Publications by authors named "David Spence"

Background: Chronic kidney disease (CKD) increases cardiovascular risk, however, traditional cardiovascular risk factors cannot entirely explain it. A real-world investigation examined the concept that renal function decline is linked to carotid total plaque area progression, which strongly confirms cardiovascular risk. We analyzed CKD patients in stages 1-3 to find risk factor relationships before the onset of severe CKD.

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Background: Pioglitazone significantly reduces the risk of stroke in people with diabetes, and in those with prediabetes, it markedly reduces the risk of stroke/myocardial infarction and new-onset diabetes. Low-dose pioglitazone provides most of the clinical benefits of high-dose pioglitazone, with fewer adverse effects. We report an economic evaluation of the cost-effectiveness of low-dose pioglitazone versus placebo from a Canadian public payer perspective in 2023 Canadian dollars.

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Article Synopsis
  • The study introduces the Auto-VWV framework, a fully automatic system for measuring the vessel-wall-volume (VWV) in carotid artery ultrasound images, aiming to enhance carotid atherosclerosis assessment and stroke risk management.
  • It employs the CAP-UNet architecture, which integrates prior knowledge and learning modules to improve segmentation accuracy, spatial continuity, and topology understanding of the carotid artery.
  • The results demonstrate that Auto-VWV outperforms existing manual and automatic measurement methods in consistency and reproducibility based on various datasets.
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Pickleball is the fastest growing sport in the United States. People of all ages participate in the sport, with the most being aged 35 years or older. Pickleball is a paddle and racket sport with a smaller court size, lighter racket, and similar rules as tennis.

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Background: Gunshot injuries are the leading cause of death among children in the United States. The goal of this study was to better understand if certain age groups, mechanisms of injury, and type of firearms were associated with the increasing rates of pediatric gun-related trauma. We hypothesized that the extremities were disproportionately targeted when compared with the random likelihood of striking specific body-surface areas.

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Objectives: To compare the clinical, radiographic, and patient-reported outcomes of nonoperative and operative treatment of adolescents with comminuted "Z-type" midshaft clavicle fractures.

Design: Prospective observational cohort.

Setting: Eight tertiary care pediatric centers.

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Aim: To assess the content and quality of YouTube videos related to cerebral palsy to provide insights into the online video resources available for individuals affected by cerebral palsy and suggest strategies for improvement.

Methods: YouTube videos were analyzed based on interaction parameters, content characteristics/category, and video source. Video reliability and quality were assessed using the Journal of American Medical Association benchmark, Global Quality Scale, and cerebral palsy-specific score.

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Article Synopsis
  • Little information exists about the impact of lipid-lowering medications on people over 75 years old, but a study assessed their effects on severe atherosclerosis in this age group.
  • The study analyzed data from 1,404 patients aged 75 and older, finding that those on lipid-lowering medications had a longer survival time free of severe atherosclerosis and less plaque progression compared to those not on the medication.
  • The findings suggest that lipid-lowering therapy is beneficial for older adults, helping to manage atherosclerosis, and monitoring plaque burden could help determine who might benefit from this treatment.
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Background: Shortening of midshaft clavicle fractures has been described as a critical fracture characteristic to guide treatment. The degree to which shortening may change in the initial weeks following injury has not been well studied. The purpose of this study was to evaluate the change in shortening of adolescent clavicle fractures in the first 2 weeks following injury.

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  • Understanding post-stroke fatigue (PSF) is important for rehabilitation, and this study examines how excessive daytime sleepiness affects the relationship between sleep and fatigue severity in stroke survivors.
  • The research involved 50 subacute stroke survivors who completed various questionnaires related to sleep quality, insomnia, and fatigue levels to assess correlations between these factors.
  • Findings indicated that sleep problems were significantly linked to fatigue severity, and a better understanding of this relationship could lead to new treatment targets for managing PSF.
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The carotid artery is unique; it is the only vessel to bifurcate into a bulb larger than itself. The history of its anatomic description, understanding of its pathophysiology and evolution of its imaging are relevant to current controversies regarding measurement of stenosis, surgical/endovascular therapies and medical management of carotid stenosis in stroke prevention. Treatment decisions on millions of symptomatic and asymptomatic patients are routinely based on information from clinical trials from over 30 years ago.

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Background: Optimal treatment of completely displaced midshaft clavicular fractures in adolescents remains controversial, with some favoring surgical management and others favoring a nonoperative approach. Few studies have comprehensively assessed longer-term nonoperative outcomes.

Purpose: To prospectively assess patient-reported outcomes (PROs) and radiographic remodeling ≥5 years after injury in teenagers undergoing nonoperative treatment of completely displaced clavicular fractures.

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Background: Anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) is being used more frequently in conjunction with anterior cruciate ligament reconstruction (ACLR). However, the knee flexion angle at which fixation of ALLR or LET is performed during the procedure is quite variable based on existing technique descriptions.

Purpose/hypothesis: The purpose of this study was to identify whether flexion angle at the time of ALLR/LET fixation affected postoperative outcomes in a clinical population.

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Background: Recent evidence suggests that for completely displaced midshaft clavicular fractures, surgery offers no clear benefit over nonoperative treatment in a general adolescent population from 10 to 18 years of age. However, the comparative outcomes of comminuted and/or severely shortened clavicular fractures specifically in older adolescent athletes have not been explored in a focused, methodologically rigorous fashion.

Hypothesis: The study hypothesis was that outcomes would be superior in older adolescent athletes who underwent operative treatment compared with nonoperative treatment for comminuted and/or severely shortened clavicular fractures.

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Most intracavity MgO:LiNbO terahertz polariton lasers generate output in the 1-3 THz range. In this study, we investigate the potential to extend this tuning range toward 6 THz. We predict broader tuning using a modified polariton gain theory that takes account of additional polariton damping at 3.

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We investigate Raman returns in oceanic light detection and ranging (LiDAR), and explore the similarities and differences to conventional elastic returns. We show that Raman returns have much more complex behavior than elastic returns, which likely cannot be well matched by simple models, making Monte Carlo simulations essential. We investigate the correlation between the time of signal arrival and the depth of the Raman event, and find that a linear correlation only exists for judicious choice of system parameters.

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