tool would increase appropriate identification of patients showing clinical evidence of ICD benefit and prompt referral to an electrophysiologist for ICD implantation.

Methods and Results—

Screening tools were affixed to medical records for patients seen in 2 outpatient cardiology offices that queried ejection fraction and whether referral to an electrophysiologist was made (N=6632). The number of appropriate referrals in the screening period were compared with analogous data collected before implementation of the screening tool (control period) through retrospective record review (n=3606). Significantly more eligible patients were offered referral during the screening period than during the control period at both sites, 80% (8/10 eligible) versus 33% (5/15) at site 1 (
P
<0.02) and 100% (44/44) versus 60% (21/35) at site 2 (
P
<0.001). Of all patients offered referral, 41% (32/78) accepted.

Conclusions—
The use of a screening tool increases referral to electrophysiology for patients in whom placement of an ICD confers the benefit of sudden cardiac death primary prevention. Barriers to referral include both physician and patient factors. Verification of these findings on a larger scale as well as studies defining the foundation of these barriers may further improve use of ICDs in patients for whom their mortality benefit is well described.
Extent of and Reasons for Nonuse of Implantable Cardioverter Defibrillator Devices in Clinical Practice Among Eligible Patients With Left Ventricular Systolic Dysfunction
Authors: Allen LaPointe Nancy M. , Al-Khatib Sana M. , Piccini Jonathan P. , Atwater Brett D. , Honeycutt Emily , Thomas Kevin , Shah Bimal R. , Zimmer Louise O. , Sanders Gillian , Peterson Eric D. 
Published: February 2011

Background—
Several studies that used claims and registry data have reported that 40% to 80% of patients eligible for an implantable cardioverter defibrillator (ICD) fail to receive one in clinical practice, and the rates are especially high among women and blacks. The extent and documented reasons for nonuse of ICDs among patients with left ventricular systolic dysfunction are unknown.

Methods and Results—
Using hospital claims and clinical data, we identified patients hospitalized with a heart failure diagnosis and left ventricular ejection fraction ≤30% between January 1, 2007, and August 30, 2007, at a tertiary-care center. Using claims data, we determined placement of an ICD or cardiac resynchronization therapy with defibrillation device at any time up to 1 year after hospitalization. Medical records for patients without an ICD were abstracted to determine reasons for nonuse. Patients with an ICD were compared with patients without an ICD and also with patients without an ICD who did not have any contraindication for an ICD as identified through chart abstraction. Of the 542 potentially eligible patients identified, 224 (41%) did not have an ICD. In the initial adjusted analysis, female sex (odds ratio=1.90; 95% CI, 1.28 to 2.81) and increasing age (odds ratio=1.07; 95% CI, 1.04 to 1.11) were associated with a higher likelihood of not having an ICD. After detailed chart review, of the 224 patients without an ICD, 117 (52%) were ineligible for the device and 38 (17%) patients refused the device, resulting in only 69 (13%) patients eligible for an ICD who failed to receive one. In this subsequent adjusted analysis, remaining factors associated with a higher likelihood of not having an ICD were absence of ventricular arrhythmias (odds ratio=4.93; 95% CI, 2.56 to 9.50), noncardiology hospital service (odds ratio=3.73; 95% CI, 1.98 to 7.04), and lack of health insurance (odds ratio=3.10; 95% CI, 1.48 to 6.46).

Conclusions—
On the basis of a detailed chart review, the true rate of ICD underuse may be substantially lower than previous estimates. In addition, after accounting for ICD eligibility criteria, patient sex and age disparities in ICD therapy were no longer present.
Low Serum Homoarginine Is a Novel Risk Factor for Fatal Strokes in Patients Undergoing Coronary Angiography
Authors: Pilz Stefan , Tomaschitz Andreas , Meinitzer Andreas , Drechsler Christiane , Ritz Eberhard , Krane Vera , Wanner Christoph , Böhm Bernhard O. , März Winfried 
Published: February 2011

Background and Purpose—
Low serum concentrations of the amino acid homoarginine have been associated with endothelial dysfunction and an increased risk of all-cause and cardiovascular mortality. We aimed to investigate whether homoarginine levels are also associated with fatal strokes and a history of nonfatal cerebrovascular disease.

Methods—
Serum homoarginine was measured in 3305 participants of the Ludwigshafen Risk and Cardiovascular Health (LURIC) study who were referred to coronary angiography at baseline (1997 to 2000) and were followed up with respect to mortality.

Results—

During a median follow-up time of 9.9 years, 991 patients died including 61 fatal (ischemic and hemorrhagic) strokes. In a binary logistic regression analysis, the odds ratio (with 95% CI) for fatal stroke per SD of homoarginine was 0.52 (0.37 to 0.73;
P
<0.001) and remained significant after multivariable adjustments (0.62 [0.42 to 0.91];
P
=0.014). For previous cerebrovascular disease events, the multivariable adjusted OR per SD of homoarginine was 0.82 (0.70 to 0.96;
P
=0.014).

Conclusions—
Low homoarginine levels are a novel risk factor for fatal strokes and are reduced in patients with a history of cerebrovascular disease. Further studies are needed to explore the significance of homoarginine to risk stratification and therapeutic approaches in the prevention of strokes.
Eulerian and Lagrangian Statistics from Surface Drifters and a High-Resolution POP Simulation in the North Atlantic
Authors: McClean Julie L. , Poulain Pierre-Marie , Pelton Jimmy W. , Maltrud Mathew E. 
Published: February 2011

Abstract
Eulerian and Lagrangian statistics were calculated from the North Atlantic surface drifter dataset for the years 1993–97 and a high-resolution eddy-resolving configuration of the Los Alamos National Laboratory (LANL) Parallel Ocean Program (POP) model. The main purpose of the study was to statistically quantify the state of the surface circulation in the North Atlantic Ocean for this period and compare it with the equivalent modeled state. Diffusivities and time and length scales are anisotropic over most of the ocean basin, except in most of the subpolar regions. Typical time and length scales are 2–4 days and 20–50 km. Longest timescales are found in the energetically quiescent regions in the south and southeast sectors of the basin. The longest length scales are found in the energetic western boundary current system, the most dispersive region of the domain. In many respects the eddy-resolving model reproduced a surface circulation in good statistical agreement with that depicted by the drifters. Model time and length scales were also anisotropic, with typical timescales of 2–4 days and length scales of 20–50 km in the zonal direction, and 30–50 km in the meridional direction. An eddy-permitting POP simulation produced unrealistic time and length scales that were too long and too short relative to the drifter scales; these were attributed to the model being too stable hydrodynamically.
“Teddies” and the Origin of the Leeuwin Current
Authors: Nof Doron , Pichevin Thierry , Sprintall Janet 
Published: February 2011

Abstract
The outflow from the Indonesian seas empties approximately 5–7 Sv of surface warm (and low salinity) Indonesian Throughflow water into the southern Indian Ocean (at roughly 12°S). Using a nonlinear 1½-layer model with a simple geometry consisting of a point source (of anomalous water) situated along a meridional wall on a β plane, the spreading of these waters is examined. An analytical solution is constructed with the aid of the “slowly varying” approach, and process-oriented numerical simulations are performed.
It is found that, immediately after emptying into the ocean, the outflow splits into two branches. One branch carries approximately 13% of the source mass flux and forms a chain of high amplitude anticyclonic eddies (lenses) immediately to the west of the source. These eddies drift westward and penetrate into the interior of the Indian Ocean. The second branch carries the remaining 87% of the mass flux via a coastal southward flowing current. Ultimately, this second branch separates from the coast and turns westward. (A detailed examination of this second branch separation is, nevertheless, beyond the scope of this study.)
It is suggested that the eddies recently observed to the west of the Island of Timor are a result of the above eddy generation process, which is not related to the classical eddy generation process associated with instabilities (i.e., the breakdown of a known steady solution). It is also suggested that this new nonlinear process explains why some of the Indonesian Throughflow water forms the source of the southward flowing coastal Leeuwin Current.
The Simulation of the Southern Great Plains Nocturnal Boundary Layer and the Low-Level Jet with a High-Resolution Mesoscale Atmospheric Model
Authors: Werth David , Kurzeja Robert , Dias Nelson Luís , Zhang Gengsheng , Duarte Henrique , Fischer Marc , Parker Matthew , Leclerc Monique 
Published: February 2011

AbstractA field project over the Atmospheric Radiation Measurement–Cloud and Radiation Test Bed (ARM–CART) site during a period of several nights in September 2007 was conducted to explore the evolution of the low-level jet (LLJ). Data were collected from in situ (a multilevel tower) and remote (sodar) sensors, and the observed LLJ activity during the project was found to agree well with data from earlier studies regarding jet speed, height, and direction. To study nocturnal boundary layer (NBL) behavior, the Regional Atmospheric Modeling System was used to simulate the ARM–CART NBL field experiment and was validated against the data collected from the site. This model was run at high resolution for calculating the interactions among the various motions within the boundary layer and their influence on the surface. The model faithfully simulated the formation and dissolution of the low-level nocturnal jet during a synoptic situation in which low pressure with warm southerly advection replaced high pressure. An additional simulation at 32.5-m resolution was performed for the most stable 5.5-h period, using a turbulence scheme adjusted to allow for greater resolved turbulent kinetic energy, and the model reproduced the turbulence statistics as determined by a power spectrum. The benefit of the high-resolution simulation is evident in the much more realistically resolved model turbulent kinetic energy and the fluxes of momentum, heat, and water vapor.
Dominant Mode of Climate Variability, Intermodel Diversity, and Projected Future Changes over the Summertime Western North Pacific Simulated in the CMIP3 Models
Authors: Kosaka Yu , Nakamura Hisashi 
Published: February 2011

Abstract
A set of multimodel twentieth-century climate simulations for phase 3 of the Coupled Model Intercomparison Project (CMIP3) is analyzed to assess the model reproducibility of the Pacific–Japan (PJ) teleconnection pattern. It is the dominant low-frequency anomaly pattern over the summertime western North Pacific (WNP), characterized by a meridional dipole of zonally elongated vorticity anomalies in the lower troposphere and by anomalous precipitation over the tropical WNP. Most of the models can reproduce the PJ pattern reasonably well as one of the leading anomaly patterns or their combination. The model reproducibility of the pattern tends to be higher for those models in which the climatological-mean state over the WNP is better reproduced. Furthermore, intermodel diversity in the summertime climatological-mean fields over the WNP, especially in the lower troposphere, is found to be large and projected most strongly onto the observed PJ pattern. Nevertheless, the multimodel ensemble (MME) mean of these climatological-mean states is close to the observations.
Projected future changes in the summertime climatological-mean state under the Intergovernmental Panel on Climate Change’s (IPCC) Special Report on Emission Scenarios (SRES) A1B also bear certain similarities with the PJ pattern, in a manner consistent with the aforementioned sensitivity of the model climate to that pattern. The MME projection indicates an overall increase in precipitation over the entire tropics, but it is overwhelmed locally by the effects of the enhanced tropospheric stratification over the tropical WNP. A resultant local reduction of the mean ascent is dynamically consistent with the anticyclonic projection around the Philippines and the cyclonic projection around Japan in MME, as in the observed anomalous dipole associated with the PJ pattern. However, the polarity and magnitude of the PJ-like projected change vary substantially from one model to another.
Simulated Response to Recent Freshwater Flux Change over the Gulf Stream and Its Extension: Coupled Ocean–Atmosphere Adjustment and Atlantic–Pacific Teleconnection
Authors: Zhang Liping , Wu Lixin , Zhang Jiaxu 
Published: February 2011

Abstract
Recent observation has shown that the dominant mode of the net freshwater flux variations over the North Atlantic Ocean is the significant trend of freshwater loss over the Gulf Stream region and its extension. In this paper, the coupled ocean–atmosphere response to this freshwater flux change is investigated based on a series of the Fast Ocean–Atmosphere Model coupled-model experiments. The model demonstrates that the freshwater loss over the Gulf Stream and its extension region directly forces an anomalous cyclonic gyre and triggers a SST dipole with cooling in the western subtropical and warming in the eastern subpolar North Atlantic. The freshwater loss also forces a significant response in the atmosphere with a negative NAO-like response in early winter and a basin-scale ridge resembling the eastern Atlantic mode (EAM) in late winter. The salinification also strengthens the Atlantic meridional overturning circulation and thus the poleward heat transport, leading to tropical cooling.
The freshwater loss over the Gulf Stream and its extension also leads to an El Niño–like warming in the tropical Pacific and cooling in the North Pacific, similar to the responses in previous water-hosing experiments with an input of freshwater in the subpolar North Atlantic. The tropical Pacific responses subsequently strengthen the Northern Hemispheric atmospheric anomalies in early winter, but reverse them in late winter through an emanation of Rossby wave trains. Overall, the tropical Pacific air–sea coupling plays a damping role, while local air–sea coupling tends to enhance the ocean and atmospheric responses over the North Atlantic.
Northern Hemisphere Modes of Variability and the Timing of Spring in Western North America
Authors: Ault Toby R. , Macalady Alison K. , Pederson Gregory T. , Betancourt Julio L. , Schwartz Mark D. 
Published: February 2011

Abstract
Spatial and temporal patterns of variability in spring onset are identified across western North America using a spring index (SI) model based on weather station minimum and maximum temperatures (Tmin and Tmax, respectively). Principal component analysis shows that two significant and independent patterns explain roughly half of the total variance in the timing of spring onset from 1920 to 2005. However, these patterns of spring onset do not appear to be linear responses to the primary modes of variability in the Northern Hemisphere: the Pacific–North American pattern (PNA) and the northern annular mode (NAM). Instead, over the period when reanalysis data and the spring index model overlap (1950–2005), the patterns of spring onset are local responses to the state of both the PNA and NAM, which together modulate the onset date of spring by 10–20 days on interannual time scales. They do so by controlling the number and intensity of warm days. There is also a regionwide trend in spring advancement of about −1.5 days decade−1 from 1950 to 2005. Trends in the NAM and PNA can only explain about one-third (−0.5 day decade−1) of this trend.
The Probability Distribution of Land Surface Wind Speeds
Authors: Monahan Adam H. , He Yanping , McFarlane Norman , Dai Aiguo 
Published: February 2011

Abstract
The probability density function (pdf) of land surface wind speeds is characterized using a global network of observations. Daytime surface wind speeds are shown to be broadly consistent with the Weibull distribution, while nighttime surface wind speeds are generally more positively skewed than the corresponding Weibull distribution (particularly in summer). In the midlatitudes, these strongly positive skewnesses are shown to be generally associated with conditions of strong surface stability and weak lower-tropospheric wind shear. Long-term tower observations from Cabauw, the Netherlands, and Los Alamos, New Mexico, demonstrate that lower-tropospheric wind speeds become more positively skewed than the corresponding Weibull distribution only in the shallow (~50 m) nocturnal boundary layer. This skewness is associated with two populations of nighttime winds: (i) strongly stably stratified with strong wind shear and (ii) weakly stably or unstably stratified with weak wind shear. Using an idealized two-layer model of the boundary layer momentum budget, it is shown that the observed variability of the daytime and nighttime surface wind speeds can be accounted for through a stochastic representation of intermittent turbulent mixing at the nocturnal boundary layer inversion.
Response of a Large Stratified Estuary to Wind Events: Observations, Simulations, and Theory for Long Island Sound
Authors: Whitney Michael M. , Codiga Daniel L. 
Published: February 2011

Abstract
The response to wind events in the Long Island Sound (LIS), a large macrotidal estuary influenced by rotation and stratification, is studied using long-term ferry-based current observations near the mouth, unstratified and stratified numerical simulations forced with along-estuary winds, and analytic solutions based on linear barotropic theory. The observed wind-event velocity anomalies for down-estuary winds have surface-intensified downwind flows flanking a deeper central upwind flow. Response to up-estuary wind events has a weaker magnitude and a broader and thicker downwind flow. The downwind and upwind flows are more laterally aligned than vertically layered, as determined by a newly defined dimensionless lateral alignment index. Simulation results and analytic solutions share the gross spatial patterns of the observed response, though statistical measures indicate weak agreement. Along-estuary variations in the simulation results and analytic solutions follow similar trends and are strongly influenced by variations of the bathymetric cross section. Wind-event anomalies in the section-averaged dynamics are dominated by the along-estuary pressure gradient opposing wind stress. In the stratified simulation, wind-driven density advection, isopycnal straining, and stirring modify stratification, eddy viscosities, and baroclinic pressure gradients. The wind-event response of the baroclinic pressure gradient is 15% of the barotropic gradient but is dynamically linked to response differences to up-estuary and down-estuary winds. The wind-event response asymmetries near the mouth are in qualitative agreement with observations and are opposite to asymmetries closer to the head.
Predictors of Malignancy in Patients with a Thyroid Nodule That Contains Hürthle Cells
Authors: Turanli Sevim , Pirhan Yavuz , Ozcelik Caglar Kazim , Cetin Abdullah 
Published: February 2011

ObjectiveFine needle aspiration cytology of a thyroid nodule with Hürthle cells can be present in both benign and malignant diseases of the thyroid. The aim of this study was to identify the factors that predict malignancy in patients who underwent thyroidectomy with a preoperative fine needle aspiration cytology that contains a predominance of Hürthle cells.Study DesignRetrospective data collection.SettingTertiary referral center.Subjects and MethodsMedical records of 70 consecutive patients were reviewed between March 2005 and August 2010. Predictive factors, as well as age, gender, preoperative serum thyroid‐stimulating hormone level, the microscopic findings of fine needle aspiration, ultrasonographic appearance, and size and number of nodules in the pathology report, were correlated with final histopathologic diagnosis of benign or malignant disease.ResultsPatients’ final pathology showed that 21 patients (30%) had malignant disease, of whom 15 patients (71.4%) had papillary carcinoma and 6 patients (28.6%) had Hürthle cell carcinoma. Forty‐nine (70%) patients had benign disease (hyperplastic/adenomatoid nodule in 24 patients, Hashimoto thyroiditis in 18 patients, Hürthle cell adenoma in 5 patients, and follicular adenoma in 2 patients). The rate of malignancy was higher in male patients (42.9% vs 28.6%), with nodules measuring ≥2 cm (36.7% vs 25.0%), the presence of a solitary nodule (34.3% vs 27.7%), and the presence of metaplasia in fine needle aspiration (36.4% vs 27.1%), although none was found to be significant (P >. 05).ConclusionThyroid nodules that are reported in cytology as Hürthle cell lesions require surgery to differentiate benign from malignant disease.
Chronic pain in the neonate: a research design connecting Ancient Delphi to the modern ‘Dutch Polder’
Authors: van Ganzewinkel Christ-jan , Andriessen Peter 
Published: February 2011

Introduction: To date research on neonatal pain has focused mainly on acute or procedural pain. It is recognised that prolonged or chronic pain exists in this age group. Studies on this subject fail to provide a clear description of chronic pain in the neonate. Objectives: To identify the most appropriate consensus-building method in order to answer three research questions concerning the definition of chronic pain in the neonate, the etiology and the clinical signs and symptoms. Methodology: We performed a literature search with regards to the methodology of the Delphi method, the Nominal Group Technique and the Consensus Development Conference. Results: We found only sparse data reviewing the Nominal Group Technique and the Consensus Development Method. More data was found for the Delphi method. Discussion: We chose to design a Delphi survey in the light of our research questions. The main arguments were the ability to include experts from all over the globe, and the low probability of introducing bias. Conclusion: All three methods have strong and weak points. A major criterion should be the validity of the design. However, conclusions on validity are hampered by the marginal amount of papers found for two of the three designs.