bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-Guided BoNT-A (Botulinum Toxin A) Injection Into the Subscapularis for Hemiplegic Shoulder Pain: A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Tan Botao , Jia Lang 
Published: September 2021

Background and Purpose:
This study aimed to assess the efficacy of an ultrasound-guided lateral approach for BoNT-A (botulinum toxin A) injections into the subscapularis in patients with hemiplegic shoulder pain.

Methods:
This single-center trial used a randomized, double-blind, placebo-controlled design. The key inclusion criteria were a visual analogue scale score of ≥4 cm and a modified Ashworth scale score of ≥1+. The patients were randomized to receive either BoNT-A injections or a placebo. The outcomes included the visual analogue scale score, modified Ashworth scale score, pain-free passive range of motion of the hemiplegic shoulder, Fugl-Meyer assessment score for the upper extremities, and Stroke-Specific Quality-of-Life score.

Results:

A total of 49 hemiplegic shoulder pain patients were screened, and 36 were included. The participants receiving the BoNT-A injection reported a significant decrease in pain (visual analogue scale, −1.39 [95% CI, −2.41 to −0.36];
P
=0.002) and spasticity (modified Ashworth scale score for shoulder internal rotation, −0.72 [95% CI, −1.10 to −0.35];
P
=0.001; modified Ashworth scale score for shoulder abduction, −0.44 [95% CI, −0.90 to −0.01];
P
=0.026) and improved pain-free passive shoulder internal rotation range of motion (14.56 [95% CI, 6.70–21.41];
P
<0.001) and quality of life (Stroke-Specific Quality-of-Life upper extremity subscale,
P
=0.025) compared with those receiving the placebo at the end point. The shoulder abduction range of motion did not significantly improve after the BoNT-A injection at the end point (
P
=0.127). In addition, the patients in the BoNT-A group showed significant improvements in the visual analogue scale score and shoulder external rotation range of motion at the 12-week follow-up. No injection-related adverse events were observed during or after the interventions in either group.

Conclusions:
The ultrasound-guided lateral approach for BoNT-A injections into the subscapularis is a precise and reliable method for reducing pain and spasticity and improving quality of life in stroke survivors with hemiplegic shoulder pain.

Registration:

URL:
https://www.chictr.org.cn
; Unique identifier: ChiCTR1900023513.
Frequency, Characteristics, and Outcomes of Endovascular Thrombectomy in Patients With Stroke Beyond 6 Hours of Onset in US Clinical Practice
Authors: Zachrison Kori S. , Schwamm Lee H. , Xu Haolin , Matsouaka Roland , Shah Shreyansh , Smith Eric E. , Xian Ying , Fonarow Gregg C. , Saver Jeffrey 
Published: September 2021

Background and Purpose:
In 2018, 2 randomized controlled trials showed the benefit of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated 6 to 24 hours from last known well using imaging-guided selection. However, little is known about outcomes in contemporary nontrial settings. We assessed the frequency of EVT and outcomes beyond 6 hours in the US Get With The Guidelines–Stroke clinical registry.

Methods:
We analyzed all acute ischemic stroke patients treated with EVT between January 1, 2009 and October, 1, 2018, at Get With The Guidelines–Stroke hospitals in the United States. We assessed trends over time in frequency of EVT beyond 6 hours, compared patient characteristics and outcomes between those treated within versus beyond 6 hours, and evaluated the associations between EVT time and outcomes.

Results:
We identified 53 702 patients at 697 sites treated with EVT during the study period. Treatment after 6 hours from last known well occurred in 17 720 (33%) of all 53 702 EVT cases (median 4.7 hours, interquartile range, 3.3–7 hours). The proportion of EVT cases treated after 6 hours from last known well varied widely across sites (median 30%, interquartile range, 24%–38%). Compared with patients treated within 6 hours, those treated beyond six hours were younger, less likely to have atrial fibrillation, less likely to arrive by ambulance, had lower stroke severity, were less likely to be anticoagulated, and more likely to be treated at centers with higher EVT volumes. After adjusting for patient and hospital characteristics, patients receiving EVT beyond 6 hours had less favorable in-hospital mortality, ambulation at discharge, and discharge disposition compared to those treated within 6 hours.

Conclusions:
EVT is frequently performed for patients with ischemic stroke after 6 hours from last known well, accounting for one-third of cases nationally, and adjusted functional outcomes at discharge are worse in these patients compared to those treated with EVT within 6 hours. Further efforts are needed for optimal EVT outcomes in clinical practice settings.
Outcomes Among Patients With Reversible Cerebral Vasoconstriction Syndrome: A Nationwide United States Analysis
Authors: Patel Smit D. , Topiwala Karan , Otite Oliver Fadar , Saber Hamidreza , Panza Gregory , Mui Gracia , Liebeskind David S. , Saver Jeffrey L. , Alberts Mark , Ducros Anne 
Published: September 2021

Background and Purpose:
Reversible cerebral vasoconstriction syndrome (RCVS) is a well-established cause of stroke, but its demographics and outcomes have not been well delineated.

Methods:
Analysis of the United States Nationwide Inpatient Sample database (2016–2017) to characterize the frequency of hospitalizations for RCVS, demographic features, inpatient mortality, and discharge outcomes.

Results:
During the 2-year study period, 2020 patients with RCVS were admitted to Nationwide Inpatient Sample hospitals, representing 0.02 cases per 100 000 national hospitalizations. The mean age at admission was 47.6 years, with 85% under 65 years of age, and 75.5% women. Concomitant neurological diagnoses during hospitalization included ischemic stroke (17.1%), intracerebral hemorrhage (11.0%), subarachnoid hemorrhage (32.7%), seizure disorders (6.7%), and reversible brain edema (13.6%). Overall, 70% of patients were discharged home, 29.7% discharged to a rehabilitation facility or nursing home and 0.3% died before discharge. Patient features independently associated with the poor outcome of discharge to another facility or death were advanced age (odds ratio [OR], 1.04 [95% CI, 1.03–1.04]), being a woman (OR, 2.45 [1.82–3.34]), intracerebral hemorrhage (OR, 2.91 [1.96–4.31]), ischemic stroke (OR, 5.72 [4.32–7.58]), seizure disorders (OR, 2.61 [1.70–4.00]), reversible brain edema (OR, 6.26 [4.41–8.89]), atrial fibrillation (OR, 2.97 [1.83–4.81]), and chronic kidney disease (OR, 3.43 [2.19–5.36]).

Conclusions:
Projected to the entire US population, >1000 patients with RCVS are hospitalized each year, with the majority being middle-aged women, and about 300 required at least some rehabilitation or nursing home care after discharge. RCVS-related inpatient mortality is rare.
Analyzing scientific mobility and collaboration in the Middle East and North Africa
Authors: El-Ouahi Jamal , Robinson-García Nicolas , Costas Rodrigo 
Published: September 2021

Abstract
This study investigates the scientific mobility and international collaboration networks in the Middle East and North Africa (MENA) region between 2008 and 2017. By using affiliation metadata available in scientific publications, we analyze international scientific mobility flows and collaboration linkages. Three complementary approaches allow us to obtain a detailed characterization of scientific mobility. First, we uncover the main destinations and origins of mobile scholars for each country. Results reveal geographical, cultural and historical proximities. Cooperation programs also contribute to explain some of the observed flows. Second, we use the academic age. The average academic age of migrant scholars in MENA was about 12.4 years. The academic age group 6–10 years is the most common for both emigrant and immigrant scholars. Immigrants are relatively younger than emigrants, except for Iran, Palestine, Lebanon, and Turkey. Scholars who migrated to Gulf Cooperation Council countries, Jordan, and Morocco were on average younger than emigrants by 1.5 years from the same countries. Third, we analyze gender differences. We observe a clear gender gap: Male scholars represent the largest group of migrants in MENA. We conclude by discussing the policy relevance of the scientific mobility and collaboration aspects.
Patch use and departure rules by gull-billed tern Gelochelidon nilotica
Authors: Ribeiro Pablo D. , Navarro Diego D. , Iribarne Oscar O. 
Published: September 2021

Abstract
The gull-billed tern Gelochelidon nilotica feeds on the fiddler crab Leptuca uruguayensis, which settles forming patches in south-eastern temperate mudflats of Argentina. Through field observations, we evaluated whether gull-billed terns used patches following the marginal value theorem (MVT). Gull-billed tern residence time in a patch was not related to crab density or travel times. The number of captures was also unrelated to crab density. Most of the times (44.6%) terns captured only one crab from each patch, and 35% of the times they left without a capture. However, crab density was lower when terns left the patches than when they arrived. This suggests that following several capture attempts by terns, crabs hide, producing a temporary decrease in their availability, forcing tern departure from the patches, which are no longer profitable. Thus, when prey availability is affected more by predator activity than by consumption, the MVT may not necessarily apply.
In the Middle of Nowhere
Authors: Goodall Jane 
Published: September 2021

Abstract
Given that the condition of ‘mortal liveness’ was a greater cause for perplexity in Beckett’s writing than the notion of an afterlife, this essay considers evocations of a post-mortal state in The Unnamable and the three works of the later trilogy, Nohow On, as a continuum from the pre-natal state he claims to recall. The paintings of Jack B. Yeats, an acknowledged influence on Beckett, exhibit significant parallels in the evocation of figures whose tenuous presence in the landscape erases the boundary between shades and mortal beings.
Beckett and the Sub Specie Aeternitatis Vision
Authors: Uhlmann Anthony 
Published: September 2021

Abstract
This essay will consider the idea of the creation of the feeling of the ‘eternal’ in Samuel Beckett through a strange identification of temporalities that involve the immediate sensation of direct perception in the present, and idealised feelings from the past. It begins by unpacking Beckett’s comment in a letter to Thomas McGreevy of 5 March 1936 that affirms the importance of the ‘sub specie aeternitatis [from the perspective of eternity] vision’ (2009b, 318–321; Knowlson, 219). It considers Spinoza’s definitions of the ‘eternal’ and draws upon Beckett’s early essay Proust in developing readings of Beckett’s late prose works Ceiling (1981) and Stirrings Still (1989). It does this not to attempt to demonstrate Beckett’s debt to Spinoza, which remains open to question, but rather to underline how Beckett’s works, in dialogue with those of Spinoza, allow us to glimpse what is at stake in a particular idea of the eternal.
On the Upper-Ocean Vertical Eddy Heat Transport in the Kuroshio Extension. Part II: Effects of Air–Sea Interactions
Authors: Yang Peiran , Jing Zhao , Sun Bingrong , Wu Lixin , Qiu Bo , Chang Ping , Ramachandran Sanjiv , Yuan Chunxin 
Published: September 2021

AbstractEncountering of energetic ocean eddies and atmosphere storms makes the winter Kuroshio extension a hotspot for air–sea interactions. This second part investigates the regulation of vertical eddy heat transport QT in the winter Kuroshio extension mixed layer by different types of air–sea interactions, including the atmosphere synoptic forcing, eddy thermal feedback resulting from eddy-induced surface heat flux anomalies, and eddy current feedback from eddy current’s imprint on wind stress. Atmosphere synoptic forcing modulates intraseasonal variation of QT by boosting its component contributed by the turbulent thermal wind balance during strong cooling events associated with intense winds. In addition, the magnitude of QT is influenced by the direction of synoptic wind stress primarily via , with the latter exhibiting enhancement both in the downfront- and upfront-wind forcing. Enhanced by the downfront-wind forcing is attributed to increased turbulent vertical viscosity and front intensity caused by the destabilizing wind-driven Ekman buoyancy flux, whereas interaction of uniform wind stress with smaller turbulent vertical viscosity at the front center than periphery (a so-called internal Ekman pumping) accounts for the increased in the upfront-wind forcing. The eddy thermal feedback reduces QT significantly through weakening the fronts. In contrast, the eddy current feedback exerts negligible influences on QT, although it weakens eddy kinetic energy (EKE) evidently. This is due to the much reduced effect of eddy current feedback in damping the fronts compared to EKE and also due to the compensation from Ekman pumping induced by the eddy current feedback.
A Coffee Yield Next-Generation Forecast System for Rain-Fed Plantations: The Case of the Samalá Watershed in Guatemala
Authors: Pons Diego , Muñoz Ángel G. , Meléndez Ligia M. , Chocooj Mario , Gómez Rosario , Chourio Xandre , Romero Carmen González 
Published: September 2021

AbstractThe provision of climate services has the potential to generate adaptive capacity and help coffee farmers become or remain profitable by integrating climate information in a risk-management framework. Yet, to achieve this goal, it is necessary to identify the local demand for climate information, the relationships between coffee yield and climate variables, and farmers’ perceptions and to examine the potential actions that can be realistically put in place by farmers at the local level. In this study, we assessed the climate information demands from coffee farmers and their perception on the climate impacts to coffee yield in the Samalá watershed in Guatemala. After co-identifying the related candidate climate predictors, we propose an objective, flexible forecast system for coffee yield that is based on precipitation. The system, known as NextGen, analyzes multiple historical climate drivers to identify candidate predictors and provides both deterministic and probabilistic forecasts for the target season. To illustrate the approach, a NextGen implementation is conducted in the Samalá watershed in southwestern Guatemala. The results suggest that accumulated June–August precipitation provides the highest predictive skill associated with coffee yield for this region. In addition to a formal cross-validated skill assessment, retrospective forecasts for the period 1989–2009 were compared with agriculturalists’ perception on the climate impacts to coffee yield at the farm level. We conclude with examples of how demand-based climate service provision in this location can inform adaptation strategies like optimum shade, pest control, and fertilization schemes months in advance. These potential adaptation strategies were validated by local agricultural technicians at the study site.
Schwannoma of the Zygomatic Branch of the Facial Nerve
Authors: Kilmpasanis Adamantios , Tsetsos Nikolaos , Poutoglidis Alexandros , Tsentemeidou Aikaterini , Sotiroudi Sotiria , Garefis Konstantinos , Forozidou Evropi , Vlachtsis Konstantinos 
Published: September 2021

Significance Statement Facial nerve schwannoma is extremely uncommon. Despite its rarity, it is considered the most common facial nerve tumor and potentially affects any segment of the nerve. Presenting symptoms vary depending on the location of the neoplasm. Tumors pertaining to the extratemporal course of the nerve mainly appear as an asymptomatic parotid mass. We present a rare case of schwannoma of the zygomatic branch of the right facial nerve that was surgically resected, without facial nerve injury.
Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review
Authors: Seco Michael , Lau Jonathan CL , Medi Caroline , Bannon Paul G 
Published: September 2021

Introduction Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibrillation surgery were included. Results A total of 10 observational studies were identified, including 644 patients. Most patients had paroxysmal atrial fibrillation. The proportion with prior unsuccessful ablation ranged from 0 to 19%, and preoperative left atrial diameter ranged from 44 ± 17 to 52 ± 8 mm. Cox–Maze IV (n = 311) was the most common technique used, followed by pulmonary vein isolation (n = 222) and Cox–Maze III (n = 98). Patients with persistent or longstanding atrial fibrillation more frequently received Cox–Maze III/IV. Ranges of early postoperative outcomes included: mortality 0 to 7%, recurrence of atrial tachyarrhythmias 4.4 to 48%, cerebrovascular events 0 to 1.5%, and pacemaker insertion 3 to 21%. Long-term data was limited. Freedom from atrial tachyarrhythmias at 1 year ranged from 74% to 96%, and at 5 years from 52% to 100%. Preoperative predictors of late atrial tachyarrhythmia recurrence included left atrial diameter >45 mm, persistent or longstanding preoperative atrial fibrillation and longer atrial fibrillation duration. Conclusion In patients with atrial fibrillation undergoing septal myectomy, the addition of ablation surgery adds low overall risk to the procedure, and likely reduces the risk of recurrent atrial fibrillation in the long term. Future randomised studies comparing septal myectomy with or without concomitant AF ablation are needed.
The effects of confronting one’s own end of life on older individuals and those with a life-threatening disease: A systematic literature review
Authors: Kukla Helena , Herrler Angélique , Strupp Julia , Voltz Raymond 
Published: September 2021

Background: Awareness of the impending end of one’s life can pose profound existential challenges, thereby impairing well-being. Confronting one’s own end of life may be an approach to meet the psychological needs and consequently enhance overall well-being. Different approaches of confrontation have been evaluated positively using measures of psychosocial comfort. To date, there exists no systematic overview on the different ways of confrontation (e.g. psychosocial or individual coping approaches). Aim: To synthesize the existing knowledge on the effects of different approaches of confronting one’s own end of life on older individuals and those with a life-threatening disease. Design: A systematic review of quantitative, qualitative, and mixed-methods full research reports was conducted. The retrieved studies were screened and appraised for methodological quality by two independent reviewers based on MMAT and CASP. The findings were synthesized narratively using the meta-summary technique by Sandelowski and Barroso. Data sources: Medline, PsycINFO, and Web of Science were searched from inception to 12/2020. Results: N = 49 studies reported on different approaches of confronting one’s own end of life, including psychosocial interventions, meaning-enhancing approaches, educational programs, and learning from lived experiences. The results suggest a clear trend toward beneficial effects on psychosocial comfort (e.g. anxiety, sense of meaning, well-being). Conclusion: Low-threshold opportunities of confrontation have the potential to improve well-being and should be emphasized in practical implementation. The results can serve as a comprehensive basis for future research aiming to investigate the determinants of psychosocial comfort for people nearing the end of life.
Monitoring the depth of palliative sedation by video-pupillometry: A case report
Authors: Elyn Antoine , Saffon Nicolas , Larson Merlin 
Published: September 2021

Background: Palliative sedation is sometimes interrupted by undesired arousals. Pupillometry has been used in anesthesiology to monitor pain and sedation but has never been used during palliative sedation. Actual case: A 48 years-old patient, with multi-metastatic cancer, underwent palliative sedation to manage global suffering. On the second day, the patient experienced arousal which required medication adjustments to ensure pain relief and increased sedation. Possible course of action: Depth of sedation is monitored with clinical scales, such as the Richmond Agitation-Sedation Scale. But these scales do not measure brain stem activity and are poor at predicting arousal. Formulation of a plan: During palliative sedation, an infrared pupillometer was used to monitor pupil size and pupillary reactivity (Neurolight®, IDMed®, Marseille, France). Outcome: The pupillary light reflex was depressed during deep sedation. In our case, we observed a low-normal reflex along with dilated pupil before arousal. Lessons from the case: Our case suggests that reflex intensity and pupil size might predict arousals during palliative sedation. View on research problems, objectives, or questions generated by the case: Prospective studies are needed to confirm our findings. Pupillometry’s acceptability should also be questioned from patient’s, families’, and caregivers’ perspectives.
The Impact of 4 Risk Communication Interventions on Cancer Screening Preferences and Knowledge
Authors: Valentine K. D. , Wegier Pete , Shaffer Victoria A. , Scherer Laura D. 
Published: September 2021

Purpose The US Preventive Services Task Force has changed their screening recommendations, encouraging informed patient choice and shared decision making as a result of emerging evidence. We aimed to compare the impact of a didactic intervention, a descriptive harms intervention, a narrative intervention, and a new risk communication strategy titled Aiding Risk Information learning through Simulated Experience (ARISE) on preferences for a hypothetical beneficial cancer screening test (one that reduces the chance of cancer death or extends life) versus a hypothetical screening test with no proven physical benefits. Method A total of 3386 men and women aged 40 to 70 completed an online survey about prostate or breast cancer screening. Participants were randomly assigned to either an unbeneficial test condition (0 lives saved due to screening) or a beneficial test condition (1 life saved due to screening). Participants then reviewed 4 informational interventions about either breast (women) or prostate (men) cancer screening. First, participants were provided didactic information alongside an explicit recommendation. This was followed by a descriptive harms intervention in which the possible harms of overdetection were explained. Participants then viewed 2 additional interventions: a narrative and ARISE (an intervention in which participants learned about probabilities by viewing simulated outcomes). The order of these last 2 interventions was randomized. Preference for being screened with the test and knowledge about the test were measured. Results With each successive intervention, preferences for screening tests decreased an equivalent amount for both a beneficial and unbeneficial test. Knowledge about the screening tests was largely unimpacted by the interventions. Conclusions Presenting detailed risk and benefit information, narratives, and ARISE reduced preferences for screening regardless of the net public benefit of screening.