bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fitness cost of vancomycin-resistant Enterococcus faecium plasmids associated with hospital infection outbreaks
Authors: Tedim Ana P , Lanza Val F , Rodríguez Concepción M , Freitas Ana R , Novais Carla , Peixe Luísa , Baquero Fernando , Coque Teresa M 
Published: August 2021

Abstract

Background
Vancomycin resistance is mostly associated with Enterococcus faecium due to Tn1546-vanA located on narrow- and broad-host plasmids of various families. This study’s aim was to analyse the effects of acquiring Tn1546-carrying plasmids with proven epidemicity in different bacterial host backgrounds.

Methods
Widespread Tn1546-carrying plasmids of different families RepA_N (n = 5), Inc18 (n = 4) and/or pHTβ (n = 1), and prototype plasmids RepA_N (pRUM) and Inc18 (pRE25, pIP501) were analysed. Plasmid transferability and fitness cost were assessed using E. faecium (GE1, 64/3) and Enterococcus faecalis (JH2-2/FA202/UV202) recipient strains. Growth curves (Bioscreen C) and Relative Growth Rates were obtained in the presence/absence of vancomycin. Plasmid stability was analysed (300 generations). WGS (Illumina-MiSeq) of non-evolved and evolved strains (GE1/64/3 transconjugants, n = 49) was performed. SNP calling (Breseq software) of non-evolved strains was used for comparison.

Results
All plasmids were successfully transferred to different E. faecium clonal backgrounds. Most Tn1546-carrying plasmids and Inc18 and RepA_N prototypes reduced host fitness (–2% to 18%) while the cost of Tn1546 expression varied according to the Tn1546-variant and the recipient strain (9%–49%). Stability of Tn1546-carrying plasmids was documented in all cases, often with loss of phenotypic resistance and/or partial plasmid deletions. SNPs and/or indels associated with essential bacterial functions were observed on the chromosome of evolved strains, some of them linked to increased fitness.

Conclusions
The stability of E. faecium Tn1546-carrying plasmids in the absence of selective pressure and the high intra-species conjugation rates might explain the persistence of vancomycin resistance in E. faecium populations despite the significant burden they might impose on bacterial host strains.
Creation of a pharmacogenomics patient portal complementary to an existing institutional provider-facing clinical decision support system
Authors: Lipschultz Elizabeth , Danahey Keith , Truong Tien M , Schierer Emily , Volchenboum Samuel L , Ratain Mark J , O’Donnell Peter H 
Published: August 2021

Abstract

Background
Applied pharmacogenomics presents opportunities for improving patient care through precision medicine, particularly when paired with appropriate clinical decision support (CDS). However, a lack of patient resources for understanding pharmacogenomic test results may hinder shared decision-making and patient confidence in treatment. We sought to create a patient pharmacogenomics education and results delivery platform complementary to a CDS system to facilitate further research on the relevance of patient education to pharmacogenomics.

Methods
We conceptualized a model that extended the data access layer of an existing institutional CDS tool to allow for the pairing of decision supports offered to providers with patient-oriented summaries at the same level of phenotypic specificity. We built a two-part system consisting of a secure portal for patient use and an administrative dashboard for patient summary creation. The system was built in an ASP.NET and AngularJS architecture, and all data was housed in a HIPAA-compliant data center, with PHI secure in transit and at rest.

Results
The YourPGx Patient Portal was deployed on the institutional network in June 2019. Fifty-eight unique patient portal summaries have been written so far, which can provide over 4500 results modules to the pilot population of 544 patients. Patient behavior on the portal is being logged for further research.

Conclusions
To our knowledge, this is the first automated system designed and deployed to provide detailed, personalized patient pharmacogenomics education complementary to a clinical decision support system. Future work will expand upon this system to allow for telemedicine and patient notification of new or updated results.
Litterfall seasonality and adaptive strategies of tropical and subtropical evergreen forests in China
Authors: Dai Yuhang , Gong Fanxi , Yang Xueqin , Chen Xiuzhi , Su Yongxian , Liu Liyang , Wu Jianping , Liu Xiaodong , Sun Qingling 
Published: August 2021

AbstractTropical and subtropical evergreen broad-leaved forests (EBFs) and needle-leaved forests (ENFs) in China exhibit complex leaf shedding strategies in responses to soil water availability, vapor pressure deficits (VPDs) and sunlight availability. However, the seasonal variations and triggers of litterfall differ significantly in tropical/subtropical forests, and there are still many uncertainties. Herein, we aim to explore the distinct climatic factors of seasonal litterfall in a climate–phenology correlation framework. We collected seasonal litterfall data from 85 sites across tropical/subtropical China and used linear correlation coefficients between sunlight and rainfall to partition synchronous/asynchronous climates. Additional phase analysis and structural equation model analysis were conducted to model the climatic triggers of tropical phenology. Results indicated two types of tropical litterfall phenology under two types of climates. In synchronous climates, where seasonal sunlight and rainfall are positively correlated, the litterfall peak of the unimodal phenology and the first litterfall peak of the bimodal phenology both happen at the end of dry season. The second litterfall peak of the bimodal phenology occurs at the end of rainy season due to water stress. In asynchronous climates, where seasonal sunlight and rainfall are negatively correlated, VPD shows consistent seasonal variations with incoming sunlight. The leaf senescence is accelerated at the end of dry season by higher VPD; while soil water deficit is in anti-phase with sunlight and mainly controls the second litterfall peak of the bimodal phenology in EBF. Our findings provide an important reference for modeling tropical phenology in Earth system models.
Effects of Guitar Accompaniment Patterns on Hospitalized Infants: A Randomized Controlled Trial
Authors: Antonacci Kory , Steele Nicole , Wheatley Jacob , Weyant Donna M , Brozanski Beverly , Stone Brittany , Mingrone Teresa 
Published: August 2021

Abstract
A neonatal intensive care unit (NICU) can be an extremely stressful environment for infants receiving complex medical care at a pediatric facility. Music therapy can help address the stressful environment by increasing comfort and relaxation as well as decreasing a patient’s physiological response of heart rate and respiratory rate. A randomized controlled trial was completed, examining the effects of 2 guitar accompaniment patterns on infants (an arpeggiated pattern and a bass/chord pattern) in a NICU. There were 180 infants enrolled with mean chronological ages of 7.4 ± 6.1 weeks and postmenstrual ages (gestational age at birth + their chronological age) of 39.8 ± 7.9 weeks. All subject enrollees participated in a 12-minute initial music therapy session. Outcome measures included heart rate, respirations, and comfort responses. The results of the research study demonstrated that the arpeggiated guitar pattern had a lower mean heart rate and respiratory across all 3 data points (pre, during, and post intervention); however, the difference in means between the 2 accompaniment pattern groups was not statistically significant. Using the Neonatal Infant Pain Scale (NIPS) to measure comfort response, the results demonstrated no difference between the 2 group accompaniment patterns. Although the results show no significant differences among accompaniment pattern groups, the researchers describe the clinical significance that supports the use of both accompaniment patterns as suitable interventions for infants in the NICU receiving music therapy intervention.
Towards a computational phenomenology of mental action: modelling meta-awareness and attentional control with deep parametric active inference
Authors: Sandved-Smith Lars , Hesp Casper , Mattout Jérémie , Friston Karl , Lutz Antoine , Ramstead Maxwell J D 
Published: August 2021

Abstract
Meta-awareness refers to the capacity to explicitly notice the current content of consciousness and has been identified as a key component for the successful control of cognitive states, such as the deliberate direction of attention. This paper proposes a formal model of meta-awareness and attentional control using hierarchical active inference. To do so, we cast mental action as policy selection over higher-level cognitive states and add a further hierarchical level to model meta-awareness states that modulate the expected confidence (precision) in the mapping between observations and hidden cognitive states. We simulate the example of mind-wandering and its regulation during a task involving sustained selective attention on a perceptual object. This provides a computational case study for an inferential architecture that is apt to enable the emergence of these central components of human phenomenology, namely, the ability to access and control cognitive states. We propose that this approach can be generalized to other cognitive states, and hence, this paper provides the first steps towards the development of a computational phenomenology of mental action and more broadly of our ability to monitor and control our own cognitive states. Future steps of this work will focus on fitting the model with qualitative, behavioural, and neural data.
Explanatory profiles of models of consciousness - towards a systematic classification
Authors: Signorelli Camilo Miguel , Szczotka Joanna , Prentner Robert 
Published: August 2021

AbstractModels of consciousness aim to inspire new experimental protocols and aid interpretation of empirical evidence to reveal the structure of conscious experience. Nevertheless, no current model is univocally accepted on either theoretical or empirical grounds. Moreover, a straightforward comparison is difficult for conceptual reasons. In particular, we argue that different models explicitly or implicitly subscribe to different notions of what constitutes a satisfactory explanation, use different tools in their explanatory endeavours and even aim to explain very different phenomena. We thus present a framework to compare existing models in the field with respect to what we call their ‘explanatory profiles’. We focus on the following minimal dimensions: mode of explanation, mechanisms of explanation and target of explanation. We also discuss the empirical consequences of the discussed discrepancies among models. This approach may eventually lead to identifying driving assumptions, theoretical commitments, experimental predictions and a better design of future testing experiments. Finally, our conclusion points to more integrative theoretical research, where axiomatic models may play a critical role in solving current theoretical and experimental contradictions.
In situ phase transitional polymeric vaccines for improved immunotherapy
Authors: Wang Jie , Wang Yi , Qiao Shenglin , Mamuti Muhetaerjiang , An Hongwei , Wang Hao 
Published: August 2021

Abstract
Cancer vaccines have exhibited immense potential in cancer treatment. Through activating the host's immune system, vaccines stimulate extensive functional T cells to eliminate cancer. However, the therapeutic efficacy of cancer vaccines is limited by their inferior lymph node delivery and inadequate uptake of dendritic cells. Herein, we propose an in situ phase transitional strategy on vaccine manufacturing to maximally enhance lymph node drainage while ensuring adequate dendritic cell uptake. The phase transitional vaccines, with dynamic size modulation property, retain a small size (24.4 ± 3.1 nm) during lymph node draining then transform into larger particles (483.0 ± 41.6 nm) on-site by external signal input. Results show that this strategy induced rapid and robust immune response in a mouse melanoma tumor model. Furthermore, a stronger humoral immune response was observed in mice when immunized with MHC-II restricted antigen, which demonstrated that lymph node-targeted cancer vaccine delivery could be effectively manipulated through dynamic size modulation.
Disease severity, flares and treatment patterns in adults with systemic lupus erythematosus in the UK: a real-world observational retrospective cohort analysis
Authors: Langham Julia , Barut Volkan , Samnaliev Mihail , Langham Sue , Weir Sharada , Wang Xia , Desta Barnabas , Hammond Edward 
Published: August 2021

Abstract

Objectives
The aim was to characterize disease severity, clinical manifestations, treatment patterns and flares in a longitudinal cohort of adults with SLE in the UK.

Methods
Adults with SLE were identified in the Clinical Practice Research Datalink–Hospital Episode Statistics database (1 January 2005–31 December 2017). Patients were required to have ≥12 months of data before and after the index date (earliest SLE diagnosis date available). SLE disease severity and flares were classified using adapted claims-based algorithms, which are based on SLE-related conditions, medications and health-service use.

Results
Of 802 patients, 369 had mild, 345 moderate and 88 severe SLE at baseline. A total of 692 initiated treatment in the first year after diagnosis. Five hundred and fifty-seven received antimalarials, 203 immunosuppressants and 416 oral CSs. Information on biologic use in hospitals was unavailable. The mean (S.d.) time to initiating any medication was 177 (385.3) days. The median time to first flare was 63 days (95% CI: 57, 71). At least one flare was experienced by 750 of 802 patients during follow-up; the first flare was mild for 549 of 750, moderate for 116 of 750 and severe for 85 of 750. The mean (S.d.) annual overall flare rate (year 1) was 3.5 (2.5). A shorter median time to first flare was significantly associated with moderate/severe disease (P &lt; 0.001) and clinical manifestations (P &lt; 0.001).

Conclusion
Our findings suggest some delay in the initiation of SLE treatment. Most patients experience a flare within 2 months of diagnosis. Early treatment might delay or reduce the severity of the first SLE flare and might translate to slower disease progression, lower accrual of organ damage and better outcomes.
Teacher–student neural coupling during teaching and learning
Authors: Nguyen Mai , Chang Ashley , Micciche Emily , Meshulam Meir , Nastase Samuel A , Hasson Uri 
Published: August 2021

AbstractHuman communication is remarkably versatile, enabling teachers to share highly abstracted and novel information with their students. What neural processes enable such transfer of information across brains during naturalistic teaching and learning? Here, a teacher was scanned in functional magnetic resonance imaging while giving an oral lecture with slides on a scientific topic followed by a review lecture. Students were then scanned while watching either the intact Lecture and Review (N = 20) or a temporally scrambled version of the lecture (N = 20). Using intersubject correlation, we observed widespread Teacher–Student neural coupling spanning sensory cortex and language regions along the superior temporal sulcus as well as higher-level regions including posterior medial cortex (PMC), superior parietal lobule, and dorsolateral and dorsomedial prefrontal cortex. Teacher–student alignment in higher-level areas was not observed when learning was disrupted by temporally scrambling the lecture. Moreover, teacher–student coupling in PMC was significantly correlated with learning: the more closely the student’s brain mirrored the teacher’s brain, the more the student improved their learning score. Together, these results suggest that the alignment of neural responses between teacher and students may reflect effective communication of complex information across brains in classroom settings.
circFAM120A participates in repeated implantation failure by regulating decidualization via the miR‐29/ABHD5 axis
Authors: Zhou Tingting , Ni Tianxiang , Li Yan , Zhang Qian , Yan Junhao , Chen Zi‐Jiang 
Published: August 2021

AbstractRepeated implantation failure (RIF) is a major problem that limits the pregnancy rate associated with assisted reproductive technology. However, the pathogenesis of RIF is still unknown. Recently, the expression levels of circular RNAs (circRNAs) were profiled in the endometrial tissues of patients with RIF. However, the exact role of circRNAs in RIF remains unclear. In our study, we found that circFAM120A levels were significantly down‐regulated in the endometrium at the window of implantation in RIF patients compared with non‐RIF controls. The suppression of circFAM120A expression inhibited decidualization in human endometrial stromal cells (hESCs). Furthermore, RNA‐seq analysis after circFAM120A knockdown revealed ABHD5 as a potential downstream target gene of circFAM120A. As expected, down‐regulating ABHD5 in hESCs also inhibited decidualization. Using the starBase and TargetScan databases, we predicted that miR‐29 may interact with ABHD5, based on nucleotide sequence matching. Luciferase reporter assay showed that miR‐29 bound to the 3′ UTR of ABHD5 at the predicted complementary sites. Moreover, miR‐29 mimics efficiently reduced ABHD5 expression levels and suppressed the decidualization process, whereas a miR‐29 inhibitor partly rescued ABHD5 mRNA expression level and decidualization reduced by the knockdown of circFAM120A. Therefore, circFAM120A modulated decidualization in RIF through the miR‐29/ABHD5 axis.
Cervical cancer screening guidelines
Authors: Shami Sarah , Coombs Jennifer 
Published: August 2021

ABSTRACT
Cervical cancer screening practices in the United States have been inefficient, with variable screening rates. Some women are screened too frequently, overmanaged, lost to follow-up, or are at risk and should be screened but are not. Timely screening, identification, and management of abnormal cervical cells is vital in order to prevent progression to cervical cancer. Educating, counseling, screening, and offering the human papillomavirus vaccine continue to be the primary methods of cervical cancer prevention practices. Guidelines and primary screening methods have been updated because of supporting evidence, and clinicians must stay up-to-date in order to provide effective patient care.
Is the high-dose influenza vaccine better for people over age 65 years?
Authors: Haley Anna , Urnoski Eric 
Published: August 2021

ABSTRACT
Influenza vaccinations are one of the largest public health initiatives each year. The vaccine's components are varied, and the high-dose influenza vaccine was designed to provide better protection for older adults. Patients may request the high-dose vaccine due to a perceived superior benefit. This article describes the vaccine formulations and whether older adults require high-dose compared with standard-dose vaccinations.
Characteristics of Second-Line Investigations of Middle-Aged Athletes Who Failed Preparticipation Examinations
Authors: Neuman Gil , Milman Anat , Ziv-Baran Tomer , Dubnov-Raz Gal 
Published: August 2021

Objective:
The role of exercise testing during preparticipation examinations (PPEs) of middle-aged athletes is uncertain. This study examined the characteristics of disqualifications after an initial PPE that includes an exercise test in competitive athletes older than 30 years. We investigated disqualification rates and reasons, second-line investigations performed, and final decisions regarding competitive sports participation.

Design:
Chart review.

Setting:
Sports medicine clinic.

Participants:
Athletes aged >30 years that performed an exercise test as part of their annual PPE at our sports medicine clinic (n = 866).

Independent Variables:
Age, sex, height, weight, sport type, cardiovascular risk factors, and abnormal PPE findings.

Main Outcome Measures:
Additional investigations performed, approval/disqualification regarding competitive sports participation.

Results:
The initial disqualification rate of athletes was 9.8%. Three (3.6%) athletes were disqualified following questionnaire and physical examination, 19 (22.4%) because of resting electrocardiogram findings, and 65 (76.5%) following the exercise test. After additional work-up, only 5 athletes (0.4%) were ultimately found ineligible for competitive sports. From those, only 2 athletes (0.2%) were disqualified because of exercise test findings, which were episodes of supraventricular tachycardia and not ischemia-related.

Conclusions:
The addition of an exercise test to the PPE of middle-aged athletes is of limited value. If exercise testing of older athletes is performed, arrhythmias are probably of higher significance than ST-T changes.
Rare Cause of Syncope in an Athlete, Matter of Brain and Heart Electricity
Authors: Navot-Mintzer Dalya , Ekstein Dana , Nof Eyal , Fogelman Rami , Beinart Roy , Honig Asaf , Constantini Naama 
Published: August 2021

Abstract:
A 17-year-old elite triathlete presented with recurrent loss of consciousness events. Implantable loop recorder (ILR) documented sinus node asystoles of up to 21 seconds. She underwent cardiac neuromodulation ablation. After ablation, a generalized tonic–clonic seizure (GTCS) occurred, without concomitant asystole on the ILR. Temporal lobe seizures were diagnosed and supported by interictal epileptic activity on electroencephalogram. We assumed that the syncope episodes were ictal asystole (IA) and that the IA terminated the epileptic seizures early after their onset. The cardiac ablation prevented IA, enabling spread of seizure activity and development of GTCS. To the best of our knowledge, this is the first case of IA treated with cardiac ablation, allowing avoidance of cardiac pacing. This case raises the awareness to epileptic seizures as a cause of asystole in athletes, with an elusive and atypical presentation.
Comparative study on the clinical characteristics of local cases of COVID-19 and imported cases from abroad
Authors: Liu Jing-He , Chang Yu-Fei , Ma Shan-Fang , Wang Ling-Hang 
Published: August 2021

Abstract
It is presently unknown whether imported cases of the 2019 coronavirus disease (COVID-19) have different characteristics when compared with local cases. To compare the clinical characteristics of local cases of COVID-19 in China compared with those imported from abroad.
This was a retrospective study of confirmed cases of COVID-19 admitted at the Beijing Ditan Fever Emergency Department between February 29th, 2020, and March 27th, 2020. The clinical characteristics of the patients were compared between local and imported cases.
Compared with local cases, the imported cases were younger (27.3 ± 11.7 vs. 43.6 ± 22.2 years, P < .001), had a shorter interval from disease onset to admission (1.0 (0.0–2.0) vs 4.0 (2.0–7.0) days, P < .001), lower frequencies of case contact (17.4% vs 94.1%, P < .001), fever (39.1% vs 82.4%, P < .001), cough (33.3% vs 51.0%, P = .03), dyspnea (1.9% vs 11.8%, P = .01), fatigue (7.5% vs. 27.5%, P = 0.001), muscle ache (4.7% vs. 25.5%, P < 0.001), and comorbidities (P < .05). The imported cases were less severe than the local cases, with 40.4% versus 5.9% mild cases, 2.8% versus 15.7% severe cases, and no critical cases (P < .001). The length of hospital stay was longer in imported cases than in local cases (32.3 ± 14.5 vs 21.7 ± 11.2 days, P < .001). The imported cases showed smaller biochemical perturbations than the local cases. More imported cases had no sign of pneumonia at computed tomography (45.0% vs 14.9%, P = .001), and none had pleural effusion (0% vs 14.9%, P < .001).
Compared with local cases, the imported cases of COVID-19 presented with milder disease and less extensive symptoms and signs.