bluuebunny/crossref_metadata_2025_split huggingface dataset:
Binary Toxin Expression by Clostridioides difficile Is Associated With Worse Disease
Authors: Young Mary K , Leslie Jhansi L , Madden Gregory R , Lyerly David M , Carman Robert J , Lyerly Matthew W , Stewart David B , Abhyankar Mayuresh M , Petri William A 
Published: January 2022

Abstract

Background
The incidence of Clostridioides difficile infection (CDI) has increased over the past 2 decades and is considered an urgent threat by the Centers for Disease Control and Prevention. Hypervirulent strains such as ribotype 027, which possess genes for the additional toxin C. difficile binary toxin (CDT), are contributing to increased morbidity and mortality.

Methods
We retrospectively tested stool from 215 CDI patients for CDT by enzyme-linked immunosorbent assay (ELISA). Stratifying patients by CDT status, we assessed if disease severity and clinical outcomes correlated with CDT positivity. Additionally, we completed quantitative PCR (PCR) DNA extracted from patient stool to detect cdtB gene. Lastly, we performed 16 S rRNA gene sequencing to examine if CDT-positive samples had an altered fecal microbiota.

Results
We found that patients with CdtB, the pore-forming component of CDT, detected in their stool by ELISA, were more likely to have severe disease with higher 90-day mortality. CDT-positive patients also had higher C. difficile bacterial burden and white blood cell counts. There was no significant difference in gut microbiome diversity between CDT-positive and -negative patients.

Conclusions
Patients with fecal samples that were positive for CDT had increased disease severity and worse clinical outcomes. Utilization of PCR and testing for C. difficile toxins A and B may not reveal the entire picture when diagnosing CDI; detection of CDT-expressing strains is valuable in identifying patients at risk of more severe disease.
Metabolic-Associated Fatty Liver Disease Is Highly Prevalent in the Postacute COVID Syndrome
Authors: Milic Jovana , Barbieri Sara , Gozzi Licia , Brigo Alberto , Beghé Bianca , Verduri Alessia , Bacca Erica , Iadisernia Vittorio , Cuomo Gianluca , Dolci Giovanni , Yaacoub Dina , Aprile Emanuele , Belli Michela , Venuta Maria , Meschiari Marianna , Sebastiani Giada , Clini Enrico , Mussini Cristina , Lonardo Amedeo , Guaraldi Giovanni , Raggi Paolo 
Published: January 2022

Abstract

Background
A proposal has recently been advanced to change the traditional definition of nonalcoholic fatty liver disease to metabolic-associated fatty liver disease (MAFLD), to reflect the cluster of metabolic abnormalities that may be more closely associated with cardiovascular risk. Long coronavirus disease 2019 (COVID-19) is a smoldering inflammatory condition, characterized by several symptom clusters. This study aims to determine the prevalence of MAFLD in patients with postacute COVID syndrome (PACS) and its association with other PACS-cluster phenotypes.

Methods
We included 235 patients observed at a single university outpatient clinic. The diagnosis of PACS was based on ≥1 cluster of symptoms: respiratory, neurocognitive, musculoskeletal, psychological, sensory, and dermatological. The outcome was prevalence of MAFLD detected by transient elastography during the first postdischarge follow-up outpatient visit. The prevalence of MAFLD at the time of hospital admission was calculated retrospectively using the hepatic steatosis index.

Results
Of 235 patients, 162 (69%) were men (median age 61). The prevalence of MAFLD was 55.3% at follow-up and 37.3% on admission (P &lt; .001). Insulin resistance (odds ratio [OR] = 1.5; 95% confidence interval [CI], 1.14–1.96), body mass index (OR = 1.14; 95% CI, 1.04–1.24), and the metabolic syndrome (OR = 2.54; 95% CI, 1.13–5.68) were independent predictors of MAFLD. The number of PACS clusters was inversely associated with MAFLD (OR = 0.86; 95% CI, .76–0.97). Thirty-one patients (13.2%) had MAFLD with no other associated PACS clusters. All correlations between MAFLD and other PACS clusters were weak.

Conclusions
Metabolic-associated fatty liver disease was highly prevalent after hospital discharge and may represent a specific PACS-cluster phenotype, with potential long-term metabolic and cardiovascular health implications.
High Burden of Cryptococcal Meningitis Among Antiretroviral Therapy–Experienced Human Immunodeficiency Virus–Infected Patients in Northern Uganda in the Era of “Test and Treat”: Implications for Cryptococcal Screening Programs
Authors: Okwir Mark , Link Abigail , Rhein Joshua , Obbo John Stephen , Okello James , Nabongo Betty , Alal Jimmy , Meya David , Bohjanen Paul R 
Published: January 2022

Abstract

Background
The impact of the “test and treat” program for human immunodeficiency virus (HIV) treatment in rural areas of Uganda on cryptococcal antigen (CrAg) screening or cryptococcal meningitis (CM) is poorly understood.

Methods
We retrospectively evaluated clinical factors in 212 HIV-infected patients diagnosed with CM from February of 2017 to November of 2019 at Lira Regional Referral Hospital in northern Uganda.

Results
Among 212 patients diagnosed with CM, 58.5% were male. Median age was 35 years; CD4 count and HIV viral load (VL) were 86 cells/μL and 9463 copies/mL, respectively. Only 10% of patients had a previous history of CM. We found that 190 of 209 (90.9%) patients were ART experienced and 19 (9.1%) were ART naive. Overall, 90 of 212 (42.5%) patients died while hospitalized (median time to death, 14 days). Increased risk of death was associated with altered mental status (hazard ratio [HR], 6.6 [95% confidence interval {CI}, 2.411–18.219]; P ≤ .0001) and seizures (HR, 5.23 [95% CI, 1.245–21.991]; P = .024).

Conclusions
Current guidelines recommend CrAg screening based on low CD4 counts for ART-naive patients and VL or clinical failure for ART-experienced patients. Using current guidelines for CrAg screening, some ART-experienced patients miss CrAg screening in resource-limited settings, when CD4 or VL tests are unavailable. We found that the majority of HIV-infected patients with CM were ART experienced (90.9%) at presentation. The high burden of CM in ART-experienced patients supports a need for improved CrAg screening of ART-exposed patients.
Lack of Clinical Utility of Labeled White Blood Cell Scintigraphy in Patients With Fever of Unknown Origin
Authors: Fisher Ronald E , Drews Ashley L , Palmer Edwin L 
Published: January 2022

Abstract

Background
Labeled white blood cell scintigraphy (WBCS) has been used for over 40 years to localize an infection source in patients with fever of unknown origin (FUO). It continues to be in widespread use for such patients in modern times, despite the tremendous advances in modern radiological imaging and laboratory medicine.

Methods
We critically evaluated the clinical contribution of WBCS performed in 132 patients with FUO at 7 hospitals from mid-2015 to the end of 2019. For each patient, all radiographic and laboratory results and all electronic clinical notes were carefully evaluated as many days before and after the scan as necessary to arrive at a final diagnosis.

Results
Although 50 WBCS (38%) showed positive findings, the majority of these were false positive (FP). Of the 19 true-positive (TP) scans, most were already known or about to become known by tests already ordered at the time of the scan. Only 2 TP scans (1.5%) contributed to the final diagnosis, and these did so only indirectly. FP scans led to 7 unnecessary procedures.

Conclusions
In FUO patients for whom an infection source is not discovered following an appropriate radiographic and laboratory workup, WBCS is not a useful procedure.
Implementing the EU Climate Law via the ‘Fit for 55’ package
Authors: Schlacke Sabine , Wentzien Helen , Thierjung Eva-Maria , Köster Miriam 
Published: January 2022

ABSTRACT
To implement the European Union (EU) Climate Law’s newly established 55% greenhouse gas reduction objective for 2030, the EU Commission suggests a wave of reforms to the European energy and climate legislation. The contribution aims to describe the EU Commission’s 16 initial legislative and strategic proposals regarding the major pillars of the European energy and climate legislation and intends to give an overview on the suggested reforms. By comparing the legal status quo with the legal framework de lege ferenda as presented by the Commission’s proposals, the planned major changes to the legal structures are identified. To achieve the 55% greenhouse gas reduction objective for 2030, all existing legal climate and energy acts are planned to be tightened by amending their targets as well as scopes and revising their structures. The suggested reforms concern the existing EU emissions trading system, effort sharing system between the Member States, energy taxation, energy efficiency and renewable energies. Additionally, the implementation of new instruments, such as the second EU emissions trading system for the sectors buildings and transport, the Carbon Border Adjustment Mechanism and the Social Climate Fund, is proposed. The design of the package shows that the Commission still generally pursues a climate legislation characterized by a mix of instruments and policies being both price based and regulatory. So, even though the major proposed change—the introduction of a second separate emissions trading system—would strengthen the role of carbon pricing, the Commission still relies on a mix of instruments without defining a leading instrument.
Testing the non-circularity of the spacetime around Sagittarius A* with orbiting pulsars
Authors: Takamori Yohsuke , Naruko Atsushi , Sakurai Yusuke , Takahashi Keitaro , Yamauchi Daisuke , Yoo Chul-Moon 
Published: January 2022

Abstract
A disformal Kerr black hole solution is a rotating black hole solution in a modified gravity theory which breaks the circular condition of spacetime differently from the case of the Kerr spacetime. In this paper, assuming that Sagittarius A* (Sgr A*) is a disformal Kerr black hole, we examine the potential to test the spacetime geometry with a hypothetical pulsar whose orbital elements are similar to those of the S2/S0-2 star. By numerically solving the equations of motion for the pulsar and photons emitted from it, we calculate the apparent position of the pulsar and the time of arrival (TOA) of the emitted pulse signals. Our analysis shows that the magnitude of the difference in the TOAs reaches the order of 10 ms if the deviation from the Kerr spacetime is significant. The time difference is mainly caused by the non-circularity of the spacetime at the 1.5 post-Newtonian order. The accuracy of the TOA measurement by a future radio telescope named the Square Kilometer Array (SKA) is between about 0.1 ms and 10 ms for a normal pulsar. Thus, we expect that the SKA can distinguish a disformal Kerr black hole from a Kerr black hole through the non-circularity of the spacetime around Sgr A*.
Phytoplankton prey of an abundant estuarine copepod identifiedin situusing DNA metabarcoding
Authors: Holmes Ann E , Kimmerer Wim J 
Published: January 2022

AbstractPlankton trophic interactions play a crucial role in ecosystem processes. Diet analysis using high-throughput sequencing methods such as metabarcoding can provide new insight where traditional methods have been limited. We used 16S ribosomal RNA gene metabarcoding to identify phytoplankton from the guts of the copepod Pseudodiaptomus forbesi and in seston from the Cache Slough Complex, a tidal freshwater reach of the San Francisco Estuary, California, USA. Cyanobacteria, assumed to have low nutritional value for copepods, were detected in all copepod samples and comprised the highest relative read abundance in metabarcoding results. Differential abundance analysis, used to compare representation of operational taxonomic units between copepod and seston samples, showed that two filamentous taxa (a streptophyte and a cyanobacterium) were most overrepresented in copepod samples, whereas cryptophytes and most ochropytes (diatoms and related taxa) were underrepresented in copepod samples. These findings could reflect unexpected feeding patterns or trophic upgrading. Understanding the capabilities and limitations of DNA metabarcoding is key to its use in diet analysis and integration with traditional approaches.
Twelve-Month Cognitive Trajectories in Individuals at Ultra-High Risk for Psychosis: A Latent Class Analysis
Authors: Allott Kelly , Schmidt Stefanie J , Yuen Hok Pan , Wood Stephen J , Nelson Barnaby , Markulev Connie , Lavoie Suzie , Brewer Warrick J , Schäfer Miriam R , Mossaheb Nilufar , Schlögelhofer Monika , Smesny Stefan , Hickie Ian B , Berger Gregor Emanuel , Chen Eric Y H , de Haan Lieuwe , Nieman Dorien H , Nordentoft Merete , Riecher-Rössler Anita , Verma Swapna , Thompson Andrew , Yung Alison R , Amminger Paul , McGorry Patrick D , Hartmann Jessica 
Published: January 2022

Abstract
Understanding longitudinal cognitive performance in individuals at ultra-high risk for psychosis (UHR) is important for informing theoretical models and treatment. A vital step in this endeavor is to determine whether there are UHR subgroups that have similar patterns of cognitive change over time. The aims were to: i) identify latent class trajectories of cognitive performance over 12-months in UHR individuals, ii) identify baseline demographic and clinical predictors of the resulting classes, and iii) determine whether trajectory classes were associated with transition to psychosis or functional outcomes. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline, 6- and 12-months (N = 288). Using Growth Mixture Modeling, a single unimpaired improving trajectory class was observed for motor function, speed of processing, verbal fluency, and BACS composite. A two-class solution was observed for executive function and working memory, showing one unimpaired and a second impaired class. A three-class solution was found for verbal learning and memory: unimpaired, mildly impaired, and initially extremely impaired, but improved (“caught up”) to the level of the mildly impaired. IQ, omega-3 index, and premorbid adjustment were associated with class membership, whereas clinical variables (symptoms, substance use), including transition to psychosis, were not. Working memory and verbal learning and memory trajectory class membership was associated with functioning outcomes. These findings suggest there is no short-term progressive cognitive decline in help-seeking UHR individuals, including those who transition to psychosis. Screening of cognitive performance may be useful for identifying UHR individuals who may benefit from targeted cognitive interventions.
A Japanese Subjective Well-Being Indicator Based on Twitter Data
Authors: CARPI Tiziana , HINO Airo , IACUS Stefano Maria , PORRO Giuseppe 
Published: January 2022

Abstract
This study presents for the first time the SWB-J index, a subjective well-being indicator for Japan based on Twitter data. The index is composed by eight dimensions of subjective well-being and is estimated relying on Twitter data by using human supervised sentiment analysis. The index is then compared with the analogous SWB-I index for Italy in order to verify possible analogies and cultural differences. Further, through structural equation models, we investigate the relationship between economic and health conditions of the country and the well-being latent variable and illustrate how this latent dimension affects the SWB-J and SWB-I indicators. It turns out that, as expected, economic and health welfare is only one aspect of the multidimensional well-being that is captured by the Twitter-based indicator.
Phylogenomics of Bony-Tongue Fishes (Osteoglossomorpha) Shed Light on the Craniofacial Evolution and Biogeography of the Weakly Electric Clade (Mormyridae)
Authors: Peterson Rose D , Sullivan John P , Hopkins Carl D , Santaquiteria Aintzane , Dillman Casey B , Pirro Stacy , Betancur-R Ricardo , Arcila Dahiana , Hughes Lily C , Ortí Guillermo 
Published: January 2022

Abstract
Bonytongues (Osteoglossomorpha) constitute an ancient clade of teleost fishes distributed in freshwater habitats throughout the world. The group includes well-known species such as arowanas, featherbacks, pirarucus, and the weakly electric fishes in the family Mormyridae. Their disjunct distribution, extreme morphologies, and electrolocating capabilities (Gymnarchidae and Mormyridae) have attracted much scientific interest, but a comprehensive phylogenetic framework for comparative analysis is missing, especially for the species-rich family Mormyridae. Of particular interest are disparate craniofacial morphologies among mormyrids which might constitute an exceptional model system to study convergent evolution. We present a phylogenomic analysis based on 546 exons of 179 species (out of 260), 28 out of 29 genera, and all six families of extant bonytongues. Based on a recent reassessment of the fossil record of osteoglossomorphs, we inferred dates of divergence among transcontinental clades and the major groups. The estimated ages of divergence among extant taxa (e.g., Osteoglossomorpha, Osteoglossiformes, and Mormyroidea) are older than previous reports, but most of the divergence dates obtained for clades on separate continents are too young to be explained by simple vicariance hypotheses. Biogeographic analysis of mormyrids indicates that their high species diversity in the Congo Basin is a consequence of range reductions of previously widespread ancestors and that the highest diversity of craniofacial morphologies among mormyrids originated in this basin. Special emphasis on a taxon-rich representation for mormyrids revealed pervasive misalignment between our phylogenomic results and mormyrid taxonomy due to repeated instances of convergence for extreme craniofacial morphologies. Estimation of ancestral phenotypes revealed contingent evolution of snout elongation and unique projections from the lower jaw to form the distinctive Schnauzenorgan. Synthesis of comparative analyses suggests that the remarkable craniofacial morphologies of mormyrids evolved convergently due to niche partitioning, likely enabled by interactions between their exclusive morphological and electrosensory adaptations. [Africa; ancestral state estimation; diversity; exon capture; freshwater fishes; Phylogenomics.]
Role of blood pressure on stroke-related mortality: a 45-year follow-up study in China
Authors: Wang Shengshu , Yang Shanshan , Jia Wangping , Han Ke , Song Yang , Zeng Jing , Cao Wenzhe , Liu Shaohua , Chen Shimin , Li Zhiqiang , Li Xuehang , Tai Penggang , Kou Fuyin , He Yao , Liu Miao 
Published: January 2022

Abstract

Background:
Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations.

Methods:
This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis.

Results:
Among 1696 participants, the average age was 44.38 ± 6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297–4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR = 2.104, 95% CI: 1.632–2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender.

Conclusions:
In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.
Antecedents of geographical expansion: The case of federally qualified health centers
Authors: Choi Seongwon , Weech-Maldonado Robert , Powers Thomas L. , Hearld Larry R. 
Published: January 2022

Background
Federally qualified health centers (FQHCs) are pivotal safety net primary care providers for the medically underserved. FQHCs have complex organizational designs, with many FQHCs providing care at multiple physical locations (“sites”). The number of sites, however, varies considerably between FQHCs, which can have important implications for differential access that may perpetuate disparities in quality of care.

Purpose
The objective of this study is to explore the organizational and environmental antecedents of the number of sites operated by each FQHC. The findings of this study contribute to a better understanding of FQHCs’ expansion that has vital implications for cost and access outcomes.

Methodology/Approach
The study is based on data between the years 2012 and 2018. Using multivariate growth curve modeling, we analyzed the final sample, consisting of 5,482 FQHC-years.

Results
The level of competition, measured as the number of FQHC sites in the Primary Care Service Area (PCSA) and the number of primary care physicians per 1,000 PCSA residents, was positively associated with the number of FQHC sites. The number of patients, the level of federal grant, and the year were also positively associated with the number of FQHC sites, whereas percentage of Medicaid patients; workforce supply, measured as primary care physician assistants per 1,000 PCSA residents; Medicaid expansion; and state/local funding available for FQHCs were not.

Conclusion
Findings of this study indicate that competition, especially between peer FQHCs, is significantly associated with FQHC expansion.

Practice Implications
This result suggests that FQHC managers and policymakers may closely monitor cost, access, and quality implications of competition and FQHC expansion.