bluuebunny/crossref_metadata_2025_split huggingface dataset:
Appendicular Lean Mass, Grip Strength, and the Development of Hospital-Associated Activities of Daily Living Disability Among Older Adults in the Health ABC Study
Authors: Andrews James S , Gold Laura S , Reed May J , Garcia Jose M , McClelland Robyn L , Fitzpatrick Annette L , Hough Catherine L , Cawthon Peggy M , Covinsky Ken E 
Published: November 2021

Abstract

Background
Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with the development of hospital-associated ADL disability in older adults in the Health ABC Study.

Methods
Individuals hospitalized during the first 5 years of follow-up (n = 1 724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual-energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of prehospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability.

Results
Each standard deviation decrement in prehospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared with not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with the development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death.

Conclusions
Prehospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.
Strategic administration of an appeasing substance to improve performance and physiological responses of Bos indicus feedlot cattle
Authors: Fonseca Vitor G L , Cappellozza Bruno I , de Sousa Osvaldo A , Sagawa Manuella , Rett Bruna , Chizzotti Mário L , Cooke Reinaldo F 
Published: November 2021

Abstract
This study was designed to evaluate the timing of administration of the bovine appeasing substance (BAS) on performance and physiological responses of Bos indicus feedlot cattle. Nellore bulls (n = 100) were ranked by initial body weight (BW; 341 ± 18.5 kg) and assigned to receive BAS (n = 50) or placebo (CON; n = 50) on d -2 of the experiment. Treatments (5 mL) were applied topically to the nuchal skin area of each bull. Bulls were loaded into commercial livestock trailers immediately after treatment administration, transported for 880 km, and unloaded on d -1 at a commercial feedyard. On d 0, bulls within each treatment were again assigned to receive, in a 2 x 2 factorial arrangement, BAS or CON as previously described (25 bulls/treatment combination). Upon treatment administration on d 0, bulls were housed in 12 feedlot pens (3 pens/treatment) for a 108-d feeding period, which was divided into an adaptation (d 0 – 19), growing (d 20 – 60), and finishing (d 61 – 108) phases. Dry matter intake (DMI) was measured daily from d 0 to 108, whereas blood samples and hair from the tail switch were collected on d -2, 0, 19, 60, and 108. Administration of BAS prior to loading (d -2) improved ADG, FE, and DMI during adaptation and across the 108-d feeding period (P ≤ 0.08), resulting in greater (P = 0.03) hot carcass weight and dressing percentage upon slaughter on d 109. A treatment × day interaction was detected for serum glucose concentrations (P = 0.05), which was greater (P = 0.03) on d 60 of the feeding period in bulls receiving CON prior to loading. Administration of BAS at feedlot entry (d 0) improved DMI, ADG, and FE during adaptation (P ≤ 0.05), but it did not impact (P ≥ 0.18) performance and carcass traits during the 108-d feeding period. Bulls administered BAS prior to loading and at feedlot entry had less (P ≤ 0.05) mean serum cortisol concentrations across the 108-d feeding period (loading × feedlot entry interaction; P = 0.10), and greater (P ≤ 0.05) serum insulin concentration on d 60 (loading × feedlot entry × day interaction; P = 0.05). In summary, BAS administration prior to loading increased overall feedlot performance of Nellore bulls. These outcomes were noted in bulls that received or not a second BAS administration at feedlot entry, suggesting that the benefits of BAS are exploited when this substance is administered before transport to the feedlot.
Racial Disparities in Outcomes of Women Undergoing Myomectomy
Authors: Dallas Kai , Dubinskaya Alexandra , Andebrhan Sarah B. , Anger Jennifer , Rogo-Gupta Lisa J. , Elliott Christopher S. , Ackerman A. Lenore 
Published: November 2021

OBJECTIVE:
To assess the association of racial and socioeconomic factors with outcomes of abdominal myomectomies.

METHODS:
All women undergoing abdominal myomectomy in California from 2005 to 2012 were identified from the OSHPD (Office of Statewide Health Planning and Development) using appropriate International Classification of Diseases and Current Procedural Terminology codes. Demographics, comorbidities, surgical approaches, and complications occurring within 30 days of the procedure were identified. Multivariate associations were assessed with mixed effects logistic regression models.

RESULTS:
The cohort of 35,151 women was racially and ethnically diverse (White, 38.8%; Black, 19.9%; Hispanic, 20.3%; and Asian, 15.3%). Among all procedures, 33,906 were performed through an open abdominal approach, and 1,245 were performed using a minimally invasive approach. Proportionally, Black patients were more likely than White patients to have open procedures, and open approaches were associated with higher complication rates. Overall, 2,622 (7.5%) women suffered at least one complication. Although severe complications did not vary by race or ethnicity, Black (9.0%), Hispanic (7.9%), and Asian (7.5%) patients were more likely to suffer complications of any severity compared with White patients (6.7%, P<.001). As compared with patients with private insurance (6.4%), those with indigent payer status (Medicaid [12.1%] and self-pay [11.1%]) had higher complication rates (P<.001). Controlling for all factors, Black and Asian patients were more likely to suffer complications compared with White patients.

CONCLUSION:
The overall complication rate after abdominal myomectomy was 7.5%. Comorbidities, an open approach, and indigent payer status were associated with increased complication risk. Controlling for all factors, Black and Asian patients still had increased risks of complications.
Performance of a Vaginal Panel Assay Compared With the Clinical Diagnosis of Vaginitis
Authors: Broache Molly , Cammarata Catherine L. , Stonebraker Elizabeth , Eckert Karen , Van Der Pol Barbara , Taylor Stephanie N. 
Published: November 2021

OBJECTIVE:
To compare the performance of vaginitis diagnosis based on clinical assessment to molecular detection of organisms associated with bacterial vaginosis, vulvovaginal candidiasis, and Trichomonas vaginalis using a vaginal panel assay.

METHODS:
This cross-sectional diagnostic accuracy study included 489 enrolled participants from five collection sites where those with vaginitis symptoms had a vaginal assay swab collected during their visit and a clinical diagnosis made. The swab was later sent to a separate testing site to perform the vaginal panel assay. Outcome measures include positive, negative, and overall percent agreement (and accompanying 95% CIs) of clinical assessment with the vaginal panel assay. P<.05 was used to distinguish significant differences in paired proportions between the vaginal panel assay and clinical diagnosis, using the McNemar test. Inter-rater agreement between the two diagnostic approaches was determined using Cohen's kappa coefficient.

RESULTS:
Clinical diagnosis had a positive percent agreement with the vaginal panel assay of 57.9% (95% CI 51.5–64.2%), 53.5% (95% CI 44.5–62.4%), and 28.0% (95% CI 12.1–49.4%) for bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis, respectively. Negative percent agreement for clinical diagnosis was 80.2% (95% CI 74.3–85.2%), 77.0% (95% CI 72.1–81.4%), and 99.8% (95% CI 98.7–99.9%), respectively. Sixty-five percent (67/103), 44% (26/59), and 56% (10/18) of patients identified as having bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis by assay, respectively, were not treated for vaginitis based on a negative clinical diagnosis. Compared with the assay, clinical diagnosis had false-positive rates of 19.8%, 23.0%, and 0.2% for bacterial vaginosis, vulvovaginal candidiasis, and T vaginalis, respectively. Significant differences in paired proportions were observed between the vaginal panel assay and clinical diagnosis for detection of bacterial vaginosis and T vaginalis.

CONCLUSION:
The vaginal panel assay could improve the diagnostic accuracy for vaginitis and facilitate appropriate and timely treatment.

FUNDING SOURCE:
Becton, Dickinson and Company.
Accessibility of Pharmacist-Prescribed Contraceptives in Utah
Authors: Magnusson Brianna M. , Christensen Sarah R. , Tanner Ashley B. , Eyring J. B. , Pilling Emily B. , Sloan-Aagard Chantel D. 
Published: November 2021

OBJECTIVE:
To assess pharmacy participation in and accessibility of pharmacist-prescribed contraception after legislation effective in the state of Utah in 2019.

METHODS:
A secret-shopper telephone survey was used to assess participation in pharmacist-prescribed contraception. Geospatial analysis was used to map the distribution of participating pharmacies by population characteristics.

RESULTS:
Of all operating Class A retail pharmacies in Utah, 127 (27%) were providing pharmacist-prescribed contraception 1 year after implementation of the Utah standing order. Oral contraceptive pills were widely accessible (100%); however, other allowed methods were not (vaginal ring 14%; contraceptive patch 2%). Consultation fees and medication costs varied widely. Participating pharmacies were mainly concentrated in population centers. Assuming access to a personal vehicle, urban areas with a high percentage of Hispanic people (Utah's largest minority race or ethnicity group) have access to a participating pharmacy within a 20-minute driving distance. However, access in rural areas with a high percentage Hispanic or other minority were limited. We identified 235 (40%) census tracts with a high proportion of Utah's residents living below the poverty line or of minority race or ethnicity who also had low access to pharmacist-prescribed contraception.

CONCLUSIONS:
Although the pharmacy-based model is intended to increase access to contraception, practical availability 1 year after the authorization of pharmacist-prescribed contraception in Utah suggests that this service does not adequately serve rural areas, particularly rural areas with a high proportion of minorities and those living below the federal poverty line.
Hereditary Cancer Risk Using a Genetic Chatbot Before Routine Care Visits
Authors: Nazareth Shivani , Hayward Laura , Simmons Emilie , Snir Moran , Hatchell Kathryn E. , Rojahn Susan , Slotnick Robert Nathan , Nussbaum Robert L. 
Published: November 2021

OBJECTIVE:
To examine user uptake and experience with a clinical chatbot that automates hereditary cancer risk triage by collecting personal and family cancer history in routine women's health care settings.

METHODS:
We conducted a multicenter, retrospective observational study of patients who used a web-based chatbot before routine care appointments to assess their risk for hereditary breast and ovarian cancer, Lynch syndrome, and adenomatous polyposis syndromes. Outcome measures included uptake and completion of the risk-assessment and educational section of the chatbot interaction and identification of hereditary cancer risk as evaluated against National Comprehensive Cancer Network criteria.

RESULTS:
Of the 95,166 patients invited, 61,070 (64.2%) engaged with the clinical chatbot. The vast majority completed the cancer risk assessment (89.4%), and most completed the genetic testing education section (71.4%), indicating high acceptability among those who opted to engage. The mean duration of use was 15.4 minutes (SD 2 hours, 56.2 minutes) when gaps of inactivity longer than 5 minutes were excluded. A personal history of cancer was reported by 19.1% (10,849/56,656) and a family history of cancer was reported by 66.7% (36,469/54,652) of patients who provided the relevant information. One in four patients (14,850/54,547) screened with the chatbot before routine care appointments met National Comprehensive Cancer Network criteria for genetic testing. Among those who were tested, 5.6% (73/1,313) had a disease-causing pathogenic variant.

CONCLUSION:
A chatbot digital health tool can help identify patients at high risk for hereditary cancer syndromes before routine care appointments. This scalable intervention can effectively provide cancer risk assessment, engage patients with educational information, and facilitate a path toward preventive genetic testing.

FUNDING SOURCE:
Implementation of the chatbot in clinics was funded by industry support from commercial genetic testing laboratories Ambry, Invitae, and Progenity.
Factors Underlying Patient and Surgeon Willingness to Participate in a Placebo Surgery Controlled trial
Authors: Bunzli Samantha , Nelson Elizabeth , Wall Laura , Schilling Chris , Lohmander L. Stefan , Balogh Zsolt J. , Tran Phong , Paolucci Francesco , Clarke Philip , Choong Peter F. M. , Dowsey Michelle M. 
Published: November 2021

Objective:
To investigate the factors underlying willingness to participate in a hypothetical trial among patients and surgeons, to inform the design of future placebo surgery controlled trials.

Background:
Placebo surgery controlled trials are the gold standard for testing the efficacy of surgical procedures. However, these trials commonly fail to meet the target sample size and terminate underpowered.

Methods:
From October 2019 to July 2020, eligible patients were identified from the orthopedic waiting list at a single tertiary hospital and surgeons were identified from orthopedic clinics at three tertiary hospitals in Australia. Qualitative interviews explored factors underlying willingness to participate in a hypothetical trial, including understanding of trial concepts; attitudes; and trial design preferences. Data collection and analysis were conducted in parallel. Recruitment ceased when no new concepts emerged. Interview data were analyzed using reflexive thematic analysis.

Results:
The majority of surgeons and only a few patients indicated a willingness to participate in a placebo surgery controlled trial. Factors underlying willingness were captured in four themes: (1) Understanding and attitudes toward placebo; (2) Attitudes towards randomization/perception of equipoise; (3) Perception of risk; and (4) Ethical concerns.

Conclusions:
To optimize recruitment in the future, trialists may consider embedding strategies into the recruitment process that validate patients’ symptoms, encourage an altruistic mindset, address surgeon biases, and involve surgeons in explaining trial concepts to patients. Trialists may also consider designing three arm trials that meet surgeons’ preferences for a “low” and “high” fidelity placebo.
Patient Perceptions and Determinants of Choice for Breast Reconstruction after Mastectomy among Saudi Patients
Authors: Aljaaly Hattan A. , Mortada Hatan , Trabulsi Nora H. 
Published: November 2021

Background:
Undergoing mastectomy is often associated with a negative impact on the mental well-being of patients. Patients who undergo postmastectomy breast reconstruction (BR) have a better self-image and higher self-esteem. Many patients with breast cancer (BC) are unaware of the availability of BR options. This study aimed to assess BC patient perceptions and identify the determinants of patient choices to undergo BR after mastectomy.

Methods:
This study was conducted between May 10, 2019 and February 29, 2020 via an interview-based questionnaire, among BC patients at King Abdul Aziz University Hospital, Jeddah, Saudi Arabia. Ethical approval was obtained from the research ethics committee before the data collection.

Results:
Altogether, 400 patients (an overall 82% response rate) were included, of whom 155 (38.75%) were group 1 (willing to undergo BR). The mean age for group 1 was 46.04 ± 8.79, which was younger than for group 2 (unwilling to undergo BR) (P < 0.001). Furthermore, 117 (75.5%) of group 1 had no history of any chronic illness compared with 145 (59.2%) of group 2 (P < 0.001). Group 1 had more knowledge about BR (69.7%, P < 0.001), and the main reason to undergo BR was to regain femininity (26.8%). The remaining patients (31.3%) were unwilling to undergo BR in order to avoid additional surgery.

Conclusions:
The lack of knowledge and misconception about BR is one factor preventing BC patients from undergoing BR. Spreading awareness and providing accurate information regarding the procedure will allow women with BC to overcome postmastectomy fear.
Multistage Ala Nasi Repair with an Expanded and Prelaminated Forehead Flap: A Case Report
Authors: Dabrosin Nina , Bjørn Stolle Lars , Hasanbegovic Emir 
Published: November 2021

Summary:
An 18-year-old man presented with a fast-growing tumor of the right ala nasi. We excised the tumor and histology report revealed a keratoacanthoma with clear margins. After surgery, the patient was left with a composite defect of 3 × 2 cm. For reconstruction, we used an expanded prelaminated forehead flap with a durable cartilage graft from the ribcage and a turnover flap for inner lining. Our technique had a pleasing end result and excellent patient satisfaction.
Clinical and Immunological Characteristics of Patients with Biopolymers and Autoimmune Inflammatory Syndrome Induced by Adjuvants
Authors: Pachón S Jaime Eduardo , Salazar Marcela C. , Pores Adriana M. , Rizo Victor Z. 
Published: November 2021

Background:
Biopolymers consist of non-biocompatible allogeneic materials. They have been associated with autoimmune inflammatory syndrome induced by adjuvants, as described by Yehuda Shoenfeld and Nancy Agmon-Levin. Therefore, this study aimed to evaluate the clinical and immunological characteristics of patients with autoimmune inflammatory syndrome induced by adjuvants treated at a plastic surgery clinic in Colombia.

Methods:
This cross-sectional, descriptive observational study included 190 patients with biopolymers in the buttocks with no evidence of autoimmune disease who were diagnosed with autoimmune inflammatory syndrome induced by adjuvants and underwent treatment at a private plastic surgery clinic from 2017 to 2020. The clinical and paraclinical parameters were measured preoperatively, when the diagnosis of autoimmune inflammatory syndrome induced by adjuvants and the need for material removal were established, and postoperatively after 3 months.

Results:
The most frequent symptoms were myalgia (92%), arthralgia (77.9%), asthenia (77.9%), adynamia (77.9%), and neurological symptoms (55.8%). Preoperatively, patients were positive for antinuclear antibody, lactate dehydrogenase, complement proteins C3 and C4, and lupus anticoagulant. However, after removal of the biopolymer, there was a decrease in positivity or conversion to a negative status of paraclinical tests. Moreover, there was an association between LDH positivity and disease severity (odds ratio: 4.1, 95% confidence interval: 1.94–8.92).

Conclusions:
The removal of biopolymers using an open surgical technique in symptomatic or asymptomatic patients is crucial for functional and reconstructive purposes and to improve the quality of life. Therefore, this condition should be known as “human adjuvant disease caused by biopolymers.” Further, this condition mimics autoimmune diseases, with clinical and paraclinical manifestations that improve biopolymer removal.
Differences in Time Burden across Local Therapy Strategies for Early-stage Breast Cancer
Authors: Swanick Cameron W. , Jiang Jing , Maldonado J. Alberto , Lei Xiudong , Shih Ya-Chen Tina , Caudle Abigail S. , Baumann Donald P. , Giordano Sharon H. , Shaitelman Simona F. , Shirvani Shervin M. , Smith Benjamin D. 
Published: November 2021

Background:
“Time burden” (time required during treatment) is relevant when choosing a local therapy option for early-stage breast cancer but has not been rigorously studied. We compared the time burden for three common local therapies for breast cancer: (1) lumpectomy plus whole-breast irradiation (Lump+WBI), (2) mastectomy without radiation or reconstruction (Mast alone), and (3) mastectomy without radiation but with reconstruction (Mast+Recon).

Methods:
Using the MarketScan database, we identified 35,406 breast cancer patients treated from 2000 to 2011 with these local therapies. We quantified the total time burden as the sum of inpatient days (inpatient-days), outpatient days excluding radiation fractions (outpatient-days), and radiation fractions (radiation-days) in the first two years postdiagnosis. Multivariable regression evaluated the effect of local therapy on inpatient-days and outpatient-days adjusted for patient and treatment covariates.

Results:
Adjusted mean number of inpatient-days was 1.0 for Lump+WBI, 2.0 for Mast alone, and 3.1 for Mast+Recon (P < 0.001). Adjusted mean number of outpatient-days was 42.9 for Lump+WBI, 42.2 for Mast alone, and 45.8 for Mast+Recon (P < 0.001). The mean number of radiation-days for Lump+WBI was 32.4. Compared with Mast+Recon (48.9 days), total adjusted time burden was 4.7 days shorter for Mast alone (44.2 days) and 27.4 days longer for Lump+WBI (76.3 days). However, use of a 15 fraction WBI regimen would reduce the time burden differential between Lump+WBI and Mast+Recon to just 10.0 days.

Conclusions:
Although Mast+Recon confers the highest inpatient and outpatient time burden, Lump+WBI carries the highest total time burden. Increased use of hypofractionation will reduce the total time burden for Lump+WBI.