bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinicians' Approach to Patent Foramen Ovale Closure after Stroke: Comparing Cardiologists and Neurologists
Authors: Khan Farhan , Fiorilli Paul , Messé Steven R. , Kasner Scott E. , Derbas Laith A. , Kavinsky Clifford J. , Favilla Christopher G. 
Published: July 2022

Background
Evidence from randomized trials and updated professional society guidelines supports patent foramen ovale (PFO) closure after cryptogenic stroke in select patients. It is unclear how this has been integrated into real‐world practice, so we aimed to compare practice patterns between cardiologists and neurologists.

Methods and Results

In March of 2021, a survey of cardiologists and neurologists who work or previously trained at the University of Pennsylvania Health System assessed practice preferences with respect to PFO closure after stroke. Clinical vignettes isolated specific variables of interest and used a 5‐point Likert scale to assess the level of support for PFO closure. Stroke neurologists and interventional cardiologists were compared by Wilcoxon‐Mann–Whitney tests. Secondarily, Kruskal–Wallis tests compared stroke neurologists, general neurologists, interventional cardiologists, and general cardiologists. We received 106 responses from 182 survey recipients (31/31 stroke neurologists, 38/46 interventional cardiologists, 20/30 general neurologists, and 17/77 general cardiologists). A similar proportion of stroke neurologists and interventional cardiologists favored PFO closure in a young patient with cryptogenic stroke, 88% and 87%, respectively (
P
=0.54). Interventionalists were more likely than stroke neurologists to support closure in the context of an alternative high‐risk stroke mechanism, 14% and 0%, respectively (
P
=0.003). Stroke neurologists were more likely to oppose closure on the basis of older age (
P
=0.01).

Conclusions
There are key differences between how neurologists and cardiologists approach PFO closure after stroke, particularly when interpreting the stroke etiology and when considering closure beyond the scope of prior trials; this underscores the importance of collaboration between cardiologists and neurologists.
Ischemic Stroke Systems of Care in California: Evolution in the Organization During the Mechanical Thrombectomy Era
Authors: Zachrison Kori S. , Hsia Renee Y. , Li Sijia , Reeves Mathew J. , Camargo Carlos A. , Yan Zhiyu , Onnela Jukka‐Pekka , Schwamm Lee H. 
Published: July 2022

Background
Optimized stroke systems of care enable access to timely care, including endovascular thrombectomy (EVT). Stroke systems have likely evolved after publication of EVT benefit (2015). Our objective was to map the stroke patient transfer network in California in terms of EVT access and patient transfer patterns, and to examine changes after 2015.

Methods
In this observational study, we identified all ischemic stroke encounters, transfers, alteplase use, and EVT procedures in California from 2010 to 2017. An established connection between any hospital pair was defined as the transfer of ≥2 patients between them. A 2‐level logistic regression model assessed whether encounters were more frequently transferred to EVT‐capable hospitals post‐2015, adjusting for patient‐ and hospital‐level factors. Linear regression examined trends in key network characteristics over time, and interrupted time series regressions examined for changes post‐2015.

Results

Among 336 247 encounters, 3.4% were transferred, 9.3% received alteplase, and 2.3% underwent EVT. From 2010 to 2017 the proportion that were EVT treated increased (1.0%–4.3%;
P
‐for‐trend<0.001) with a significant increase post‐2015 (
P
=0.01). Odds of transfer to EVT‐capable hospital were greater post‐2015 (adjusted odds ratio, 6.54; [95% CI 5.52–7.74]), but were lower for patients who were older, Black, Hispanic, and presented to a rural hospital. Significant network changes from 2010 to 2017 included increased number of encounters transferred, increased number of transferring hospitals, decreasing number of receiving hospitals, and increased proportion of receiving hospitals performing EVT. However, none of these network changes demonstrated a significant inflection point after 2015.

Conclusion
The California stroke network has been dynamic over time. Although most changes have been incremental, after the release of EVT trial data in 2015 changes in transfer patterns did lead to increased access to EVT.
Cultural Reconstruction of Ọzọ Initiation Rites in Igbo-Ukwu Southeast, Nigeria and Identity Preservation
Authors: Okoye Obiageli C. 
Published: July 2022

Abstract
Most aspects of Igbo culture were abandoned and some faced the threat of extinction as a result of colonialism and Christian religion. Ọzọ title taking, an exclusive title for honest and successful men was abandoned in Igbo-Ukwu because of its connection with Igbo traditional religion. The study employed qualitative approach to investigate the traditional ọzọ initiation ritual, the reconstructed version and the role of the ọzọ title taking in preserving Igbo culture and identity. The study established that the realization of the role of ọzọ institution in building morals and preserving Igbo identity by the traditional leadership of Igbo-Ukwu led to its revival by reconstructing its initiation rite. The reconstruction involves removing parts of the ọzọ initiation rite connected with Igbo traditional religion to make it more acceptable to people of all religious leanings. Although, some people argued that the disconnection of the ọzọ title from Igbo traditional religion has reduced it to a mere social title. They fail to realize that any aspect of culture that is not adapted to meet the current societal need will eventually be extinct. The study recommends the thorough character investigation of prospective ọzọ candidates to ensure they are honest and responsible men. Van Gennep’s Rites of Passage is adopted as explanatory framework for this study. Secondary data were used to compliment primary data collected. Primary data were analyzed descriptively.
Sexual dimorphism in the mountain dragon, Diploderma micangshanensis (Squamata: Lacertilia: Agamidae) from central China
Authors: Xiong Jianli , Bai Yinlong , Li Guanglu , You Zhangqiang 
Published: July 2022

Abstract
Sexual dimorphism (SD) is a common phenomenon in the animal kingdom, especially in lizards. The mountain dragon (Diploderma micangshanensis) is a Chinese endemic that is widely distributed in montane regions of northern Sichuan, western Hubei Province, southern Gansu, Henan, and Shanxi Provinces. However, little is known about its morphology, ecology, behavior, physiology, and natural history. In this study, SD in size and shape in a population of D. micangshanensis from Henan Province, Central China was examined based on a sample of 35 males and 23 females. Sexual dimorphism was observed in a few body shape variables (e.g., head and trunk length) but not in body size (snout-vent length). Males had longer and wider heads and shorter trunks. Sexual dimorphism in these traits can be explained by the sexual selection, ecological divergence, and fecundity advantage hypotheses. Additional studies of the ecology, reproductive biology, natural history, and behavior of D. micangshanensis are needed to evaluate the relative contributions of these mechanisms to determining the patterns of SD observed in this population.
Attitudes and Ecumenical Recognition. How Do Attitudes Define, Facilitate, or Inhibit Ecumenical Advancement?
Authors: Hietamäki Minna 
Published: July 2022

Abstract
Ecumenical texts cultivate a rich language of attitudes referring to trust, commitment, love, faithfulness, openness, etc., but their role in ecumenical advancement has been taken for granted. This article discusses attitudes in ecumenical advancement by focusing on ecumenical recognition. Some recognition theories hold attitudes, specifically personifying attitudes, to be a precondition for recognition. Contemporary recognition theories offer a rich analysis of attitudes concerning subjects and objects of recognition, the direction, and the consequences of recognition. Based on an overview of recognitive attitudes this article aims to offer new insights on (ecumenical) attitudes and a deeper understanding of ecumenical recognition and some of its challenge. Some of the main points of discussion include recognition on the interpersonal level and its relation to institutional level recognition, the individual, corporate and institutional subjects and objects of recognition, and the variety of ways attitudes relate to recognition.
WTO Law and Jurisprudence on Invasive Alien Species in the Global South
Authors: EJ Mogomotsi Goemeone , Mogomotsi Patricia K , O Moeti Onthatile 
Published: July 2022

Abstract
International trade is a significant factor in the introduction of invasive alien species around the world. The preparedness of countries through their domestic regulations to combat invasive alien species differs from country to country. This article discusses the potential of WTO law in combating the spread of invasive alien species in countries with weak environmental regulation regimes such as Botswana. It recognises the possibility of invoking provisions of WTO agreements by member states to combat the introduction and spread of invasive alien species. It concludes that the use of WTO agreements by developing countries may be an immediate solution to address and combat biodiversity losses in the global south. The article recommends the building of technical and scientific capacity by developing countries to effectively use international trade law for environmental protection.
Uh and Um as Pragmatic Markers in Dialogues: A Contrastive Perspective on the Functions of Planners in Fiction and Conversation
Authors: Tonetti Tübben Ilenia , Landert Daniela 
Published: July 2022

Abstract
The planners uh and um fulfil a range of interpersonal and discursive functions, akin to other pragmatic markers. Although there appear to be differences between the planners’ functions across genres, the factors influencing these differences have not been analysed comprehensively so far. In our study, we analyse the frequency and functions of uh and um across three different genres: spontaneous conversation, scripted dialogues in television series and dialogues in improvised theatre. Our findings suggest that both the fictional nature of a text and its degree of composition have an influence on the planners’ functions. Our results confirm that planners are indeed pragmatic markers which serve a range of textual and interpersonal functions, and that the frequency and functions of planners are affected by factors relating to the context of language production, which include spontaneity as well as the content and function of a text.
Shared Responsibilities in Fighting the Plague in Moldavia, 1800–1830
Authors: Grigoruță Sorin 
Published: July 2022

Abstract
The plague was the epidemic disease that had the deepest impact upon the lives and memories of the people who lived in Moldavia up to the mid-nineteenth century. By investigating a series of anti-epidemic measures, this paper aims to emphasise the shared responsibility for care during the plague epidemics. The tasks of coordinating and financing these anti-epidemic efforts were assumed by the reigning leaders. Their authority, in some situations, was substituted by representatives of the Russian military administration, at times when the Romanian Principalities were occupied by Russian troops. The anti-epidemic mobilization gathered all available forces to fight the spread of disease: amongst others, the boyars, merchants, and local authorities. The physicians of the times represented a discrete, but sometimes, an essential presence. More numerous but scarcely involved in the 1828–1830 epidemic period, doctors played a decisive role especially in the context of the medical-administrative transformations after 1830. The role of the Church should also be noted, as priests had the task of popularizing the anti-epidemic measures within their communities and of persuading their congregations to accept public health measures.
The ‘Greenlandization’ of Care: Disability in Postcolonial Greenland, 1950s–1980s
Authors: Derksen Anna 
Published: July 2022

Abstract
When the former Danish colony Greenland obtained Home Rule in 1979, becoming an autonomous region within the Danish Realm, it faced the challenge of having to establish a comprehensive social welfare system. This article looks at disability care and its interrelations with post-colonialism and national identity formation, as previous practices of medical care and accommodation in Danish institutions were replaced with local solutions. Frame analysis reveals the outlines of the responsibilities of Danish experts for disabled Greenlanders under colonial rule and during the modernization period until 1979. The transition phase of the early 1980s was a central arena for Greenlandic national discourse wherein care responsibilities in welfare policies, disability care institutions, advocacy organizations and the media were framed and renegotiated. The ‘Greenlandization’ of disability care and the respective shift in responsibilities was a highly uneven process that continued to be suffused with Danish norms and practices.
Impact of Advection Schemes on Tracer Interrelationships in Large-Eddy Simulations of Deep Convection
Authors: Hernández Pardo Lianet , Morrison Hugh , Lauritzen Peter H. , Pöhlker Mira 
Published: July 2022

Abstract
This study investigates the preservation of tracer interrelationships during advection in large-eddy simulations of an idealized deep convective cloud, which is particularly relevant to chemistry, aerosol, and cloud microphysics models. Employing the Cloud Model 1, advection is represented using third-, fifth-, and seventh-order weighted essentially non-oscillatory schemes. As a simplified analogy for cloud hydrometeors and aerosols, several inert passive tracers following linear and nonlinear relationships are initialized after the cloud reaches ∼6-km depth. Numerical mixing in the simulated turbulent convective clouds leads to significant deviations from the initial nonlinear relationships between tracers. In these simulations, a considerable fraction of the grid points where the tracers’ nonlinear relationships are altered from advection are classified as unrealistic (e.g., ∼13% for the environmental tracers on average), including errors from range-preserving unmixing and overshooting. Errors in the sum of three tracers are also relatively large, ranging between ∼1% and 16% for 5% of the grid points in and near the cloud. The magnitude of unrealistic mixing and errors in the sum of three tracers generally increase with the order of accuracy of the advection scheme. These results are consistent across model grid spacings ranging from 50 to 200 m, and across three different flow realizations for each combination of grid spacing and advection scheme tested. Tests employing a previously proposed scalar normalization procedure show substantially reduced errors in the sum of three tracers with a relatively small negative impact on other tracer relationships. This analysis, therefore, suggests efficacy of the normalization procedure when applied to turbulent three-dimensional cloud simulations.

Significance Statement
In nature, transporting several quantities through bulk motions of a fluid does not affect preexisting relationships between them. However, this is not always accomplished in numerical models of the atmosphere, because of intrinsic limitations in the transport algorithms employed. We aim to investigate how these errors behave in 3D realistic simulations of a cumulus cloud, where the turbulent flow constitutes a particular challenge. We show that relationships between quantities are significantly and frequently perturbed during bulk transport in the model. Moreover, our results suggest that increasing complexity of the bulk-transport algorithms (in a way that is conventionally employed for improving the representation of individual quantities) tends to worsen the representation of relationships between two or three quantities.
3T external phased-array magnetic resonance imaging in detection of obstetric anal sphincter lesions: a pilot study
Authors: Pinta Tarja , Ruohonen Jyrki , Kallio-Packalen Marja , Zhabin Ivan , Kirss Jaan 
Published: July 2022

Background Three-dimensional endoanal ultrasound (3D EAUS) has been the gold standard for detecting anal sphincter lesions in patients with a history of obstetric anal sphincter injury (OASI). Advances in imaging technologies have facilitated the detection of these lesions with external phased-array magnetic resonance imaging (MRI), which could offer an alternative imaging modality for the diagnosis of residual OASI (ROASI) in centers where 3D EAUS imaging is not available. Purpose To compare two diagnostic modalities: the 3D EAUS and 3T external phased-array MRI in the detection of residual anal sphincter lesions. Material and Methods A total of 24 women with a history of OASI were imaged with both 3D EAUS and 3T external phased-array MRI after primary repair of the injury. Intraclass correlation (ICC) and interrater reliability (IRR) values were calculated for the grade and circumference of the sphincter lesion. Sphincter lesions were graded according to the Sultan classification. Results There was an almost perfect agreement between 3D EAUS and 3T external phased-array MRI in determining the extent of the sphincter lesions according to the Sultan classification (κ = 0.881; P < 0.001) and the circumference of the external anal sphincter defects, measured in degrees (κ = 0.896; P < 0.001). Conclusion The results of this study indicate that 3T external phased-array MRI and 3D EAUS yield comparable results in the diagnosis of ROASI. These findings suggest that 3T external phased-array MRI could serve as an alternative diagnostic modality to 3D EAUS in the diagnosis of ROASI.
Mitochondrial measures in neuronally enriched extracellular vesicles predict brain and retinal atrophy in multiple sclerosis
Authors: Ladakis Dimitrios C , Yao Pamela J , Vreones Michael , Blommer Joseph , Kalaitzidis Grigorios , Sotirchos Elias S , Fitzgerald Kathryn C , Saidha Shiv , Calabresi Peter A , Kapogiannis Dimitrios , Bhargava Pavan 
Published: July 2022

Background: Mitochondrial dysfunction plays an important role in multiple sclerosis (MS) disease progression. Plasma extracellular vesicles are a potential source of novel biomarkers in MS, and some of these are derived from mitochondria and contain functional mitochondrial components. Objective: To evaluate the relationship between levels of mitochondrial complex IV and V activity in neuronally enriched extracellular vesicles (NEVs) and brain and retinal atrophy as assessed using serial magnetic resonance imaging (MRI) and optical coherence tomography (OCT). Methods: Our cohort consisted of 48 people with MS. NEVs were immunocaptured from plasma and mitochondrial complex IV and V activity levels were measured. Subjects underwent OCT every 6 months and brain MRI annually. The associations between baseline mitochondrial complex IV and V activities and brain substructure and retinal thickness changes were estimated utilizing linear mixed-effects models. Results: We found that higher mitochondrial complex IV activity and lower mitochondrial complex V activity levels were significantly associated with faster whole-brain volume atrophy. Similar results were found with other brain substructures and retinal layer atrophy. Conclusion: Our results suggest that mitochondrial measures in circulating NEVs could serve as potential biomarkers of disease progression and provide the rationale for larger follow-up longitudinal studies.
Personality disorders and outcome after multidisciplinary pain therapy
Authors: Heyn Jens , Uenze Birgit , Christoph Ricarda , Baumann Nanette , Kiesewetter Isabel , Mihatsch Lorenz , Luchting Benjamin 
Published: July 2022

Objectives Interdisciplinary treatment programmes are the gold standard for patients suffering from chronic pain. However, several patient-related factors seem to influence the patients’ outcome. The aim of our study was to inquire whether patients with personality disorders (PD) might benefit less from an interdisciplinary treatment programme compared to patients without PD. Methods A prospective, observational study with chronic pain patients attending a 5-week interdisciplinary treatment programme was performed. Main outcome parameters were psychological stabilization and pain intensity before and after the programme. Results Out of the 104 included patients, 71 (68.3%) showed personality accentuations and 16 (15.4%) were diagnosed with PDs. PDs were mostly classified as histrionic, followed by borderline and narcistic personality. Patients diagnosed with histrionic accentuation showed a significantly better treatment response in terms of pain. Reduction in ADS (Allgemeine Depressionsskala – depression scale) was 3.4 in patients with PD and 11.1 in those without PD. Borderline patients showed a significant increase of ADS (by 2.0; p < 0.05) after programme completion. Discussion Patients with chronic pain and personality accentuations or disorder only showed a slightly different outcome after interdisciplinary treatment programme and should therefore not be excluded from these programmes. Registered at German Clinical Trials Register (DRKS-ID: DRKS00015141).
Illness conversations: Self-disclosure among children and youth with chronic illnesses
Authors: Pathmalingam Tharanni , Moola Fiona J , Woodgate Roberta L 
Published: July 2022

Objective Illness disclosure refers to when individuals with chronic illnesses make decisions to tell others about their disease. There is a lack of research on the complexity of disclosure among children and youth with chronic illnesses. We conducted a review of the literature to understand the process of disclosure among children and youth with chronic illnesses in the context of peer-based relationships. Methods A narrative review was completed using three databases. The search yielded 11 articles that utilized various research designs. Results Most of the literature was qualitative in nature. Most children and youth engaged in non-disclosure and concealment which is born out of fears of discrimination. Fewer children and youth engaged in unplanned disclosure, passive disclosure, partial disclosure, and open disclosure. Children and youth carefully consider who they are disclosing to and perceptions about other peoples’ responses strongly impact disclosure. Children and youth disclose verbally, behaviorally, and in written form. Disclosure is associated with both positive and negative effects, such as confidence, self-advocacy, and distress. Discussion Health providers and researchers should critically support disclosure and empower children and youth with the resources they need to be agents in their own disclosure decisions.