bluuebunny/crossref_metadata_2025_split huggingface dataset:
#2: Use of Plasma Metagenomic Next Generation Sequencing for Pathogen Identification in Pediatric Endocarditis
Authors: To Rachel K , Ramchandar Nanda , Gupta Aamisha , Pong Alice , Cannavino Christopher , Foley Jennifer , Farnaes Lauge , Coufal Nicole G 
Published: June 2021

Abstract

Background
Pediatric infective endocarditis (IE) incurs significant morbidity and most commonly occurs among children with underlying heart disease. Identification of causative pathogens on blood culture allows for more targeted antibiotic therapy, optimizing patient outcomes. However, standard diagnostic testing has limited sensitivity. As a result, there is an opportunity to explore alternative methods to identify pathogens in IE using cell-free plasma next generation sequencing (mNGS). mNGS utilizes a high-throughput approach that is culture-independent and non-invasive to detect microbial DNA. We describe a single center retrospective case series of children with IE in whom plasma mNGS was sent as part of the diagnostic evaluation.

Methods
In this case series, we evaluated the impact of mNGS on the clinical management of IE by conducting a retrospective chart review of children hospitalized with IE from January 1, 2017 to January 17, 2020. Inclusion criteria included subjects 0–21 years of age who had a diagnosis of IE based on admission diagnosis and problem list. Demographics, echocardiography and diagnostics were obtained by chart review.

Results
We identified 14 children who were diagnosed with IE, 10 of whom had mNGS sent for diagnostic testing. mNGS detected an organism in 8 of 10 (80%) children as compared to standard of care blood cultures and 16S PCR which identified an organism in only 5 of 10 (30%). Out of 8 subjects with organisms identified by mNGS, clinical management was impacted in 4 of 8 subjects and 3 subjects were only diagnosed through mNGS.

Conclusion
Although blood and tissue cultures are the historical gold standard for organism identification in IE, new diagnostic modalities such as mNGS may be more sensitive. This could lead to more targeted and possibly more effective therapeutic regimens in cases when empiric antibiotic therapy may hinder pathogen identification. In at least one instance, a change in antibiotic choice to penicillin to target Corynebacterium diphtheriae resulted in a clinical cure that may not have otherwise been achieved. As a result of mNGS, three other subjects also had changes in management that resulted in narrowing of antibiotic choice or adjustments to the antibiotic regimen. Our observations suggest that mNGS is more sensitive than standard blood cultures and that the clinical utility of mNGS may be beneficial to the management of infective endocarditis in children.
#3: Gram-Negative Antibacterial Resistance Prevalence at a Tertiary Care Hospital in Central America
Authors: Dantuluri Keerti , Forrester Jeanne , Benincasa Lisette Castro , Posadas Sofia , Quiñónez Fabiola , Karunanandaa Aravinth , Morris Lee 
Published: June 2021

Abstract

Background
Latin America has some of the highest rates of multi-drug resistant gram-negative bacteria worldwide. However, local surveillance registries to compare rates of resistance among countries are lacking, particularly in Central America. Awareness of local resistance patterns in this region is critical to improve antibiotic use and patient outcomes. We sought to measure the prevalence of resistant gram-negative bacilli (GNB) at a tertiary hospital in Guatemala.

Methods
We retrospectively conducted a single-center study to measure the percentage of GNB that were non-susceptible to various antibiotics between April and October of 2017. All cultures (blood, urine, cerebrospinal fluid, and other body fluids) were collected as part of routine clinical care during the study period. Duplicate isolates, defined as multiple specimens with the same organism from the same patient, were excluded. Antibiotic susceptibility testing was performed by disk diffusion method. Bacterial isolates were categorized as susceptible, intermediate, or resistant based upon the Clinical Laboratory Standard Institute 27th edition per guidance from the National Laboratory of Guatemala.

Results
A total of 969 unique gram-negative isolates from 818 patients were included. Urine was the most common culture type. The most frequently isolated bacteria were Escherichia coli and Klebsiella species. The percentage of GNB which were non-susceptible to individual antibiotics are detailed in Table 1. Of the isolates tested, 12 – 66% of GNB were non-susceptible to cephalosporins, 7 – 31% were non-susceptible to carbapenems, and 14 – 44% were non-susceptible to fluroquinolones.

Conclusions
The prevalence of multi-drug resistant GNB is high in Escuintla, Guatemala. Continued surveillance is vital to guide judicious and appropriate empiric antibiotic use in the setting of rising rates of antibiotic resistance. Local and regional resistance rates are known to vary, underlying the importance of developing more regional and national antibiotic resistance surveillance networks within Guatemala and other countries in Central America where there is a paucity of data.
#30: Coronavirus Disease 2019 (COVID-19) Incidence in Pediatric Oncology Patient: Does Routine Screening Affect the Risk for the Transmission in the Hospital
Authors: Adrizain Riyadi , Sari Nurmelani 
Published: June 2021

Abstract

Background
Cancer patients are at higher risk of COVID-19 infection and more likely they have higher morbidity and mortality than the general population. On the other hand, the oncology patient sometimes can show asymptomatic COVID-19 disease with a risk of longer viral shedding and spreading the infection to others immunosuppressed individuals. Oncology patients also regularly travel between hospital and sometimes lodge in boarding house for routine chemotherapy. As we known, prevention strategy for COVID-19 among pediatric oncology patients can be implemented by minimizing these risks factors for transmission by identifying all patients infected with COVID-19. Here, we report our experience before and after implementing COVID-19 testing policy of patients with hematology and oncology diseases in our center.

Method
We collected data of pediatric oncology patients admitted to Hasan Sadikin General hospital between July 1st, 2020 to January 8th, 2021. The data consisted of the total number of patients and COVID-19 status by using SARS-CoV-2 Nucleic Acid Amplification Test (NAAT) performed in the patient during two periods. In the first period, we performed NAAT if the patient was suspected of COVID-19. In the second period, after the policy was changed, NAAT was performed routinely as screening for all oncologic patients admitted to the hospital.

Results
Between July 1st to December 2nd, 2020, the first period, there was 3 positive results from 36 suspected COVID-19 patients among 181 total pediatric oncology patients. In the second period, we found 8 positive results from 121 hospitalized patients, none of them had signs and symptoms of COVID-19; and 4 of them came from boarding house.

Conclusion
Routine screening for COVID-19 should be considered as a policy for hospitalization of a pediatric oncology patient because of the high risk that asymptomatic COVID-19 patients can transmit the infection to other patient and to health care workers in the hospital.
#42: COVID-19 in Pediatric Hemato-Oncology Patients from Three Hispaniola Hospitals
Authors: Santana Genara , Gil María Dolores , Morel Manauri H , Contreras Johanny , Rivera Karina , Castillo María , Gassant Pascale Yola , Fleury Marie Immacula , Happ Brooke , Vázquez Milka , Homsi Maysam R , Caniza Miguela A 
Published: June 2021

Abstract

Background
In late 2019, a novel coronavirus, SARS-CoV-2, was reported in China, which rapidly spread across the globe. The WHO declared a pandemic of coronavirus disease (COVID-19) in early 2020. In March, both the Dominican Republic and Haiti reported their first cases. The three pediatric oncology units (POUs) that make up the St. Jude Global Infectious Diseases Hispaniola Project began to see COVID-19 among patients in Santo Domingo in March and in both Santiago and Port-au-Prince in June. We report the experience of managing pediatric hemato-oncology patients with COVID-19 in these three POUs.

Methods
We added COVID-19 data to our ongoing healthcare-associated infection surveillance in the POUs of the Hispaniola Project. The population studied included all patients tested for SARS-CoV-2 by PCR and/or serological methods. Patient data was recorded on a basic line listing. Cases were categorized using a published clinical symptom severity scale and case definition criteria from the WHO and the US Centers for Disease Control and Prevention (CDC).

Results
In total, 31 pediatric oncology patients met either the WHO and/or CDC case definition for COVID-19. The average age was 8 years (range: 5 months to 15 years). Just over half (17, 55%) of cases were female. The most common oncology diagnosis was acute lymphoblastic leukemia in 17 of the cases, followed by acute myeloid leukemia (5) and solid tumor (4). Five (16%) cases were in the consolidation phase, 7 (23%) in induction, and 11 (35%) in maintenance. Using the symptom severity scale, 13 (32%) cases were asymptomatic; symptoms were considered mild in 14 (45%) cases, moderate in 3 (10%), severe in 0 (0%), and critical in 1 (3%). Three deaths were attributed to COVID-19. Eighteen cases met the WHO criteria, 13 (72%) of which were confirmed, 1 probable, and 4 suspected. Twenty-six cases met the CDC criteria, 13 (50%) of which were confirmed and 13 (50%) were suspected; there were 0 probable cases.

Conclusions
Our findings about COVID-19 in pediatric oncology patients are consistent with data reported globally that disease presentation is mostly asymptomatic or mild but with increased mortality. The high contagiousness and unpredictable clinical response of children with cancer call for rigorous measures to prevent infections in this population. In low resource settings, the scarcity of antiviral, immunologic, and supportive medications further underscores this need. Additionally, we observed differences in our data depending on which COVID-19 case criteria were used (WHO versus CDC); this highlights the importance of standardized definitions that can be used at all resource levels to promote reliable measurement of disease burden.
#46: Changes in the hospital admission profile in a Peruvian National Tertiary Children’s Hospital during the First Year of Covid-19 Pandemic
Authors: Baca Yeni , Muñante Cesar , Santillan Carlos 
Published: June 2021

Abstract

Background
During the first year of the current COVID-19 pandemic, health systems around the world have faced the challenge of maintaining health services for patients with non-communicable diseases, despite the logistical and personnel constraints. Despite SARS-CoV-2 infection is usually more benign in children, there is limited information about how this pandemic affected their healthcare at a population level.

Methods
We performed a cross sectional study at the Peruvian National Children′s Hospital San Borja, which is a 312-bed tertiary National referral health center, in Lima. We include all hospital admissions during 2020, with respect to the two previous years. We defined hospital admission as the permanence at the hospital for more than 24 hours irrespectively of patient′s initial destination (emergency observation unit, regular medical floor, or intensive care unit). We described demographic characteristics among hospitalized patients and compared them between 2018–19 and 2020 using standard descriptive tests. We use the International Classification of Diseases 10th (ICD-10) codes from the electronic patient registration system to ascertain three major non-communicable conditions: congenital cardiopathies, hematooncological disorders and burns non-communicable conditions. We set level for statistical significance at 0.05.

Results
There were 11635 patients admitted during 2018–19 period and 3480 patients admitted during 2020. The average daily hospital admission during 2018–19 was different compared to 2020 (15.9±6.1 vs. 9.6±6.0, p&lt;0.001). There were also differences in the frequency of the gender (male 55.1% vs. 58.9%, p&lt;0.001) and if the patient′s place of origin was outside Lima (49.0% vs. 41.1%, p&lt;0.001). Among hospitalized patients, 3036 presented one of the three non-communicable conditions during the baseline period and 871 during 2020. There was a significant difference between the distribution of hospitalization among patients with one of the three non-communicable conditions (p&lt;001), towards a decrease in hospitalizations due to congenital heart disease, and an increase in the hospitalizations due to burns.

Conclusion
During the first year of COVID-19 pandemic, there was a decrease in the number of hospitalizations of children with non-communicable conditions compared to the previous two years. It will be important to consider the implementation of public health policies aimed to increase accessibility to health care for children with non-communicable conditions during the coming months of the pandemic in Peru.
#56: A novel test for diagnosis and surveillance of Wuchereria bancrofti infection
Authors: Greene Sarah E , Curtis Kurt , Fischer Peter U , King Christopher L , Weil Gary J 
Published: June 2021

Abstract

Background
Elephantiasis or Lymphatic filariasis (LF) is a parasitic infection that causes significant morbidity and impacts hundreds of millions of people in 73 countries. Most LF is caused by the nematode Wuchereria bancrofti, but Brugia species cause LF in some areas of Southeast Asia. The global program to eliminate LF uses mass drug administration (MDA) of antifilarial drugs in endemic areas to kill the microfilaria (MF) stage of the parasite that is required for ongoing transmission by mosquitos. Better tools are needed for assessing the success of MDA, because of limitations of available diagnostic tests. MF testing is often not feasible, because it requires collection of blood at night in most endemic areas. Existing antibody and antigen tests remain positive long after effective treatment, and their results do not correlate well with current infectivity. The Brugia Rapid test detects antibodies to BmR1, a Brugia protein that is expressed by MF. These antibodies disappear 2–3 years after effective treatment, and that makes the Brugia Rapid test a useful marker for persistent infection in the few countries with brugian filariasis. We set out to develop a novel antibody test for W. bancrofti infection based on a BmR1 homologue in W. bancrofti.

Methods
We cloned, expressed and purified a Wuchereria bancrofti protein (provisional name WbN1) that is a homologue of the Brugia malayi protein BmR1. Sera from patients infected with Wuchereria bancrofti as well as sera from patients infected with other closely related filarial species were tested for IgG4 antibodies to WbN1 by indirect ELISA.

Results
The ELISA has a sensitivity of 90.7% for infection with W. bancrofti based on the 80 bancrofti patient samples tested thus far. Specificity was 91.5% with 59 sera samples from patients infected with Onchocerca volvulus or Loa loa, which are filarial parasites that are co-endemic with W. bancrofti in Africa. Specificity was 97.9% with North American control samples. ELISA with sera from a clinical trial in Sri Lanka demonstrated that antibodies to WbN1 decreased significantly faster after treatment than antibodies to the previously described filarial antigen Bm14. Similar declines in antibody to WbN1 occurred after patients in Papua New Guinea received a single dose of triple drug treatment for LF with Ivermectin Diethylcarbamazine and Albendazole, that is effective for clearing MF from the blood without clearing filarial antigenemia.

Conclusions
While additional studies are needed, this ELISA for IgG4 antibody to the recombinant protein WbN1 could be a promising new surveillance tool for assessing for ongoing transmission of LF following MDA.
How professional actions connect and protect
Authors: Faulconbridge James , Folke Henriksen Lasse , Seabrooke Leonard 
Published: June 2021

AbstractBelow we provide responses to the ongoing debate sparked by Mirko Noordegraaf’s intervention in suggesting that we are moving toward forms of ‘connective professionalism’. Critics in this debate have objected to Noordegraaf in a number of ways. Some object to a conflation of ideal types and empirical description. Others assert that Noordegraaf suggests a staged process of moving from protective to connective types of professionalism does not ring true; that we can finds forms of connection and protection in contemporary professionalism and in professional action. Our companions in this issue (Alvehus, Avnoon, and Oliver) suggest that greater connectiveness also permits new forms of protection as part of professionalism. Our short essays contribute to the Noordegraaf debate by focusing less on professionalism and more on how forms of professional action lead to mechanisms of connection and protection.
Narrow Therapeutic Index drugs: clinical pharmacology perspective
Authors: Habet Sam 
Published: June 2021

Abstract

Objectives
Historically, the identification of drugs with the Narrow Therapeutic Index (NTI) has been empirically based on the clinical practice. In general terms, NTI drugs can be defined based on the steepness of the dose–response relationship and the degree of overlap between the effective and the toxic concentrations.

Key findings
The current definition in the Code of Federal Regulations is based on animal data and as such lacks direct clinical relevance. By basing these criteria on those factors that affect the degree of separation of the concentrations that elicit the therapeutic and the adverse effects, it was attempted to avoid the vagaries inherent in preparing a list of individual drugs themselves.

Summary
The overall conclusions are: (1) The issue of NTI drugs is still highly controversial, (2) The lists of NTI drugs are arbitrary and (3) Variability may contribute to the safety and efficacy. The objectives are to (1) To facilitate consensus on the definition of a NTI, (2) To identify characteristics of NTI and (3) To develop criteria for identifying NTI. The FDA should consider not only the pharmacokinetics (PK) studies, but also comparative efficacy and safety studies, for the NTI drugs to further to try ‘convince or educate’ the prescribers.
The heat is on: how crop growth, development, and yield respond to high temperature
Authors: Zhu Tingting , Fonseca De Lima Cassio Flavio , De Smet Ive 
Published: June 2021

Abstract
Plants are exposed to a wide range of temperatures during their life cycle and need to continuously adapt. These adaptations need to deal with temperature changes on a daily and seasonal level and with temperatures affected by climate change. Increasing global temperatures negatively impact crop performance, and several physiological, biochemical, morphological, and developmental responses to increased temperature have been described that allow plants to mitigate this. In this review, we assess various growth-, development-, and yield-related responses of crops to extreme and moderately high temperature, focusing on knowledge gained from both monocot (e.g. wheat, barley, maize, and rice) and dicot crops (e.g. soybean and tomato) and incorporating information from model plants (e.g. Arabidopsis and Brachypodium). This revealed common and different responses between dicot and monocot crops, and defined different temperature thresholds depending on the species, growth stage, and organ.
Transcription factors DkBZR1/2 regulate cell wall degradation genes and ethylene biosynthesis genes during persimmon fruit ripening
Authors: He Yiheng , Liu Hui , Li Huan , Jin Mijing , Wang Xianglan , Yin Xueren , Zhu Qinggang , Rao Jingping 
Published: June 2021

Abstract
BRASSINAZOLE RESISTANT (BZR) transcription factors are critical components of the brassinosteroid signalling pathway, but their possible roles in fruit ripening have rarely been reported. In this study, four BZR sequences were isolated from persimmon fruit. Among the four BZR genes, DkBZR1/2 were expressed in persimmon fruit; DkBZR1 protein amount decreased and dephosphorylated DkBZR2 gradually accumulated during the storage period. DkBZR1/2 proteins were localized in both the nucleus and cytoplasm and accumulated in the nucleus after 24-epibrassinolide treatment. DkBZR1 suppressed the transcription of Diospyros kaki endo-1,4-betaglucanase 1 (DkEGase1) and 1-aminocyclopropane-1-carboxylate synthase 1 (DkACS1) by binding to the BR response element (BRRE) in their promoters, and DkBZR2 activated the transcription of pectate lyase 1 (DkPL1) and 1-aminocyclopropane-1-carboxylate oxidase 2 (DkACO2) by binding to the E-box motif in their promoters. Transient overexpression of DkBZR2 promoted the conversion of acid-soluble pectin to water-soluble pectin and increased ethylene production in persimmon fruit. Our findings indicate that DkBZR1 and DkBZR2 serve as repressors and activators of persimmon fruit ripening, respectively.
“They Stood like Men”: Horses, Myth, and Carnophallogocentrism in Toni Morrison’s Home
Authors: Alonso-Recarte Claudia 
Published: June 2021

Abstract
Toni Morrison’s fiction has frequently attracted critical attention on account of her strategic use of myth (whether classical or Afrocentric) and symbols. This paper examines the role that horses have, as rhetorical constructs, in strengthening the mythical and symbolic unity of her tenth novel Home (2012). Horses have figured widely in the articulation of African American history and letters, often serving as symbols of the abused slaves upon whose bodies the equipment and instruments of oppression and bondage were violently placed. Within Morrison’s cornucopia of animal imagery, their presence is essential for an understanding of the rituals that are so much a part of the novel’s exploration of masculinity and the overcoming of trauma. The horses in Home stand as mythopoetic agents around whom the problematic completion of rituals revolves. As namely linguistic constructs, the rhetorical devices and choices employed in the description of the horses and their final fate points to a discourse that signifies on the structural tensions that are characteristic of classical mythology but that also draw on the African American communal experience. At the same time, they invite a reading of Morrison’s ritualistic pulse through Jacques Derrida’s carnophallogocentric schema. The schema links together the different motifs and interspecies similes and metaphors that populate the text, enabling a deconstruction of the “centaur” image that lies at the heart of the protagonist’s homecoming journey