Risk factor burden, heart failure, and survival in women of different ethnic groups insights from the women's health initiative

BACKGROUND: The higher risk of heart failure (HF) in African-American and Hispanic women compared with white women is related to the higher burden of risk factors (RFs) in minorities. However, it is unclear if there are differences in the association between the number of RFs for HF and the risk of development of HF and death within racial/ethnic groups. METHODS AND RESULTS: In the WHI (Women's Health Initiative; 1993-2010), African-American (n=11996), white (n=18479), and Hispanic (n=5096) women with 1, 2, or 3+ baseline RFs were compared with women with 0 RF within their respective racial/ethnic groups to assess risk of developing HF or all-cause mortality before and after HF, using survival analyses. After adjusting for age, socioeconomic status, and hormone therapy, the subdistribution hazard ratio (95% confidence interval) of developing HF increased as number of RFs increased (P<0.0001, interaction of race/ethnicity and RF number P=0.18)-African-Americans 1 RF: 1.80 (1.01-3.20), 2 RFs: 3.19 (1.84-5.54), 3+ RFs: 7.31 (4.26-12.56); Whites 1 RF: 1.27 (1.04-1.54), 2 RFs: 1.95 (1.60-2.36), 3+ RFs: 4.07 (3.36-4.93); Hispanics 1 RF: 1.72 (0.68-4.34), 2 RFs: 3.87 (1.60-9.37), 3+ RFs: 8.80 (3.62-21.42). Risk of death before developing HF increased with subsequent RFs (P<0.0001) but differed by racial/ethnic group (interaction P=0.001). The number of RFs was not associated with the risk of death after developing HF in any group (P=0.25; interaction P=0.48). CONCLUSIONS: Among diverse racial/ethnic groups, an increase in the number of baseline RFs was associated with higher risk of HF and death before HF but was not associated with death after HF. Early RF prevention may reduce the burden of HF across multiple racial/ethnic groups

Accounting for International War: The State of the Discipline

In studies of war it is important to observe that the processes leading to so frequent an event as conflict are not necessarily those that lead to so infrequent an event as war. Also, many models fail to recognize that a phenomenon irregularly distributed in time and space, such as war, cannot be explained on the basis of relatively invariant phenomena. Much research on periodicity in the occurrence of war has yielded little result, suggesting that the direction should now be to focus on such variables as diffusion and contagion. Structural variables, such as bipolarity, show contradictory results with some clear inter-century differences. Bipolarity, some results suggest, might have different effects on different social entities. A considerable number of studies analysing dyadic variables show a clear connection between equal capabilities among contending nations and escalation of conflict into war. Finally, research into national attributes often points to strength and geographical location as important variables. In general, the article concludes, there is room for modest optimism, as research into the question of war is no longer moving in non-cumulative circles. Systematic research is producing results and there is even a discernible tendency of convergence, in spite of a great diversity in theoretical orientations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69148/2/10.1177_002234338101800101.pd

Muslim-non-Muslim marriage, rights and the state in Southeast Asia

Muslim-Non-Muslim Marriage: Political and Cultural Contestations in Southeast Asia1-3

Preface

Muslim-Non-Muslim Marriage: Political and Cultural Contestations in Southeast Asiavii-vii

Muslim-non-Muslim marriage: Political and cultural contestations in Southeast Asia

Muslim-Non-Muslim Marriage: Political and Cultural Contestations in Southeast Asia1-32

Tai Chi (sic) Pedicle Screw Placement for Severe Scoliosis

Study Design: Retrospective. Objective: To evaluate the clinical safety and accuracy of the Tai Chi (sic) technique for placing pedicle screws, without intraoperative radiographic imaging, in severe scoliotic spines. Summary of Background Data: The current techniques for pedicle screw placement have a number of drawbacks in cases of severe scoliosis, including difficulty or impossibility to use, delayed operative time, requiring the presence of trained personnel for the duration of the surgery, high cost issues, increased radiation exposure, and technical challenges. No previous report has described the application of the Tai Chi pedicle screw placement technique for severe scoliosis. Material and Methods: Between 2006 and 2008, the cases of 39 consecutive patients with severe scoliosis (Cobb angle >100 degrees) who underwent posterior correction and stabilization (from T1 to L5) using 992 transpedicular screws were examined. The mean patient age was 25.7 (range, 11 to 63) years at the time of surgery. Pedicle screws were inserted by the Tai Chi technique using anatomic landmarks and preoperative radiographs as a guide. Tai Chi drilling fully utilizes the natural anatomic and physical characteristics of pedicles and unconstrained circular force. By nature, a drill bit driven by unconstrained circular force would migrate within the pedicle along a path of least resistance, advancing along the central cancellous bone tunnel spontaneously. Accurate drilling was achieved by following the nature and sticking to the hand sensation when the drill bit broke through the cancellous bone. The total time for inserting all pedicle screws in each case was recorded. Postoperative computed tomography scans were performed to evaluate the position of the inserted pedicle screws. The screw position was classified as &quot;in&quot; or &quot;out.&quot; The distance of perforation was measured. Result: The average Cobb angle was 127 degrees (range, 100 to 153 degrees). The number of screws inserted at each level were as follows: T-1 (n = 10), T-2 (n = 34), T-3 (n = 46), T-4 (n = 53), T-5 (n = 61), T-6 (n = 69), T-7 (n = 75), T-8 (n = 76), T-9 (n = 76), T-10 (n = 77), T-11 (n = 76), T-12 (n = 78), L-1 (n = 77), L-2 (n = 68), L-3 (n = 56), L-4 (n = 38), and L-5 (n = 22). There were 923 (93%) &quot;in&quot; screws and 69 (7%) &quot;out&quot; screws. The overall accuracy of screw placement was 93%. There were no neurological, vascular, or visceral complications. No screws required postoperative repositioning. The average time for pedicle screw placement was 73 seconds. Conclusions: Our findings suggest that the Tai Chi pedicle screw placement technique, which does not require intraoperative radiographic imaging, is an accurate, reliable, safe, and timesaving method of placing pedicle screws in severe scoliotic spines

Quality Control of Reconstructed Sagittal Balance for Sagittal Imbalance

Study Design. Prospective radiographic study. Objective. To investigate the feasibility of controlling quality of reconstructed sagittal balance for sagittal imbalance. Summary of Background Data. Patients with sagittal imbalance cannot walk or stand erect without overwork of musculature because of compromised biomechanical advantage. The result is muscle fatigue and activity-related pain. During reconstructive surgery, restoration of optimal sagittal balance is crucial for obtaining satisfactory clinical results. However, there is no way to control quality of reconstructed sagittal balance before or during surgery. Methods. A method was developed to determine the lumbosacral curve in a way that theoretically would bring sagittal balance to an ideal state by calculation and simulation for each patient before surgery and then template rods of the curve and a blueprint were made accordingly for operative procedures. Ninety-four consecutive patients with sagittal imbalance due to lumbar kyphosis were treated for intractable pain and then followed up for a mean of 4.3 years. Radiographs were analyzed before surgery, 2 months after surgery, and at most recent follow-up. Results. The mean estimated values of L1-S1 lordosis, sacral inclination angle, sacrofemoral distance, and distribution of L1-S1 lordosis at the closing-opening wedge osteotomy site and L4-S1 segments were -30.8 degrees, 24.6 degrees, 0 mm, 16.1% (-5 degrees), and 62% (-19 degrees), respectively. The mean reconstructed values were -41.1 degrees, 23.3 degrees, 3.9 mm, 41% (-17 degrees), and 46% (-19 degrees), respectively. There were significant differences between estimated and reconstructed values of L1-S1 lordosis and the percentage of distributions; however, there was no significant difference between the estimated and reconstructed magnitude of L4-S1 lordosis, sacral inclination angle, and sacrofemoral distance. A properly oriented pelvis can be brought nearly directly above the hip axis. The mean sagittal global balance, represented by the distance between the vertical line through the hip axis and sacral promontory, improved from 61.4 mm before surgery to 3.9 mm 2 months after surgery, and 1.3 mm at final follow-up. Normal sagittal global balance was reconstructed and maintained. The mean sagittal spinal balance measured as the horizontal distance between the C7 sagittal plumb line and the posterior superior corner of S1 improved from 97.4 mm before surgery to 11 mm 2 months after surgery. However, there was significant loss of sagittal spinal balance to 25.4 mm at the final visit. Normal sagittal spinal balance was reconstructed and appeared to be maintained. The magnitude of T1-T12 kyphosis compensated from 13 degrees before surgery to 25.2 degrees 2 months after surgery and 34.5 degrees at final follow-up. Conclusions. Quality control of the reconstructed sagittal balance for sagittal imbalance is possible. Correctly orienting the pelvis, reconstructed by the restoration of enough L1-S1 lordosis with adequate distribution at L4-S1 segments, is a matter of critical importance for optimizing reconstructed sagittal balance. The correctly oriented pelvis can be determined before surgery. Preventing junctional fracture and persistent rehabilitation of surgically injured lumbar extensor musculature are crucial for maintaining the reconstructed sagittal balance