Arthur Stillman | Emory University (original) (raw)

Papers by Arthur Stillman

Circulation: Cardiovascular Imaging, 2008

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Background-It is unclear whether an evaluation incorporating coronary computed tomographic angiog... more Background-It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes. Methods-In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes. Results-The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P<0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, P<0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65). Conclusions-In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National Heart, Lung, and Blood Institute; ROMICAT-II ClinicalTrials.gov number, NCT01084239.) Treatment of Patients with Acute chest pain but an inconclusive initial evaluation with the use of biomarkers and electrocardiographic (ECG) testing is often diagnostically challenging

F1000Research, Jul 13, 2017

In order to make these reviews as Faculty comprehensive and accessible as possible, peer review t... more In order to make these reviews as Faculty comprehensive and accessible as possible, peer review takes place before publication; the referees are listed below, but their reports are not formally published.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Background-To determine whether high-risk plaque as detected by coronary computed tomography angi... more Background-To determine whether high-risk plaque as detected by coronary computed tomography angiography (CTA) permits improved early diagnosis of acute coronary syndrome (ACS) independent to the presence of significant CAD in acute chest pain patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Purpose: To comprehensively investigate the diagnostic performance of coronary artery angiography... more Purpose: To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT. Materials and Methods: PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem. Results: 91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results .95% and a positive post-test probability ,95% could be obtained for patients with a pre-test probability of ,73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was .73%, the diagnostic role was reversed, with a positive post-test probability of CAD .95% and a negative post-test probability of CAD ,95%. Conclusion: The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD,73%, while for patients with a pre-test probability of CAD. 73%, CTA is a test used to confirm the presence of CAD.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

F1000 - Post-publication peer review of the biomedical literature, 2017

F1000 - Post-publication peer review of the biomedical literature, 2017

F1000 - Post-publication peer review of the biomedical literature, 2017

F1000 - Post-publication peer review of the biomedical literature, 2017

Neurosurgery, 1993

Hachinski observes, "Soft neck collars have become the formal dress of too many claimants to allo... more Hachinski observes, "Soft neck collars have become the formal dress of too many claimants to allow a dispassionate examination of the whiplash patient." These sorts of comments not only bring a wry smile to the reader, but also epitomize the context of the illnesses. On the other hand, the relative weakness of the book is that its role in a practicing physician's library is unclear. Its lack of comprehensiveness means that one would not automatically reach for it in the face of clinical problems. Instead, one would have to recall that those two chapters on dizziness or that one chapter on treating refractory Parkinson's disease were found in this particular book. Alternatively, one could rip out individual chapters or Xerox individual chapters and file them under their respective topics, but that is less than desirable. Thus, the strengths of this text in the short term as a compendium of several excellent reviews is also its weakness in the long term as a functioning part of one's reference library. Probably, most clinicians will find one or more chapters to be of particular use to them, whereas other chapters may be somewhat peripheral. The fact that the book's focus may seem too diffuse for some readers may discourage them from purchasing it, which would be unfortunate, because there are many excellent individual chapters that might otherwise be considered the definitive, concise review of the topic.

Journal of Chemical Physics, Jun 15, 1976

The difficulties in using diagonalizing algorithms in the calculation of molecular spectra are di... more The difficulties in using diagonalizing algorithms in the calculation of molecular spectra are discussed. An alternative method is proposed in which the complex matrix equation is solved directly. The inherent inefficiency of this method is largely bypassed by first reducing the matrix into Hessenberg or triangular form by means of similarity transformations. This method is found to yield accurate line shapes even for matrices for which many diagonalizing algorithms fail.

The nematogen-like spin probe N-(p-methoxybenzylidene)-4-amino-2,2,6,6-tetramethylpiperidino-l-ox... more The nematogen-like spin probe N-(p-methoxybenzylidene)-4-amino-2,2,6,6-tetramethylpiperidino-l-oxyl (MBATPO) in the various solid modifications of the liquid crystal MBBA was investigated by EPR spectroscopy. In particular, by cooling the solution in a magnetic field of 6000 G, a nematic glass was prepared and the orientation dependent EPR spectra were studied as a function of the temperature. As the temperature is raised the nematic glass converts irreversibly to the polycrystalline state. The EPR spectra in both solid modifications reveal motional effects which are analyzed utilizing the methods of Freed and co-workers.

Journal of magnetic resonance, May 1, 1976

ABSTRACT

Molecular Physics, Feb 1, 1978

ABSTRACT

The Journal of Physical Chemistry, Oct 1, 1981

ABSTRACT

Journal of Chemical Physics, Oct 15, 1978

A generalized cumulant expansion theory for electron spin relaxation in liquids is presented whic... more A generalized cumulant expansion theory for electron spin relaxation in liquids is presented which describes the phase memory decay found in pulse experiments. It is found that for pulse times τ≫τc, the two-pulse electron spin echo envelope decays exponentially, and for motionally narrowed systems, the phase memory decay rate is given by the elements of the Redfield relaxation matrix. For radicals undergoing slow rotational reorientation, the phase memory time is shown to be sensitive to both the rotational correlation time and the assumed dynamical model for rotational diffusion even for correlation times so long that the cw EPR spectra appear to be rigid. If τ≳τc, the echo envelope is found to decay in a complex, oscillatory manner.

The Journal of Physical Chemistry, 1981

ABSTRACT

Circulation: Cardiovascular Imaging, 2008

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Background-It is unclear whether an evaluation incorporating coronary computed tomographic angiog... more Background-It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes. Methods-In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes. Results-The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P<0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, P<0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65). Conclusions-In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National Heart, Lung, and Blood Institute; ROMICAT-II ClinicalTrials.gov number, NCT01084239.) Treatment of Patients with Acute chest pain but an inconclusive initial evaluation with the use of biomarkers and electrocardiographic (ECG) testing is often diagnostically challenging

F1000Research, Jul 13, 2017

In order to make these reviews as Faculty comprehensive and accessible as possible, peer review t... more In order to make these reviews as Faculty comprehensive and accessible as possible, peer review takes place before publication; the referees are listed below, but their reports are not formally published.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Background-To determine whether high-risk plaque as detected by coronary computed tomography angi... more Background-To determine whether high-risk plaque as detected by coronary computed tomography angiography (CTA) permits improved early diagnosis of acute coronary syndrome (ACS) independent to the presence of significant CAD in acute chest pain patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

Purpose: To comprehensively investigate the diagnostic performance of coronary artery angiography... more Purpose: To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT. Materials and Methods: PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem. Results: 91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results .95% and a positive post-test probability ,95% could be obtained for patients with a pre-test probability of ,73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was .73%, the diagnostic role was reversed, with a positive post-test probability of CAD .95% and a negative post-test probability of CAD ,95%. Conclusion: The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD,73%, while for patients with a pre-test probability of CAD. 73%, CTA is a test used to confirm the presence of CAD.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 27, 2017

F1000 - Post-publication peer review of the biomedical literature, 2017

F1000 - Post-publication peer review of the biomedical literature, 2017

F1000 - Post-publication peer review of the biomedical literature, 2017

F1000 - Post-publication peer review of the biomedical literature, 2017

Neurosurgery, 1993

Hachinski observes, "Soft neck collars have become the formal dress of too many claimants to allo... more Hachinski observes, "Soft neck collars have become the formal dress of too many claimants to allow a dispassionate examination of the whiplash patient." These sorts of comments not only bring a wry smile to the reader, but also epitomize the context of the illnesses. On the other hand, the relative weakness of the book is that its role in a practicing physician's library is unclear. Its lack of comprehensiveness means that one would not automatically reach for it in the face of clinical problems. Instead, one would have to recall that those two chapters on dizziness or that one chapter on treating refractory Parkinson's disease were found in this particular book. Alternatively, one could rip out individual chapters or Xerox individual chapters and file them under their respective topics, but that is less than desirable. Thus, the strengths of this text in the short term as a compendium of several excellent reviews is also its weakness in the long term as a functioning part of one's reference library. Probably, most clinicians will find one or more chapters to be of particular use to them, whereas other chapters may be somewhat peripheral. The fact that the book's focus may seem too diffuse for some readers may discourage them from purchasing it, which would be unfortunate, because there are many excellent individual chapters that might otherwise be considered the definitive, concise review of the topic.

Journal of Chemical Physics, Jun 15, 1976

The difficulties in using diagonalizing algorithms in the calculation of molecular spectra are di... more The difficulties in using diagonalizing algorithms in the calculation of molecular spectra are discussed. An alternative method is proposed in which the complex matrix equation is solved directly. The inherent inefficiency of this method is largely bypassed by first reducing the matrix into Hessenberg or triangular form by means of similarity transformations. This method is found to yield accurate line shapes even for matrices for which many diagonalizing algorithms fail.

The nematogen-like spin probe N-(p-methoxybenzylidene)-4-amino-2,2,6,6-tetramethylpiperidino-l-ox... more The nematogen-like spin probe N-(p-methoxybenzylidene)-4-amino-2,2,6,6-tetramethylpiperidino-l-oxyl (MBATPO) in the various solid modifications of the liquid crystal MBBA was investigated by EPR spectroscopy. In particular, by cooling the solution in a magnetic field of 6000 G, a nematic glass was prepared and the orientation dependent EPR spectra were studied as a function of the temperature. As the temperature is raised the nematic glass converts irreversibly to the polycrystalline state. The EPR spectra in both solid modifications reveal motional effects which are analyzed utilizing the methods of Freed and co-workers.

Journal of magnetic resonance, May 1, 1976

ABSTRACT

Molecular Physics, Feb 1, 1978

ABSTRACT

The Journal of Physical Chemistry, Oct 1, 1981

ABSTRACT

Journal of Chemical Physics, Oct 15, 1978

A generalized cumulant expansion theory for electron spin relaxation in liquids is presented whic... more A generalized cumulant expansion theory for electron spin relaxation in liquids is presented which describes the phase memory decay found in pulse experiments. It is found that for pulse times τ≫τc, the two-pulse electron spin echo envelope decays exponentially, and for motionally narrowed systems, the phase memory decay rate is given by the elements of the Redfield relaxation matrix. For radicals undergoing slow rotational reorientation, the phase memory time is shown to be sensitive to both the rotational correlation time and the assumed dynamical model for rotational diffusion even for correlation times so long that the cw EPR spectra appear to be rigid. If τ≳τc, the echo envelope is found to decay in a complex, oscillatory manner.

The Journal of Physical Chemistry, 1981

ABSTRACT