bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overcoming Barriers to Childhood and Adolescent Vaccination: Opportunities in Precision Health Promotion
Authors: White Brianna M , Kumsa Fekede , Singh Nupur , Shaban-Nejad Arash 
Published: October 2024

Abstract

Background
Vaccination remains one of the greatest success stories in public health as cost-effective interventions to reduce morbidity and mortality from infectious diseases at the population level. However, the COVID-19 pandemic created unprecedented challenges to the immunization sector. Uptake of routine childhood and adolescent vaccinations was forestalled by challenges related to pandemic lockdowns/quarantine, reduced patient-provider interactions, parental reluctance to seek preventative services, poor access to health services, and loss of income and/or health insurance. Compared to pre-pandemic estimations, the pandemic era brought a consequential decline in coverage of all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This study sought to address suboptimal adolescent vaccine delivery systems and bolster uptake in the post-pandemic era with the introduction of precision health promotion strategies centered around the use of Personal Health Libraries (PHL).

Methods
Leveraging artificial intelligence (AI), and semantic web technologies to integrate contextual knowledge (i.e., clinical, biomedical, and SDoH data) with patient preferences, proposed PHL platforms could aid in generating personalized evidence-based recommendations useful to both care provider promotion of vaccination and mitigating patient and caregiver hesitancy. The proposed application stands to provide customized digital health interventions by 1) facilitating remote knowledge acquisition, exchange, and visualization of the benefits of on-time vaccination, 2) improving health information-seeking behaviors to reduce hesitancy, 3) bolstering patient reminder and recall systems for follow-up and series completion, and 4) learning usage patterns to incorporate end-user preferences to empower patients, promote best practices, and enable them to make informed health decisions.

Results
The proposed PHL would serve as an ecosystem to manage and deliver tailored vaccine-related information to inform health decision-making regarding ACIP-recommended immunizations. Such a resource could administer health education and promotion that addresses common misconceptions regarding vaccination, alleviate safety, efficacy, and side effect concerns, and deliver evidence-based support of vaccines as primary protective measures (i.e., cancer prevention).

Conclusion
The use of PHL would enable rapid and real-time collection and interpretation of patient data beyond the traditional clinical setting, supplying care providers with tools for optimal vaccination recommendation to bolster uptake in the post-pandemic era. Moreover, the application would enable patients and caregivers to readily access vital health information and play a crucial role in addressing the obstacles encountered when seeking accurate and dependable vaccine-related information.
Short-Lived Zika Virus-Specific Antibodies in Infants: Findings from a Translational Macaque Model
Authors: Arroyo Laura , Krabbe Nicholas P , Bhattacharya Saswati , Razo Elaina , Mohr Emma 
Published: October 2024

Abstract

Background
In utero Zika virus (ZIKV) infection is a significant public health threat for infants as it can be vertically transmitted from mother to fetus, resulting in several health problems. Prolonged maternal viremia sometimes occurs in pregnant women with ZIKV infection. We hypothesize that mothers with prolonged viremia will be more likely to vertically transmit ZIKV to their fetuses. To evaluate this hypothesis, we developed a rhesus macaque pregnancy model of ZIKV infection, where some days have prolonged viremia (&gt;10 days) and others have quickly cleared viremia (&lt;10 days). Because the diagnosis of fetal ZIKV infection in newborns is challenging given the transient nature of ZIKV RNA viremia, we use infant-produced ZIKV-specific IgG as a marker of ZIKV vertical transmission. Here, we used a rhesus macaque model to define the association between longitudinal ZIKV-specific IgG antibody titers in infants and duration of maternal viremia.

Methods
Pregnant dams were inoculated in the first trimester, and their infants (n=8) were monitored for 12 months. ZIKV-specific IgG titers were measured in ZIKV-exposed infant serum samples using a whole virion ELISA at 1, 3, 6, 12, 18, 24, 30, and 36 months of age. Optical density was detected at 450nm on a SpectraMax M5e plate reader and IgG binding antibody curves were generated using R studio. Samples were below the limit of detection if they had EC90 values lower than the lowest serum dilution.

Results
One of the eight infants displayed ZIKV-specific IgG titers at 12 months of age with undetectable ZIKV-specific IgG before 12 months of age, suggesting that these infants were infected in utero and produced their own ZIKV-specific IgG. This infant was born to a dam with a short duration of plasma viremia. The remaining seven infants displayed measurable ZIKV-specific IgG in the first 3 months of life and nothing after that point, indicating the presence of maternal antibody and no infant-specific antibody. There was no apparent association between maternal viremia duration and the presence of infant-produced ZIKV-specific IgG.

Conclusion
ZIKV vertical transmission was confirmed in 1 of 8 pregnancies, and that case did not have a longer viremia compared to the other pregnancies. This indicates that either the rate of vertical transmission is not high in this macaque model, or that diagnostic methods for in utero infection with ZIKV are limited. We have additional pregnancies to complete antibody testing for in our cohort (10 additional pregnancies) and will learn more about this diagnostic method in these future studies.
Th2 and IL-17 responses inChlamydia pneumoniae-stimulated PBMC in asthmatic and non-asthmatic subjects
Authors: Ahmed Wefag , Shidid Sarah , Amornruk Nutchaya , Abdelmajid Haram , Norowitz Yitzchok M , Kohlhoff Stephan , Smith-Norowitz Tamar A 
Published: October 2024

Abstract

Background
Chlamydia pneumoniae (C. pneumoniae) is a gram-negative intracellular bacterium that causes respiratory infections in humans, including asthmatic and non-asthmatic subjects. C. pneumoniae activates cells in vitro and produces cytokines that may contribute to the inflammatory responses observed in asthma. Different asthma endotypes are described, including Th2-high and Th2-low. Th2-low endotypes are characterized by IL-17 production and neutrophilic inflammation. The aim of this study was to investigate the role of C. pneumoniae in regulating Th2 versus Th17 responses in peripheral blood mononuclear (PBMC) from subjects with or without asthma.

Methods
PBM) (1×106/mL) from asthmatic (N=6) and non-asthmatic subjects (N=14) were infected +/- C. pneumoniae TW-183 at a multiplicity of infection (MOI) = 0.1, using dose responses (1:10, 1:100), and cultured 48 hrs. Cytokine responses (Interferon (IFN)-gamma, Interleukin (IL)-2, IL-4, IL-17 A/F) were measured in supernatants (ELISA).

Results
Comparison of cytokine responses (the mean differences in non-asthmatic versus asthmatic subjects) were significant for IFN gamma (unstimulated; P&lt;0.0001), IL-2 (unstimulated and 1:100; P&lt;0.0001, P=0.0002, respectively), IL-4 (unstimulated, 1:10, 1:100; P=0.0001, P&lt;0.0001, P&lt;0.0001, respectively) and IL-17 A/F (unstimulated, P&lt;0.0001) (Wilcoxon signed-rank test). Cytokine levels were higher in asthmatic subjects for IFN-gamma (unstimulated,1:10, 1:100), IL-2 (unstimulated), and IL-17 A/F (unstimulated) compared with non-asthmatic subjects. However, IL-4 levels were higher in non-asthmatics (unstimulated, 1:10, 1:100).

Conclusion
Differences in Th2 and IL-17 cytokines responses in PBMC from subjects with and without asthma may indicate the involvement of cell-mediated immunity, while Th17 responses, which were increased in subjects with asthma at baseline, did not increase further in response to C. pneumoniae stimulation.
Unique Pattern of Missed Opportunities for Congenital Syphilis Prevention in Alabama Compared to National Trends
Authors: Blair Isabella , Poole Claudette 
Published: October 2024

Abstract

Background
Missed opportunities to prevent congenital syphilis include no syphilis testing during prenatal care, late prenatal care, inadequate treatment, no prenatal care, late identification, and unidentified missed opportunities. Cases of unidentified missed opportunities are those identified as newborns with congenital syphilis born to mothers that received adequate treatment thirty days before delivery. Missed opportunities in Alabama may differ from national trends. Comparing rates of missed opportunities in Alabama to national trends may help inform Alabama physicians of the most effective intervention points for our state.

Methods
Data on congenital syphilis cases and rates of missed opportunities from 2018-2021 were collected from the Alabama Department of Public Health and CDC STI datasets. The occurrence of missed opportunity types in Alabama was determined and compared to national trends.

Results
No timely prenatal care or syphilis testing was the greatest missed opportunity nationally at 37.58%. However, the most prevalent missed opportunity in Alabama was late identification of seroconversion at 44.44% in comparison to 14.22% nationally. Second most common missed opportunity in Alabama was no timely prenatal care or syphilis testing (divided into no prenatal care at 14.81% and late prenatal care at 6.17%). Additionally, evidence of congenital syphilis despite maternal treatment was the least common missed opportunity nationally (3.75%) but made up 25% of missed opportunities in Alabama in 2021.

Conclusion
The incidence of late identification of seroconversion in Alabama is three times the national average, which emphasizes the need for targeted interventions to address this disparity. Furthermore, congenital syphilis despite maternal treatment in Alabama is six times the national rate, suggesting a need for further investigation into other missed opportunities.
Bloodstream infections in a Brazilian Pediatric Tertiary Oncology Hospital: 30-month analysis regarding the classification of the infection, distribution of microorganisms and their resistance profile
Authors: Prado Seila Israel do , Ignácio Júnior José Carlos , de Castro Paulo Tarso Oliveira e 
Published: October 2024

Abstract

Background
Infections are a major cause of morbidity and mortality in pediatric oncology patients during their treatment. Bloodstream infections are the main site of infection in these patients. Bacteremia in these patients can be secondary to a primary infectious focus, result from central line associated bloodstream infections (CLABSIs) or mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI).

Methods
Descriptive study of bloodstream infections in pediatric patients undergoing oncological treatment and hematopoietic stem cell transplantation in a tertiary pediatric oncology hospital in Brazil from January 1st, 2021 to June 30th, 2023. Infections were classified according to the Centers for Disease Control and Prevention/ National Healthcare Safety Network (CDC/NHSN) criteria into CLABSIs, MBI-LCBIs and secondary bloodstream infections.
Among the bloodstream infections that met CDC/NHSN criteria for CLABSI, were analyzed separately those who also met the criteria of catheter-related bloodstream infection (CRBSI) according to Infectious Diseases Society of America (IDSA).

Results
During this period were diagnosed 335 episodes of bloodstream infection (123 episodes in 2021, 150 in 2022 and 62 episodes in the first 6 months of 2023). There were 378 microorganisms isolated.
These infections were classified into: 35% CLABSIs, 27% MBI-LCBIs, 23% CRBSIs, and 15% secondary bloodstream infections.
Among the CLABSIs, the most common microorganisms were non-fermenting gram negative bacilli (NFGNB) 38%, enterobacteriaceae 35% and coagulase-negative staphylococcus (CoNS) 11%. Between CRBSIs, there were 31% enterobacteriaceae, 22% CoNS and 19% NFGNB.
Among the MBI-LCBIs there were 66% enterobacteriaceae and 23% group viridans streptococci (VGS). Streptococcus pneumoniae (33%) was the most common microorganism in secondary infections followed by Staphylococcus aureus (17%).
Assessing all infections together, the main enterobacteriaceae were Klebsiella spp. (40%) and only 50% of them were sensitive to cefepime while 10% were carbapenems resistant. Among NFGNB, 13% of Pseudomonas spp. and 5% of Acinetobacter spp. were carbapenems resistant.
Between the gram-positive bacteria, 77% of the S. aureus were methicillin sensitive, the same percentage of the VGS were sensitive to cefepime.

Conclusion
Among bloodstream infections, there were a predominance of CLABSI followed by MBI-LCBIs. Antimicrobial resistance between gram-positive bacteria, is of little concern in our institution. In the case of gram-negative bacteria, resistance to cefepime is becoming worrying among enterobacteriaceae.
Cytomegalovirus infection in transplant patients according to pre-transplant risk in a Hospital in Northeastern Mexico
Authors: Aparicio Denisse Vaquera , Martinez Valeria Barrientos , Antolinez Valentine Jimenez , Rodríguez Mariana Chávez , Bejarano José Iván Castillo , de Santos Abiel Mascareñas los 
Published: October 2024

Abstract

Background
Cytomegalovirus (CMV) is an important cause of morbidity and mortality in patients who receive a hematopoietic stem cell transplant (HSCT). It is possible to stratify the risk of developing the disease due to this agent according to the serological status of the HSCT donor and recipient. In post-transplant patients, significant T lymphocyte dysfunction occurs, so reactivation of CMV is common, which is why it should be monitored after HSCT. Our objective is to determine the association of CMV infection in post-transplant patients according to pre-transplant risk status.

Methods
Patients who received HSCT from January 2019 to June 2023 were included, they were classified according to their pre-transplant risk status and CMV infection was diagnosed by performing a viral load on day 30.

Results
70 patients with hemato-oncological diseases who received an HSCT were included, a median age of 9 years (0-16) was found, predominance of the male sex (60%), the most frequent type of transplant was haploidentical (82.9 %). Of these, 20 (28.5%) had CMV infection, with pre-transplant risk status mostly high risk (85%), of the low-risk patients (25.7%) 10% had the infection and the very high risk (4.3%) only 5% were reported infected. The period during which the infection occurred most frequently was in the early post-pregnancy stage (66.6%) and the majority received treatment with valganciclovir (95%). Of the patients infected with CMV, 15 (75%) were asymptomatic, and 5 (25%) had associated symptoms, with 2 (10%) presenting with urinary symptoms (dysuria, frequency, suprapubic pain, tenesmus), and 2 (10%) with fever, and 1 hematochezia (5%). Regarding clinical outcomes, 17 patients (85%) presented resolution of the disease, 1 (5%) presented therapeutic failure and 1 (5%) died due to multiple organ failure.

Conclusion
Due to the high prevalence of CMV infection, it is important to maintain a high index of suspicion of this pathology in this population, with the aim of achieving early diagnosis and timely initiation of treatment.
Evaluation of an intervention to decrease length of stay in children with low-risk febrile neutropenia
Authors: Rogers Molly , Morton Theodore , Cross Shane , Graetz Dylan , Hashmi Saman , Wolf Joshua 
Published: October 2024

Abstract

Background
Febrile neutropenia is one of the most common serious complications of myelosuppressive chemotherapy. For this reason, pediatric oncology patients with FN have traditionally been admitted to the hospital and started on empiric intravenous antibiotics. However, not all FN patients are at high risk of developing subsequent complications, and a low-risk group exists that could safely be discharged early.

Methods
A retrospective study of 194 FN episodes presenting in pediatric oncology patients at St. Jude Children’s Research Hospital. Outcomes of FN episodes were studied and compared before and after early discharge guidelines for low-risk febrile neutropenic (LRFN) were implemented at St. Jude on May 6, 2020.

Results
Total length of hospital stay was similar in the pre- and post-intervention groups (median 4 [IQR 3,6] vs. 4 [IQR 3,7] days, P = 0.443). Differences in adverse outcomes were insignificant between the pre- and post-intervention cohorts, with only two ICU admissions after the first 24 hours inpatient in the post-intervention group, one new positive blood culture (&gt; 24 hours – 14 days of admission) in each group, and 36.2% versus 21% new fever after resolution of initial fever in pre- and post-intervention cohorts respectively. Cumulative antibiotic use between the pre- and post-intervention groups was statistically insignificant (median 13.5 [IQR 22.8,8] vs. 14 [IQR 22,9] days, P = 0.537), whereas Levofloxacin use was significantly longer in the post-intervention cohort versus the pre-intervention cohort (median 0 [IQR 0,4] vs. 0 [IQR 0,0] days, P = &lt;0.001).

Conclusion
The implementation of guidelines for early discharge of LRFN patients showed no reduction in hospital stay. Understanding the optimal strategy for effectiveness of guideline implementation is crucial to improve quality and efficiency of care.
Surveillance of fever and neutropenia episodes at Yeolyan Hematology and Oncology Center in Armenia
Authors: Grigoryan Mark , Petrosyan Mery , Minasyan Elya , Hovhannisyan Saten , Vagharshakyan Lala , Sargsyan Lilit , Tamamyan Gevorg , Licona Sergio , Faughnan Lane , Muniz-Talavera Himy , Mukkada Sheena 
Published: October 2024

Abstract

Background
Fever and neutropenia frequently occur as complications in pediatric patients with malignancies, significantly escalating morbidity and mortality if not appropriately addressed. We implemented a fever registry to identify patient factors and outcomes associated with fever in patients undergoing treatment at our facility.

Methods
We conducted a single-center prospective observational study at the Pediatric Cancer and Blood Disorders Center of Armenia. All patients aged 0-21 years with a malignancy diagnosis and developing fever and neutropenia between June 25 and November 20, 2023, were included. Variables collected included age, gender, date and time of fever onset, patient symptoms, time to antibiotic administration, identified microbiologic and clinical infections, and subsequent outcomes, including mortality and requirement for critical care level interventions. Data were entered in Microsoft Excel 2016 and analyzed using descriptive statistical methods.

Results
Sixty-one patient episodes in 36 patients met the inclusion criteria. Of these, 22% of episodes had fever at home. The most common malignancy was acute leukemia, specifically B-ALL (21/61), followed by T-ALL (9/61), AML (7/61), and mixed T- and B-type (1/61). Eight out of 61 fever episodes occurred in patients with relapsed disease. The median time-to-antibiotics was 100 minutes (max: 24 hours 40 minutes) in patients developing fever outside the hospital; for inpatient cases, the median time-to-antibiotics was 30 minutes (max: 6 hours 45 minutes). The time-to-antibiotics was longer for patients experiencing fever at home compared to those in inpatient settings (p=0.043). 21% of patient episodes were pretreated, however 11 out of 61 patient episodes (18%) had a positive blood culture. Of 13 total positive cultures, ten were obtained at the time of the patient’s presentation. The most common pathogens identified were Staphylococcus spp. (8/13) including coagulase-negative (3/8), and Klebsiella spp. (3/13). Polymicrobial-positive cultures were observed during two fever and neutropenia episodes.
During 35 episodes, patients presented with no complaints except for general weakness. Among the identified sources of infection (20/61), central-line-related bloodstream infections (n=6), bacteremia (n=5), and Clostridiodes difficile colitis (n=5) were the most common. One febrile neutropenia episode resulted in death (1.6%).

Conclusion
In summary, over 75% of episodes were observed among patients with hematologic malignancies, and localizing symptoms were absent in half of episodes at presentation. We have identified opportunities for quality improvement in time to administration of antibiotics in outpatient fever episodes. The adaptation of an electronic-based medical record system will simplify the tracking process for a febrile episode.
A meta-analysis and systematic review of the use of transition tools for patients transitioning from paediatric to adult rheumatology services
Authors: Griffin Kiron , Pearce Fiona , Packham Jonathan 
Published: October 2024

Abstract

Objectives
Transitioning from paediatric to adult care can be challenging, but transition tools are designed to increase successful rates of transfer. We aimed to conduct a meta-analysis and systematic review of the use of transition tools in the transfer of care from paediatric to adult services for rheumatology patients.

Methods
An extensive literature search was conducted using MEDLINE, PubMed and Embase. A total of 12 papers were included in the systematic review and 8 in the meta-analysis looking at the use of transition tools in successful follow-up in adult clinics.

Results
The meta-analysis showed 86.6% (95% CI 53.3, 80.6) of patients who used a transition tool attended an adult outpatient clinic within 1 year of their last paediatric appointment, compared with 67.7% (95% CI 56.7, 99.7) of patients who successfully transferred without a transition tool.

Conclusions
The systematic review demonstrated several unique transition tools with local success, but no dominant method. This article demonstrated a general positive influence of transition tools on successful transfer, but more research is needed to strengthen the association.
The New (White) Normal: Human Anatomy and the Naturalisation of White Bodies in British University Teaching, 1860–1910
Authors: Martin Rebecca 
Published: October 2024

Summary
The discipline of human anatomy has often been overlooked in histories of race science in favour of comparative anatomy, anthropology, ethnography and statistics. However, understanding the historical relationship between human anatomy and race science is particularly important because of the discipline’s central role, unlike its sister disciplines, in medical education. This article begins to redress this oversight, demonstrating that human anatomy played a key role in the development of nineteenth-century race science in Britain. This article considers three main elements of ideas about racial anatomical difference: the language of racial hierarchy, anatomists’ location of racial difference within the body and the perpetuation of these ideas over time. In so doing, I argue that research into racial difference was demonstrably anatomical during the late nineteenth century, playing a key role in British anatomists’ discipline-building processes, and that these ideas were present within the classroom, influencing generations of medical students.