bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors
Authors: Ismail Nafiu , Jordan Kelvin P. , Kadam Umesh T. , Edwards John J. , Kinnaird Tim , Mamas Mamas A. 
Published: October 2019

Background
The incidence and predictors of bleeding after acute coronary syndrome are unclear within the real‐world setting. Our objective was to determine the incidence, types, timing, and predictors of bleeding complications following hospital discharge after acute coronary syndrome.

Methods and Results

We used the Clinical Practice Research Datalink, with linkage to Hospital Episode Statistics, to determine the incidence, timing, and types of bleeding events within 12 months after hospital discharge for acute coronary syndrome. We assessed independent associations between postdischarge bleeding and baseline patient characteristics using a competing risk regression model, accounting for death as a competing event. Among 27 660 patients surviving to hospital discharge, 3620 (13%) experienced bleeding complications at a median time of 123 days (interquartile range, 45–223 days) after discharge. The incidence of bleeding was 162/1000 person‐years (95%
CI
, 157–167/1000 person‐years) within the first 12 months after hospital discharge. Bruising (949 bleeds [26%]) was the most common type of first bleeding event, followed by gastrointestinal bleed (705 bleeds [20%]), whereas intracranial bleed was relatively rare (81 bleeds [2%]). Significant predictors of postdischarge bleeding included history of bleeding complication, oral anticoagulant prescription, history of peripheral vascular disease, chronic obstructive pulmonary disease, and advanced age (>80 years). Predictors for postdischarge bleeding varied, depending on the anatomic site of the bleeding event.

Conclusions
Bleeding complications after hospital discharge for acute coronary syndrome are common. Patients who experience these bleeding events have distinct baseline characteristics, which vary by anatomic site of the bleed. These characteristics can inform risk‐benefit considerations in deciding on favorable combination and duration of secondary antithrombotic therapy.
Plurality in the Theological Struggle against Apartheid
Authors: van Wyngaard George J. (Cobus) 
Published: October 2019

AbstractThe church struggle against apartheid remains a key case study in ecumenical public theology, with particular relevance for the Reformed tradition. The importance of Christian theology in both the justification of and opposition to apartheid is well known. Also, the process of ecumenical discernment for responding to apartheid became a significant marker in global ecumenical reflection on what today we might describe as public theology. However, the idea of a theological struggle against apartheid risks ironing out the different theological positions that oppose apartheid. This article highlights some of the attempts to analyze the theological plurality in responses to apartheid. Then it proceeds to present an alternative way of viewing this plurality by focusing on the way in which different classic theological questions were drawn upon to analyze apartheid theologically. Using as examples the important theologians David Bosch, Simon Maimela, and Albert Nolan, it highlights how apartheid was described as a problem of ecclesiology, theological anthropology, and soteriology. It argues that this plurality of theological analyses allows us to rediscover theological resources that might be of particular significance as race and racism take on new forms in either democratic South Africa or the contemporary world. Simultaneously, it serves as a valuable example in considering a variety of theological questions when theologically reflecting on issues of public concern.
Spatial Correction of Multimodel Ensemble Subseasonal Precipitation Forecasts over North America Using Local Laplacian Eigenfunctions
Authors: Vigaud N. , Tippett M. K. , Yuan J. , Robertson A. W. , Acharya N. 
Published: October 2019

Abstract
The extent to which submonthly forecast skill can be increased by spatial pattern correction is examined in probabilistic rainfall forecasts of weekly and week-3–4 averages, constructed with extended logistic regression (ELR) applied to three ensemble prediction systems from the Subseasonal-to-Seasonal (S2S) project database. The new spatial correction method projects the ensemble-mean rainfall neighboring each grid point onto Laplacian eigenfunctions and then uses those amplitudes as predictors in the ELR. Over North America, individual and multimodel ensemble (MME) forecasts that are based on spatially averaged rainfall (e.g., first Laplacian eigenfunction) are characterized by good reliability, better sharpness, and higher skill than those using the gridpoint ensemble mean. The skill gain is greater for week-3–4 averages than week-3 leads and is largest for MME week-3–4 outlooks that are almost 2 times as skillful as MME week-3 forecasts over land. Skill decreases when using more Laplacian eigenfunctions as predictors, likely because of the difficulty in fitting additional parameters from the relatively short common reforecast period. Higher skill when increasing reforecast length indicates potential for further improvements. However, the current design of most subseasonal forecast experiments may prove to be a limit on the complexity of correction methods. Relatively high skill for week-3–4 outlooks with winter starts during El Niño and MJO phases 2–3 and 6–7 reflects particular opportunities for skillful predictions.
An Analysis of Alternatives for the COSMIC-2 Constellation in the Context of Global Observing System Simulation Experiments
Authors: Cucurull L. , Mueller M. J. 
Published: October 2019

Abstract
Observing system simulation experiments (OSSEs) were conducted to evaluate the potential impact of the six Global Navigation Satellite System (GNSS) radio occultation (RO) receiver satellites in equatorial orbit from the initially proposed Constellation Observing System for Meteorology, Ionosphere, and Climate-2 (COSMIC-2) mission, known as COSMIC-2A. Furthermore, the added value of the high-inclination component of the proposed mission was investigated by considering a few alternative architecture designs, including the originally proposed polar constellation of six satellites (COSMIC-2B), a constellation with a reduced number of RO receiving satellites, and a constellation of six satellites but with fewer observations in the lower troposphere. The 2015 year version of the operational three-dimensional ensemble–variational data assimilation system of the National Centers for Environment Prediction (NCEP) was used to run the OSSEs. Observations were simulated and assimilated using the same methodology and their errors assumed uncorrelated. The largest benefit from the assimilation of COSMIC-2A, with denser equatorial coverage, was to improve tropical winds, and its impact was found to be overall neutral in the extratropics. When soundings from the high-inclination orbit were assimilated in addition to COSMIC-2A, positive benefits were found globally, confirming that a high-inclination orbit constellation of RO receiving satellites is necessary to improve weather forecast skill globally. The largest impact from reducing COSMIC-2B from six to four satellites was to slightly degrade weather forecast skill in the Northern Hemisphere extratropics. The impact of degrading COSMIC-2B to the COSMIC level of accuracy, in terms of penetration into the lower troposphere, was mostly neutral.
Parenting stress mediates the association between cyanotic congenital heart disease and internalising problems in children and adolescents
Authors: Chang Ling-Yin , Chiu Shuenn-Nan , Wang Chia-Ching , Weng Wen-Chin , Chang Hsing-Yi 
Published: October 2019

Background: Children and adolescents with cyanotic congenital heart disease have been found to be at an increased risk of internalising problems. The underlying mechanisms, however, remain uncertain. Aims: To examine the association between cyanotic congenital heart disease and internalising problems and assess whether parenting stress mediates this association. Method: The study sample was 699 children and adolescents (aged 2–17 years) with congenital heart disease (253 with cyanotic congenital heart disease and 446 with acyanotic congenital heart disease) in Taiwan. The Child Behavior Checklist and the Parenting Stress Index were used to assess internalising problems and parenting stress, respectively. A series of multiple regression models was conducted using the SPSS PROCESS procedure to test the association between types of congenital heart disease and internalising problems and the mediating role of parenting stress. A bootstrapping approach was applied to determine the significance of mediation. Results: Compared with acyanotic congenital heart disease, cyanotic congenital heart disease was associated with increased levels of internalising problems (B=2.52, P<0.01), and this association was mediated by parenting stress (B=0.97, 95% bias-corrected bootstrap confidence interval 0.24, 1.75). In particular, parents of children with cyanotic congenital heart disease reported significantly more parenting stress compared with parents of children with acyanotic congenital heart disease (B=4.63, P<0.01), which contributed to elevated levels of internalising problems in the offspring (B=0.21, P<0.001). Conclusion: Cyanotic congenital heart disease conferred risks for internalising problems in children and adolescents, and this association was mediated by parenting stress. Interventions to decrease internalising problems in children and adolescents with cyanotic congenital heart disease may be more effective by targeting parenting stress.
Role of Total Ankle Arthroplasty in Stiff Ankles – Long Term Follow-Up
Authors: Brodsky James W. , Kane Justin M. , Pao Andrew W. , Vier David D. , Coleman Scott , Daoud Yahya 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Operative treatment of end-stage ankle arthritis involves either ankle arthrodesis (AA) or total ankle arthroplasty (TAA). The theoretical benefit of TAA is the ability to preserve range of motion (ROM) at the tibiotalar joint. Previous studies have questioned whether it is justified to perform TAA over AA in stiff, arthritic ankles. However, a recent study showed that patients who underwent TAA with stiff ankles preoperatively experienced significant clinical improvement in range of motion and gait function compared to more flexible groups at 1-year follow-up. We retrospectively assessed these same gait and functional parameters to see if these improvements held up in long-term follow-up. Methods: A retrospective study of long-term, prospectively collected functional gait data in 33 TAA patients at a mean of 7.6 years postoperatively (range 4.8-13.3) used a multivariate regression model to determine the effect of ankle stiffness on the long- term, objective outcomes of TAA. Data was analyzed by quartiles (Q1, Q2+Q3, Q4) of preoperative sagittal ROM using one-way analysis of variance (ANOVA) to compare both preop and postop gait parameters. The two middle quartiles were combined to conform to distribution of the data. The multivariate analysis determined the independent effect of age, gender, BMI, years post- surgery, and preop ROM on every preop and postop parameter of gait. Results: Statistically significant differences were found in all three gait parameter categories, including temporal-spatial (step length and walking speed), kinematic (total sagittal ROM and maximum plantarflexion), and kinetic (peak ankle power). The stiffest ankles preoperatively (Q1) had the greatest absolute increase in total sagittal ROM postoperatively, +5.3o, compared to -1.3o (p<0.0174) in Q4 (most flexible). However, Q1 had the lowest absolute total postoperative sagittal ROM of 13.1 o, compared to 19.7 o (p<0.0108) in Q4. Q1 also had the lowest preoperative step length, walking speed, maximal plantarflexion, and peak ankle power when compared to the other subgroups. There was no difference in any of these same parameters postoperatively. BMI and years post-surgery had no effect on outcomes, while age and gender had a minimal effect. Conclusion: Preoperative range of motion was once again predictive of overall postoperative gait function in long-term follow-up at an average of 7.2 years. A greater degree of preoperative sagittal range of motion was predictive of greater postoperative sagittal range of motion in long-term follow-up. Patients with the stiffest ankles preoperatively once again had a statistically and clinically greater improvement in function as measured by multiple parameters of gait. This shows that the clinically meaningful improvement in gait function after total ankle arthroplasty holds up in long-term follow-up, even in the setting of limited preoperative sagittal range of motion.
Patient Related Outcome Measures (PROMs) in Morton’s Neuroma: Conservative vs. Surgical Management at One-Year Follow-Up
Authors: Faulkner Alastair , Mayne Alistair , Harrold Fraser 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.
Opioid Consumption Following Outpatient Foot and Ankle Surgery: A Prospective Analysis
Authors: Heiman Erick M. , Wu Kevin , Idarraga Alexander J. , Bohl Daniel D. , Lin Johnny , Holmes George B. , Lee Simon , Hamid Kamran S. 
Published: October 2019

Category: Prescription Practices Introduction/Purpose: Opioid abuse has recently reached the conscience of the US healthcare system and news cycle. This epidemic is in part propagated by surgeon over-prescription for common procedures. The purpose of this study is to examine postoperative opioid use following outpatient foot and ankle surgery in order to potentially guide prescription patterns of postoperative narcotics. Methods: Patients undergoing outpatient foot or ankle surgery, performed by one of four fellowship-trained orthopedic foot and ankle surgeons from a single institution, were prospectively enrolled from January to November 2018. Subjects were consented to participate in a phone interview within 7 days of their surgery, with subsequent interviews as needed for continued monitoring. Information collected included: age, gender, procedure, smoking status, payor type, analgesic regimen, number of tablets remaining, pain scale, pain control satisfaction, additional analgesic medications taken, reason for stopping opioid medications, and any adverse reactions encountered. Results: A total of 94 subjects were consented to participate. Of these, 11 were lost to follow up and 2 withdrew from the study, leaving 81 (86%) subjects for analysis. The mean (± standard deviation) number of opioid pills prescribed was 52.2 (±16.4; range: 6-80) pills. Subjects were satisfied or somewhat satisfied with their pain control in 91% of cases. On average, 18.4 (±14.9) pills were consumed by subjects, stopping consumption on post-operative day 4.8 (±3.6). There was no statistically significant difference in narcotic medications consumed whether undergoing ankle surgery (16.4, ±13.7) or foot surgery (20.7, ±15.9) (p=0.11). Overall, an average of 34.3 (±19.3) pills remained unconsumed at the completion of narcotic use, equaling a total of 2,706 excessively prescribed pills in the study cohort. Conclusion: There is a substantial excess of opioid pain medication prescribed to patients for outpatient foot and ankle surgeries, with a wide variation in prescription patterns. Based on our institutional data, a prescription of 35 opioid pills should be sufficient for approximately two-thirds of outpatient procedures and 50 pills should be sufficient for approximately 95% of patients regardless of whether the procedure is for the ankle or foot. This quality improvement assessment has influenced physician practice in our group and prospective follow-up analysis after intervention is warranted.
A New Intraoperative Measurement that Predicts Ankle Syndesmotic Joint Malreduction
Authors: Abarca Mario , Besa Pablo , Palma Joaquin , Mora Eduardo , Mery Pablo , Villa Andres , Filippi Jorge 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Distal tibio-fibular syndesmotic reduction (SR) is an independent predictor of good functional outcome following ankle surgery. Classic intraoperative fluoroscopic parameters have shown to be poor predictors of distal SR. Syndesmotic malreduction (S-MR) has been reported up to 52% of surgically treated patients. Grenier et al proposed the Anteroposterior Tibio Fibular Ratio (APTF) to evaluate normal sagittal syndesmotic anatomy, showing good interobserver agreement and high correlation between both sides in normal ankles. We propose the use of the comparative APTF index (cAPTF), calculated as the absolute difference of APTF index between the normal and surgically treated ankle, to guide intraoperative sagittal SR. The aim of this study was to determine the capability of the intraoperative cAPTF to predict S-MR. Methods: Prospective observational study. Patients who required syndesmotic fixation for an unstable ankle fracture and who had a contralateral healthy ankle were prospectively enrolled. Intraoperative APTF was measured under fluoroscopy in both ankles according to Grenier et al and the cAPTF was calculated. No surgeons were informed of APTF measurements during the procedure. Bilateral postoperative CT was obtained, and quality of SR was evaluated using the method described by Dikos et al. To estimate the discriminatory power of the cAPTF, a receiver operative characteristic (ROC) curve was obtained and the area under the curve was calculated. Youden index was used to determine the ideal cAPTF cut-off value for S-MR and its sensitivity, specificity, positive likelihood ratio (LR+) and negative probability (LR-) were calculated. Results: Forty-seven patients were enrolled. Sixteen (34%) had S-MR on the postoperative CT. The cAPTF varied between 0.005 and 0.435. The cAPTF cut-off value to predict S-MR was 0.161. A cAPTF value greater than 0.161 had Sensitivity 100%; specificity 94%; LR+ 15.50; and LR- 0.06, for predicting malreduction of the syndesmosis. The area under the ROC curve was 0.99. Conclusion: Intraoperative cAPTF index demonstrated excellent discriminatory power for predicting syndesmotic malreduction. We propose the routine use of this new method to improve the results of syndesmotic reduction.
Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti- Inflammatory Medications
Authors: Barnds Brandon , Heenan G. Matthew , Tarakemeh Armin , Schroeppel J. Paul , Mullen Scott , Vopat Bryan G. 
Published: October 2019

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Controversy exists regarding the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing. Our retrospective study uses a private payer database to isolate patients diagnosed with 5th metatarsal (MT) fractures and compare the rate of delayed open reduction and internal fixation (ORIF) or non/malunion repair as a surrogate for nonunion or delayed union, in those prescribed anti-inflammatories and those not prescribed anti-inflammatories. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD-10 codes. All patients included had a diagnosis of 5th MT fracture and did not receive ORIF or repair of non/malunion within 60 days of diagnosis. Two groups were then created based on the presence or absence of insurance claim records for anti-inflammatory medications within 60 days of diagnosis. The number of patients in each group who underwent ORIF or non/malunion repair after 60 days post- diagnosis was determined, and the rates were compared using a chi-square analysis. Results: 10,626 patients had a diagnosis of 5th MT fracture and did not undergo early repair/ORIF (within 60 days). 1,615 had records of insurance claims for anti-inflammatories within 60 days of diagnosis, leaving 9,011 who did not receive these medications. 18 (1.11%) patients who received an anti-inflammatory medication underwent ORIF or repair of non/malunion after 60 days post-diagnosis. 44 (0.49%; p=0.0055) subjects who did not receive an anti-inflammatory prescription underwent ORIF or repair of non/malunion after 60 days post-diagnosis. Conclusion: The rate of delayed ORIF or non/malunion repair of 5th MT fractures, a surrogate for delayed union or nonunion in an insurance database study, was significantly higher in subjects receiving anti-inflammatories within 60 days of diagnosis. This study isolates a specific fracture and finds a negative correlation between NSAIDs and fracture healing. Further, this provides valuable information to help guide future higher level studies.