bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Diagnostic Paradigm for Group A and Non–Group A Streptococcal Pharyngitis in the College Student Population
Authors: Rich Shannan N , Prosperi Mattia , Klann Emily M , Codreanu Pavel T , Cook Robert L , Turley Melissa K 
Published: November 2021

Abstract

Background
Acute pharyngitis is a frequent illness presenting in outpatient settings. Antibiotics are only recommended for bacterial pharyngitis caused by group A β-hemolytic streptococci (GAS); however, infections with non–group A β-hemolytic streptococci (NGAS) have similar clinical presentations and are common in young adult populations. The objective of this study was to analyze the performance of a current (expert) diagnostic algorithm for GAS pharyngitis, the Centor score, and compare it to alternative models developed to predict GAS and NGAS in a college student population.

Methods
Electronic health records were obtained for all patients who received a streptococcal rapid antigen detection test (RADT) and/or a bacterial throat culture (n = 3963) at a southeastern US university in 2014. Bivariate and multivariable regression models (least absolute shrinkage and selection operator [LASSO] and stepwise-selected) were fitted to assess and compare their diagnostic performances for GAS-positive and NGAS-positive infections.

Results
Prevalence of GAS was 18.8%. In the subset of RADT-negative patients who received bacterial throat cultures (n = 313), growth of NGAS occurred in 34.8%, with group C streptococci the most frequent isolate. Mean Centor score was higher for NGAS (3.2) vs GAS (2.9) infections (P = .0111). The area under the curve (AUC) for GAS prediction was 0.64 using the Centor score and 0.70 using the LASSO model. For NGAS, the most important features were cough, pharyngeal erythema, tonsillar exudate, and gastrointestinal symptoms (AUC = 0.63).

Conclusions
GAS and NGAS pharyngitis were indistinguishable among college students in this study utilizing a commonly applied decision score. Alternative models using additional clinical criteria may be useful for supporting diagnosis of this common illness.
Bloodstream Infection Following Cardiac Valve Repair: A Population-Based Study
Authors: McHugh Jack W , Talha Khawaja M , Baddour Larry M , Fischer Karen M , Crestanello Juan , Arghami Arman , DeSimone Daniel C 
Published: November 2021

Abstract

Background
The aim of this study was to determine the incidence, epidemiology, and associated risk factors of bloodstream infection (BSI) in patients who had previously undergone cardiac valve repair.

Methods
A population-based study that included 7 counties in southeastern Minnesota using the expanded Rochester Epidemiology Project (e-REP) for adults (≥18 years) who underwent valve repair between 1 January 2010 and 31 December 2018 was conducted. Electronic health records were screened for development of BSI and infective endocarditis (IE) from the date of valve repair through 30 July 2020. A 1:4 nested case-control analysis was performed to determine an association, if any, of male sex, Charlson comorbidity index (CCI), and county of residence with BSI.

Results
A total of 335 patients underwent valve repair, of whom 28 (8.3%) developed an index case of BSI, with 14 episodes occurring within 1 year of surgery. The median age of patients with BSI was 70 years, and 79% were male. The crude incidence of BSI was 1671 cases per 100000 person-years and Escherichia coli was the most common pathogen. Case-control analysis demonstrated a significant correlation between CCI and incidence of BSI (P &lt; .001). Only 4 (14.3%) patients developed IE concurrent with the onset of BSI, and no patients developed IE subsequent to BSI.

Conclusions
The crude incidence of BSI following valve repair was higher in our e-REP cohort than previous population-based studies, and half of the BSI cases occurred within 1 year of surgery. Patients with a higher CCI at baseline were at increased risk of subsequent BSI.
PfEMP1-Specific Immunoglobulin G Reactivity Among Beninese Pregnant Women With Sickle Cell Trait
Authors: Lopez-Perez Mary , Viwami Firmine , Seidu Zakaria , Jensen Anja T R , Doritchamou Justin , Ndam Nicaise Tuikue , Hviid Lars 
Published: November 2021

Abstract

Background
Sickle cell trait (HbAS) protects against severe Plasmodium falciparum malaria but not against placental malaria (PM). In this study, P falciparum erythrocyte membrane protein (PfEMP1)-specific antibodies were measured in HbAA and HbAS Beninese pregnant women as a proxy of exposure to specific PfEMP1 variants.

Methods
Plasma samples collected at delivery from 338 HbAA and 63 HbAS women were used to measure immunoglobulin (Ig)G levels to 6 recombinant PfEMP1 proteins and 3 corresponding native proteins expressed on the infected erythrocyte (IE) surface. Immunoglobulin G-mediated inhibition of VAR2CSA+ IEs adhesion to chondroitin sulfate A (CSA) was also tested.

Results
Levels of PfEMP1-specific IgG were similar in the 2 groups, except for native IT4VAR09 on IEs, where IgG levels were significantly higher in HbAS women. Adjusted odds ratios for women with positive IgG to HB3VAR06 and PFD1235w suggest a lower risk of infection with these virulent variants among HbAS individuals. The percentage of IEs binding to CSA did not differ between HbAA and HbAS women, but it correlated positively with levels of anti-VAR2CSA and parity. Women with PM had lower levels of anti-VAR2CSA-specific IgG and lower IgG-mediated inhibition of IE adhesion to CSA.

Conclusions
The findings support similar malaria exposure in HbAA and HbAS women and a lack of HbAS-dependent protection against placental infection among pregnant women.
Extensively Drug-Resistant Typhoid Fever in the United States
Authors: Hughes Michael J , Birhane Meseret G , Dorough Layne , Reynolds Jared L , Caidi Hayat , Tagg Kaitlin A , Snyder Caroline M , Yu Alexander T , Altman Shana M , Boyle Michelle M , Thomas Deepam , Robbins Amy E , Waechter HaeNa A , Cody Irina , Mintz Eric D , Gutelius Bruce , Langley Gayle , Francois Watkins Louise K 
Published: November 2021

Abstract
Cases of extensively drug-resistant (XDR) typhoid fever have been reported in the United States among patients who did not travel internationally. Clinicians should consider if and where the patient traveled when selecting empiric treatment for typhoid fever. XDR typhoid fever should be treated with a carbapenem, azithromycin, or both.
The EU–UK Trade and Cooperation Agreement: lessons learnt
Authors: Bennett Adam , Vines David 
Published: November 2021

Abstract
This paper analyses the Trade and Cooperation Agreement (TCA) between the EU and the UK. We focus on two specific features: rules of origin and non-tariff barriers. The putative purpose of the TCA was to promote free trade between the signatories, and both of the features identified have ‘level-playing-field’ objectives which are designed to promote that purpose. However, both can also be used for covert protectionism against the other party to the agreement. The paper recommends that rules of origin and non-tariff barriers should be recrafted where possible, and there is a description of how this might be done. The aim of such action would be to make transparent the role of these features in preserving a level playing field. Doing this would also make clear that any residual unadulterated rules of origin and non-tariff barriers existed for purely protectionist reasons and jeopardized open borders. Hopefully, the exposure of such protectionism would encourage its dismantlement.
Cis-regulatory sequences in plants: Their importance, discovery, and future challenges
Authors: Schmitz Robert J , Grotewold Erich , Stam Maike 
Published: November 2021

Abstract
The identification and characterization of cis-regulatory DNA sequences and how they function to coordinate responses to developmental and environmental cues is of paramount importance to plant biology. Key to these regulatory processes are cis-regulatory modules (CRMs), which include enhancers and silencers. Despite the extraordinary advances in high-quality sequence assemblies and genome annotations, the identification and understanding of CRMs, and how they regulate gene expression, lag significantly behind. This is especially true for their distinguishing characteristics and activity states. Here, we review the current knowledge on CRMs and breakthrough technologies enabling identification, characterization, and validation of CRMs; we compare the genomic distributions of CRMs with respect to their target genes between different plant species, and discuss the role of transposable elements harboring CRMs in the evolution of gene expression. This is an exciting time to study cis-regulomes in plants; however, significant existing challenges need to be overcome to fully understand and appreciate the role of CRMs in plant biology and in crop improvement.
Intra-Articular Platelet Rich Plasma vs Corticosteroid Injections for Sacroiliac Joint Pain: A Double-Blinded, Randomized Clinical Trial
Authors: Chen Allen S , Solberg Joseph , Smith Clark , Chi Michelle , Lowder Ryan , Christolias George , Singh Jaspal Ricky 
Published: November 2021

Abstract

Objective
Using stringent inclusion criteria, a double-blinded study protocol, and fluoroscopically guided injections, we compare intra-articular sacroiliac joint platelet-rich plasma injections with intra-articular steroids.

Design
Double-blind, randomized controlled trial.

Setting
Two large university-based interdisciplinary spine centers.

Subjects
A total of 26 patients with a positive diagnostic block (&gt;80% relief).

Methods
Subjects who had a positive diagnostic block were randomized to undergo either a fluoroscopically guided intra-articular injection of steroid or a platelet-rich plasma injection. Follow-up was at 1 month, 3 months, and 6 months. Outcomes included level of pain, as indicated on a 0- to 100-mm numeric pain rating scale, and functional disability score, obtained via the Oswestry Disability Index (ODI).

Results
At 1, 3, and 6 months, both groups improved; however, subjects who received steroid injections reported lower pain scores than did subjects who received platelet-rich plasma. Using categorical data, we observed significantly more responders (defined as pain scores that improved by 50% or more from baseline) at 1 and 3 months in the group who received steroids than in the group who received platelet-rich plasma.

Conclusion
Although both groups showed improvements in pain and function, the steroid group had significantly greater response and significantly more responders than did the platelet-rich plasma group.
A systematic review exploring pre-COVID-19 telehealthcare models used in the management of patients with rheumatological disease
Authors: Nelson Alexandra Jayne , Anderson Marina Ellen 
Published: November 2021

AbstractObjectiveThe aim was to assess the use of telehealthcare in rheumatology before coronavirus disease 2019 (COVID-19), to which future comparisons of newer interventions adapted during the crisis can be made.MethodsWe performed a registered systematic literature search using MEDLINE, EMBASE, CENTRAL and PubMed databases. All full-length articles comparing telehealthcare delivery models with standard care (face-to-face consultation) in the management of patients with rheumatic conditions were assessed for inclusion.ResultsA total of 4809 studies were identified; 108 studies were suitable for review by full text, and 13 studies were appropriate to be included in this review. Five studies (38%) included patients with RA, four studies (31%) included patients with mixed disease cohorts, two studies (15%) included patients with OA, one study (8%) included patients with JIA, and one study (8%) included patients with FM. Six studies (46%) used telephone consultation, three studies (23%) used mixed method communication, three studies (23%) used videoconferencing, and one study (8%) used website-delivered telecommunication as their method of telehealthcare delivery. Overall, seven studies (54%) identified the telehealthcare intervention to be an effective method of consultation, and six studies (46%) identified the telehealthcare intervention as non-inferior when compared with standard care.ConclusionCurrent evidence for telehealthcare in rheumatology is lacking, and the evidence for effectiveness is limited by methodological bias and clinical heterogeneity of telehealthcare interventions, preventing definitive inferences. Scrutinous assessment of the current telehealthcare interventions used during COVID-19 is required to accommodate recommendations and guideline reviews directed from international working groups.
Understanding flare in axial spondyloarthritis: novel insights from daily self-reported flare experience
Authors: Barnett Rosemarie , Ng Stanley , Sengupta Raj 
Published: November 2021

Abstract

Objectives
Our objective was to explore daily self-reported experiences of axial SpA (axSpA) flare based on data entered into the Project Nightingale smartphone app (www.projectnightingale.org), between 5 April 2018 and 1 April 2020.

Methods
Paired t-tests were conducted for mean_flare_on and mean_flare_off scores for each recorded variable. The mean estimated difference between flare and non-flare values for each variable was calculated with 95% CIs. Mean, S.d. and range were reported for flare duration and frequency. Participants with ≥10 days of data entry were included for affinity propagation cluster analysis. Baseline characteristics and mean flare on vs mean flare off values were reported for each cluster. Welch’s t-test was used to assess differences between clusters.

Results
A total of 143/189 (75.7%) participants recorded at least one flare. Each flare lasted a mean of 4.30 days (S.d. 6.82, range 1–78), with a mean frequency of once every 35.32 days (S.d. 65.73, range 1–677). Significant relationships were identified between flare status and variable scores. Two clusters of participants were identified with distinct flare profiles. Group 1 experienced less severe worsening of symptoms during flare in comparison to group 2 (P &lt; 0.01). However, they experienced significantly longer flare duration (7.2 vs 3.5 days; P &lt; 0.01), perhaps indicating a prolonged, yet less intense flare experience. Groups were similar in terms of flare frequency and clinical characteristics.

Conclusions
Two clusters of participants were identified with distinct flare experiences but similar baseline clinical characteristics. Smartphone technologies capture subtle changes in disease experience not currently considered in clinical practice.
Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-naïve early psoriatic arthritis
Authors: Dubash Sayam R , Alabas Oras A , Michelena Xabier , Garcia-Montoya Leticia , De Marco Gabriele , Merashli Mira , Wakefield Richard J , Emery Paul , McGonagle Dennis , Tan Ai Lyn , Marzo-Ortega Helena 
Published: November 2021

Abstract

Objective
To evaluate the relationship between clinical examination/US synovitis in DMARD-naïve early PsA.

Methods
Eligible patients underwent matched clinical/US 44-joint assessment for tender and/or swollen joints (TJ/SJ) and US synovitis [grey scale (GS) ≥ 2 or power Doppler (PD) ≥ 1]. Statistical agreement between TJ/SJ, GS ≥ 2 and PD ≥ 1 was calculated by prevalence-adjusted and bias-adjusted κ (PABAK). To derive probabilities of GS ≥ 2/PD ≥ 1, mixed-effects logistic regression-modelled odds of US synovitis in TJ/SJ were conducted.

Results
In 155 patients, 5616 joints underwent clinical/US examination. Of these joints, 1039 of 5616 (18.5%) were tender, 550 of 5616 (9.8%) were swollen, 1144 of 5616 (20.4%) had GS ≥ 2, and 292 of 5616 (5.2%) had PD ≥ 1. GS ≥ 2 was most prevalent in concomitantly tender and swollen joints [205 of 462 (44%)], followed by swollen non-tender joints [32 of 88 (36.4%)], tender non-swollen joints [148 of 577 (25.7%)] and non-tender non-swollen joints (subclinical synovitis) [759 of 4489 (16.9%)]. Agreement between SJ/PD ≥ 1 was high at the individual joint level (82.6–96.3%, PABAK 0.65–0.93) and for total joints combined (89.9%, PABAK 0.80). SJ/GS ≥ 2 agreement was greater than between TJ/GS ≥ 2 [73.5–92.6% vs 51.0–87.4% (PABAK 0.47–0.85 vs PABAK 0.35–0.75), respectively]. Swelling was independently associated with higher odds of GS ≥ 2 [odds ratio (OR) (95% CI); 4.37 (2.62, 7.29); P &lt; 0.001] but not tenderness [OR = 1.33 (0.87, 2.06); P = 0.192]. Swelling [OR = 8.78 (3.92, 19.66); P &lt; 0.001] or tenderness [OR = 3.38 (1.53, 7.50); P = 0.003] was independently associated with higher odds of PD ≥ 1.

Conclusion
Synovitis (GS ≥ 2 and/or PD ≥ 1) was more likely in swollen joints than in tender joints in DMARD-naïve, early PsA. Agreement indicated that swollen joints were the better proxy for synovitis, adding to greater understanding between clinical and US assessments.
Napping behavior in adults with episodic migraine: a six-week prospective cohort study
Authors: Vgontzas Angeliki , Mostofsky Elizabeth , Hagan Kobina , Rueschman Michael , Mittleman Murray A , Bertisch Suzanne M 
Published: November 2021

Abstract

Study Objectives
Patients with migraine commonly endorse napping as a strategy for headache pain relief, but also experience high rates of sleep disturbance. To elucidate the relationship between napping behavior and migraine, we evaluated the association between napping and headache frequency, severity, and intensity among adults with episodic migraine. We also examined the association between daily napping and that night’s sleep.

Methods
In this six-week prospective cohort study, 97 adults with episodic migraine completed twice-daily headache and sleep electronic diaries and wore a wrist actigraph. We modeled the associations between napping (yes/no) and headaches with conditional logistic regression and daily napping and nighttime sleep with linear regression.

Results
Over 4,353 study days, participants reported 1,059 headache days and 389 days with naps. More than 80% of participants napped during the study, with mean nap duration of 76.7 ± 62.4 min. Naps were more likely to occur on day 2 of headache 35/242 (14.5%) than on nonheadache days 279/3294 (8.5%, OR 2.2 [95% CI 1.4, 3.4]). Mean nap onset time (14:40 ± 3.3 h) was later than headache onset (12:48 ± 5.3 h). In adjusted models, napping was associated with an additional 1.1 (95% CI −1.4, 3.6) headache days/month. Naps were not associated with worse self-reported or objective sleep that night.

Conclusions
Our findings suggest that naps may be an uncommonly used behavioral strategy for prolonged migraine attacks and do not contribute to nightly sleep disturbance. Future studies are needed to examine the acute analgesic effects of daytime napping in patients with migraine.
A Theory of Political Backlash: Assessing the Religious Right’s Effects on the Religious Field
Authors: Braunstein Ruth 
Published: November 2021

AbstractA growing body of evidence suggests that the rise in religious disaffiliation can be partly attributed to a political backlash against the Religious Right. Yet the concept of “political backlash” remains undertheorized, limiting our ability to evaluate how backlash against the Religious Right has impacted the religious field as a whole. This article develops a general account of how political backlash against a radical actor can impact participants within a given field, distinguishing between broad backlash, narrow backlash, and counter backlash. It then applies this framework to the case of the religious field. An analysis of available evidence suggests that backlash against the Religious Right has had ripple effects beyond the rise of the “nones,” including a rise in “spiritual” identification, positive attention to the “Religious Left,” depoliticization of liberal religion, and purification and radicalization within the Religious Right itself. This article encourages religion scholars to connect dots between trends that have not been understood as related, and deepens our understanding of the relational nature of religious change. More generally, it offers a framework for understanding how backlash against radical actors can shape entire fields.
Intake, nutrient digestibility, rumen parameters, growth rate, carcase characteristics and cannabinoid residues of sheep fed pelleted rations containing hemp (Cannabis sativa L.) stubble
Authors: Krebs Gaye L , De Rosa Daniel W , White Dana M , Blake Bronwyn L , Dods Kenneth C , May Christopher D , Tai Zi X , Clayton E H , Lynch Emma E 
Published: November 2021

Abstract
The feeding value and impact of hemp stubble in the diet of ruminants is unknown. Fifteen Merino castrated male sheep were maintained in individual pens and fed one of three pelletized experimental inclusion diets, as a 0% (Control), 28% (Hemp 1), and 56% (Hemp 2) pellet that delivered a diet meeting the nutrient requirements of the animals. Inclusion of hemp stubble had no effect (P &gt; 0.05) on either DM intake, live weight gain or the feed to gain ratio but positively impacted (P &lt; 0.05) on nutrient digestibility. Hemp stubble inclusion increased the concentration (but not molar proportions) of acetic and butyric acids and increased both the concentrations and molar proportions of iso-butyric, iso-valeric, hexanoic and heptanoic acids, possibly due to increased protein digestibility and/or changes in the composition of rumen cellulolytic bacteria. Tetrahydrocannabinolic acid (THCA) was the only cannabinoid found in plasma in the sheep fed the hemp-containing diets, and this was found at very low concentrations (&lt;16 μg/L). The psychoactive cannabinoid delta-9-tetrahydrocannabinol (Δ 9-THC) was not detected in any plasma samples. THCA was detected in the liver of two sheep fed the Hemp 1 pellets and two sheep fed the Hemp 2 pellets. Cannabidiol (CBD) was detected in the liver of one sheep fed the Hemp 2 pellets (but no liver THCA was detected in this sheep). Δ 9-THC was detected in both the kidney fat and subcutaneous fat of all sheep fed hemp stubble, with the concentrations being higher (P &lt; 0.05) in the sheep fed the Hemp 1 pellets. THCA was also detected in the subcutaneous fat of one of the sheep fed the Hemp 1 pellets. Four of the five sheep fed the Hemp 1 pellet and one of the five sheep fed Hemp 2 pellet had detectable levels of Δ 9-THC in the meat (loin). No other cannabinoids were detected in the meat. Current food standards regulations in Australia prohibit presence of any cannabinoid residues in commercial meat products; thus, determination of a withholding period is required to enable the safe feeding of hemp-stubble to sheep. Further research is also required to gain a greater understanding of the rumen metabolism of cannabinoids.
Family History a Risk for Early-Onset Colorectal Cancer
Authors: Todd Betsy 
Published: November 2021

First-degree relatives of people with early-onset colorectal cancer are six times more likely than the general population to be diagnosed with this condition.First-, second-, and third-degree relatives of people with early-onset colorectal cancer are at higher risk for both early-onset colorectal cancer and colorectal cancer at any age.