A systematic review of disparities in the medical management of atherosclerotic cardiovascular disease in females.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States and worldwide. Medical management of known modifiable risk factors, such as dyslipidemia, hypertension, and diabetes, is a key aspect to its treatment. Unfortunately, there are substantial sex-based differences in the treatment of ASCVD that result in poor medical management and worse clinical outcomes. The objective of this systematic review was to summarize known disparities in the medical management of ASCVD in females. We included prior studies with specific sex- and sex-based analyses regarding the medical treatment of the following three major disease entities within ASCVD: cerebrovascular disease, coronary artery disease, and peripheral artery disease. A total of 43 articles met inclusion criteria. In our analysis, we found that females were less likely to receive appropriate treatment of dyslipidemia or be prescribed antithrombotic medications. However, treatment differences for diabetes and hypertension by sex were not as clearly represented in the included studies. In addition to rectifying these disparities in the medical management of ASCVD, this systematic review highlights the need to address larger issues, such as underrepresentation of females in clinical trials, decreased access to care, and underdiagnosis of ASCVD to improve overall care for females.

Maintenance and Salvage of Hemodialysis Access.

Many end-stage kidney failure patients require hemodialysis as a life-sustaining treatment. Hemodialysis access via arteriovenous fistula or graft creation is preferred over long-term dialysis catheters, but intervention to maintain patency and prevent access failure is common. Endovascular and open surgical techniques are both utilized to address the underlying etiology of failure. Endovascular options include balloon angioplasty, angioplasty with stenting, and drug-eluting stents. Open revision is commonly needed for recurrent stenosis, aneurysmal or pseudoaneurysmal change, hemodialysis access-induced distal ischemia, and infection. Treatment plans should be guided by patient's individualized goals of care and require a multidisciplinary approach to the management of this complex disease.

A comprehensive review on antithrombotic therapy for peripheral artery disease.

Peripheral artery disease (PAD) is a morbid and costly disease that can result in loss of limb and life if not managed appropriately with risk factor modification, antithrombotic therapy, and revascularization when necessary. Antithrombotic therapy includes antiplatelet and anticoagulant drugs. Antiplatelet agents used in PAD can include aspirin, reversible and irreversible P2Y12 inhibitors, and PAR-1 antagonists. These drugs are prescribed as both monotherapy or dual-antiplatelet therapy and are critical components of pre- and post-revascularization maintenance. Anticoagulants, such as vitamin K antagonists and heparin products, have long been used in cardiac disease; in patients with PAD, these drugs have been largely supplanted by new direct factor Xa antagonists, which offer superior safety profiles and reduced adverse events after revascularization. Anticoagulants are often used alongside antiplatelet medications after PAD revascularization; however, there is a lack of guideline consensus about therapy selection and large regional disparity in regard to antithrombotic prescribing patterns. In this review, we analyze the existing literature and guidelines regarding the use of antithrombotic therapy in patients with PAD and offer a framework to aid clinicians' decision making regarding therapy selection and duration based on current existing evidence.

Angle of impact determination from bullet holes in a metal surface.

Using the best-fit ellipse method, single bullet impacts in thin sheet metal were assessed to investigate the accuracy of impact angle estimation. When a bullet passes through a metal panel, the yielding nature of metal causes changes to the metal surface and the resultant hole. This deformation of the metal complicates the assessment of single impacts using the ellipse method. Determining the correct impact angle may not be obvious and results in considerable errors between the known and calculated angle. To determine if the calculated angle varies in any particular way to the known angle, impacts were created on metal panels using six different types of 9 mm ammunition and seven angles from 90° to 14°. Impact angles, determined using the ellipse method, were compared with known firing angles and the error pattern assessed. The results show an error pattern with a significant quadratic relationship for three ammunition types, with the error pattern for the remaining three ammunitions not explained by a quadratic formula and requiring further study. Results suggest that single bullet impacts for a given type of ammunition with a quadratic error pattern, can be assessed with accuracy due to a more consistent behavior. This characteristic pattern of error requires further study but is a promising step for determining an accurate impact angle and bullet path from a single impact point in a metal surface.

Resolving Reflection and Resolution in 3D Imaging of Fresh Bone.

Structured light scanning is a noninvasive, accurate, and cost-effective 3D imaging technique, but due to reflection issues is yet to be utilized for tool mark analysis on fresh bone. During imaging, reflection from shiny surfaces, such as greasy bone, disrupts image formation. This study tested the David SLS-1 scanner's ability to image saw marks and explored six strategies to reduce reflection by [1] dulling the surface or [2] altering the projected light. The surface was dulled by freezing, talcum powder, dulling spray, or compressed air. The projected light was altered with a diffuser or limited to single pattern-coded. Results demonstrated that the resolution was insufficient for capturing minute details of striae. All six tests failed to reduce reflection sufficiently to produce complete images, but projecting vertical pattern-coded light showed the most promise. Future research is required concentrating on enhancing resolution and exploring the role of pattern-coded light in reducing reflection.