bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations of Modified Healthy Aging Index With Major Adverse Cardiac Events, Major Coronary Events, and Ischemic Heart Disease
Authors: Huang Ninghao , Zhuang Zhenhuang , Song Zimin , Wang Wenxiu , Li Yueying , Zhao Yimin , Xiao Wendi , Dong Xue , Jia Jinzhu , Liu Zhonghua , Smith Caren E. , Huang Tao 
Published: March 2023

Background
The Healthy Aging Index (HAI) has been regarded as useful in capturing the health status of multiple organ systems. However, to what extent the HAI is associated with major cardiovascular events remains largely unknown. The authors constructed a modified HAI (mHAI) to quantify the association of physiological aging with major vascular events and explored how the effects of a healthy lifestyle can modify this association.

Methods and Results
The participants with either missing values of any individual mHAI component or major illnesses such as heart attack, angina and stroke, and self‐reported cancer at baseline were excluded. The mHAI components include systolic blood pressure, reaction time, forced vital capacity, serum cystatin c, and serum glucose. The authors used Cox proportional hazard models to quantify the association of mHAI with major adverse cardiac events, major coronary events, and ischemic heart disease. Cumulative incidence at 5 and 10 years was estimated, and joint analyses were stratified by age group and 4 mHAI categories. The mHAI was significantly correlated with major cardiovascular events, which is a better reflection of the aging level of the body than chronological age. An mHAI was calculated in 338 044 participants aged 38 to 73 years in the UK Biobank. Each point increase in the mHAI was associated with a 44% higher risk of major adverse cardiac events (adjusted hazard ratio [aHR], 1.44 [95% CI, 1.40–1.49]), 44% higher risk of major coronary events (aHR, 1.44 [95% CI, 1.40–1.48]), and 36% higher risk of ischemic heart disease (aHR, 1.36 [95% CI, 1.33–1.39]). The percentage of population‐attribution risk was 51% (95% CI, 47–55) for major adverse cardiac events, 49% (95% CI, 45–53) for major coronary events, and 47% (95% CI, 44–50) for ischemic heart disease, which means that a substantial portion of these events could be prevented. Systolic blood pressure was the factor most significantly associated with major adverse cardiac events (aHR, 1.94 [95% CI, 1.82–2.08]; percentage of population‐attribution risk, 36%), major coronary events (aHR, 2.01 [95% CI, 1.85–2.17]; percentage of population‐attribution risk, 38%), and ischemic heart disease (aHR, 1.80 [95% CI, 1.71–1.89]; percentage of population‐attribution risk, 32%). A healthy lifestyle significantly attenuated mHAI associations with incidence of vascular events.

Conclusions
Our findings indicate that higher mHAI is associated with increased major vascular events. A healthy lifestyle may attenuate these associations.
Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke
Authors: Sloane Kelly L. , Kasner Scott E. , Favilla Christopher G. , Rothstein Aaron , Witsch Jens , Hamilton Roy H. , Schneider Andrea L. C. 
Published: March 2023

Background
Psychological health is as an important contributor to recovery after cardiovascular disease, but the roles of both optimism and depression in stroke recovery are not well characterized.

Methods and Results

A total of 879 participants in the SRUP (Stroke Recovery in Underserved Populations) 2005 to 2006 Study, aged ≥50 years, with incident stroke admitted to a rehabilitation facility were included. Optimism was assessed by the question: “Are you optimistic about the future?” Depression was defined by Center for Epidemiologic Studies Depression scale score >16. Participants were categorized into 4 groups: optimistic/without depression (n=581), optimistic/with depression (n=197), nonoptimistic/without depression (n=36), and nonoptimistic/with depression (n=65). Functional Independence Measure scores were used to assess stroke outcomes at discharge, 3 months after discharge, and 1 year after discharge with adjusted linear mixed models to estimate score trajectories. Participants were a mean age of 68 years (SD, 13 years), 52% were women, and 74% were White race. The optimistic/without depression group experienced the most recovery of total Functional Independence Measure scores in the first 3 months, 24.0 (95% CI, 22.5–25.4), followed by no change in the following 9 months, −0.3 (95% CI, −2.3 to 1.7), similar to the optimistic/with depression group with rapid recovery in 0 to 3 months, 21.1 (95% CI, 18.6–23.6) followed by minimal change in 3 to 12 months, 0.7 (95% CI, −2.8 to 4.1). The nonoptimistic groups demonstrated slow but continued recovery throughout the 12‐month period, with overall change, 25.4 (95% CI, 17.6–33.2) in the nonoptimistic/without depression group and 17.6 (95% CI, 12.0–23.1) in the nonoptimistic/with depression group. There was robust effect modification between optimism and depression (
P
interaction
<0.001).

Conclusions
In this longitudinal cohort, optimism and depression are synergistically associated with functional recovery after stroke. Measuring optimism status may help identify individuals at risk for worse poststroke recovery.
Antithrombotic Treatment, Prehospital Blood Pressure, and Outcomes in Spontaneous Intracerebral Hemorrhage
Authors: Larsen Kristin Tveitan , Sandset Else Charlotte , Selseth Maiken Nordahl , Jahr Silje Holt , Koubaa Nojoud , Hillestad Vigdis , Kristoffersen Espen Saxhaug , Rønning Ole Morten 
Published: March 2023

Background
In acute intracerebral hemorrhage, both elevated blood pressure (BP) and antithrombotic treatment are associated with poor outcome. Our aim was to explore interactions between antithrombotic treatment and prehospital BP.

Methods and Results

This observational, retrospective study included adult patients with spontaneous intracerebral hemorrhage diagnosed by computed tomography within 24 hours, admitted to a primary stroke center during 2012 to 2019. The first recorded prehospital/ambulance systolic and diastolic BP were analyzed per 5 mm Hg increment. Clinical outcomes were in‐hospital mortality, shift on the modified Rankin Scale at discharge, and mortality at 90 days. Radiological outcomes were initial hematoma volume and hematoma expansion. Antithrombotic (antiplatelet and/or anticoagulant) treatment was analyzed both together and separately. Modification of associations between prehospital BP and outcomes by antithrombotic treatment was explored by multivariable regression with interaction terms. The study included 200 women and 220 men, median age 76 (interquartile range, 68–85) years. Antithrombotic drugs were used by 252 of 420 (60%) patients. Compared with patients without, patients with antithrombotic treatment had significantly stronger associations between high prehospital systolic BP and in‐hospital mortality (odds ratio [OR], 1.14 versus 0.99,
P
for interaction 0.021), shift on the modified Rankin Scale (common OR, 1.08 versus 0.96,
P
for interaction 0.001), and hematoma volume (coef. 0.03 versus −0.03,
P
for interaction 0.011).

Conclusions
In patients with acute, spontaneous intracerebral hemorrhage, antithrombotic treatment modifies effects of prehospital BP. Compared with patients without, patients with antithrombotic treatment have poorer outcomes with higher prehospital BP. These findings may have implications for future studies on early BP lowering in intracerebral hemorrhage.
Using Epidemiological Data to Inform Clinical Trial Feasibility Assessments: A Case Study
Authors: Stanton Robert J. , Robinson David J. , Aziz Yasmin N. , Sucharew Heidi , Khatri Pooja , Broderick Joseph P. , Janis L. Scott , Kemp Stephanie , Mlynash Michael , Lansberg Maarten G. , Albers Gregory W. , Saver Jeffrey L. , Flaherty Matthew L. , Adeoye Opeolu , Woo Daniel , Ferioli Simona , Kissela Brett M. , Kleindorfer Dawn O. 
Published: March 2023

Background:
Clinical trial enrollment and completion is challenging, with nearly half of all trials not being completed or not completed on time. In 2014, the National Institutes of Health StrokeNet in collaboration with stroke epidemiologists from GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study) began providing proposed clinical trials with formal trial feasibility assessments. Herein, we describe the process of prospective feasibility analyses using epidemiological data that can be used to improve enrollment and increase the likelihood a trial is completed.

Methods:
In 2014, DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) trialists, National Institutes of Health StrokeNet, and stroke epidemiologists from GCNKSS collaborated to evaluate the initial inclusion/exclusion criteria for the DEFUSE 3 study. Trial criteria were discussed and an assessment was completed to evaluate the percent of the stroke population that might be eligible for the study. The DEFUSE 3 trial was stopped early with the publication of DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct), and the Wilcoxon rank-sum statistic was used to analyze whether the trial would have been stopped had the proposed changes not been made, following the DEFUSE 3 statistical analysis plan.

Results:
After initial epidemiological analysis, 2.4% of patients with acute stroke in the GCNKSS population would have been predicted to be eligible for the study. After discussion with primary investigators and modifying 4 key exclusion criteria (upper limit of age increased to 90 years, baseline modified Rankin Scale broadened to 0–2, time since last well expanded to 16 hours, and decreased lower limit of National Institutes of Health Stroke Scale score to <6), the number predicted to be eligible for the trial increased to 4%. At the time of trial conclusion, 57% of the enrolled patients qualified only by the modified criteria, and the trial was stopped at an interim analysis that demonstrated efficacy. We estimated that the Wilcoxon rank-sum value for the unadjusted predicted enrollment would not have crossed the threshold for efficacy and the trial not stopped.

Conclusions:
Objectively assessing trial inclusion/exclusion criteria using a population-based resource in a collaborative and iterative process including epidemiologists can lead to improved recruitment and can increase the likelihood of successful trial completion.
Assessing Disparities in Access to Advanced Stroke Care in 4 Northeastern States Using the Social Vulnerability Index
Authors: Isenberg Derek L. , Isenberg Raluca , Henry Kevin A. , Kraus Chadd K. , Ackerman Daniel , Sigal Adam , Herres Joseph , Brandler Ethan S. , Kuc Alexander , Nomura Jason T. , Cooney Derek R. , Gentile Nina T. 
Published: March 2023

Background
Access to endovascular stroke centers (ESCs) is crucial for patients to receive optimal care for large‐vessel occlusion strokes. Disparities in stroke care are well documented, including differences in patients who receive intravenous thrombolysis and endovascular therapy. Here, we describe racial, ethnic, sex, and social disparities in access to ESCs using the Social Vulnerability Index (SVI), a composite measure of a community's health.

Methods
This is a population‐based study of 4 Northeastern states. We geocoded all ESCs in New York, New Jersey, Pennsylvania, and Delaware and calculated the distance from the centroid of each census tract to the nearest ESC. We then used the US Centers for Disease Control's Social Vulnerability Index and its 4 subcomponents to calculate the health of that census tract. Results are presented as mean drive times by quartile of SVI (quartile 1=least vulnerable, quartile 4=most vulnerable) and the mean SVI dichotomized to census tracts located less than and greater than 60 minutes to the nearest ESC.

Results
A total of 42 000 000 people and 10 000 census tracts were included in our data. There were no significant differences in the mean SVI for census with drive times of <60 minutes versus >60 minutes to the nearest ESC. However, there were significant differences in 2 subcomponents of the SVI: Minority Status & Language and Household Composition & Disability. In the Minority Status subcomponent of the SVI, those in the most vulnerable census tracts (quartile 4) were located closest to ESCs compared with the least vulnerable census tracts (quartile 1), while for the Household Composition subcomponent, the most vulnerable census tracts were located farthest from the ESCs.

Conclusion
The SVI is a valuable tool for assessing disparities in access to advanced stroke care and predicting where additional ESCs should be added to benefit the population as a whole.
A Novel Preoperative Patient Survey Predicts Adverse Patient Outcomes—Implementation and Preliminary Results of the Tennessee Preoperative Assessment Tool
Authors: Schmocker Ryan K. , Gray Keith D. , Eric Heidel R. , Vanterpool Stephanie G. , McLoughlin James M. 
Published: March 2023

Background Accurate preoperative risk stratification remains elusive. Existing tools are often missing important patient-reported and functional factors. We sought to implement a novel tool, with dynamic functional data and comorbidity variables, to define factors which predict postoperative outcomes. Materials and Methods We expanded a previously validated functional questionnaire to create the Tennessee Preoperative Assessment Tool (TPAT). Unique elements included change in functional status, usual and best activity tolerance, and development of new conditions. The survey was administered to all new patients seen in several surgery clinics from July 2021 to June 2022. Results A total of 1950 patients completed the survey. Of the completed surveys, 197 patients underwent an elective, inpatient, abdominal surgery and were included in the study. Several patient-reported factors were associated with poor postoperative outcomes. For example, decrease in functional activity in the previous 60 days (n = 50; 25.4%) was a strong predictor of poor postoperative outcomes including readmission (30-day: 8.8% vs .0%; P = .034), wound dehiscence (12.0% vs 3.4%; P = .022), blood transfusion (6.0% vs .0%; P = .003), sepsis (4.0% vs .0%; P = .015), and wound infection (18.0% vs 6.8%; P = .076). Discussion In this preliminary implementation study, patients undergoing elective, inpatient, abdominal surgery, utilization of a novel, patient-reported survey tool proactively identifies patients at risk of clinically relevant postoperative outcomes. Patient-reported decreased activity in the 60 days prior to surgeon evaluation was associated with several adverse postoperative outcomes. Additionally, this study demonstrates that the TPAT can be seamlessly integrated into the usual clinical workflow and is hypothesis generating for future interventional studies.
Congenital Lobar Emphysema Developing Massive Hemoptysis in Adulthood Treated by Thoracoscopic Lobectomy
Authors: McNamee Molly M. , Harvell Robert T. , Benton Mary H , Qutob Hisham F. , Budde Jason M. 
Published: March 2023

Congenital lobar emphysema (CLE) is a rare developmental lung disorder characterized by lobar hyperinflation secondary to bronchopulmonary obstruction. Half of patients are symptomatic at birth, with many requiring urgent or emergent surgical resection to treat respiratory distress. Meanwhile, patients achieving late childhood or adolescence without symptoms usually never require surgery. We present a case of a 26 year old otherwise healthy female with known CLE who developed massive hemoptysis and required urgent videoscopic (VATS) resection of her right lung upper lobe. We know of no other report of CLE causing life-threatening bleeding at any age, and herein review pathology and pathophysiology of the condition.
A National Survey Assessing the Variability in the Management of Traumatic Cardiac Arrest
Authors: Roche Keelin F. , Quinn Megan , Mannino Elizabeth A. , Ventura Liane , Brown Cecelia , Lawson Christy M. , Burns Bracken J. 
Published: March 2023

Background Resuscitation of traumatic cardiac arrest (TCA) is variable, with approaches that overlap Advanced Trauma Life Support (ATLS) and Advanced Cardiac Life Support (ACLS) algorithms. There is no standard algorithm for TCA, with some withholding ACLS protocols given abysmal outcomes. This study aims to assess surgeon practices and attitudes toward resuscitation practices in TCA. Materials and Methods A 16-question web-based survey was distributed to the membership of a national trauma association. Respondent demographics and management of TCA were analyzed. Chi-squared tests determined statistical significance. Open-ended responses were coded and analyzed inductively. Results Two hundred and three surveys were completed. 73.4% of respondents reported utilizing ACLS, while 26.6% reported they never utilized ACLS. A statistically significant difference in the performance of ACLS was found based on number of years in practice ( P = .025) and the state of practice ( P = .006). There was no significant difference in self-reported survival rates or legal, ethical, or interpersonal conflicts. Qualitative data highlighted themes of interpersonal conflict and futility. Discussion This study shows that one-quarter of respondents never utilize ACLS in TCA. Of those that utilize ACLS, there was variability in the technique, indication, and duration of resuscitation. Despite significant variability in technique, there appears to be similar survival rates and incidence of conflict. The association between years in practice and ACLS use suggests this may represent an emerging change in practice. The low response rate limits generalizability; however, there is significant variability in practice, highlighting a need for evidence-based guidelines.
Small Bowel Intussusception Secondary to Malignant Melanoma 11 Years After Melanoma-In-Situ Excision
Authors: Briscoe W. Eric , Cockerham W. Todd , Harrell Kevin N. 
Published: March 2023

Small bowel is a well-described site of malignant melanoma; however, it is a rare cause of intussusception. A patient presented with malignant melanoma causing jejunojejunal intussusception 11 years after resection of melanoma-in-situ. The patient was managed with exploration and resection. Despite complete resection of melanoma-in-situ and limited literature about its metastatic potential, malignant melanoma as a lead point for intussusception should be on the differential for any patient with pertinent history. To our knowledge, this appears to be the first case of melanoma-in-situ causing small bowel intussusception.
Public auditing: What impact does the quality of the institutional framework have on the level of corruption?
Authors: Nonki Tadida Eriole Zita 
Published: March 2023

Supreme audit institutions (SAIs) are a component of a nation's institutional system. This article defines the concept of an institutional anti-corruption system centered on the SAI through four main characteristics: independence, accountability, mandate and collaboration. The article aims to assess the impact that the quality of the anti-corruption system has on perceived levels of corruption. Data from the 2019 International Budget Partnership Open Budget Survey covering 117 countries are used for this purpose. The regression results show that the quality of the institutional anti-corruption system centered on the SAI is associated with a low level of perceived corruption. However, other elements must be implemented to create an anti-corruption environment, such as citizens’ involvement as controlling actors. Points for practitioners It is important that policy makers recognize and leverage the potential of SAIs in reducing corruption. Contemporary governance and the complexity of corruption require the protection of SAI's independence, but also call for the establishment of collaborative mechanisms that engage civil society and the media.
Comparison of two surgical strategies for fractures of the anterior process of the calcaneus with or without bridging plate fixation
Authors: Hua Xi , Zhang Junxin , Liu Hao , Guan Yuehong , Chen Kangwu , Qian Zhonglai 
Published: March 2023

Objective To evaluate the therapeutic effects of applying internal fixation with a T-shaped locking plate that was used on the distal radius in fractures of the anterior process of the calcaneus (APC) with calcaneocuboid (CC) joint injury. Methods This retrospective study enrolled adult patients diagnosed with APC with CC joint injury that had received internal fixation with a T-shaped locking plate of the distal radius. Group NA underwent open reduction with ‘not-across’ CC joint plate fixation; and group A underwent open reduction with ‘across’ CC joint locking plate fixation. The outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, a visual analogue scale (VAS) pain score and radiological evaluations. Results A total of 72 patients were enrolled in the study; 36 in each group. At 1 month after surgery, the outcomes of group NA were superior to group A in terms of AOFAS and VAS scores. Compared with group A, group NA showed significantly lower intraoperative blood loss, operation time and length of hospital stay. There were no significant differences in the postoperative improvement of Bolher's and Gissane's angles between the two groups. Conclusion Early functional recovery was faster in group NA than group A.
Enhanced recovery concepts in paediatric patients who underwent appendectomy: a retrospective cohort study at a tertiary university hospital
Authors: Al-Taher Raed , Alshahwan Hebah , Abdelhadi Saja , Abeeleh Farah Abu , Rashdan Mohammad , Amarin Marzouq , Addasi Rami , Alsaraireh Doha , Abu-shanab Ahmad , Alaridah Nader 
Published: March 2023

Objective To investigate if the implementation of enhanced recovery after surgery (ERAS) pathways could be effective in paediatric patients undergoing appendectomy. Methods This retrospective study analysed the data from patients aged ≤18 years that underwent appendectomies. The data collected included age, sex, application of enhanced recovery concepts (ERCs) and clinical outcomes. Results A total of 93 paediatric patients were retrospectively categorized into two groups: patients in group 1 did not experience the use of ERCs during their appendectomies; and patients in group 2 had ERCs applied during their appendectomies. Patients in both groups were exposed to some elements of ERAS, including preoperative patient/parent counselling, limited fasting durations, antibiotic prophylaxis and no bowel preparations. Duration of hospital stay was significantly longer in group 1 compared with group 2 (3.47 ± 1.81 days versus 2.24 ± 1.52 days, respectively. There were no significant differences between the two groups in term of postoperative pain control, hospital cost, readmissions, reoperations and emergency room visits. Conclusion Implementing ERCs in paediatric patients undergoing appendectomies provided a significant improvement in patient recovery with a shorter hospital stay, with no increase in postoperative pain, hospital cost, rate of readmission and reoperation.