1058 10 20655 https://socictopen.socict.org/files/original/ac42084b15ff86e0076be78e4b624fa3.pdf 9021d8b7d8402d996635a6cb35e58527 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization. Creator An entity primarily responsible for making the resource Mark D Messina, Marjorie W Stein, Ian J Armstrong, Ellen L Wolf Description An account of the resource To analyze the change in utilization of healthcare resources through a review of ultrasound examinations performed in the emergency department of an urban healthcare system in NYC during the time of peak COVID-19 outbreak. This is a retrospective review analyzing ED ultrasound exams performed by the radiology department of an urban healthcare system during the 8-week time period of the peak COVID-19 outbreak in NYC, compared to a time-matched period one year prior. Data regarding the examination type and indication were obtained in addition to patient demographics and indicators of outcomes including admission, length of stay, and mortality. There was a 58% decrease in ED ultrasounds performed by the radiology department during the COVID-19 time period. Exams performed during the pandemic compared to the pre-pandemic period were more likely to be performed on men (28.3 vs 18.0%, p < 0.01), older patients (36 vs. 35 years, p = 0.02), and patients subsequently admitted (17.8 vs. 13.4%, p = 0.03). There was also a difference in the distribution of exam type (p = 0.01). There was no difference in death, rate of surgery/intervention performed, or distribution of clinical indication. When correcting for gender, there was only an increase in studies leading to hospital admission in the female-only group (14.9 vs. 10.7%, p = 0.05). COVID-19 had a drastic impact on the utilization of emergency department ultrasounds performed by the radiology department, with a decrease in total exams performed and changes in patient demographics, including a higher proportion of male patients and increases in some markers of disease severity, including rate of hospital admission. Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource covid-19, ultrasound, Emergency radiology, Imaging utilization Identifier An unambiguous reference to the resource within a given context 10.1007/s10140-021-01936-z Source A related resource from which the described resource is derived Emergency radiology https://socictopen.socict.org/files/original/b75a33f84d98631f88db46e59ffda658.pdf 4f51ec82bc9f1f050ea558dc35aaff7b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the COVID-19 pandemic on surgery for thyroid cancer in Italy: nationwide retrospective study. Creator An entity primarily responsible for making the resource F Medas, G L Ansaldo, N Avenia, G Basili, M Bononi, A Bove, P Carcoforo, A Casaril, G Cavallaro, G Conzo, L De Pasquale, P Del Rio, G Dionigi, C Dobrinja, G Docimo, G Graceffa, M Iacobone, N Innaro, C P Lombardi, G Novelli, N Palestini, F Pedicini, G Perigli, A Pezzolla, L Pezzullo, G Scerrino, S Spiezia, M Testini, P G Calò Date A point or period of time associated with an event in the lifecycle of the resource 2021 Identifier An unambiguous reference to the resource within a given context 10.1093/bjs/znab012 Source A related resource from which the described resource is derived The British journal of surgery https://socictopen.socict.org/files/original/18312edc6a2471a87d44759557868b57.pdf 8985facf017f1a333f541083a0c96c59 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs Creator An entity primarily responsible for making the resource Paul Van Royen, Hilde Philips, Veronique Verhoeven, Giannoula Tsakitzidis Description An account of the resource Objectives The current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline.Design, setting, participants We performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis.Results Changes in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak—as well as the measures taken to control it—will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves.Conclusions The current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Identifier An unambiguous reference to the resource within a given context 10.1136/bmjopen-2020-039674 Source A related resource from which the described resource is derived Epidemiology and Health Publisher An entity responsible for making the resource available Korean Society of Epidemiology Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Medicine https://socictopen.socict.org/files/original/c5855641177cd10c508c40f35c6c6c10.pdf 00eb244988db2f7b5ec9018175df681e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the COVID-19 pandemic on the mental health and well-being of UK healthcare workers. Creator An entity primarily responsible for making the resource James Gilleen, Aida Santaolalla, Lorena Valdearenas, Clara Salice, Montserrat Fusté Description An account of the resource The coronavirus disease 2019 (COVID-19) pandemic has had a significant psychological impact on healthcare workers (HCWs). There is an urgent need to understand the risk and protective factors associated with poor mental well-being of UK HCWs working during the COVID-19 pandemic. Shortly after the April 2020 UK COVID-19 peak 2773 HCWs completed a survey containing measures of anxiety, depression, post-traumatic stress disorder and stress, as well as questions around potential predictors such as roles, COVID-19 risk perception and workplace-related factors. Respondents were classified as high or low symptomatic on each scale and logistic regression revealed factors associated with severe psychiatric symptoms. Change in well-being from pre- to during COVID-19 was also quantified. Nearlya third of HCWs reported moderate to severe levels of anxiety and depression, and the number reporting very high symptoms was more than quadruple that pre-COVID-19. Several controllable factors were associated with the most severe level of psychiatric symptoms: insufficient personal protective equipment availability, workplace preparation, training and communication, and higher workload. Being female, 'front line', previous psychiatric diagnoses, traumatic events, and being an allied HCW or manager were also significantly associated with severe psychiatric symptoms. Sharing stress, resilience and ethical support for treatment decisions were significantly associated with low psychiatric symptoms. Front-line workers showed greater worsening of mental health compared with non-front-line HCWs. Poor mental well-being was prevalent during the COVID-19 response, however, controllable factors associated with severe psychiatric symptoms are available to be targeted to reduce the detrimental impact of COVID-19 and other pandemics on HCW mental health. Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource healthcare worker, covid-19, health care, well-being, NHS Identifier An unambiguous reference to the resource within a given context 10.1192/bjo.2021.42 Source A related resource from which the described resource is derived BJPsych open https://socictopen.socict.org/files/original/77fe2affb9e68413cc62289a8949f5e2.pdf baff5a568a0b3989ebd413fb03d8e63b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the COVID-19 Pandemic on the Romanian Labor Market Creator An entity primarily responsible for making the resource Carmen Valentina Radulescu, Georgiana-Raluca Ladaru, Sorin Burlacu, Florentina Constantin, Corina Ioanăș, Ionut Laurentiu Petre Description An account of the resource The present research aims to establish the impact that the current crisis situation the planet is facing, namely the COVID-19 pandemic, has had so far on the Romanian labor force market. In this context, given the lack of information and information regarding this pandemic and its effects, the administration of a questionnaire among the population was considered to identify the research results. The method of semantic differential and the method of ordering the ranks were used for the interpretation of the results. With the help of this questionnaire, it will be possible to answer the question of the research in this study: What are the main effects of the COVID-19 pandemic on the Romanian labor market? The main results showed that the COVID-19 pandemic affected the Romanian workforce; the respondents of the applied questionnaire claimed that they obtained better results and maintained a similar income, but the health crisis also influenced the mentality of employees, with respondents stating that in the event of changing jobs, they would consider it very important for the new employer to ensure the conditions for preventing and combating COVID-19, as well as complex health insurance. However, analyzing at the macroeconomic level, it was found that the COVID-19 pandemic induced an increase in the number of unemployed people in the Romanian labor market. Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource covid-19 pandemic, labor market, Romanian labor market Identifier An unambiguous reference to the resource within a given context 10.3390/su13010271 Source A related resource from which the described resource is derived Biotemas Publisher An entity responsible for making the resource available Universidade Federal de Santa Catarina Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Environmental effects of industries and plants, Renewable energy sources, Environmental sciences https://socictopen.socict.org/files/original/0fb1e8a004242bf83a1c7e5cc3267b91.pdf b166f8720818eda315b99084c970c822 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the COVID-19 pandemic on tuberculosis management in Spain. Creator An entity primarily responsible for making the resource M L Aznar, J Espinosa-Pereiro, N Saborit, N Jové, F Sánchez Martinez, S Pérez-Recio, A Vitoria, S Sanjoaquin, E Gallardo, J Llenas-García, V Pomar, I O García, J Cacho, Lisbeth Goncalves De Freitas, J V San Martin, J F García Rodriguez, M Á Jiménez-Fuentes, M L De Souza-Galvao, T Tórtola, R Zules, I Molina, Adrián Sánchez-Montalvá Description An account of the resource The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients remains unknown. Participant centres completed a structured web-based survey regarding changes in the management of TB patients during the COVID-19 pandemic. In addition, investigators included all patients ≥ 18 years with a TB diagnosis in two different periods: from March 15th to June 30th of 2020 and March 15th to June 30th, 2019. Clinical variables and information about household contacts were retrospectively collected. Seven (70%) TB Units reported changes in the TB team usual operation. A total of 169 patients were diagnosed with active TB in both periods of study (90 in 2019 and 79 in 2020). Patients diagnosed in 2020 showed more frequently bilateral lesions in CXR compared with patients diagnosed in 2019 (p = 0·004). A higher percentage of LTBI and active TB among children household contacts of patients diagnosed in 2020 compared to patients diagnosed in 2019 (p = 0·001) was observed. COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during COVID pandemic showed more extended pulmonary forms. The increase in LTBI infection and active TB in household children could reflect an expanded household transmission derived from antiCOVID19 measures. Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource transmission, covid-19, Tuberculosis, Pandemic, impact, household contact screening Identifier An unambiguous reference to the resource within a given context 10.1016/j.ijid.2021.04.075 Source A related resource from which the described resource is derived International Journal of Infectious Diseases Publisher An entity responsible for making the resource available Elsevier https://socictopen.socict.org/files/original/7a0b76c0107c58a6805ea3db78ddc798.pdf f3f7dc4f28cee87ec62fb54a3addf29a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the COVID-19 pandemic: The perceptions of health professions educators Creator An entity primarily responsible for making the resource Richard Hays, Barbara Jennings, Trevor Gibbs, Julie Hunt, Kerrie McKay Description An account of the resource What are health professions educators doing during the COVID-19 pandemic? A search of articles in MedEdPublish on the topics of COVID-19 revealed 39 articles published in the first 3 months of the pandemic. Topics included curriculum adaptation, guidelines for using technology, assessment adaptation, impact on students, faculty and career development, and conference adaptation. There was significant overlap among articles, particularly those discussing teaching, learning, and assessment practices. Common themes were adaptation, innovation, remote delivery, flexibility in the face of a pandemic, and how to continue to educate and graduate competent health professionals. All articles were descriptive, and none included data describing efficacy, likely due to the short timeline since the pandemic's inception. Additional study is necessary to produce evidence for the teaching and assessment adaptations described. Some changes are likely to persist longer-term and may outlast the pandemic itself. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Subject The topic of the resource covid-19, Pandemic, innovation, Medical education, Learning Technology Source A related resource from which the described resource is derived Epidemiology and Health Publisher An entity responsible for making the resource available Korean Society of Epidemiology Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Medicine, Special aspects of education https://socictopen.socict.org/files/original/a2849e6db7b2256dc37c2045bcc7243c.pdf 572917e493521948f346fdd8c7c7aba6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey Creator An entity primarily responsible for making the resource Ryan E. Rhodes, John C. Spence, Guy Faulkner, Mark S. Tremblay, Leigh M. Vanderloo, Sarah A. Moore, Mariana Brussoni, Tala Chulak-Bozzer, Leah J. Ferguson, Raktim Mitra, Norm O’Reilly Description An account of the resource Abstract Background Healthy childhood development is fostered through sufficient physical activity (PA; including time outdoors), limiting sedentary behaviours (SB), and adequate sleep; collectively known as movement behaviours. Though the COVID-19 virus outbreak has changed the daily lives of children and youth, it is unknown to what extent related restrictions may compromise the ability to play and meet movement behaviour recommendations. This secondary data analysis examined the immediate impacts of COVID-19 restrictions on movement and play behaviours in children and youth. Methods A national sample of Canadian parents (n = 1472) of children (5–11 years) or youth (12–17 years) (54% girls) completed an online survey that assessed immediate changes in child movement and play behaviours during the COVID-19 outbreak. Behaviours included PA and play, SB, and sleep. Family demographics and parental factors that may influence movement behaviours were assessed. Correlations between behaviours and demographic and parental factors were determined. For open-ended questions, word frequency distributions were reported. Results Only 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined movement behaviour guidelines during COVID-19 restrictions. Children and youth had lower PA levels, less outside time, higher SB (including leisure screen time), and more sleep during the outbreak. Parental encouragement and support, parental engagement in PA, and family dog ownership were positively associated with healthy movement behaviours. Although families spent less time in PA and more time in SB, several parents reported adopting new hobbies or accessing new resources. Conclusions This study provides evidence of immediate collateral consequences of the COVID-19 outbreak, demonstrating an adverse impact on the movement and play behaviours of Canadian children and youth. These findings can guide efforts to preserve and promote child health during the COVID-19 outbreak and crisis recovery period, and to inform strategies to mitigate potential harm during future pandemics. Date A point or period of time associated with an event in the lifecycle of the resource 2020 Identifier An unambiguous reference to the resource within a given context 10.1186/s12966-020-00987-8 Source A related resource from which the described resource is derived Epidemiology and Health Publisher An entity responsible for making the resource available Korean Society of Epidemiology Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Public aspects of medicine, Nutritional diseases. Deficiency diseases https://socictopen.socict.org/files/original/14843a55cf1c884d53e1f1fe51f73668.pdf 3d5019fdd0083ba2086eb3e1554dfa57 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center. Creator An entity primarily responsible for making the resource Carolin A Kreis, Birte Ortmann, Moritz Freistuehler, René Hartensuer, Hugo Van Aken, Michael J Raschke, Benedikt Schliemann Description An account of the resource In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents. Date A point or period of time associated with an event in the lifecycle of the resource 2021 Subject The topic of the resource covid-19, Pandemic, SARS-CoV-2, shut-down, emergency operation, Level I trauma center Identifier An unambiguous reference to the resource within a given context 10.1007/s00068-021-01654-8 Source A related resource from which the described resource is derived European journal of trauma and emergency surgery : official publication of the European Trauma Society https://socictopen.socict.org/files/original/d414dd6062fb8c5bad3d781d4df6d1d1.pdf e00908aac5991b60d309aa05437aa8b9 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Coronavirus Description An account of the resource Dominio científico: Coronavirus Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Impact of the Regulators SigB, Rot, SarA and sarS on the Toxic Shock Tst Promoter and TSST-1 Expression in Staphylococcus aureus. Creator An entity primarily responsible for making the resource Diego O. Andrey, Ambre Jousselin, Maite Villanueva, Adriana Renzoni, Antoinette Monod, Christine Barras, Natalia Rodríguez, William L Kelley Description An account of the resource Staphylococcus aureus is an important pathogen manifesting virulence through diverse disease forms, ranging from acute skin infections to life-threatening bacteremia or systemic toxic shock syndromes. In the latter case, the prototypical superantigen is TSST-1 (Toxic Shock Syndrome Toxin 1), encoded by tst(H), and carried on a mobile genetic element that is not present in all S. aureus strains. Transcriptional regulation of tst is only partially understood. In this study, we dissected the role of sarA, sarS (sarH1), RNAIII, rot, and the alternative stress sigma factor sigB (σB). By examining tst promoter regulation predominantly in the context of its native sequence within the SaPI1 pathogenicity island of strain RN4282, we discovered that σB emerged as a particularly important tst regulator. We did not detect a consensus σB site within the tst promoter, and thus the effect of σB is likely indirect. We found that σB strongly repressed the expression of the toxin via at least two distinct regulatory pathways dependent upon sarA and agr. Furthermore rot, a member of SarA family, was shown to repress tst expression when overexpressed, although its deletion had no consistent measurable effect. We could not find any detectable effect of sarS, either by deletion or overexpression, suggesting that this regulator plays a minimal role in TSST-1 expression except when combined with disruption of sarA. Collectively, our results extend our understanding of complex multifactorial regulation of tst, revealing several layers of negative regulation. In addition to environmental stimuli thought to impact TSST-1 production, these findings support a model whereby sporadic mutation in a few key negative regulators can profoundly affect and enhance TSST-1 expression. Date A point or period of time associated with an event in the lifecycle of the resource 2015 Identifier An unambiguous reference to the resource within a given context DOI: 10.1371/journal.pone.0135579 Source A related resource from which the described resource is derived PLoS ONE Publisher An entity responsible for making the resource available Public Library of Science (PLoS) Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant Science, Medicine Language A language of the resource EN