bluuebunny/crossref_metadata_2025_split huggingface dataset:
#50: Vancomycin Doses and Trough Concentrations in Pediatric Patients
Authors: Vilchez Medalit Luna , Gil César Ugarte , Alvarez Diana Portillo , Afaray Julio Maquera , Mesones Blanca Salazar , Huauya Emilio Aguilar , Revilla José López 
Published: March 2021

Abstract

Background
Vancomycin serum trough concentrations are monitored to reduce nephrotoxicity and optimize therapeutic efficacy. Vancomycin pharmacokinetics and trough levels used in pediatric patients are extrapolated from the adult population. The pediatric dosing strategies are empirical and there is limited evidence to suggest that these doses result in the recommended steady-state trough concentrations. The objective of the study was to determine the association between vancomycin dosing regimens and trough concentrations levels of 10 to 20 μg/mL in pediatric patients with complicated infections.

Methods
Retrospective cohort, 505 trough vancomycin serum concentrations of patients of 1 month to 18 years from hospital wards and the Intensive Care Unit of the Instituto Nacional de Salud del Niño San Borja during December 2015 to April 2019. It included only the first vancomycin trough level measured 30 minutes before the fourth doses and serum trough concentrations of 10 to 20 μg/mL were considered as therapeutic levels. A multinomial logistic regression model to estimate the relative risk ratio (RRR) with a 95% confidence interval was used, the comparator group was therapeutic vancomycin levels and it was adjusted by glomerular filtration rate, age group, hospital room, dose interval, and weight.

Results
Five hundred and five vancomycin dosages were analyzed. Infants and children were 43.12% and 39.22%, respectively, 45.17% were women. 56.77% had a high glomerular filtration rate and only 28.02% of the patients obtained therapeutic trough levels of vancomycin. The RRR of having sub-therapeutic levels in patients with low glomerular filtration rates compared with normal filtration rates was 0.31 (P = 0.049) and the RRR of having sub-therapeutic levels in patients from 2 to 12 years compared with patients under 2 years old was 2.38 (P = 0.007). There was no difference in having therapeutic levels using doses equal or greater than 60 mg/kg/day vs. less than 40 mg/kg/day comparing sub-therapeutic levels (P = 0.655) and supratherapeutic levels (P = 0.264).

Conclusions
The empirical vancomycin regimens used in pediatric patients did not reach the recommended therapeutic trough levels of 10 to 20 μg/mL. Patients of 2 to 12 years and low glomerular filtration rates were associated to have sub-therapeutic trough levels.
#69: Improving Communication About the Care and Prevention of Infections in a Pediatric Oncology Unit by Using Patient Daily Goals in Multidisciplinary Rounds
Authors: Griselda Escobedo-Melendez , Manuel Martinez-Albarran , Isadora Magaña-Saldivar , Norma Jimenez , Elizabeth Gomez-Huerta , Monserrat Pardo-Zepeda , Marcela Espinoza , Cuauhtli Acosta-Rubio , Dulce Inzunza-Valenzuela , Fernando Sanchez-Zubieta , Jeannette Kirby , Miguela Caniza 
Published: March 2021

Abstract

Background
In children with cancer infections are the most frequent complication, with fatal outcomes if not addressed promptly. Therefore, care and prevention of infections in these patients require multidisciplinary interventions, with effective communication among healthcare providers to reduce the morbidity, length of stay, and the inappropriate use of resources. We used the Institute of Healthcare Improvement (IHI) model for improving the communication among healthcare providers by using patient daily goals after the oncology pediatric unit multidisciplinary rounds.

Methods
A multidisciplinary team was identified in the pediatric oncology unit. The team received weekly coaching on the IHI methodology. The methodology used included the creation of a block diagram to understand the baseline processes and a key driver diagram. Then, after a literature review, a data collection plan and measures were identified. The team identified different ideas for changes and prioritized them using an impact-effort matrix. Finally, several rounds of Plan-Do-Study-Act (PDSA) cycles reached the desired changes that organized the patient daily goals for sharing in the form of a worksheet. This worksheet was shared with nurses and pharmacist staff, a chat group was created, and the routine use of the daily goals for patient management was taught and incorporated into the rest of the care team staff. The percentage of excellent communication among all multidisciplinary teams and outcomes (length of stay, intensive care unit admission, and mortality) were recorded at baseline and endline. We determined the statistical significance of the baseline vs. endline difference by using χ 2 and t-tests.

Results
A total of 105 patients with suspected infections were included over a 6-month period (June through November 2019). We found a significant increase per month in the percent of agreement in excellent communication in the patient daily goals between infectious diseases specialist faculty and fellows, nurses, pharmacist, and pediatric oncology faculty and fellows (33.3% vs. 91.3%) (P = 0.004). Length of stay decreased monthly after our interventions (baseline: mean 14.7 days [SD 12.4] vs. after intervention: mean 6.7 days [SD 2.7]) (P = 0.014). There were only one ICU admission and no deaths during the implementation period.

Conclusions
Our approach using patient daily goals improved communication among a multidisciplinary team, leading to decreased length of stay and supporting adequate outcomes.
Sex-related Differences in Functional Movement Screen Scores Among Reserve Officers’ Training Corps Cadets
Authors: Johnson Quincy R , Scraper Jacob , Lockie Robert , Orr Robin M , Dawes J Jay 
Published: March 2021

ABSTRACTIntroductionThe primary aim of Reserve Officers’ Training Corps (ROTC) programs is to prepare cadets for future military service. To successfully complete one of these programs and perform active duty responsibilities, cadets must be able to complete a variety of physical tasks. Therefore, performing movement screening may be useful for identifying potential movement disparities that could lead to injury. The purpose of this investigation was to determine whether sex-related differences in movement patterns exist on the Functional Movement Screen (FMS). The FMS is a tool that uses seven functional movements to assess movement pattern deficits and asymmetries; deep squat, hurdle step, inline lunge (ILL), shoulder mobility, active straight-leg raise (ASLR), trunk stability pushup (TSPU), and rotary stability.Materials and MethodsArchived data for 93 (male, n = 69; female n = 24) ROTC cadets were provided to the primary investigators for analysis. Independent t-tests (P &lt; .05) were conducted to analyze differences in assessments between sexes.ResultsSignificant differences between sexes were observed on the ILL (P = .014), ASLR (P &lt; .001), and TSPU (P &lt; .001). Females scored higher on both the ILL (2.13 ± 0.54) and ASLR (2.04 ± 0.69) compared with males (1.81 ± 0.52 and 1.48 ± 0.58). Males scored significantly higher (P ≤ .001) on the TSPU (2.57 ± .581) compared with females (2.00 ± .417). No significant differences were observed in the deep squat (P = .865), hurdle step (P = .829), shoulder mobility (P = .342), and rotary stability (P = .230) assessments.ConclusionsSex differences in the ILL, ASLR, and TSPU may be because of greater mobility in the ankle and hamstrings and reduced upper-body muscle mass for females compared with males. Males performed better than females on the TSPU test. In conclusion, sex-related differences in FMS performance do exist within the ROTC population. Additionally, these differences should be taken into consideration when designing specific exercise programs for ROTC cadets.
Origins and demographics of wandering black holes
Authors: Ricarte Angelo , Tremmel Michael , Natarajan Priyamvada , Zimmer Charlotte , Quinn Thomas 
Published: March 2021

ABSTRACT
We characterize the population of wandering black holes, defined as those physically offset from their halo centres, in the romulus cosmological simulations. Unlike most other currently available cosmological simulations, black holes are seeded based on local gas properties and are permitted to evolve dynamically without being fixed at halo centres. Tracking these black holes allows us to make robust predictions about the offset population. We find that the number of wandering black holes scales roughly linearly with the halo mass, such that we expect thousands of wandering black holes in galaxy cluster haloes. Locally, these wanderers account for around 10 per cent of the local black hole mass budget once seed masses are accounted for. Yet for higher redshifts ($z$ ≳ 4), wandering black holes both outweigh and outshine their central supermassive counterparts. Most wandering black holes, we find, remain close to the seed mass and originate from the centres of previously disrupted satellite galaxies. While most do not retain a resolved stellar counterpart, those that do are situated farther out at larger fractions of the virial radius. Wanderers with higher luminosities are preferentially at lower radius, more massive, and either closer to their host’s mid-planes or associated with a stellar overdensity. This analysis shows that our current census of supermassive black holes is incomplete and that a substantial population of off-centre wanderers likely exists.
Analysis of physical processes in eruptive YSOs with near-infrared spectra and multiwavelength light curves
Authors: Guo (郭震) Zhen , Lucas P W , Contreras Peña C , Smith L C , Morris C , Kurtev R G , Borissova J , Alonso-García J , Minniti D , Chené A-N , Kumar M S N , Caratti o Garatti A , Froebrich D , Stimson W H 
Published: March 2021

ABSTRACT
The decade-long Vista Variables in the Via Lactea (VVV) survey has detected numerous highly variable young stellar objects (YSOs). We present a study of 61 highly variable VVV YSOs (ΔKs = 1–5 mag), combining near-infrared spectra from Magellan and ESO Very Large Telescope with VVV and NEOWISE light curves to investigate physical mechanisms behind eruptive events. Most sources are spectroscopically confirmed as eruptive variables (typically Class I YSOs) but variable extinction is also seen. Among them, magnetically controlled accretion, identified by H i recombination emission (usually accompanied by CO emission), is observed in 46 YSOs. Boundary layer accretion, associated with FU Ori-like outbursts identified by CO overtone and H2O absorption, is observed only in longer duration events (≥5 yr total duration). However, even in long duration events, the magnetically controlled accretion mode predominates, with amplitudes similar to the boundary layer mode. Shorter (100–700 d) eruptive events usually have lower amplitudes and these events are generally either periodic accretors or multiple time-scale events, wherein large photometric changes occur on time-scales of weeks and years. We find that the ratio of amplitudes in Ks and W2 can distinguish between variable accretion and variable extinction. Several YSOs are periodic or quasi-periodic variables. We identify examples of periodic accretors and extinction-driven periodicity among them (with periods up to 5 yr) though more data are needed to classify some cases. The data suggest that dynamic interactions with a companion may control the accretion rate in a substantial proportion of eruptive systems, although star–disc interactions should also be considered.
Ultraviolet spectra of extreme nearby star-forming regions: Evidence for an overabundance of very massive stars
Authors: Senchyna Peter , Stark Daniel P , Charlot Stéphane , Chevallard Jacopo , Bruzual Gustavo , Vidal-García Alba 
Published: March 2021

ABSTRACT
As deep spectroscopic campaigns extend to higher redshifts and lower stellar masses, the interpretation of galaxy spectra depends increasingly upon models for very young stellar populations. Here we present new HST/COS ultraviolet spectroscopy of seven nearby (&lt;120 Mpc) star-forming regions hosting very young stellar populations (∼4–20 Myr) with optical Wolf–Rayet stellar wind signatures, ideal laboratories in which to benchmark these stellar models. We detect nebular C iii] in all seven, but at equivalent widths uniformly &lt;10 Å. This suggests that even for very young stellar populations, the highest equivalent width C iii] emission at ≥15 Å is reserved for inefficiently cooled gas at metallicities at or below that of the SMC. The spectra also reveal strong C iv P-Cygni profiles and broad He ii emission formed in the winds of massive stars, including some of the most prominent He ii stellar wind lines ever detected in integrated spectra. We find that the latest stellar population synthesis prescriptions with improved treatment of massive stars nearly reproduce the entire range of stellar He ii wind strengths observed here. However, we find that these models cannot simultaneously match the strongest wind features alongside the optical nebular line constraints. This discrepancy can be naturally explained by an overabundance of very massive stars produced by a high incidence of binary mass transfer and mergers occurring on short ≲10 Myr time-scales, suggesting these processes may be crucial for understanding systems dominated by young stars both nearby and in the early Universe.
New models for the rapid evolution of the central star of the Stingray Nebula
Authors: Lawlor T M 
Published: March 2021

Abstract
We present stellar evolution calculations from the Asymptotic Giant Branch (AGB) to the Planetary Nebula (PN) phase for models of initial mass 1.2 M⊙ and 2.0 M⊙ that experience a Late Thermal Pulse (LTP), a helium shell flash that occurs following the AGB and causes a rapid looping evolution between the AGB and PN phase. We use these models to make comparisons to the central star of the Stingray Nebula, V839 Ara (SAO 244567). The central star has been observed to be rapidly evolving (heating) over the last 50 to 60 years and rapidly dimming over the past 20–30 years. It has been reported to belong to the youngest known planetary nebula, now rapidly fading in brightness. In this paper we show that the observed timescales, sudden dimming, and increasing Log(g), can all be explained by LTP models of a specific variety. We provide a possible explanation for the nebular ionization, the 1980’s sudden mass loss episode, the sudden decline in mass loss, and the nebular recombination and fading.
The effects of surface fossil magnetic fields on massive star evolution – III. The case of τ Sco
Authors: Keszthelyi Z , Meynet G , Martins F , de Koter A , David-Uraz A 
Published: March 2021

ABSTRACT
τ Sco, a well-studied magnetic B-type star in the Upper Sco association, has a number of surprising characteristics. It rotates very slowly and shows nitrogen excess. Its surface magnetic field is much more complex than a purely dipolar configuration which is unusual for a magnetic massive star. We employ the cmfgen radiative transfer code to determine the fundamental parameters and surface CNO and helium abundances. Then, we employ mesa and genec stellar evolution models accounting for the effects of surface magnetic fields. To reconcile τ Sco’s properties with single-star models, an increase is necessary in the efficiency of rotational mixing by a factor of 3–10 and in the efficiency of magnetic braking by a factor of 10. The spin-down could be explained by assuming a magnetic field decay scenario. However, the simultaneous chemical enrichment challenges the single-star scenario. Previous works indeed suggested a stellar merger origin for τ Sco. However, the merger scenario also faces similar challenges as our magnetic single-star models to explain τ Sco’s simultaneous slow rotation and nitrogen excess. In conclusion, the single-star channel seems less likely and versatile to explain these discrepancies, while the merger scenario and other potential binary-evolution channels still require further assessment as to whether they may self-consistently explain the observables of τ Sco.
How does the mass and activity history of the host star affect the population of low-mass planets?
Authors: Kubyshkina Daria , Vidotto Aline A 
Published: March 2021

ABSTRACT
The evolution of the atmospheres of low- and intermediate-mass planets is strongly connected to the physical properties of their host stars. The types and the past activities of planet-hosting stars can, therefore, affect the overall planetary population. In this paper, we perform a comparative study of sub-Neptune-like planets orbiting stars of different masses and different evolutionary histories. We discuss the general patterns of the evolved population as a function of parameters and environments of planets. As a model of the atmospheric evolution, we employ the own framework combining planetary evolution in Modules for Experiments in Stellar Astrophysics (mesa) with the realistic prescription of the escape of hydrogen-dominated atmospheres. We find that the final populations look qualitatively similar in terms of the atmospheres survival around different stars, but qualitatively different, with this difference accentuated for planets orbiting more massive stars. We show that a planet has larger chances of keeping its primordial atmosphere in the habitable zone of a solar-mass star compared to M or K dwarfs and if it starts the evolution having a relatively compact envelope. We also address the problem of the uncertain initial temperatures (luminosities) of planets and show that this issue is only of particular importance for planets exposed to extreme atmospheric mass losses.
SILCC VI – Multiphase ISM structure, stellar clustering, and outflows with supernovae, stellar winds, ionizing radiation, and cosmic rays
Authors: Rathjen Tim-Eric , Naab Thorsten , Girichidis Philipp , Walch Stefanie , Wünsch Richard , Dinnbier Frantis̆ek , Seifried Daniel , Klessen Ralf S , Glover Simon C O 
Published: March 2021

ABSTRACT
We present simulations of the multiphase interstellar medium (ISM) at solar neighbourhood conditions including thermal and non-thermal ISM processes, star cluster formation, and feedback from massive stars: stellar winds, hydrogen ionizing radiation computed with the novel treeray radiative transfer method, supernovae (SN), and the injection of cosmic rays (CR). N-body dynamics is computed with a 4th-order Hermite integrator. We systematically investigate the impact of stellar feedback on the self-gravitating ISM with magnetic fields, CR advection and diffusion, and non-equilibrium chemical evolution. SN-only feedback results in strongly clustered star formation with very high star cluster masses, a bi-modal distribution of the ambient SN densities, and low volume-filling factors (VFF) of warm gas, typically inconsistent with local conditions. Early radiative feedback prevents an initial starburst, reduces star cluster masses and outflow rates. Furthermore, star formation rate surface densities of $\Sigma _{\dot{M}_\star } = 1.4-5.9 \times 10^{-3}$$\mathrm{M}_\odot \, \mathrm{yr}^{-1}\, \mathrm{kpc}^{-2}$, VFFwarm = 60–80 per cent as well as thermal, kinetic, magnetic, and cosmic ray energy densities of the model including all feedback mechanisms agree well with observational constraints. On the short, 100 Myr, time-scales investigated here, CRs only have a moderate impact on star formation and the multiphase gas structure and result in cooler outflows, if present. Our models indicate that at low gas surface densities SN-only feedback only captures some characteristics of the star-forming ISM and outflows/inflows relevant for regulating star formation. Instead, star formation is regulated on star cluster scales by radiation and winds from massive stars in clusters, whose peak masses agree with solar neighbourhood estimates.
Inferring the Genetic Basis of Sex Determination from the Genome of a Dioecious Nightshade
Authors: Wu Meng , Haak David C , Anderson Gregory J , Hahn Matthew W , Moyle Leonie C , Guerrero Rafael F 
Published: March 2021

Abstract
Dissecting the genetic mechanisms underlying dioecy (i.e., separate female and male individuals) is critical for understanding the evolution of this pervasive reproductive strategy. Nonetheless, the genetic basis of sex determination remains unclear in many cases, especially in systems where dioecy has arisen recently. Within the economically important plant genus Solanum (∼2,000 species), dioecy is thought to have evolved independently at least 4 times across roughly 20 species. Here, we generate the first genome sequence of a dioecious Solanum and use it to ascertain the genetic basis of sex determination in this species. We de novo assembled and annotated the genome of Solanum appendiculatum (assembly size: ∼750 Mb scaffold N50: 0.92 Mb; ∼35,000 genes), identified sex-specific sequences and their locations in the genome, and inferred that males in this species are the heterogametic sex. We also analyzed gene expression patterns in floral tissues of males and females, finding approximately 100 genes that are differentially expressed between the sexes. These analyses, together with observed patterns of gene-family evolution specific to S. appendiculatum, consistently implicate a suite of genes from the regulatory network controlling pectin degradation and modification in the expression of sex. Furthermore, the genome of a species with a relatively young sex-determination system provides the foundational resources for future studies on the independent evolution of dioecy in this clade.
Analysis of Fungal Genomes Reveals Commonalities of Intron Gain or Loss and Functions in Intron-Poor Species
Authors: Lim Chun Shen , Weinstein Brooke N , Roy Scott W , Brown Chris M 
Published: March 2021

Abstract
Previous evolutionary reconstructions have concluded that early eukaryotic ancestors including both the last common ancestor of eukaryotes and of all fungi had intron-rich genomes. By contrast, some extant eukaryotes have few introns, underscoring the complex histories of intron–exon structures, and raising the question as to why these few introns are retained. Here, we have used recently available fungal genomes to address a variety of questions related to intron evolution. Evolutionary reconstruction of intron presence and absence using 263 diverse fungal species supports the idea that massive intron reduction through intron loss has occurred in multiple clades. The intron densities estimated in various fungal ancestors differ from zero to 7.6 introns per 1 kb of protein-coding sequence. Massive intron loss has occurred not only in microsporidian parasites and saccharomycetous yeasts, but also in diverse smuts and allies. To investigate the roles of the remaining introns in highly-reduced species, we have searched for their special characteristics in eight intron-poor fungi. Notably, the introns of ribosome-associated genes RPL7 and NOG2 have conserved positions; both intron-containing genes encoding snoRNAs. Furthermore, both the proteins and snoRNAs are involved in ribosome biogenesis, suggesting that the expression of the protein-coding genes and noncoding snoRNAs may be functionally coordinated. Indeed, these introns are also conserved in three-quarters of fungi species. Our study shows that fungal introns have a complex evolutionary history and underappreciated roles in gene expression.