bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a Clinical Score (A
2
DS
2
) to Predict Pneumonia in Acute Ischemic Stroke
Authors: Hoffmann Sarah , Malzahn Uwe , Harms Hendrik , Koennecke Hans-Christian , Berger Klaus , Kalic Marianne , Walter Georg , Meisel Andreas , Heuschmann Peter Ulrich 
Published: July 2012

Background and Purpose—
Poststroke pneumonia is a potentially preventable complication after stroke associated with poor outcome. We developed and externally validated a prognostic score for predicting risk of pneumonia after ischemic stroke.

Methods—
The prognostic score was developed based on clinical data routinely collected after admission from the Berlin Stroke Register, Germany. The association of demographics, comorbidities, and clinical characteristics with poststroke pneumonia was investigated using multivariable logistic regression analyses. Independent predictors of poststroke pneumonia were translated into a point scoring system based on the corresponding regression coefficients. The predictive properties of the developed prognostic score were externally validated using an independent data set from the Stroke Register Northwest-Germany.

Results—

Between 2007 and 2009, 15 335 patients with ischemic stroke were registered within the Berlin Stroke Register. The observed rate of pneumonia in hospital was 7.2%. A 10-point score was derived for prediction of poststroke pneumonia (Age ≥75 years=1, Atrial fibrillation=1, Dysphagia=2, male Sex=1, stroke Severity, National Institutes of Health Stroke Scale 0–4=0, 5–15=3, ≥16=5; A
2
DS
2
). The proportion of pneumonia varied between 0.3% in patients with a score of 0 point to 39.4% in patients with a score of 10 points. The score demonstrated excellent discrimination (C-statistic 0.84; 95% CI, 0.83–0.85) and calibration (McFadden
R
2
=0.21). Prediction, discrimination, and calibration properties were reproduced in the validation cohort consisting of 45 085 patients with ischemic stroke.

Conclusions—

The A
2
DS
2
score is a valid tool for predicting poststroke pneumonia based on routinely available data. A
2
DS
2
might be useful for guiding monitoring of high-risk patients or prophylactic pneumonia management in clinical routine.
Higher Plasma Fractalkine Is Associated With Better 6-Month Outcome From Ischemic Stroke
Authors: Donohue Megan M. , Cain Kevin , Zierath Dannielle , Shibata Dean , Tanzi Patricia M. , Becker Kyra J. 
Published: July 2012

Background and Purpose—
Fractalkine (CX3CL1) is a unique chemokine that is constitutively expressed on neurons where it serves as an adhesion molecule for lymphocytes and monocytes. CX3CL1 may also be cleaved from the surface of these cells and enter the circulation to act as a traditional chemokine. CX3CL1 could thus influence the inflammatory response after stroke. We hypothesized that patients with higher plasma CX3CL1 after stroke would have a more robust inflammatory response and experience worse outcome.

Methods—
Plasma CX3CL1 concentrations were assessed in 85 patients who were part of a larger study evaluating immune responses after ischemic stroke; CX3CL1 values were available from Day 1 to Day 180 after stroke onset. CX3CL1 was correlated to measures of inflammation and its effect on outcome assessed.

Results—
At 1 day after stroke, CX3CL1 was lower in patients with severe strokes. At 180 days after stroke, CX3CL1 concentrations were lower in patients with poor outcome. The association of CX3CL1 and outcome at 180 days was independent of initial stroke severity. Plasma CX3CL1 at 180 days was inversely associated with systemic markers of inflammation, including white blood cell counts and high-sensitivity C-reactive protein.

Conclusions—
In contrast to our original hypothesis, lower concentrations of CX3CL1 are associated with worse stroke outcome. In light of recent studies suggesting an immunomodulatory and neuroprotective role for CX3CL1 in a variety of neurodegenerative diseases, a therapeutic role for CX3CL1 in stroke recovery should be considered.
Spectrum of Transient Focal Neurological Episodes in Cerebral Amyloid Angiopathy
Authors: Charidimou Andreas , Peeters Andre , Fox Zoe , Gregoire Simone M. , Vandermeeren Yves , Laloux Patrice , Jäger Hans R. , Baron Jean-Claude , Werring David J. 
Published: July 2012

Background and Purpose—
Transient focal neurological episodes (TFNE) are recognized in cerebral amyloid angiopathy (CAA) and may herald a high risk of intracerebral hemorrhage (ICH). We aimed to determine their prevalence, clinical neuroimaging spectrum, and future ICH risk.

Methods—
This was a multicenter retrospective cohort study of 172 CAA patients. Clinical, imaging, and follow-up data were collected. We classified TFNE into: predominantly positive symptoms (“aura-like” spreading paraesthesias/positive visual phenomena or limb jerking) and predominantly negative symptoms (“transient ischemic attack–like” sudden-onset limb weakness, dysphasia, or visual loss). We pooled our results with all published cases identified in a systematic review.

Results—

In our multicenter cohort, 25 patients (14.5%; 95% confidence interval, 9.6%–20.7%) had TFNE. Positive and negative symptoms were equally common (52% vs 48%, respectively). The commonest neuroimaging features were leukoaraiosis (84%), lobar ICH (76%), multiple lobar cerebral microbleeds (58%), and superficial cortical siderosis/convexity subarachnoid hemorrhage (54%). The CAA patients with TFNE more often had superficial cortical siderosis/convexity subarachnoid hemorrhage (but not other magnetic resonance imaging features) compared with those without TFNE (50% vs 19%;
P
=0.001). Over a median period of 14 months, 50% of TFNE patients had symptomatic lobar ICH. The meta-analysis showed a risk of symptomatic ICH after TFNE of 24.5% (95% confidence interval, 15.8%–36.9%) at 8 weeks, related neither to clinical features nor to previous symptomatic ICH.

Conclusions—
TFNE are common in CAA, include both positive and negative neurological symptoms, and may be caused by superficial cortical siderosis/convexity subarachnoid hemorrhage. TFNE predict a high early risk of symptomatic ICH (which may be amenable to prevention). Blood-sensitive magnetic resonance imaging sequences are important in the investigation of such episodes.
Impact of Acute Ischemic Stroke Treatment in Patients >80 Years of Age
Authors: Willey Joshua Z. , Ortega-Gutierrez Santiago , Petersen Nils , Khatri Pooja , Ford Andria L. , Rost Natalia S. , Ali Latisha K. , Gonzales Nichole R. , Merino Jose G. , Meyer Brett C. , Marshall Randolph S. 
Published: July 2012

Background and Purpose—
Few studies have addressed outcomes among patients ≥80 years treated with acute stroke therapy. In this study, we outline in-hospital outcomes in (1) patients ≥80 years compared with their younger counterparts; and (2) those over >80 years receiving intra-arterial therapy (IAT) compared with those treated with intravenous recombinant tissue-type plasminogen activator (IV rtPA).

Methods—
Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collected data on all patients treated with IV rtPA or IAT from January 1, 2005, to December 31, 2010. IAT was defined as receiving any endovascular therapy; IAT was further divided into bridging therapy when the patient received both IAT and IV rtPA and endovascular therapy alone. In-hospital mortality was compared in (1) all patients aged ≥80 years versus younger counterparts; and (2) IAT, bridging therapy, and endovascular therapy alone versus IV rtPA only among those age ≥80 years using multivariable logistic regression. An age-stratified analysis was also performed.

Results—
A total of 3768 patients were included in the study; 3378 were treated with IV rtPA alone and 808 with IAT (383 with endovascular therapy alone and 425 with bridging therapy). Patients ≥80 years (n=1182) had a higher risk of in-hospital mortality compared with younger counterparts regardless of treatment modality (OR, 2.13; 95% CI, 1.60–2.84). When limited to those aged ≥80 years, IAT (OR, 0.95; 95% CI, 0.60–1.49), bridging therapy (OR, 0.82; 95% CI, 0.47–1.45), or endovascular therapy alone (OR, 1.15; 95% CI, 0.64–2.08) versus IV rtPA were not associated with increased in-hospital mortality.

Conclusions—
IAT does not appear to increase the risk of in-hospital mortality among those aged >80 years compared with IV thrombolysis alone.
Cortical Changes After Mental Imagery Training Combined With Electromyography-Triggered Electrical Stimulation in Patients With Chronic Stroke
Authors: Hong Il Ki , Choi Jong Bae , Lee Jong Ha 
Published: July 2012

Background and Purpose—
Paresis of the upper extremity after stroke is not effectively solved by existing therapies. We investigated whether mental imagery training combined with electromyogram-triggered electric stimulation improved motor function of the paretic upper extremity in patients with chronic stroke and induced cortical changes.

Methods—

Fourteen subjects with chronic stroke (≥12 months) were randomly allocated to receive mental imagery training combined with electromyogram-triggered electric stimulation (n=7) or generalized functional electric stimulation (n=7) on the forearm extensor muscles of the paretic extremity in 2 20-minute daily sessions 5 days a week for 4 weeks. The upper extremity component of the Fugl-Meyer Motor Assessment, the Motor Activity Log, the modified Barthel Index, and
18
F-fluorodeoxyglucose brain positron emission tomography were measured before and after the intervention.

Results—

The group receiving mental imagery training combined with electromyogram-triggered electric stimulation exhibited significant improvements in the upper extremity component of the Fugl-Meyer Motor Assessment after intervention (median, 7; interquartile range, 5–8;
P
<0.05), but the group receiving functional electric stimulation did not (median, 0; interquartile range, 0–3). Differences in score changes between the 2 groups were significant. The mental imagery training combined with electromyogram-triggered electric stimulation group showed significantly increased metabolism in the contralesional supplementary motor, precentral, and postcentral gyri (
P
uncorrected
<0.001) after the intervention, but the functional electric stimulation group showed no significant differences.

Conclusions—
Mental imagery training combined with electromyogram-triggered electric stimulation improved motor function of the paretic extremity in patients with chronic stroke. The intervention increased metabolism in the contralesional motor–sensory cortex.

Clinical Trial Registration—

URL:
https://e-irb.khmccri.or.kr/eirb/receipt/index.html?code=02&status=5
. Unique identifier: KHUHMDIRB 1008-02.
Hangar Talk Survey
Authors: Kearns Suzanne K. , Sutton Jennifer E. 
Published: July 2012

Objective: The current study developed an online hangar talk survey (HTS) to solicit narratives describing challenging scenarios that professional pilots encountered during the hours-building phase of their career. Background: The predicted pilot shortage will effectively reduce the minimum flying hours required for pilots to be hired at an airline, resulting in less opportunity to develop nontechnical skills naturalistically. To compensate, threat and error data from the hours-building phase of a pilot’s career are required to inform training development. Pilots often share stories of such experiences, colloquially termed “hangar talk.” Method: The HTS gathered 132 narrative descriptions of general aviation (GA) events from pilots along with the event’s impact and whether the pilots would react differently if the scenario were encountered again. Results: The distribution of threats reported by GA pilots was similar to that reported at the airline level. Logistic regression analysis revealed that decision-making errors were associated with recognition of the need to react differently in the future, and decision-making errors and proficiency errors were associated with greater perceived impact on skill development. Conclusion: The current HTS solicited an array of data similar to the findings of airline-based threat and error observations. Pilots perceive decision-making and proficiency errors as impactful on skill development. Application: An HTS can be used to gather naturalistic threat and error data and to create a database of operational stories that can be used to develop nontechnical training based on narrative thought.
The Complex Spine
Authors: Marras William S. 
Published: July 2012

Objective: The aim of this study was to examine the logic behind the knowledge of low-back problem causal pathways. Background: Low-back pain and low-back disorders (LBDs) continue to represent the major musculoskeletal risk problem in the workplace, with the prevalence and costs of such disorders increasing over time. In recent years, there has been much criticism of the ability of ergonomics methods to control the risk of LBDs. Method: Logical assessment of the systems logic associated with our understanding and prevention of LBDs. Results: Current spine loading as well as spine tolerance research efforts are bringing the field to the point where there is a better systems understanding of the inextricable link between the musculoskeletal system and the cognitive system. Loading is influenced by both the physical environment factors as well as mental demands, whereas tolerances are defined by both physical tissue tolerance and biochemically based tissue sensitivities to pain. However, the logic used in many low-back risk assessment tools may be overly simplistic, given what is understood about causal pathways. Current tools typically assess only load or position in a very cursory manner. Conclusion: Efforts must work toward satisfying both the physical environment and the cognitive environment for the worker if one is to reliably lower the risk of low-back problems. Application: This systems representation of LBD development may serve as a guide to identify gaps in our understanding of LBDs.
Variation in Fat, Lactose, and Protein Composition in Breast Milk over 24 Hours
Authors: Khan Sadaf , Hepworth Anna R. , Prime Danielle K. , Lai Ching T. , Trengove Naomi J. , Hartmann Peter E. 
Published: July 2012

Background: Data regarding the association between breast milk composition and infant feeding patterns (frequency and amount of breast milk taken) would help in understanding the regulation of food intake in breastfed infants. Objective: This study examined the relationship between breast milk macronutrient concentration and patterns of milk intake in breastfeeding infants over a 24-hour breastfeeding period. Methods: Mothers of healthy term infants (n = 15) collected pre- and postfeed breast milk samples from each feed at each breast over a 24-hour period. Breast milk samples were analyzed for fat, lactose, total protein, casein, and whey protein content. The energy content for each feed was calculated. Results: Breastfeeding patterns and milk composition varied greatly between individuals. The fat content of milk significantly differed over 24 hours ( P = .01), whereas the concentration of lactose and protein content remained the same. The mean 24-hour total protein, whey, and casein intake was inversely ( P < .01), whereas lactose concentration was positively ( P = .03) related to the number of breast feeds per day. No relationship was seen either between fat or energy content and feeding patterns. The mean (SD) concentration of fat, lactose, and total protein over the 24-hour period was 43 (12) g/L, 68 (7) g/L, and 13 (2) g/L, respectively. Conclusion: The association between milk protein intake and the breastfeeding frequency suggests that the protein intake may play a role in infant appetite control.
The influence of precipitation and friction control agents on forces at the wheel/rail interface in heavy haul railways
Authors: Oldknow Kevin , Eadie Donald T , Stock Richard 
Published: July 2012

This paper presents an analysis of the influence of materials that can be present in the so-called “third-body layer” at the wheel/rail interface on curving forces generated in heavy haul operating conditions. The third-body layer is the interfacial layer whose shear properties determine the bulk frictional characteristics that emerge in wheel/rail contact. It is often postulated that precipitation (rain) provides an effective form of lubrication at the wheel tread/rail head interface, reducing curving forces and corresponding wear. The postulate is explored through the analysis of lateral and vertical force data collected under a wide range of environmental conditions in full-scale revenue service. The effects of precipitation are rigorously explored and compared with the effects of top of rail friction modifiers, which are intentionally introduced into the third-body layer. This paper originated from the 2011 IHHA Conference.
Physician Knowledge, Attitude, and Experience With Advance Care Planning, Palliative Care, and Hospice
Authors: Snyder Sara , Hazelett Susan , Allen Kyle , Radwany Steven 
Published: July 2012

Purpose: To evaluate primary care physicians’ understanding of and experience with advance care planning (ACP), palliative care, and hospice and how this might affect their utilization of these services. Methods: Investigator-generated survey. Results: Older age, more years in practice, and more personal and professional experience with ACP were correlated with an increase in the percentage of patients with progressive, chronic life-limiting diseases with whom physicians discussed advance directives. Overall, 97.5% of physician’s expressed comfort in discussing ACP yet reported discussing advance directives with only 43% of appropriate patients. Discussion: Often, discussions about ACP or referrals to palliative care or hospice do not occur until the patient is near the end of life. Our results indicate that primary care physician’s personal and professional experience with ACP may be contributing to some of the barriers to these discussions.
Assessing households’ willingness to pay for an immediate pandemic influenza vaccination programme
Authors: Asgary Ali 
Published: July 2012

Aims: This study sought to contribute to the existing literature on pandemic influenza vaccination studies by providing additional evidences of households’ willingness to pay (WTP) for protection against influenza during a pandemic situation from North America. Methods: A standard dichotomous-choice contingent valuation survey was designed and completed in a sample of 306 individuals living in the Greater Toronto Area, Ontario, Canada. Results: This study shows that, on average, households are willing to pay $417.35 for immediate pandemic influenza (H1N1) vaccination. Results show that the vaccine price, age, gender, occupation, organisation, annual family income, receiving annual flu shot, having additional insurance, having someone with a serious illness in the house, knowledge about pandemics, trusting official information on pandemics, supporting government expenditure, and rating government pandemic planning have significant effects on the decision to accept the vaccine bids. Conclusions: The results reconfirm the findings of similar studies that influenza vaccine programmes are highly cost-effective despite the high programme cost, because people’s WTP (benefits) for this programme is much higher than the actual costs. Pandemic influenza vaccination programmes should consider the demographic and economic status of the target population as such characteristics have significant impacts on the benefits that people place on such programmes.
When inferiority meets non-inferiority: Implications for interim analyses
Authors: Bratton Daniel J , Williams Hywel C , Kahan Brennan C , Phillips Patrick PJ , Nunn Andrew J 
Published: July 2012

Background The objective of a non-inferiority trial is to determine whether a new or existing treatment is not less effective than another existing or current treatment by more than a pre-specified margin, Δ, usually with the requirement that the new treatment has some other advantage such as reduced cost or lower toxicity. A possible but unusual result in a non-inferiority trial is for the confidence interval for the treatment effect to lie between zero and Δ, implying that the new treatment is both inferior and non-inferior to the control. Such a result could occur in non-inferiority trials with large sample sizes or large non-inferiority margins. The possibility of this scenario occurring has implications for interim analyses. In standard superiority trials, stopping guidelines are often based on the p value obtained from testing whether treatments are equally effective. In non-inferiority trials, however, even if a new treatment is found to be inferior to the control at an interim analysis, there may still be a reasonable chance of demonstrating non-inferiority in the final analysis. Purpose To explore the issues arising from trials where a simultaneously inferior and non-inferior result could occur and to describe appropriate methods for deciding whether such trials should be stopped for futility at an interim analysis. Methods Conditional power is used to assess futility or the inability of the trial to show non-inferiority at the final analysis, by calculating the probability of demonstrating non-inferiority in the final analysis conditional on the observed results and upon assumptions on the future results of the trial. The Bullous Pemphigoid Steroids and Tetracyclines Study (BLISTER) trial is an example of a trial where a simultaneous inferior and non-inferior result could occur. A method for calculating conditional power for non-inferiority using simulations is described and applied at a hypothetical interim analysis of this trial. Results Stopping guidelines for futility based on conditional power are shown to be better suited to non-inferiority trials than the typical methods used in superiority trials. Simulations are a straightforward and flexible way of calculating conditional power. Limitations Calculating conditional power relies on assumptions about future treatment efficacy, and therefore, a number of different conditional power values can be obtained. Careful consideration should be given to which assumptions are most likely to be true. Additionally, when choosing a stopping guideline for futility, consideration needs to be given to avoid overinflating the type II error rate. Conclusions Conditional power is an appropriate tool for defining stopping guidelines for futility in non-inferiority trials, particularly those with large non-inferiority margins.
VEGFR-3 is expressed on megakaryocyte precursors in the murine bone marrow and plays a regulatory role in megakaryopoiesis
Authors: Thiele Wilko , Krishnan Jaya , Rothley Melanie , Weih Debra , Plaumann Diana , Kuch Vanessa , Quagliata Luca , Weich Herbert A. , Sleeman Jonathan P. 
Published: July 2012

Abstract
VEGFR-3 is a transmembrane receptor tyrosine kinase that is activated by its ligands VEGF-C and VEGF-D. Although VEGFR-3 has been linked primarily to the regulation of lymphangiogenesis, in the present study, we demonstrate a role for VEGFR-3 in megakaryopoiesis. Using a human erythroleukemia cell line and primary murine BM cells, we show that VEGFR-3 is expressed on megakaryocytic progenitor cells through to the promegakaryoblast stage. Functionally, specific activation of VEGFR-3 impaired the transition to polyploidy of CD41+ cells in primary BM cultures. Blockade of VEGFR-3 promoted endoreplication consistently. In vivo, long-term activation or blockade of VEGFR-3 did not affect steady-state murine megakaryopoiesis or platelet counts significantly. However, activation of VEGFR-3 in sublethally irradiated mice resulted in significantly elevated numbers of CD41+ cells in the BM and a significant increase in diploid CD41+ cells, whereas the number of polyploid CD41+ cells was reduced significantly. Moreover, activation of VEGFR-3 increased platelet counts in thrombopoietin-treated mice significantly and modulated 5-fluorouracil–induced thrombocytosis strongly, suggesting a regulatory role for VEGFR-3 in megakaryopoiesis.