bluuebunny/crossref_metadata_2025_split huggingface dataset:
Response of Blood Pressure and Blood Glucose to Treatment With Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke
Authors: Kerr Daniel M. , Fulton Rachael L. , Higgins Peter , Bath Philip M.W. , Shuaib Ashfaq , Lyden Patrick , Lees Kennedy R. ,   for the VISTA Collaborators*
Published: November 2011

Background and Purpose—
Elevations in blood pressure (BP) and blood glucose are common during stroke and may represent a stress response secondary to the acute neurological deficit. If so, they should settle more completely in recombinant tissue-type plasminogen activator (rtPA)-treated patients in association with improved neurological status.

Methods—
We performed a controlled comparison of 24-hour declines in BP and glucose in rtPA-treated and control patients from the Virtual Stroke International Stroke Trial Archive (VISTA) database. Twenty-four-hour falls in BP and glucose were compared using multiple regression to account for baseline imbalances. The logarithmic transformation of glucose was used and 24-hour differences expressed as ratios of 24 hours to admission geometric means. Two-way analysis of variance was used to test for interaction between rtPA and early improvement for 24-hour falls in BP and blood glucose.

Results—

BP analysis included 5406 patients (rtPA=41%) and glucose analysis 4288 (rtPA=37%). rtPA-treated patients were younger, less likely to have a history of hypertension or diabetes, and had more severe strokes on admission. BP and glucose were lower at baseline in rtPA-treated patients than control subjects. On regression, rtPA predicted significantly greater 24-hour falls in systolic BP (β=3.9; 95% CI, 2.8–5.0), diastolic BP (β=3.1; 95% CI, 2.4–3.9), and glucose (β=0.97; 95% CI, 0.95–0.99). rtPA did not interact with early neurological improvement for 24-hour falls in systolic BP (
P
=0.72), diastolic BP (
P
=0.79), or blood glucose (
P
=0.51).

Conclusions—
A stress response does not appear to be the principal cause of elevations in BP and glucose during stroke.
Concurrent Validity and Reliability of Retrospective Scoring of the Pediatric National Institutes of Health Stroke Scale
Authors: Beslow Lauren A. , Kasner Scott E. , Smith Sabrina E. , Mullen Michael T. , Kirschen Matthew P. , Bastian Rachel A. , Dowling Michael M. , Lo Warren , Jordan Lori C. , Bernard Timothy J. , Friedman Neil , deVeber Gabrielle , Kirton Adam , Abraham Lisa , Licht Daniel J. , Jawad Abbas F. , Ellenberg Jonas H. , Lautenbach Ebbing , Ichord Rebecca N. 
Published: November 2011

Background and Purpose—
The Pediatric National Institutes of Health Stroke Scale (PedNIHSS), an adaptation of the adult National Institutes of Health Stroke Scale, is a quantitative measure of stroke severity shown to be reliable when scored prospectively. The ability to calculate the PedNIHSS score retrospectively would be invaluable in the conduct of observational pediatric stroke studies. The study objective was to assess the concurrent validity and reliability of estimating the PedNIHSS score retrospectively from medical records.

Methods—
Neurological examinations from medical records of 75 children enrolled in a prospective PedNIHSS validation study were photocopied. Four neurologists of varying training levels blinded to the prospective PedNIHSS scores reviewed the records and retrospectively assigned PedNIHSS scores. Retrospective scores were compared among raters and to the prospective scores.

Results—

Total retrospective PedNIHSS scores correlated highly with total prospective scores (
R
2
=0.76). Interrater reliability for the total scores was “excellent” (intraclass correlation coefficient, 0.95; 95% CI, 0.94–0.97). Interrater reliability for individual test items was “substantial” or “excellent” for 14 of 15 items.

Conclusions—
The PedNIHSS score can be scored retrospectively from medical records with a high degree of concurrent validity and reliability. This tool can be used to improve the quality of retrospective pediatric stroke studies.
Aortic Stiffness Predicts Functional Outcome in Patients After Ischemic Stroke
Authors: Gąsecki Dariusz , Rojek Agnieszka , Kwarciany Mariusz , Kubach Marlena , Boutouyrie Pierre , Nyka Walenty , Laurent Stephane , Narkiewicz Krzysztof 
Published: November 2011

Background and Purpose—
Increased aortic stiffness (measured by carotid–femoral pulse wave velocity) and central augmentation index have been shown to independently predict cardiovascular events, including stroke. We studied whether pulse wave velocity and central augmentation index predict functional outcome after ischemic stroke.

Methods—
In a prospective study, we enrolled 99 patients with acute ischemic stroke (age 63.7±12.4 years, admission National Institutes of Health Stroke Scale score 6.6±6.6, mean±SD). Carotid–femoral pulse wave velocity and central augmentation index (SphygmoCor) were measured 1 week after stroke onset. Functional outcome was evaluated 90 days after stroke using the modified Rankin Scale with modified Rankin Scale score of 0 to 1 considered an excellent outcome.

Results—

In univariate analysis, low carotid–femoral pulse wave velocity (
P
=0.000001) and low central augmentation index (
P
=0.028) were significantly associated with excellent stroke outcome. Age, severity of stroke, presence of previous stroke, diabetes, heart rate, and peripheral pressures also predicted stroke functional outcome. In multivariate analysis, the predictive value of carotid–femoral pulse wave velocity (<9.4 m/s) remained significant (OR, 0.21; 95% CI, 0.06–0.79;
P
=0.02) after adjustment for age, National Institutes of Health Stroke Scale score on admission, and presence of previous stroke. By contrast, central augmentation index had no significant predictive value after adjustment.

Conclusions—
This study indicates that aortic stiffness is an independent predictor of functional outcome in patients with acute ischemic stroke.
Sensitivity of Idealized Squall-Line Simulations to the Level of Complexity Used in Two-Moment Bulk Microphysics Schemes
Authors: Van Weverberg Kwinten , Vogelmann Andrew M. , Morrison Hugh , Milbrandt Jason A. 
Published: November 2011

AbstractThis paper investigates the level of complexity that is needed within bulk microphysics schemes to represent the essential features associated with deep convection. To do so, the sensitivity of surface precipitation is evaluated in two-dimensional idealized squall-line simulations with respect to the level of complexity in the bulk microphysics schemes of H. Morrison et al. and of J. A. Milbrandt and M. K. Yau. Factors examined include the number of predicted moments for each of the precipitating hydrometeors, the number and nature of ice categories, and the conversion term formulations. First, it is shown that simulations of surface precipitation and cold pools are not only a two-moment representation of rain, as suggested by previous research, but also by two-moment representations for all precipitating hydrometeors. Cold pools weakened when both rain and graupel number concentrations were predicted, because size sorting led to larger graupel particles that melted into larger raindrops and caused less evaporative cooling. Second, surface precipitation was found to be less sensitive to the nature of the rimed ice species (hail or graupel). Production of hail in experiments including both graupel and hail strongly depends on an unphysical threshold that converts small hail back to graupel, indicating the need for a more physical treatment of the graupel-to-hail conversion. Third, it was shown that the differences in precipitation extremes between the two-moment microphysics schemes are mainly related to the treatment of drop breakup. It was also shown that, although the H. Morrison et al. scheme is dominated by deposition growth and low precipitation efficiency, the J. A. Milbrandt and M. K. Yau scheme is dominated by riming processes and high precipitation efficiency.
The natural ventilation performance of buildings under alternative future weather projections
Authors: Barclay Michael , Sharples Steve , Kang Jian , Watkins Richard 
Published: November 2011

Different climate change projections, such as UK Climate Impacts Program (UKCIP02) and 2009 UK Climate projections (UKCP09), have generated a large quantity of data that represent a range of possible future weather scenarios. This article investigates the potential consequences of alternative scenarios for the natural ventilation of non-domestic buildings. The article considers future natural ventilation rates in example buildings, the risk of summer overheating and whether natural ventilation will be a viable thermal control option for future summers. The wind is obviously a key driver of natural ventilation, and a necessary component of building simulation weather files. Problems associated with the generation of wind data from UKCP09 for the natural ventilation analyses are discussed and the influence of differences in weather files on predicted performance considered. These differences are important to the understanding of the consequences for the wider use of UKCP09 derived weather data for building energy evaluation. Practical applications: Weather data are widely used in practice to evaluate the potential and performance of natural ventilation in non-domestic buildings. The predicted differences in future weather data will have direct implications for the design of naturally ventilated buildings, and engineers will need to be aware of the possible implications these climatic differences will create.
Factors Correlating with Burnout in Practicing Otolaryngologists
Authors: Fletcher Aaron M. , Pagedar Nitin , Smith Richard J. H. 
Published: November 2011

ObjectiveThis study sought to determine which demographic and practice characteristics were predictive of professional burnout in otolaryngologists.Study DesignCross‐sectional survey.SettingTertiary care hospital.Subjects and MethodsPostal mailings, including the Maslach Burnout Inventory (MBI), were sent to alumni of the University of Iowa Hospitals and Clinics otolaryngology program. Participants completed the MBI according to the enclosed instructions. In addition, they answered a brief questionnaire comprising 8 items designed to collect demographic information. The MBI was then scored and subjects were classified according to their degree of burnout. Statistical analysis was then performed, and correlations were used to summarize associations between continuous variables.ResultsThis study had a response rate of 49% to the survey. Of the respondents, 3.5% met criteria for burnout syndrome, and 16% were classified as having high levels of burnout according to the MBI. Young age, number of hours worked per week, and length of time in practice were found to be statistically significant predictors of burnout. In addition, the length of time married and the presence of children in the home were also significant predictors of burnout.ConclusionThe authors report an investigation of burnout in practicing otolaryngologists using a validated instrument with correlation to potentially modifiable risk factors. The experience of burnout was found to correlate significantly with both personal and professional factors, each of which can potentially be addressed to curb the incidence of burnout. Further understanding of the potential risk factors for burnout is necessary to minimize and prevent burnout among practicing otolaryngologists.
Qualitative evaluation of a problem-solving intervention for informal hospice caregivers
Authors: Washington Karla T , Demiris George , Parker Oliver Debra , Wittenberg-Lyles Elaine , Crumb Edith 
Published: November 2011

Background: Informal hospice caregivers may experience compromised well-being as a result of significant stress. Although quite limited, problem-solving interventions with this population have garnered empirical support for improved caregiver well-being. Aim: Researchers sought to answer the following question: which specific intervention processes impacted informal hospice caregivers who participated in a problem-solving intervention? Design: Researchers conducted a thematic analysis of open-ended exit interviews with informal hospice caregivers who had participated in a structured problem-solving intervention. Setting/participants: Participants were friends and family members who provided unpaid care for a home hospice patient receiving services from one of two hospice agencies located in the Pacific Northwest region of the United States. Results: During their participation in the problem-solving intervention, caregivers actively reflected on caregiving, structured problem-solving efforts, partnered with interventionists, resolved problems, and gained confidence and control. Conclusions: The study findings provide much needed depth to the field’s understanding of problem-solving interventions for informal hospice caregivers and can be used to enhance existing support services.
Long-term stability study of clofarabine injection concentrate and diluted clofarabine infusion solutions
Authors: Kaiser Jeanette , Krämer Irene 
Published: November 2011

Purpose: The aim of this study was to investigate the physicochemical stability of clofarabine (CAFdA) injection concentrate and ready-to-use CAFdA infusion solutions over a prolonged period of 28 days. Methods: To determine the stability of CAFdA infusion solutions, the injection concentrate (Evoltra®, 1 mg/mL, Genzyme) was diluted either with 0.9% sodium chloride or 5% glucose infusion solution. The resulting concentrations of 0.2 mg/mL or 0.6 mg/mL, respectively, were chosen to represent the lower and upper limit of the ordinary concentration range. Test solutions were stored under refrigeration (2–8°C) or at room temperature either light protected or exposed to light. CAFdA concentrations and pH values were determined at different time intervals throughout a 28-day storage period. Compatibility of diluted CAFdA infusion solutions (0.1–0.4 mg/mL) with different container materials (polyvinyl chloride (PVC), glass, and polypropylene/polyethylene (PP/PE)) was tested over a 48-h storage period. CAFdA concentrations were measured by a stability-indicating reversed phase high-performance liquid chromatography (HPLC) assay with ultraviolet detection. Results: CAFdA injection concentrate and CAFdA infusion solutions remained physicochemically stable (>90% CAFdA) for 4 weeks. Results are independent of storage conditions, drug concentrations (0.2, 0.6, and 1.0 mg/mL) and diluents (0.9% sodium chloride, 5% glucose infusion solution). Adsorption of CAFdA to container material can be excluded. Conclusions: CAFdA injection concentrate and diluted infusion solutions in commonly used vehicles are stable for at least 28 days either refrigerated or at room temperature. Physicochemical stability favors pharmacy-based centralized preparation. Due to microbiological reasons, strict aseptic handling and storage of the products under refrigeration is recommended.
Loading profile of topotecan into polyvinyl alcohol microspheres (DC Bead™) over a 7-day period
Authors: Kaiser Jeanette , Krämer Irene 
Published: November 2011

Purpose: DC Bead™ is successfully used for chemoembolization of various liver cancers. The purpose of this study was todetermine the loading capacity of the semi-synthetic topoisomerase-1 inhibitor topotecan into the DC Bead™ microspheres under static or agitated conditions and to assess the physicochemical stability over a period of 7 days. Methods: Commercially available topotecan hydrochloride powder (Hycamtin®) was reconstituted with water for injection to yield a nominal concentration of 1 mg/mL topotecan. Polyvinyl alcohol (PVA)-based microspheres (DC Bead™, 300–500 µm, 2 mL/vial) were mixed with 4 mL of the reconstituted topotecan solution. Vials were stored light protected at room temperature under static or agitated conditions for 7 days ( n = 3, for each loading condition). At different time intervals, samples were taken from the excess solution and assayed via a stability-indicating HPLC assay. Drug-loading profiles were determined by measuring the remaining topotecan concentration in the excess solution. Results: Under agitated conditions, topotecan was loaded into the microspheres rapidly after mixing. After 5 min 86.4 ± 0.1% of topotecan was loaded. Under static conditions, drug uptake was slower. Only 65.0 ± 0% were loaded after 5 min; 86.6 ± 0.1% drug uptake was achieved not until 1 h. Over a storage period of 7 days, topotecan remained loaded in the DC Bead™ microspheres at a level of >90%. Conclusion: Drug uptake of 4 mg topotecan (1 mg/mL solution) into DC Beads™ was faster under agitated loading conditions. Nevertheless, after 1 h, ∼90% of topotecan was loaded into the DC Bead™ microspheres independent from the type of loading condition. The loading rate remained >90% over the observation period of 7 days and light-protected storage at room temperature. Loading and stability of topotecan-loaded DC Beads™ is suitable and convenient for preparation in a pharmacy-based cytotoxic preparation unit.
Reduced time for urinary alkalinization before high-dose methotrexate with preadmission oral bicarbonate
Authors: Kintzel Polly E , Campbell Alan D , Yost Kathleen J , Brinker Brett T , Arradaza Nicole V , Frobish Daniel , Wehr Alison M , O’Rourke Timothy J 
Published: November 2011

Purpose: Hydration and urinary alkalinization are essential for reducing renal dysfunction with high dose methotrexate (HDMTX). This report presents an analysis of institutional methods used to achieve adequate urinary alkalinization and output for patients receiving single agent HDMTX. Renal and metabolic parameters of tolerance were examined. Methods: Medical records of adult patients receiving HDMTX during the calendar years of 2008–2009 were retrospectively reviewed to determine the time to achieve urine pH > 7. Number of hospital days, bicarbonate dose, ordered hydration rate, urine output, and urine pH were assessed. A survival analysis model was run for time to urine pH > 7 using preadmission oral bicarbonate as a predictor variable and including a frailty term. Observational statistics were performed for other parameters. Results: The analysis included 79 encounters for ten patients. Urine pH > 7 was achieved more rapidly in patients receiving preadmission oral bicarbonate (P = 0.012). The number of patients receiving HDMTX on the same day as admission was greater for those receiving preadmission oral bicarbonate (47%) in comparison to those who did not (2%), and they spent less time in the hospital. A standard regimen for hydration and urinary alkalinization based on this project is reported. The nature and frequency of adverse events were as expected for this treatment. Conclusion: At our institution, the time to achieve urinary alkalinization was reduced for patients receiving preadmission oral bicarbonate which facilitated chemotherapy infusion on the same day as admission and decreased the number of calendar days that patients stayed in the hospital.
Temporal patterns of occupational asbestos exposure and risk of pleural mesothelioma
Authors: Lacourt Aude , Leffondré Karen , Gramond Céline , Ducamp Stéphane , Rolland Patrick , Gilg Soit Ilg Anabelle , Houot Marie , Imbernon Ellen , Févotte Joëlle , Goldberg Marcel , Brochard Patrick 
Published: November 2011

Asbestos is the primary cause of pleural mesothelioma (PM). The objective of this study was to elucidate the importance of different temporal patterns of occupational asbestos exposure on the risk of PM using case–control data in male subjects.Cases were selected from a French case–control study conducted in 1987–1993 and the French National Mesothelioma Surveillance Program in 1998–2006. Population controls were frequency matched to cases by year of birth. Occupational asbestos exposure was evaluated with a job–exposure matrix. The dose–response relationships were estimated using restricted cubic spline functions in logistic regression models.A total of 2,466 ever-asbestos-exposed males (1,041 cases and 1,425 controls) were used. After adjustment for intensity and total duration of occupational asbestos exposure, the risk of PM was lower for subjects first exposed after the age of 20 yrs and continued to increase until 30 yrs after cessation of exposure. The effect of total duration of exposure decreased when age at first exposure and time since last exposure increased.These results, based on a large population-based case–control study, underline the need to take into account the temporal pattern of exposure on risk assessment.
Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy
Authors: Marklund Marie , Verbraecken Johan , Randerath Winfried 
Published: November 2011

Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report.Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA.In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.
Telemedicine enhances quality of forced spirometry in primary care
Authors: Burgos Felip , Disdier Carlos , de Santamaria Elena Lopez , Galdiz Batxi , Roger Núria , Rivera Maria Luisa , Hervàs Ramona , Durán-Tauleria Enric , Garcia-Aymerich Judith , Roca Josep 
Published: November 2011

Forced spirometry is pivotal for diagnosis and management of respiratory diseases, but its use in primary care is suboptimal. The aim of the present study was to assess a web-based application aiming at fostering high-quality spirometry in primary care.This was a randomised controlled trial with 12 intervention primary care units (PCi) and six control units (PCc) studied over 12 months. All 34 naïve nurses (PCi and PCc) received identical training. The PCi units had access to educational material and remote expert support. Quality of spirometry and usability of the web application were assessed.We included 4,581 patients (3,383 PCi and 1,198 PCc). At baseline, quality was similar (PCi 71% and PCc 67% high-quality tests). During the study, PCi showed higher percentage (71.5%) of high-quality tests than PCc (59.5%) (p<0.0001). PCi had 73% more chance of high-quality performance than PCc. The web application was better for assessing quality of testing than the automatic feedback provided by the spirometer. Healthcare professionals’ satisfaction and usability were high.The web-based remote support for primary care by specialists generated a sustained positive impact on quality of testing. The study expands the potential of primary care for diagnosis and management of patients with pulmonary diseases.