bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mycoplasma genitalium Infection Is Not Associated With Genital Tract Inflammation Among Adolescent and Young Adult Women in Baltimore, Maryland
Authors: Wang Runzhi , Trent Maria E. , Bream Jay H. , Nilles Tricia L. , Gaydos Charlotte A. , Carson Kathryn A. , Coleman Jenell S. 
Published: July 2021

Background

Mycoplasma genitalium (MG) is a prevalent sexually transmitted infection, but little is known about the associated inflammatory signatures in the genital tract of adolescents and young adult women.

Methods
Adolescents and young adult women aged 13 to 24 years were recruited. Demographic information, sexual behavior history, and medical history were collected. Vaginal swab samples were tested for MG, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis, and measurement of 13 cytokines, chemokines, and antimicrobial proteins. Vaginal cytokine concentrations were compared by MG infection status. The strength of associations between multiple factors and MG infection was evaluated.

Results
Of 215 participants, 16.7% (95% confidence interval [CI], 12.0%–22.4%) had MG infection. Inflammation was not associated with MG infection (P > 0.05). M. genitalium infection was associated with C. trachomatis infection (adjusted prevalence ratio [aPrR], 3.02; 95% CI, 1.69–5.39), bisexual behavior in the past 3 months (aPrR, 2.07; 95% CI, 1.18–3.64), genitourinary symptoms (aPrR, 2.06; 95% CI, 1.22–3.49), and self-reported Black race (aPrR, 3.53; 95% CI, 1.11–11.18).

Conclusions
Higher levels of genital tract cytokines were not associated with MG infection. C. trachomatis infection, bisexual behavior, self-reported Black race, and genitourinary symptoms were associated with an increased likelihood of MG infection.
Increased infectious-cause hospitalization among infants who are HIV-exposed uninfected compared with HIV-unexposed
Authors: Anderson Kim , Kalk Emma , Madlala Hlengiwe P. , Nyemba Dorothy C. , Kassanjee Reshma , Jacob Nisha , Slogrove Amy , Smith Mariette , Eley Brian S. , Cotton Mark F. , Muloiwa Rudzani , Spittal Graeme , Kroon Max , Boulle Andrew , Myer Landon , Davies Mary-Ann 
Published: July 2021

Objectives:
Increased risk of morbidity and hospitalization has been observed in children who are HIV-exposed uninfected (HEU) compared with HIV-unexposed uninfected (HUU). Studies in the era of universal maternal antiretroviral treatment (ART) are limited.

Design:
Prospective cohort.

Methods:
We investigated hospitalization between 29 days and 12 months of life in a South African cohort of infants born between February 2017 and January 2019 (HEU = 455; HUU = 458). All mothers known with HIV during pregnancy received ART. We reviewed hospital records and classified and graded infectious diagnoses using a standardized tool. We examined factors associated with infectious-cause hospitalization using mixed-effects Poisson regression.

Results:
Infants HEU vs. HUU had higher all-cause and infectious-cause hospitalization (13 vs. 7%, P = 0.004 and 10 vs. 6%, P = 0.014, respectively). Infectious causes accounted for most hospitalizations (77%). More infants HEU were hospitalized with severe or very severe infections than those HUU (9 vs. 6%; P = 0.031). Mortality (<1%) did not differ between groups. HIV exposure was a significant risk factor for infectious-cause hospitalization [adjusted incidence rate ratios (aIRRs) = 2.8; 95% confidence interval (CI) 1.5–5.4]. Although increased incidence of preterm birth (14 vs. 10%; P < 0.05) and shorter duration of breastfeeding (44 vs. 68% breastfed for ≥3 months, P < 0.001) among infants HEU vs. HUU contributed to increased hospitalization, they did not account for all the increased risk.

Conclusion:
Infectious-cause hospitalization incidence was higher among infants HEU vs. HUU, likely partly because of higher incidence of preterm birth and lower breastfeeding rates among infants HEU. The increased infectious disease burden in HEU infants has important implications for health services in sub-Saharan Africa.
Low-Density Granulocytes and Neutrophil Extracellular Traps as Biomarkers of Disease Activity in Adult Inflammatory Myopathies
Authors: Torres-Ruiz Jiram , Carrillo-Vázquez Daniel Alberto , Leal-Alanis Araceli , Zentella-Dehesa Alejandro , Tapia-Rodríguez Miguel , Maravillas-Montero Jose Luis , Nuñez-Álvarez Carlos Alberto , Carazo-Vargas Edgar Rafael , Romero-Hernández Izamar , Juárez-Vega Guillermo , Alcocer-Varela Jorge , Gómez-Martín Diana 
Published: July 2021

Background/Objective
Biomarkers for disease activity and damage accrual in idiopathic inflammatory myopathies (IIMs) are currently lacking. The purpose of this cross-sectional study is to analyze the relationship among low-density granulocytes (LDGs), neutrophil extracellular traps (NETs), and clinical and immunological features of patients with IIM.

Methods
We assessed disease activity, damage accrual, amount of LDGs, NETs, expression of LL-37, and serum cytokines in 65 adult patients with IIM. Differences between groups and correlations were assessed by Kruskal-Wallis, Mann-Whitney U, and Spearman ρ tests. The association between LDGs, NETs, disease activity, calcinosis, and cutaneous ulcers was assessed by logistic regression. To address the capacity of LDGs and NETs to diagnose disease activity, we used receiving operating characteristic curves.

Results
Low-density granulocytes were higher in patients with active disease, ulcers, calcinosis, and anti–MDA5 antibodies, which correlated with serum levels of IL-17A and IL-18. Neutrophil extracellular traps were higher in patients with calcinosis, elevated titers of antinuclear antibodies, and positive anti-PM/Scl75 tests. The combination of a high proportion of both total LDGs and NETs was associated with the presence of calcinosis and cutaneous ulcers. LL-37 was higher in NETs originating from LDGs. Normal-density neutrophils were elevated in patients with active dermatomyositis.

Conclusions
Low-density granulocytes and NETs containing LL-37 are increased in patients with IIM and active disease, and correlate with proinflammatory cytokines. Both total and CD10+ LDGs are potential biomarkers for disease activity and, in combination with NETs, have the potential to detect patients who are at risk for cutaneous ulcers and calcinosis.
Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: A Latent Class Analysis
Authors: Hemady Chad Lance , Speyer Lydia Gabriela , Murray Aja Louise , Brown Ruth Harriet , Meinck Franziska , Fry Deborah , Do Huyen , Sikander Siham , Madrid Bernadette , Fernando Asvini , Walker Susan , Dunne Michael , Foley Sarah , Hughes Claire , Osafo Joseph , Baban Adriana , Taut Diana , Ward Catherine L. , Thang Vo Van , Fearon Pasco , Tomlinson Mark , Valdebenito Sara , Eisner Manuel 
Published: July 2021

AbstractAims This paper explores the number and characterization of latent classes of adverse childhood experiences across the Evidence for Better Lives Study cohort and investigates how the various typologies link to prenatal substance use (i.e., smoking, alcohol, and illicit drugs) and poor infant outcomes (i.e., infant prematurity and low birth weight). Participants and setting A total of 1,189 mother-infant dyads residing in eight diverse low- and middle-income countries (LMICs) were recruited. Methods Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions with distal outcomes were performed. Results The LCA identified three high-risk classes and one low-risk class, namely: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Overall, across all latent classes, there were low probabilities of prenatal substance use and poor infant outcomes. However, pairwise comparisons between classes indicate that class 1 and 3 had higher probabilities of prenatal illicit drug use compared to class 4. Additionally, class 2 had higher probability of low birth weight compared to the three remaining classes. Conclusion The results further our understanding of the dynamic and multifaceted nature of ACEs. More research grounded on LMICs is warranted with more attention to various parameters of risk exposure (i.e., severity, duration, chronicity).
Assessing the Effects of Behavioral Circadian Rhythm Disruption in Shift-Working Police Academy Trainees
Authors: Erickson Melissa L. , Wang Will , Counts Julie , Redman Leanne M. , Parker Daniel , Huebner Janet L. , Dunn Jessilyn , Kraus William E. 
Published: July 2021

ABSTRACTNight shift work, characterized by behavioral circadian disruption, increases cardiometabolic disease risk. Our long-term goal is to develop a novel methodology to quantify behavioral circadian disruption in field-based settings and to explore relations to four metabolic salivary biomarkers of circadian rhythm. This pilot study enrolled 36 police academy trainees to test the feasibility of using wearable activity trackers to assess changes in behavioral patterns. Using a two-group observational study design, participants completed in-class training during dayshift for six weeks followed by either dayshift or nightshift field-training for six weeks. We developed a novel data-post processing step that improves sleep detection accuracy of sleep episodes that occur during daytime. We next assessed changes to resting heart rate (RHR) and sleep regularity index (SRI) during dayshift versus nightshift field training. Secondarily, we examined changes in field-based assessments of salivary cortisol, uric acid, testosterone, and melatonin during dayshift versus nightshift. Compared to dayshift, nightshift workers experienced larger changes to resting heart rate, sleep regularity index (indicating reduced sleep regularity), and alternations to sleep/wake activity patterns accompanied by blunted salivary cortisol. Salivary uric acid, testosterone, and melatonin did not change. These findings show that nightshift work—a form of behavioral circadian rhythm disruption—was detectable in police trainees using activity trackers alone and in combination with a specialized data analysis methodology.KEY POINTSNight shift work increases cardiometabolic disease risk and this may be a consequence of behavioral circadian misalignment.To advance this hypothesis, methodologies to quantify behavioral irregularities during nightshift in field-based settings are needed.In this pilot study, commercially available activity trackers combined with a novel data processing step were used to assess alterations in sleep/wake patterns in police trainees during dayshift versus nightshift.We also explored relations with four metabolic salivary biomarkers of circadian rhythm during dayshift versus nightshift.Compared to dayshift, nightshift resulted in larger perturbations of resting heart rate, sleep regularity index (indicating reduced regularity), and alterations in sleep and activity patterns; this was accompanied by blunted cortisol.This novel data processing step extends commercially available technology for successful application in real-world shift work settings.
Machine Learning Applied to Routine Blood Tests and Clinical Metadata to Identify and Classify Heart failure
Authors: James Nick , Gerrish Lianna , Rokotyan Nikita , Gladding Patrick A. 
Published: July 2021

AbstractIntroductionWe applied machine learning (ML) to routine bloods, then to advanced haematology data from a full blood count (rawFBC) plus biochemistry, to build predictive models for heart failure, which were then used at population scale.MethodsRoutine blood results from 8,031 patients with heart failure, with equal number of controls, were used in ML training and testing datasets (Split 80:20). NT-proBNP was used for diagnostic comparison. rawFBC metadata was used in a dataset of 698 patients, 314 of whom had heart failure, to train and test ML models (Split 70:30) from rawFBC, rawFBC plus biochemistry and routine bloods. The rawFBC model was used to predict heart failure in a validation dataset of 69,492 FBCs (2.3% heart failure prevalence).ResultsHeart failure was predicted from rawFBC and biochemistry versus rawFBC AUROC 0.93 versus 0.91, 95% CI -0.023 to 0.048, P = 0.5, and predicted from routine bloods and NT-proBNP, AUROC 0.87 versus 0.81, 95% CI 0.004 to 0.097, P = 0.03. In the validation cohort heart failure was predicted from rawFBC with AUROC 0.83, 95% CI 0.83 to 0.84, P < 0.001, sensitivity 75%, specificity 76%, PPV 7%, NPV 99.2% (Figure 2). Elevated NT-proBNP (≥ 34 pmol/L) was predicted from rawFBC with AUROC 0.97, 95% CI 0.93 to 0.99, P < 0.0001. Common predictive features included markers of erythropoiesis (red cell distribution width, haemoglobin, haematocrit).ConclusionHeart failure can be predicted from routine bloods with accuracy equivalent to NT-proBNP. Predictive features included markers of erythropoiesis, with therapeutic monitoring implications.
Prognostic accuracy of triage tools for adults with suspected COVID-19 in a pre-hospital setting: an observational cohort study
Authors: Marincowitz Carl , Sutton Laura , Stone Tony , Pilbery Richard , Campbell Richard , Thomas Benjamin , Turner Janette , Bath Peter A. , Bell Fiona , Biggs Katie , Hasan Madina , Hopfgartner Frank , Mazumdar Suvodeep , Petrie Jennifer , Goodacre Steve 
Published: July 2021

AbstractStudy ObjectiveTools proposed to triage patient acuity in COVID-19 infection have only been validated in hospital populations. We estimated the accuracy of five risk-stratification tools recommended to predict severe illness and compare accuracy to existing clinical decision-making in a pre-hospital setting.MethodsAn observational cohort study using linked ambulance service data for patients attended by EMS crews in the Yorkshire and Humber region of England between 18th March 2020 and 29th June 2020 was conducted to assess performance of the PRIEST tool, NEWS2, the WHO algorithm, CRB-65 and PMEWS in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support.ResultsOf 7549 patients in our cohort, 17.6% (95% CI:16.8% to 18.5%) experienced the primary outcome. The NEWS2, PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes with a high sensitivity (>0.95) and specificity ranging from 0.3 (NEWS2) to 0.41 (PRIEST tool). The high sensitivity of NEWS2 and PMEWS was achieved by using lower thresholds than previously recommended. On index assessment, 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84 (95% CI 0.83 to 0.85) and specificity of 0.39 (95% CI 0.39 to 0.40).ConclusionUse of NEWS2, PMEWS, PRIEST tool and WHO algorithm could improve sensitivity of EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool would improve sensitivity of triage without increasing the number of patients conveyed to hospital.
Excess morbidity and mortality among survivors of childhood acute lymphoblastic leukaemia: 25 years of follow-up from the United Kingdom Childhood Cancer Study (UKCCS)
Authors: Kane Eleanor , Kinsey Sally , Bonaventure Audrey , Johnston Tom , Simpson Jill , Howell Debra , Smith Alexandra , Roman Eve 
Published: July 2021

AbstractObjectivesTo examine morbidity and mortality in survivors of childhood acute lymphoblastic leukaemia (ALL) across their teenage and young adult (TYA) years; comparing the patterns observed with individually matched general population controls.DesignCase-control study with follow-up linkage to administrative healthcare databases for up to 25 years.SettingThe study population comprises all children (0-14 years) registered for primary care with the National Health Service (NHS) in England 1992-1996.Participants1082 five-year survivors of ALL diagnosed <15 years of age, and 2018 age- and sex-matched population-based controls; followed to 15 March 2020.Main outcome measuresAssociations with hospital activity, cancer, and mortality were assessed using incidence rate ratios and absolute risk difference.ResultsMortality 5-25 years after diagnosis was 20 times higher in cases than controls (Rate Ratio 21.3, 95% Confidence Interval 11.2-45.6), and cancer incidence 10 time higher (IRR 9.9 95% CI 4.1-29.1). Hospital activity was increased for many clinical specialties, the strongest effects being for endocrinology; outpatient IRR 36.7, 95% CI 17.3-93.4 and inpatient 19.7, 95% CI 1.9-25.5 for males, and 11.0, 95% CI 6.2-21.1 and 6.2 95% CI 3.1-13.5 respectively for females. Notable excesses were also evident for cardiology, neurology, ophthalmology, respiratory medicine and general medicine. Males were also more likely to attend gastroenterology, ENT (ear, nose and throat), urology, and dermatology; while females were more likely to be seen in plastic surgery and less likely in midwifery.ConclusionsAdding to a large excess risk of death and cancer, survivors of childhood ALL experience excess outpatient and inpatient activity across their TYA years. Involving most clinical specialties, the observed effects are striking, showing no signs of diminishing over the first 25 years of follow-up. These findings underscore the need to take prior ALL drug and/or radiation treatment into account when interpreting seemingly unrelated symptoms in later life.
Science in School: Transforming K-12 Outreach through Scientist Teacher Partnerships
Authors: Abramowitz Brian , Ennes Megan , Killingsworth Stephanie , Antonenko Pavlo , MacFadden Bruce , Ivory Alan 
Published: July 2021

AbstractThe Scientist in Every Florida School (SEFS) program was started in 2019 with a long-term vision to connect Earth systems scientists with public K-12 schools in Florida and therefore create long-term scientist-teacher partnerships. SEFS fulfills personalized requests to create meaningful and impactful interactions to support teacher pedagogy and student learning. We have as part of our mission a focus on mainstream public schools, and in particular, those that are Title I. We also are committed to working with at-risk teachers. The major components of our program include the scientist-teacher partnerships, focused professional development workshops on Florida’s Earth systems (air, water, land, and life), classroom visits, and other web-based activities. Although still only in its first few years, the project and its more than 600 scientists have a wide reach with over 850 teachers and 53,000 students participating in our programs, which were delivered virtually in the 2020-2021 school year covering about 60% of Florida’s 67 counties. In this article, we describe our programmatic features as well as recommendations for those who could implement similar programs.
Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: From Key Lessons to a Framework for Implementation
Authors: Li Edmond , Tsopra Rosy , Gimenez Geronimo Larrain , Serafini Alice , Gusso Gustavo , Lingner Heidrun , Fernandez Maria Jose , Irving Greg , Petek Davorina , Hoffman Robert , Lazic Vanja , Ensieh Memarian , Koskela Tuomas , Collins Claire , Espitia Sandra Milena , Clavería Ana , Nessler Katarzyna , O’Neill Braden Gregory , Hoedebecke Kyle , Ungan Mehmet , Laranjo Liliana , Ghafur Saira , Fontana Gianluca , Majeed Azeem , Car Josip , Darzi Ara , Neves Ana Luisa 
Published: July 2021

AbstractBackgroundWith the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems.ObjectiveWe explored GPs’ perspectives on the main benefits and challenges of using digital remote care.MethodsGPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data.Results1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and the accompanying legal frameworks.Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses.ConclusionAt the frontline of care delivery, GPs can provide important insights on what worked well, why, and how. Lessons learned during the emergency phase can be used to inform the stable adoption of virtual care solutions, and co-design processes and platforms that are technologically robust, secure, and supported by a strategic long-term plan.
Genomic epidemiologic assessment implicates prolonged silent carriage, virulence factors and transmission between staff and patients in a NICU outbreak of MRSA
Authors: Madera Sharline , McNeil Nicole , Serpa Paula Hayakawa , Kamm Jack , Pak Christy , Caughell Carolyn , Nichols Amy , Dynerman David , Li Lucy M. , Sanchez-Guerrero Estella , Phelps Maira , Detweiler Angela M. , Neff Norma , Reyes Helen , Miller Steve , Yokoe Deborah , DeRisi Joseph L. , Ramirez-Avila Lynn , Langelier Charles R. 
Published: July 2021

ABSTRACTIntroductionMethicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in neonatal intensive care units (NICU) that carries significant morbidity and mortality. Improving our understanding of MRSA transmission dynamics, especially among high risk patients, is an infection prevention priority.MethodsWe investigated a cluster of clinical MRSA cases in the NICU using a combination of epidemiologic review and whole genome sequencing (WGS) of isolates from clinical and surveillance cultures obtained from patients and healthcare personnel (HCP).ResultsPhylogenetic analysis identified two genetically distinct phylogenetic clades and revealed multiple silent transmission events between HCP and infants. The predominant outbreak strain harbored multiple virulence factors. Epidemiologic investigation and genomic analysis identified a HCP colonized with the dominant MRSA outbreak strain who cared for the majority of NICU patients who were infected or colonized with the same strain, including one NICU patient with severe infection seven months before the described outbreak. These results guided implementation of infection prevention interventions that prevented further transmission events.ConclusionSilent transmission of MRSA between HCP and NICU patients likely contributed to a NICU outbreak involving a virulent MRSA strain. WGS enabled data-driven decision making to inform implementation of infection control policies that mitigated the outbreak. Prospective WGS coupled with epidemiologic analysis can be used to detect transmission events and prompt early implementation of control strategies.SummaryWhole genome sequencing identified a NICU outbreak of MRSA preceded by silent transmission between health care personnel and patients seven months prior to outbreak detection. This study suggests prospective genomic analysis may identify isolates with high virulence potential, offering an early opportunity for intervention.