bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Homocysteine and Vascular Calcification Incidence, Prevalence, and Progression in the MESA Cohort
Authors: Karger Amy B. , Steffen Brian T. , Nomura Sarah O. , Guan Weihua , Garg Parveen K. , Szklo Moyses , Budoff Matthew J. , Tsai Michael Y. 
Published: January 2020

Background
While elevated homocysteine has been associated with calcification in several studies, its importance as a cardiovascular risk factor remains unclear. This study examines the relationship between homocysteine and vascular and valve calcification in the MESA (Multi‐ethnic Study of Atherosclerosis) cohort.

Methods and Results

MESA
participants with baseline homocysteine measurements and cardiac computed tomography scans were included (N=6789). Baseline and follow‐up assessment of vascular (coronary artery [CAC], descending thoracic aorta [DTAC]) and valve (aortic valve [AVC], mitral annular [MAC]) calcification was performed. Prevalence ratio/relative risk regression was used to assess the relationship of homocysteine with prevalent and incident calcification, and multivariable logistic regression was used to assess associations between homocysteine and calcification progression. Elevated homocysteine was associated with greater relative risk of prevalent and incident
CAC
and incident
DTAC
. We also identified a strong association between elevated homocysteine and
CAC
and
DTAC
progression. Elevated homocysteine was found to confer a >2‐fold increased risk of severe
CAC
progression (defined as Δ
CAC
≥100/year) and an ≈1.5‐fold increased risk for severe
DTAC
progression (defined as Δ
DTAC
≥100/year).

Conclusions
To our knowledge, this is the first study demonstrating an association between elevated homocysteine and both incidence and progression of coronary and extra‐coronary vascular calcification. Our findings suggest a potential role for elevated homocysteine as a risk factor for severe vascular calcification progression. Future studies are warranted to further assess the utility of homocysteine as a biomarker for vascular calcification incidence and progression.

Clinical Trial Registration

https://www.clinicaltrials.gov/
. Unique identifier:
NCT
00005487.
Bringing Critical Race Praxis Into the Study of Electrophysiological Substrate of Sudden Cardiac Death: The ARIC Study
Authors: Jensen Kelly , Howell Stacey J. , Phan Francis , Khayyat‐Kholghi Maedeh , Wang Linda , Haq Kazi T. , Johnson John , Tereshchenko Larisa G. 
Published: January 2020

Background
Race is an established risk factor for sudden cardiac death (SCD). We sought to determine whether the association of electrophysiological substrate with SCD varies between black and white individuals.

Methods and Results

Participants from the ARIC (Atherosclerosis Risk in Communities) study with analyzable ECGs (n=14 408; age, 54±6 years; 74% white) were included. Electrophysiological substrate was characterized by ECG metrics. Two competing outcomes were adjudicated: SCD and non‐SCD. Interaction of ECG metrics with race was studied in Cox proportional hazards and Fine‐Gray competing risk models, adjusted for prevalent cardiovascular disease, risk factors, and incident nonfatal cardiovascular disease. At the baseline visit, adjusted for age, sex, and study center, blacks had larger spatial ventricular gradient magnitude (0.30 mV; 95% CI, 0.25–0.34 mV), sum absolute QRST integral (18.4 mV*ms; 95% CI, 13.7–23.0 mV*ms), and Cornell voltage (0.30 mV; 95% CI, 0.25–0.35 mV) than whites. Over a median follow‐up of 24.4 years, SCD incidence was higher in blacks (2.86 per 1000 person‐years; 95% CI, 2.50–3.28 per 1000 person‐years) than whites (1.37 per 1000 person‐years; 95% CI, 1.22–1.53 per 1000 person‐years). Blacks with hypertension had the highest rate of SCD: 4.26 (95% CI, 3.66–4.96) per 1000 person‐years. Race did not modify an association of ECG variables with SCD, except QRS‐T angle. Spatial QRS‐T angle was associated with SCD in whites (hazard ratio, 1.38; 95% CI, 1.25–1.53) and hypertension‐free blacks (hazard ratio, 1.52; 95% CI, 1.09–2.12), but not in blacks with hypertension (hazard ratio, 1.15; 95% CI, 0.99–1.32) (
P
‐interaction=0.004).

Conclusions
Race did not modify associations of electrophysiological substrate with SCD and non‐SCD. Electrophysiological substrate does not explain racial disparities in SCD rate.
The Consistency of MJO Teleconnection Patterns on Interannual Time Scales
Authors: Tseng Kai-Chih , Maloney Eric , Barnes Elizabeth A. 
Published: January 2020

AbstractThe Madden–Julian oscillation (MJO) excites strong variations in extratropical geopotential heights that modulate extratropical weather, making the MJO an important predictability source on subseasonal to seasonal time scales (S2S). Previous research demonstrates a strong similarity of teleconnection patterns across MJO events for certain MJO phases (i.e., pattern consistency) and increased model ensemble agreement during these phases that is beneficial for extended numerical weather forecasts. However, the MJO’s ability to modulate extratropical weather varies greatly on interannual time scales, which brings extra uncertainty in leveraging the MJO for S2S prediction. Few studies have investigated the mechanisms responsible for variations in the consistency of MJO tropical–extratropical teleconnections on interannual time scales. This study uses reanalysis data, ensemble simulations of a linear baroclinic model, and a Rossby wave ray tracing algorithm to demonstrate that two mechanisms largely determine the interannual variability of MJO teleconnection consistency. First, the meridional shift of stationary Rossby wave ray paths indicates increases (decreases) in the MJO’s extratropical modulation during La Niña (El Niño) years. Second, a previous study proposed that the constructive interference of Rossby wave signals caused by a dipole Rossby wave source pattern across the subtropical jet during certain MJO phases produces a consistent MJO teleconnection. However, this dipole feature is less clear in both El Niño and La Niña years due to the extension and contraction of MJO convection, respectively, which would decrease the MJO’s influence in the extratropics. Hence, considering the joint influence of the basic state and MJO forcing, this study suggests a diminished potential to leverage the MJO for S2S prediction in El Niño years.
Effect of Repositioning Aids and Patient Weight on Biomechanical Stresses When Repositioning Patients in Bed
Authors: Wiggermann Neal , Zhou Jie , McGann Nancy 
Published: January 2020

Objective The aim of the study was to estimate the risk of injury when repositioning patients of different weight with commonly used repositioning aids. Background Repositioning dependent patients in bed is the most common type of patient handling activity and is associated with high rates of musculoskeletal disorders in healthcare workers. Several studies have evaluated repositioning aids, but typically for a single patient weight and often without estimating risk of injury based on biomechanical analysis. Method Ten nurses performed four repositioning activities on three participants (50, 77, 141 kg) using three repositioning aids (pair of friction-reducing sheets [FRS], turn and position glide sheet, air-assisted transfer device) and a draw sheet. Motion capture, hand forces, and ground reaction forces were recorded. Spine loading was estimated using a dynamic biomechanical model. Results Hand forces and spine compression exceeded recommended limits for most patient weights and repositioning tasks with the draw sheet. FRS and glide sheet reduced these loads but still exceeded recommended limits for all but the 50-kg patient. Only the air-assisted transfer device reduced forces to accepted levels for all patient weights. Physical stresses were relatively low when turning patients. Conclusion Most repositioning aids are insufficient to properly mitigate risk of musculoskeletal injury in healthcare workers. Only the air-assisted transfer device was sufficient to adequately mitigate the risk of injury when moving patients of average or above-average weight. Application To safely move dependent patients, a robust solution requires mechanical lifts and may utilize air-assisted transfer devices for patient transfers.
Self-management of patients with advanced cancer: A systematic review of experiences and attitudes
Authors: van Dongen Sophie I , de Nooijer Kim , Cramm Jane M , Francke Anneke L , Oldenmenger Wendy H , Korfage Ida J , Witkamp Frederika E , Stoevelaar Rik , van der Heide Agnes , Rietjens Judith AC 
Published: February 2020

Background: Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention. Aim: To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management. Design: A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting. Data sources: MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019). Results: Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient–professional partnerships (three articles). Conclusion: Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.
Drivers of care costs and quality in the last 3 months of life among older people receiving palliative care: A multinational mortality follow-back survey across England, Ireland and the United States
Authors: Yi Deokhee , Johnston Bridget M , Ryan Karen , Daveson Barbara A , Meier Diane E , Smith Melinda , McQuillan Regina , Selman Lucy , Pantilat Steven Z , Normand Charles , Morrison R Sean , Higginson Irene J 
Published: February 2020

Background: Care costs rise towards the end of life. International comparison of service use, costs and care experiences can inform quality and improve access. Aim: The aim of this study was to compare health and social care costs, quality and their drivers in the last 3 months of life for older adults across countries. Null hypothesis: no difference between countries. Design: Mortality follow-back survey. Costs were calculated from carers’ reported service use and unit costs. Setting: Palliative care services in England (London), Ireland (Dublin) and the United States (New York, San Francisco). Participants: Informal carers of decedents who had received palliative care participated in the study. Results: A total of 767 questionnaires were returned: 245 in England, 282 in Ireland and 240 in the United States. Mean care costs per person with cancer/non-cancer were US$37,250/US$37,376 (the United States), US$29,065/US$29,411 (Ireland), US$15,347/US$16,631 (England) and differed significantly ( F = 25.79/14.27, p < 0.000). Cost distributions differed and were most homogeneous in England. In all countries, hospital care accounted for > 80% of total care costs; community care 6%–16%, palliative care 1%–15%; 10% of decedents used ~30% of total care costs. Being a high-cost user was associated with older age (>80 years), facing financial difficulties and poor experiences of home care, but not with having cancer or multimorbidity. Palliative care services consistently had the highest satisfaction. Conclusion: Poverty and poor home care drove high costs, suggesting that improving community palliative care may improve care value, especially as palliative care expenditure was low. Major diagnostic variables were not cost drivers. Care costs in the United States were high and highly variable, suggesting that high-cost low-value care may be prevalent.
Accuracy of talonavicular injection using ultrasound versus anatomical landmark: a cadaver study
Authors: Jha Aaradhana J , Viner Gean C , McKissack Haley , Anderson Matthew , Prather John , Shah Ashish B , Caycedo Francisco 
Published: February 2020

Background Intra-articular injections have diagnostic and therapeutic roles in foot and ankle pathologies due to complex anatomy, small size, diverse bones, and joints with proximity in this region. Conventionally, these injections are carried out using anatomical landmark technique and/or fluoroscopic guidance. The small joint space and needle size make the injection challenging. Fluoroscopy is not readily available in the clinical setting; ultrasound-guidance for injections is therefore increasingly being used. We compared the accuracy of intra-articular talonavicular injections using the anatomical landmark technique versus the ultrasound-guided method. Purpose To determine whether ultrasound guidance yields superior results in intra-articular injections of the talonavicular joint compared to injections using palpatory method guided by anatomical landmarks. Material and Methods The feet of 10 cadaveric specimens were held in neutral position by an assistant while a fellowship-trained foot-ankle orthopedic surgeon injected 2 cc of radiopaque dye using anatomical landmarks and palpation method in five specimens and under ultrasound guidance in the remaining five. The needles were left in situ in all specimens and their placement was confirmed fluoroscopically. Results In all five specimens injected under ultrasound guidance, the needle was found to be in the joint, whereas all five injected by palpation only were out of the joint, with one in the naviculo-cuneiform joint, showing ultrasound guidance to significantly increase the accuracy of intra-articular injections in the talonavicular joint than palpatory method alone. Conclusion Ultrasound-guided injections not only confirm correct needle placement, but also delineate any tendon and/or joint pathology simultaneously.
Post-needling soreness and trigger point dry needling for hemiplegic shoulder pain following stroke
Authors: Mendigutía-Gómez Ana , Quintana-García María T , Martín-Sevilla Miriam , de Lorenzo-Barrientos Diego , Rodríguez-Jiménez Jorge , Fernández-de-las-Peñas César , Arias-Buría José L 
Published: February 2020

Objectives: To determine the presence of post-needling induced pain in subjects who had suffered a stroke and received trigger point (TrP) dry needling (DN), and to investigate the effects of including TrP-DN into a rehabilitation program for shoulder pain in this population. Methods: A randomized clinical trial was conducted. Sixteen patients who had suffered a stroke and presented with shoulder pain were randomly assigned to receive rehabilitation alone or rehabilitation combined with DN. Both groups received a neurorehabilitation session including modulatory interventions targeting the central nervous system. Patients in the DN group also received a single session of DN over active TrPs in the shoulder musculature. A numerical pain rating scale (NPRS, 0–10) was used to asses post-needling induced pain at 1 min, 24 h, and 72 h after needling. Shoulder pain (NPRS, 0–10) was assessed at baseline, and 3 and 7 days after DN in both groups. Results: Five (62%) patients receiving TrP-DN reported post-needling induced pain. Post hoc analysis found that post-needling induced pain decreased significantly at 24 and 72 h (both p < 0.001) after DN. Patients receiving TrP-DN plus rehabilitation exhibited greater decreases in shoulder pain intensity at 3 days (Δ = −4.2, 95% confidence interval (CI) = −5.8 to −2.6) and 7 days (Δ = −4.3, 95% CI = −5.9 to −2.7) after the intervention compared with those receiving rehabilitation alone (all p < 0.001). Conclusion: This trial found that 50% of stroke patients receiving DN experienced post-needling induced pain, a side effect that almost disappeared 72 h after the intervention without any additional therapeutic action. In addition, the inclusion of TrP-DN into a rehabilitation session was effective at decreasing shoulder pain in these patients.
Acupuncture for stroke: perceptions and possibilities
Authors: Robinson Nicola , Ye Tian , Ronan Patricia , Garbelli Pietro Emanuele , Smithard David 
Published: January 2020

Objective: To investigate perceptions and acceptability of, and attitudes towards, acupuncture for post-acute stroke and rehabilitation care by exploring the views of different stakeholders. Methods: Three electronic surveys were conducted to gauge the breadth of knowledge and acceptance of acupuncture in post-acute stroke and rehabilitation care among three stakeholder groups: (1) traditional acupuncturists registered with the British Acupuncture Council (BAcC); (2) National Health Service (NHS) professionals attending the 2017 UK Stroke Forum conference; and (3) the UK network of Stroke Club co-ordinators. Results: Of 278 NHS respondents, 31% were doctors. Over half (52%) of all NHS respondents reported they had insufficient knowledge about acupuncture, its effectiveness (23%) or how to refer (21%). Only 12% had previously referred stroke patients for acupuncture but 46% thought that there was role for acupuncture in post-acute stroke care (50% were unsure). Two thirds of BAcC acupuncturist respondents had treated at least one stroke patient, with 70.1% having treated 1–5 stroke patients and 71% having provided treatment in the last year, most commonly for motor impairment (88.2%). Of 99 Stroke Club coordinators who responded, only seven had ever been asked about acupuncture by patients, but most felt there would be interest. Conclusion: Interest in the provision of acupuncture for post-acute stroke care was expressed by both NHS practitioners and acupuncturists. Further research is required on the acceptability of acupuncture to patients as well as evidence of its clinical and cost effectiveness.
Geopersonality of Preventable Death in the United States: Anger-Prone States and Opioid Deaths
Authors: Gerhart James , Duberstein Paul , Paull Danielle , O’Mahony Sean , Burns John , DeNicolo Martin , Hoerger Michael 
Published: February 2020

Background: Opioid overdoses have reached epidemic levels in the United States and have clustered in Northeastern and “Rust Belt” states. Five Factor Model (FFM) personality traits also vary at the state level, with anger-prone traits clustered in the Northeast region. This study tested the hypothesis that state-level anger proneness would be associated with a greater increase in rates of opioid overdose death. Methods: This was a secondary analysis of state-level data on FFM traits, opioid overdose deaths, and other classes of preventable death. Robust mixed models tested whether change in rates of opioid overdose death from 2008 to 2016 was moderated by state-level anger proneness. Results: State-level anger proneness was significantly associated with greater increases in rates of opioid overdose deaths (B = 1.01, standard error = 0.19, P < .001, 95% confidence interval: 0.63-1.39). The slope of increase in opioid overdose death rates was 380% greater in anger-prone states and held after adjustment for potential confounders such as state-level prevalence of major depressive disorder, number of mental health facilities, and historical patterns of manufacturing decline. A similar pattern was observed between state-level anger proneness and benzodiazepine overdose deaths but was not significant for the latter after adjustment for potential confounders. Conclusion: These findings suggest that states characterized as more anger prone have experienced greater increases in opioid overdose deaths.
Weak psoas and spine extensors potentially predispose to hip fracture
Authors: Kim Keong-Hwan , Lee Jun Hee , Lim Eic Ju 
Published: January 2020

Introduction: We performed a computed tomography analysis of muscle composition characteristics in hip fracture patients and non-hip fracture controls. Methods: In total, 43 patients (9 men, 34 women) were included in the hip fracture group, matched 1 to 1 with non-hip fracture controls. Muscle cross-sectional areas were measured in axial CT scan at the body level of the 4th lumbar vertebra (L4), intervertebral disc level between the 5th lumbar vertebra and the 1st sacral vertebra (L5-S1) and just below level of the lesser trochanter (LT). Attenuation was also evaluated through the mean Hounsfield unit (HU) in these areas. Results: The cross-sectional area per weight (CSA/Wt, mm2/kg) of psoas muscle and extensor muscles of the spine showed a significant difference between the 2 groups at both L4 (9.7 vs. 12.4, p  < 0.001 and 26.3 vs. 29.2, p  = 0.025) and L5-S1 (9.6 vs. 11.5, p  = 0.001 and 8.8 vs. 10.3, p  = 0.041) levels. In addition, the HU of these muscles differed significantly between the 2 groups at both L4 (33.3 vs. 47.6, p  < 0.001 and 13.7 vs. 30.2, p  < 0.001) and L5-S1 (39.7 vs. 52.6, p  < 0.001 and 3.8 vs. 15.1, p  = 0.012) levels. There was no difference in abdominal wall, gluteal, or thigh compartment musculature between the groups. Conclusions: Poorer quantity and quality of psoas muscle and extensor muscles of the spine rather than whole body muscles may contribute to falls and were characteristic features of the hip fracture patients in this series. These findings should be considered when recommending a preventive exercise and rehabilitation protocol.
Managing orthodontic appliances in everyday life: A qualitative study of young people’s experiences with removable functional appliances, fixed appliances and retainers
Authors: Kettle Jennifer E , Hyde Amy C , Frawley Tom , Granger Clare , Longstaff Sarah J , Benson Philip E 
Published: February 2020

Objective: To compare young people’s experiences of wearing a range of orthodontic appliances. Design: A cross-sectional, qualitative study with purposive sampling. Setting: UK dental teaching hospital. Participants: Twenty-six orthodontic patients aged 11–17 years. Methods: Patients participated in in-depth semi-structured interviews. All interviews were transcribed verbatim and analysed thematically. Results: Young people reported physical, practical and emotional impacts from their appliances. Despite these reported impacts, participants described ‘getting used’ to and, therefore, not being bothered by their appliance. Framework analysis of the data identified a multi-dimensional social process of managing everyday life with an appliance. This involves addressing the ‘dys-appearance’ of the body through physically adapting to an appliance. This process also includes psychological approaches, drawing on social networks, developing strategies and situating experiences in a longer-term context. Engaging in this process allowed young people to address the physical, practical and emotional impacts of their appliances. Conclusion: This qualitative research has identified how young people manage everyday life with an appliance. Understanding this process will help orthodontists to support their patients.