bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes of Children With COVID-19 by SARS-CoV-2 Strain
Authors: Klingensmith Lauren M. , Goel Swati , Kampalath Vinay N. , Cohn Keri A. 
Published: September 2023

Objective
We sought to investigate the disease outcomes and predictors of severe outcomes among children infected with the Delta variant of SARS-CoV-2 compared with pre-Delta strains.

Methods
Single-center retrospective cohort study in an emergency department located within an urban academic children's hospital. Patients included children (0–18 years) who tested positive for SARS-CoV-2. Main outcomes measured include need for hospital admission or COVID-directed therapies.

Results
There was a trend toward decreased hospital admission and no significant difference in the severity of outcomes in the Delta cohort relative to the pre-Delta cohort. The Delta cohort had lower odds of hospital admission (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.51–1.23), but the result was not statistically significant. Logistic regression analyses showed that overall, age 1 to 4 years (OR, 2.35; 95% CI, 1.23–4.57) and public insurance (OR, 1.80, 95% CI, 1.08–3.01) were predictors of hospital admission. Within the Delta cohort, the presence of any comorbidity increased the odds of admission (OR, 2.52; 95% CI, 1.09–6.04). Black children had lower odds of admission than white children (overall OR, 0.53; 95% CI, 0.31–0.90; pre-Delta OR, 0.50; 95% CI, 0.26–0.95).

Conclusions
The severity of measured disease outcomes was similar in pediatric patients when comparing children infected with the pre-Delta and Delta variants of SARS-CoV-2, even among children with comorbidities once adjusting for acuity.
Ongoing research is essential to determine disease severity and risk for children with comorbidities because SARS-CoV-2 continues to mutate, including with Omicron subvariants.
Seize the Opportunity
Authors: Shakir Rashida M. , Doshi Samir , Blakeslee Samantha , Jessee Morgan 
Published: September 2023

Objectives
Our objective was to increase human immunodeficiency virus (HIV) screening in adolescents presenting to our community pediatric emergency department with symptoms suggestive of a sexually transmitted infection (STI) and who were being tested for gonorrhea and chlamydia. Specifically, we aimed to increase the monthly average proportion of adolescents concurrently screened for HIV in this target group from 11% to 50% in 6 months.

Methods
We identified barriers to HIV screening, focusing on physician-related challenges and adolescents' concerns about confidentiality. We designed interventions targeting these barriers and implemented them in plan-do-study-act cycles beginning in February 2020. We educated physicians and nurses about screening recommendations, emphasized a physician-conducted private interview during which confidential contact information could be obtained, and assured confidentiality on after visit summaries by removing STI results. We also provided regular feedback to physicians on the screening rate. In addition, we implemented an electronic health record quick order set and a documentation tool. Using a statistical process control chart, we measured the average monthly proportion of adolescents in the target group who were offered HIV screening or tested for HIV before and after interventions.

Results
A total of 140 adolescents in the target group presented to our pediatric emergency department from February 2020 through December 2021. After plan-do-study-act cycles, the average monthly screening rate increased to 80%.

Conclusions
Raising physician awareness of HIV screening recommendations and the importance of conducting a private interview improved screening rates. Assuring adolescent minors of confidentiality in a private interview, removing STI results from the after visit summary, and obtaining confidential contact information were important measures to overcome confidentiality barriers.
Virtual Coaching and the Reduction of Radial Head Subluxation
Authors: Istasy Paul , Lynch Tim P. , Van Aarsen Kristine , Helleman Krista E. , Edmonds Marcia L. 
Published: September 2023

Objectives
After the establishment of the virtual pediatric emergency medicine clinic at our institution, we noted that several physicians independently began to instruct caregivers virtually on reducing a radial head subluxation. We thus conducted a case series to investigate the number, success, and follow-ups for the virtual reduction of radial head subluxation.

Methods
The electronic medical records at our institution were searched from the inception of the virtual clinic in May 2020 until August 2022 (inclusive), for visits and discharge diagnosis containing the word “elbow” or “arm.”

Results
Fourteen charts were retrieved; however, 2 were excluded because they were not a suspected radial head subluxation. A virtual reduction was attempted for eight (66.7%) of the 12 patients. In 6 of 8 patients (75.0%), the reduction was deemed successful, and for 2 patients (25.0%), it was deemed unsuccessful. Of the latter, one was found to have a nondisplaced radial neck fracture. All 4 patients (33.3%) for whom a virtual reduction was not attempted were referred to the emergency department.

Conclusions
Virtual video coaching of pulled elbow reduction was completed at our institution with overall good success rate. All the physicians involved noted the essential need and benefits of video conferencing for successfully reducing radial head subluxation. We note that a pediatric population may be more amenable to video-based appointments than other populations due to their caregivers' familiarity with digital technology. Finally, as nonphysician models of healthcare delivery for virtual urgent care visits expand, we propose a checklist based on our experience to ensure patient safety.
Protein appetite as an integrator in the obesity system: the protein leverage hypothesis
Authors: Raubenheimer David , Simpson Stephen J. 
Published: September 2023

Despite the large volume and extensive range of obesity research, there is substantial disagreement on the causes and effective preventative strategies. We suggest the field will benefit from greater emphasis on integrative approaches that examine how various potential contributors interact, rather than regarding them as competing explanations. We demonstrate the application of nutritional geometry, a multi-nutrient integrative framework developed in the ecological sciences, to obesity research. Such studies have shown that humans, like many other species, regulate protein intake more strongly than other dietary components, and consequently if dietary protein is diluted there is a compensatory increase in food intake—a process called protein leverage. The protein leverage hypothesis (PLH) proposes that the dilution of protein in modern food supplies by fat and carbohydrate-rich highly processed foods has resulted in increased energy intake through protein leverage. We present evidence for the PLH from a variety of sources (mechanistic, experimental and observational), and show that this mechanism is compatible with many other findings and theories in obesity research.
This article is part of a discussion meeting issue ‘Causes of obesity: theories, conjectures and evidence (Part II)’.
Reflections on the Teaching Symposium at the Microbiology Society Annual Conference 2023
Authors: Lacey Melissa M , Jones Kirsty L , Gostić Monika , Easton Victoria , Efthimiou Georgios , Kelly Bridget G , Graham Alison I 
Published: September 2023

The Microbiology Society Education and Outreach Network (EON) recently hosted the Teaching Symposium at the Microbiology Society Annual Conference, sponsored by Access Microbiology. The presence of the Symposium as an established parallel session within the wider Annual Conference reflects the importance of high-quality, contemporary microbiology education and outreach delivered in an enthusiastic and inclusive manner. At the 2023 Symposium, a variety of pedagogical research projects in higher education learning, teaching and assessment, as well as public engagement projects, were showcased through flash talks, offered talks, invited talks and posters. The event was attended by up to 70 delegates. Several themes were noted throughout the day: engaging with GenZ, active learning, art in science, and engaging with non-HE audiences. Inclusivity was a key driver in the organisation of the Symposium; the room was set up to encourage discussion and participants could ask questions using an online platform as well as speaking in the room. We now encourage all speakers to consider publishing their work as a peer-reviewed article for further dissemination and impact.
ALK signalling primes the DNA damage response sensitizing ALK-driven neuroblastoma to therapeutic ATR inhibition
Authors: Borenäs Marcus , Umapathy Ganesh , Lind Dan E. , Lai Wei-Yun , Guan Jikui , Johansson Joel , Jennische Eva , Schmidt Alexander , Kurhe Yeshwant , Gabre Jonatan L. , Aniszewska Agata , Strömberg Anneli , Bemark Mats , Hall Michael N. , Van den Eynden Jimmy , Hallberg Bengt , Palmer Ruth H. 
Published: September 2023

AbstractHigh-risk neuroblastoma (NB) is a significant clinical challenge. MYCN and ALK, which are often involved in high-risk NB, lead to increased replication stress in cancer cells, suggesting therapeutic strategies. We previously identified an ATR/ALK inhibitor (ATRi/ALKi) combination as such a strategy in two independent genetically modified mouse NB models. Here, we identify an underlying molecular mechanism, in which ALK signalling leads to phosphorylation of ATR and CHK1, supporting an effective DNA damage response. The importance of ALK inhibition is supported by mouse data, in which ATRi monotreatment resulted in a robust initial response, but subsequent relapse, in contrast to a 14-day ALKi/ATRi combination treatment that resulted in a robust and sustained response. Finally, we show that the remarkable response to the 14-day combined ATR/ALK inhibition protocol reflects a robust differentiation response, reprogramming tumour cells to a neuronal/Schwann cell lineage identity. Our results identify a unique ability of ATR inhibition to trigger neuroblastoma differentiation and underscore the importance of further exploring combined ALK/ATR inhibition in NB, particularly in high-risk patient groups with oncogene-induced replication stress.
Advances in genomic characterization ofUrochloa humidicola: exploring polyploid inheritance and apomixis
Authors: da Costa Lima Moraes Aline , Mollinari Marcelo , Ferreira Rebecca Caroline Ulbricht , Aono Alexandre , de Castro Lara Letícia Aparecida , Pessoa-Filho Marco , Barrios Sanzio Carvalho Lima , Garcia Antonio Augusto Franco , do Valle Cacilda Borges , de Souza Anete Pereira , Vigna Bianca Baccili Zanotto 
Published: September 2023

AbstractTropical forage grasses are an important food source for animal feeding, withUrochloa humidicola, also known as Koronivia grass, being one of the main pasture grasses for poorly drained soils in the tropics. However, genetic and genomic resources for this species are lacking due to its genomic complexity, including high heterozygosity, evidence of segmental allopolyploidy, and reproduction by apomixis. These complexities hinder the application of marker-assisted selection (MAS) in breeding programs. Here, we developed the highest-density linkage map currently available for the hexaploid tropical forage grassU. humidicola. This map was constructed using a biparental F1 population generated from a cross between the female parent H031 (CIAT 26146), the only known sexual genotype for the species, and the apomictic male parent H016 (BRS cv. Tupi). The linkage analysis included 4,873 single nucleotide polymorphism (SNP) markers with allele dosage information. It allowed mapping of the apospory locus and phenotype to linkage group 3, in a region syntenic with chromosome 3 ofUrochloa ruziziensisand chromosome 1 ofSetaria italica. We also identified hexaploid haplotypes for all individuals, assessed the meiotic configuration, and estimated the level of preferential pairing in parents during the meiotic process, which revealed the autopolyploid origin of sexual H031 in contrast to H016, which presented allopolyploid behavior in preferential pairing analysis. These results provide new information regarding the genetic organization, mode of reproduction, and allopolyploid origin ofU. humidicola, potential SNPs markers associated to apomixes for MAS and resources for research on polyploids and tropical forage grasses.Key messageWe present the highest-density genetic map for the hexaploidUrochloa humidicola. SNP markers expose genetic organization, reproduction, and species origin, aiding polyploid and tropical forage research.
Changes in pro inflammatory and regulatory immune responses during controlled human schistosome infection and the development of clinical symptoms
Authors: Houlder Emma L. , Stam Koen A. , Koopman Jan Pieter R. , König Marion H. , Langenberg Marijke C.C. , Hoogerwerf Marie-Astrid , Niewold Paula , Sonnet Friederike , Janse Jacqueline J. , Partal Miriam Casacuberta , Sijtsma Jeroen C. , de Bes-Roeleveld Laura H. M. , Kruize Yvonne C.M. , Yazdanbakhsh Maria , Roestenberg Meta 
Published: September 2023

AbstractSchistosomiasis is a prevalent helminthiasis, affecting over 230 million people worldwide, with varied, stage specific morbidity. Whilst the Th2 and regulatory immune responses in chronic infection have been relatively well studied, we have little understanding of human immune responses during acute infection. This is despite the initial infective stages being proposed as crucial targets for much-needed vaccine development. Here, we comprehensively map immune responses in male and female single-sex controlled humanSchistosoma mansoniinfection. Using unbiased, high dimensional techniques we show that human immune responses to male and female single-sex infection are comparable. An early Th1-biased inflammatory response was observed at week 4 post infection, which was particularly apparent in individuals experiencing symptoms of acute schistosomiasis. This included expansion of HLA-DR+effector memory T cells, CD38+monocytes and an increase in serum IFNγ. By week 8 post infection these inflammatory responses were followed by an expansion of Th2 and of regulatory cell subsets, including IL-10 producing CD4-CD8-T cells, CD11c+atypical memory B cells and serum IL-10. This study provides immunological insight into the clinical manifestations of acute schistosomiasis, as well as critical context through which to understand the development of immune responses observed in natural infection.One sentence summaryControlled human schistosome infection reveals cellular and cytokine responses to schistosome infection, with early inflammatory responses in symptomatic individuals at week 4 and a balanced Th1, Th2 and regulatory response in all participants by week 8.
Improving emotion control in social anxiety by targeting rhythmic brain activity
Authors: Meijer Sjoerd , Bramson Bob , Toni Ivan , Roelofs Karin 
Published: September 2023

AbstractSocial avoidance is a hallmark of social anxiety disorder. Difficulties in controlling avoidance behavior are the core maintaining factor of this impairing condition, hampering the efficacy of existing therapies. This preregistered study tested a physiologically-grounded non-invasive enhancement of control over social approach and avoidance behavior in socially anxious individuals. Their prefrontal and sensorimotor areas received dual-site phase-coupled electrical stimulation, to enhance inter-regional theta-gamma phase-amplitude coupling, a mechanism known to support emotion control in non-anxious individuals. We measured behavioral and fMRI-BOLD responses during in-phase, anti-phase, and sham stimulations, while participants performed a social approach-avoidance task, involving either automatic or controlled emotional actions. In-phase (vs. anti-phase) stimulation selectively enhanced control over approach-avoidance actions, and modulated neural responses in the same prefrontal region where stimulation-reactivity increased as a function of trait anxiety. These findings illustrate how human neurophysiological connectivity can be leveraged to improve control over social avoidance, opening the way for mechanistically grounded clinical interventions of persistent avoidance in anxiety disorders.TeaserEmotion control in social anxiety can be boosted by targeting rhythmic brain activity between prefrontal and sensorimotor cortex
The entire brain, more or less, is at work: ‘Language regions’ are artefacts of averaging
Authors: Aliko Sarah , Wang Bangjie , Small Steven L , Skipper Jeremy I 
Published: September 2023

AbstractModels of the neurobiology of language suggest that a small number of anatomically fixed brain regions are responsible for language functioning. This observation derives from centuries of examining brain injury causing aphasia and is supported by decades of neuroimaging studies. The latter rely on thresholded measures of central tendency applied to activity patterns resulting from heterogeneous stimuli. We hypothesised that these methods obscure the whole brain distribution of regions supporting language. Specifically, cortical ‘language regions’ and the corresponding ‘language network’ consist of input regions and connectivity hubs. The latter primarily coordinate peripheral regions whose activity is variable, making them likely to be averaged out following thresholding. We tested these hypotheses in two studies using neuroimaging meta-analyses and functional magnetic resonance imaging during film watching. Both converged to suggest that averaging over heterogeneous words is localised to regions historically associated with language but distributed throughout most of the brain when not averaging over the sensorimotor properties of those words. The localised word regions are composed of highly central hubs. The film data shows that these hubs are not fixed. Rather, they are spatiotemporally dynamic, making connections with 44% of peripheral sensorimotor regions at any moment, and only appear in the aggregate over time. Results suggest that ‘language regions’ are an artefact of indiscriminately averaging across heterogeneous language representations and linguistic processes. Rather, these regions are mostly dynamic connectivity hubs coordinating whole-brain distributions of networks for processing the complexities of real-world language use, explaining why damage to them results in aphasia.
A Cross-Sectional Evaluation of Health Resource Use in Patients with Functional Neurological Disorders Referred to a Tertiary Neuroscience Centre
Authors: O’Mahony Brian , Nelson-Sice R. , Nielsen Glenn , Hunter Rachel , Cope Sarah , Agrawal Niruj , Edwards Mark , Yogarajah Mahinda 
Published: September 2023

AbstractIntroductionFunctional Neurological Disorder (FND) is a common cause of referral to neurology services. FND has been shown to lead to significant healthcare resource use, and is associated with significant disability, comorbidity, and distress. This leads to substantial direct, indirect, and intangible costs to the patient and society.MethodsWe recruited consecutive patients with FND referred to a tertiary FND specialist clinic. We assessed health and social care resource use, in the 6 months preceding their consultation through a modified version of the Client Service Receipt Inventory (CSRI) in the form of a postal questionnaire. The total cost was estimated by combining the number and frequency of health resource use with standard national unit costs. We also assessed indirect costs such as informal care and loss of income.ResultsWe collected data on 118 subjects. Patients with comorbid anxiety or depression had higher costs in the preceding 6 months, as did patients who had a longer duration of FND symptoms. Indirect costs were larger than the already substantial direct costs, and a large proportion of FND patients were receiving government support.ConclusionThis study highlights the high cost of FND to both patients and health systems. Adequate reform of the patient pathway and re-organization of services to make diagnoses, and initiate treatment more quickly, would likely reduce these costs.
How Large Language Models Perform on the United States Medical Licensing Examination: A Systematic Review
Authors: Brin Dana , Sorin Vera , Konen Eli , Nadkarni Girish , Glicksberg Benjamin S , Klang Eyal 
Published: September 2023

ABSTRACTObjectiveThe United States Medical Licensing Examination (USMLE) assesses physicians’ competency and passing is a requirement to practice medicine in the U.S. With the emergence of large language models (LLMs) like ChatGPT and GPT-4, understanding their performance on these exams illuminates their potential in medical education and healthcare.Materials and MethodsA literature search following the 2020 PRISMA guidelines was conducted, focusing on studies using official USMLE questions and publicly available LLMs.ResultsThree relevant studies were found, with GPT-4 showcasing the highest accuracy rates of 80-90% on the USMLE. Open-ended prompts typically outperformed multiple-choice ones, with 5-shot prompting slightly edging out zero-shot.ConclusionLLMs, especially GPT-4, display proficiency in tackling USMLE-standard questions. While the USMLE is a structured evaluation tool, it may not fully capture the expansive capabilities and limitations of LLMs in medical scenarios. As AI integrates further into healthcare, ongoing assessments against trusted benchmarks are essential.
Self-reported bruxism in patients with post-traumatic stress disorder
Authors: de Oliveira Solis Ana Cristina , Corchs Felipe , Duran Érica Panzani , Silva Cláudio , Del Real Natalia , Araújo Álvaro Cabral , Wang Yuan-Pang , Lotufo-Neto Francisco 
Published: September 2023

AbstractObjectiveThe present study aimed to investigate the association between self-reported awake/sleep bruxism, and orofacial pain with post-traumatic stress disorder (PTSD).MethodsParticipants were recruited from a university-based Trauma Ambulatory. The diagnosis of PTSD was established through a clinical interview and the Structured Clinical Interview (SCID-I/P). Thirty-eight PTSD patients and 38 controls completed the Research Diagnostic Criteria for Temporomandibular Disorders Axis-II to categorize awake/sleep bruxism and orofacial pain. Following this, we performed a short clinical examination of the temporomandibular joint and extraoral muscles.ResultsAdjusted logistic regression analysis showed that awake bruxism was associated with PTSD (OR = 3.38, 95% CI = 1.01-11.27,p= 0.047). Sleep bruxism was not associated with any covariate included in the model. In a Poisson regression model, PTSD (IRR = 3.01, 95% CI = 1.38-6.55,p= 0.005) and the muscle pain/ discomfort (IRR = 5.12, 95% CI = 2.80-9.36,p< 0.001) were significant predictors for current orofacial pain.ConclusionsPTSD was associated with self-reported awake bruxism and low-intensity orofacial pain. These conditions were frequent outcomes in patients previously exposed to traumatic events.