bluuebunny/crossref_metadata_2025_split huggingface dataset:
Swallowing, Oral Motor, Motor Speech, and Language Impairments Following Acute Pediatric Ischemic Stroke
Authors: Sherman Victoria , Martino Rosemary , Bhathal Ishvinder , DeVeber Gabrielle , Dlamini Nomazulu , MacGregor Daune , Pulcine Elizabeth , Beal Deryk S. , Thorpe Kevin E. , Moharir Mahendranath 
Published: March 2021

Background and Purpose:
Following adult stroke, dysphagia, dysarthria, and aphasia are common sequelae. Little is known about these impairments in pediatric stroke. We assessed frequencies, co-occurrence and associations of dysphagia, oral motor, motor speech, language impairment, and caregiver burden in pediatric stroke.

Methods:
Consecutive acute patients from term birth-18 years, hospitalized for arterial ischemic stroke (AIS), and cerebral sinovenous thrombosis, from January 2013 to November 2018 were included. Two raters reviewed patient charts to detect documentation of in-hospital dysphagia, oral motor dysfunction, motor speech and language impairment, and caregiver burden, using a priori operational definitions for notation and assessment findings. Other variables abstracted included demographics, preexisting conditions, stroke characteristics, and discharge disposition. Impairment frequencies were obtained by univariate and bivariate analysis and associations by simple logistic regression.

Results:
A total of 173 patients were stratified into neonates (N=67, mean age 2.9 days, 54 AIS, 15 cerebral sinovenous thrombosis) and children (N=106, mean age 6.5 years, 73 AIS, 35 cerebral sinovenous thrombosis). Derived frequencies of impairments included dysphagia (39% neonates, 41% children); oral motor (6% neonates, 41% children); motor speech (37% children); and language (31% children). Common overlapping impairments included oral motor and motor speech (24%) and dysphagia and motor speech (23%) in children. Associations were found only in children between stroke type (AIS over cerebral sinovenous thrombosis) and AIS severity (more severe deficit at presentation) for all impairments except feeding impairment alone. Caregiver burden was present in 58% patients.

Conclusions:
For the first time, we systematically report the frequencies and associations of dysphagia, oral motor, motor speech, and language impairment during acute presentation of pediatric stroke, ranging from 30% to 40% for each impairment. Further research is needed to determine long-term effects of these impairments and to design standardized age-specific assessment protocols for early recognition following stroke.
Prehospital Triage Accuracy in Patients With Stroke Symptoms Assessed Within 6 to 24 Hours or With an Unknown Time of Onset
Authors: Almqvist Tove , Berglund Annika , Sjöstrand Christina , Eriksson Einar , Mazya Michael V. 
Published: March 2021

Background and Purpose:
The Stockholm Stroke Triage System, implemented in 2017, identifies patients with high likelihood of large vessel occlusion (LVO) stroke. A previous report has shown Stockholm Stroke Triage System notably reduced time to endovascular thrombectomy (EVT). As the indication for EVT now includes patients up to 24 hours, we aimed to assess Stockholm Stroke Triage System triage accuracy for LVO stroke and EVT treatment for patients presenting late (within 6-24 hours or with an unknown onset), put in contrast to triage accuracy within 0 to 6 hours.

Methods:
Between October 2017 and October 2018, we included 2905 patients with suspected stroke, transported by priority 1 ground ambulance to a Stockholm Region hospital. Patients assessed 6 to 24 hours from last known well or with unknown onset were defined as late-presenting; those within <6 hours as early-presenting. Triage positivity was defined as transport to comprehensive stroke center because of suspected stroke, hemiparesis and high likelihood of EVT-eligible LVO per teleconsultation.

Results:
Overall triage accuracy was high in late-presenting patients (90.9% for LVO, 93.9% for EVT), with high specificity (95.7% for LVO, 94.5% for EVT), and low to moderate sensitivity (34.3% for LVO, 64.7% for EVT), with similar findings in the early-presenting group.

Conclusions:
Our results may support using the Stockholm Stroke Triage System for primary stroke center bypass in patients assessed by ambulance up to 24 hours from time of last known well.
Twelfth-Century Latin Medicine in Hebrew Garb: Doeg the Edomite as a Cultural Intermediary
Authors: Freudenthal Gad , McVaugh Michael , Mesler Katelyn 
Published: March 2021

Abstract
In 1197–1199 an anonymous scholar completed the translation of twenty-four medical works from Latin into Hebrew, which he listed in a Preface he wrote to the entire corpus. Some seventeen of these translations are extant. The translator describes himself as a Jew who took baptism but subsequently repented. His self-image as an apostate is reflected in his referring to himself as “Doeg the Edomite,” an appellation we also use. Doeg’s motivation to embark on his gigantic translation project was to keep Jews from flocking at the doors of Christian doctors, who prescribe to them medicines containing impure foodstuffs. Doeg also followed the aim of “enlightening” the Jews and reports that he was taken to task for this.
The works translated by Doeg, which we seek to identify, mostly belong to the Salerno corpus. We argue that Doeg is likely to have worked in the setting of a Latin medical school, where the books he put into Hebrew were used in a program of learning. Doeg’s use of Occitan vernacular words transliterated in Hebrew letters allows us to conclude that he lived in the Midi, suggesting that he was in contact with medical scholars in Montpellier. Doeg’s corpus of translations is a significant index to the medical texts valued in Montpellier and sheds light on both Hebrew and Latin intellectual history. Comparisons of Hebrew passages from Doeg’s translations with their Latin Vorlagen allow us to conclude that for the most part Doeg translated literally, although at times reverting to paraphrases or shortening his texts.
We argue that, whereas in the domains of philosophy and science most translations in the Midi were made from Arabic, in medicine Latin-into-Hebrew translations were fairly frequent already in the thirteenth century. Doeg’s story points to the causes of this difference: the medical field was one, comprising Jewish and gentile doctors and patients, with the ensuing collaborations or competition over patients compelling Jewish doctors to avail themselves of the best available knowledge.
Modulation of Cross-Isothermal Velocities with ENSO in the Tropical Pacific Cold Tongue
Authors: Deppenmeier Anna-Lena , Bryan Frank O. , Kessler William S. , Thompson LuAnne 
Published: March 2021

AbstractThe tropical Pacific Ocean cold tongue (CT) plays a major role in the global climate system. The strength of the CT sets the zonal temperature gradient in the Pacific that couples with the atmospheric Walker circulation. This coupling is an essential component of the El Niño–Southern Oscillation (ENSO). The CT is supplied with cold water by the Equatorial Undercurrent that follows the thermocline as it shoals toward the east, adiabatically transporting cold water toward the surface. As the thermocline shoals, its water is transformed through diabatic processes, producing water mass transformation (WMT) that allows water to cross mean isotherms. Here, we examine WMT in the cold-tongue region from a global high-resolution ocean simulation with saved budget terms that close its heat budget exactly. Using the terms of the heat budget, we quantify each individual component of WMT (vertical mixing, horizontal mixing, eddy fluxes, and solar penetration) and find that vertical mixing is the single most important contribution in the thermocline and solar heating dominates close to the surface. Horizontal diffusion is much smaller. During El Niño events, vertical mixing, and hence cross-isothermal flow as a whole, are much reduced, whereas, during La Niña periods, strong vertical mixing leads to strong WMT, thereby cooling the surface. This analysis demonstrates the enhancement of diabatic processes during cold events, which in turn enhances cooling of the CT from below the surface.
Off-Equatorial Deep-Cycle Turbulence Forced by Tropical Instability Waves in the Equatorial Pacific
Authors: Cherian D. A. , Whitt D. B. , Holmes R. M. , Lien R.-C. , Bachman S. D. , Large W. G. 
Published: March 2021

AbstractThe equatorial Pacific cold tongue is a site of large heat absorption by the ocean. This heat uptake is enhanced by a daily cycle of shear turbulence beneath the mixed layer—“deep-cycle turbulence”—that removes heat from the sea surface and deposits it in the upper flank of the Equatorial Undercurrent. Deep-cycle turbulence results when turbulence is triggered daily in sheared and stratified flow that is marginally stable (gradient Richardson number Ri ≈ 0.25). Deep-cycle turbulence has been observed on numerous occasions in the cold tongue at 0°, 140°W, and may be modulated by tropical instability waves (TIWs). Here we use a primitive equation regional simulation of the cold tongue to show that deep-cycle turbulence may also occur off the equator within TIW cold cusps where the flow is marginally stable. In the cold cusp, preexisting equatorial zonal shear uz is enhanced by horizontal vortex stretching near the equator, and subsequently modified by horizontal vortex tilting terms to generate meridional shear υz off of the equator. Parameterized turbulence in the sheared flow of the cold cusp is triggered daily by the descent of the surface mixing layer associated with the weakening of the stabilizing surface buoyancy flux in the afternoon. Observational evidence for off-equatorial deep-cycle turbulence is restricted to a few CTD casts, which, when combined with shear from shipboard ADCP data, suggest the presence of marginally stable flow in TIW cold cusps. This study motivates further observational campaigns to characterize the modulation of deep-cycle turbulence by TIWs both on and off the equator.
Computer-Aided Rhinoplasty Using a Novel “navigated” Nasal Osteotomy Technique: A Pilot Study
Authors: Wick Elizabeth H. , Whipple Mark E. , Hohman Marc H. , Moe Kris S. 
Published: March 2021

Objective: To describe the surgical technique of navigation-guided nasal osteotomies and assess feasibility of this technique for treating complex nasal bone deformities in reconstructive rhinoplasty. Methods: A retrospective chart review was performed in order to identify patients who underwent computer-aided rhinoplasty from August 2014 to February 2017. Inclusion criteria were nasal bone deformities on computed-tomography (CT) that correlated with specific nasal complaints. All patients underwent computer-aided rhinoplasty with navigation-guided nasal osteotomies using a standard navigation system. Osteotomies were performed using real-time visualization on the navigation screen. Additional soft tissue procedures were performed as needed. Medical records were reviewed for presenting symptoms, radiologic and operative findings, and postoperative course. Cosmetic outcomes were subjectively based on patients’ standard 6-view photo-documentation from pre- and post-operative timepoints. Results: Twenty-one patients were included in the study; 8 were revision cases and 3 had mild-to-moderate hemifacial microsomia. Fifteen were completely closed procedures. No cases were opened because of inadequate visualization or difficulty accessing bony pathology. Mean (range) follow up was 98.6 (6-559) days. There were no intra-operative complications, unplanned admissions or re-admissions, or iatrogenic cosmetic complications (ie, “inverted V” or “saddle nose” deformities). Two patients required revision. One was after suffering nasal trauma within 4 weeks of initial rhinoplasty. The second underwent further correction of a deformity that required a costochondral graft. Both experienced good final results. Conclusions: Computer-aided rhinoplasty is safe and feasible for treating complex nasal deformities using standard navigation systems.
Lysergic acid diethylamide differentially modulates the reticular thalamus, mediodorsal thalamus, and infralimbic prefrontal cortex: An in vivo electrophysiology study in male mice
Authors: Inserra Antonio , De Gregorio Danilo , Rezai Tamim , Lopez-Canul Martha Graciela , Comai Stefano , Gobbi Gabriella 
Published: March 2021

Background: The reticular thalamus gates thalamocortical information flow via finely tuned inhibition of thalamocortical cells in the mediodorsal thalamus. Brain imaging studies in humans show that the psychedelic lysergic acid diethylamide (LSD) modulates activity and connectivity within the cortico-striato-thalamo-cortical (CSTC) circuit, altering consciousness. However, the electrophysiological effects of LSD on the neurons in these brain areas remain elusive. Methods: We employed in vivo extracellular single-unit recordings in anesthetized adult male mice to investigate the dose–response effects of cumulative LSD doses (5–160 µg/kg, intraperitoneal) upon reticular thalamus GABAergic neurons, thalamocortical relay neurons of the mediodorsal thalamus, and pyramidal neurons of the infralimbic prefrontal cortex. Results: LSD decreased spontaneous firing and burst-firing activity in 50% of the recorded reticular thalamus neurons in a dose–response fashion starting at 10 µg/kg. Another population of neurons (50%) increased firing and burst-firing activity starting at 40 µg/kg. This modulation was accompanied by an increase in firing and burst-firing activity of thalamocortical neurons in the mediodorsal thalamus. On the contrary, LSD excited infralimbic prefrontal cortex pyramidal neurons only at the highest dose tested (160 µg/kg). The dopamine D2 receptor (D2) antagonist haloperidol administered after LSD increased burst-firing activity in the reticular thalamus neurons inhibited by LSD, decreased firing and burst-firing activity in the mediodorsal thalamus, and showed a trend towards further increasing the firing activity of neurons of the infralimbic prefrontal cortex. Conclusion: LSD modulates firing and burst-firing activity of reticular thalamus neurons and disinhibits mediodorsal thalamus relay neurons at least partially in a D2-mediated fashion. These effects of LSD on thalamocortical gating could explain its consciousness-altering effects in humans.
Neurologic Features Associated With SARS-CoV-2 Infection in Children: A Case Series Report
Authors: Sandoval Francisca , Julio Katherine , Méndez Gastón , Valderas Carolina , Echeverría Alejandra C. , Perinetti María José , Suarez N. Mario , Barraza Gonzalo , Piñera Cecilia , Alarcón Macarena , Samaniego Fernando , Quesada-Rios Pía , Robles Carlos , Izquierdo Giannina 
Published: March 2021

Introduction: Although multiple neurologic manifestations associated with SARS-CoV-2 infection have been described in adults, there is little information about those presented in children. Here, we described neurologic manifestations associated with COVID-19 in the pediatric population. Methods: Retrospective case series report. We included patients younger than 18 years, admitted with confirmed SARS-CoV-2 infection and neurologic manifestations at our hospital in Santiago, Chile. Demographics, clinical presentations, laboratory results, radiologic and neurophysiological studies, treatment, and outcome features were described. Cases were described based on whether they presented with predominantly central or peripheral neurologic involvement. Results: Thirteen of 90 (14.4%) patients admitted with confirmed infection presented with new-onset neurologic symptoms and 4 patients showed epilepsy exacerbation. Neurologic manifestations ranged from mild (headache, muscle weakness, anosmia, ageusia), to severe (status epilepticus, Guillain-Barré syndrome, encephalopathy, demyelinating events). Conclusions: We found a wide range of neurologic manifestations in children with confirmed SARS-CoV-2 infection. In general, neurologic symptoms were resolved as the systemic presentation subsided. It is essential to recognize and report the main neurologic manifestations related to this new infectious disease in the pediatric population. More evidence is needed to establish the specific causality of nervous system involvement.
Association of D-dimer and Fibrinogen With Hypercoagulability in COVID-19 Requiring Extracorporeal Membrane Oxygenation
Authors: Chandel Abhimanyu , Patolia Saloni , Looby Mary , Bade Najeebah , Khangoora Vikramjit , King Christopher S. 
Published: March 2021

Background: D-dimer concentration has been used by institutions to identify candidates for intensified anticoagulant treatment for venous thromboembolism prevention and for the mitigation of the microthrombotic complications associated with COVID-19. Thromboelastography (TEG) maximum amplitude (MA) has been validated as a marker of hypercoagulability and MA ≥68 mm has been utilized as a marker of hypercoagulability in other conditions. Methods: The goal of this study was to evaluate the relationship between coagulation, inflammatory, and TEG parameters in patients with COVID-19 on extracorporeal membrane oxygenation (ECMO). We performed a single-center retrospective analysis of consecutive patients that received ECMO for the treatment of COVID-19. TEG, inflammatory, and coagulation markers were compared in patients with and without a thrombotic complication. Correlation tests were performed to identify the coagulation and inflammatory markers that best predict hypercoagulability as defined by an elevated TEG MA. Results: A total of 168 TEGs were available in 24 patients. C-reactive protein and fibrinogen were significantly higher in patients that developed a thrombotic event versus those that did not ( P = 0.04 and P = 0.04 respectively). D-dimer was negatively correlated with TEG MA ( P < 0.01), while fibrinogen was positively correlated ( P < 0.01). A fibrinogen >441 mg/dL was found to have a sensitivity of 91.2% and specificity of 85.7% for the detection of MA ≥68 mm. Conclusions: In critically ill patients with COVID-19 treated with ECMO, D-dimer concentration had an inverse relationship with degree of hypercoagulability as measured by TEG MA. D-dimer elevation may potentially reflect hemostatic perturbation in patients on ECMO or the severity of COVID-19 related sepsis rather than designate patients likely to benefit from anticoagulation. Fibrinogen concentration may represent a more useful marker of hypercoagulability in this population.
Prognosis of patients in prolonged coma after severe carbon monoxide poisoning
Authors: Gao Y , Gu H , Yang J , Yang L , Li Z , Zhang J 
Published: March 2021

Background: Late recovery in patients following prolonged coma from carbon monoxide poisoning have been reported, but the probability is unclear. The purpose of this research was to assess the prognosis of patients in prolonged coma after severe carbon monoxide poisoning and related clinical and imaging features. Methods: There were 13 patients who had been in a state of coma for >7 days after acute carbon monoxide poisoning in the retrospective observational study, and demographic data, clinical data, laboratory data, complications, and image data were collected. Outcome was assessed by means of the Glasgow outcome scale after 1 year. The relationship between complications and imaging manifestations and prognosis was also analyzed. Results: One year after severe carbon monoxide poisoning, two patients (15.4%) had died (GOS 1), nine (69.2%) were in a persistent vegetative state (GOS 2), one (7.7%) was moderately disabled (GOS 4), and one (7.7%) achieved a good recovery (GOS 5) with minimal disability. Conclusions: Most patients with prolonged coma after severe carbon monoxide poisoning had a poor prognosis, although the younger patients had a better prognosis. Respiratory failure, hypotension and renal failure during the course of the disease were associated with a poor prognosis. The prognosis of patients with injuries in two sites in early CT was poor. Multiple lesions (≥3) and extensive white matter damage (Fazekas grade (PVH or DWMH) = 3) on MRI of chronic phase were also associated with a poor prognosis.
Necrotizing Enterocolitis Mortality: A New Parameter to Predict High Risk
Authors: García Miriam , Casal Isabel , Pértega Sonia , González Cristina , Bouzán Jesús Caramés 
Published: March 2021

Introduction: Necrotizing enterocolitis, is the most common gastrointestinal emergency in the preterm infant and is associated with high mortality and morbidity. Predict which infants will progress to more severity stages of the illness and are in high risk for mortality is one of the challenges in relation to this disease. The objective of this study is to identify which factors are associated with mortality in infants diagnoses of NEC in our centre along a 12-year period. Material and Methods: A total of 124 consecutively patients were included in the study diagnosed of NEC at the Complejo Hospitalario Universitario de A Coruña, Spain. Information was obtained from medical records to compare patient demographics characteristics, prenatal information, clinical and radiological findings, relevant analytical data, therapeutic management and outcomes of infants who survived NEC and infants who died. Informed consent and ethical review board was obtained. Associations were analyzed by bivariate and multivariate analysis. Results: Among 124 patients, 110 patients survived NEC and 14 died. In multivariate analysis, the patients who died presented at birth low Apgar levels at minute one, apneas in the neonatal period, coagulopathy and low levels of serum proteins at diagnoses of NEC.
Use of Pediatric Injectable Medicines Guidelines and Associated Medication Administration Errors: A Human Reliability Analysis
Authors: Jones Matthew D. , Clarke Jonathan , Feather Calandra , Franklin Bryony Dean , Sinha Ruchi , Maconochie Ian , Darzi Ara , Appelbaum Nicholas 
Published: March 2021

Background: In a recent human reliability analysis (HRA) of simulated pediatric resuscitations, ineffective retrieval of preparation and administration instructions from online injectable medicines guidelines was a key factor contributing to medication administration errors (MAEs). Objective: The aim of the present study was to use a specific HRA to understand where intravenous medicines guidelines are vulnerable to misinterpretation, focusing on deviations from expected practice ( discrepancies) that contributed to large-magnitude and/or clinically significant MAEs. Methods: Video recordings from the original study were reanalyzed to identify discrepancies in the steps required to find and extract information from the NHS Injectable Medicines Guide (IMG) website. These data were combined with MAE data from the same original study. Results: In total, 44 discrepancies during use of the IMG were observed across 180 medication administrations. Of these discrepancies, 21 (48%) were associated with an MAE, 16 of which (36% of 44 discrepancies) made a major contribution to that error. There were more discrepancies (31 in total, 70%) during the steps required to access the correct drug webpage than there were in the steps required to read this information (13 in total, 30%). Discrepancies when using injectable medicines guidelines made a major contribution to 6 (27%) of 22 clinically significant and 4 (15%) of 27 large-magnitude MAEs. Conclusion and Relevance: Discrepancies during the use of an online injectable medicines guideline were often associated with subsequent MAEs, including those with potentially significant consequences. This highlights the need to test the usability of guidelines before clinical use.