bluuebunny/crossref_metadata_2025_split huggingface dataset:
ST‐Segment–Elevation Myocardial Infarction (STEMI) Patients Without Standard Modifiable Cardiovascular Risk Factors—How Common Are They, and What Are Their Outcomes?
Authors: Vernon Stephen T. , Coffey Sean , D'Souza Mario , Chow Clara K. , Kilian Jens , Hyun Karice , Shaw James A. , Adams Mark , Roberts‐Thomson Philip , Brieger David , Figtree Gemma A. 
Published: November 2019

Background
Programs targeting the standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, smoking) are critical to tackling coronary heart disease at a community level. However, myocardial infarction in SMuRF‐less individuals is not uncommon. This study uses 2 sequential large, multicenter registries to examine the proportion and outcomes of SMuRF‐less ST‐segment–elevation myocardial infarction (STEMI) patients.

Methods and Results

We identified 3081 STEMI patients without a prior history of cardiovascular disease in the Australian GRACE (Global Registry of Acute Coronary Events) and CONCORDANCE (Cooperative National Registry of Acute Coronary Syndrome Care) registries, encompassing 42 hospitals, between 1999 and 2017. We examined the proportion that were SMuRF‐less as well as outcomes. The primary outcome was in‐hospital mortality, and the secondary outcome was major adverse cardiovascular events (death, myocardial infarction, or heart failure, during the index admission). Multivariate regression models were used to identify predictors of major adverse cardiovascular events. Of STEMI patients without a prior history of cardiovascular disease 19% also had no history of SMuRFs. This proportion increased from 14% to 23% during the study period (
P
=0.0067). SMuRF‐less individuals had a higher in‐hospital mortality rate than individuals with 1 or more SMuRFs. There were no clinically significant differences in major adverse cardiovascular events at 6 months between the 2 groups.

Conclusions
A substantial and increasing proportion of STEMI presentations occur independently of SMuRFs. Discovery of new markers and mechanisms of disease beyond standard risk factors may facilitate novel preventative strategies. Studies to assess longer‐term outcomes of SMuRF‐less STEMI patients are warranted.
The Manaledi Clay Mine: a ca. 1500 Year-Long Record of Potting from a Single Clay Source in the Tswapong Hills, Eastern Botswana
Authors: Wilmsen Edwin N. , Griffiths Anne , Killick David , Thebe Phenyo 
Published: November 2019

Abstract
Current potters in Manaledi village in the Tswapong Hills of Botswana aver that they and their ancestors for five generations have made pottery exclusively with clay from nearby sources. We begin with an examination of Manaledi and its clay mine to uncover current dialectics between village, landscape, clay, potters, and ancestors. Archaeological sherds found around the village and clay sources document occupation by makers of Early Iron Age (ca. AD 500-750), Middle Iron Age (ca. AD 750-1050), Late Iron Age (ca. AD 1420-1800), and 18th-20th century wares related to current Manaledi pottery. The proximity of archaeological deposits, clay sources, and village made it possible to conduct simultaneously what might otherwise be considered three separate projects. As a consequence, we are able to document that Manaledi clays have been used to make pottery for some 1500 years and to consider long-standing constraints on potting this implies.
Endoscopic Transoral Hybrid Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy
Authors: Nakayama Meijin , Orosco Ryan K. , Holsinger F. Christopher , Spriano Giuseppe , Succo Giovanni , De Virgilio Armando , Oridate Nobuhiko 
Published: November 2019

Objectives: The hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP, that is, open partial horizontal laryngectomies OPHL Type IIa) has been described using a flexible next generation robotic surgical platform for manipulation. We sought to evaluate the feasibility of performing this procedure using endoscopic transoral (EndoT) surgical techniques without robotics. Methods: Preclinical cadaveric study using two human cadavers. Hybrid SCPL-CHEP was performed with a flexible endoscope for visualization and hand-held instruments for manipulation (SILS Hook monopolar and Dissect, HAVAS LaryngoFIT malleable straight jaw instruments, and Stratafix 4-0 spiral knotless barbed suture). Results: EndoT hybrid SCPL-CHEP was successfully performed. The hand-manipulated rigid instruments allowed for transoral incisions and mucosal suturing. We provide the procedural steps of EndoT hybrid techniques. Conclusions: EndoT hybrid SCPL-CHEP was technically feasible in the preclinical cadaveric laboratory setting and appeared comparable to the hybrid SCPL-CHEP via transoral robotic surgery (TORS). Selected handheld instruments and flexible endoscopy appear to facilitate minimally invasive surgery of the larynx. This novel procedure and technique warrant further clinical study for consideration of feasibility, applicability, and patient benefit.
Characterisation of the calcitonin gene-related peptide receptor antagonists ubrogepant and atogepant in human isolated coronary, cerebral and middle meningeal arteries
Authors: Rubio-Beltran Eloísa , Chan Ka Yi , Danser AH Jan , MaassenVanDenBrink Antoinette , Edvinsson Lars 
Published: November 2019

Background Migraine has been associated with a dysfunctional activation of the trigeminovascular system. Calcitonin gene-related peptide, a neuropeptide released from the trigeminal nerve fibres, has an important role in the pathophysiology of migraine and is a current therapeutic target for migraine treatment. Methods We examined the effects of two novel calcitonin gene-related peptide receptor antagonists, ubrogepant and atogepant, on the relaxations induced by α calcitonin gene-related peptide in human isolated middle meningeal, cerebral and coronary arteries. Furthermore, the contractile responses to atogepant and ubrogepant per se were studied and compared to the responses elicited by zolmitriptan in proximal and distal human coronary arteries. Results In intracranial arteries, both blockers antagonized the calcitonin gene-related peptide-induced relaxations more potently when compared to the inhibition observed in distal human coronary arteries, with atogepant showing a higher potency. When analysing their antagonistic profile in HCA, ubrogepant showed a competitive antagonist profile, while atogepant showed a non-competitive one. Neither of the gepants had vasoconstrictor effect at any of the concentrations studied in human coronary arteries, whereas zolmitriptan elicited concentration-dependent contractions. Conclusion ubrogepant and atogepant differentially inhibit the calcitonin gene-related peptide-dependent vasodilatory responses in intracranial arteries when compared to distal human coronary arteries. Also, both gepants are devoid of vasoconstrictive properties in human coronary arteries.
Changes in quality of life in relation to disease activity in systemic lupus erythematosus: post-hoc analysis of the BLISS-52 Trial
Authors: Jolly M , Annapureddy N , Arnaud L , Devilliers H 
Published: November 2019

Objectives To quantify changes in generic patient-reported outcomes against clinically meaningful, disease activity measures in systemic lupus erythematosus (SLE). Methods Using BLISS-52 trial data (867 SLE patients), we estimated the mean difference in change of patient-reported outcome scores (Medical Outcomes Study SF-36 and FACIT-fatigue) in relation to disease activity (SELENA-SLEDAI, SELENA-SLEDAI flare index, SLE responder index and British Isles Lupus Assessment Group (BILAG)), considering all study visits by the mean of multivariate mixed models. Predefined disease activity criteria were used to define for improvement and worsening. Results Mean changes in physical component summary/mental component summary and FACIT-fatigue in response to changes in SELENA-SLEDAI and SELENA-SLEDAI flare index were significantly lower than 2.5. New SELENA-SLEDAI flare index flare led to a significant change in all patient-reported outcome scores, except role emotional. Mean improvement in patient-reported outcomes with achievement of SLE responder index ranged between +6.2 (physical function) and +11.3 (bodily pain) for SF-36 domains, + 3.4 and +3.3 for mental component summary and physical component summary, and was +4.2 for FACIT-fatigue. When considering disease activity changes by organ system, changes in BILAG (constitutional) was independently associated with significant changes in FACIT-fatigue and all SF-36 domains (except physical function), changes in BILAG (musculoskeletal and hematological) were independently associated with significant changes in patient-reported outcome scores, except for role emotional (musculoskeletal) and general health/mental health (hematological). Mean changes in every SF-36 domain varied (and was >5) with SLE responder index attainment. Conclusions Knowledge of changes in patient-reported outcomes, against clinically meaningful changes in SLE disease activity measures, is crucial for designing of clinical trials, interpretation of results and shared decision-making for patient care.
Cantonese tone production in pre-school Urdu–Cantonese bilingual minority children
Authors: Yao Yao , Chan Angel , Fung Roxana , Wu Wing Li , Leung Natalie , Lee Sarah , Luo Jin 
Published: November 2019

Aim: In this study, we examine the production of Cantonese tones by preschool Urdu–Cantonese children living in Hong Kong. Methodology: 21 first language Urdu second language Cantonese children (ages 4–6) and 20 age-matched first language Cantonese children participated in a picture-naming experiment with 86 words (109 syllables in total). Data and Analysis: Acoustic analysis was carried out for perceptually correct and incorrect tone productions of each tone. Comparisons were also made across speaker groups regarding accuracy rates and error patterns. Findings: Overall, first-language Urdu participants had lower accuracy and greater tone confusion than first language Cantonese participants. The pattern is attributable to influence from Urdu prosody, ongoing Cantonese tone mergers, and general sensitivity to phonetic information. Originality: This is the first empirical study on the acquisition of Cantonese tones by children who are heritage speakers of a non-tone language. Significance: This study extends the literature of early bilingual phonology by furthering our understanding of an under-studied bilingual population, that is, heritage children of a non-tone language acquiring a tone language as the majority language. The findings of this study also produce implications for the practice of language educators and speech therapy professionals working with bilingual children.
Access Policies: Between Institutional Competition and the Search for Equality of Opportunities
Authors: Amaral Alberto , Magalhães António 
Published: November 2019

Portuguese higher education can be characterised as a mass system, as the total gross participation rate in universities and polytechnics, public and private, is over 50 per cent. Recently, under the simultaneous pressure of demographic decreasing of the population potentially involved with higher education and financial stringency, higher education institutions, both public and private, have started to compete for students, while responding to an increasing social demand for more diversified higher education. The government and higher education institutions are being challenged to widen access to higher education to improve the country's educational and economic performance, with the objective of attracting new publics and students from a broader range of social backgrounds. In the public sector, the competition for students is being mainly felt in the polytechnic sector, but it is in the private sector, both universities and polytechnics, that the need to recruit more students is felt more intensely. The Portuguese government, allegedly to enhance the equality of opportunities in the access to higher education and to attract new publics, has recently broadened the area of recruitment of the special contingent of adult students who have not completed secondary education courses, by lowering the qualification age from 25 years to 23 years old, and has completely deregulated the system by allocating to each institution the responsibility for the selection of adult students. This paper intends, firstly, to contextualise this governmental action in the framework of the access policies, that, since the beginning of the 2000s, can be characterised as offering not only ‘more’ higher education but also ‘more diverse’ higher education; secondly, to identify the strategies that Portuguese higher education institutions are deploying to meet institutional needs (meaning institutions’ own good) and the political goals assigned by the government; finally, to identify differences of institutional reactions according to their public or private nature and university or polytechnic identity.
Endovascular Management of Neurofibromatosis Type I-Associated Vasculopathy: A Case Series and Brief Review of the Literature
Authors: Raborn Joel , McCafferty Benjamin J. , Gunn Andrew J. , Moawad Sherif , Mahmoud Khalid , Aal Ahmed K. Abdel , Saddekni Souheil 
Published: November 2019

Purpose: Neurofibromatosis type 1 (NF1) is an autosomal-dominant disorder found in approximately 1 of every 3000 individuals. Neurofibromatosis type 1 can have vascular manifestations including aneurysms, stenoses, and arteriovenous malformations. The purpose of this article is to describe the clinical manifestations of NF1 vasculopathy, discuss therapeutic options, and highlight endovascular therapies from our institutional experience. Materials and Methods: The radiology information system was searched for cases of NF1. Cases with vasculopathy managed with endovascular therapies were included. Demographics, clinical histories, procedural details, and outcomes were recorded. A review of the literature for the management strategies of NF1 vasculopathy was performed. Results: Two pediatric patients with NF1 were identified, both of whom presented with hypertension found to be secondary to renal artery stenosis. One of the patients also had infrarenal aortic narrowing. Both patients were successfully treated with balloon angioplasty, resulting in improved blood pressures. The review of the literature identified case series of pharmacologic, surgical, and endovascular therapies, although, endovascular therapies appear to be preferred due to lower morbidity and mortality. Conclusions: NF1 vasculopathy is a rare condition that most often presents with hypertension due to renal artery stenosis. In these situations, endovascular management is the preferred approach.
Exploring the utility of self-determination theory in complex interventions in multimorbidity: A qualitative analysis of patient experiences of the CARE Plus intervention
Authors: McCallum Marianne , Gray Cindy M , Hanlon Peter , O’Brien Rosaleen , Mercer Stewart W 
Published: November 2019

Objectives CARE Plus is a primary-care-based complex intervention for patients with multimorbidity living in areas of high socioeconomic deprivation. This study explores patients’ experience of the intervention and whether self-determination theory is useful to understand reported impacts. Method Thematic analysis of semistructured interviews of 14 participants conducted during a randomised controlled trial of CARE Plus. Improvement in wellbeing in daily lives following CARE Plus was estimated from participants’ accounts of their experiences of the intervention. Findings Participants valued the CARE Plus consultations irrespective of perceived improvements. Six participants reported changes in wellbeing that improved daily life, three reported slight improvement (not impacting daily life) and five no improvement. Evidence of satisfaction of the three major self-determination theory psychological needs – relatedness, competence and autonomy – was prominent in the accounts of those experiencing improved wellbeing in daily life; this group also spoke in ways congruent with more self-determined motivational regulation. These changes were not evident in those with little or no improvement in wellbeing. Discussion This study suggests self-determination theory has utility in understanding the impact of CARE Plus on patients and may be a useful theory to inform development of future interventions to improve outcomes for patients with multimorbidity.
Tarsal Morphology Differs in Plano Valgus Feet
Authors: Moore Erik S. , Kindig Matthew W. , McKearney Daniel A , Telfer Scott , Sangeorzan Bruce , Ledoux William R 
Published: November 2019

Category: Hindfoot Introduction/Purpose: While there are established associated conditions, the intrinsic cause of symptomatic adult flatfoot is not known. There are published data suggesting that the relationship of the hindfoot bones in acquired flatfoot are subluxated. And there is some support in 2 D for the concept that the bones are shaped differently in flatfoot but the complexity of bone shape and human variation makes comparisons difficult. The purpose of this study was to utilize principal component analysis (PCA) to determine whether morphology of the hind- and midfoot bones differs in neutral and plano-valgus feet. Methods: Forty subjects (23 male and 17 Female, average age 52.6 +/- 8.9) with no history of injury or surgery underwent bilateral foot WB CT scan for another study. The talus, calcaneus, navicular and cuboid were segmented into bone models from these previously acquired CT images. Morphometric Shape analysis software (Geomorph) was used to assess shape variations among foot types using Principal component analysis (PCA). PCA is a statistical modelling technique used to study variation in the shape of structures that are difficult to compare and bring out strong patterns in a dataset objectively. Forty feet had been classified into 4 foot groups prior to this study; neutral, cavus, asymptomatic flatfoot and symptomatic flatfoot. This study included the painful flatfeet and neutral feet. Each bone was compared between the feet that were flat and those that were neutral. Comparisons were made between men and women as well. Results: There were no differences between groups in age or sex. There were 38 principle components identified. The first two PC accounted for 38% of the calcaneal variation and 33% of the talar variation. Subtle differences between men and women were found only at the talus and navicular. The cuboid did not exhibit any differences between foot types. The navicular in symptomatic planus had a more posteriorly positioned tuberosity (tuber wrapped around the medial side of the talus) and were wider than neutral feet. The calcaneus showed planus feet to have calcanei that have decreased height and increased length compared to neutrally aligned feet. The cross -sectional area of the calcaneus was reduced compared to neutral feet. The talar shape was not different in the PC. Conclusion: A flat foot is present in over 20% of the population and most often not symptomatic. The root cause of symptomatic adult plano valgus foot is not known and is likely multi factorial. The study demonstrates that there is intrinsic difference in the shape of the calcaneus and navicular bones in flat foot. it is possible that the catalyst for collapse is bony rather than soft tissue.
Vigilance: An Unmeasured Patient-Centered Outcome for Ankle Reconstruction
Authors: Pinsker Ellie , Sale Joanna E.M. , Gignac Monique A.M. , Daniels Timothy R. , Beaton Dorcas E. 
Published: November 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: A wide range of patient-reported outcome measures are used to evaluate ankle reconstruction outcomes, but there is little agreement regarding which best captures patients’ perceptions of illness and treatment outcomes. There has been little exploration of what outcomes are important to patients. Qualitative work offers one approach to try to understand patients’ experiences of ankle reconstruction for treatment of end-stage ankle osteoarthritis. Methods: Individuals were recruited from an existing cohort of persons who had undergone total ankle replacement or ankle fusion. Twenty-five English-speaking individuals who had surgery at least one year prior and were receptive to in-depth interviews were asked to participate following a routine clinic visit. Semi-structured, face-to-face interviews were conducted by a qualitative researcher in a private hospital room. Results: Twenty-five adults (12 women, 13 men) ages 25–82 years were interviewed for 1–2 hours. Participants commonly described a state of having to keep careful watch for potential environmental challenges on a daily basis. ‘Vigilance’ was related to ongoing symptoms (i.e. pain, stiffness) and concerns related to balance, stability, and damage to the fused ankle or implant. Findings indicated that vigilance existed along a continuum with higher levels associated with stress, mental exhaustion, and a negative impact on relationships with friends and family. Vigilance appeared to effect participants’ perception of their surgical outcome, with high levels of vigilance linked to negative perceptions of outcome. The degree to which individuals perceived they needed to be vigilant was influenced by environmental factors like uneven ground or crowds. Conclusion: Vigilance, or the constant appraisal of the environment and personal ability, is not captured by current instruments assessing ankle reconstruction outcomes. However, the mental load and worry associated with high ‘vigilance’ was important to patients and played a role in their perception of outcome, distinct from related pain or functional status. As such, reducing high levels of vigilance appears to be an appropriate target for patient-centered treatment outcomes and one that can be managed or remedied. A thorough outcome battery for ankle reconstruction should consider this domain.