bluuebunny/crossref_metadata_2025_split huggingface dataset:
D-Dimer as Predictor of Large Vessel Occlusion in Acute Ischemic Stroke
Authors: Ramos-Pachón Anna , López-Cancio Elena , Bustamante Alejandro , Pérez de la Ossa Natàlia , Millán Mònica , Hernández-Pérez Maria , Garcia-Berrocoso Teresa , Cardona Pere , Rubiera Marta , Serena Joaquín , Ustrell Xavier , Garcés Moisés , Terceño Mikel , Dávalos Antoni , Montaner Joan 
Published: February 2021

Background and Purpose:
Improving prehospital triage of large vessel occlusion (LVO) would reduce time to reperfusion therapies. We aimed to study early predictors of LVO in acute ischemic stroke to identify candidates for endovascular treatment.

Methods:
The Stroke-Chip was a prospective observational study conducted at 6 Stroke Centers in Catalonia. Blood samples were obtained in the first 6 hours from symptom onset of consecutive patients. Stroke severity was evaluated with National Institutes of Health Stroke Scale (NIHSS) and LVO was assessed. Independent association of multiple blood biomarkers with LVO was evaluated using logistic regression models adjusted by covariates. Sensitivity, specificity, and predictive values were assessed for NIHSS and the combination of NIHSS and selected serum biomarkers levels.

Results:
One thousand three hundred eight suspected strokes were enrolled for a 17-month period. LVO was not assessed in 131 patients. One thousand one hundred seventy-seven patients were selected for analysis (mean age 69.3 years, 56% men, median baseline NIHSS of 6, and median time to blood collection 2.5 hours). LVO was detected in 262 patients. LVO patients were older, had higher baseline NIHSS, history of atrial fibrillation, and lower time from stroke onset to admission. After logistic regression analysis, D-dimer remained an independent predictor of LVO (odds ratio, 1.59 [1.31–1.92]). Specificity and positive predictive value to exclude or detect LVO were higher when using combined D-dimer levels and NIHSS score assessment rather than NIHSS alone.

Conclusions:
Early D-dimer levels are an independent predictor of LVO and may be useful to better optimize prehospital patient transport to the appropriate stroke center.
The reinstrumentalization of theDiagnostic and Statistical Manual of Mental Disorders(DSM) in psychological publications: A citation context analysis
Authors: Li Kai 
Published: February 2021

AbstractResearch instruments play significant roles in the construction of scientific knowledge, even though we have only acquired very limited knowledge about their life cycles from quantitative studies. This paper aims to address this gap by quantitatively examining the citation contexts of an exemplary research instrument, the Diagnostic and Statistical Manual of Mental Disorders (DSM), in full-text psychological publications. We investigated the relationship between the citation contexts of the DSM and its status as a valid instrument being used and described by psychological researchers. We specifically focused on how this relationship has changed over the DSM’s citation histories, especially through the temporal framework of its versions. We found that a new version of the DSM is increasingly regarded as a valid instrument after its publication; this is reflected in various key citation contexts, such as the use of hedges, attention markers, and the verb profile in sentences where the DSM is cited. We call this process the reinstrumentalization of the DSM in the space of scientific publications. Our findings bridge an important gap between quantitative and qualitative science studies and shed light on an aspect of the social process of scientific instrument development that is not addressed by the current qualitative literature.
The role of touch in captive and semi-captive Antillean manatees (Trichechus manatus manatus)
Authors: Lucchini Karen , Umeed Rebecca , Guimarães Luana , Santos Paulo , Sommer Iara , Bezerra Bruna 
Published: February 2021

Abstract
Tactile signals have been neglected in aquatic animal studies despite being a major communication modality. We investigated Antillean manatees’ tactile behavioural repertoire and budget in captivity (7-females and 4-males) and semi-captivity (4-males) in Brazil. We detected 17 tactile behaviours (14.03% of the activity budget) with social, self-maintenance, or environmental exploration functions. The observation method influenced the detection of self-maintenance behaviours — focal animal and ad libitum detected more of these behaviours than scan sampling. Age, sex, housing, and centre routines influenced the tactile repertoire. The captive females and semi-captive males tactile patterns differed, suggesting that sex and animal-pool density play a role in tactile patterns. We recommend carefully choosing the observation method when investigating functional categories of manatee tactile behaviours. The monitoring and stimulation of manatee tactile behaviours should integrate rehabilitation and reintroduction practices. Environmental enrichment may stimulate tactile behaviours related to habitat exploration, key behaviours in aiding manatee navigation.
South-South Exchanges
Authors: Lima Thayse Leal 
Published: February 2021

Abstract
This article addresses circulation and exchange in the Global South by examining the case of Biblioteca Ayacucho (1973), a transnational collection of over 500 books from several Latin American countries. Conceived as an “instrument for Latin American integration,” Ayachucho sought to connect the region by assembling and disseminating its diverse cultural and intellectual traditions. I discuss Ayacucho’s strategies of transnationalization which, in addition to book publishing, also relied on networks of intellectual collaboration and exchange. Focusing on its Brazilian titles, I argue that Ayacucho articulates a model of world literature that employs a contextually grounded yet transnationally based framework. By engaging Latin American specialists and relying on local scholarship, Ayacucho offers an inclusive model of world literature that allies both distant and close reading in the construction of a transnational literature. As such, it defies established assumptions about literary circulation and center-based conceptions of world literature.
Levels of Evidence in Rhinology and Skull Base Surgery Research
Authors: Silver Jennifer A. , Mascarella Marco , Tali George , Varshney Rickul , Tewfik Marc A. , Tajudeen Bobby A. , Schwartz Joseph S. 
Published: February 2021

ObjectiveThe purpose of this study was to evaluate the quality of evidence of rhinology and rhinologic skull base surgery (RSBS) research and its evolution over the past decade.Study DesignReview article.SettingWe reviewed articles from 2007 to 2019 in 4 leading peer‐reviewed otolaryngology journals and 3 rhinology‐specific journals.MethodsThe articles were reviewed and levels of evidence were assigned using the Oxford Centre for Evidence‐Based Medicine 2011 guidelines. High quality was defined as level of evidence 1 or 2.ResultsIn total, 1835 articles were reviewed in this study spanning a 13‐year period. Overall, the absolute number of RSBS publications increased significantly 22.6% per year, from 108 articles in 2007 to 481 in 2019 (P <. 001; 95% CI, 7.9‐37.2). In 2007, only 13 articles, or 15%, were high quality, and this grew to 146 articles, or 39%, in 2019. A 14.0% per year exponential increase in the number of high‐quality publications was found to be statistically significant (P <. 001; 95% CI, 7.2, 20.7). Overall, high‐quality publications represented just 25.8% of RSBS articles overall. There was no significant difference in quality between rhinology‐specific journals and general otolaryngology journals (χ2 = 3.1, P =. 077).ConclusionThe number of overall publications and of high‐quality RSBS publications has significantly increased over the past decade. However, the proportion of high‐quality studies continues to represent a minority of total RSBS research.
Body mass index as a determinant of clozapine plasma concentrations: A pharmacokinetic-based hypothesis
Authors: Kuzin Maxim , Haen Ekkehard , Hiemke Christoph , Bochon Benjamin , Bochon Karolina , Gründer Gerhard , Paulzen Michael , Schoretsanitis Georgios 
Published: February 2021

Background: Knowledge regarding the impact of body composition measures on pharmacokinetics of antipsychotics is limited. Aims: Our aim was to investigate the impact of body weight and body mass index on clozapine pharmacokinetics using a therapeutic drug monitoring database. Methods: A large therapeutic drug monitoring dataset of clozapine plasma concentrations considering three patient subgroups was analysed: a control group (CLZ0, 20–30 kg/m2, n=266), a group with high body mass index (CLZhigh, body mass index ⩾30 kg/m2, n=162) and with low body mass index values (CLZlow, body mass index <20 kg/m2, n=27). Comparisons of plasma and dose-adjusted plasma concentrations (C/D) of clozapine were based on the Spearman’s correlation ( rs), Kruskal Wallis and Mann-Whitney-U tests. For percentages we used the Pearson chi-square test (χ2). To assess effects of confounders we used bootstrapping analysis of covariates. Results/outcomes: Regarding demographic characteristics, groups differed only for sex percentage with more females than males in CLZlow and CLZhigh compared to CLZ0 ( p=0.001 for χ2 test). Plasma and C/D values were positively associated with body mass index ( rs=0.108, p=0.022 and rs=0.156, p=0.001 respectively). Intergroup differences were observed for plasma and dose-adjusted concentrations of clozapine ( p=0.031 and p=0.029 for Kruskal Wallis respectively): post-hoc pairwise comparisons showed higher plasma concentrations and C/D of clozapine in CLZhigh compared to CLZ0 ( p=0.014 and p=0.007 respectively for Mann-Whitney U-test), by mean 21 and 18%, respectively. Differences for C/D values remained after accounting for sex ( p=0.02). Conclusions/interpretation: In obese patients, bioavailability, distribution or elimination of clozapine may be altered due to increased clozapine deposits in fat tissue and hepatic enzyme activity changes.
Aesthetic and functional outcomes of thinned anterolateral thigh flap in reconstruction of complex wounds of the upper limb
Authors: Ellabban Mohamed A. , Gomaa Amr A. , Moghazy Amr M. , Elbadawy Mohamed A. , Adly Osama A. 
Published: February 2021

We studied outcomes of reconstruction of complex upper limb wounds using thinned anterolateral thigh flaps. There were 18 patients with a mean age of 27.5 years. The mean thickness of the flap before and after thinning was 23 mm and 5 mm, respectively. Two patients had partial tip necrosis that was treated conservatively. Aesthetic and functional evaluations were performed using a 5-point Likert scale, QuickDASH score, passive range of motion and power grip at 12 months after surgery. The study showed good results in the aesthetic evaluation by a panel of plastic surgeons (mean score: 19.7) and patient self-assessment (mean score: 18.1). There was a significant correlation between the total scores of the panel and the patients. The mean QuickDASH score was 21, with a high percentage in the middle category ‘had a problem but working’. The thinned anterolateral thigh flap is versatile and safe in upper limb reconstruction with good aesthetic and functional results. Level of evidence: IV
Breastfeeding practice in China from 2013 to 2018: a study from a national dynamic follow-up surveillance
Authors: Kang Leni , Liang Juan , He Chunhua , Miao Lei , Li Xiaohong , Dai Li , Li Qi , Liu Zheng , Zhu Jun , Wang Yanping , Liu Hanmin 
Published: February 2021

Abstract
Background
Breastfeeding is important for the physical and psychological health of the mother and child. Basic data on breastfeeding practice in China are out-of-date and vary widely. This study aimed to evaluate the progress of breastfeeding practice in China, as well as to explore the bottlenecks in driving better practice.

Methods
This was an observational study. We used data from the Under-5 Child Nutrition and Health Surveillance System in China for the period 2013–2018. The prevalence of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) were calculated for each year for subgroups of China. The Cochran-Armitage test was used to explore the time trends. The annual percent of change (APC) were calculated by log-linear regression followed by exp transformation.

Results
The prevalence of EIBF increased significantly from 44.57% (95% CI: 44.07, 45.07) in 2013 to 55.84% (95% CI: 55.29, 56.38) in 2018 (Ptrend < 0.001), with an APC of 4.67% (95% CI: 3.51, 5.85). And the prevalence of EBF increased rapidly from 16.14% (95% CI: 15.10, 17.18) to 34.90% (95% CI: 33.54, 36.26) (Ptrend < 0.001), with an APC of 14.90% (95% CI: 9.97, 20.04). Increases were observed in both urban and rural areas, with urban areas showing greater APCs for EIBF (6.05%; 95% CI: 4.22, 7.92 v.s. 2.26%; 95% CI: 1.40, 3.12) and EBF (18.21%; 95% CI: 11.53, 25.29 v.s. 9.43%; 95% CI: 5.52, 13.49). The highest EBF prevalence was observed in the East, but the Central area showed the highest APC. The prevalence of EBF decreased with increasing age within the first 6 months, especially after 3 months.

Conclusion
The prevalence of both EIBF and EBF in China are improving in recent years. The rural and West China could be the key areas in the future actions. More efforts should be made to protect and promote breastfeeding to achieve near- and long-term goals for child health.
Influence of the knot position on the union of the greater trochanter after bipolar hip arthroplasty via the modified Dall approach: a prospective non-randomized study
Authors: Kataoka Masanao , Fujita Hiroshi , Hara Hiroaki , Harada Hideto , Okutani Yuki , Murotani Yoshiki 
Published: February 2021

Abstract
Background
In our institute, all elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach. To our knowledge, there are no reports on the knot position of the greater trochanter reattachment. The aim of this study was to determine influence of two knot positions (anterior or posterior) on the complications of the greater trochanter.

Methods
This is a prospective non-randomized study conducted on 95 elderly patients (95 hips) from September 2013 to December 2017. The knot position was changed from anterior to posterior alternately. The X-ray images obtained immediately after the operation were compared with those obtained at 3 months postoperatively; thereafter, the status of the greater trochanter was classified into three types: type A, no apparent shifting and fracture; type C, over 1-mm shifting of the fragment; and type F, fracture of the greater trochanter.

Results
Regarding age at operation, sex, BMI, size of the greater trochanteric fragment, stem type, and surgeon, there was no significant difference between two groups. In the anterior group, 34 hips (72.3%), 5 hips (10.6%), and 8 hips (17.0%) were classified under type A, C, and F, respectively. In the posterior group, 44 hips (91.7%), 1 hip (2.1%), and 3 hips (6.3%) were classified under type A, C, and F, respectively. There were significantly fewer greater trochanteric complications in the posterior group.

Conclusions
The posterior knot position improved the union of the greater trochanter after BHA compared with the anterior knot position.

Trial registration
We had approved IRB at our hospital clinical research review committee. Retrospectively registered.
Usefulness of an accelerometer-based navigation system in bilateral one-stage total knee arthroplasty
Authors: Laoruengthana Artit , Rattanaprichavej Piti , Tantimethanon Thanawat , Eiamjumras Watcharapong , Teekaweerakit Passakorn , Pongpirul Krit 
Published: February 2021

Abstract
Background
Bilateral one-stage total knee arthroplasty (BTKA) have increased because it provides a number of advantages. Recently, Accelerometer-based navigation (ABN) system which guide the cutting plane without intramedullary disturbance might result in less endothelial and microvascular damage. Therefore, we hypothesized that the ABN may reduce blood loss, reduce postoperative pain, and better restore BTKA alignment compared to conventional instruments.

Methods
We retrospectively compared 44 consecutive patients receiving ABN assisted BTKA (iBTKA) to 57 patients with conventional instruments (cBTKA). Identical pre- and post-operative care was utilized to all patients. The outcome measures assessed were hemoglobin (Hb), calculated blood loss (CBL), blood transfusion, VAS score for pain, morphine consumption, knee flexion angle, and length of stay (LOS). Radiographic assessment included mechanical axis (MA) and component positioning at 3–6 months of follow up.

Results
Both iBTKA and cTKA groups had equivalent demographic data. Postoperative Hb of the cBTKA group was significantly lower than those in the iBTKA group at 24 h (p = 0.02), but there was no significant difference in drain volume, CBL, and blood transfusion rate. For radiographic measures, the iBTKA group had more accurate MA and component orientation, and had a lower number of outliers than those in the cBTKA group (p ≤ 0.01), except for the sagittal femoral component angle.

Conclusion
The ABN assisted BTKA could not reduce blood loss or postoperative pain more than cBTKA, nor improve functional recovery. However, the ABN significantly improved the accuracy of MA and prostheses positioning.

Trial registration
The protocol of this study was registered in the Thai Clinical Trials Registry database No. TCTR20180731001# on 25 July 2018.
A national cross-sectional survey of the attitudes, skills and use of evidence-based practice amongst Spanish osteopaths
Authors: Alvarez Gerard , Justribo Cristian , Sundberg Tobias , Thomson Oliver P. , Leach Matthew J. 
Published: February 2021

Abstract
Background
Although evidence-based practice (EBP) is largely supported across healthcare professions, its implementation in manual therapy professions such as osteopathy remains limited and debated. There is currently little knowledge of how Spanish osteopaths relate to EBP.

Objectives
The main aim of this study was to investigate the attitudes, skills and use of EBP among Spanish osteopaths. A secondary aim was to identify barriers and facilitators for the adoption of EBP in the Spanish osteopathic context.

Methods
National cross-sectional survey of Spanish osteopaths registered and non-registered to an osteopathic association in Spain. Eligible participants were invited by a range of recruitment strategies including email and social media campaigns to complete the Spanish-translated Evidence-Based practice Attitude and utilization Survey (EBASE) anonymously online.

Results
A total of 567 osteopaths completed the survey which represents an approximate response rate of 9%. Participant’s attitudes toward EBP were largely positive. Most respondents agreed or strongly agreed that EBP was necessary in the practice of osteopathy (89.6%) and that professional literature and research findings were useful to their day-to-day practice (88.9%). Levels of perceived skill in EBP were reported as low to moderate with lowest levels for items related to ‘research conduct’. Except reading/reviewing professional literature and using online search engines to find practice-related literature, participant engagement in all other EBP-related activities was generally infrequent. The perceived proportion of clinical practice that was based on clinical research evidence was reported to be very small. Main barriers to EBP uptake included a lack of clinical evidence in osteopathy and insufficient skills for applying research findings. Main facilitators of EBP uptake included access to full-text articles, internet at the workplace and online databases.

Conclusions
Spanish osteopaths were largely supportive of evidence-based practice, had low to moderate skills in EBP and engaged in EBP activities infrequently. Formal regulation of the profession in Spain and the inclusion of osteopathic programs into the university sector would potentially improve EBP skills and use.
Autopsy and statistical evidence of disturbed hemostasis progress in COVID-19: medical records from 407 patients
Authors: Jiang Tiebin , Lv Bo , Liu Hongxia , He Shiwen , Zhang Guogang , Li Chanyi , Li Wanqiong , Li Weilin , He Yaqi , Zhang Tong , Wang Yunyun , Mo Wu , Yi Ning , Peng Luying , Li Ying , Ruan Chunhong , Li Chengyuan , Liu Yaqi , Luo Peipei , Jiang Huan , Xue Zhigang , Liu Liang , Wang Wenjun 
Published: February 2021

AbstractBackgroundThe progression of coagulation in COVID-19 patients with confirmed discharge status and the combination of autopsy with complete hemostasis parameters have not been well studied.ObjectiveTo clarify the thrombotic phenomena and hemostasis state in COVID-19 patients based on epidemiological statistics combining autopsy and statistical analysis.MethodsUsing autopsy results from 9 patients with COVID-19 pneumonia and the medical records of 407 patients, including 39 deceased patients whose discharge status was certain, time-sequential changes in 11 relevant indices within mild, severe and critical infection throughout hospitalization according to the Chinese National Health Commission (NHC) guidelines were evaluated. Statistical tools were applied to calculate the importance of 11 indices and the correlation between those indices and the severity of COVID-19.ResultsAt the beginning of hospitalization, platelet (PLT) counts were significantly reduced in critically ill patients compared with severely or mildly ill patients. Blood glucose (GLU), prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer levels in critical patients were increased compared with mild and severe patients during the entire admission period. The International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) score was also high in critical patients. In the relatively late stage of nonsurvivors, the temporal changes in PLT count, PT, and D-dimer levels were significantly different from those in survivors. A random forest model indicated that the most important feature was PT followed by D-dimer, indicating their positive associations with disease severity. Autopsy of deceased patients fulfilling diagnostic criteria for DIC revealed microthromboses in multiple organs.ConclusionsCombining autopsy data, time-sequential changes and statistical methods to explore hemostasis-relevant indices among the different severities of the disease helps guide therapy and detect prognosis in COVID-19 infection.