bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shifts in outdoor activity patterns in the time of COVID-19 and its implications for exposure to vector-borne diseases in the United States.
Authors: Fernandez Pilar , Bron Gebbiena , Kache Pallavi , Tsao Jean , Bartholomay Lyric , Hayden Mary , Ernst Kacey , Berry Kevin , Diuk-Wasser Maria 
Published: May 2021

Abstract
Unintended consequences of human behavioral changes induced by governmental and individual responses to COVID-19 risk are yet to be fully realized. Herein, we evaluated changes in outdoor activity patterns during the spring and summer of 2020 vs. 2019 in the Northeast and Midwest United States. We used self-reported data from daily surveys available through a smartphone application, The Tick App. We simultaneously assessed changes in exposure to tick vectors in relation to changes in outdoor recreation. Outdoor activities and particularly peridomestic activities, increased by two-fold between years, while recreational activities in green spaces decreased by 70%. Tick encounters increased by 30%, and were mainly associated with outdoor activities and living in a rural county. Changes in outdoor recreation were associated with statewide stay-at-home orders in 2020 and persisted as out-of-home mobility increased. Our findings suggest that public health response should also address competing hazards from COVID-19 related outdoor exposure.
Subclinical Brain Lesion in MRI is a Potential Indicative of PFO-Related Migraine in Younger Patients
Authors: Ma Fei , Luo Xiang , Lin Fan , Li Rui , Zhou Qiang , Zeng Hesong , Wang Dao Wen , Wang Hong 
Published: May 2021

Abstract
Background: The causal relationship of migraine with PFO remains controversial and a major question unresolved is how to define the PFO-attributable migraine.Objective: In this study, we evaluated diffusion-weighted-imaging (DWI) presentation in brain MRI and its association with PFO in patients with migraine. We aimed to define if brain lesion could be a potential indicative of PFO-related migraine. Methods: Consecutive migraine patients <60 years with or without aura from 2017 to 2019 who underwent transthoracic echocardiography (TTE) or transcranial Doppler (TCD) examination with agitated saline contrast (ASC) injection were assessed for right-to-left shunt (RLS). We then assessed brain DWI findings in the patients and tested the association of brain lesion with PFO. Results: A total of 424 patients with mean age 44.39±12.06 years were included in the study. Among them, 244 patients (57.5%) had PFO and 246 patients (58%) had subclinical brain lesion. The brain lesion presented as single or multiple scattered lesion. Although there was no association between PFO prevalence and brain lesion in the total cohort (OR 0.499, 95% CI 0.236-1.052), the association was significant in patients who were aged less than 46 years (OR 3.614 in group of age<34 years, 95% CI 1.128-11.580, and 3.132 in group of 34 years≤age<46 years, 95% CI 1.334-7.350, respectively). DWI lesion in patients with PFO was more coming from anterior or multiple than posterior vascular territory (p=0.033). DWI lesion numbers, location and RLS amounts were not affecting the association between DWI lesion and PFO. Conclusions: This study demonstrated that subclinical brain lesion are associated with PFO in migraineurs younger than 46 years. The DWI pattern of brain lesions may be used as a potential predictor of PFO-related migraine in patients who are aged less than 46 years and aids in selection of appropriate candidates for PFO closure.
Parasitism of Egeria radiata (Lamarck, 1804) in Lower Sanaga delta, Cameroon: Prevalence, Diversity, Intensity and its Impact on This Economic and Nutritional Clam Species
Authors: DIKOUME Adolphe , NWUTIH Gordon AJONINA , FOKO Loick Pradel KOJOM , EYANGO Minette TOMEDI 
Published: May 2021

Abstract
Background: Clams are an important source of economic incomes and animal protein source in Cameroon. In contrast, parasitism is a serious threat to the economy and health risk to Cameroonian populations. The present study aimed at determine diversity and intensity of parasitism along with its impact on E. radiata, a major clam species in the country. Methods: Parasitic screening of freshwater Egeria radiata was carried out December 2017 to July 2018 at lower Sanaga delta in the Littoral region of Cameroon. Bolounga and Maldjedou were local stations of sampling, where clams were collected and in situ measurements of weight, length and width and were transported to the laboratory for parasites survey. Parasites were examined and attempt was made on the identification using appropriate keys. Results: Statistical analysis of results showed that the parasitic prevalence was 74.5% overall and was 56% and 90% at Bolounga and Maldjedou respectively. The prevalence of parasites habour found were Protozoans (10% vs 0%; p=0.01), Trematodes (4% vs 16.7%; p=0.04), Cestodes (6% vs 23%; p=0.01) and Nematodes (12% vs 31.7%; p=0.01) at respectively Bolounga and Maldjedou stations. Parasites diversity of Egeria radiata show Intensity index at Bolounga and Maldjedou was respectively 1.35 and 1.31 with 1.32 overall. Abundance rate was 0.99 overall and was 0.76 and 1.18 at Bolounga and Maldjedou respectively. Significative correlation can be observed with Burrow and parasitic index ; The size of clams in two stations show lengths (5.2mm vs 4.5mm), height (4.1cm vs 3.5cm), total shell weight (38.9g vs 30.0g) and left shell weight (19.6g vs 15.2g). higher values were encountered in Maldjedou with significant differences that were observed.Conclusion: Velocity of parasites inside bivalve species to burrow and filter water expose it to infection with these above mentioned groups of parasites that cause a mass mortality and significant economic losses and public health.
First Record of Traumatic Myiasis Obtained From Forest Musk Deer (Moschus Berezovskii) Using Dna Barcoding
Authors: Gao Yunyun , Fu Yajun , Yan Liping , Hu Defu , Jiang Benmo , Zhang Dong 
Published: May 2021

Abstract
BackgroundMyiasis is an infestation of maggots on living tissue in humans and animals all over the world. It is known to occur in wild animals, while no information is reported in forest musk deer. We found a case of traumatic myiasis of an injured forest musk deer (Moschus berezovskii), the wound of which was infected by numerous maggots, and the fur was covered by clusters of eggs. The affected individual was clinically treated immediately and recovered. MethodsDNA barcoding is an efficient technique for species diagnosis, therefore is employed to identify the blowfly samples collected from the infected forest musk deer. Firstly, we extracted genomic DNA from larvae and eggs respectively. The DNA barcoding sequences of 49 individuals were obtained and subsequently analyzed calculating nucleotide composition and divergence and haplotypes, constructing a neighbor-joining (NJ) tree, for accurate identification of these blowflies. ResultsOur results suggest that the average nucleotide divergence between the 49 sequences of blowfly samples is 0.0022, 0.0054 is between sequences of blowfly samples and Lucilia caesar (Linnaeus, 1758) (Diptera: Calliphoridae). Furthermore, the NJ tree construction indicates that the flies collected from the forest musk deer are clustered together with L. caesar. The sequences of sampled blowflies have nine haplotypes, including two shared haplotypes, with haplotype diversity 0.588, nucleotide diversity 0.00215, and the average number of nucleotide differences was 1.374. Conclusions﻿We report traumatic myiasis of forest musk deer for the first time, which expands the information on parasite and myiasis of forest musk deer and confirmed the potential risk of traumatic myiasis of forest musk deer.
Neutrophils Defensively Degrade Graphene Oxide in a Lateral Dimension Dependent Manner through Two Distinct Myeloperoxidase Mediated Mechanisms
Authors: Huang Shiyi , Li Sijie , Liu Yanlei , Ghalandari Behafarid , Hao Ling , Huang Chengjie , Su Wenqiong , Ke Yuqing , Cui Daxiang , Zhi Xiao , Ding Xianting 
Published: May 2021

Abstract
The boosting exploitation of graphene oxide (GO) increases exposure risk to human beings. However, as the first line defender, neutrophils’ mechanism of defensive behavior towards GO invasion remains unclear. Herein, we discover that neutrophils defensively degrade GO in a lateral dimension dependent manner. The micrometer-sized GO (mGO) induces NETosis by releasing neutrophil extracellular traps (NETs), while nanometer-sized GO (nGO) elicits neutrophil degranulation. The neutrophils’ defensive behavior is accompanied with generation of reactive oxygen species and activation of p-ERK and p-Akt kinases. We unveil that mGO-induced NETosis is NADPH oxidase (NOX)-independent, while nGO-triggered degranulation is NOX-dependent. Furthermore, myeloperoxidase (MPO) is identified to be a determinant mediator despite distinct neutrophil phenotypes in the biodegradation. Neutrophils release NETs comprising of MPO upon activated with mGO, while MPO is secreted via nGO induced-degranulation. Moreover, the binding energy between MPO and GO is calculated to be 69.8728 kJ·mol− 1, which indicates that electrostatic interactions mainly cause the spontaneous binding process in a spatial distance of 9.2 Å. Meanwhile, the central enzymatic biodegradation is found to occur at oxygenic active sites and defects on GO. Mass spectrometry analysis deciphers the degradation products are biocompatible molecules like flavonoids and polyphenols. Our study provides fundamental evidence and practical guidance for functional biomaterial development in sustainable nanotechnology, including but not limited to vaccine adjuvant and drug carrier.
To Evaluate the Safety and Efficacy of Drug‐eluting Beads Bronchial Arterial Chemoembolization Loaded with Pirarubicin in the Treatment of Advanced Non-small-cell Lung Cancer
Authors: Li Zhaonan , Chen Quanjing , Jiao Dechao , Han Xinwei 
Published: May 2021

Abstract
Objectives The control of solid tumors by drug-eluting beads has been recognized in clinical practice, but there are still few applications regarding drug‐eluting beads bronchial arterial chemoembolization (DEB‐BACE) in lung cancer. To further investigate the role of DEB-BACE in patients with lung cancer. We evaluated the efficacy and safety of Pirarubicin-loaded CalliSpheres beads in patients treated for advanced non-small cell lung cancer (NSCLC). MethodsFrom June 2017 to January 2018, 54 patients with advanced NSCLC received DEB‐BACE with Pirarubicin‐loaded CalliSpheres® beads. After the treatment, the progression-free survival (PFS) and overall survival (OS) were analyzed. Moreover, adverse events and complications were also reported. ResultsAfter DEB‐BACE treatment, most of the adverse events and complications were CTCAE grade 1 or 2 (mild symptoms, no or local/noninvasive intervention indicated) . Of the 54 patients, 2 persons (4%) had grade-3 lung abscess and required percutaneous drainage, 1(2%) had a grade-3 pulmonary infection that caused difficulty breathing and required intravenous antibiotics and ventilator adjuvant therapy. Moreover, the patient’s mean PFS was 7.828 months (95% CI: 6.614, 9.043), and the mean OS rates were 17.678 months (95% CI: 15.573, 19.783). Additionally, both univariate and multivariate cox regression indicated that the disease stage (stage III) seems related to better PFS in patients with advanced NSCLC (P=0.013). ConclusionsThe clinical effect of DEB‐BACE with Pirarubicin‐loaded CalliSpheres® beads on advanced NSCLC is probably significant and could improve the PFS, the adverse events and complications were tolerable.
Vaccinate Early and Vaccinate Broadly: On the health and Economic Effects of COVID-19 Vaccines
Authors: Ganslmeier Michael , Deb Pragyan , Furceri Davide , Ostry Jonathan , Tawk Nour 
Published: May 2021

Abstract
Recent progress in COVID-19 vaccination campaigns has provided real hope for people around the world to successfully end the pandemic, decrease fatality rates and lift social distancing rules for timely economic recovery. Even though several RCT and single-country case studies have shown the high efficacy of the developed vaccines, little is known about how vaccination will result in lower cases and higher economic activity at the macro level. Quantifying the speed of these effects using observational data is of great relevance for policymakers as they grapple with decisions on vaccine distribution and equity, costly containment and social distancing measures, healthcare planning and expenditures, and macroeconomic policy support.

With this article, we aim to contribute to the pandemic literature by measuring the effect of vaccination rates on new cases and macroeconomic activity indicators using daily real-world observational data from 314 regions/states in 17 countries. Our results show that: (i) vaccination has a delayed containment effect which increases over time; (ii) the effects on changes in economic activity are transitory after large initial rises—that is, vaccination has permanent level effects; and (iii) the effect of the second vaccine dose is only present for new cases while being insignificant for economic activity.
Utility of an Artificial Intelligence System for Classification of Esophageal Lesions when Simulating its Clinical use
Authors: Tajiri Ayaka , ISHIHARA Ryu , KATO Yusuke , INOUE Takahiro , MATSUEDA Katsunori , MIYAKE Muneaki , WAKI Kotaro , SHIMAMOTO Yusaku , FUKUDA Hiromu , MATSUURA Noriko , EGAWA Satoshi , YAMAGUCHI Shinjiro , OGIYAMA Hideharu , OGISO Kiyoshi , NISHIDA Tsutomu , AOI Kenji , TADA Tomohiro 
Published: May 2021

Abstract
Background:Previous reports have shown favorable performance of artificial intelligence (AI) systems for diagnosing esophageal squamous cell carcinoma (ESCC) compared with endoscopists. However, these findings don’t reflect performance in clinical situations, as endoscopists classify lesions based on both magnified and non-magnified videos, while AI systems often use only a few magnified narrow band imaging (NBI) still images. We evaluated the performance of the AI system in simulated clinical situations.Methods:We used 25,048 images from 1,433 superficial ESCC and 4,746 images from 410 noncancerous esophagi to construct our AI system. For the validation dataset, we took NBI videos of suspected superficial ESCCs. The AI system diagnosis used one magnified still image taken from each video, while 19 endoscopists used whole videos. Results:We used 147 datasets including 83 superficial ESCC and 64 non-ESCC lesions. The accuracy, sensitivity and specificity for the classification of ESCC were, respectively, 80.9%, 85.5%, and 75.0% for the AI system and 69.2%, 67.5%, and 71.5% for the endoscopists. The AI system correctly classified all ESCCs invading the muscularis mucosa or submucosa and 96.8% of lesions ≥ 20 mm, whereas even the experts misdiagnosed some of them.Conclusions:Our AI system showed higher diagnostic ability for classifying ESCC and non-ESCC than endoscopists. It may provide valuable diagnostic support to endoscopists.
Foraging Roots and their Associated Microbes Slow the Decay of Belowground Litters in a Temperate Hardwood Forest
Authors: Beidler Katilyn , Oh Young Eui , Pritchard Seth G. , Phillips Richard P. 
Published: May 2021

Abstract
1. There is increasing evidence that plant roots and mycorrhizal fungi, whether living or dead, play a central role in soil carbon (C) cycling. Root-mycorrhizal-microbial interactions can both suppress and enhance litter decay, with the net result dependent upon belowground nutrient acquisition strategies and soil nutrient availability. 2. We measured the net effect of living roots and mycorrhizal fungi on the decay of dead roots and fungal hyphae in a hardwood forest dominated by either sugar maple (Acer saccharum) or white oak (Quercus alba) trees. Root and fungal litter were allowed to decompose within root-ingrowth bags and root-exclusion cores. In conjunction with root effects on decay, we assessed foraging responses and root induced changes in soil moisture, nitrogen (N) availability and enzyme activity. 3. After one year, maple root production increased, and mycorrhizal fungal colonization decreased in the presence of decaying litter Additionally, we found that actively foraging roots suppressed the decay of root litter (-14%) more than fungal litter (-3%), and suppression of root decay was stronger for oak (-20%) than maple roots (-8%). Suppressive effects of oak roots on decay were greatest when roots also reduced soil N availability, which corresponded with reductions in β-glucosidase, (BG) enzyme activity and enhanced oxidative (OX) enzyme activities. 4. These findings further our understanding of context-dependent drivers of root–mycorrhizal–microbial interactions and demonstrate the potential for suppression of soil saprotrophs to contribute to the accumulation of root and fungal derived soil C in temperate forests.
Effect of Obesity on Mortality in Pulmonary Hypertension, Does Obesity Paradox Exist?
Authors: Reddy Raju M , Khan Akram , Singh Saminder , Alzghoul Bashar , Gause Sherie , Colaco Nalini , Robinson Jeffrey , Zayed Yazan 
Published: May 2021

Abstract
Obesity is reported to have a protective effect on mortality in pulmonary hypertension (PH), a phenomenon known as obesity paradox. However, the data is conflicting with some studies showing decreased mortality while other studies found no effect of obesity on mortality. Therefore, we performed a meta-analysis to examine the effect of obesity on mortality in PH. Only patients with PH diagnosed by right heart catheterization were included. We also performed a sub-group analysis of subjects with pre-capillary PH only. A total of seven studies met the inclusion criteria with a sample size of 79,577 patients. Obese subjects had lower mortality compared to non-obese subjects in the mixed PH group (hazard ratio 0.67, 95% CI 0.51-0.87, P<0.00001) and in the pre-capillary PH group (hazard ratio 0.74; 95% CI 0.58-0.96; P<0.00001). Body mass index ≥ 30 kg/m2 may be associated with reduced mortality but these results must be interpreted with caution.
In-Office Communication About Excessive Daytime Sleepiness Associated with Treated Obstructive Sleep Apnea: Insights from an Ethnographic Study of Physician-Patient Visits
Authors: Won Christine , Bogan Richard K , Doghramji Karl , Ojile Joseph , Bujanover Shay , Hyman Danielle L , Hewett Kathleen A , Thomas Robert 
Published: May 2021

Abstract
Background: Excessive daytime sleepiness (EDS), a primary symptom of obstructive sleep apnea (OSA), negatively affects functioning and quality of life (QoL). EDS can persist despite primary airway therapy, and often remains unmanaged, potentially due to inadequate provider-patient communication. Ethnographic research was conducted to assess provider-patient communication about EDS. Methods: Participating physicians (primary care n=5; pulmonologists n=5; sleep specialists n=3) identified adult patients (n=33) diagnosed with OSA who were prescribed positive airway pressure (PAP) therapy ≥6 months prior and previously reported EDS. Visits and post-visit interviews were video-recorded and analyzed using standardized, validated sociolinguistic techniques. Results: Despite 55% of patients (18/33) reporting QoL impacts post-visit, this was discussed during 28% (5/18) of visits. Epworth Sleepiness Scale was administered during 27% (9/33) of visits. Many patients (58% [19/33]) attributed EDS to factors other than OSA. Physicians provided EDS education during 24% of visits (8/33). No pharmacotherapy for EDS was prescribed to patients not currently taking medications despite 78% (18/23) reporting EDS.Conclusions: EDS was minimally discussed and rarely reassessed or treated after PAP therapy initiation in this study. Patients often attributed EDS to factors other than OSA. The findings suggest physicians and patients may benefit from dialogue tools, routine use of screening tools, and patient education.
A Practical Measure of Health Facility Efficiency: an Innovation in the Application of Routine Health Information to Determine Health Worker Productivity in Ethiopia
Authors: Hasan Md Zabir , Dinsa Girmaye D. , Berman Peter 
Published: May 2021

Abstract
BackgroundA simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low and middle-income countries. This paper presents a proof of concept of using routine information from primary healthcare (PHC) facilities to measure health workers’ productivity and its application in three regions of Ethiopia.MethodsIn four steps, we constructed a productivity measure of the health workforce of Health Centers (HCs) and demonstrated its practical application: (1) developing an analytical dataset using secondary data from health management information systems (HMIS) and human resource information system (HRIS); (2) principal component analysis and factor analysis to estimate a summary measure of output from five indicators (annual service volume of outpatient visits, family planning, first antenatal care visits, facility-based deliveries by skilled birth attendance, and children [<1 year] with three pentavalent vaccines); (3) calculating a productivity score by combining the summary measure and the total number of health workers (input); and (4) implementing regression models to identify the determinant of productivity and ranking HCs based on their adjusted productivity score. ResultsWe developed an analytical dataset of 1,128 HCs; however, significant missing values and outliers were reported in the data. The principal component and factor scores developed from the five output measures were highly consistent (correlation coefficient = 0.98). We considered the factor score as the summary measure of outputs for estimating productivity. A very weak association was observed between the summary measure of output and the total number of staff. The result also highlighted a large variability in productivity across similar health facilities in Ethiopia, represented by the significant dispersion in summary measure of output occurring at similar levels of the health workers. ConclusionsWe successfully demonstrated the analytical steps to estimate health worker productivity and its practical application using HMIS and HRIS. The methodology presented in this study can be readily applied in low and middle-income countries using widely available data – such as DHIS2 – that will allow further explorations to understand the causes of technical inefficiencies in the health system.