bluuebunny/crossref_metadata_2025_split huggingface dataset:
Searching for a dusty cometary belt around TRAPPIST-1 with ALMA
Authors: Marino S , Wyatt M C , Kennedy G M , Kama M , Matrà L , Triaud A H M J , Henning Th 
Published: January 2020

ABSTRACT
Low-mass stars might offer today the best opportunities to detect and characterize planetary systems, especially those harbouring close-in low-mass temperate planets. Among those stars, TRAPPIST-1 is exceptional since it has seven Earth-sized planets, of which three could sustain liquid water on their surfaces. Here we present new and deep ALMA observations of TRAPPIST-1 to look for an exo-Kuiper belt which can provide clues about the formation and architecture of this system. Our observations at 0.88 mm did not detect dust emission, but can place an upper limit of 23 µJy if the belt is smaller than 4 au, and 0.15 mJy if resolved and 100 au in radius. These limits correspond to low dust masses of ∼10−5 to 10−2 M⊕, which are expected after 8 Gyr of collisional evolution unless the system was born with a &gt;20 M⊕ belt of 100 km-sized planetesimals beyond 40 au or suffered a dynamical instability. This 20 M⊕ mass upper limit is comparable to the combined mass in TRAPPIST-1 planets, thus it is possible that most of the available solid mass in this system was used to form the known planets. A similar analysis of the ALMA data on Proxima Cen leads us to conclude that a belt born with a mass ≳1 M⊕ in 100 km-sized planetesimals could explain its putative outer belt at 30 au. We recommend that future characterizations of debris discs around low-mass stars should focus on nearby and young systems if possible.
Implementing Large Genomic Single Nucleotide Polymorphism Data Sets in Phylogenetic Network Reconstructions: A Case Study of Particularly Rapid Radiations of Cichlid Fish
Authors: Olave Melisa , Meyer Axel 
Published: January 2020

AbstractThe Midas cichlids of the Amphilophus citrinellus spp. species complex from Nicaragua (13 species) are an extraordinary example of adaptive and rapid radiation ($&lt;$24,000 years old). These cichlids are a very challenging group to infer its evolutionary history in phylogenetic analyses, due to the apparent prevalence of incomplete lineage sorting (ILS), as well as past and current gene flow. Assuming solely a vertical transfer of genetic material from an ancestral lineage to new lineages is not appropriate in many cases of genes transferred horizontally in nature. Recently developed methods to infer phylogenetic networks under such circumstances might be able to circumvent these problems. These models accommodate not just ILS, but also gene flow, under the multispecies network coalescent (MSNC) model, processes that are at work in young, hybridizing, and/or rapidly diversifying lineages. There are currently only a few programs available that implement MSNC for estimating phylogenetic networks. Here, we present a novel way to incorporate single nucleotide polymorphism (SNP) data into the currently available PhyloNetworks program. Based on simulations, we demonstrate that SNPs can provide enough power to recover the true phylogenetic network. We also show that it can accurately infer the true network more often than other similar SNP-based programs (PhyloNet and HyDe). Moreover, our approach results in a faster algorithm compared to the original pipeline in PhyloNetworks, without losing power. We also applied our new approach to infer the phylogenetic network of Midas cichlid radiation. We implemented the most comprehensive genomic data set to date (RADseq data set of 679 individuals and $&gt;$37K SNPs from 19 ingroup lineages) and present estimated phylogenetic networks for this extremely young and fast-evolving radiation of cichlid fish. We demonstrate that the MSNC is more appropriate than the multispecies coalescent alone for the analysis of this rapid radiation. [Genomics; multispecies network coalescent; phylogenetic networks; phylogenomics; RADseq; SNPs.]
Electronic medical documentation
Authors: Smith Phillip 
Published: January 2020

ABSTRACT

Objective:
To quantify PA attitudes about electronic-assisted documentation in the outpatient setting.

Method:
Survey data were collected from PAs to determine the documentation method used to record outpatient encounters. For clinicians using electronic-assisted documentation, information on the documentation style (including format of documentation, accuracy of generated encounters, and overall readability of encounters) was quantitatively measured.

Results:
129 PAs completed the survey and met the inclusion criteria of documenting outpatient encounters using an electronically assisted format. A statistically significant shift (P < .001) in documentation style from free-text formatted entries to structured data entry was seen as the volume of daily patient encounters increased. A statistically significant (P < .001) decrease in both accuracy and readability was noted with encounters using a structured data entry format.

Conclusion:
In outpatient settings, a volume-dependent shift to structured data element documentation despite self-assessed deficiencies in both accuracy and readability was noted. This shift has the potential to negatively affect the integrity of medical documentation and raises patient safety concerns.
Perinatal Counseling Following a Diagnosis of Trisomy 13 or 18
Authors: Leuthner Steven R. , Acharya Krishna 
Published: January 2020

Background:
Families with a prenatal diagnosis of trisomy 13 or 18 are told many things, some true and some myths. They present with differing choices on how to proceed that may or may not be completely informed.

Purpose:
To provide the prenatal counselor with a review of the pertinent obstetrical and neonatal outcome data and ethical discussion to help them in supporting families with the correct information for counseling.

Methods/Search Strategy:
This article provides a review of the literature on facts and myths and provides reasonable outcome data to help families in decision making.

Findings/Results:
These disorders comprise a heterogeneous group regarding presentation, outcomes, and parental goals. The authors maintain that there needs to be balanced decision-making between parents and providers for the appropriate care for the woman and her infant.

Implications for Practice:
Awareness of this literature can help ensure that prenatal and palliative care consultation incorporates the appropriate facts and parental values and in the end supports differing choices that can support the infant's interests.
Abnormal Splanchnic Regional Saturations in a Preterm Infant That Developed Necrotizing Enterocolitis Following a Red Blood Cell Transfusion
Authors: Baserga Mariana , Reich Brixen , Braski Katherine 
Published: January 2020

Background:
Necrotizing enterocolitis (NEC) has been associated with red blood cell (RBC) transfusions in preterm infants. Near-infrared spectroscopy (NIRS) can be used to noninvasively monitor regional oxygen saturations (rSO2).

Clinical Findings:
This former 28-week female premature infant, 29 days old, received an RBC transfusion due to increased apneic spells and a hematocrit of 27%. Within 24 hours she developed abdominal distension and passed a bloody stool (Bell's stage 2 NEC on abdominal x-ray). She completed 7 days of antibiotics and nothing-by-mouth status and was discharged home on room air and oral feedings on day of life 70.

Primary Diagnosis:
We describe the presentation of NEC following a RBC transfusion in a preterm infant monitored with cerebral and splanchnic NIRS.

Interventions:
Mean rSO2 (cerebral and splanchnic) measurements were continuously recorded and calculated in 30-minute periods at baseline (prior to packed RBC transfusion), every hour during the RBC transfusion, and every 3 hours for the following 48 hours.

Outcomes:
In this infant, average baseline splanchnic rSO2 was low at 46.5%, and increased during transfusion to 65%. However, following the RBC transfusion and an enteral feeding, splanchnic rSO2 dramatically decreased to 26%, and remained low until the time of NEC diagnosis.

Practice Recommendations:
To develop awareness of the increased risk for NEC in premature infants with significant anemia that receive packed RBC transfusions. With further studies and education, NIRS could be a valuable tool for the nurses and medical team to identify these at-risk neonates.
Vitamin D status in children and adolescents: A prospective cohort study
Authors: Buhr Neeley , Oeffinger Donna , Kryscio Richard , Milbrandt Todd A. , Muchow Ryan D. , Talwalkar Vishwas R. , Iwinski Henry J. , Riley Scott A. , Walker Janet L. 
Published: January 2020

Background:
The National Health and Nutritional Examination Survey III, 2009 reported that 48% of adolescents in the United States are vitamin D insufficient/deficient. Nutritional and environmental factors are implicated. The purpose of this study was to measure the prevalence of vitamin D insufficiency in orthopaedic patients and typical children and identify risk factors to aid in screening.

Methods:
This prospective study recruited 138 patients and 30 typical children ages 2 to <18 yr. Those with known problems with abnormal vitamin D metabolism or diminished ability to play outside were excluded. Height, weight, and serum 25-OH vitamin D levels were measured. Questionnaires assessed skin type, sunscreen use, diet, and physical activity.

Results:
Statistical analysis failed to detect any differences between patients and controls. Therefore, they were combined for statistical analysis (N=168). The mean age was 11.9±4.2 yr. The mean vitamin D level was 26.5±7.8 ng/mL, which was deficient (<20 ng/mL, n=33) or insufficient (≥21 to <30 ng/mL, n=84) for 71% of participants. Children with sufficient vitamin D levels were younger than those with insufficient/deficient levels (P=0.02). Multivariate analysis showed that vitamin D levels were negatively affected in ethnic minority groups, those with higher body mass index, those with Medicaid or no insurance status, and those with outside playtime of less than 20 min/day (P=0.0006, P=0.001, P=0.0004, P=0.0005, respectively).

Conclusions:
Vitamin D insufficiency in 71% of our population is much greater than that being reported. The high rate of vitamin D insufficiency suggests that routine screening may be necessary to prevent long-term effects on bone growth and fragility. Characteristics of those at highest risk are ethnic minority, older age, obesity, time spent outdoors of less than 20 min per day, and no private health insurance.

Level of Evidence:
Level II.
Do Hyponatremia or Its Underlying Mechanisms Associate With Mortality Risk in Observational Data?
Authors: Danziger John , Lee Joon , Mark Roger G. , Celi Leo Anthony , Mukamal Kenneth J. 
Published: January 2020

Objectives:
Whether unaccounted determinants of hyponatremia, rather than water excess per se, primarily associate with mortality in observational studies has not been explicitly examined.

Design:
Retrospective cohort study of the association between hyponatremia and mortality, stratified by outpatient diuretic use in three strata.

Setting:
An inception cohort of 13,661 critically ill patients from a tertiary medical center.

Measurements and Main Results:
Admission serum sodium concentrations, obtained within 12 hours of admission to the ICU, were the primary exposure. Hyponatremia was associated with 1.82 (95% CI, 1.56–2.11; p < 0.001) higher odds of mortality, yet differed according to outpatient diuretic use (multiplicative interaction between thiazide and serum sodium < 133 mEq/L; p = 0.002). Although hyponatremia was associated with a three-fold higher (odds ratio, 3.11; 95% CI, 2.32–4.17; p < 0.001) odds of mortality among those prescribed loop diuretics, no increase of risk was observed among thiazide diuretic users (odds ratio, 0.87; 95% CI, 0.47–1.51; p = 0.63). When examined as a continuous variable, each one mEq/L higher serum sodium was associated with 8% (odds ratio, 0.92; 95% CI, 0.90–0.94; p < 0.001) lower odds of mortality in loop diuretic patients and 5% (odds ratio, 0.95; 95% CI, 0.93–0.96, p < 0.001) lower in diuretic naïve patients, but was not associated with mortality risk among thiazide users (odds ratio, 0.99; 95% CI, 0.95–1.02; p = 0.45).

Conclusions:
Hyponatremia is not uniformly associated with increased mortality, but differs according to diuretic exposure. Our results suggest that the underlying pathophysiologic factors that lead to water excess, rather water excess itself, account in part for the association between hyponatremia and poor outcomes. More accurate estimations about the association between hyponatremia and outcomes might influence clinical decision-making.
Is Being Left Handed an Advantage toward a Plastic Surgery Residency?
Authors: Shay Tamir , Kaufman Tal , Cohen Avi A. , Ad-El Dean 
Published: January 2020

Background:
Left hand dominance is a minority trait historically regarded as disadvantageous for surgeons. Contemporary scientific literature and folklore have shed new light on left handedness as a “boutique trait” and possible marker of gifted and exceptional individuals. Our subjective impression that left handedness is prevalent in the unique field of plastic surgery raised questions regarding the scope and possible causality of this phenomenon.

Methods:
One hundred eleven medical doctors in our medical center filled out a 13-item questionnaire regarding hand dominance, medical speciality, and various creative outlets or hobbies.

Results:
Sixty-four percent of the participating plastic surgeons were left handed (significantly higher than the approximate 12% of the general population; P = 0.007). Many of the left-handed doctors admitted to practicing musical instruments and various arts, crafts, and other hobbies.

Conclusions:
Plastic surgery is a unique profession requiring astute minds capable of creative and “outside-the-box” thinking; traits we have learned in recent decades may be particularly keen in left-handed individuals, perhaps suggest a causal relationship to the conglomeration of a majority of left-handed plastic surgeons.
Extended Prophylactic Antibiotics for Mastectomy with Immediate Breast Reconstruction: A Meta-analysis
Authors: Hai Yang , Chong Weelic , Lazar Melissa A. 
Published: January 2020

Background:
The risk of surgical site infection (SSI) for breast surgery in patients without additional risk factors is low, below 5%. Evidence shows the risk of SSI is significantly elevated in patients undergoing immediate breast reconstruction (IBR). However, there is no consensus regarding the use of extended antibiotic prophylaxis. We aim to determine the effect of extended antibiotic prophylaxis on the incidence of SSI after IBR.

Methods:
PubMed and Scopus were searched by 2 independent reviewers. Data abstracted included types of study, basic characteristics, detailed antibiotic prophylaxis information, SSI event, and other secondary outcomes. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study and used a random-effects model to estimate the results. Study quality, bias, and heterogeneity were also analyzed.

Results:
A total of 11 studies (15,966 mastectomy procedures) were included. We found an overall 5.99% SSI rate in our population. Three studies comparing topical antibiotics with no topical antibiotics demonstrated statistical significance (RR = 0.26, 95% CI: 0.12–0.60, P = 0.001), whereas 8 studies comparing extended systemic antibiotics with standard of care found no statistical significance (RR = 0.80, 95% CI: 0.60–1.08, P = 0.13).

Conclusions:
In the setting of IBR following mastectomy, there is insufficient evidence for the use of extended prophylactic antibiotics to reduce SSI rates. Well-designed randomized controlled trials in patients undergoing IBR should be conducted to determine the appropriate regimen and/or duration of prophylactic antibiotics on SSI outcomes.
Elevated levels of the secreted wingless agonist R-spondin 3 in preeclamptic pregnancies
Authors: Ueland Thor , Estensen Mette-Elise , Grindheim Guro , Bollerslev Jens , Henriksen Tore , Aukrust Pål , Aakhus Svend , Gullestad Lars , Lekva Tove 
Published: January 2020

Objective:
Preeclampsia is a syndrome characterized by hypertension and poor placental development. The developmental wingless (Wnt) pathway plays an important role in placental development and we hypothesized that Wnt signaling would be dysregulated in preeclampsia.

Methods:
To elucidate aberrations in the Wnt signaling pathway we conducted a pathway analysis on placental mRNA in late-onset preeclampsia and normal pregnancy from the STORK study [n = 10 in each group, RNA sequencing (RNAseq)] to identify differentially expressed genes. In addition, we compared circulating levels of secreted Wnt agonists and antagonists at term pregnancy and 6 months postpartum from an acute preeclampsia study (preeclampsia n = 34, normal pregnancy n = 61).

Results:
We found circulating and placental mRNA levels of the secreted Wnt agonist R-spondin 3 (RSPO3) at term elevated in preeclampsia. Increased plasma RSPO3 was associated with high mean arterial pressure. Further, pathway analysis of placental tissue revealed elevated mRNA levels of upstream ligands WNT6 and WNT10A and frizzled receptors 2 and 4 in preeclampsia and downstream activation of the noncanonical Ca2+/NFAT pathway. Finally, plasma dickkopf 3 was decreased in preeclampsia 6 months postpartum.

Conclusion:
We identify a potential role for RSPO3 and activation of noncanonical Wnt signaling in preeclampsia.
Hypertension in military veterans is associated with combat exposure and combat injury
Authors: Howard Jeffrey T. , Stewart Ian J. , Kolaja Claire A. , Sosnov Jonathan A. , Rull Rudolph P. , Torres Isaias , Janak Jud C. , Walker Lauren E. , Trone Daniel W. , Armenta Richard F. 
Published: January 2020

Background:
Although the long-term effects of combat injury are not well understood, there is emerging concern that exposure to combat environments and subsequent injury may increase the risk of hypertension through changes in inflammatory responses, psychological stress and mental health, and health behaviors.

Methods:
Data from the Millennium Cohort Study and the Department of Defense Trauma Registry were used to identify combat-exposed and combat-injured participants. Incident hypertension diagnoses were ascertained from the Millennium Cohort survey. The associations between combat exposure/injury and hypertension risk was estimated using multivariable complementary log-log survival models.

Results:
The final analysis sample consisted of 38 734 participants. Of these, 50.8% deployed but were not exposed to combat, 48.6% deployed and were exposed to combat, and 0.6% had combat injury. Overall prevalence of hypertension was 7.6%. Compared with participants who deployed but did not experience combat (mild exposure), elevated odds of hypertension were observed among those who experienced combat but not wounded (moderate exposure; AOR, 1.28; 95% CI, 1.19–1.38) and those wounded in combat (high exposure; AOR, 1.46; 95% CI, 1.07–2.00). Sleep duration of less than 4 h (AOR, 1.21; 95% CI, 1.03–1.43), sleep duration of 4–6 h (AOR, 1.16; 95% CI, 1.05–1.29), posttraumatic stress disorder (AOR, 1.54; 95% CI, 1.26–1.87), and overweight (AOR, 1.77; 95% CI, 1.61–1.95) and obese (AOR, 2.77; 95% CI, 2.45–3.12) status were also associated with higher odds of hypertension.

Conclusion:
Results support the hypotheses that combat exposure increases hypertension risk and that combat injury exacerbates this risk.
Routine disaccharidase testing: are we there yet?
Authors: Opekun Antone R. , Chumpitazi Bruno P. , Abdulsada Mustafa M. , Nichols Buford L. 
Published: January 2020

Purpose of review
Disaccharidase testing, as applied to the evaluation of gastrointestinal disturbances is available but it is not routinely considered in the diagnostic work-up. The purpose of this review was to determine if disaccharidase testing is clinically useful and to consider how the results could alter patient management.

Recent findings
Indicate that carbohydrate maldigestion could contribute functional bowel disorders and negatively impact the fecal microbiome. Diagnostic techniques include enzyme activity assays performed on random endoscopically obtained small intestinal biopsies, immunohistochemistry, stable isotope tracer and nonenriched substrate load breath testing, and genetic testing for mutations. More than 40 sucrase--isomaltase gene variants coding for defective or reduced enzymatic activity have been reported and deficiency conditions are more common than previously thought.

Summary
The rationale for disaccharidase activity testing relates to a need to fully assess unexplained recurrent abdominal discomfort and associated symptoms. All disaccharidases share the same basic mechanism of mucosal expression and deficiency has far reaching consequences. Testing for disaccharidase expression appears to have an important role in symptom evaluation, but there are accuracy and logistical issues that should be considered. It is likely that specific recommendations for patient management, dietary modification, and enzyme supplementation would come from better testing methods.
Long‐term Outcomes and Health Perceptions in Pediatric‐onset Portal Hypertension Complicated by Varices
Authors: Luoto Topi T. , Koivusalo Antti I. , Pakarinen Mikko P. 
Published: January 2020

ABSTRACTObjectives:Outcomes of pediatric‐onset portal hypertension are poorly defined. We aimed to assess population‐based long‐term outcomes of pediatric‐onset portal hypertension complicated by varices.Methods:All children with esophageal varices (n = 126) were identified from 14,144 single nationwide referral center endoscopy reports during 1987 to 2013, and followed up through national health care and death registers. A questionnaire was sent to survivors (n = 94) of whom 65 (69%) responded.Results:Nineteen underlying disorders included biliary atresia (35%), extrahepatic portal vein obstruction (35%), autosomal recessive polycystic kidney disease (7%), and other disorders (23%). During median follow‐up of 15.2 (range 0.5–43.1) years patients underwent median 9 (1–74) upper gastrointestinal endoscopies. Esophageal varices were first observed at a median age of 4.0 (0.3–18.2) years, 112 (89%) patients underwent median 6 (1–56) sclerotherapy/banding sessions, and 61 (48%) experienced median 2 (range 1–20) variceal bleeding episodes. Forty‐eight surgical shunt procedures were performed to 41 (36%) patients and 38% underwent liver transplantation. Portal hypertensive biliopathy was diagnosed in 4 patients. Hepatopulmonary syndrome necessitated liver transplantation in 2 patients, hepatic encephalopathy in 2, and hepatorenal syndrome in 1. No patient died of variceal bleeding. Patient‐reported perception of health on a scale of 1 to 10 was 9 (range 4–10), and 86% reported no current symptoms attributable to esophageal varices.Conclusions:Pediatric‐onset portal hypertension is a heterogeneous disease with significant long‐term morbidity, requiring multimodal approach with considerable resources and continuation of follow‐up in adulthood. Although mortality to variceal bleeding was avoided, bleeding episodes recurred also in adulthood, while patient‐reported health of long‐term survivors was encouraging.