bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial differences in the dermatological manifestations of tuberous sclerosis complex and the potential effects on diagnosis and care
Authors: Pounders Ashley J. , Rushing Gabrielle V. , Mahida Sonal , Nonyane Bareng Aletta Sanny , Thomas Emily A. , Tameez Rabiah Sundus , Gipson Tanjala T. 
Published: December 2022

Background: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder of non-malignant tumor growths throughout major organ systems and neurological, neuropsychiatric, renal, and pulmonary co-morbidities. Skin manifestations are readily visible, often develop early in life, and are major features that contribute to TSC diagnosis. Medical photographs of such manifestations are commonly shown as examples from White individuals creating a potential barrier to accurately identifying these features in darker skinned individuals. Objectives: The aim of this report is to raise awareness of dermatological manifestations associated with TSC, compare their appearance by race, and consider how recognition of these features could impact diagnosis and treatment of TSC. Design and Methods: We conducted a retrospective chart review at the TSC Center of Excellence (TSCOE) at the Kennedy Krieger Institute, which included all patients in the center from 2009 (inception) through the end of the calendar year 2015 and analyzed data from the TSC Alliance Natural History Database (NHD). Results: Among TSCOE patients, 50% of Black patients were diagnosed before the age of 1 year, compared with 70% of White patients. NHD data corroborated this trend showing a significant difference with only 38% of Blacks as compared with 50% of Whites were diagnosed at age ⩽1 year. A significant difference was observed where White participants had higher odds of having received genetic testing in both data sets. While no differences in the total number of TSC features was observed in either data set, shagreen patches and cephalic fibrous plaques were more frequently recorded in the NHD for Black individuals. Conclusion: We highlight a disparity in the representation of Black participants within the NHD, TSCOE, and TSC trials, in addition to differences in utilization of molecular testing and topical mechanistic target of rapamycin (mTOR) inhibitor therapy between Black and White individuals. We show a trend toward later diagnosis age in Black individuals. These differences between races warrant further study across additional clinical sites and other minority groups.
Audit of a computerized version of the Manchester triage system and a SIRS-based system for the detection of sepsis at triage in the emergency department
Authors: Dewitte Ken , Scheurwegs Elyne , Van Ierssel Sabrina , Jansens Hilde , Dams Karolien , Roelant Ella 
Published: December 2022

Abstract
Background and importance
Different triage systems can be used to screen for sepsis and are often incorporated into local electronic health records. Often the design and interface of these digitalizations are not audited, possibly leading to deleterious effects on screening test performance.

Objective
To audit a digital version of the MTS for detection of sepsis during triage in the ED.

Design
A single-center retrospective study

Settings and participants
Patients (n=29766) presenting to an ED of a tertiary-care center who received formal triage were included.

Outcome measures and analysis
Calculated performance measures included sensitivity, specificity, likelihood ratios, and AUC for the detection of sepsis. Errors in the application of the specific sepsis discriminator of the MTS were recorded.

Main results
A total of 189 (0.7%) subjects met the Sepsis-3 criteria, with 47 cases meeting the criteria for septic shock. The MTS had a low sensitivity of 47.6% (95% CI 40.3 to 55.0) for allocating sepsis patients to the correct triage category. However, specificity was high at 99.4% (95% CI 99.3 to 99.5).
Assisted clustering of gene expression data using regulatory data from partially overlapping sets of individuals
Authors: Jiang Wenqing , Joehanes Roby , Levy Daniel , O’Connor George T , Dupuis Josée 
Published: December 2022

Abstract
Background
As omics measurements profiled on different molecular layers are interconnected, integrative approaches that incorporate the regulatory effect from multi-level omics data are needed. When the multi-level omics data are from the same individuals, gene expression (GE) clusters can be identified using information from regulators like genetic variants and DNA methylation. When the multi-level omics data are from different individuals, the choice of integration approaches is limited.

Methods
We developed an approach to improve GE clustering from microarray data by integrating regulatory data from different but partially overlapping sets of individuals. We achieve this through (1) decomposing gene expression into the regulated component and the other component that is not regulated by measured factors, (2) optimizing the clustering goodness-of-fit objective function. We do not require the availability of different omics measurements on all individuals. A certain amount of individual overlap between GE data and the regulatory data is adequate for modeling the regulation, thus improving GE clustering.

Results
A simulation study shows that the performance of the proposed approach depends on the strength of the GE-regulator relationship, degree of missingness, data dimensionality, sample size, and the number of clusters. Across the various simulation settings, the proposed method shows competitive performance in terms of accuracy compared to the alternative K-means clustering method, especially when the clustering structure is due mostly to the regulated component, rather than the unregulated component. We further validate the approach with an application to 8,902 Framingham Heart Study participants with data on up to 17,873 genes and regulation information of DNA methylation and genotype from different but partially overlapping sets of participants. We identify clustering structures of genes associated with pulmonary function while incorporating the predicted regulation effect from the measured regulators. We further investigate the over-representation of these GE clusters in pathways of other diseases that may be related to lung function and respiratory health.

Conclusion
We propose a novel approach for clustering GE with the assistance of regulatory data that allowed for different but partially overlapping sets of individuals to be included in different omics data.
Pathogen exposure influences immune parameters around weaning in pigs reared in commercial farms
Authors: Hervé Julie , Haurogné Karine , Buchet Arnaud , Bacou Elodie , Mignot Grégoire , Allard Marie , Leblanc-Maridor Mily , Gavaud Solenn , Lehébel Anne , Terenina Elena , Mormède Pierre , Merlot Elodie , Belloc Catherine , Bach Jean-Marie , Lieubeau Blandine 
Published: December 2022

Abstract
Background
Multiple antigenic stimulations are crucial to immune system training during early post-natal life. These stimulations can be either due to commensals, which accounts for the acquisition and maintenance of tolerance, or to pathogens, which triggers immunity. In pig, only few works previously explored the influence of natural exposition to pathogens upon immune competence. We propose herein the results of a multicentric, field study, conducted on 265 piglets exposed to contrasted pathogen levels in their living environment. Piglets were housed in 15 different commercial farms, sorted in two groups, low (HSLOW)- and high (HSHIGH)-health status farms, depending on their recurrent exposition to five common swine pathogens.

Results
Using animal-based measures, we compared the immune competence and growth performances of HSLOW and HSHIGH pigs around weaning. As expected, we observed a rise in the number of circulating leucocytes with age, which affected different cell populations. Monocyte, antigen-experienced and cytotoxic lymphocyte subpopulation counts were higher in piglets reared in HSLOW farms as compared to their HSHIGH homologs. Also, the age-dependent evolution in γδ T cell and neutrophil counts was significantly affected by the health status. With age, circulating IFNα level decreased and IgM level increased while being greater in HSLOW piglets at any time. After weaning, LPS-stimulated blood cells derived from HSLOW piglets were more prone to secrete IL-8 than those derived from HSHIGH pigs did. Monocytes and granulocytes issued from HSLOW pigs also exhibited comparable phagocytosis capacity. Altogether our data emphasize the more robust immunophenotype of HSLOW piglets. Finally, piglets raised under higher pathogen pressure grew less than HSHIGH piglets did and exhibited a different metabolic profile. The higher cost of the immune responses associated with the low farm health status may account for lower HSLOW piglet performances.

Conclusions
Altogether, our data, obtained in field conditions, provide evidence that early exposure to pathogens shapes the immune competence of piglets. They also document the negative impact of an overstimulation of the immune system on piglets’ growth.
Correspondence: is there an association between centre volume and survival or neurological outcomes among out-of-hospital cardiac arrest patients?
Authors: Goh Amelia Xin Chun , Ho Andrew Fu Wah 
Published: December 2022

AbstractThis commentary discusses the findings of a study by Tsuchida et al. on the effect of annual hospital admissions of out-of-hospital cardiac arrest patients on survival and neurological outcomes in OHCA patients in the context of existing literature on the topic, and the implications on future studies investigating the volume-outcome relationship in cardiac arrest.
Characterizing the use of virtual care in primary care settings during the COVID-19 pandemic: a retrospective cohort study
Authors: Singer Alexander , Kosowan Leanne , LaBine Lisa , Shenoda Daniel , Katz Alan , Abrams Elissa M , Halas Gayle , Wong Sabrina T. , Talpade Siddhesh , Kirby Sarah , Baldwin Alanna , Francois Jose 
Published: December 2022

Abstract
Background
In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic.

Methods
Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescriptions) and provider (sex, age, clinic location, provider type, remuneration, country of graduation, return visit rate) characteristics describe the study population by visit type. Generalized estimating equation models describe factors associated with virtual care.

Results
There were 146,372 visits provided by 154 primary care providers between 03/14/20 and 06/30/20, of which 33.6% were virtual care. Female patients (OR 1.16, CI 1.09–1.22), patients with ≥ 3 comorbidities (OR 1.71, CI 1.44–2.02), and patients with ≥ 10 prescriptions (OR 2.71, 2.2–1.53) had higher odds of receiving at least one virtual care visit compared to male patients, patients with no comorbidities and patients with no prescriptions. There was no significant difference between the number of follow-up visits that were provided as a clinic visit compared to a virtual care visit (8.7% vs. 5.8%) (p = 0.6496).

Conclusion
Early in the pandemic restrictions, approximately one-third of visits were virtual. Virtual care was utilized by patients with more comorbidities and prescriptions, suggesting that patients with chronic disease requiring ongoing care utilized virtual care. Virtual care as a primary care visit type continues to evolve. Ongoing provision of virtual care can enhance quality, patient-centered care moving forward.
Pneumococcal concentration and serotype distribution in preschool children with radiologically confirmed pneumonia compared to healthy controls prior to introduction of pneumococcal vaccination in Zanzibar: an observational study
Authors: Elfving Kristina , Strömberg Lucia Gonzales , Geravandi Shadi , Andersson Maria , Bachelard Marc , Msellem Mwinyi , Shakely Delér , Trollfors Birger , Nordén Rickard , Mårtensson Andreas , Björkman Anders , Lindh Magnus 
Published: December 2022

Abstract
Background
The World Health Organization recommends pneumococcal vaccination (PCV) in the first year of life. We investigated pneumococcal serotypes in children with clinical or radiologically confirmed pneumonia and healthy controls prior to PCV13 vaccine introduction in Zanzibar.

Methods
Children (n = 677) with non-severe acute febrile illness aged 2–59 months presenting to a health centre in Zanzibar, Tanzania April–July 2011 were included. Nasopharyngeal swabs collected at enrolment were analysed by real-time PCR to detect and quantify pneumococcal serotypes in patients (n = 648) and in healthy asymptomatic community controls (n = 161). Children with clinical signs of pneumonia according to the Integrated Management of Childhood illness guidelines (“IMCI pneumonia”) were subjected to a chest-X-ray. Consolidation on chest X-ray was considered “radiological pneumonia”.

Results
Pneumococcal DNA was detected in the nasopharynx of 562/809 (69%) children (70% in patients and 64% in healthy controls), with no significant difference in proportions between patients with or without presence of fever, malnutrition, IMCI pneumonia or radiological pneumonia. The mean pneumococcal concentration was similar in children with and without radiological pneumonia (Ct value 26.3 versus 27.0, respectively, p = 0.3115). At least one serotype could be determined in 423 (75%) participants positive for pneumococci of which 33% had multiple serotypes detected. A total of 23 different serotypes were identified. One serotype (19F) was more common in children with fever (86/648, 13%) than in healthy controls (12/161, 7%), (p = 0.043). Logistic regression adjusting for age and gender showed that serotype 9A/V [aOR = 10.9 (CI 2.0–60.0, p = 0.006)] and 14 [aOR = 3.9 (CI 1.4–11.0, p = 0.012)] were associated with radiological pneumonia. The serotypes included in the PCV13 vaccine were found in 376 (89%) of the 423 serotype positive participants.

Conclusion
The PCV13 vaccine introduced in 2012 targets a great majority of the identified serotypes. Infections with multiple serotypes are common. PCR-determined concentrations of pneumococci in nasopharynx were not associated with radiologically confirmed pneumonia.
Trial registration Clinicaltrials.gov (NCT01094431).
Using time-dependent reproduction number to predict turning points of COVID-19 outbreak in Dalian, Liaoning province, China
Authors: An Qingyu , Wu Jun , Bai Jin jian , Li Xiaofeng 
Published: December 2022

Abstract
Objectives
To forecast the development trend of current outbreak in Dalian, mainly to predict turning points of COVID-19 outbreak in Dalian, Liaoning province, China, the results can be used to provide a scientific reference for timely adjustment of prevention and control strategies.

Methods
During the outbreak, Bayesian framework was used to calculated the time-dependent reproduction number ($${R_{t}}$$

R
t

), and then above acquired $${R_{t}}$$

R
t

and exponential trend equation were used to establish the prediction model, through the model, predict the $${R_{t}}$$

R
t

value of following data and know when $${R_{t}}$$

R
t

smaller than 1.

Results
From July 22 to August 5, 2020, and from March 14 to April 2, 2022, 92 and 632 confirmed cases and asymptomatic infected cases of COVID-19 were reported (324 males and 400 females) in Dalian. The R square for exponential trend equation were 0.982 and 0.980, respectively which fit the $${R_{t}}$$

R
t

with illness onset between July 19 to July 28, 2020 and between March 5 to March 17, 2022. According to the result of prediction, under the current strength of prevention and control, the $${R_{t}}$$

R
t

of COVID-19 will drop below 1 till August 2, 2020 and March 26, 2022, respectively in Dalian, one day earlier or later than the actual date. That is, the turning point of the COVID-19 outbreak in Dalian, Liaoning province, China will occur on August 2, 2020 and March 26, 2022.

Conclusions
Using time-dependent reproduction number values to predict turning points of COVID-19 outbreak in Dalian, Liaoning province, China was effective and reliable on the whole, and the results can be used to establish a sensitive early warning mechanism to guide the timely adjustment of COVID-19 prevention and control strategies.
Comparison of in-person vs. telebehavioral health outcomes from rural populations across America
Authors: McCord Carly , Ullrich Fred , Merchant Kimberly A. S. , Bhagianadh Divya , Carter Knute D. , Nelson EveLynn , Marcin James P. , Law Kari Beth , Neufeld Jonathan , Giovanetti Annaleis , Ward Marcia M. 
Published: December 2022

Abstract
Background
This study investigates outcomes from two federal grant programs: the Evidence-Based Tele-Behavioral Health Network Program (EB THNP) funded from September 2018 to August 2021 and the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP) funded from September 2017 to August 2020. As part of the health services implementation program, the aims of this study were to evaluate outcomes in patient symptoms of depression and anxiety across the programs’ 17 grantees and 95 associated sites, with each grantee having data from telehealth patients and from an in-person comparison group.

Methods
The research design is a prospective multi-site observational study. Each grantee provided data on a nonrandomized convenience sample of telehealth patients and an in-person comparison group from sites with similar rural characteristics and during the same time period. Patient characteristics were collected at treatment initiation, and clinical outcome measures were collected at baseline and monthly. The validated clinical outcome measure instruments included the Patient Health Questionnaire-9 (PHQ-9) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) scale for anxiety-related symptoms. Linear mixed models, with grantee as the random effect, were used to determine the association of behavioral health delivery (telehealth versus in-person) on the one-month change in PHQ-9 and GAD-7 while adjusting for covariates.

Results
Across a total of 1,514 patients, one-month change scores were improved indicating that PHQ-9 and GAD-7 scores decreased from baseline to the one-month follow-up at similar rates in both the in-person and telehealth groups. Reduction in scores averaged 2.8 for the telehealth treatment group and 2.9 for the in-person treatment group in the PHQ-9 subsample and 2.0 for the telehealth treatment group and 2.4 for the in-person treatment group in the GAD-7 subsample. There was no statistically significant association between the modality of care (telehealth treatment group versus in-person comparison group) and the one-month change scores for either PHQ-9 or GAD-7. Individuals with higher baseline scores demonstrated the greatest decrease in scores for both measures. Upon adjusting for baseline scores and grantee program, patient demographics were not found to be significantly associated with change in anxiety or depression symptoms.

Conclusion
In our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person.
Epidémiology of malaria from 2019 to 2021 in the southeastern city of Franceville, Gabon
Authors: Lendongo-Wombo Judicael-Boris , Oyegue-Liabagui Sandrine-Lydie , Biteghe-Bi-Essone Jean-Claude , Ngoungou Edgard Brice , Lekana-Douki Jean-Bernard 
Published: December 2022

Abstract
Background
In Gabon, a new national malaria control policy was implemented in 2003. It resulted in a decrease in the number of malaria cases in the country. In March 2020, the disruption of routine health services due to the COVID-19 pandemic has led to an increase in cases and deaths due to malaria. However, in Franceville, south-east Gabon, no data on malaria cases recorded before, during and after the COVID-19 epidemic has been published. Thus, the objective of this study was to determine the epidemiological characteristics of malaria in Franceville from 2019 to 2021.

Methods
A retrospectively study of malaria cases was performed at the Hôpital de l’Amitié Sino-Gabonaise (HASG). Information regarding age, gender, malaria diagnosis by microscopy and hematology cell count were collected from laboratory registers from June 2019 to December 2021. Malaria data were analyzed and correlated with seasonal variations.

Results
The data of 12,695 febrile patients were collected from the laboratory registers of the HASG, among which 4252 (33.5%) patients were found positive for malaria. The malaria prevalence was 37.5% in 2020 year. This prevalence was highest compared to the 2019 (29.6%) and 2021 (31.5%) year (p < 0.001). During the short rainy season (October to December), a large increase in malaria cases was observed all three year, from 2019 to 2021 (p > 0.05).

Conclusion
The prevalence of malaria in Franceville was very high during COVID-19 pandemic. It is therefore necessary to strengthen existing interventions and implement more effective interventions.