bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bostwick Autoderm and Implant Technique: Improved Outcomes for Obese Patients in Immediate Breast Reconstruction
Authors: Danker Sara , Schmitt Mike , Smith Ning , Chong H. Jonathan , Sandholm Patricia H. , Murphy Jennifer A. , Ladizinsky Daniel A. 
Published: November 2020

Background:
The Bostwick autoderm technique uses the patient’s own deepithelialized mastectomy flap for lower pole coverage of an implant, similar to the use of acellular dermal matrix. The skin is closed over the autoderm flap in a Wise pattern. Unlike acellular dermal matrix, autoderm is perfused tissue that offers immediate protection for the implant. Because of this extra protective vascularized layer, implants can often be salvaged in cases of wound breakdown.

Methods:
A retrospective review of 370 patients and 592 immediate implant reconstructed breasts was performed.

Results:
Four hundred twenty-two (71 percent) were reconstructed with autoderm, 93 (16 percent) with total muscle coverage, and 77 (13 percent) with acellular dermal matrix. Higher body mass index patients were overrepresented in the autoderm group. Ninety-one of the reconstructions in the autoderm group (21.3 percent) were performed on patients with a body mass index greater than 35 kg/m2 compared to four (4.3 percent) in the total muscle coverage group and two (2.6 percent) in the acellular dermal matrix group. Despite this higher proportion of obese patients, the complication rate in the autoderm group was similar to that of the acellular dermal matrix group. The implant loss rate for all reconstructions was 3.4 percent. There were 17 losses (4 percent) in the autoderm group, zero in the total muscle coverage group, and 20 (3.4 percent) in the acellular dermal matrix group. There were 15 patients and 28 breasts that had prepectoral reconstruction.

Conclusion:
The autoderm flap is a safe, reliable, and resource-conscientious technique for immediate, implant-based breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Ice giant seismology: prospecting for normal modes
Authors: Friedson A. James 
Published: November 2020

The properties of ice giant normal mode oscillations, including their periods, spatial structure, stratospheric amplitudes and relative influence on the external gravity field, are surveyed for the purpose of formulating the best strategy for their eventual detection. Measurement requirements for detecting a normal mode's periodic pressure and temperature variations, including a possible stratospheric signal, and its effect on the external gravity field, are discussed in terms of its radial velocity amplitude at the 1 bar pressure level. It is found that for reasonable amplitudes, detection of the pressure and temperature variations of ice giant normal modes presents an extraordinary technical challenge. The prospects for detecting their gravitational influence on an orbiting spacecraft are more promising, with requirements that lie within the range of current technology.
This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
The underexplored frontier of ice giant dynamos
Authors: Soderlund K. M. , Stanley S. 
Published: November 2020

TheVoyager 2flybys of Uranus and Neptune revealed the first multipolar planetary magnetic fields and highlighted how much we have yet to learn about ice giant planets. In this review, we summarize observations of Uranus’ and Neptune’s magnetic fields and place them in the context of other planetary dynamos. The ingredients for dynamo action in general, and for the ice giants in particular, are discussed, as are the factors thought to control magnetic field strength and morphology. These ideas are then applied to Uranus and Neptune, where we show that no models are yet able to fully explain their observed magnetic fields. We then propose future directions for missions, modelling, experiments and theory necessary to answer outstanding questions about the dynamos of ice giant planets, both within our solar system and beyond.This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
Neptune and Uranus: ice or rock giants?
Authors: Teanby N. A. , Irwin P. G. J. , Moses J. I. , Helled R. 
Published: November 2020

Existing observations of Uranus and Neptune’s fundamental physical properties can be fitted with a wide range of interior models. A key parameter in these models is the bulk rock:ice ratio and models broadly fall into ice-dominated (ice giant) and rock-dominated (rock giant) categories. Here we consider how observations of Neptune’s atmospheric temperature and composition (H2, He, D/H, CO, CH4, H2O and CS) can provide further constraints. The tropospheric CO profile in particular is highly diagnostic of interior ice content, but is also controversial, with deep values ranging from zero to 0.5 parts per million. Most existing CO profiles imply extreme O/H enrichments of >250 times solar composition, thus favouring an ice giant. However, such high O/H enrichment is not consistent with D/H observations for a fully mixed and equilibrated Neptune. CO and D/H measurements can be reconciled if there is incomplete interior mixing (ice giant) or if tropospheric CO has a solely external source and only exists in the upper troposphere (rock giant). An interior with more rock than ice is also more compatible with likely outer solar system ice sources. We primarily consider Neptune, but similar arguments apply to Uranus, which has comparable C/H and D/H enrichment, but no observed tropospheric CO. While both ice- and rock-dominated models are viable, we suggest a rock giant provides a more consistent match to available atmospheric observations.This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
The exoplanet perspective on future ice giant exploration
Authors: Wakeford H. R. , Dalba P. A. 
Published: November 2020

Exoplanets number in their thousands, and the number is ever increasing with the advent of new surveys and improved instrumentation. One of the most surprising things we have learnt from these discoveries is not that small-rocky planets in their stars habitable zones are likely to be common, but that the most typical size of exoplanets is that not seen in our solar system—radii between that of Neptune and the Earth dubbed mini-Neptunes and super-Earths. In fact, a transiting exoplanet is four times as likely to be in this size regime than that of any giant planet in our solar system. Investigations into the atmospheres of giant hydrogen/helium dominated exoplanets has pushed down to Neptune and mini-Neptune-sized worlds revealing molecular absorption from water, scattering and opacity from clouds, and measurements of atmospheric abundances. However, unlike measurements of Jupiter, or even Saturn sized worlds, the smaller giants lack a ground truth on what to expect or interpret from their measurements. How did these sized worlds form and evolve and was it different from their larger counterparts? What is their internal composition and how does that impact their atmosphere? What informs the energy budget of these distant worlds? In this we discuss what characteristics we can measure for exoplanets, and why a mission to the ice giants in our solar system is the logical next step for understanding exoplanets.
This article is part of a discussion meeting issue ‘Future exploration of ice giant systems’.
Atmospheric implications of the lack of H
3
+
detection at Neptune
Authors: Moore L. , Moses J. I. , Melin H. , Stallard T. S. , O’Donoghue J. 
Published: November 2020

H
3
+
has been detected at all of the solar system giant planets aside from Neptune. Current observational upper limits imply that there is far less H
3
+
emission at Neptune than rudimentary modelling would suggest. Here, we explore via modelling a range of atmospheric conditions in order to find some that could be consistent with observational constraints. In particular, we consider that the upper atmosphere might be much cooler than it was during the 1989 Voyager 2 encounter, and we examine the impact of an enhanced influx of external material that could act to reduce H
3
+
density. Resulting ionosphere models that are consistent with existing H
3
+
observational constraints have an exospheric temperature of 450 K or less, 300 K lower than the Voyager 2 value. Alternatively, if a topside CO influx of 2 × 10
8
cm
−2
s
−1
is imposed, the upper atmospheric temperature can be higher, up to 550 K. The potential cooling of Neptune’s atmosphere is relevant for poorly understood giant planet thermospheric energetics, and would also impact aerobreaking manoeuvers for any future spacecraft. Such a large CO influx, if present, could imply Triton is a very active moon with prominent atmospheric escape, and/or that Neptune’s rings significantly modify its upper atmosphere, and the introduction of so much exogenic material would complicate interpretation of the origin of species observed in Neptune’s lower atmosphere.

This article is part a discussion meeting issue ‘Future exploration of ice giant systems’.
Does total triage and remote-by-default consulting impact vulnerable groups: A pilot study
Authors: Verity Aaminah , Naidu Dharmendra , Tzortziou-Brown Victoria 
Published: November 2020

AbstractBackgroundCOVID-19 mandated a rapid and dramatic transformation of general practice. ‘Total Triage’ (TT), where all consultations should be triaged first, and ‘Remote-by-Default’ (RbD) consulting, where a clinician should consult remotely unless there is a “clinical exception”, were advised. It is unclear how these new ways of working were implemented in practice, and how they impacted vulnerable patients.AimTo assess the impact of TT and RbD on vulnerable patients and identify mitigation strategies.Design and SettingA mixed methods service evaluation in Lewisham, London, an area of high deprivation.MethodThree parallel datasets were collected and analysed: Semi-structured interviews with stakeholders working with vulnerable groups and qualitative data from forums with black and ethnic minority patients, a survey of General Practitioners exploring implementation of TT and RbD, and a mystery shopper exercise reviewing access and messaging of ten practices.ResultsBarriers to access for vulnerable patients included challenges navigating the new model, difficulty engaging with remote consultations and digital exclusion. There was wide variation in messaging regarding changes to services and the practical application of TT and RbD. Potential solutions included clearer practice guidance and patient messaging, more consistent implementation, and identification and recording of patient access needs to enable better tailoring of care provision.ConclusionThis pilot study identified perceived and actual barriers to accessing general practice for vulnerable patients following the rapid introduction of TT and RbD consulting. It proposes immediate steps to mitigate some of these impacts and highlights the need for further research in this area.How This Fits InThe rapid and widespread adoption, recommended by NHS England, of total triage and remote-by-default consulting in general practice has yet to be evaluated. We provide a first look at how these changes are impacting those with historic difficulties in accessing primary care under the traditional GP model. We also provide some local recommendations that can be implemented easily at practice level and beyond, to mitigate the impact of these changes whilst making recommendations for further research to corroborate these findings widely.
Non applicability of validated predictive models for intensive care admission and death of COVID-19 patients in a secondary care hospital in Belgium
Authors: Parisi Nicolas , Janier-Dubry Aurore , Ponzetto Ester , Pavlopoulos Charalambos , Bakalli Gaetan , Molinari Roberto , Guerrier Stéphane , Mili Nabil 
Published: November 2020

AbstractObjectiveTo set up simple and reliable predictive scores for intensive care admissions and deaths in COVID-19 patients. These scores adhere to the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) reporting guidelines.DesignMonocentric retrospective cohort study run from early March to end of May in Clinique Saint-Pierre Ottignies, a secondary care hospital located in Ottignies-Louvain-la-Neuve, Belgium. The outcomes of the study are (i) admission in the Intensive Care Unit and (ii) death.Data sourcesAll patients admitted in the Emergency Department with a positive RT-PCR SARS-CoV-2 test were included in the study. Routine clinical and laboratory data were collected at their admission and during their stay. Chest X-Rays and CT-Scans were performed and analyzed by a senior radiologist.MethodsA recently published predictive score conducted on a large scale was used as a benchmark value (Liang score)1. Logistic regressions were used to develop predictive scores for (i) admission to ICU among emergency ward patients; (ii) death among ICU patients on 40 clinical variables. These models were based on medical intuition and simple model selection tools. Their predictive capabilities were then compared to Liang score.ResultsOur results suggest that Liang score may not provide reliable guidance for ICU admission and death. Moreover, the performance of this approach is clearly outperformed by models based on simple markers. For example, a logistic regression considering only the LDH yields to similar sensitivity and greater specificity. Finally, all models considered in this study lead to levels of specificity under or equal to 50%.ConclusionsIn our experience, the results of a predictive score based on a large-scale Chinese study cannot be applied in the Belgian population. However, in our small cohort it appears that LDH above 579 UI/L and venous lactate above 3.02 mmol/l may be considered as good predictive biological factors for ICU admission. With regards to death risk, NLR above 22.1, tobacco abuse status and80 % ofrespiratory impairment appears to be relevant predictive factors. A predictive score for admission to ICU or death is desperately needed in secondary hospitals. Optimal allocation of resources guided by evidence-based indicators will best guide patients at time of admission and avoid futile treatments in intensive care units.
The role of children in the transmission chain of SARS-CoV-2: a systematic review and update of current evidence
Authors: Suk Jonathan E. , Vardavas Constantine , Nikitara Katerina , Phalkey Revati , Leonardi-Bee Jo , Pharris Anastasia , Wiltshire Emma , Funk Tjede , Ferland Lisa , Bundle Nick , Semenza Jan C. 
Published: November 2020

AbstractDecisions on school closures and on safe schooling during the COVID-19 pandemic should be evidence-based. We conducted a systematic literature review to assess child-to-child and child-to-adult SARS-CoV-2 transmission and to characterise the potential role of school closures on community transmission. 1337 peer-reviewed articles published through August 31, 2020 were screened; 22 were included in this review. The literature appraised provides sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in community, household and school settings. Transmission by children was most frequently documented in household settings, while examples of children as index cases in school settings were rare. Included studies suggested that school closures may help to reduce SARS- CoV-2 transmission, but the societal, economic, and educational impacts of prolonged school closures must be considered. In-school mitigation measures, alongside continuous surveillance and assessment of emerging evidence, will promote the protection and educational attainment of students and support the educational workforce.
Efficacy of broflanilide (VECTRON™ T500), a new meta-diamide insecticide, for indoor residual spraying against pyrethroid-resistant malaria vectors
Authors: Ngufor Corine , Govoetchan Renaud , Fongnikin Augustin , Vigninou Estelle , Syme Thomas , Akogbeto Martin , Rowland Mark 
Published: November 2020

AbstractThe rotational use of insecticides with different modes of action for indoor residual spraying (IRS) is recommended for improving malaria vector control and managing insecticide resistance. A more diversified portfolio of IRS insecticides is required; insecticides with new chemistries which can provide improved and prolonged control of insecticide-resistant vector populations are urgently needed. Broflanilide is a newly discovered insecticide being considered for malaria vector control. We investigated the efficacy of a wettable powder (WP) formulation of broflanilide (VECTRON™ T500) for IRS on mud and cement wall substrates in WHO laboratory and experimental hut studies against pyrethroid-resistant malaria vectors in Benin, in comparison with pirimiphos-methyl CS (Actellic® 300CS). There was no evidence of cross-resistance to pyrethroids and broflanilide in CDC bottle bioassays. In laboratory cone bioassays, mortality of susceptible and pyrethroid-resistantA. gambiaes.l. with broflanilide WP treated substrates was >80% for 6-14 months. At application rates of 100mg/m2and 150 mg/m2, mortality of wild pyrethroid-resistantA. gambiaes.l. entering treated experimental huts in Covè, Benin was 57%-66% with broflanilide WP and did not differ significantly from pirimiphos-methyl CS (57-66% vs. 56%, P>0.05). Mosquito mortality did not differ between the two application rates and local wall substrate-types tested (P>0.05). Throughout the 6-month hut trial, monthly wall cone bioassay mortality on broflanilide WP treated hut walls remained >80% for both susceptible and resistant strains ofA. gambiaes.l.. Broflanilide shows potential to significantly improve the control of malaria transmitted by pyrethroid-resistant mosquito vectors and would thus be a crucial addition to the current portfolio of IRS insecticides.One Sentence SummaryVECTRON™ T500, a new wettable powder formulation of broflanilide developed for indoor residual spraying, showed high and prolonged activity against wild pyrethroid-resistant malaria vectors, on local wall substrates, in laboratory bioassays and experimental household settings in Benin.
DeepCOMBI: Explainable artificial intelligence for the analysis and discovery in genome-wide association studies
Authors: Mieth Bettina , Rozier Alexandre , Rodriguez Juan Antonio , Höhne Marina M.-C. , Görnitz Nico , Müller Klaus-Robert 
Published: November 2020

AbstractDeep learning algorithms have revolutionized data science in many fields by greatly improving prediction performances in comparison to conventional approaches. Recently, explainable artificial intelligence (XAI) has emerged as a novel area of research that goes beyond pure prediction improvement. Knowledge embodied in deep learning methodologies is extracted by interpreting their results. We investigate such explanations to explore the genetic architectures of phenotypes in genome-wide association studies. Instead of testing each position in the genome individually, the novel three-step algorithm, called DeepCOMBI, first trains a neural network for the classification of subjects into their respective phenotypes. Second, it explains the classifiers’ decisions by applying layerwise relevance propagation as one example from the pool of XAI techniques. The resulting importance scores are eventually used to determine a subset of most relevant locations for multiple hypothesis testing in the third step. The performance of DeepCOMBI in terms of power and precision is investigated on generated datasets and a 2007 WTCCC study. Verification of the latter is achieved by validating all findings with independent studies published up until 2020. DeepCOMBI is shown to outperform ordinary raw p-value thresholding as well as other baseline methods. Moreover, two novel disease associations (rs10889923 for hypertension and rs4769283 for type 1 diabetes) were identified.
Longitudinal Auditory Pathophysiology Following Mild Blast Induced Trauma
Authors: Han Emily X. , Fernandez Joseph M. , Swanberg Caitlin , Shi Riyi , Bartlett Edward L. 
Published: November 2020

AbstractBlast-induced hearing difficulties affect thousands of veterans and civilians. The long-term impact of even a mild blast exposure on the central auditory system is hypothesized to contribute to lasting behavioral complaints associated with mild blast traumatic brain injury (bTBI). Although recovery from mild blast has been studied separately over brief or long time windows, few, if any, studies have investigated recovery longitudinally over short-term and longer-term (months) time windows. Specifically, many peripheral measures of auditory function either recover or exhibit subclinical deficits, masking deficits in processing complex, real-world stimuli that may recover differently. Thus, examining the acute time course and pattern of neurophysiological impairment using appropriate stimuli is critical to better understanding and intervention of bTBI-induced auditory system impairments. Here, we compared auditory brainstem response, middle-latency auditory evoked potentials, and envelope following responses. Stimuli were clicks, tone pips, amplitude modulated tones in quiet and in noise, and speech-like stimuli (iterated rippled noise pitch contours) in adult male rats subjected to mild blast and sham exposure over the course of two months. We found that blast animals demonstrated drastic threshold increases and auditory transmission deficits immediately after blast exposure, followed by substantial recovery during the window of 7-14 days post-blast, though with some deficits remaining even after two months. Challenging conditions and speech-like stimuli can better elucidate mild bTBI-induced auditory deficit during this period. Our results suggest multiphasic recovery and therefore potentially different time windows for treatment, and deficits can be best observed using a small battery of sound stimuli.New and NoteworthyFew studies on blast-induced hearing deficits go beyond simple sounds and sparsely track post-exposure. Therefore, the recovery arc for potential therapies and real-world listening is poorly understood. Evidence suggested multiple recovery phases over 2 months post-exposure. Hearing thresholds largely recovered within 14 days and partially explained recovery. However, mid-latency responses, responses to AM in noise, and speech-like pitch sweeps exhibited extended changes, implying persistent central auditory deficits and the importance of subclinical threshold shifts.