bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records
Authors: Gitsels Lisanne Andra , Bakbergenuly Ilyas , Steel Nicholas , Kulinskaya Elena 
Published: May 2021

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.ResultsCurrent statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.ConclusionsUsing regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.
Atrial fibrillation and risk of incident heart failure with reduced versus preserved ejection fraction
Authors: Nicoli Charles D , O’Neal Wesley T , Levitan Emily B , Singleton Matthew J , Judd Suzanne E , Howard George , Safford Monika M , Soliman Elsayed Z 
Published: May 2021

ObjectiveAssociations between atrial fibrillation (AF) and heart failure (HF) have been established. We compared the extent to which AF is associated with each primary subtype of HF, with reduced (HFrEF) versus preserved ejection fraction (HFpEF).MethodsWe included 25 787 participants free of baseline HF from the REGARDS (REasons for Geographic And Racial Differences in Stroke) cohort. Baseline AF was ascertained from ECG and self-reported history of physician diagnosis. Incident HF events were determined from physician-adjudicated review of hospitalisation medical records and HF deaths. Based on left ventricular ejection fraction (LVEF) at the time of HF event, HFrEF, HFpEF, and mid-range HF were defined as LVEF <40%, ≥50% and 40%–49%, respectively. Multivariable Cox proportional-hazards models examined the association between AF and HF. The Lunn-McNeil method was used to compare associations of AF with incident HFrEF versus HFpEF.ResultsOver a median of 9 years of follow-up, 1109 HF events occurred (356 HFpEF, 388 HFrEF, 77 mid-range and 288 unclassified). In a model adjusted for sociodemographics, cardiovascular risk factors, and incident coronary heart disease, AF was associated with increased risk of all HF events (HR 1.67, 95% CI 1.38 to 2.01). The associations of AF with HFrEF versus HFpEF events did not differ significantly (HR 1.87 (95% CI 1.38 to 2.54) and HR 1.65 (95% CI 1.20 to 2.28), respectively; p value for difference=0.581). These associations were consistent in sex and race subgroups.ConclusionsAF is associated with both HFrEF and HFpEF events, with no significant difference in the strength of association among these subtypes.
Gradient changes in bioprosthetic valve thrombosis: duration of anticoagulation and strategies to improve detection
Authors: Naser Jwan A , Petrescu Ioana , Ionescu Filip , Nkomo Vuyisile T , Pislaru Cristina , Schaff Hartzell V , Pellikka Patricia A , Connolly Heidi M , Egbe Alexander C , Pislaru Sorin V 
Published: May 2021

ObjectiveBioprosthetic valve thrombosis (BPVT) is increasingly recognised as a major cause of prosthetic dysfunction in the first years postimplantation. How early abnormal gradients can be detected prior to diagnosis and how fast they normalise with anticoagulant therapy is unknown. We set forth to (1) evaluate patterns of increase in gradients prior to BPVT diagnosis and (2) characterise time-course of response to anticoagulation.MethodsPatients treated with warfarin for BPVT (1999–2019) with clinically significant reduction of mean gradients (≥25%) were identified retrospectively. Recovery was defined as gradient decrease ≥50%, to postimplantation or to normal-range gradients per position, model and size. Time-to-BPVT (implantation—BPVT diagnosis), potential diagnostic delay (first abnormal gradient by position, model and size—BPVT diagnosis) and time-to-recovery (BPVT diagnosis—complete resolution) were recorded.Results77 patients were identified; 32 (42%) aortic (23 surgical—12 porcine, 11 pericardial; 9 transcatheter); 24 (31%) mitral; 21 (27%) tricuspid. Median time-to-BPVT was 24, 21 and 10 months, respectively. Potential diagnostic delay was median 21 months for aortic, 4 months for mitral, but 0 for tricuspid. Recovery was significantly faster in mitral than aortic (median 2.5 vs 4.8 months, p=0.038) and tricuspid (median 5.9 months, p=0.025) positions. Porcine aortic valves responded faster than pericardial aortic valves (median 2.9 vs 20.3 months, p=0.004).ConclusionGradients start to increase months before the clinical BPVT diagnosis. Recovery is faster in mitral and surgical aortic porcine valves; a longer warfarin trial seems indicated in tricuspid and surgical aortic pericardial valves.
Flexor Synovectomy as an Adjunct to Carpal Tunnel Release in Primary Carpal Tunnel Syndrome: A Meta-Analysis
Authors: Chiang Jenny , An Vincent Vinh Gia , Graham David , Lawson Richard , Sivakumar Brahman 
Published: May 2021

Background: Carpal tunnel release (CTR) aims to achieve surgical decompression of the median nerve for the treatment of carpal tunnel syndrome (CTS). Flexor tenosynovectomy (FS) has been carried out as an adjunct to routine CTR, on the basis that chronic flexor tenosynovitis has been implicated as an etiological factor in idiopathic CTS. However, the benefits of this additional procedure remains unclear. As such, we aimed to compare functional outcomes, nerve function and complication rates from CTR with and without FS. Methods: A systematic review of published literature was performed for original data English language studies comparing outcomes of CTR with and without FS in the treatment of primary CTS. Mean weighted differences and their 95% confidence interval were used for analysis. Results: Three studies comprising 292 wrists were included. Meta-analysis showed no improvement in post-operative grip strength, symptom severity score, functional status score, median nerve motor latency or major complications with FS. Recurrence rate was not reported in the 3 selected articles. Conclusions: The available evidence suggests FS is an unnecessary adjunct which provides no benefit to CTR, and should not be used routinely to treat primary CTS. Larger studies are needed to validate our findings. FS may have a role in recurrent or secondary CTS.
Outcomes of Unconstrained Proximal Interphalangeal Joint Arthroplasty: A Systematic Review
Authors: Kulkarni Kunal , Sheikh Nomaan , Aujla Randeep , Divall Pip , Dias Joseph 
Published: May 2021

Background: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants and arthrodesis. This systematic review appraises their outcomes. Methods: 30 studies comprising 1,324 joints (813 pyrocarbon, 511 MoP) were included. Mean patient age was 59 years (38 to 78) and mean follow-up period was 54 months (1.2 to 380). Results: There were mean improvements of 4.5 points (2 to 6.9) in pain Visual Analogue Score, 10.5° (−26 to 58) in range of motion (ROM), 3.1 kg (−4 to 7) in grip strength, 0.6 kg (−1.5 to 2) in pinch strength, and 18 points (−3 to 29) in the Disabilities of the Arm, Shoulder and Hand score, with no significant differences between implant types. ROM gains, in particular, deteriorated over time. Clinical complications were frequent (23%), and significantly more common with pyrocarbon, as were radiographic complications. However, most were mild-moderate and did not necessarily correlate with negative outcomes or dissatisfaction. Overall reoperation rate was 21%, and revision rate 11%, both more frequent with pyrocarbon. Most revisions were within 24 months, beyond which survival was maintained up to ten years. Conclusions: Unconstrained PIP joint arthroplasty is effective at improving pain scores, active ROM, grip/pinch strength, and patient reported outcome measures, particularly in patients with osteoarthritis. Results are generally maintained at least to the medium term, although gains diminish in the longer term. Complication and early revision rates are high, particularly with pyrocarbon implants. The majority of patients express positive attitudes to arthroplasty, with significant improvements in patient-reported outcome measures for both pyrocarbon and MoP implants. Patients with post-traumatic and inflammatory arthropathy are generally less satisfied. There is currently insufficient data to recommend one implant type over another, although the early-to-medium term results of MoP implants are promising. Prospective surveillance via small joint registries is recommended.
Single-Cell Epigenomics and Functional Fine-Mapping of Atherosclerosis GWAS Loci
Authors: Örd Tiit , Õunap Kadri , Stolze Lindsey K. , Aherrahrou Redouane , Nurminen Valtteri , Toropainen Anu , Selvarajan Ilakya , Lönnberg Tapio , Aavik Einari , Ylä-Herttuala Seppo , Civelek Mete , Romanoski Casey E. , Kaikkonen Minna U. 
Published: May 2021

Rationale:
Genome-wide association studies have identified hundreds of loci associated with coronary artery disease (CAD). Many of these loci are enriched in cisregulatory elements but not linked to cardiometabolic risk factors nor to candidate causal genes, complicating their functional interpretation.

Objective:
Single-nucleus chromatin accessibility profiling of the human atherosclerotic lesions was used to investigate cell type–specific patterns of cisregulatory elements, to understand transcription factors establishing cell identity, and to interpret CAD-relevant, noncoding genetic variation.

Methods and Results:
We used single-nucleus ATAC-seq (assay for transposase-accessible chromatin with sequencing) to generate DNA accessibility maps in >7000 cells derived from human atherosclerotic lesions. We identified 5 major lesional cell types including endothelial cells, smooth muscle cells, monocyte/macrophages, natural killer/T cells, and B cells and further investigated subtype characteristics of macrophages and smooth muscle cells transitioning into fibromyocytes. We demonstrated that CAD-associated genetic variants are particularly enriched in endothelial and smooth muscle cell–specific open chromatin. Using single-cell coaccessibility and cis–expression quantitative trait loci information, we prioritized putative target genes and candidate regulatory elements for ≈30% of all known CAD loci. Finally, we performed genome-wide experimental fine-mapping of the CAD variants identified in genome-wide association studies using epigenetic quantitative trait loci analysis in primary human aortic endothelial cells and self-transcribing active regulatory region sequencing (STARR-Seq) massively parallel reporter assay in smooth muscle cells. This analysis identified potential causal single-nucleotide polymorphisms (SNPs) and the associated target gene for over 30 CAD loci. We present several examples where the chromatin accessibility and gene expression could be assigned to one cell type predicting the cell type of action for CAD loci.

Conclusions:
These findings highlight the potential of applying single-nucleus ATAC-seq to human tissues in revealing relative contributions of distinct cell types to diseases and in identifying genes likely to be influenced by noncoding genome-wide association study variants.
The Global Satellite Precipitation Constellation: Current Status and Future Requirements
Authors: Kidd Chris , Huffman George , Maggioni Viviana , Chambon Philippe , Oki Riko 
Published: May 2021

AbstractTo address the need to map precipitation on a global scale, a collection of satellites carrying passive microwave (PMW) radiometers has grown over the last 20 years to form a constellation of about 10–12 sensors at any one time. Over the same period, a broad range of science and user communities has become increasingly dependent on the precipitation products provided by these sensors. The constellation presently consists of both conical and cross-track-scanning precipitation-capable multichannel instruments, many of which are beyond their operational and design lifetime but continue to operate through the cooperation of the responsible agencies. The Group on Earth Observations and the Coordinating Group for Meteorological Satellites (CGMS), among other groups, have raised the issue of how a robust, future precipitation constellation should be constructed. The key issues of current and future requirements for the mapping of global precipitation from satellite sensors can be summarized as providing 1) sufficiently fine spatial resolutions to capture precipitation-scale systems and reduce the beam-filling effects of the observations; 2) a wide channel diversity for each sensor to cover the range of precipitation types, characteristics, and intensities observed across the globe; 3) an observation interval that provides temporal sampling commensurate with the variability of precipitation; and 4) precipitation radars and radiometers in low-inclination orbit to provide a consistent calibration source, as demonstrated by the first two spaceborne radar–radiometer combinations on the Tropical Rainfall Measuring Mission (TRMM) and Global Precipitation Measurement (GPM) mission Core Observatory. These issues are critical in determining the direction of future constellation requirements while preserving the continuity of the existing constellation necessary for long-term climate-scale studies.
The large-scale, long-term coupling of temperature, hydrology, and water isotopes
Authors: Siler Nicholas , Bailey Adriana , Roe Gerard H. , Buizert Christo , Markle Bradley , Noone David 
Published: May 2021

AbstractThe stable isotope ratios of oxygen and hydrogen in polar ice cores are known to record environmental change, and they have been widely used as a paleothermometer. Although it is known to be a simplification, the relationship is often explained by invoking a single condensation pathway with progressive distillation to the temperature at the location of the ice core. In reality, the physical factors are complicated, and recent studies have identified robust aspects of the hydrologic cycle’s response to climate change that could influence the isotope-temperature relationship. In this study, we introduce a new zonal-mean isotope model derived from radiative transfer theory, and incorporate it into a recently developed moist energy balance climate model (MEBM), thus providing an internally consistent representation of the tight physical coupling between temperature, hydrology, and isotope ratios in the zonal-mean climate. The isotope model reproduces the observed pattern of meteoric δ18O in the modern climate, and allows us to evaluate the relative importance of different processes for the temporal correlation between δ18O and temperature at high latitudes. We find that the positive temporal correlation in polar ice cores is predominantly a result of suppressed high-latitude evaporation with cooling, rather than local temperature changes. The same mechanism also explains the difference in the strength of the isotope-temperature relationship between Greenland and Antarctica.
Adaptation confusion? A longitudinal examination of the concept “climate change adaptation” in Norwegian municipal surveys.
Authors: Selseng Torbjørn , Klemetsen Marit , Rusdal Tone 
Published: May 2021

AbstractIn recent decades, there has been a surge in the scholarship on climate change adaptation (CCA) terminology and diverging interpretations of the term has emerged. Given the crucial role of local governments in building society-wide adaptive capacity, understanding how municipalities understand and interpret CCA, is important. In this study, we analyse twelve large-scale questionnaires from 2007 to 2020 distributed to all Norwegian municipalities. Using a combination of directed and conventional content analysis of the questions and answers, we summarise and map the progress of adaptation work over the 14 years and assess the consistency and the scope of the surveys in light of the current research on climate adaptation. We find diverging views on what adaptation entails, both from the researchers, in the phrasing of questions, and from the respondents. The empirical evidence suggests an overall imbalanced interpretation of CCA, both in terms of the risks and consequences we may face, the climate that needs adapting to, as well as adequate adaptation strategies. We go on to discuss the implications of these findings, highlighting the need for a shared and well-communicated framework for local CCA and a closer monitoring of the actual efforts of the municipalities. If instead left unchecked, this confusion might lead to unsustainable maladaptation at the local government level throughout Norway and beyond.
Structural Change, Balance of Payments Constraint, and Economic Growth: Evidence from Vietnam
Authors: Lee Woocheol 
Published: May 2021

The impact of demand-side factors and rapid structural changes have largely been ignored in explaining the economic growth of Vietnam. This paper employs the multisectoral balance-of-payments constrained economic growth model to capture the influence of structural changes on the exports and economic growth of Vietnam over the period 1997–2016. Based on the estimates for the sectoral income elasticities of demand for exports and imports obtained from autoregressive distributed lag models, this paper argues that it is not relative prices but income that has played a significant role in Vietnam’s economic growth, the income elasticities of demand for exports have grown faster than those of demand for imports, and the weight of exports has significantly moved from primary to high-technology products. JEL Classification: E12, F43, O53
The Diagnostic Yield of Magnetic Resonance Cholangiopancreatography in the Setting of Acute Pancreaticobiliary Disease — A Single Center Experience
Authors: Yahya Sultan , Alabousi Abdullah , Abdullah Peri , Ramonas Milita 
Published: May 2021

Purpose: To discern whether preceding ultrasound (US) results, patient demographics and biochemical markers can be implemented as predictors of an abnormal Magnetic Resonance Cholangiopancreatography (MRCP) study in the context of acute pancreaticobiliary disease. Methods: A retrospective study was performed assessing US results, age, gender, elevated lipase and biliary enzymes for consecutive patients who underwent an urgent MRCP following an initial US for acute pancreaticobiliary disease between January 2017-December 2018. Multivariable binary logistic regression models were constructed to assess for predictors of clinically significant MRCPs, and discrepant US/MRCP results. Results: A total of 155 patients (mean age 56, 111 females) were included. Age (OR 1.03, P < 0.05), hyperlipasemia (OR 5.33, P < 0.05) and a positive US (OR 40.75, P < 0.05) were found to be independent predictors for a subsequent abnormal MRCP. Contrarily, gender and elevated biliary enzymes were not reliable predictors of an abnormal MRCP, or significant MRCP/US discrepancies. Of 66 cases (43%) of discordant US/MRCPs, half had clinically significant discrepant findings such as newly discovered choledocholithiasis and pancreaticobiliary neoplasia. Age was the sole predictor for a significant US/MRCP discrepancy, with 2% increase in the odds of a significant discrepancy per year of increase in age. Conclusion: An abnormal US, hyperlipasemia and increased age serve as predictors for a subsequent abnormal MRCP, as opposed to gender and biliary enzyme elevation. Age was the sole predictor of a significant US/MRCP discrepancy that provided new information which significantly impacted subsequent management. In the remaining cases, however, MRCP proved useful in reaffirming the clinical diagnosis and avoiding further investigations.
Economic Evaluation of Palliative Care Interventions: A Review of the Evolution of Methods From 2011 to 2019
Authors: Parackal Anna , Ramamoorthi Karishini , Tarride Jean-Eric 
Published: May 2021

Background: End-of-life care is a driver of increasing healthcare costs; however, palliative care interventions may significantly reduce these costs. Economic evaluations that measure the incremental cost per quality adjusted life years (QALY) are warranted to inform cost-effectiveness of the intervention relative to a comparator and permit evaluation of investment against other therapeutic interventions. Evidence from the literature up to 2011 indicates a scarcity of cost-utility studies in palliative care research. Aim: This literature review evaluates economic studies published between 2011 and 2019 to determine whether the methods of economic evaluations have evolved since 2011. Design and Data Sources: A literature search was completed using CENTRAL, OVID MEDLINE, EMBASE and other sources for publications between 2011 and 2019. Study characteristics, methodology and key findings of publications that met the inclusion criteria were reviewed. Quality of studies were assessed using indicators developed by authors of the previous literature review. Results: 46 papers were included for qualitative synthesis. Among them only 6 studies conducted formal cost-effectiveness evaluations-of these 5 measured QALYs and 1 employed probabilistic analyses. In addition, with the exception of 1 costing analysis, all other economic evaluations undertook a healthcare payer perspective. Quality of evidence were comparable to the previous literature review published in 2011. Conclusion: Despite the small increase in the number of cost-utility studies, the methods of palliative care economic evaluations have not evolved significantly since 2011. More probabilistic cost-utility analyses of palliative care interventions from a societal perspective are necessary to truly evaluate the value for money.