bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneous survival upon disinfection underlies evolution of increased tolerance
Authors: Nordholt Niclas , Sobisch Lydia-Yasmin , Gödt Annett , Lewerenz Dominique , Schreiber Frank 
Published: October 2024

ABSTRACT

Disinfection is important to limit the spread of infections, but failure of disinfection may foster the evolution of antimicrobial resistance in bacteria. Persisters are phenotypically tolerant subpopulations that survive toxic stress longer than susceptible cells, leading to failure in treatments with antimicrobials and facilitating resistance evolution. To date, little is known about persistence in the context of disinfectants. The aim of this study was to investigate the influence of persisters on disinfection and to determine the consequences of disinfectant persistence for the evolution of increased tolerance to disinfectants. Disinfection kinetics with high temporal resolution were recorded for
Escherichia coli
exposed to the following six disinfectants: hydrogen peroxide (H
2
O
2
), glutaraldehyde (GTA), chlorhexidine (CHX), benzalkonium chloride (BAC), didecyldimethylammonium chloride (DDAC), and isopropanol (ISO). A mathematical model was used to infer the presence of persisters from the time–kill data. Time–kill kinetics for BAC, DDAC, and ISO were indicative of persisters, whereas no or weak evidence was found for H
2
O
2
, GTA, and CHX. When subjected to comparative experimental evolution under recurring disinfection,
E. coli
evolved increased tolerance to substances for which persisters were predicted (BAC and ISO), whereas adaptation failed for substances in which no persisters were predicted (GTA and CHX), causing extinction of exposed populations. Our findings have implications for the risk of disinfection failure, highlighting a potential link between persistence to disinfectants and the ability to evolve disinfectant survival mechanisms.

IMPORTANCE

Disinfection is key to control the spread of infections. But the application of disinfectants bears the risk to promote the evolution of reduced susceptibility to antimicrobials if bacteria survive the treatment. The ability of individual bacteria to survive disinfection can display considerable heterogeneity within isogenic populations and may be facilitated by tolerant persister subpopulations. Using time–kill kinetics and interpreting the data within a mathematical framework, we quantify heterogeneity and persistence in
Escherichia coli
when exposed to six different disinfectants. We find that the level of persistence, and with this the risk for disinfection failure, depends on the disinfectant. Importantly, evolution experiments under recurrent disinfection provide evidence that links the presence of persisters to the ability to evolve reduced susceptibility to disinfectants. This study emphasizes the impact of heterogeneity within bacterial populations on disinfection outcomes and the potential consequences for the evolution of antimicrobial resistances.
IT Service Disruptions and Provider Choice
Authors: Yeo M. Lisa , Hidaji Hooman , Rolland Erik , Patterson Raymond A. , Nault Barrie , Kolfal Bora 
Published: October 2024

Digital supply chains are increasingly interconnected and vulnerable to disruption, causing service interruptions impacting many firms and their customers. Combating threats to the digital supply chain is the top challenge for leaders in most supply chain industries, demonstrated by the tacit approval of nation-states for cyber-attacks on corporate supply chains to disrupt downstream firms.
Disruptions to digital supply chains are not new. In April 2019, hundreds of flights in the United States were delayed when a critical service provider, AeroData, had a computer systems failure. AeroData delivers flight planning services to many airlines including Southwest, United, American, and Delta. All flight operations for AeroData’s over 100 clients simultaneously ceased and thousands of customers were stranded at airports across the country. In an increasingly connected business environment, competitors may be simultaneously disrupted due to a common service provider, impacting all affected firms’ demand.
The synchronization of disruptions for firms that use a common service provider has implications for service provider choice and investment. We use a two-stage game to model how a firm’s customer demand is impacted by disruptions at a service provider, and how this subsequently affects the firms’ choices in managing service provider risk. Considering downstream demand effects from upstream service disruptions, the contribution of this paper is the examination of how risk synchronization impacts provider choice decisions and profits. In addition, we illustrate how these choices impact upstream industry concentration.
Disparities in the Use of Annual Heart Health Screenings Among Latino, Black, and Asian Immigrants: Evidence from the 2011 to 2018 National Health Interview Survey
Authors: Benjasirisan Chitchanok , Elias Sabrina , Lim Arum , Byiringiro Samuel , Chen Yuling , Kruahong Suratsawadee , Turkson‐Ocran Ruth‐Alma , Dennison Himmelfarb Cheryl R. , Commodore‐Mensah Yvonne , Koirala Binu 
Published: October 2024

Background
Immigrants are disproportionately affected by cardiovascular disease burden. Heart health screenings, including blood pressure, fasting blood glucose (FBG), and blood cholesterol screenings, can help identify cardiovascular disease risk. Evidence on heart health screenings among diverse immigrant groups is still limited. This study examined the disparities in heart health screenings among the immigrant population compared with US‐born White adults.

Methods and Results
A cross‐sectional design was used to analyze data from the 2011 to 2018 National Health Interview Survey. Generalized linear models with Poisson distribution were applied to compare the prevalence of annual blood pressure, fasting blood glucose, and blood cholesterol screenings among Latino, Black, and Asian immigrants and US‐born White adults. The analysis included 145 149 adults (83.60% US‐born White adults, 9.55% Latino immigrants, 1.89% Black immigrants, and 4.96% Asian immigrants), with a mean age of 50 years and 53.62% women. Latino (adjusted odds ratio [aOR], 0.92 [95% CI, 0.91–0.93]) and Asian (aOR, 0.93 [95% CI, 0.92–0.94]) immigrants were less likely to have blood pressure screening than US‐born White adults. Latino (aOR, 1.22 [95% CI, 1.19–1.25]), Black (aOR, 1.15 [95% CI, 1.09–1.21]), and Asian (aOR, 1.12 [95% CI, 1.08–1.15]) immigrants were more likely to have fasting blood glucose screening, and Latino (aOR, 1.11 [95% CI, 1.09–1.13]), Black or (aOR, 1.12 [95% CI, 1.09–1.16]), and Asian (aOR, 1.05 [95% CI, 1.04–1.07]) immigrants were more likely to have blood cholesterol screening than US‐born White adults.

Conclusions
Latino and Asian immigrants have lower odds of annual blood pressure screenings than US‐born White adults. More studies exploring facilitators and barriers to the accessibility and use of heart health screenings are needed.
Lipoprotein(a) and High‐Sensitivity C‐Reactive Protein Compound the Risk of Hypoattenuating Leaflet Thickening After Transcatheter Aortic Valve Replacement
Authors: Shi Wence , Feng Dejing , Hu Xiangming , Wang Can , Niu Guannan , Zhao Zhenyan , Zhang Hongliang , Wang Moyang , Wu Yongjian 
Published: October 2024

Background
The mechanism for hypoattenuating leaflet thickening (HALT) after transcatheter aortic valve replacement is still not well elucidated, and the role of Lp(a) (lipoprotein[a]) and hs‐CRP (high‐sensitivity C‐reactive protein) has rarely been studied. This study sought to test the hypothesis that the risk of HALT is associated with an elevated level of Lp(a) or hs‐CRP.

Methods and Results
A total of 307 consecutive individuals who underwent a transcatheter aortic valve replacement procedure were included. All patients received their first postoperative computed tomography scans within 12 months, and raw data were analyzed on 3mensio software. HALT was defined as visually identified increased leaflet thickness with typical meniscal appearance and at least 2 different multiplanar reformation projections. Associations of Lp(a) or hs‐CRP with the risk of HALT were evaluated using multivariable logistic regression analysis. The incidence of HALT within 12 months after transcatheter aortic valve replacement in this study was 36.2%, and the risk of HALT was associated with higher baseline Lp(a) (the multivariable adjusted odds ratio [OR] for every 10 mg/dL change was 1.18 [95% CI, 1.09–1.29]) and hs‐CRP level (the multivariable adjusted OR for every 1 mg/L change was 1.08 [95% CI, 1.00–1.27]). Compared with individuals out of the top 25th percentile for both Lp(a) and hs‐CRP, the multivariable adjusted OR for HALT was 4.74 (95% CI, 1.65–14.37) for the top 25th percentile. This result remained consistent after excluding patients receiving anticoagulant therapy.

Conclusions
The top 25th percentile of Lp(a) level (≥40 mg/dL) combined with the top 25th percentile of hs‐CRP level (≥3.5 mg/L) conferred a 4.74‐fold risk of HALT.
Choroid Plexus Volume in Rural Chinese Older Adults: Distribution and Association With Cardiovascular Risk Factors and Cerebral Small Vessel Disease
Authors: Li Chunyan , Zhang Huisi , Wang Jiafeng , Han Xiaodong , Liu Cuicui , Li Yuanjing , Gong Tao , Hou Tingting , Wang Yongxiang , Cong Lin , Kalpouzos Grégoria , Wardlaw Joanna , Song Lin , Du Yifeng , Qiu Chengxuan 
Published: October 2024

Background
The choroid plexus (CP) is involved in neurodegenerative diseases. However, the association of CP with cardiovascular risk factors and cerebral small vessel disease in older adults remains unclear.

Methods and Results

This population‐based study included 1263 participants (60 years and older) from the MIND‐China (Multimodal Interventions to Delay Dementia and Disability in Rural China) substudy (2018–2020), of which 111 individuals completed diffusion tensor imaging examination. CP volume was automatically segmented. White matter hyperintensities (WMHs), enlarged perivascular spaces (EPVS), cerebral microbleeds, and lacunes were assessed following the Standards for Reporting Vascular Changes on Neuroimaging 1. Peak width of skeletonized mean diffusivity and free water were derived from diffusion tensor imaging images. We used linear regression models to evaluate the association between CP volume and cardiovascular risk factors, WMH volumes, and diffusion tensor imaging metrics, and logistic regression models to examine the association between CP volume and EPVS, cerebral microbleeds, and lacunes. The CP volume increased with age (
P
<0.001). Men (β coefficient=0.47 [95% CI, 0.29–0.64]) and participants with diabetes (β coefficient=0.16 [95% CI, 0.01–0.31]) had larger CP volumes than women and individuals without diabetes, respectively (
P
<0.05). Greater CP volume was significantly associated with larger total and periventricular WMH volumes and moderate to severe EPVS in basal ganglia (
P
<0.05) but not with deep WMHs, EPVS in centrum semiovale, lacunes, or cerebral microbleeds. In the diffusion tensor imaging subsample, enlarged CP was significantly associated with higher peak width of skeletonized mean diffusivity and free water of periventricular and deep white matter (
P
<0.05).

Conclusions
An enlarged CP is associated with larger global and periventricular WMH volume and higher likelihoods of EPVS in basal ganglia and impaired white matter integrity, suggesting that an enlarged CP may represent a precursor of cerebral small vessel disease.
Enhancing Blood–Brain Barrier Integrity in Patients With Acute Ischemic Stroke Via Normobaric Hyperoxia
Authors: Li Weili , Hu Wenbo , Yuan Shuhua , Chen Jiahao , Wang Qi , Ding Jiayue , Chen Zhiying , Qi Zhifeng , Han Ju 
Published: October 2024

BACKGROUND
Recent advancements in animal studies have demonstrated the potential of normobaric hyperoxia (NBO) as a promising intervention for preserving the integrity of the blood–brain barrier (BBB). However, there is still limited understanding of the effects of NBO on BBB function in patients with clinical stroke. Therefore, the objective of this study was to investigate the efficacy of NBO therapy in attenuating BBB damage and reducing brain injury in individuals undergoing endovascular treatment (EVT) for acute stroke.

METHODS AND RESULTS

This study enrolled patients from the OPENS‐1 (Normobaric Hyperoxia Combined With Reperfusion for Acute Ischemic Stroke) study, with 43 patients receiving NBO combined with EVT and 43 patients receiving EVT alone. The main outcome measures included serum levels of occludin, MMP‐9 (matrix metalloproteinase‐9), NSE (neuron‐specific enolase), and S100b at 24 hours and 7 days, as well as the intracranial extravasation rate at 24 hours. Serum markers were assessed using ELISA, and intracranial contrast extravasation was visualized using dual‐energy computed tomography scan. We analyzed a total of 86 patients and found that the 24‐hour serum markers levels of BBB damage and brain injury were significantly lower in the group receiving NBO therapy combined with EVT compared with the group receiving EVT alone. Similarly, at 7 days, the levels of occludin, MMP‐9, and NSE were lower in the NBO+EVT group. We also found that the 24‐hour serum levels of occludin and MMP‐9 were correlated with intracranial contrast extravasation. Additionally, the incidence of intracranial contrast extravasation was lower in the NBO+EVT group compared with the EVT group (35.9% versus 60.5%,
P
=0.031).

CONCLUSIONS
This study offers valuable insights into the positive impact of NBO on maintaining BBB integrity and reducing brain injury in patients with acute stroke undergoing EVT.
Evaluating the Safety and Efficacy of Telemedicine Physician Assessments on a Mobile Stroke Unit: Protocol for a Prospective Open‐Label Blinded End‐Point Randomized Controlled Trial
Authors: Yogendrakumar Vignan , Balabanski Anna H. , Johns Hannah , Churilov Leonid , Parsons Nicola K. , Beharry James , Weir Louise , Yassi Nawaf , Zhao Henry , Warwick Alex , Coote Skye , Langenberg Francesca , Branagan Leigh , Siddiqi Wasseem , Bivard Andrew , Campbell Bruce C. V. , Donnan Geoffrey A. , Davis Stephen M. , Mutimer Chloe , Barker James , Santos Angela Dos , Ng Jo Lyn , Ng Felix , Yan Bernard , Ma Margaret , Wong Joey , Park Ashley , Sharobeam Angelos , Valente Michael , Williams Cameron , Ho Stan , Scarff Patrick , Beltrame Cassandra , Shin Christine , Thijs Vincent , Fink John , Barber Alan , Lin Longting 
Published: October 2024

Background
Mobile stroke units have been shown to deliver faster patient care and improve clinical outcomes. However, costs associated with staffing limit their use to densely populated cities. Using the Melbourne mobile stroke unit, we aim to evaluate the safety, timeliness, and resource efficiency of a telemedicine model, where the neurologist assesses a patient remotely, via telemedicine, compared with an onboard neurologist model. We hypothesize that, without compromising patient safety, the telemedicine model will provide timely care and superior resource efficiency.

Methods
Using a prospective, randomized, blinded end‐point controlled design, 270 participants consecutively assessed on the Melbourne mobile stroke unit over ≈12 months will be assigned into 2 arms: (1) telemedicine neurologist assessment (intervention) versus (2) onboard assessment (comparator). Enrollment is based on prospectively designated randomized days of neurologist review onboard versus telemedicine. The primary outcome will be the odds that a randomly selected participant in the telemedicine arm will have a better outcome than a randomly selected participant in the onboard arm, measured using a desirability‐of‐outcome ranking, an outcome measure that includes, in order of importance: (1) safety, (2) scene‐to‐treatment‐decision time metrics, and (3) resource usage. All participants within each arm will be compared with those in the other, resulting in a “win/tie/loss” distribution for telemedicine compared with the onboard model.

Conclusions
The study will establish whether use of a telemedicine neurologist delivers superior resource efficiency without compromising patient care. This would enable the broader use of mobile stroke units, particularly relevant to regions with limited access to neurologists, thus improving equity in access to time‐critical, lifesaving stroke care.

Registration

URL:
clinicaltrials.gov
; Unique Identifier: NCT05991310.
RUFCO: A Deep Learning Framework to Postprocess Subseasonal Precipitation Accumulation Forecasts
Authors: Worsnop Rochelle P. , Scheuerer Michael , Hamill Thomas M. , Smith Timothy A. , Schlör Jakob 
Published: October 2024

Abstract
Postprocessing is a critical step in attaining calibrated and reliable probabilistic forecast output from numerical weather prediction models. A novel deep learning framework is proposed to postprocess 20 years of 7- and 14-day precipitation accumulation reforecasts from the Global Ensemble Forecast System at subseasonal time scales (week 1, week 2, and combined weeks 3–4 forecasts) over the contiguous United States. The network builds upon previous studies and is a combination of three parallel-trained components suitable for subseasonal prediction. The first is a ResUnet architecture which learns nonlinear relationships between binned observed precipitation and input images of weather and geographical variables. The second conditions the network to the month-of-year via a feature-wise linear modulation (FiLM) layer. The third helps the network learn when to revert the forecast to that of climatology. The RUFCO (named for its components ResUnet, FiLM, and Climatological-Offramp) forecasts are compared against raw and climatological forecasts as well as those from a state-of-the-art distributional regression postprocessing model, “censored, shifted gamma distribution (CSGD),” and a simple bias-corrected model. At week 1, every method exhibited a competitive advantage over climatological forecasts. At week 2, RUFCO generated forecasts with statistically significant improvement over climatology at 82%–94% of the domain, beating CSGD’s coverage of 76%–90% of the grid points. At week 3, RUFCO’s skillful coverage was 65%–85%, while CSGDs dropped to only 12%–37%. At the longer lead times, RUFCO achieved the highest domain-averaged skill scores across seasons. However, the network tends to “smooth” forecast skill, making it less competitive with CSGD in limited areas with strongly spatially varying biases.

Significance Statement
Precipitation accumulation forecasts 1, 2, and 3–4 weeks in advance are increasingly in-demand for a variety of decision-making applications around hydrologic forecasting, flood and drought awareness, and wildfire preparedness. However, raw forecasts from numerical weather prediction systems have errors that hinder skill. Postprocessing methods remove those errors and provide more reliable and skillful forecasts. We show that a new neural network technique is an effective and competitive postprocessing tool compared to more traditional techniques.
NAMAH—An Innovative Tele-ECHO Mentoring Program to Foster Well-being Among Physicians
Authors: Parate Nidhi , BR Manjunatha , R Sanchitha , Narasimha Venkata Lakshmi , Mahadevan Jayant , Chand Prabhat , Murthy Pratima , Arora Sanjeev 
Published: October 2024

Background: The current study aimed to develop and implement the National Assistance in Mental Health for Health Care Providers (NAMAH) module, which focused on wellness and building resilience for a cohort of physicians. Methods: The NAMAH module is a 12-week tele-mentoring program leveraging videoconference technology that uses the ECHO (Extension of Community Healthcare Outcome) HUB and SPOKE and consists of real-life case discussions and a brief didactic. The module’s content was developed after iterative feedback from experts and incorporated suggestions from healthcare providers (HCPs) following a needs assessment. A pre and post-design was used to assess the impact of the module on psychological distress using the self-reported Kessler Psychological Distress Scale (K10) and burnout using the Maslach Burnout—Inventory-Human Services Survey (MBI-HSS) among the 32 physicians who participated. Results: There was a significant decrease in the mean scores before (19.5 ± 6.27) and after (17.38 ± 6.23) the NAMAH module ( p < .05) in the psychological distress as measured by K 10 with a Cohen’s d of 0.41 (95% CI: 0.05–0.77). There was also a significant decrease in the mean scores after the intervention in the emotional exhaustion and depersonalization domain of the MBI-HSS with a medium effect size (Cohen’s d of 0.65) and large effect size (Cohen’s d of 0.94), respectively. Conclusion: The findings from this pilot study lay a foundational framework, encouraging further exploration, research, and scaling-up of such interventions to enhance mental health among physicians and HCPs.
Meta-analysis of improved mitral regurgitation after aortic valve replacement
Authors: Naito Noritsugu , Takagi Hisato 
Published: October 2024

Background This meta-analysis aimed to compare survival outcomes among patients experiencing improvement in untreated significant mitral regurgitation (MR) following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, in contrast to those without improvement. Methods We conducted a comprehensive search through February 2024. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were computed. Kaplan-Meier curves depicting all-cause mortality were reconstructed using individual patient data derived from the included studies. Results A systematic review identified twelve non-randomized studies encompassing 4040 patients. The pooled all-cause mortality of the meta-analysis demonstrated a significant reduction in patients whose MR improved compared to those with persistent MR after aortic valve replacement (AVR) (HR [95% CI] = 0.55 [0.47–0.64], p < .01). The hazard ratio, derived from reconstructed time-to-event data, indicated lower all-cause mortality in patients with improved MR after AVR relative to the other cohort (HR [95% CI] = 0.50 [0.40–0.62], p < .01 in all patients, 0.48 [0.34–0.68], p < .01 in patients undergoing SAVR, and 0.58 [0.42–0.80], p < .01 in those receiving TAVR). Conclusion In conclusion, this meta-analysis revealed that improved MR after AVR, whether surgically or by transcatheter approach, correlates with superior survival. The benefits of simultaneous or staged intervention on the mitral valve in individuals undergoing AVR warrant validation in future investigations.