bluuebunny/crossref_metadata_2025 huggingface dataset:
Genomic predictions in purebreds with a multibreed genomic relationship matrix1
Authors: Steyn Yvette , Lourenco Daniela A L , Misztal Ignacy
Published: September 2019

Combining breeds in a multibreed evaluation can have a negative impact on prediction accuracy, especially if single nucleotide polymorphism (SNP) effects differ among breeds. The aim of this study was to evaluate the use of a multibreed genomic relationship matrix (G), where SNP effects are considered to be unique to each breed, that is, nonshared. This multibreed G was created by treating SNP of different breeds as if they were on nonoverlapping positions on the chromosome, although, in reality, they were not. This simple setup may avoid spurious Identity by state (IBS) relationships between breeds and automatically considers breed-specific allele frequencies. This scenario was contrasted to a regular multibreed evaluation where all SNPs were shared, that is, the same position, and to single-breed evaluations. Different SNP densities (9k and 45k) and different effective population sizes (Ne) were tested. Five breeds mimicking recent beef cattle populations that diverged from the same historical population were simulated using different selection criteria. It was assumed that quantitative trait locus (QTL) effects were the same over all breeds. For the recent population, generations 1–9 had approximately half of the animals genotyped, whereas all animals in generation 10 were genotyped. Generation 10 animals were set for validation; therefore, each breed had a validation group. Analyses were performed using single-step genomic best linear unbiased prediction. Prediction accuracy was calculated as the correlation between true (T) and genomic estimated breeding values (GEBV). Accuracies of GEBV were lower for the larger Ne and low SNP density. All three evaluation scenarios using 45k resulted in similar accuracies, suggesting that the marker density is high enough to account for relationships and linkage disequilibrium with QTL. A shared multibreed evaluation using 9k resulted in a decrease of accuracy of 0.08 for a smaller Ne and 0.12 for a larger Ne. This loss was mostly avoided when markers were treated as nonshared within the same G matrix. A G matrix with nonshared SNP enables multibreed evaluations without considerably changing accuracy, especially with limited information per breed.
Characterizing Fentanyl Variability Using Population Pharmacokinetics in Pediatric Burn Patients
Authors: Grimsrud Kristin N , Lima Kelly M , Tran Nam K , Palmieri Tina L
Published: September 2019

Opioids are essential first line analgesics for pain management after burn injury. Opioid dosing remains challenging in burn patients, particularly in children, due to the immense variability in efficacy between patients. Opioid pharmacokinetics are altered in burned children, increasing variability and obviating dosing regimens extrapolated from adult-data. The present study aimed to characterize variability in fentanyl pharmacokinetics and identify significant contributors to variability in children with ≥10% total body surface area burn requiring fentanyl during routine wound care. We recorded patient demographics and clinical data. Blood samples were collected following fentanyl administration for pharmacokinetics at time 0, 30, 60, 120, and 240 minutes on day of admission and repeated on days 3 and 7. Serum fentanyl concentrations were quantified using tandem liquid chromatography mass spectrometry. Population analysis was used to estimate pharmacokinetics parameters. Fourteen patients, 1.2–17 years, with burns from 10–50.5% were included in analysis. A two-compartment model with body weight as a covariate best described fentanyl pharmacokinetics for the overall population. The population clearance and intercompartmental clearance were 7.19 and 2.16 L/hour, respectively, and the volume of distribution for the central and peripheral compartments was 4.01 and 25.1 L, respectively. Individual patient parameter estimates had extensive variability. This study confirmed the high variability in pediatric burn patient fentanyl pharmacokinetics and demonstrates similarities and differences to other populations reported in literature. Further research is needed with a larger number of patients to extensively investigate the impact of burns, genetic polymorphisms, and other factors on fentanyl efficacy and patient outcomes.
A nearby recent supernova that ejected the runaway star ζ Oph, the pulsar PSR B1706−16, and 60Fe found on Earth
Authors: Neuhäuser R , Gießler F , Hambaryan V V
Published: September 2019

The detection of ∼1.5–3.2 Myr old 60Fe on Earth indicates recent nearby core-collapse supernovae. For supernovae in multiple stars, the primary stars may become neutron stars, while former companions may become unbound and become runaway stars. We wrote software for tracing back the space motion of runaway and neutron stars to young associations of massive stars. We apply it here to the nearby young Scorpius–Centaurus–Lupus groups, all known runaway stars possibly coming from there, and all 400 neutron stars with known transverse velocity. We find kinematic evidence that the runaway ζ Oph and the radio pulsar PSR B1706−16 were released by a supernova in a binary 1.78 ± 0.21 Myr ago at 107 ± 4 pc distance (for pulsar radial velocity 260 ± 43 km s−1); association age and flight time determine the progenitor mass (16–18 M⊙), which can constrain supernova nucleosynthesis yields and 60Fe uptake on Earth. In addition, we notice that the only high-mass X-ray binary in Scorpius–Centaurus–Lupus (1H11255−567 with μ1 and μ2 Cru) may include a neutron star formed in another SN, up to ∼1.8 Myr ago at 89−112 pc, i.e. also yielding 60Fe detectable on Earth. Our scenario links 60Fe found on Earth to one or two individual supernovae in multiple stars.
The main sequence of star-forming galaxies – II. A non-evolving slope at the high-mass end
Authors: Popesso P , Morselli L , Concas A , Schreiber C , Rodighiero G , Cresci G , Belli S , Ilbert O , Erfanianfar G , Mancini C , Inami H , Dickinson M , Pannella M , Elbaz D
Published: September 2019

By using the deepest available mid- and far-infrared surveys in the CANDELS, GOODS, and COSMOS fields we study the evolution of the main sequence (MS) of star-forming galaxies (SFGs) from z ∼ 0 to ∼ 2.5 at stellar masses larger than 1010 M⊙. The MS slope and scatter are consistent with a rescaled version of the local relation and distribution, shifted at higher values of star formation rate (SFR) according to ∝ (1 + $z$)3.2. The relation exhibits a bending at the high-mass end and a slightly increasing scatter as a function of the stellar mass. We show that the previously reported evolution of the MS slope, in the considered mass and redshift range, is due to a selection effect. The distribution of galaxies in the MS region at fixed stellar mass is well represented by a single lognormal distribution at all redshifts and masses, with starburst galaxies occupying the tail at high SFR.
A new class of galaxy models with a central BH – I. The spherical case
Authors: Ciotti Luca , Mancino Antonio , Pellegrini Silvia
Published: September 2019

The dynamical properties of spherically symmetric galaxy models, where a Jaffe stellar density profile is embedded in a total mass density decreasing as r−3 at large radii, are presented. The orbital structure of the stellar component is described by the Osipkov–Merritt anisotropy; the dark matter halo is isotropic, and a black hole is added at the centre of the galaxy. First, the conditions for a nowhere negative and monotonically decreasing dark matter halo density profile are derived; this profile can be made asymptotically coincident with an NFW profile at the centre and large radii. Then, the minimum value of the anisotropy radius for phase-space consistency is derived as a function of the galaxy parameters. The Jeans equations for the stellar component are solved analytically; the projected velocity dispersion at the centre and large radii is also obtained, for generic values of the anisotropy radius. Finally, analytical expressions for the terms entering the Virial Theorem are derived, and the fiducial anisotropy limit required to prevent the onset of Radial Orbit Instability is determined as a function of the galaxy parameters. The presented models, built following an approach already adopted in our previous works, can be a useful starting point for a more advanced modelling of the dynamics of elliptical galaxies, and can be easily implemented in numerical simulations requiring a realistic dynamical model of a galaxy.
Astrometric and photometric study of NGC 6067, NGC 2506, and IC 4651 open clusters based on wide-field ground and Gaia DR2 data
Authors: Rangwal Geeta , Yadav R K S , Durgapal Alok , Bisht D , Nardiello D
Published: September 2019

We present an analysis of three southern open star clusters NGC 6067, NGC 2506, and IC 4651 using wide-field photometric and Gaia DR2 astrometric data. They are poorly studied clusters. We took advantage of the synergy between Gaia DR2 high precision astrometric measurements and ground-based wide-field photometry to isolate cluster members and further study these clusters. We identify the cluster members using proper motions, parallax and colour–magnitude diagrams. Mean proper motion of the clusters in μαcosδ and μδ is estimated as −1.90 ± 0.01 and −2.57 ± 0.01 mas yr−1 for NGC 6067, −2.57 ± 0.01, and 3.92 ± 0.01 mas yr−1 for NGC 2506 and −2.41 ± 0.01 and −5.05 ± 0.02 mas yr−1 for IC 4651. Distances are estimated as 3.01 ± 0.87, 3.88 ± 0.42, and 1.00 ± 0.08 kpc for the clusters NGC 6067, NGC 2506, and IC 4651, respectively, using parallaxes taken from Gaia DR2 catalogue. Galactic orbits are determined for these clusters using Galactic potential models. We find that these clusters have circular orbits. Cluster radii are determined as 10 arcmin for NGC 6067, 12 arcmin for NGC 2506, and 11 arcmin for IC 4651. Ages of the clusters estimated by isochrones fitting are 66 ± 8 Myr, 2.09 ± 0.14 Gyr, and 1.59 ± 0.14 Gyr for NGC 6067, NGC 2506, and IC 4651, respectively. Mass function slope for the entire region of cluster NGC 2506 is found to be comparable with the Salpeter value in the mass range of 0.77–1.54 M⊙. The mass function analysis shows that the slope becomes flat when one goes from halo to core region in all the three clusters. A comparison of dynamical age with cluster’s age indicates that NGC 2506 and IC 4651 are dynamically relaxed clusters.
Comprehensive models of novae at metallicity Z = 0.02 and Z = 10−4
Authors: Chen Hai-Liang , Woods T E , Yungelson L R , Piersanti Luciano , Gilfanov M , Han Zhanwen
Published: September 2019

Novae are the observational manifestations of thermonuclear runaways on the surface of accreting white dwarfs (WDs). Although novae are an ubiquitous phenomenon, their properties at low metallicity are not well understood. Using the publicly-available stellar evolution code Modules for Experiments in Stellar Astrophysics (mesa), we model the evolution of accreting carbon–oxygen WDs and consider models that accrete matter with metallicity Z = 0.02 or 10−4. We consider both models without mixing and with matter enriched by CO-elements assuming that mixing occurs in the process of accretion (with mixing fraction 0.25). We present and contrast ignition mass, ejected mass, recurrence period, and maximum luminosity of novae for different WD masses and accretion rates for these metallicities and mixing cases. We find that models with Z  = 0.02 have ignition masses and recurrence periods smaller than models with low Z, while the ejected mass and maximum luminosity are larger. Retention efficiency during novae outbursts decreases with increasing metallicity. In our implementation, inclusion of mixing at the H/He interface reduces accreted mass, ejected mass, and recurrence period as compared to the no-mixing case, while the maximum luminosity becomes larger. Retention efficiency is significantly reduced, becoming negative in most of our models. For ease of use, we provide a tabular summary of our results.
Expected dust grain-size distributions in galaxies detected by ALMA at z > 7
Authors: Liu Hsin-Min , Hirashita Hiroyuki
Published: September 2019

The dust properties in high-redshift galaxies provide clues to the origin of dust in the Universe. Although dust has been detected in galaxies at redshift z > 7, it is difficult to constrain the dominant dust sources only from the total dust amount. Thus, we calculate the evolution of grain-size distribution, expecting that different dust sources predict different grain-size distributions. Using the star formation time-scale and the total Baryonic mass constrained by the data in the literature, we calculate the evolution of grain-size distribution. To explain the total dust masses in ALMA-detected z > 7 galaxies, the following two solutions are possible: (i) high dust condensation efficiency in stellar ejecta and (ii) efficient accretion (dust growth by accreting the gas-phase metals in the interstellar medium). We find that these two scenarios predict significantly different grain-size distributions: in (i), the dust is dominated by large grains ($a\gtrsim 0.1\,{\mu m}$, where a is the grain radius), while in (ii), the small-grain ($a\lesssim 0.01\,{\mu m}$) abundance is significantly enhanced by accretion. Accordingly, extinction curves are expected to be much steeper in (ii) than in (i). Thus, we conclude that extinction curves provide a viable way to distinguish the dominant dust sources in the early phase of galaxy evolution.
A predicted correlation between age gradient and star formation history in FIRE dwarf galaxies
Authors: Graus Andrew S , Bullock James S , Fitts Alex , Cooper Michael C , Boylan-Kolchin Michael , Weisz Daniel R , Wetzel Andrew , Feldmann Robert , Faucher-Giguère Claude-André , Quataert Eliot , Hopkins Philip F , Keres̆ Dus̆an
Published: September 2019

We explore the radial variation of star formation histories (SFHs) in dwarf galaxies simulated with Feedback In Realistic Environments (FIRE) physics. The sample contains 26 field dwarf galaxies with Mstar = 105–109 M⊙. We find age gradients are common in our dwarfs, with older stars dominant at large radii. The strength of the gradient correlates with overall galaxy age such that earlier star formation produces a more pronounced gradient. The relation between formation time and strength of the gradient is driven by both mergers and star formation feedback. Mergers can both steepen and flatten the age gradient depending on the timing of the merger and SFHs of the merging galaxy. In galaxies without significant mergers, feedback pushes stars to the outskirts. The strength of the age gradient is determined by the subsequent evolution of the galaxy. Galaxies with weak age gradients constantly grow to z  = 0, meaning that young star formation occurs at a similar radius to which older stars are heated to. In contrast, galaxies with strong age gradients tend to maintain a constant half-mass radius over time. If real galaxies have age gradients as we predict, stellar population studies that rely on sampling a limited fraction of a galaxy can give a biased view of its global SFH. Central fields can be biased young by Gyrs while outer fields are biased old. Fields positioned near the 2D half-light radius will provide the least biased measure of a dwarf galaxy’s global SFH.
The ASKAP EMU Early Science Project: radio continuum survey of the Small Magellanic Cloud
Authors: Joseph T D , Filipović M D , Crawford E J , Bojičić I , Alexander E L , Wong G F , Andernach H , Leverenz H , Norris R P , Alsaberi R Z E , Anderson C , Barnes L A , Bozzetto L M , Bufano F , Bunton J D , Cavallaro F , Collier J D , Dénes H , Fukui Y , Galvin T , Haberl F , Ingallinera A , Kapinska A D , Koribalski B S , Kothes R , Li D , Maggi P , Maitra C , Manojlović P , Marvil J , Maxted N I , O’Brien A N , Oliveira J M , Pennock C M , Riggi S , Rowell G , Rudnick L , Sano H , Sasaki M , Seymour N , Soria R , Stupar M , Tothill N F H , Trigilio C , Tsuge K , Umana G , Urošević D , van Loon J Th , Vardoulaki E , Velović V , Yew M , Leahy D , Chu Y-H , Michałowski M J , Kavanagh P J , Grieve K R
Published: September 2019

We present two new radio continuum images from the Australian Square Kilometre Array Pathfinder (ASKAP) survey in the direction of the Small Magellanic Cloud (SMC). These images are part of the Evolutionary Map of the Universe (EMU) Early Science Project (ESP) survey of the Small and Large Magellanic Clouds. The two new source lists produced from these images contain radio continuum sources observed at 960 MHz (4489 sources) and 1320 MHz (5954 sources) with a bandwidth of 192 MHz and beam sizes of 30.0 × 30.0 arcsec2 and 16.3 × 15.1 arcsec2, respectively. The median root mean square (RMS) noise values are 186 $\mu$Jy beam−1 (960 MHz) and 165 $\mu$Jy beam−1 (1320 MHz). To create point source catalogues, we use these two source lists, together with the previously published Molonglo Observatory Synthesis Telescope (MOST) and the Australia Telescope Compact Array (ATCA) point source catalogues to estimate spectral indices for the whole population of radio point sources found in the survey region. Combining our ASKAP catalogues with these radio continuum surveys, we found 7736 point-like sources in common over an area of 30 deg2. In addition, we report the detection of two new, low surface brightness supernova remnant candidates in the SMC. The high sensitivity of the new ASKAP ESP survey also enabled us to detect the bright end of the SMC planetary nebula sample, with 22 out of 102 optically known planetary nebulae showing point-like radio continuum emission. Lastly, we present several morphologically interesting background radio galaxies.
A significant feature in the general relativistic time evolution of the redshift of photons coming from a star orbiting Sgr A*
Authors: Saida Hiromi , Nishiyama Shogo , Ohgami Takayuki , Takamori Yohsuke , Takahashi Masaaki , Minowa Yosuke , Najarro Francisco , Hamano Satoshi , Omiya Masashi , Iwamatsu Atsushi , Takahashi Mizuki , Gorin Haruka , Kara Tomohiro , Koyama Akinori , Ohashi Yosuke , Tamura Motohide , Nagatomo Schun , Zenko Tetsuya , Nagata Tetsuya
Published: September 2019

The star S0-2, orbiting the Galactic central massive black hole candidate Sgr A$^\ast$, passed its pericenter in 2018 May. This event is the first chance to detect the general relativistic (GR) effect of a massive black hole, free from non-gravitational physics. The observable GR evidence in the event is the difference between the GR redshift and the Newtonian redshift of photons coming from S0-2. Within the present observational precision, the first post-Newtonian (1PN) GR evidence is detectable. In this paper, we give a theoretical analysis of the time evolution of the 1PN GR evidence, under a presupposition that is different from used in previous papers. Our presupposition is that the GR/Newtonian redshift is always calculated with the parameter values (the mass of Sgr A$^\ast$, the initial conditions of S0-2, and so on) determined by fitting the GR/Newtonian motion of S0-2 with the observational data. It is then revealed that the difference of the GR redshift and the Newtonian one shows two peaks before and after the pericenter passage. This double-peak appearance is due to our presupposition, and reduces to a single peak if the same parameter values are used in both GR and Newtonian redshifts as considered in previous papers. In addition to this theoretical discussion, we report our observational data obtained with the Subaru telescope by 2018. The quality and the number of Subaru data in 2018 are not sufficient to confirm the detection of the double-peak appearance.
Personalized Pain Goals and Responses in Advanced Cancer Patients
Authors: Mercadante Sebastiano , Adile Claudio , Aielli Federica , Gaetano Lanzetta , Mistakidou Kyriaki , Maltoni Marco , Soares Luiz Guilherme , DeSantis Stefano , Ferrera Patrizia , Rosati Marta , Rossi Romina , Casuccio Alessandra
Published: September 2019

Objective

To assess the personalized pain intensity goal (PPIG), the achievement of a personalized pain goal response (PPGR), and patients' global impression (PGI) in advanced cancer patients after a comprehensive pain and symptom management.

Design

Prospective, longitudinal

Setting

Acute pain relief and palliative/supportive care.

Subjects

689 advanced cancer patients.

Methods

Measurement of Edmonton Symptom Assessment Score (ESAS) and personalized pain intensity goal (PPIG) at admission (T0). After a week (T7) personalized pain goal response (PPGR) and patients' global impression (PGI) were evaluated.

Results

The mean PPIG was 1.33 (SD 1.59). A mean decrease in pain intensity of − 2.09 was required on PPIG to perceive a minimal clinically important difference (MCID). A better improvement corresponded to a mean change of − 3.41 points, while a much better improvement corresponded to a mean of − 4.59 points. Patients perceived a MCID (little worse) with a mean increase in pain intensity of 0.25, and a worse with a mean increase of 2.33 points. Higher pain intensity at T0 and lower pain intensity at T7 were independently related to PGI. 207 (30.0%) patients achieved PPGR. PPGR was associated with higher PPIG at T0 and T7, and inversely associated to pain intensity at T0 and T7, and Karnofsky level. Patients with high pain intensity at T0 achieved a favorable PGI, even when PPIG was not achieved by PPGR.

Conclusion

PPIG, PPGR and PGI seem to be relevant for evaluating the effects of a comprehensive management of pain, assisting decision-making process according to patients' expectations. Some factors may be implicated in determining the individual target and the clinical response.
A novel approach to the computation of one-loop three- and four-point functions: I. The real mass case
Authors: Guillet J Ph , Pilon E , Shimizu Y , Zidi M S
Published: September 2019

This article is the first of a series of three presenting an alternative method of computing the one-loop scalar integrals. This novel method enjoys a couple of interesting features as compared with the method closely following ’t Hooft and Veltman adopted previously. It directly proceeds in terms of the quantities driving algebraic reduction methods. It applies to the three-point functions and, in a similar way, to the four-point functions. It also extends to complex masses without much complication. Lastly, it extends to kinematics more general than that of the physical, e.g., collider processes relevant at one loop. This last feature may be useful when considering the application of this method beyond one loop using generalized one-loop integrals as building blocks.
The Association Between Hearing Impairment and Problem Behaviors in 11-Year-Old Pacific Children Living in New Zealand
Authors: Paterson Janis , Purdy Suzanne C. , Tautolo El-Shadan , Iusitini Leon , Schluter Philip J. , Sisk Rose
Published: September 2019

Objectives:

Hearing impairment in childhood is a serious disability that can impose a heavy social and economic burden on individuals and families. It was hypothesized that hearing loss or middle ear disease in 11-year-old Pacific children living in New Zealand would be associated with higher levels of engagement in (1) delinquent behaviors, and (2) clinical level internalizing and externalizing problem behaviors than Pacific children with no hearing loss or middle ear disease. Based on earlier findings, peer pressure, self-perception, physical punishment (slapping), sex, and ethnicity were controlled for in the association between hearing difficulties and behavioral outcomes.

Design:

In the school setting, pure-tone audiometry and immittance audiometry assessments were used to establish the hearing level in 11-year-old Pacific children (n = 920). These children also completed multidisciplinary questionnaires, which included questions about involvement in delinquent behaviors, peer pressure, and self-perception. In the home setting, maternal reports were gathered on internalizing and externalizing problem behaviors in their offspring, their parenting style, and sociodemographic details.

Results:

A significant effect of hearing level was detected for the odds of reporting mild delinquency versus no delinquency (odds ratio: 1.02, 95% CI: 1.00 to 1.05), and odds of moderate delinquency versus no delinquency (odds ratio: 0.97, 95% CI: 0.94 to 1.00). No significant effect was detected for hearing level and severe delinquency or internalizing or externalizing behavioral problems in the clinical range. Middle ear disease (abnormal tympanogram in the worse ear) was not significantly associated with delinquency at any level or with internalizing behaviors in the clinical range. However, children with middle ear disease were significantly less likely than all other participants to exhibit disruptive externalizing behavior in the clinical range.

Conclusions:

Relatively young children with hearing loss reported engagement in moderate levels of delinquency that represent serious antisocial and potentially violent acts. This finding provides evidence of the significant effect that hearing loss has on child behavior. This association between hearing loss and moderate delinquency requires ethnic-specific interventions that are targeted for maximum benefit at appropriate times in childhood to mitigate potentially long-term health, educational, and behavioral risks.
Cones and sleeves in knee arthroplasty: a narrative review
Authors: Salim Xiang , Lopez D’Jon , Jeys Lee , Carey Smith Richard
Published: September 2019

Total knee arthroplasty (TKA) volume is expected to continue increasing worldwide. In Australia last year TKA increased 2.8% from the previous year. This trend has led to an increasing rate of revision TKA procedures for loosening, infection, and periprosthetic fracture. Periprosthetic bone loss can present challenges, and various techniques have been described to manage this intraoperatively. This review article discusses the indications and advantages of cones and metaphyseal sleeves in cases involving bone loss.
Methicillin-Resistant Staphylococcus Aureus Carrier Rate in Orthopaedic Trauma Patients: A Prospective Cohort Study
Authors: Shaw Jordan T. , Whalen Christopher J. , Mitchell Joseph , Siy Alexander B. , Simske Natasha M. , Doro Christopher J. , Goodspeed David C. , Lang Gerald J. , Whiting Paul S.
Published: September 2019

Objectives:

To identify the methicillin-resistant Staphylococcus aureus (MRSA) carrier rate among surgical patients on an orthopaedic trauma service and to determine whether screening is an effective tool for reducing postoperative MRSA infection in this population.

Design:

Prospective.

Setting:

Level 1 trauma center.

Patients/Participants:

Two hundred forty-eight patients with operatively managed orthopaedic trauma conditions during the study period. Two hundred three patients (82%) had acute orthopaedic trauma injuries. Forty-five patients (18%) underwent surgery for a nonacute orthopaedic trauma condition, including 36 elective procedures and 9 procedures to address infection.

Intervention:

MRSA screening protocol, preoperative antibiotics per protocol.

Main Outcome Measurements:

MRSA carrier rate, overall infection rate, MRSA infection rate.

Results:

Our screening captured 71% (175/248) of operatively treated orthopaedic trauma patients during the study period. The overall MRSA carrier rate was 3.4% (6/175). When separated by group, the acute orthopaedic trauma cohort had an MRSA carrier rate of 1.4% (2/143), and neither MRSA-positive patient developed a surgical site infection. Only one MRSA infection occurred in the acute orthopaedic trauma cohort. The nonacute group had a significantly higher MRSA carrier rate of 12.5% (4/32, P = 0.01), and the elective group had the highest MRSA carrier rate of 15.4% (4/26, P < 0.01). The odds ratio of MRSA colonization was 10.1 in the nonacute group (95% confidence interval, 1.87–75.2) and 12.8 for true elective group (95% confidence interval, 2.36–96.5) when compared with the acute orthopaedic trauma cohort.

Conclusions:

There was a low MRSA colonization rate (1.4%) among patients presenting to our institution for acute fracture care. Patients undergoing elective surgery for fracture-related conditions such as nonunion, malunion, revision surgery, or implant removal have a significantly higher MRSA carrier rate (15.4%) and therefore may benefit from MRSA screening. Our results do not support routine vancomycin administration for orthopaedic trauma patients whose MRSA status is not known at the time of surgery.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Limited internal fixation combined with a joint-spanning external fixator in the treatment of Midfoot injuries in children
Authors: Lu Ming , Lu Xuemin , Xu Yijing , Yan Guisen
Published: September 2019

The aim of this study was to explore the clinical features and surgical treatment methods of unstable midfoot injuries in children. Eleven children with severe unstable midfoot injuries admitted to Jishuitan Hospital, Beijing, from June 2009 to October 2016 were enrolled, including seven patients with Lisfranc injuries and four patients with Chopart injuries. All Lisfranc injuries had radiographic data from the healthy sides, and radiographs of the affected sides showed that all injured Lisfranc joints separated more than 3 mm compared with the healthy sides. The treatment methods employed a joint-spanning external fixator to distract and maintain the length of the medial and lateral columns, combined with joint-preserving trans-joint locking plate fixation or trans-articular cannulated screw and Kirschner wire fixation that passed through the joint. The patients were followed up for 53.7 months (17–110 months). The average operation time was 95.1 minutes, and the average intraoperative blood loss was 83.3 ml. Nine of the 11 patients were treated with an external fixator to distract and fix the medial or lateral column. Bone healing was achieved in all patients, and none of the patients complained of chronic pain in the midfoot. Flatfoot and valgus deformity were corrected after the surgery in the child with old fracture, and the pain in the calcaneocuboid joint disappeared. The average American Orthopedic Foot and Ankle Society mid-foot score at the last follow-up was 93.4, of which nine cases were greater than 90 and two cases were between 75 and 89. Children’s midfoot injury is characterized by fracture-dislocation. Simple joint capsule tear or ligament rupture is rare and often accompanied by severe cuboid compression fracture. The treatment should be focused on restoring the stability of the bony structure and the length of the medial and lateral columns. The use of a joint-spanning external fixator helps maintain reduction and restore the length of the medial and lateral columns.
Isavuconazole-induced Acute Liver Failure in a Pediatric Patient With Invasive Aspergillosis
Authors: Brivio Erica , Verna Marta , Migliorino Guglielmo Marco , Foresti Sergio , Zucchini Nicola , Rovelli Attilio
Published: September 2019

Isavuconazole is a new azole approved for adults with invasive aspergillosis and mucormycosis, with a favorable hepatic tolerability reported in Phase III trials. Here, we report on a case of drug-induced liver failure related to isavuconazole in a pediatric patient treated for invasive aspergillosis after bone marrow transplant.
Acinetobacter baumannii Is a Risk Factor for Lower Respiratory Tract Infections in Children and Adolescents With a Tracheostomy
Authors: Grosse-Onnebrink Joerg , Rudloff Johanna , Kessler Christina , Werner Claudius , Dougherty Gerard W. , Kerschke Laura , Kahl Barbara C. , Omran Heymut
Published: September 2019

Background:

Lower respiratory tract infections (LRIs) are a major cause of hospitalization for children and adolescents with a tracheostomy. The aim of this study was to identify risk factors for LRI.

Methods:

In this retrospective study, we assessed the number of LRI and hospitalizations for LRI from 2004 to 2014 at the University Hospital Muenster Pediatric Department. We analyzed associations between LRI and clinical findings, and we cultured pathogens in tracheal aspirates (TAs) during noninfection periods. Univariable and multivariable negative, binomial regression analyses were applied to identify associations between possible risk factors and LRI.

Results:

Seventy-eight patients had 148 LRI, of which 99 were treated in hospital. The median number of LRI per year was 0.4. Six-hundred thirteen pathogens were detected in 315 specimens; Staphylococcus aureus (22.5%), Pseudomonas aeruginosa (14.8%) and Haemophilus influenzae (6.2%) were most frequently detected. Acinetobacter baumannii is an independent risk factor for LRI (rate ratio, 1.792; P = 0.030) and hospital admissions for LRI (rate ratio, 1.917; P = 0.011).

Conclusions:

Children with a tracheostomy have frequent LRI. A. baumannii but not P. aeruginosa or S. aureus in TA is a risk factor for LRI in children with a long-term tracheostomy. This supports repetitive culture of TA for microbiologic workup to identify children and adolescents with an increased risk for LRI.
Tuberculosis Treatment Outcomes Among Children in Rural Southern Mozambique
Authors: Moon Troy D. , Nacarapa Edy , Verdu M. Elisa , Macuácua Salésio , Mugabe Didier , Gong Wu , Carlucci James G. , Ramos Jose M. , Valverde Emilio
Published: September 2019

Background:

Globally, tuberculosis (TB) remains a serious cause of morbidity and mortality for children. Mozambique is 1 of 30 high TB and TB/HIV burden countries. This study aimed to assess treatment outcomes of childhood TB in Chókwè District, Mozambique.

Methods:

A retrospective cohort study of children <15-years-old treated for TB from 2006 to 2017 was conducted at Carmelo Hospital of Chókwè. Descriptive statistics were used to summarize patient characteristics. Treatment outcomes stratified by HIV status were compared with χ2. Multivariable logistic regression was used to estimate the odds of a favorable TB treatment outcome. Kaplan-Meier curves were used to estimate the cumulative incidence of death.

Results:

Nine hundred thirty-three cases of childhood TB were enrolled, 45.9% of which were female and 49.6% were <5-years-old. Five hundred sixty-five (62%) children were HIV positive. Seven hundred sixty-two (83.6%) cases had a favorable TB treatment outcome. In comparison to children 0–4 years, the 5–14 age group had a higher odds of a favorable outcome [odds ratio: 2.02, 95% confidence interval: 1.42–3.05]. Being 5–14 years was associated with lower risk of death (hazard ratio: 0.435; 95% confidence interval: 0.299–0.632). Those starting anti-TB treatment ≤3 months after antiretroviral therapy initiation had a survival probability of approximately 75% at 1 year compared with 95% for those who were HIV negative.

Conclusions:

Most children in this cohort had favorable TB treatment outcomes. Worse outcomes were observed for younger children and if anti-TB treatment started ≤3 months after initiation of antiretroviral therapy. Rigorous screening for TB and isoniazid preventative therapy may reduce the burden of TB in this population and lead to better outcomes.
Bivalirudin Experience in a Heterogeneous Ventricular Assist Device Population
Authors: Bates Angela , Buchholz Holger , Freed Darren , MacArthur Roderick , PiDBorochynski Tara , Conway Jennifer
Published: September 2019

Ventricular assist devices (VADs) are an increasingly common therapy for end-stage heart failure across all ages as a bridge to recovery or transplant and more recently as destination therapy. With increasing experience and difficulties with establishing therapeutic heparin levels, we have begun to explore the effectiveness of direct thrombin inhibitors in this patient population. This is a retrospective review of all long-term VAD patients, both adult and pediatric, who were anticoagulated with bivalirudin between January 2009 and January 2016. The starting dose was 0.3 mg/kg/hr, and dose was titrated for a goal partial thromboplastin time (PTT) of 70–100. There were 14 patients (13 males, 5 ≤18 years) with 17 episodes of bivalirudin therapy. The median age on initiation was 45 years (range, 15 days–67 years) with 10 episodes associated with a HeartWare HVAD, five a HeartMate II, and two with a Berlin Heart EXCOR. The predominant indication of bivalirudin therapy was suspected pump thrombosis (13/17). The median time from VAD insertion to initiation of bivalirudin was 116 days (range, 3–1,870) with the median duration of therapy being 21 days (range, 3–113). In patients with pump thrombosis, the mean baseline lactate dehydrogenase (LDH) was 229 ± 64 U/L, peak 690 ± 380 U/L, and decreased to 330 ± 243 U/L when bivalirudin was stopped. The outcomes following suspected pump thrombosis included: transitioned to warfarin (n = 7), death in two destination therapy patients who did not undergo pump exchange, transplantation (n = 2), and pump exchange (n = 2). A major bleeding complication occurred in only one patient. Our experience highlights the potential use of bivalirudin in a heterogenous VAD population. Although these initial results suggest some potential role for direct thrombin inhibitors for use in long-term VADs, larger prospective studies are required to support these preliminary observations and to determine who may benefit from direct thrombin inhibitors (DTIs) and the side effect profile in this patient population.
A Case of Sulfhemoglobinemia Secondary to a Urinary Tract Infection
Authors: Campagna Giovanni , Espaillat Andre , Pfeiffer Thomas , Powers Jacquelyn M. , McClure Meghan , Hess Lauren M.
Published: September 2019

Sulfhemoglobinemia (SulfHb) is a rare dyshemoglobinemia that can present with cyanosis in the absence of respiratory distress. It has been reported secondary to drug ingestion and chronic constipation. We present a case of SulfHb in an adolescent female with spina bifida and neurogenic bladder in the setting of an Escherichia coli urinary tract infection. An arterial blood gas differentiated a dyshemoglobinemia from other causes of hypoxemia. The resolution was achieved with antibiotics and red cell transfusion. Here we review the pathophysiology of SulfHb and contribute a unique case report to the limited body of literature on this topic.
Physical Activity and Sedentary Behaviors in Childhood Acute Lymphoblastic Leukemia Survivors
Authors: Lemay Valérie , Caru Maxime , Samoilenko Mariia , Drouin Simon , Mathieu Marie-Eve , Bertout Laurence , Lefebvre Geneviève , Raboisson Marie-Josée , Krajinovic Maja , Laverdière Caroline , Andelfinger Gregor , Sinnett Daniel , Curnier Daniel
Published: September 2019

Introduction:

More than two thirds of survivors have long-term adverse effects, and no study proposes a portrait of physical activity level in childhood acute lymphoblastic leukemia survivors. The aims of this study were to present the cardiorespiratory fitness (CRF) levels of survivors detailed overview sedentary activities portrait.

Methods:

A total of 247 childhood acute lymphoblastic leukemia survivors were included in our study. Survivors underwent a cardiopulmonary exercise test on ergocycle and completed physical activity and sedentary questionnaires to assess their leisure physical and sedentary activities and total daily energy expenditure.

Results:

Up to 67% of survivors (84% below 18 y and 60% 18 y of age or above) did not fulfill the physical activity guidelines. Their CRF was reduced by almost 16% in regard to their predicted maximum oxygen consumption (VO2peak). Almost three quarters of the survivors (70% below 18 y and 76% 18 y of age or above) spent >2 hours/day in leisure sedentary activities. Adult survivors who received high doses of anthracyclines and those who received radiation therapy had decreased odds to spend ≥2 hours/day in sedentary activities.

Conclusions:

Our results showed that survivors, especially children, were not active enough and had a reduced CRF. This study highlights the importance of promoting physical activity in survivors, especially because they are exposed to an increased risk of chronic health problems, which could be mitigated by physical activity.
Feasibility of six-point Goal Attainment Scale among subacute and chronic stroke patients
Authors: Debreceni-Nagy Adél , Horváth Judit , Nagy Szabina , Bajusz-Leny Ágnes , Jenei Zoltán
Published: September 2019

Feasibility of six-point Goal Attainment Scale among stroke patients were examined. Thirty-five subacute and chronic stroke patients with upper limb function problems were included (December 2015–March 2017). Sixty-minute conventional therapy and 30-minute occupational therapy was provided on every consecutive weekday, for 4 weeks. Beside Functional Independence Measure, Action Reach Arm test, Fugl-Meyer upper extremity assessment motor function subtest and six-point Goal Attainment Scale were collected. The content of the previous tests was linked with International Classification of Functioning, Disability and Health domains. Feasibility characteristics were checked according to previous feasibility studies and the following aspects: acceptability, demand, implementation, practicality, integration, and expansion. Data analysis was done in 2018. Participants’ global functions were described with the Functional Independence Measure median points were 116.5. All of the outcome measures showed significant improvement at group level (P < 0.001). Most of the goals matched to one or more International Classification of Functioning, Disability and Health domains but were not covered with the Action Reach Arm test or the Fugl-Meyer tests. Association between clinically relevant change of the first Goal Attainment Scale and the other tests was not significant. Six-point Goal Attainment Scale proved to be a feasible outcome measure among subacute and chronic stroke participants. It completed the functional picture of a patient, beside standardized measures. Further studies needed to complete the psychometric properties of six-point Goal Attainment Scale among stroke patients and in other patient groups.
Pain in persons with mild-moderate Parkinson’s disease: a cross-sectional study of pain severity and associated factors
Authors: Joseph Conran , Jonsson-Lecapre Jondi , Wicksell Rikard , Svenningsson Per , Franzén Erika
Published: September 2019

The aims of this study were to determine pain severity in persons with mild-moderate Parkinson’s disease compared with healthy age- and sex-matched controls, and identify related factors, that is, demographic, disease severity, and functioning, of pain severity in the Parkinson’s disease group. A cross-sectional study design was adopted to assess pain severity in 100 persons with Parkinson’s disease and 47 healthy controls. Bodily pain was assessed using item 21 of the Short Form 36, whereas pain severity was determined using the entire Short Form 36 Bodily Pain subscale (score ranging from 0 to 100). Self-report questionnaires and clinical tests were completed to determine factors, that is, demographic and disease severity characteristics as well as physical functioning indicators, related to pain severity. Based on fulfillment of assumptions of data normality, both univariate and multivariate regression analysis were carried out. Pain severity (P < 0.001) was significantly higher in persons with Parkinson’s disease than healthy controls. Among persons with Parkinson’s disease, the multivariate predictor model, explaining 34% of the variance in pain severity scores, identified three independently associated factors. Poorer balance performance, a shorter disease duration, and poorer health-related quality of life were independently associated with pain severity. Pain severity is higher in those living with Parkinson’s disease than controls, and severity appears to be associated with disease characteristics and overall health. Further research is required to assess pain origin in Parkinson’s disease with the aim of developing targeted interventions.
Vacuum-Assisted Closure for the Treatment of Deep Sternal Wound Infection After Pediatric Cardiac Surgery
Authors: Sherman Gilad , Shulman-Manor Orit , Dagan Ovadia , Livni Gilat , Scheuerman Oded , Amir Gabriel , Frenkel George , Levy Itzhak
Published: September 2019

Objectives:

Vacuum-assisted closure is being increasingly used to treat deep sternal wound infection following cardiac surgery, but most of the data refer to adults. This study investigated the safety and efficacy of vacuum-assisted closure in pediatric patients.

Design:

Retrospective file review.

Setting:

Tertiary pediatric medical center.

Patients:

All children with deep sternal wound infection treated with vacuum-assisted closure in 2003–2016.

Interventions:

Epidemiological, clinical, and microbiological data were collected from the medical records.

Measurements and Main Results:

The cohort included 50 patients (0.9% of cardiac patients operated during the study period) of median age 6.5 months (interquartile range, 2–12.75 mo; range, 1 wk to 14 yr) and median weight 5.1 kg (interquartile range, 4–9.75 kg). The most frequent heart defects were tetralogy of Fallot (22%) and ventricular septal defect (20%); 38% of patients had cyanotic heart disease. Deep sternal wound infections appeared a median of 10 days postoperatively (interquartile range, 7–14 d; range 3–100 d). Vacuum-assisted closure was applied a median of 13 days postoperatively (interquartile range, 10–18.5 d; range, 5–103 d) for a median duration of 10 days (interquartile range, 7–13.25 d; range, 1–21 d). Wound cultures were positive in 48 patients (96%); most isolates were Gram-positive (76%). The main bacterial pathogen was methicillin-susceptible Staphylococcus aureus (61%). Most patients were treated with cloxacillin for a median of 38 days (interquartile range, 28–42 d; range, 9–189 d). There were no statistically significant differences in clinical or treatment characteristics between bacteremic (56%) and nonbacteremic patients. Compared with older patients, infants less than 3 months old (36%) had a significantly longer hospitalization time (41 vs 25 d; p = 0.001) and higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality Category (3 vs 2; p = 0.003). All cases except one (contact dermatitis) were uneventful. In 10 patients, wounds were closed surgically after vacuum-assisted closure. Two patients required a pectoralis flap, both treated before 2005. One of the two deaths was infection-related.

Conclusions:

Vacuum-assisted closure is a feasible treatment option of deep sternal wound infection after pediatric cardiac surgery and was not associated with independent morbidity.
Unpredictable stress delays recovery from exercise-induced muscle pain: contribution of the sympathoadrenal axis
Authors: Alvarez Pedro , Green Paul G. , Levine Jon D.
Published: September 2019

Introduction:

Although stress is a well-establish risk factor for the development of chronic musculoskeletal pain, the underlying mechanisms, specifically the contribution of neuroendocrine stress axes, remain poorly understood.

Objective:

To evaluate the hypothesis that psychological stress-induced activation of the sympathoadrenal stress axis prolongs the muscle pain observed after strenuous exercise.

Methods:

Adult male Sprague-Dawley rats were exposed to unpredictable sound stress and eccentric exercise. The involvement of the sympathoadrenal stress axis was evaluated by means of surgical interventions, systemic administration of epinephrine, and intrathecal β2-adrenergic receptor antisense.

Results:

Although sound stress alone did not modify nociceptive threshold, it prolonged eccentric exercise-induced mechanical hyperalgesia. Adrenal medullectomy (ADMdX) attenuated, and administration of stress levels of epinephrine to ADMdX rats mimicked this effect of sound stress. Knockdown of β2-adrenergic receptors by intrathecal antisense also attenuated sound stress-induced prolongation of eccentric exercise-induced hyperalgesia.

Conclusion:

Together, these results indicate that sympathoadrenal activation, by unpredictable sound stress, disrupts the capacity of nociceptors to sense recovery from eccentric exercise, leading to the prolongation of muscle hyperalgesia. This prolonged recovery from ergonomic pain is due, at least in part, to the activation of β2-adrenergic receptors on muscle nociceptors.