bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of a Chronic Neck Abscess in a U.S. Navy Bottlenose Dolphin
Authors: Lee Clara , Jensen Eric D , Meegan Jenny , Ivančić Marina , Bailey James , Hendrickson Dean , Weiss Jeffrey , Grindley Jonathan , Costidis Alexander M , Wisbach Gordon 
Published: February 2019

Abstract
Surgical intervention on cetaceans is rarely performed due to challenges including general anesthesia and post-operative wound healing. This report describes the evaluation and treatment of an adult female bottlenose dolphin (Tursiops truncatus) with the US Navy Marine Mammal Program, with a chronic ventral cervical abscess caused by Candida glabrata. Despite aspiration and lavage along with multiple antifungal drugs, the patient developed inspiratory stridor with decreased performance level and surgical treatment was pursued. Under general anesthesia with the dolphin in dorsal recumbency position a 12-cm longitudinal ventral midline neck incision was used for exploration. Intraoperative ultrasound aided the identification of surgical landmarks and the abscess cavity. After adequate drainage and curettage, a closed-suction drain was placed in the surgical site. Retention sutures were used to close the incision and the external drain bulb was secured to a pectoral fin strap. One-year post-op, the dolphin was clinically normal and follow-up imaging showed no significant recurrence of the abscess. This case demonstrates a novel surgical approach of managing abscesses in dolphins, including placement and management of a negative suction drain in a submerged patient. The successful collaboration between veterinary anesthesiology, veterinary medicine, radiology, and general surgery allowed the patient to continue her normal activities as a full-duty service member.
Regional Anesthesia in the Combat Setting: Are ACGME Requirements Enough?
Authors: Dhanjal Sandeep T , Highland Krista B , Nguyen Daniel M , Santos Danielle M , Burch Robert H , Maani Christopher V , Aden James K , Patel Ronil , Buckenmaier Chester C 
Published: February 2019

AbstractIntroductionUpdated Joint Trauma System Clinical Practice Guidelines (CPG) indicate regional anesthesia and pain management (RAAPM) are important for combat casualty care. However, it is unclear whether military anesthesiology residents are receiving adequate RAAPM training to meet the CPGs. The goal of this study was to conduct a preliminary evaluation of resident-completed combat-relevant regional anesthesia procedures. It was hypothesized that most residents would perform an adequate number of each procedure to presume proficiency.Materials and MethodsResident-performed, combat-relevant regional anesthesia procedure frequency was extracted from a database maintained at a military anesthesiology residency program. Data collection was limited to a 1-year period. Univariate statistics described procedure distributions, frequencies, and proportion of residents achieving pre-defined, empirically-supported experience criteria for each technique. Analyses examined proportional differences in meeting experience criteria by training-year.ResultsResidents (N = 41) performed a variety of procedures. Simple procedures, such as saphenous peripheral nerve blocks, were performed at a greater frequency than more complicated procedures such as thoracic epidurals, continuous peripheral nerve blocks, and transverse abdominus plane blocks. The majority of residents met experience criteria for four out of the eight measured combat-relevant blocks. There were no proportional differences in meeting procedural experience criteria across the different training levels.ConclusionsThese results suggest a possible gap between the needs of the Military Health System during conflict and current residency training experiences. Reasons for this gap, as well as solutions, are explored.
Health Characteristics of the Wayuu Indigenous People
Authors: Lennon Robert P , Lopez Kristian Camilo Orduña , Socha Javier Andres Moreno , Montealegre Fabián Eduardo García , Chandler Jerry W , Sweet Nicholas N , Hawley Lesley A , Smith Dustin K , Sanchack Kristian E 
Published: February 2019

Abstract

Introduction
The identified number of isolated populations with unique medical characteristics is growing. These populations are difficult to study. Civil-military humanitarian operations are part of our medical force readiness training, and are also a venue through which unique populations can be simultaneously served and evaluated. Continuing Promise 2017 was a collaborative effort between the US Navy, non-governmental organizations, and the Colombian Ministry of Health, Navy and Army to provide primary medical care to the Wayuu indigenous people in the La Guajira Department of Colombia.

Materials and Methods
In the course of providing primary care services, demographic and health data of the Wayuu people were collected. Descriptive statistics were used to generate averages, and t-tests were used to compare Wayuu means with age and gender matched US means for weight and age in children and blood pressure in adults. Observational data on skin afflictions and arthritis were also collected. This project was approved by Naval Medical Center Portsmouth Institutional Review Board.

Results
Although the Wayuu live in an arid desert with chronic sun exposure, they have no apparent affliction from squamous cell carcinoma or melanoma. They live almost exclusively through manual labor, yet rarely develop osteoarthritic joint disease. Their incidence of hypertension is 35% lower than their US age and gender matched cohort. Although their region is known for extreme poverty and malnutrition, their weight-for-age curve from 2 months through 17 years is similar to their US cohort.

Conclusions
This study is the first to document the general health characteristics of the Wayuu people. It demonstrates that in addition to providing important readiness training to our own personnel, humanitarian missions can provide medical care and explore unique, isolated populations. Although retrospective and limited in size, it can be used to shape future medical missions to their region, and will hopefully stimulate formal research into their remarkable characteristics.
Pebble accretion in self-gravitating protostellar discs
Authors: Forgan D H 
Published: February 2019

Abstract
Pebble accretion has become a popular component to core accretion models of planet formation, and is especially relevant to the formation of compact, resonant terrestrial planetary systems. Pebbles initially form in the inner protoplanetary disc, sweeping outwards in a radially expanding front, potentially forming planetesimals and planetary cores via migration and the streaming instability. This pebble front appears at early times, in what is typically assumed to be a low-mass disc. We argue this picture is in conflict with the reality of young circumstellar discs, which are massive and self-gravitating. We apply standard pebble accretion and streaming instability formulae to self-gravitating protostellar disc models. Fragments will open a gap in the pebble disc, but they will likely fail to open a gap in the gas, and continue rapid inward migration. If this does not strongly perturb the pebble disc, our results show that disc fragments will accrete pebbles efficiently. We find that in general the pebble-to-gas-density ratio fails to exceed 0.01, suggesting that the streaming instability will struggle to operate. It may be possible to activate the instability if 10 cm grains are available, and spiral structures can effectively concentrate them in regions of low gravito-turbulence. If this occurs, lunar mass cores might be assembled on time-scales of a few thousand years, but this is likely to be rare, and is far from proven. In any case, this work highlights the need for study of how self-gravitating protostellar discs define the distribution and properties of solid bodies, for future planet formation by core accretion.
Prevalence of radio jets associated with galactic outflows and feedback from quasars
Authors: Jarvis M E , Harrison C M , Thomson A P , Circosta C , Mainieri V , Alexander D M , Edge A C , Lansbury G B , Molyneux S J , Mullaney J R 
Published: February 2019

Abstract
We present 1–7 GHz high-resolution radio imaging (VLA and e-MERLIN) and spatially resolved ionized gas kinematics for 10 z < 0.2 type 2 ‘obscured’ quasars (log [LAGN/erg s−1] ≳ 45) with moderate radio luminosities ($\log [L_{\rm {1.4\,GHz}}$/W Hz−1] = 23.3–24.4). These targets were selected to have known ionized outflows based on broad [O iii] emission-line components (full width at half-maximum ≈ 800–1800 km s−1). Although ‘radio-quiet’ and not ‘radio AGN’ by many traditional criteria, we show that for nine of the targets, star formation likely accounts for ≲10 per cent of the radio emission. We find that ∼80–90 per cent of these nine targets exhibit extended radio structures on 1–25 kpc scales. The quasars’ radio morphologies, spectral indices, and position on the radio size–luminosity relationship reveals that these sources are consistent with being low power compact radio galaxies. Therefore, we favour radio jets as dominating the radio emission in the majority of these quasars. The radio jets we observe are associated with morphologically and kinematically distinct features in the ionized gas, such as increased turbulence and outflowing bubbles, revealing jet–gas interaction on galactic scales. Importantly, such conclusions could not have been drawn from current low-resolution radio surveys such as FIRST. Our observations support a scenario where compact radio jets, with modest radio luminosities, are a crucial feedback mechanism for massive galaxies during a quasar phase.
Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California
Authors: Antin Tamar M J , Hess Catherine , Kaner Emily , Lipperman-Kreda Sharon , Annechino Rachelle , Hunt Geoffrey 
Published: February 2019

Abstract

Introduction
Existing research on youth’s adoption of alternative nicotine delivery systems (ANDS) has focused on identifying pathways of nicotine product use, specifically examining whether vaping encourages progression to smoking. Few studies have considered other pathways of initiation. Qualitative studies suggest that meanings of vaping vary significantly, suggestive of the need for a more nuanced understanding of the role of vaping for youth with different pathways into vaping and smoking.

Methods
We conducted in-depth qualitative interviews with 49 Californian youth between 15 and 25 years old who reported ever vaping nicotine to gain a deeper understanding of their initiation pathways of vaping and smoking, paying special attention to youth’s experiences and reasons for ANDS initiation and use. Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, we then compared the meaning and role of vaping across three distinct pathways of use: (1) smoking to vaping, (2) vaping to smoking, and (3) vaping only.

Results
The most common pathway reported was smoking to vaping (74%), eight participants began vaping before smoking, and five participants reported only vaping but never smoking. Analysis of participants’ narratives emphasized that youth in our study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products considering relative risks.

Conclusion
Findings from this study suggest that ANDS serve as a transitional tool for youth who are keenly aware of the health consequences of smoking, thus challenging conventional discourses about ANDS as a threat to youth’s health.

Implications
This qualitative study queries concerns about the potential of alternative nicotine delivery systems (ANDS) to serve as a gateway into cigarette smoking for youth and young adults. Findings suggest that most of the youth participants discussed and considered relative risks in their pathways of initiation, highlighting the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation.
Understanding the Complexity of Iron Sensing and Signaling Cascades in Plants
Authors: Kobayashi Takanori 
Published: February 2019

Abstract
Under iron-deficient conditions, plants induce the expression of a set of genes involved in iron uptake and translocation. This response to iron deficiency is regulated by transcriptional networks mediated by transcription factors (TFs) and protein-level modification of key factors by ubiquitin ligases. Several of the basic helix–loop–helix TFs and the HRZ/BTS ubiquitin ligases are conserved across graminaceous and non-graminaceous plants. Other regulators are specific, such as IDEF1 and IDEF2 in graminaceous plants and FIT/FER and MYB10/72 in non-graminaceous plants. IMA/FEP peptides positively regulate the iron-deficiency responses in a wide range of plants by unknown mechanisms. Direct binding of iron or other metals to some key regulators, including HRZ/BTS and IDEF1, may be responsible for intracellular iron-sensing and -signaling events. In addition, key TFs such as FIT and IDEF1 interact with various proteins involved in signaling pathways of plant hormones, oxidative stress and metal abundance. Thus, FIT and IDEF1 might function as hubs for the integration of environmental signals to modulate the responses to iron deficiency. In addition to local iron signaling, root iron responses are modulated by shoot-derived long-distance signaling potentially mediated by phloem-mobile substances such as iron, iron chelates and IMA/FEP peptides.
Validating Accelerometry as a Measure of Arm Movement for Children With Hemiplegic Cerebral Palsy
Authors: Dawe Jaclyn , Yang Jaynie F , Fehlings Darcy , Likitlersuang Jirapat , Rumney Peter , Zariffa José , Musselman Kristin E 
Published: February 2019

Abstract

Background
For children with hemiplegic cerebral palsy (HCP), rehabilitation aims to increase movement of the affected arm. However, no validated measure objectively examines this construct in pediatric practice or daily life.

Objective
The objective of this study was to evaluate the criterion and known-groups validity of accelerometry as a measure of arm movement in children and adolescents with HCP.

Design
This was a prospective cross-sectional study.

Methods
Twenty-seven children and adolescents with typical development (3.4–13.9 years old) and 11 children and adolescents with HCP (4.7–14.7 years old; Manual Ability Classification System rating I or II) wore accelerometers on their wrists while engaged in 20 minutes of play, which included intermittent intervals of stillness and vigorous movement of the arms. Vector magnitude (VM) values identified the presence (VM &gt; 2.0 counts per epoch) and absence (VM ≤ 2.0 counts per epoch) of arm movement for every 2-second epoch. Video was simultaneously recorded; each 2-second interval of footage was scored as “movement” or “no movement” for each arm.

Results
Agreement between accelerometry and video observation was greater than or equal to 81%, and the prevalence-adjusted and bias-adjusted κ value was greater than or equal to 0.69 for both groups of participants; these results supported the criterion validity of accelerometry. The ratio of nondominant arm movement to dominant arm movement measured by accelerometry was significantly greater in participants with typical development (mean [SD] = 0.87 [0.09]) than in participants with HCP (mean = 0.78 [0.07]) on the basis of 10 age- and sex-matched pairs; these results supported known-groups validity.

Limitations
The small sample size of the group with HCP prevented the stratification of data by age. Participants with HCP had high or moderately high function of the affected arm; hence, the findings do not apply to children and adolescents with more significant hemiparesis.

Conclusions
Accelerometry is a valid measure of arm movement in children with HCP and children without HCP. These findings contribute to the development of innovative upper limb assessments for children with hemiparesis.
Risk of relapse after discontinuation of tocilizumab therapy in giant cell arteritis
Authors: Adler Sabine , Reichenbach Stephan , Gloor Andrea , Yerly Daniel , Cullmann Jennifer L. , Villiger Peter M. 
Published: February 2019

AbstractObjectiveIt is currently unknown how long GCA should be treated with tocilizumab. In the first randomized controlled trial, the biologic agent was stopped after 52 weeks. We therefore studied what proportion of patients relapsed, when relapses occurred and whether factors might predict relapse after tocilizumab treatment discontinuation.MethodsAll patients in the tocilizumab arm who had received a 52-week treatment were evaluated. In case of lasting remission, magnetic resonance angiography (MRA) was performed and sera were taken to search for biomarkers associated with subclinical disease activity.ResultsSeventeen of 20 patients randomized to the tocilizumab treatment arm were in lasting remission without any co-medication at week 52. Mean follow-up after study end was 28.1 months (range 17–44). Eight patients relapsed after a mean of 6.3 months (range 2–14) (six within the first 5 months, two patients at months 13 and 14, respectively). Relapsing patients were younger and showed more signs of mural enhancement in MRA compared with non-relapsing patients. MRA documented low-intensity vessel wall signals in all subjects. No morphological changes such as formation of aneurysm of aorta occurred. Biomarkers in sera did not indicate subclinical disease activity: levels of IL-6, MMP-3, soluble TNF receptor 2, soluble CD163, soluble intercellular adhesion molecule-1 and Pentraxin-3 did not differ from matched healthy controls.ConclusionThe data show that a 52-week treatment with tocilizumab induces a lasting remission that persists in half of the patients after treatment stop. None of the clinical, serological or MRA findings qualify to predict relapse. Remarkably, MRA revealed a persisting wall enhancement of the descending aorta.
Repeated evolution of flightlessness in Dryolimnas rails (Aves: Rallidae) after extinction and recolonization on Aldabra
Authors: Hume Julian P , Martill David 
Published: February 2019

AbstractThe Aldabra rail, Dryolimnas cuvieri subsp. aldabranus, endemic to the Aldabra Atoll, Seychelles, is the last surviving flightless bird in the Indian Ocean. Aldabra has undergone at least one major, total inundation event during an Upper Pleistocene (Tarantian age) sea-level high-stand, resulting in the loss of all terrestrial fauna. A flightless Dryolimnas has been identified from two temporally separated Aldabran fossil localities, deposited before and after the inundation event, providing irrefutable evidence that a member of Rallidae colonized the atoll, most likely from Madagascar, and became flightless independently on each occasion. Fossil evidence presented here is unique for Rallidae and epitomizes the ability of birds from this clade to successfully colonize isolated islands and evolve flightlessness on multiple occasions.
Extracranial Internal Carotid Aneurysm in a 10-Year-Old Boy Diagnosed via Ultrasound
Authors: Sosa Philip A. , Matar Phillip , Gross Isabel T. 
Published: February 2019

Background
Extracranial carotid aneurysms in children are extremely rare but carry a high mortality and morbidity. For pediatric patients, they are often complications of pharyngeal infections and surgical trauma but can also arise from congenital and inflammatory diseases. They have a wide range of presentation from an asymptomatic mass to a rapidly fatal hemorrhage.

Case
A 10-year-old boy presented to the emergency department with complaints of a neck mass and residual cough from a recent upper respiratory infection. Ultrasound revealed a carotid aneurysm that was further characterized by magnetic resonance angiography as a 3-cm aneurysm of the internal carotid artery. The patient was taken for surgery where he underwent resection and placement of an interposition graft. The procedure was well tolerated and the boy recovered fully.

Discussion
Carotid aneurysms in children can present with 1 or more of the following: a pulsatile neck mass, hematemesis, epistaxis, neurologic symptoms, and symptoms of airway compression. Although ultrasound is the preferred initial test, the choice of additional imaging for further characterization will depend most on the patient age, hemodynamic stability, airway status, and availability of pediatric anesthesia. Hemodynamic and neurologic status should be monitored closely, and clinicians must also be prepared for a potentially complicated airway. Surgery is indicated for children owing to high risk of neurologic complications.

Conclusions
Although these lesions are rare, it is crucial that physicians recognize when there is a need for further evaluation so that these children have the most favorable outcomes possible.
Comparison of three different eye-tracking tasks for distinguishing autistic from typically developing children and autistic symptom severity
Authors: Kou Juan , Le Jiao , Fu Meina , Lan Chunmei , Chen Zhuo , Li Qin , Zhao Weihua , Xu Lei , Becker Benjamin , Kendrick Keith M 
Published: February 2019

AbstractAltered patterns of visual social attention preference detected using eye-tracking and a variety of different paradigms are increasingly proposed as sensitive biomarkers for autism spectrum disorder. However, few eye tracking studies have compared the relative efficacy of different paradigms to discriminate between autistic compared with typically developing children and their sensitivity to specific symptoms. To target this issue, the current study used three common eye tracking protocols contrasting social versus non-social stimuli in young (2-7 years old) Chinese autistic (n = 35) and typically developing (n = 34) children matched for age and gender. Protocols included dancing people vs. dynamic geometrical images, biological motion (dynamic light point walking human or cat) vs. non-biological motion (scrambled controls) and child playing with toy vs. toy alone. Although all three paradigms differentiated autistic and typically developing children, the dancing people versus dynamic geometry pattern paradigm was the most effective, with autistic children showing marked reductions in visual preference for dancing people and correspondingly increased one for geometric patterns. Furthermore, this altered visual preference in autistic children was correlated with the ADOS social affect score and had the highest discrimination accuracy. Our results therefore indicate that decreased visual preference for dynamic social stimuli may be the most effective visual attention-based paradigm for use as a biomarker for autism in Chinese children. Clinical trial ID: NCT03286621 (clinicaltrials.gov); Clinical trial name: Development of Eye-tracking Based Markers for Autism in Young Children.Lay summaryEye-tracking measures may be useful in aiding diagnosis and treatment of autism, although it is unclear which specific tasks are optimal. Here we compare the ability of three different social eye-gaze tasks to discriminate between autistic and typically developing young Chinese children and their sensitivity to specific autistic symptoms. Our results show that a dynamic task comparing visual preference for social (individuals dancing) versus geometric patterns is the most effective both for diagnosing autism and sensitivity to its social affect symptoms.