bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of government agencies and other actors in influencing access to medicines in three East African countries
Authors: Odoch Walter Denis , Dambisya Yoswa , Peacocke Elizabeth , Sandberg Kristin Ingstad , Hembre Berit Sofie Hustad 
Published: December 2020

Abstract
The WHO Model List of Essential Medicines (MLEM) has since 1977 helped prioritize and ensure availability of medicines especially in low- and middle-income countries. The MLEM consists mainly of generic medicines, though recent trends point towards listing expensive on-patent medicines and increasing global support for medicines against non-communicable diseases. However, the implications of such changes for national essential medicines list (NEML) updates for access to essential medicines has received relatively little attention. This study examined how government agencies and other actors in Kenya, Uganda and Tanzania participate in and influence the NEML update process and subsequent availability of prioritized medicines; and the alignment of these processes to WHO guidance. A mixed study design was used, with qualitative documentary review, key informant interviews and thematic data analysis. Results show that NEML updating processes were similar amongst the three countries and aligned to WHO guidelines, albeit conducted irregularly, with tendency to reprioritization during procurement stages, and were not always accompanied by revision of clinical guidelines. Variations were noted in the inclusion of medicines against cancer and hepatitis C, and the utilization of health technology assessment (HTA). For medicines against diseases with high global engagement, such as HIV/AIDS and TB, national stakeholders had more limited inputs in prioritization and funding. Furthermore, national actors were not influenced by the pharmaceutical industry during the NEML update process, nor were any conflicting agendas identified between health, trade and industrial policies. Hence, the study suggests that more attention should be paid to the combination of HTAs and NEMLs, particularly as countries work towards universal health coverage, in addition to heightened awareness of how global disease-specific initiatives may confound national implementation of the NEML. The study concludes with a call to strengthen country-level policy and procedural coherence around the process of prioritizing and ensuring availability of essential medicines.
Emergence and dissemination of three mild outbreaks ofNeisseria gonorrhoeaewith high-level resistance to azithromycin in Barcelona, 2016–18
Authors: Salmerón P , Moreno-Mingorance A , Trejo J , Amado R , Viñado B , Cornejo-Sanchez T , Alberny M , Barbera M J , Arando M , Pumarola T , Hoyos-Mallecot Y , Serra-Pladevall J , González-López J J 
Published: December 2020

AbstractBackgroundNeisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy.ObjectivesThis study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018.MethodsWGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records.ResultsTwelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour.ConclusionsOur findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.
High rate of virological failure and HIV drug resistance in semi-rural Gabon and implications for dolutegravir-based regimen efficacy
Authors: Engone-Ondo Jéordy D , Mouinga-Ondémé Augustin , Lékana-Douki Sonia E , Diané Abdoulaye , Mamimandjiami Antony I , Banga Octavie , Ndong-Atome Guy-Roger , Aghokeng Avelin F 
Published: December 2020

Abstract

Background
The projected UNAIDS goal of ending AIDS by 2030 requires significant global efforts to improve current and future ART strategies. In this study, we assessed viral load (VL) suppression and acquired drug resistance, as well as future efficacy of dolutegravir-based combinations for patients living in semi-rural regions of Gabon.

Methods
Eligible study participants were adults receiving ART and recruited between 2018 and 2019 in Franceville, Gabon. VL testing was conducted to assess VL suppression and HIV drug resistance (HIVDR) testing was performed to identify resistance mutations and assess their impact on ongoing and future ART regimens.

Results
We recruited 219 participants overall. The median time on ART was 27 months and 216/219 participants were on first-line ART. VL suppression (VL &lt; 1000 copies/mL) was 57.1% (95% CI 50.5–63.8) overall; 59.4% (51.4–67.5) and 52.2% (40.3–64.2) for women and men, respectively. The overall prevalence of HIVDR was 21.9% among the study population and 67.2% among those who failed ART. Presence of both NRTI and NNRTI mutations was found in 84.6% of sequences with drug resistance mutations, and full activity of a dolutegravir-based first-line regimen including tenofovir disoproxil fumarate/lamivudine/dolutegravir was expected only for 5/39 patients with a resistant virus.

Conclusions
This study shows a very low rate of VL suppression in a semi-rural context in Africa. Moreover, the high burden of HIVDR has affected both current and newly recommended ART strategies. Better management of ART in resource-limited settings is still a challenging ambition.
Alternative vanHAX promoters and increased vanA-plasmid copy number resurrect silenced glycopeptide resistance in Enterococcus faecium
Authors: Wagner Theresa Maria , Janice Jessin , Sivertsen Audun , Sjögren Ingegerd , Sundsfjord Arnfinn , Hegstad Kristin 
Published: December 2020

Abstract

Background
Vancomycin variable enterococci (VVE) are van-positive isolates with a susceptible phenotype that can convert to a resistant phenotype during vancomycin selection.

Objectives
To describe a vancomycin-susceptible vanA-PCR positive ST203 VVE Enterococcus faecium isolate (VVESwe-S) from a liver transplantation patient in Sweden which reverted to resistant (VVESwe-R) during in vitro vancomycin exposure.

Methods
WGS analysis revealed the genetic differences between the isolates. Expression of the van-operon was investigated by qPCR. Fitness and stability of the revertant were investigated by growth measurements, competition and serial transfer.

Results
The VVESwe-R isolate gained high-level vancomycin (MIC &gt;256 mg/L) and teicoplanin resistance (MIC = 8 mg/L). VVESwe-S has a 5′-truncated vanR activator sequence and the VVESwe-R has in addition acquired a 44 bp deletion upstream of vanHAX in a region containing alternative putative constitutive promoters. In VVESwe-R the vanHAX-operon is constitutively expressed at a level comparable to the non-induced prototype E. faecium BM4147 strain. The vanHAX operon of VVESwe is located on an Inc18-like plasmid, which has a 3–4-fold higher copy number in VVESwe-R compared with VVESwe-S. Resistance has a low fitness cost and the vancomycin MIC of VVESwe-R decreased during in vitro serial culture without selection. The reduction in MIC was associated with a decreased vanA-plasmid copy number.

Conclusions
Our data support a mechanism by which vancomycin-susceptible VVE strains may revert to a resistant phenotype through the use of an alternative, constitutive, vanR-activator-independent promoter and a vanA-plasmid copy number increase.
The influence of art censorship on New York collectors in the Gilded Age
Authors: Werbel Amy 
Published: December 2020

Abstract
With ample funds to furnish enormous homes and contribute to new public art museums, New York collectors in the mid-nineteenth century made a variety of choices regarding nudity and sexual themes in the works they purchased. After a surge in art censorship cases, beginning in 1883, collectors increasingly were confronted with polemical rhetoric urging them to refrain from purchasing art representing nude figures. While some collectors clearly adhered to this moralizing advice, including William H. Vanderbilt, James Lenox and Morris K. Jesup, others – most famously Henry O. and Louisine Havemeyer – were spurred on by their advocacy for civil liberties and cosmopolitan sophistication to purchase more nudes. Understanding both the intended and unintended consequences of art censorship campaigns in the Gilded Age is instructive for the likely outcome of analogous debates about appropriate subject matter on display in our own time.
Johann Daniel Major (1634–1693) and the experimental museum
Authors: Keller Vera 
Published: December 2020

Abstract
In the late seventeenth century, Johann Daniel Major, professor of medicine at Kiel University, claimed to have founded a new discipline, the ‘tactica conclavium’ – that is, the study of arranging a collection. At times, scholars have characterized Major’s museology as a form of disordered polyhistorism. This essay emphasizes that the goal of the ‘tactica conclavium’ was experimental use. It situates Major’s interventions as an early example of a ‘political–gallant’ model of learning that would become an increasingly dominant ideal by the turn of the eighteenth century and would shape academic research infrastructures. Recasting collected objects as materials for experiments meant re-envisioning everything about the collection, from its contents to the cabinetry and architecture, the cataloguing and the aesthetics of display.
Discrepancies in Parent Perceptions of Child Vulnerability in Youth With Spina Bifida
Authors: Kritikos Tessa K , Driscoll Colleen F Bechtel , Holmbeck Grayson N 
Published: December 2020

AbstractObjective This study aimed to describe informant discrepancies between mother and father reports of child vulnerability in youth with spina bifida (SB) and examine variables that were associated with these discrepancies.Methods Ninety-two parent dyads, with a child with SB (ages 8–15 years), were recruited as a part of a longitudinal study. Mothers and fathers completed questionnaires assessing parental perception of child vulnerability (PPCV), as well as medical and demographic information, behavioral aspects of the couple relationship, parenting stress, mental health of the parent, and child behavioral adjustment. The degree to which there was a parenting alliance was assessed with observational data. Mother–father discrepancies were calculated at the item level.Results Findings revealed that greater father mental health symptoms, parenting stress, and child behavior problems were associated with “father high and mother low” discrepancies in PPCV. There were also lower scores on observed parenting alliance when there were higher rates of “father high and mother low” discrepancies in PPCV.Conclusions For families of youth with SB, discrepancies in PPCV where fathers perceive high vulnerability and mothers perceive low vulnerability may be a “red flag” for the presence of other parental and child adjustment difficulties. Findings are discussed in terms of the Attribution Bias Context Model and underscore the importance of including fathers in research on families who have children with chronic health conditions.
A Surge in Pediatric Coronavirus Disease 2019 Cases: The Experience of Texas Children’s Hospital From March to June 2020
Authors: Foster Catherine E , Marquez Lucila , Davis Andrea L , Tocco Elizabeth , Koy Tjin H , Dunn James , Revell Paula A , Arrington Amy S , Campbell Judith R 
Published: December 2020

Abstract

Background
An understanding of the clinical characteristics of children with coronavirus disease 2019 in diverse communities is needed to optimize the response of healthcare providers during this pandemic.

Methods
We performed a retrospective review of all children presenting to the Texas Children’s Hospital system with testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 10, 2020, through June 28, 2020. Demographics were recorded for all patients undergoing testing and clinical characteristics and outcomes were recorded for children with positive tests.

Results
Of 16 554 unique patients ≤ 21 years of age who were tested for SARS-CoV-2, 1215 (7.3%) patients tested positive. Infants under 1 year of age and patients aged 18–21 years had the highest percent of positive tests at 9.9% (230/2329) and 10.7% (79/739), respectively. Hispanic children accounted for 66% (802/1215) of positive tests, though they only represented 42.1% (6972/16 554) of all children tested for SARS-CoV-2. Of the 1215 children with a positive test, 55.7% had fever, 40.9% had cough, 39.8% had congestion or rhinorrhea, 21.9% had gastrointestinal complaints, and 15.9% were asymptomatic. Only 97 (8%) patients were hospitalized (of which 68% were Hispanic). Most of the hospitalized patients had underlying medical conditions (62/97, 63.9%), including obesity. Thirty-one hospitalized patients (31/97, 32%) required respiratory support and 9 patients (9/97, 9.3%) received SARS-CoV-2 antiviral therapy. Two patients died.

Conclusions
A relatively high percentage of Hispanic children tested positive for SARS-CoV-2 and were hospitalized. Most of the children with detection of SARS-CoV-2 had uncomplicated illness courses; some children were critically ill; and 2 patients died.
New X-ray detections of known Wolf–Rayet stars
Authors: Nazé Yaël , Gosset Eric , Marechal Quentin 
Published: December 2020

ABSTRACT
Using XMM–Newton, we undertook a dedicated project to search for X-ray bright wind–wind collisions in 18 WR+OB systems. We complemented these observations with Swift and Chandra data sets, allowing for the study of two additional systems. We also improved the ephemerides, for these systems displaying photometric changes, using TESS, Kepler, and ASAS-SN data. Five systems displayed a very faint X-ray emission (log [LX/LBOL] &lt; −8) and three a faint one (log [LX/LBOL] ∼ −7), incompatible with typical colliding wind emission: not all WR (Wolf–Rayet) binaries are thus X-ray bright. In a few other systems, X-rays from the O-star companion cannot be excluded as being the true source of X-rays (or a large contributor). In two additional cases, the emission appears faint but the observations were taken with the WR wind obscuring the line of sight, which could hide a colliding wind emission. Clear evidence of colliding winds was however found in the remaining six systems (WR 19, 21, 31, 97, 105, and 127). In WR 19, a large absorption and larger emission at periastron are even detected, in line with expectations of adiabatic collisions.
A simple, heuristic derivation of the Balescu-Lenard kinetic equation for stellar systems
Authors: Hamilton Chris 
Published: December 2020

Abstract
The unshielded nature of gravity means that stellar systems are inherently inhomogeneous. As a result, stars do not move in straight lines. This obvious fact severely complicates the kinetic theory of stellar systems because position and velocity turn out to be poor coordinates with which to describe stellar orbits – instead, one must use angle-action variables. Moreover, the slow relaxation of star clusters and galaxies can be enhanced or suppressed by collective interactions (‘polarisation’ effects) involving many stars simultaneously. These collective effects are also present in plasmas; in that case they are accounted for by the Balescu-Lenard (BL) equation, which is a kinetic equation in velocity space. Recently, several authors have shown how to account for both inhomogeneity and collective effects in the kinetic theory of stellar systems by deriving an angle-action generalisation of the BL equation. Unfortunately their derivations are long and complicated, involving multiple coordinate transforms, contour integrals in the complex plane, and so on. On the other hand, Rostoker’s superposition principle allows one to pretend that a long-range interacting N-body system, such as a plasma or star cluster, consists merely of uncorrelated particles that are ‘dressed’ by polarisation clouds. In this paper we use Rostoker’s principle to provide a simple, intuitive derivation of the BL equation for stellar systems which is much shorter than others in the literature. It also allows us to straightforwardly connect the BL picture of self-gravitating kinetics to the classical ‘two-body relaxation’ theory of uncorrelated flybys pioneered by Chandrasekhar.
Multiple positron emission tomography tracers for use in the classification of gliomas according to the 2016 World Health Organization criteria
Authors: Miyake Keisuke , Suzuki Kenta , Ogawa Tomoya , Ogawa Daisuke , Hatakeyama Tetsuhiro , Shinomiya Aya , Kudomi Nobuyuki , Yamamoto Yuka , Nishiyama Yoshihiro , Tamiya Takashi 
Published: December 2020

Abstract

Background
The molecular diagnosis of gliomas such as isocitrate dehydrogenase (IDH) status (wild-type [wt] or mutation [mut]) is especially important in the 2016 World Health Organization (WHO) classification. Positron emission tomography (PET) has afforded molecular and metabolic diagnostic imaging. The present study aimed to define the interrelationship between the 2016 WHO classification of gliomas and the integrated data from PET images using multiple tracers, including 18F-fluorodeoxyglucose (18F-FDG), 11C-methionine (11C-MET), 18F-fluorothymidine (18F-FLT), and 18F-fluoromisonidazole (18F-FMISO).

Methods
This retrospective, single-center study comprised 113 patients with newly diagnosed glioma based on the 2016 WHO criteria. Patients were divided into 4 glioma subtypes (Mut, Codel, Wt, and glioblastoma multiforme [GBM]). Tumor standardized uptake value (SUV) divided by mean normal cortical SUV (tumor–normal tissue ratio [TNR]) was calculated for 18F-FDG, 11C-MET, and 18F-FLT. Tumor–blood SUV ratio (TBR) was calculated for 18F-FMISO. To assess the diagnostic accuracy of PET tracers in distinguishing glioma subtypes, a comparative analysis of TNRs and TBR as well as the metabolic tumor volume (MTV) were calculated by Scheffe's multiple comparison procedure for each PET tracer following the Kruskal–Wallis test.

Results
The differences in mean 18F-FLT TNR and 18F-FMISO TBR were significant between GBM and other glioma subtypes (P &lt; .001). Regarding the comparison between Gd-T1WI volumes and 18F-FLT MTVs or 18F-FMISO MTVs, we identified significant differences between Wt and Mut or Codel (P &lt; .01).

Conclusion
Combined administration of 4 PET tracers might aid in the preoperative differential diagnosis of gliomas according to the 2016 WHO criteria.
The mutational landscape of spinal chordomas and their sensitive detection using circulating tumor DNA
Authors: Mattox Austin K , Yang Beibei , Douville Christopher , Lo Sheng-fu , Sciubba Daniel , Wolinsky Jean Paul , Gokaslan Ziya L , Robison Jamie , Blair Cherie , Jiao Yuchen , Bettegowda Chetan 
Published: December 2020

Abstract

Background
Chordomas are the most common primary spinal column malignancy in the United States. The aim of this study was to determine whether chordomas may be detected by evaluating mutations in circulating tumor DNA (ctDNA).

Methods
Thirty-two patients with a biopsy-confirmed diagnosis of chordoma had blood drawn pre-operatively and/or at follow-up appointments. Mutations in the primary tumor were identified by whole exome sequencing and liquid biopsy by ddPCR and/or RACE-Seq was used to detect one or more of these mutations in plasma ctDNA at concurrent or later time points.

Results
At the time of initial blood draw, 87.1% of patients were ctDNA positive (P &lt;.001). Follow-up blood draws in twenty of the patients suggest that ctDNA levels may reflect the clinical status of the disease. Patients with positive ctDNA levels were more likely to have greater mutant allele frequencies in their primary tumors (P = .004) and undergo radiotherapy (P = .02), and the presence of ctDNA may correlate with response to systemic chemotherapy and/or disease recurrence.

Conclusions
Detection of ctDNA mutations may allow for the detection and monitoring of disease progression for chordomas.
Decompression of a Dorsal Arachnoid Web of the Spine: 2-Dimensional Operative Video
Authors: Andrews John P , Chan Andrew K , Mummaneni Praveen V 
Published: December 2020

Abstract
Arachnoid webs of the spine are a relatively rare entity with unique radiological findings, most notably the scalpel-sign on sagittal magnetic resonance imaging (MRI).
1-4
To date there have been no videographic descriptions of the surgical treatment for this clinical entity. We present the case of a patient with progressive myelopathy and MRI showing a cervical and thoracic syrinx with a sharp transition point at the level of the T5 vertebral body. On computed tomography myelogram, there was preserved cerebrospinal fluid (CSF) in the ventral subarachnoid space—this space is often interrupted in ventral cord herniation, and preserved in dorsal arachnoid webs.
5
A laminectomy with intradural excision of arachnoid web was offered and the patient consented for the procedure. Preoperatively, a fiducial screw was placed at T5. A T4-6 laminectomy was performed. A clearly compressive arachnoid web was encountered on exposure. Bands were dissected under an operating microscope, restoring normal CSF flow. Ventral dural defect was ruled out by passing a delicot beneath the cord and withdrawing it on the contralateral side. The patient did well and has shown improvement in myelopathic symptoms at 1- and 3-mo follow-up. Arachnoid webs of the spine can be treated effectively with a prudent, stepwise approach, and careful microsurgical technique. The neurosurgeon should consult closely with their neuroradiology colleagues to rule out other entities prior to the operation, such as ventral cord herniations, which can mimic dorsal arachnoid webs radiologically and clinically. We have received informed consent of the patient to submit this video.