bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing and improving child death review team recommendations
Authors: Wirtz Stephen J , Foster Valodi , Lenart Gretchen A 
Published: January 2011

BackgroundChild death review teams (CDRTs) are multi-agency, multidisciplinary teams that review the circumstances surrounding child deaths. Although the potential of CDRTs to promote systems improvement and prevention is well recognised, teams often struggle to translate their findings into effective preventive actions.ObjectiveTo present results from a study assessing the quality of written recommendations in published CDRT reports; and provide guidelines for improving the quality and effectiveness of these written recommendations.MethodsA descriptive, non-experimental design was used to analyse a set of 1093 recommendations from 21 randomly selected, publicly available state and local CDRT reports. An assessment instrument, modelled on the public health approach, was developed to score the quality of recommendations. It consists of three components divided into 10 dimensions: problem assessment; written recommendations; and action on recommendations.ResultsCDRT reports scored highest in the problem assessment component (mean score: 2.7/dimension), followed by written recommendations (2.2/dimension), and action on recommendations (1.9/dimension). Even among the highest ranked dimensions, the average scores were only in the mid range of quality on our assessment scale.ConclusionsThe results suggest that CDRTs are doing a better job of ‘assessing the problem’ than in ‘proposing solutions’ as indicated by their written recommendations. CDRT reports often do not address follow-up of their written recommendations. Guidelines are offered for use as a practical tool to help CDRTs enhance the likelihood of producing effective recommendations that prevent future child injuries and deaths.
The novel use of fast track CT to select patients for lung cancer clinics: effect on clinic efficiency, waiting times, and patient satisfaction
Authors: Lal Abhimanyu , Phillips Sophie , Russell Carolyn , Woolhouse Ian 
Published: January 2011

ABSTRACT

Background
Lung cancer is the most common cause of cancer death in the UK, and triaging patients ‘straight to test’ is recommended to improve patient experience and outcomes. While such pathways are likely to lead to earlier diagnosis and treatment, the data to support this assumption are limited.

Objectives
To assess the impact of a fast track CT pathway to select patients for lung cancer clinics on clinic efficiency, diagnostic and treatment delays, and patient satisfaction.

Methods
Retrospective comparative cohort study of patients referred to lung cancer clinics for investigation of suspicious imaging from January to December 2006 and June to December 2007.

Results
The proportion of patients seen in clinic subsequently diagnosed with lung cancer increased from 124/399 (31%) to 86/168 (51%) (p&lt;0.001). Time from referral to diagnosis reduced from 22 to 17 days (p&lt;0.001). Time from referral to first discussion at the multidisciplinary team (MDT) meeting fell from 32 to 22 days (p&lt;0.001). Time from referral to decision to treat reduced from 42 to 35 days (p&lt;0.05). Time from referral to first treatment fell from 55 to 49 days (p=0.095). The proportion of patients who felt the diagnostic process took too long fell from 15/80 (19%) to 3/49 (6%) (p&lt;0.05).

Conclusions
The new pathway led to more effective use of clinic appointments, reduced diagnostic delay, and more rapid treatment decision times. Patient satisfaction with the speed of the diagnostic process increased. It is recommended that hospital trusts in England consider adopting similar ‘straight to test’ triaging to select patients for lung cancer clinics.
Circulating Proprotein Convertase Subtilisin/Kexin 9 (PCSK9) Regulates VLDLR Protein and Triglyceride Accumulation in Visceral Adipose Tissue
Authors: Roubtsova Anna , Munkonda Mercedes Nancy , Awan Zuhier , Marcinkiewicz Jadwiga , Chamberland Ann , Lazure Claude , Cianflone Katherine , Seidah Nabil G. , Prat Annik 
Published: January 2011

Objective—
Proprotein convertase subtilisin/kexin 9 (PCSK9) promotes the degradation of the low-density lipoprotein receptor (LDLR), and its gene is the third locus implicated in familial hypercholesterolemia. Herein, we investigated the role of PCSK9 in adipose tissue metabolism.

Methods and Results—

At 6 months of age,
Pcsk9
−/−
mice accumulated ≈80% more visceral adipose tissue than wild-type mice. This was associated with adipocyte hypertrophy and increased in vivo fatty acid uptake and ex vivo triglyceride synthesis. Moreover, adipocyte hypertrophy was also observed in
Pcsk9
−/−
Ldlr
−/−
mice, indicating that the LDLR is not implicated. Rather, we show here by immunohistochemistry that
Pcsk9
−/−
males and females exhibit 4- and ≈40-fold higher cell surface levels of very-low-density lipoprotein receptor (VLDLR) in perigonadal depots, respectively. Expression of PCSK9 in the liver of
Pcsk9
−/−
females reestablished both circulating PCSK9 and normal VLDLR levels. In contrast, specific inactivation of PCSK9 in the liver of wild-type females led to ≈50-fold higher levels of perigonadal VLDLR.

Conclusion—
In vivo, endogenous PCSK9 regulates VLDLR protein levels in adipose tissue. This regulation is achieved by circulating PCSK9 that originates entirely in the liver. PCSK9 is thus pivotal in fat metabolism: it maintains high circulating cholesterol levels via hepatic LDLR degradation, but it also limits visceral adipogenesis likely via adipose VLDLR regulation.
Macrophage Activation Is Responsible for Loss of Anticontractile Function in Inflamed Perivascular Fat
Authors: Withers Sarah B. , Agabiti-Rosei Claudia , Livingstone Daniel M. , Little Matthew C. , Aslam Rehima , Malik Rayaz A. , Heagerty Anthony M. 
Published: January 2011

Objective—
The aim of this study was to determine whether macrophages dispersed throughout perivascular fat are crucial to the loss of anticontractile function when healthy adipose tissue becomes inflamed and to gain an understanding of the mechanisms involved.

Methods and Results—
Pharmacological studies on in vitro small arterial segments from a mouse model of inducible macrophage ablation and on wild-type animals were carried out with and without perivascular fat using 2 physiological stimuli of inflammation: aldosterone and hypoxia. Both inflammatory insults caused a similar loss of anticontractile capacity of perivascular fat and increased macrophage activation. Aldosterone receptor antagonism and free radical scavengers were able to restore this capacity and reduce macrophage activation. However, in a mouse deficient of macrophages CD11b-diptheria toxin receptor (CD11b-DTR), there was no increase in contractility of arteries following aldosterone incubation or hypoxia.

Conclusion—
The presence and activation of macrophages in adipose tissue is the key modulator of the increase in contractility in arteries with perivascular fat following induction of inflammation. Despite multiple factors that may be involved in bringing about the vascular consequences of obesity, the ability of eplerenone to ameliorate the inflammatory effects of both aldosterone and hypoxia may be of potential therapeutic interest.
Novel Dynamic Four-Dimensional CT Angiography Revealing 2-Type Motions of Cerebral Arteries
Authors: Umeda Yasuyuki , Ishida Fujimaro , Hamada Kazuhide , Fukazawa Keiji , Miura Yoichi , Toma Naoki , Suzuki Hidenori , Matsushima Satoshi , Shimosaka Shinichi , Taki Waro 
Published: January 2011

Background and Purpose—
We developed a novel dynamic 4-dimensional CT angiography to accurately evaluate dynamics in cerebral aneurysm.

Methods—
Dynamic 4-dimensional CT angiography achieved high-resolution 3-dimensional imaging with temporal resolution in a beating heart using dynamic scanning data sets reconstructed with a retrospective simulated R-R interval reconstruction algorithm.

Results—
Movie artifacts disappeared on dynamic 4-dimensional CT angiography movies of 2 kinds of stationary phantoms (titanium clips and dry bone). In the virtual pulsating aneurysm model, pulsation on the dynamic 4-dimensional CT angiography movie resembled actual movement in terms of pulsation size. In a clinical study, dynamic 4-dimensional CT angiography showed 2-type motions: pulsation and anatomic positional changes of the cerebral artery.

Conclusions—
This newly developed 4-dimensional visualizing technique may deliver some clues to clarify the pathophysiology of cerebral aneurysms.
A 5-Item Scale to Predict Stroke Outcome After Cortical Middle Cerebral Artery Territory Infarction
Authors: Vora Nirav A. , Shook Steven J. , Schumacher H. Christian , Tievsky Andrew L. , Albers Greg W. , Wechsler Lawrence R. , Gupta Rishi 
Published: January 2011

Background and Purpose—
Various clinical, laboratory, and radiographic parameters have been identified as predictors of outcome for ischemic stroke. The purpose of this study was to combine these parameters into a validated scale for outcome prognostication in patients with a middle cerebral artery territory infarction.

Methods—
We retrospectively reviewed 129 patients over a 2-year period and considered demographic, clinical, laboratory, and radiographic parameters as potential predictors of outcome. Inclusion criteria were unilateral hemispheric infarcts within the middle cerebral artery territory >15 mm in diameter. Our primary outcome measure was a favorable recovery defined as a modified Rankin Score was ≤2 at 30 days. A multivariable model was used to determine independent predictors of outcome and weighted to create a 5-item scale to predict stroke recovery. External validation of this model was done using data from the Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution (DEFUSE) study.

Results—

The 5 independent predictors of outcome were as follows: age (OR, 1.09; 95% CI, 1.03 to 1.14;
P
=0.001), National Institutes of Health Stroke Scale score (OR, 1.17; 95% CI, 1.06 to 1.30;
P
=0.003), infarct volume (OR, 1.01; 95% CI, 1.00 to 1.02;
P
=0.03), admission white blood cell count (8.5×10
3
/mm
3
; OR, 1.16; 95% CI, 1.03 to 1.27;
P
=0.04), and presence of hyperglycemia (OR, 4.2; 95% CI, 1.1 to 16.4;
P
=0.04). Combining these variables into a point scale significantly improved prediction over the individual variables accounted alone as evidenced by the area underneath the receiver operating curve (OR, 0.91; 95% CI, 0.87 to 0.96;
P
=0.0001). When applied to the DEFUSE study population for validation, the model achieved a sensitivity of 83% and specificity of 86%.

Conclusions—
With validation from a prospective study of similar patients, this model serves as a useful clinical and research tool to predict stroke recovery after cortical middle cerebral artery territory infarction.
Osteopontin Reduced Hypoxia–Ischemia Neonatal Brain Injury by Suppression of Apoptosis in a Rat Pup Model
Authors: Chen Wanqiu , Ma Qingyi , Suzuki Hidenori , Hartman Richard , Tang Jiping , Zhang John H. 
Published: January 2011

Background and Purpose—
Osteopontin (OPN) is neuroprotective in ischemic brain injuries in adult experimental models; therefore, we hypothesized that OPN would provide neuroprotection and improve long-term neurological function in the immature brain after hypoxic–ischemic (HI) injury.

Methods—

HI was induced by unilateral ligation of the right carotid artery followed by hypoxia (8% O
2
for 2 hours) in postnatal Day 7 rats. OPN (0.03 μg or 0.1 μg) was injected intracerebroventricularly at 1 hour post-HI. Temporal expression of endogenous OPN was evaluated in the normal rat brain at the age of 0, 4, 7, 11, 14, and 21 days and in the ipsilateral hemisphere after HI. The effects of OPN were evaluated using 2-3-5-triphenyl tetrazolium chloride staining, apoptotic cell death assay, and cleaved caspase-3 expression. Neurological function was assessed by the Morris water maze test.

Results—
Endogenous OPN expression in the brain was the highest at the age of 0 day with continuous reduction until the age of 21 days during development. After HI injury, endogenous OPN expression was increased and peaked at 48 hours. Exogenous OPN decreased infarct volume and improved neurological outcomes 7 weeks after HI injury. OPN-induced neuroprotection was blocked by an integrin antagonist.

Conclusions—
OPN-induced neuroprotection was associated with cleaved-caspase-3 inhibition and antiapoptotic cell death. OPN treatment improved long-term neurological function against neonatal HI brain injury.
AMIP GCM Simulations of Precipitation Variability over the Yangtze River Valley
Authors: Wang Chenghai , Liang Xin-Zhong , Samel Arthur N. 
Published: January 2011

Abstract
Analysis of 26 simulations from 11 general circulation models (GCMs) of the Atmospheric Model Intercomparison Project (AMIP) II reveals a basic inability to simultaneously predict the Yangtze River Valley (YRV) precipitation (PrYRV) annual cycle and summer interannual variability in response to observed global SST distributions. Only the Community Climate System Model (CCSM) and L’Institut Pierre-Simon Laplace (IPSL) models reproduce the observed annual cycle, but both fail to capture the interannual variability. Conversely, only Max Planck Institute (MPI) simulates interannual variability reasonably well, but its annual cycle leads observations by 2 months.
The interannual variability of PrYRV reveals two distinct signals in observations, which are identified with opposite subtropical Pacific SST anomalies in the east (SSTe) and west (SSTw). First, negative SSTe anomalies are associated with equatorward displacement of the upper-level East Asian jet (ULJ) over China. The resulting transverse circulation enhances low-level southerly flow over the South China Sea and south China while convergent flow and upward motion increase over the YRV. Second, positive SSTw anomalies are linked with westward movement of the subtropical high over the west-central Pacific. This strengthens the low-level jet (LLJ) to the south of the YRV. These two signals act together to enhance PrYRV. The AMIP II suite, however, generally fails to reproduce these features. Only the MPI.3 realization is able to simulate both signals and, consequently, realistic PrYRV interannual variations. It appears that PrYRV is governed primarily by coherent ULJ and LLJ variations that act as the atmospheric bridges to remote SSTe and SSTw forcings, respectively. The PrYRV response to global SST anomalies may then be realistically depicted only when both bridges are correctly simulated. The above hypothesis does not exclude other signals that may play important roles linking PrYRV with remote SST forcings through certain atmospheric bridges, which deserve further investigation.
The Impacts of Inter–El Niño Variability on the Tropical Atlantic and Northeast Brazil Climate
Authors: Rodrigues Regina R. , Haarsma Reindert J. , Campos Edmo J. D. , Ambrizzi Tércio 
Published: January 2011

Abstract
In this study, observations and numerical simulations are used to investigate how different El Niño events affect the development of SST anomalies in the Atlantic and how this relates to the Brazilian northeast (NE) precipitation. The results show that different types of El Niño have different impacts on the SST anomalies of the equatorial and tropical South Atlantic but a similar SST response in the tropical North Atlantic. Strong and long (weak and short) El Niños with the main heating source located in the eastern (central) Pacific generate cold (warm) anomalies in the cold tongue and Benguela upwelling regions during boreal winter and spring. When the SST anomalies in the eastern equatorial and tropical South Atlantic are cold (warm), the meridional SST gradient across the equator is positive (negative) and the ITCZ is not allowed (allowed) to move southward during the boreal spring; as a consequence, the precipitation is below (above) the average over the NE. Thus, strong and long (weak and short) El Niños are followed by dry (wet) conditions in the NE. During strong and long El Niños, changes in the Walker circulation over the Atlantic and in the Pacific–South Atlantic (PSA) wave train cause easterly wind anomalies in the western equatorial Atlantic, which in turn activate the Bjerknes mechanism, establishing the cold tongue in boreal spring and summer. These easterly anomalies are also responsible for the Benguela upwelling. During short and weak El Niños, westerly wind anomalies are present in the western equatorial Atlantic accompanied by warm anomalies in the eastern equatorial and tropical South Atlantic; a positive phase of the South Atlantic dipole develops during boreal winter. The simulations highlight the importance of ocean dynamics in establishing the correct slope of the equatorial thermocline and SST anomalies, which in turn determine the correct rainfall response over the NE.
The Role of Human Activity in the Recent Warming of Extremely Warm Daytime Temperatures
Authors: Christidis Nikolaos , Stott Peter A. , Brown Simon J. 
Published: January 2011

Abstract
Formal detection and attribution analyses of changes in daily extremes give evidence of a significant human influence on the increasing severity of extremely warm nights and decreasing severity of extremely cold days and nights. This paper presents an optimal fingerprinting analysis that also detects the contributions of external forcings to recent changes in extremely warm days using nonstationary extreme value theory. The authors’ analysis is the first that attempts to partition the observed change in warm daytime extremes between its anthropogenic and natural components and hence attribute part of the change to possible causes. Changes in the extreme temperatures are represented by the temporal changes in a parameter of an extreme value distribution. Regional distributions of the trend in the parameter are computed with and without human influence using constraints from the global optimal fingerprinting analysis. Anthropogenic forcings alter the regional distributions, indicating that extremely warm days have become hotter.
Near-Surface and Land Surface Forecast System of the Vancouver 2010 Winter Olympic and Paralympic Games
Authors: Bernier Natacha B. , Bélair Stéphane , Bilodeau Bernard , Tong Linying 
Published: January 2011

AbstractA high-resolution 2D near-surface and land surface model was developed to produce snow and temperature forecasts over the complex alpine region of the Vancouver 2010 Winter Olympic and Paralympic Games. The model is driven by downscaled operational outputs from the Meteorological Service of Canada’s regional and global forecast models. Downscaling is applied to correct forcings for elevation differences between the operational forecast models and the high-resolution surface model. The high-resolution near-surface and land surface model is then used to further refine the forecasts. The model was validated against temperature and snow depth observations. The largest improvements were found in regions where low-resolution (i.e., on the order of 10 km or more) operational models typically lack the spatial resolution to capture rapid elevation changes. The model was found to better reproduce the intermittent snow cover at low-lying stations and to reduce snow depth error by as much as 3 m at alpine stations.
Association of echocardiographic left ventricular structure with the ACE D/I polymorphism: a meta-analysis
Authors: Yu Jin  , Kuznetsova Tatiana , Thijs Lutgarde , Richart Tom , Stolarz-Skrzypek Katarzyna , Yanping Liu  , Fagard Robert , Manunta Paolo , Bianchi Giuseppe , Staessen Jan A 
Published: January 2011

Introduction: In a previous meta-analysis, we derived pooled estimates for the association of left ventricular mass (LVM) and hypertrophy (LVH), as diagnosed by electrocardiography or echocardiography, with the ACE D/I polymorphism. We updated this meta-analysis until May 2009 only considering echocardiographic phenotypes. Methods: We computed pooled estimates from a random-effects model. Results: Across 38 studies, both DD homozygotes ( n = 2440) and DI heterozygotes ( n = 4310) had higher ( p ≤ 0.002) LVM or LVM index than II homozygotes ( n = 2229). Across 21 studies with available data, this was due to increased mean wall thickness (MWT) with no difference in left ventricular internal diameter (LVID). Standardised differences (DD versus II) were 0.39 ( p < 0.001) for LVM, 0.34 ( p = 0.009) for MWT, and 0.066 ( p = 0.26) for LVID. Across 16 studies (4894 participants), the pooled odds ratios of LVH (versus II homozygotes) were 1.11 ( p = 0.29) and 1.02 ( p = 0.88) for the DD and DI genotypes, respectively. Sensitivity analyses were confirmatory. Conclusions: Our meta-analysis supports the hypothesis that the enhanced ACE activity associated with the D allele is associated with higher LV mass. Smaller sample size might explain the lack of significant association with LVH.
The association between circulating angiotensin-converting enzyme and cardiovascular risk in the elderly: a cross-sectional study
Authors: Ljungberg Liza , Alehagen Urban , Länne Toste , Björck Hanna , De Basso Rachel , Dahlström Ulf , Persson Karin 
Published: January 2011

Introduction: A polymorphism in the angiotensin-converting enzyme gene (ACE I/D polymorphism) has been associated with increased risk for cardiovascular disease (CVD). This polymorphism affects the level of circulating ACE, but there is great individual variation, even between those with the same genotype. Few previous studies have investigated the link between circulating ACE and cardiovascular risk. The aim of this study was to investigate this association, and to examine the relationship between ACE level, ACE genotype and CVD. Materials and methods : The study population consisted of 322 men and 350 women aged 69—87. Plasma ACE level was determined using enzyme-linked immunosorbent assay (ELISA), and ACE genotype was analysed using PCR followed by gel electrophoresis. Results: In men, ACE levels increased with increasing number of cardiovascular risk factors ( p = 0.003). There was a significant association in men between increased ACE level and both diabetes ( p = 0.007) and smoking ( p = 0.037). Conclusions:This study shows that cardiovascular risk factors (such as smoking and diabetes) are associated with higher levels of circulating ACE in men. High ACE levels may represent one of the cellular mechanisms involved in producing the vascular damage associated with cardiovascular risk factors.
Getting a diagnosis v. learning to live with it? The case of the progressive ataxias
Authors: Daker-White Gavin , Sanders Caroline , Greenfield Julie , Ealing John , Payne Katherine 
Published: January 2011

Objectives: To examine the perceptions and experiences of the diagnosis process in people with a progressive ataxia, a group of rare complex neurological conditions usually leading to disturbances in balance and speech. Methods: An explorative qualitative study involving analysis of public accounts posted to specialist Internet discussion forums by people with symptoms of ataxia. Internet data were utilized partly because ataxia is a rare condition. Results: The main themes that emerged were diagnosis as an arduous process, achieving diagnosis as a privilege, the importance of getting a medical label, being believed with regard to symptoms and ‘idiopathic’ diagnosis as a non-diagnosis. The accounts of people who were not able to secure a definitive diagnosis suggested that their priorities had changed from getting a diagnosis to managing and learning to live with their progressive disabilities. Conclusions: The diagnosis of the progressive ataxias presents challenges for patients, clinicians and in terms of the extensive use of finite healthcare resources. Our findings suggest there are varied views on the importance of diagnosis to people with progressive ataxia. This warrants further in-depth research to understand how people rate the relative utility of diagnostics.