bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis C Virus Testing Among Men With Human Immunodeficiency Virus Who Have Sex With Men: Temporal Trends and Racial/Ethnic Disparities
Authors: Li Jun , Armon Carl , Palella Frank J , Tedaldi Ellen , Novak Richard M , Fuhrer Jack , Simoncini Gina , Carlson Kimberly , Buchacz Kate ,   for the HIV Outpatient Study (HOPS) Investigators, Li Jun , Buchacz Kate , Durham Marcus D , Akridge Cheryl , Purinton Stacey , Rayeed Nabil , Agbobil-Nuwoaty Selom , Chagaris Kalliope , Carlson Kimberly , Armon Carl , Battalora Linda , Mahnken Jonathan , Palella Frank J , Jahangir Saira , Flaherty Conor Daniel , Bustamante Patricia , Hammer John , Greenberg Kenneth S , Widick Barbara , Franklin Rosa , Ward Douglas J , Thomas Troy , Stewart Cheryl , Fuhrer Jack , Ording-Bauer Linda , Kelly Rita , Esteves Jane , Tedaldi Ellen M , Christian Ramona A , Ruley Faye , Beadle Dania , Davenport Princess , Novak Richard M , Wendrow Andrea , Mayer Stockton , Scott Mia , Thomas Billie , Van Slyke Loraine , Mayer Cynthia , Beitler Terry , Maroney Karen , Franklin Denise
Published: April 2021

Background

National guidelines recommend that sexually active people with human immunodeficiency virus (PWH) who are men who have sex with men (MSM) be tested for hepatitis C virus (HCV) infection at least annually. Hepatitis C virus testing rates vary by race/ethnicity in the general population, but limited data are available for PWH.

Methods

We analyzed medical records data from MSM in the HIV Outpatient Study at 9 human immunodeficiency virus (HIV) clinics from January 1, 2011 through December 31, 2019. We excluded observation time after documented past or current HCV infection. We evaluated HCV antibody testing in each calendar year among HCV-seronegative MSM, and we assessed testing correlates by generalized estimating equation analyses.

Results

Of 1829 eligible MSM who were PWH, 1174 (64.2%) were non-Hispanic/Latino white (NHW), 402 (22.0%) non-Hispanic black (NHB), 187 (10.2%) Hispanic/Latino, and 66 (3.6%) of other race/ethnicity. Most were ≥40 years old (68.9%), privately insured (64.5%), with CD4 cell count/mm3 (CD4) ≥350 (77.0%), and with HIV viral load <200 copies/mL (76.9%). During 2011–2019, 1205 (65.9%) had ≥1 HCV antibody test and average annual HCV percentage tested was 30.3% (from 33.8% for NHB to 28.5% for NHW; P < .001). Multivariable factors positively associated (P < .05) with HCV testing included more recent HIV diagnosis, public insurance, lower CD4, prior chlamydia, gonorrhea, syphilis, or hepatitis B virus diagnoses, and elevated liver enzyme levels, but not race/ethnicity.

Conclusions

Although we found no disparities by race/ethnicity in HCV testing, low overall HCV testing rates indicate suboptimal uptake of recommended HCV testing among MSM in HIV care.
Candida Empyema Thoracis at Two Academic Medical Centers: New Insights Into Treatment and Outcomes
Authors: Senger Suheyla S , Thompson George R , Samanta Palash , Ahrens Jillian , Clancy Cornelius J , Nguyen M Hong
Published: April 2021

Background

Candida empyema thoracis (pleural empyema) is an uncommon manifestation of invasive candidiasis, for which optimal treatment is unknown.

Methods

This is a retrospective study of patients with Candida empyema at 2 academic medical centers from September 2006 through December 2015.

Results

We identified 81 patients with Candida empyema (median age, 62 years; 68% men). Sixty-five percent of patients underwent surgery or an invasive intervention of the thorax or abdomen within the preceding 90 days. Candida empyema originated from intrathoracic (51%) or intra-abdominal sources (20%), spontaneous esophageal rupture (12%), pleural space manipulation (9%), and pneumonia (6%). Eighty-four percent and 41% of patients were intensive care unit residents and in septic shock, respectively, within 3 days of diagnosis. Causative species were Candida albicans (65%), Candida glabrata (26%), Candida parapsilosis (11%), Candida tropicalis (4%), Candida krusei (2%), and Candida dubliniensis (1%). Bacteria were recovered from empyemas in 51% of patients. Concurrent candidemia was diagnosed in only 2% of patients. Management included pleural drainage and antifungal treatment in 98% and 85% of patients, respectively. Mortality at 100 days was 27%, and it was highest for cases stemming from esophageal rupture (67%). Spontaneous esophageal rupture and echinocandin rather than fluconazole treatment were independent risk factors for death at 100 days (P = .003 and .04, respectively); receipt of antifungal therapy was an independent predictor of survival (P = .046).

Conclusions

Candida empyema mortality rates were lower than reported previously. Optimal management included pleural drainage and fluconazole treatment. Superiority of fluconazole over echinocandins against Candida empyema needs to be confirmed in future studies.
Bictegravir-Based Antiretroviral Therapy-Associated Accelerated Hyperglycemia and Diabetes Mellitus
Authors: Nolan Nathanial S , Adamson Samantha , Reeds Dominic , O’Halloran Jane A
Published: April 2021

Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is first line for treatment of people with human immunodeficiency virus (PWH). Emerging data suggest the possibility of adverse metabolic effects of these medications. We describe 3 cases in which PWH developed hyperglycemia and ketoacidosis within months of being switched to bictegravir-based ART.
Incidence and Predictors of Hepatitis B Surface Antigen Clearance in HIV Patients: A Retrospective Multisite Study
Authors: Jain Mamta K , Vigil Karen J , Parisot Paul , Go Gabriella , Vu Trung , Li Xilong , Hansen Laura , Taylor Barbara S
Published: April 2021

Background

New therapies to achieve hepatitis B surface antigen (HBsAg) clearance are under development. However, gaps in knowledge exist in understanding the incidence and predictors of HBsAg clearance in a racially diverse HIV population.

Methods

We examined the incidence and risk of HBsAg clearance in a retrospective cohort of people with HIV/hepatitis B virus (HBV). Included patients had sufficient data to establish chronic infection based on Centers for Disease Control and Prevention guidelines. We examined the incident rate for HBsAg loss and hazard rate ratios to evaluate predictors for HBsAg clearance in a multivariable model.

Results

Among 571 HIV/HBV patients, 87% were male, 61% were Black, 45% had AIDS, 48% were HBeAg positive, and the median follow-up was 88 months. Incident HBsAg clearance was 1.5 per 100 person-years. In the multivariate model, those with AIDS at baseline (adjusted hazard ratio [aHR], 2.43; 95% CI, 1.37–4.32), Hispanics (aHR, 3.57; 95% CI, 1.33–9.58), and those with injection drug use as an HIV risk factor (aHR, 3.35; 95% CI, 1.26–8.89) were more likely to lose HBsAg, whereas those who were HBeAg positive (aHR, 0.34; 95% CI, 0.19–0.63) were less likely to lose HBsAg. The median change in CD4 cell count during the observation period was 231 cells/mm3 in those with HBsAg loss vs 112 cells/mm3 in those with HBsAg persistence (P = .004).

Conclusions

HBsAg loss occurs in about 10% of those with chronic HBV infection. Being Hispanic, having AIDS at baseline, having an injection drug use history, and having HBeAg-negative status at baseline predicted the likelihood of HBsAg loss. Immune restoration may be a mechanism through which HBsAg loss occurs in HIV patients.
Clinical Effectiveness of Lyme Vaccine: A Matched Case–Control Study
Authors: Oliveira Carlos R , Massad Christopher , Shapiro Eugene D , Vazquez Marietta
Published: April 2021

We conducted a matched case–control study to assess the effectiveness of Lyme vaccine (LYMErix) as it was used in clinical practice. We found ≥3 doses to be 71% effective against Lyme disease. This is the first study to show that the Lyme vaccine is effective in a real-world setting.
Invasive Mycobacterium abscessus Outbreak at a Pediatric Dental Clinic
Authors: Singh Jasjit , O’Donnell Kathleen , Nieves Delma J , Adler-Shohet Felice C , Arrieta Antonio C , Ashouri Negar , Ahuja Gurpreet , Cheung Michele , Holmes W Nathan , Huoh Kevin , Tran Lisa , Tran M Tuan , Pham Nguyen , Zahn Matthew
Published: April 2021

Background

Mycobacterium species, specifically M. abscessus and M. chelonae (MABs), are known to contaminate water systems and are uncommon causes of health care–associated infection, but morbidity can be significant and treatment complex.

Methods

Odontogenic MAB infections occurred in patients following pulpotomy procedures at dental clinic A from 1 January to 6 September 2016. We identified confirmed and probable cases using culture data, imaging, pathology results, and surgical findings. Epidemiologic and clinical data including demographics, symptoms, laboratory findings, treatment regimens, and outcomes were extracted.

Results

Of 1082 at-risk patients, 71 case patients (22 confirmed; 49 probable) were identified. Median age was 6 years. Median symptom onset was 85 days postpulpotomy. Pain and/or swelling on admission occurred in 79%. On imaging, 49 of 70 had abnormalities of the mandible or maxilla, 13 of 70 had lymphadenopathy, and 19 of 68 had pulmonary nodules. Seventy were hospitalized (average of 8.5 days). Intravenous antibiotics were administered to 32 cases for a median length of 137 days. Clofazimine was administered to 29 patients as part of their multidrug regimen. Antibiotic treatment was associated with many adverse effects. Treated children showed evidence of jaw healing with resolved/improving pulmonary nodules at 1-year follow-up.

Conclusions

This is the largest outbreak of invasive MAB infections associated with a pediatric dental practice. While infections were indolent, patients suffered medical and surgical consequences of treatment, including permanent tooth loss. Identification of this outbreak led to a change in water standards for pediatric dental procedures in California. Enhanced national dental water quality standards are needed to prevent future outbreaks.
The Characteristics of Capnocytophaga Infection: 10 Years of Experience
Authors: Chesdachai Supavit , Tai Don Bambino Geno , Yetmar Zachary A , Misra Anisha , Ough Natalie , Abu Saleh Omar
Published: April 2021

Background

Capnocytopha ga is a gram-negative, facultative anaerobe. Human infection is rare but can lead to devastating outcomes. Capnocytophaga canimorsus can cause sepsis following an animal bite, whereas human-oral–associated Capnocytophaga infections were reported in immunocompromised patients. Current data on these infections are not robust. Our goal is to provide a contemporary description of a unique characteristic of Capnocytophaga infections.

Methods

We performed a retrospective review of all patients with Capnocytophaga infection from January 2010 to August 2020 at 3 main hospitals of Mayo Clinic in Rochester, Minnesota; Scottsdale, Arizona; and Jacksonville, Florida. We collected baseline demographic data, clinical characteristics, microbiological data, and outcomes of C. canimorsus and human-oral–associated Capnocytophaga infection.

Results

Among 82 patients with Capnocytophaga infection, 46 patients (56.0%) had bacteremia. The most common species identified in this group was C. sputigena (57.9%), followed by C. canimorsus (34.8%). Patients with human-oral–associated Capnocytophaga bacteremia were often immunocompromised, presented with neutropenic fever, and had worse 6-month all-cause mortality compared to C. canimorsus bacteremia (36.4% vs 6.2%, P = .03). They also had a higher β-lactamase production rate (36.4% vs 0.0%, P = .02). Among patients without bacteremia, the main clinical syndrome was polymicrobial head and neck infections (47.2%).

Conclusions

Human-oral–associated Capnocytophaga bacteremia occurs primarily in immunocompromised patients, particularly those with hematologic malignancy. In contrast, C. canimorsus bacteremia is more likely to present with community-onset infection related to zoonotic exposure. Human-oral–associated Capnocytophaga infection without bacteremia is frequently isolated in polymicrobial infection; this phenomenon’s significance is yet to be fully understood.
Control and Elimination of Schistosomiasis as a Public Health Problem: Thresholds Fail to Differentiate Schistosomiasis Morbidity Prevalence in Children
Authors: Wiegand Ryan E , Secor W Evan , Fleming Fiona M , French Michael D , King Charles H , Montgomery Susan P , Evans Darin , Utzinger Jürg , Vounatsou Penelope , de Vlas Sake J
Published: April 2021

Background

Current World Health Organization guidelines utilize prevalence of heavy-intensity infections (PHIs), that is, ≥50 eggs per 10 mL of urine for Schistosoma haematobium and ≥400 eggs per gram of stool for S. mansoni, to determine whether a targeted area has controlled schistosomiasis morbidity or eliminated schistosomiasis as a public health problem. The relationship between these PHI categories and morbidity is not well understood.

Methods

School-age participants enrolled in schistosomiasis monitoring and evaluation cohorts from 2003 to 2008 in Burkina Faso, Mali, Niger, Tanzania, Uganda, and Zambia were surveyed for infection and morbidity at baseline and after 1 and 2 rounds of preventive chemotherapy. Logistic regression was used to compare morbidity prevalence among participants based on their school’s PHI category.

Results

Microhematuria levels were associated with the S. haematobium PHI categories at all 3 time points. For any other S. haematobium or S. mansoni morbidity that was measured, PHI categories did not differentiate morbidity prevalence levels consistently.

Conclusions

These analyses suggest that current PHI categorizations do not differentiate the prevalence of standard morbidity markers. A reevaluation of the criteria for schistosomiasis control is warranted.
Evaluation of Clinical Outcomes After Introduction of a Dedicated Infectious Diseases–Critical Care Medicine Service in Critical Care Units
Authors: Trachuk Polina , Hemmige Vagish , Eisenberg Ruth , Cowman Kelsie , Chen Victor , Weston Gregory , Gendlina Inessa , Ferguson Nadia , Dicpinigaitis Peter , Berger Jay , Pirofski Liise-anne , Sarwar Uzma N
Published: April 2021

Background

Infection is a leading cause of admission to intensive care units (ICUs), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID–critical care medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU.

Methods

In this single-site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during the postintervention period from January 1 to December 31, 2017, and compared it to antibiotic utilization in the same ICUs during the preintervention period from January 1 to December 31, 2015.

Results

Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam, and cefepime during the intervention period. When compared to the preintervention period there was no difference in-hospital mortality, hospital length of stay, and readmission.

Conclusions

With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.
Partnering With Barbershops and Salons to Engage Vulnerable Communities During the COVID-19 Pandemic
Authors: Hill Krystal , Haynes Norrisa , Momplaisir Florence
Published: April 2021

This manuscript conveys the story of the health and economic challenges faced by a coalition of barbershops and salons in West Philadelphia. It is grounded in city and national data that illustrate the widening racial and class disparities during coronavirus disease 2019. Ultimately, it is a story of resilience that outlines a budding partnership between barbershop and salon owners, their community, and medical providers.
Mycobacterium chimaera Genomics With Regard to Epidemiological and Clinical Investigations Conducted for an Open Chest Postsurgical Mycobacterium chimaera Infection Outbreak
Authors: Lecorche Emmanuel , Daniau Côme , La Kevin , Mougari Faiza , Benmansour Hanaa , Kumanski Sylvain , Robert Jérôme , Fournier Sandra , Lebreton Guillaume , Carbonne Anne , Cambau Emmanuelle ,   CNR-MyRMA, Alauzet Corentine , Cavalié Laurent , Chefson-Girault Christine , Belmonte Olivier , Bounhiol Colin Catherine , Bourgoin Anne , Bousseau Anne , Brasme Lucien , Cépoulain Céline , Cizeau Florence , De Champs Christophe , Decousser Jean-Winoc , Ducellier David , Fines Guyon Marguerite , Fournier Sandra , Gambarotto Karine , Grare Marion , Guet-Revillet Hélène , Jansen Chloe , Janvier Frederic , Kassis-Chikhani Najiby , Lalande Valerie , Lanotte Philippe , Lefebvre Annick , Lesteven Claire , Levy Marc , Maitre Thomas , Malavaud Sandra , Morel Stéphanie , Podglajen Isabelle , Poisnel Elodie , Poulain Cécile , Rafidiarisoa Marie-Fleur , Ringeval Jean , Rivier Alexandre , Robert Jerome , Roques-Ceschin Christine , Skalli Soumaya , Traore Ousmane , Vauterin Celine , Verdet Charlotte
Published: April 2021

Background

Postsurgical infections due to Mycobacterium chimaera appeared as a novel nosocomial threat in 2015, with a worldwide outbreak due to contaminated heater-cooler units used in open chest surgery. We report the results of investigations conducted in France including whole-genome sequencing comparison of patient and heater-cooler unit isolates.

Methods

We sought M. chimaera infection cases from 2010 onwards through national epidemiological investigations in health care facilities performing cardiopulmonary bypass, together with a survey on good practices and systematic heater-cooler unit microbial analyses. Clinical and heater-cooler unit isolates were subjected to whole-genome sequencing analyzed with regard to the reference outbreak strain Zuerich-1.

Results

Only 2 clinical cases were shown to be related to the outbreak, although 23% (41/175) of heater-cooler units were declared positive for M. avium complex. Specific measures to prevent infection were applied in 89% (50/56) of health care facilities, although only 14% (8/56) of them followed the manufacturer maintenance recommendations. Whole-genome sequencing comparison showed that the clinical isolates and 72% (26/36) of heater-cooler unit isolates belonged to the epidemic cluster. Within clinical isolates, 5–9 nonsynonymous single nucleotide polymorphisms were observed, among which an in vivo mutation in a putative efflux pump gene was observed in a clinical isolate obtained for 1 patient on antimicrobial treatment.

Conclusions

Cases of postsurgical M. chimaera infections have been declared to be rare in France, although heater-cooler units were contaminated, as in other countries. Genomic analyses confirmed the connection to the outbreak and identified specific single nucleotide polymorphisms, including 1 suggesting fitness evolution in vivo.
Clinical and Virologic Characteristics and Outcomes of Coronavirus Disease 2019 at a Cancer Center
Authors: Yoke Leah H , Lee Juhye M , Krantz Elizabeth M , Morris Jessica , Marquis Sara , Bhattacharyya Pooja , So Lisa , Riedo Francis X , Simmons Jason , Khaki Ali Raza , Cheng Guang-Shing , Greninger Alexander L , Pergam Steven A , Waghmare Alpana , Ogimi Chikara , Liu Catherine
Published: April 2021

Background

High morbidity and mortality have been observed in patients with cancer and coronavirus disease 2019 (COVID-19); however, there are limited data on antimicrobial use, coinfections, and viral shedding.

Methods

We conducted a retrospective cohort study of adult patients at the Seattle Cancer Care Alliance diagnosed with COVID-19 between February 28, 2020 and June 15, 2020 to characterize antimicrobial use, coinfections, viral shedding, and outcomes within 30 days after diagnosis. Cycle threshold values were used as a proxy for viral load. We determined viral clearance, defined as 2 consecutive negative results using severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction results through July 30, 2020.

Results

Seventy-one patients were included with a median age of 61 years; 59% had a solid tumor. Only 3 patients had documented respiratory bacterial coinfection. Empiric antibiotics for pneumonia were prescribed more frequently early in the study period (February 29–March 28, 2020; 12/34) compared to the later period (March 29–June 15, 2020; 2/36) (P = .002). The median number of days from symptom onset to viral clearance was 37 days with viral load rapidly declining in the first 7–10 days after symptom onset. Within 30 days of diagnosis, 29 (41%) patients were hospitalized and 12 (17%) died. Each additional comorbidity was associated with 45% lower odds of days alive and out of hospital in the month following diagnosis in adjusted models.

Conclusions

Patients at a cancer center, particularly those with multiple comorbidities, are at increased risk of poor outcomes from COVID-19. Prolonged viral shedding is frequently observed among cancer patients, and its implications on transmission and treatment strategies warrant further study.
Prospective Clinical Assessments of Hospitalized Patients With Positive SARS-CoV-2 PCR Tests for Necessity of Isolation
Authors: Rhee Chanu , Baker Meghan A , Kanjilal Sanjat , Tucker Robert , Vaidya Vineeta , Badwaik Amy , Blaeser Elizabeth Mermel , Coughlin Cassie , Elloyan Jennifer , Hsieh Candace , Holtzman Meghan , Solem Ofelia , Klompas Michael
Published: April 2021

We prospectively assessed 536 hospitalized patients with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction tests for infectiousness based on symptoms, cycle thresholds, and SARS-CoV-2 history, with repeat testing and serologies in select cases. One hundred forty-eight (28%) patients were deemed noninfectious, most with evidence of prior infection, and managed on standard precautions without evidence of transmission.
Delayed Rise of Oral Fluid Antibodies, Elevated BMI, and Absence of Early Fever Correlate With Longer Time to SARS-CoV-2 RNA Clearance in a Longitudinally Sampled Cohort of COVID-19 Outpatients
Authors: Antar Annukka A R , Yu Tong , Pisanic Nora , Azamfirei Razvan , Tornheim Jeffrey A , Brown Diane M , Kruczynski Kate , Hardick Justin P , Sewell Thelio , Jang Minyoung , Church Taylor , Walch Samantha N , Reuland Carolyn , Bachu Vismaya S , Littlefield Kirsten , Park Han-Sol , Ursin Rebecca L , Ganesan Abhinaya , Kusemiju Oyinkansola , Barnaba Brittany , Charles Curtisha , Prizzi Michelle , Johnstone Jaylynn R , Payton Christine , Dai Weiwei , Fuchs Joelle , Massaccesi Guido , Armstrong Derek T , Townsend Jennifer L , Keller Sara C , Demko Zoe O , Hu Chen , Wang Mei-Cheng , Sauer Lauren M , Mostafa Heba H , Keruly Jeanne C , Mehta Shruti H , Klein Sabra L , Cox Andrea L , Pekosz Andrew , Heaney Christopher D , Thomas David L , Blair Paul W , Manabe Yukari C
Published: April 2021

Background

Sustained molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in the upper respiratory tract (URT) in mild to moderate coronavirus disease 2019 (COVID-19) is common. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection.

Methods

Ninety-five symptomatic outpatients self-collected midturbinate nasal, oropharyngeal (OP), and gingival crevicular fluid (oral fluid) samples at home and in a research clinic a median of 6 times over 1–3 months. Samples were tested for viral RNA, virus culture, and SARS-CoV-2 and other human coronavirus antibodies, and associations were estimated using Cox proportional hazards models.

Results

Viral RNA clearance, as measured by SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR), in 507 URT samples occurred a median (interquartile range) 33.5 (17–63.5) days post–symptom onset. Sixteen nasal-OP samples collected 2–11 days post–symptom onset were virus culture positive out of 183 RT-PCR-positive samples tested. All participants but 1 with positive virus culture were negative for concomitant oral fluid anti-SARS-CoV-2 antibodies. The mean time to first antibody detection in oral fluid was 8–13 days post–symptom onset. A longer time to first detection of oral fluid anti-SARS-CoV-2 S antibodies (adjusted hazard ratio [aHR], 0.96; 95% CI, 0.92–0.99; P = .020) and body mass index (BMI) ≥25 kg/m2 (aHR, 0.37; 95% CI, 0.18–0.78; P = .009) were independently associated with a longer time to SARS-CoV-2 viral RNA clearance. Fever as 1 of first 3 COVID-19 symptoms correlated with shorter time to viral RNA clearance (aHR, 2.06; 95% CI, 1.02–4.18; P = .044).

Conclusions

We demonstrate that delayed rise of oral fluid SARS-CoV-2-specific antibodies, elevated BMI, and absence of early fever are independently associated with delayed URT viral RNA clearance.
Predictors of CMV Infection in CMV-Seropositive Kidney Transplant Recipients: Impact of Pretransplant CMV-Specific Humoral Immunity
Authors: Kirisri Similan , Vongsakulyanon Apirom , Kantachuvesiri Surasak , Razonable Raymund R , Bruminhent Jackrapong
Published: April 2021

Background

Although cytomegalovirus (CMV)-seropositive solid organ transplant recipients have a relatively lower risk of CMV infection than CMV-seronegative recipients who receive allograft from CMV-seropositive donors, some patients remain at risk of CMV infection after transplant. We investigated the pretransplant CMV-specific humoral immunity (CHI) and other CMV infection predictors in CMV-seropositive kidney transplant (KT) recipients.

Methods

This retrospective study was conducted on adult CMV-seropositive KT recipients during 2017 and 2018. The cumulative incidence of CMV infection was estimated using the Kaplan-Meier method. CHI, measured with an enzyme-linked fluorescent immunoassay and other predictors for CMV infection, was analyzed using Cox proportional hazards models.

Results

Of the 340 CMV-seropositive KT recipients (37% female; mean ± SD age, 43 ± 11 years), 69% received deceased-donor allograft and 64% received induction therapy. During a mean follow-up of 14 months, the cumulative incidence of CMV infection was 14.8%. In multivariate analysis, low pretransplant CHI (defined as anti-CMV immunoglobulin [IgG] titer <20 AU/mL) was significantly associated with CMV infection (hazard ratio [HR], 2.98; 95% CI, 1.31–6.77; P = .009). Other significant predictors of CMV infection included older donor age (HR, 1.03; 95% CI, 1.01–1.06; P = .005), antithymocyte induction therapy (HR, 2.90; 95% CI, 1.09–7.74; P = .033), and prolonged cold ischemic time (HR, 1.06; 95% CI, 1.02–1.10; P = .002).

Conclusions

A low pretransplant CHI is independently associated with post-transplant CMV infection in CMV-seropositive KT recipients. A quantitative anti-CMV IgG assay could potentially stratify CMV-seropositive patients at risk of CMV infection after KT.
Lower Urine Tenofovir Concentrations Among Individuals Taking Tenofovir Alafenamide Versus Tenofovir Disoproxil Fumarate: Implications for Point-of-Care Testing
Authors: Johnson Kelly A , Niu Xin , Glidden David V , Castillo-Mancilla Jose R , Yager Jenna , MaWhinney Samantha , Morrow Mary , Okochi Hideaki , Cressey Tim R , Drain Paul K , Gandhi Monica , Anderson Peter L , Spinelli Matthew A
Published: April 2021

From directly observed therapy studies, urine tenofovir (TFV) levels were 74% lower when taking tenofovir alafenamide (TAF) vs tenofovir disoproxil fumarate. Urine TFV remains quantifiable across a range of TAF adherence patterns, but a separate point-of-care lateral flow immunoassay with a lower TFV threshold will be needed to support TAF adherence monitoring.
The Wrong in Negligence
Authors: Oberdiek John
Published: April 2021

The elements of the tort of negligence are well known: injury, duty, breach, and actual and proximate cause. It is uncontroversial that the plaintiff must establish each of these elements to make out the prima facie case of negligence. Accordingly, there is no tort unless all of these elements are established. As torts are understood to be wrongs, it seems to follow that there is a wrong if and only if all of the elements of the tort of negligence are satisfied. It seems to follow, then, that the wrong of negligence is constituted by the completed tort of negligence. This is the conclusion that I wish to challenge here. I shall contend that the wrong of negligence does not require the kind of legally cognisable injury that the tort of negligence plainly requires. Causing a material harm to another is not a prerequisite for wronging them. Instead, one wrongs another when one breaches the duty of care that one owes to them.
Value of 3-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping
Authors: Marbacher Serge , Halter Matthias , Vogt Deborah R , Kienzler Jenny C , Magyar Christian T J , Wanderer Stefan , Anon Javier , Diepers Michael , Remonda Luca , Fandino Javier
Published: April 2021

BACKGROUND

The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison.

OBJECTIVE

To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics.

METHODS

We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments.

RESULTS

Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005).

CONCLUSION

Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.
Low reproductive success of the endangered Iberá Seedeater in its only known breeding site, the Iberá Wetlands, Argentina
Authors: Browne Melanie , Turbek Sheela P , Pasian Constanza , Di Giacomo Adrián S
Published: April 2021

Subtropical grasslands are highly susceptible to habitat conversion and number among South America’s most threatened ecosystems. The grasslands of northeastern Argentina have been identified as a priority conservation area for threatened capuchino seedeaters because they constitute the main breeding area of these migratory birds. The Iberá Seedeater (Sporophila iberaensis) is a newly described species in the Iberá Wetlands in Argentina whose biology is still poorly understood. The endangered species inhabits grasslands but has only been reported to breed in the Iberá Wetlands ecoregion of northeastern Argentina. To explore the species’ association with grassland vegetation, we studied the breeding biology (clutch size, hatching success, and fledgling production) of the Iberá Seedeater and the main parameters that influence nest survival and nest-site selection. We conducted nest searches and banded adults and nestlings in Iberá National Park during the breeding seasons of 2016–2018. The breeding season of the Iberá Seedeater was highly synchronous and the cumulative probability of nest survival was 0.16. The daily nest survival rate decreased as the breeding season advanced, survival was lower for nests supported by Rhynchospora corymbosa than Paspalum durifolium, the two main nest substrates, and the main causes of nest failure were nest predation and strong winds. Additionally, the population exhibited male-biased site fidelity and a low female return rate. In contrast to other capuchinos, whose breeding biology is associated with upland grasslands, the Iberá Seedeater nested exclusively in flooded lowland grasslands on marsh plants. Thus, effective lowland grassland management is key to maintain the vegetation structure required for reproduction in the Iberá Seedeater.
Integrating tracking and resight data enables unbiased inferences about migratory connectivity and winter range survival from archival tags
Authors: Rushing Clark S , Van Tatenhove Aimee M , Sharp Andrew , Ruiz-Gutierrez Viviana , Freeman Mary C , Sykes Paul W , Given Aaron M , Sillett T Scott
Published: April 2021

Archival geolocators have transformed the study of small, migratory organisms but analysis of data from these devices requires bias correction because tags are only recovered from individuals that survive and are re-captured at their tagging location. We show that integrating geolocator recovery data and mark–resight data enables unbiased estimates of both migratory connectivity between breeding and nonbreeding populations and region-specific survival probabilities for wintering locations. Using simulations, we first demonstrate that an integrated Bayesian model returns unbiased estimates of transition probabilities between seasonal ranges. We also used simulations to determine how different sampling designs influence the estimability of transition probabilities. We then parameterized the model with tracking data and mark–resight data from declining Painted Bunting (Passerina ciris) populations breeding in the eastern United States, hypothesized to be threatened by the illegal pet trade in parts of their Caribbean, nonbreeding range. Consistent with this hypothesis, we found that male buntings wintering in Cuba were 20% less likely to return to the breeding grounds than birds wintering elsewhere in their range. Improving inferences from archival tags through proper data collection and further development of integrated models will advance our understanding of the full annual cycle ecology of migratory species.
Avian taxonomy in turmoil: The 7-point rule is poorly reproducible and may overlook substantial cryptic diversity
Authors: Rheindt Frank E , Ng Elize Y X
Published: April 2021

The ornithological world has 4 global checklists (as of early 2020). While 3 follow the results of peer-reviewed research at varying pace and conservatism, the HBW/BirdLife checklist, which is adopted by the global Red List authority, has implemented Tobias et al.’s (2010) 7-point scoring system to overhaul global ornithological treatment. Critically received in some academic quarters, this scoring system is lauded by other ornithologists for its simplicity and reproducibility, a claim that remains to be tested. We subjected 26 ornithologists to a set of 48 bird skins belonging to 20 controversial taxonomic complexes and observed a wide variance in scoring results, in most cases straddling anywhere from far below to above the species threshold of the 7-point rule and casting doubt on claims of high reproducibility. For a detailed assessment of genuine taxonomic discord, we compared the taxonomic coverage of the avifauna of the Indonesian Archipelago (comprising ~1,400 species) between the HBW/BirdLife checklist, other major authorities, and the peer-reviewed literature. We detected that controversial treatments supported by the 7-point rule but at odds with the peer-reviewed literature predominantly refer to lumps, not splits, which are the usual subject of modern taxonomic quarrels. Notably, the method tends to unite morphologically (and sometimes vocally) cryptic forms into single larger species because of its inability to accommodate molecular and massive bioacoustic datasets that would indicate otherwise. On the other hand, the 7-point rule has produced numerous novel proposals for splits that may or may not be corroborated by future peer-reviewed inquiry. We recommend the 7-point rule as one of the multiple unofficial exploratory tools to flag cases of potentially cryptic species requiring further inquiry, but we advise against its adoption by other taxonomic authorities and the ornithological community.
Bill size, bill shape, and body size constrain bird song evolution on a macroevolutionary scale
Authors: Demery Amelia-Juliette Claire , Burns Kevin J , Mason Nicholas A
Published: April 2021

Studying macroevolutionary patterns of phenotypic variation and their driving forces in large radiations can shed light on how biodiversity is generated across broad spatiotemporal scales. In this study, we integrated song and morphological variation across more than 300 species representing the largest family of songbirds, the tanagers (Thraupidae), to uncover how morphological variables of the vocal tract combine to shape vocal evolution on a macroevolutionary scale. We found that body size correlated with multiple frequency parameters, concurring with past studies that show how body size constrains vocal evolution. Furthermore, bill size predicted multiple frequency and temporal song characters while bill shape was strongly associated with trill rates, suggesting that bill size and shape both constrain distinct elements of avian song independently of body size covariation. Our results demonstrate that the relationship between morphology and song exhibits modular variation when expanded to a macroevolutionary scale. Furthermore, our study emphasizes the need to consider multiple components of the avian vocal tract when exploring the macroevolutionary interplay of morphological traits and acoustic signals.
Phytoplankton nutritional quality is altered by shifting Si:N ratios and selective grazing
Authors: Makareviciute-Fichtner Kriste , Matthiessen Birte , Lotze Heike K , Sommer Ulrich
Published: April 2021

Diatoms often dominate phytoplankton in temperate, polar and upwelling regions. Decreases in silicate availability or silicon to nitrogen (Si:N) ratios may induce silicon limitation in diatoms and lower their proportion within phytoplankton communities. The effects of such changes on the nutritional quality of phytoplankton are not well understood. To examine how changing Si:N ratios affect plankton nutritional value, we applied a range of Si:N ratios on a natural plankton community and manipulated grazing pressure to assess top-down effects of copepod selective grazing. Diatom proportion in phytoplankton increased with increasing Si:N ratios and so did phytoplankton nutritional quality in terms of major fatty acid concentrations, such as polyunsaturated fatty acids, docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids. However, stoichiometric quality (carbon to nitrogen and carbon to phosphorus ratios), DHA:EPA and omega 3:6 (ω3:ω6) ratios declined with increasing Si:N ratios, suggesting that proportions between essential compounds in copepod diet may be more favorable in lowered Si:N ratios. Copepods had a negative effect on DHA contents, DHA:EPA and ω3:ω6 ratios, indicating possible selective grazing on more nutritious plankton. Our findings show that declining silicate concentrations can affect stoichiometric and biochemical quality of phytoplankton, which copepods can also moderate by selective grazing.
Arabidopsis myosin XIK interacts with the exocyst complex to facilitate vesicle tethering during exocytosis
Authors: Zhang Weiwei , Huang Lei , Zhang Chunhua , Staiger Christopher J.
Published: April 2021

Myosin motors are essential players in secretory vesicle trafficking and exocytosis in yeast and mammalian cells; however, similar roles in plants remain a matter for debate, at least for diffusely growing cells. Here, we demonstrate that Arabidopsis (Arabidopsis thaliana) myosin XIK, via its globular tail domain (GTD), participates in the vesicle tethering step of exocytosis through direct interactions with the exocyst complex. Specifically, myosin XIK GTD bound directly to several exocyst subunits in vitro and functional fluorescently tagged XIK colocalized with multiple exocyst subunits at plasma membrane (PM)-associated stationary foci. Moreover, genetic and pharmacological inhibition of myosin XI activity reduced the rate of appearance and lifetime of stationary exocyst complexes at the PM. By tracking single exocytosis events of cellulose synthase (CESA) complexes with high spatiotemporal resolution imaging and pair-wise colocalization of myosin XIK, exocyst subunits, and CESA6, we demonstrated that XIK associates with secretory vesicles earlier than exocyst and is required for the efficient localization and normal dynamic behavior of exocyst complex at the PM tethering site. This study reveals an important functional role for myosin XI in secretion and provides insights about the dynamic regulation of exocytosis in plants.
Augmenting Household Expenditure Forecasts with Online Employee-generated Company Reviews
Authors: Symitsi Efthymia , Stamolampros Panagiotis , Karatzas Antonios
Published: April 2021

We assess the ability of online employee-generated content in predicting consumption expenditures. In so doing, we aggregate millions of employee expectations for the next six-month business outlook of their employer and build an employee sentiment index. We test whether forward-looking employee sentiment can contribute to baseline models when forecasting aggregate consumption in the United States and compare its performance to well-established, survey-based consumer sentiment indexes. We reveal that online employee opinions have incremental information that can be used to augment the accuracy of consumption forecasting models and inform economic policy decisions.
The Text and Stemma of ‘To Sr H: W: Going into Venice:’
Authors: Dickson Donald R
Published: April 2021

The text of Donne’s verse letter to Sir Henry Wotton on his appointment as ambassador to Venice, beginning ‘After those reverent papers’, published in the Variorum edition of the verse letters (2018) is based on Trinity College, Dublin Ms. 877 (Variorum siglum DT1). While the Variorum text resembles most of the printed versions of the poem, I argue that it differs considerably from what Donne likely presented to Wotton as he left England for his embassy in 1604. I base my argument principally upon bibliographic evidence found in the Burley Ms. (Variorum siglum LR1), which was compiled mainly during Wotton’s first embassy (1604–1610). Below the copy of HWVenice (Variorum short form) in this manuscript, the scribe recorded a prose postscript that in all likelihood was taken from the now lost original holograph among Wotton’s personal papers in Venice. No other copy of HWVenice includes this postscript, a fact leaving little doubt that the LR1 text of the poem and its postscript stand closer to Donne’s own hand than any other surviving witness. After analysing the stemma published in the Variorum, I propose a more likely stemma and a more authoritative text for HWVenice.
Patient and rheumatologist perspectives on tapering DMARDs in rheumatoid arthritis: a qualitative study
Authors: Hazlewood Glen S , Loyola-Sanchez Adalberto , Bykerk Vivian , Hull Pauline M , Marshall Deborah , Pham Tram , Barber Claire E H , Barnabe Cheryl , Sirois Alexandra , Pope Janet , Schieir Orit , Richards Dawn , Proulx Laurie , Bartlett Susan J
Published: April 2021

Objectives

To understand the perspectives of patients and rheumatologists for tapering DMARDs in RA.

Methods

Using semi-structured interview guides, we conducted individual interviews and focus groups with RA patients and rheumatologists, which were audiotaped and transcribed. We conducted a pragmatic thematic analysis to identify major themes, comparing and contrasting different views on DMARD tapering between patients and rheumatologists.

Results

We recruited 28 adult patients with RA (64% women; disease duration 1–54 y) and 23 rheumatologists (52% women). Attitudes across both groups towards tapering DMARDs were ambivalent, ranging from wary to enthusiastic. Both groups expressed concerns, particularly the inability to ‘recapture’ the same level of disease control, while also acknowledging potential positive outcomes such as reduced drug harms. Patient tapering perspectives (whether to and when) changed over time and commonly included non-biologic DMARDs. Patient preferences were influenced by lived experiences, side effects, previous tapering experiences, disease trajectory, remission duration and current life roles. Rheumatologists’ perspectives varied on timing and patient profile to initiate tapering, and were informed by both data and clinical experience. Patients expressed interest in shared decision-making (SDM) and close monitoring during tapering, with ready access to their health-care team if problems arose. Rheumatologists were generally open to tapering (not stopping), though sometimes only when requested by their patients.

Conclusion

The perspectives of patients and rheumatologists on tapering DMARDs in RA vary and evolve over time. Rheumatologists should periodically discuss DMARD tapering with patients as part of SDM, and ensure monitoring and flare management plans are in place.
Altered CD4+ T cell and cytokine levels in peripheral blood and skin samples from systemic sclerosis patients and IL-35 in CD4+ T cell growth
Authors: Yang Chenxi , Lei Ling , Pan Jie , Zhao Cheng , Wen Jing , Qin Fang , Dong Fei , Wei Wanling
Published: April 2021

Objective

This study explored the role of IL-35 in CD4+ T lymphocyte and human skin fibroblast (HSF) activity and cytokine levels in systemic sclerosis.

Methods

Blood and skin biopsies were collected from 41 patients and 39 healthy controls to assess CD4+ T lymphocytes and IL-35-related factors. CD4+ T lymphocytes were co-cultured with HSFs, recombinant human IL-35 and IL-35 mAb to evaluate the cell viability, activation of CD4+ T lymphocytes and HSF cells.

Results

The proportion of blood Th1/Th2 was lower and Th17/Treg was higher in patients than in controls (P < 0.05). IL-35 and IL-17A levels were higher and IFN-γ, IL-10 and TGF-β levels were lower in patients than in controls. IL-17A, forkhead box P3, TGF-β1 and collagen type I (COL-1) mRNA and phospho (p)-signal transducer and activator of transcription (STAT) 1 and p-STAT4 were higher in skin tissues from patients than in those from controls (P < 0.05). IL-6 levels were higher, whereas IL-10 levels were lower in cell culture supernatants. α-Smooth muscle actin (α-SMA) and COL-1 proteins and Ki67 positivity were higher in CD4+ T + HSF cells from patients than in those from controls. Recombinant human IL-35 treatment inhibited proliferation (P < 0.001), but increased IL-10 and decreased IL-17A, α-SMA and COL-1 secretion into the conditioned medium of CD4+ T lymphocytes + HSFs from patients compared with those from controls. IL-35 mAb blocked the effects of IL-35 in CD4+ T + HSF cells (P < 0.05).

Conclusions

IL-35 plays an inhibitory role in CD4+ T lymphocyte proliferation but induces Treg cell differentiation by STAT1 signalling activation, HSF proliferation and collagen expression in systemic sclerosis.