bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of Target Enrichment Sequencing for Population Genetic Analyses of the Obligate Plant Pathogens Pseudoperonospora cubensis and P. humuli in Michigan
Authors: Bello Julian C. , Hausbeck Mary K. , Sakalidis Monique L. 
Published: July 2021

Technological advances in genome sequencing have improved our ability to catalog genomic variation and have led to an expansion of the scope and scale of genetic studies over the past decade. Yet, for agronomically important plant pathogens such as the downy mildews (Peronosporaceae), the scale of genetic studies remains limited. This is, in part, due to the difficulties associated with maintaining obligate pathogens and the logistical constraints involved in the genotyping of these species (e.g., obtaining DNA of sufficient quantity and quality). To gain an evolutionary and ecological perspective of downy mildews, adaptable methods for the genotyping of their populations are required. Here, we describe a targeted enrichment (TE) protocol to genotype isolates from two Pseudoperonospora species (P. cubensis and P. humuli), using less than 50 ng of mixed pathogen and plant DNA for library preparation. We were able to enrich 830 target genes across 128 samples and identified 2,514 high-quality single nucleotide polymorphism (SNP) variants. Using these SNPs, we detected significant genetic differentiation (analysis of molecular variance [AMOVA], P = 0.01) between P. cubensis subpopulations from Cucurbita moschata (clade I) and Cucumis sativus (clade II) in the state of Michigan. No evidence of location-based differentiation was detected within the P. cubensis (clade II) subpopulation in Michigan. However, a significant effect of location on the genetic variation of the P. humuli subpopulation was detected in the state (AMOVA, P = 0.01). Mantel tests found evidence that the genetic distance among P. humuli samples was associated with the physical distance of the hop yards from which the samples were collected (P = 0.005). The differences in the distribution of genetic variation of the Michigan P. humuli and P. cubensis subpopulations suggest differences in the dispersal of these two species. The TE protocol described here provides an additional tool for genotyping obligate biotrophic plant pathogens and the execution of new genetic studies. [Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Proximal Tibia Skeletal Traction: Technique and Indications
Authors: Obey Mitchel R. , Berkes Marschall B. , McAndrew Christopher M. , Miller Anna N. 
Published: July 2021

Summary:
Skeletal traction is a fundamental tool for the orthopaedic surgeon caring for patients with traumatic pelvic and lower-extremity orthopaedic injuries. Skeletal traction has proven to be an effective initial means of stabilization in patients with these injuries. Traction may be used for both temporary and definitive treatment in a variety of orthopaedic injuries. With the appropriate knowledge of regional anatomy, skeletal traction pins can be placed safely and with a low rate of complications. Several methods for placing skeletal traction have been described, and it is critical for orthopaedic surgeons to be proficient not only in their application but also understanding of the appropriate indications for use. Here we present a case example of a patient with a right femur fracture and discuss the technique and indications for placement of proximal tibia skeletal traction.
Management of Pediatric Femur Fracture Using 90-90 Traction
Authors: Kim Victoria , Milton Joe , Mashru Rakesh P. , Graf Kenneth W. 
Published: July 2021

Summary:
This video discusses treatment of pediatric femur fractures using 90-90 traction, followed by delayed spica casting. This study details the treatment of a 2-year-old girl with a subtrochanteric femur fracture featuring a 4-cm acute shortening and severe malalignment. The patient was placed in 90-90 traction in the operative setting. When adequate callous was observed radiographically, the patient was treated with a spica cast in the hospital on day 16. She was noted to have obtained uneventful healing of the fracture with no functional deficits, as detailed during serial office visits.
Tibia Antibiotic Intramedullary Nail
Authors: Tatman Lauren M. , Gajari Vamshi , Obremskey William T. 
Published: July 2021

Summary:
This video depicts the materials and steps for creating an antibiotic cement spacer in the form of an intramedullary nail and demonstrates how to insert the nail into a tibia. The indication for this patient was a history of a type 3B open tibia fracture 6 months before treated with an intramedullary nail that subsequently developed an infected nonunion.
Screening of Acute Traumatic Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients: A Pilot Study
Authors: Mazo Ashley , Waddell Megan , Raddatz Julia , Blankenship Kelly , Rachal James C. , Reynolds Stacy , Christmas A. Britton 
Published: July 2021

Background:
Children who experience traumatic physical injuries are at risk of developing acute stress disorder and posttraumatic stress disorder (PTSD). Early identification and treatment of these high-risk children can lead to improved mental health outcomes in this population.

Objective:
This study assesses the feasibility of a study protocol that compares 3 screening tools for identifying patients at a high risk of later development of acute stress disorder or PTSD among pediatric trauma patients.

Methods:
This pilot study compared 3 questionnaires used as screening tools for predictors of later development of PTSD in a convenience sample of pediatric trauma patients aged 7–17 years. Patients were randomized to one of 3 screening tools. Families were contacted at 30, 60, and 90–120 days postinjury to complete the Child Report of Post-Traumatic Symptoms questionnaire. The sensitivity and negative predictive value of the screening tools were compared for the diagnosis of PTSD defined using the Child Report of Post-Traumatic Symptoms questionnaire.

Results:
Of the 263 patients identified for possible enrollment, 52 patients met full inclusion criteria and agreed to participate. Only 29 (55.7%) patients completed at least one follow-up questionnaire. The prevalence of acute stress disorder and PTSD in our population was 41% (95% CI [24, 61]) and 31% (95% CI [15, 51]), respectively.

Conclusions:
In this pilot study, we sought to determine the utility of the 3 commonly used screening instruments for measuring traumatic stress symptoms in pediatric trauma patients to predict the diagnosis of acute stress disorder or PTSD. Limitations include the use of the Child Report of Post-Traumatic Symptoms screening tool as the gold standard for calculating test characteristics and lack of 24/7 enrollment capabilities. As such, a significant portion of patients were discharged prior to our teams' engagement for enrollment.
Comprehensive Initiative to Decrease Trauma Venous Thromboembolism
Authors: Johns Tracy J. , Fabico-Dulin Josephine , Montgomery Anne , Dulin Janelle F. , Ashley Dennis W. 
Published: July 2021

Background:
Our trauma center was a high outlier for pulmonary embolism on a 2017 American College of Surgeons Trauma Quality Improvement Program (TQIP) report. The odds ratio for developing a pulmonary embolus was 1.76 and was in the 10th decile (worst results). Of the patients who received chemoprophylaxis, only 69% of patients received the “gold standard” low-molecular-weight heparin.

Objective:
The purpose of this study was to describe and evaluate a multicomponent performance improvement project to prevent pulmonary embolus incidence.

Methods:
This descriptive study was a before-and-after time-series analysis of adult trauma patients. Ongoing data validation, concurrent monitoring, and analysis on incidence of venous thrombolytic events identified barriers to evidence-based chemoprophylaxis administration.

Results:
There were a total of 4,711 trauma patients in the analysis. Compared with preintervention (fall 2017), the fall 2019 TQIP report indicated the pulmonary embolus odds ratio dropped to 0.56, lowering the benchmark decile from 10 (worst) to 1 (best). The proportion of patients receiving no chemoprophylaxis decreased to 23% and was lower than all hospitals (32%). The rate of low-molecular-weight heparin use increased to 80% for patients receiving chemoprophylaxis, and unfractionated heparin use plummeted to 14%. The proportion of patients with no chemoprophylaxis in the severe traumatic brain injury cohort fell to 21%.

Conclusions:
The high pulmonary embolus rate was driven by inaccurate data, infrequent monitoring, suboptimal ordering, and administration of chemoprophylaxis. A sustained decrease in the pulmonary embolus incidence was achieved through collaboration, updated guidelines, expanded education, concurrent validation, monitoring, and frequent reporting.
Short-term Focused Feedback
Authors: Sauers-Ford Hadley , Statile Angela M. , Auger Katherine A. , Wade-Murphy Susan , Gold Jennifer M. , Simmons Jeffrey M. , Shah Samir S. 
Published: July 2021

Background:
Our grant from the Patient-Centered Outcomes Research Institute (PCORI) focused on the use of nurse home visits postdischarge for primarily pediatric hospital medicine patients. While our team recognized the importance of engaging parents and other stakeholders in our study, our project was one of the first funded to address transitions of care issues in patients without chronic illness; little evidence existed about how to engage acute stakeholders longitudinally.

Objective:
This manuscript describes how we used both a short-term focused feedback model and longitudinal engagement methods to solicit input from parents, home care nurses, and other stakeholders throughout our 3-year study.

Results:
Short-term focused feedback allowed the study team to collect feedback from hundreds of stakeholders. Initially, we conducted focus groups with parents with children recently discharged from the hospital. We used this feedback to modify our nurse home visit intervention, then used quality improvement methods with continued short-term focus feedback from families and nurses delivering the visits to adjust the visit processes and content. We also used their feedback to modify the outcome collection. Finally, during the randomized controlled trial, we added a parent to the study team to provide longitudinal input, as well as continued to solicit short-term focused feedback to increase recruitment and retention rates.

Conclusion:
Research studies can benefit from soliciting short-term focused feedback from many stakeholders; having this variety of perspectives allows for many voices to be heard, without placing an undue burden on a few stakeholders.
Opening Pandora’s Box
Authors: Reeves Mathew J. , Fritz Michele C. , Osunkwo Ifeyinwa , Grudzen Corita R. , Hsu Lewis L. , Li Jing , Lawrence Raymona H. , Bettger Janet Prvu 
Published: July 2021

Background:
Measuring the effectiveness of transitional care interventions has historically relied on health care utilization as the primary outcome. Although the Care Transitions Measure was the first outcome measure specifically developed for transitional care, its applicability beyond the hospital-to-home transition is limited. There is a need for patient-centered outcome measures (PCOMs) to be developed for transitional care settings (ie, TC-PCOMs) to ensure that outcomes are both meaningful to patients and relevant to the particular care transition. The overall objective of this paper is to describe the opportunities and challenges of integrating TC-PCOMs into research and practice.

Methods and Results:
This narrative review was conducted by members of the Patient-Centered Outcomes Research Institute (PCORI) Transitional Care Evidence to Action Network. We define TC-PCOMs as outcomes that matter to patients because they account for their individual experiences, concerns, preferences, needs, and values during the transition period. The cardinal features of TC-PCOMs should be that they are developed following direct input from patients and stakeholders and reflect their lived experience during the transition in question. Although few TC-PCOMs are currently available, existing patient-reported outcome measures could be adapted to become TC-PCOMs if they incorporated input from patients and stakeholders and are validated for the relevant care transition.

Conclusion:
Establishing validated TC-PCOMs is crucial for measuring the responsiveness of transitional care interventions and optimizing care that is meaningful to patients.
Predictors of Elevated Social Risk in Pediatric Emergency Department Patients and Families
Authors: Rucker Alexandra C. , Watson Ar'Reon , Badolato Gia , Boyle Meleah , Hendrix Christian , Jarvis Lenore , Patel Shilpa J. , Goyal Monika K. 
Published: July 2021

Objective
This study aimed to identify predictors of high unmet social needs among pediatric emergency department (ED) patients. We hypothesized that obesity, frequent nonurgent visits, reported food insecurity, or an at-risk chief complaint (CC) would predict elevated social risk.

Methods
We administered a tablet-based survey assessing unmet social needs in 13 domains to caregivers of patients aged 0 to 17 years presenting to an urban pediatric ED. Responses were used to tabulate a social risk score (SRS). We performed multivariable logistic regression to measure associations between a high SRS (≥3) and obesity, frequent nonurgent visits, food insecurity, or an at-risk CC (physical abuse, sexual abuse, assault, mammalian bites, reproductive/sexual health complaints, intoxication, ingestion/poisoning, psychiatric/behavioral complaints, or any complaint triaged as “least urgent”).

Results
Five hundred seventy caregivers completed the survey. Eighty-one percent reported at least one unmet social need, and 33% identified ≥3 social needs. Caregivers of patients with an at-risk CC had twice the odds of a high SRS (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.0–3.3). Caregivers of patients reporting food insecurity had 4 times the odds of a high SRS (aOR, 4.3; 95% CI, 2.5–7.3). Neither obesity (aOR, 1.5; 95% CI, 0.9–2.6) nor frequent nonurgent visits (aOR, 0.9; 95% CI, 0.4–1.9) were predictive of a high SRS.

Conclusions
Unmet social needs are prevalent among caregivers of pediatric ED patients, supporting universal screening in this population. Patients with an at-risk CC or reported food insecurity might benefit from proactive intervention. Future studies should examine optimal methods for ED-based interventions that address social determinants of health.
Testicular Torsion Patients Should Be Manually Detorsed at Diagnosis
Authors: Cabral Dias Filho Aderivaldo , Rincon Cintra da Cruz Pedro , Zanettini Riccetto Cassio Luis 
Published: July 2021

Objective
The aim of the study was to assess organ salvage in testicular torsion patients submitted to manual detorsion according to interhospital transfer and surgical wait times.

Methods
Retrospective analysis of consecutive surgically treated testicular torsion patients between 2012 and 2018. We compared testicular surgical salvage in testicular torsion patients submitted to manual detorsion either at clinical diagnosis (immediate detorsion) or after interhospital transfer from lower level-of-care facilities (delayed detorsion) and estimated the influence of interhospital transfer and surgical wait times on outcomes. Analysis included Bayesian logistic regression after propensity score matching. We excluded patients first examined at off-state and private facilities, with prediagnostic time of more than 24 hours, not initially diagnosed with testicular torsion or not submitted to manual detorsion at any time.

Results
One hundred sixty-two patients (median age, 15.8 years) fulfilled inclusion criteria. The median prediagnostic, transfer, and surgical wait times were respectively 4.9, 2.4, and 4.3 hours, with 58 patients undergoing immediate and 104 delayed detorsion. Propensity score matching for prediagnostic and surgical wait times paired 58 immediate with 40 delayed detorsion patients, with corresponding surgical salvage rates of 54/58 (93%) and 33/40 (82%). Forty-seven patients (29%) still had torsion at surgery. Transfer time was inversely associated with testicular salvage, with median 13% greater probability of an unfavorable outcome for each hour of transfer time. Similarly, each hour of surgical wait time decreased surgical salvage by 6%.

Conclusions
Immediate detorsion led to improved surgical outcomes in testicular torsion patients. Because of residual torsion, surgery for detorsed patients should not be postponed.
Brief Report: Acute Kidney Injury in People Living With HIV Hospitalized With Coronavirus Disease 2019: Clinical Characteristics and Outcomes
Authors: Fisher Molly C. , Fazzari Melissa J. , Hanna David B. , Patel Viraj V. , Felsen Uriel R. , Alahiri Emad , Byju Arjun , Akiyama Matthew J. , Ginsberg Mindy S. , Anastos Kathryn , Ross Michael J. 
Published: July 2021

Background:
Data on clinical characteristics and outcomes of people living with HIV (PLWH) hospitalized with coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) are limited.

Setting:
Large tertiary health care system in the Bronx, NY.

Methods:
We performed a retrospective cohort study of 83 PLWH and 4151 patients without HIV hospitalized with COVID-19 from March 10, 2020, to May 11, 2020. We compared the clinical characteristics and outcomes associated with AKI by HIV serostatus and evaluated HIV-related factors for AKI among PLWH. AKI was defined and staged using Kidney Disease Improving Global Outcomes criteria.

Results:
The incidence of AKI in hospitalized patients with COVID-19 did not differ significantly by HIV serostatus (54.2% in PLWH vs 49.5% in patients without HIV, P = 0.6). Despite a higher incidence of stage 3 AKI (28.9% vs 17.1% P = 0.05) in PLWH compared with those without HIV, there was no significant difference in the need for renal replacement therapy (22.2% vs 13.4% P = 0.12), renal recovery (76.9% vs 82.5% P = 0.61), or dependence on renal replacement therapy (7.7% vs 3.8% P = 0.27). CD4 T-cell count, HIV-1 RNA viral suppression, and antiretroviral therapy use were not associated with AKI. AKI was associated with increased need for invasive ventilation and in-hospital death, but HIV was not an independent risk factor of in-hospital death after AKI [adjusted hazard ratio 1.01 (95% CI: 0.59 to 1.72), P = 0.98].

Conclusions:
HIV-related factors were not associated with increased risk of AKI in PLWH hospitalized with COVID-19. PLWH hospitalized with COVID-19 had more stage 3 AKI, but outcomes after AKI were similar to those without HIV.
Robotic Gastrectomy Versus Laparoscopic Gastrectomy for Gastric Cancer
Authors: Li Zheng-Yan , Zhou Yan-Bing , Li Tai-Yuan , Li Ji-Peng , Zhou Zhi-Wei , She Jun-Jun , Hu Jian-Kun , Qian Feng , Shi Yan , Tian Yu-Long , Gao Geng-Mei , Gao Rui-Zi , Liang Cheng-Cai , Shi Fei-Yu , Yang Kun , Wen Yan , Zhao Yong-Liang , Yu Pei-Wu ,   on behalf of the Robotic, Laparoscopic Surgery Committee of Chinese Research Hospital Association
Published: July 2021

Objective:
A large-scale multicenter retrospective cohort study was conducted to compare the short- and long-term outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer.

Summary of Background Data:
RG is being increasingly used worldwide, but data from large-scale multicenter studies on the short- and long-term oncologic outcomes of RG versus LG are limited. The potential benefits of RG compared with LG for gastric cancer remain controversial.

Methods:
Data from eligible patients who underwent RG or LG for gastric cancer of 11 experienced surgeons from 7 centers in China between March 2010 and October 2019 were collected. The RG group was matched 1:1 with the LG group by using propensity score matching. The primary outcome was postoperative complications.

Results:
After propensity score matching, a well-balanced cohort of 3552 patients was included for further analysis. The occurrence of overall complications (12.6% vs 15.2%, P = 0.023) was lower in the RG group than in the LG group. RG was associated with less blood loss (126.8 vs 142.5 mL, P < 0.001) and more retrieved lymph nodes in total (32.5 vs 30.7, P < 0.001) and in suprapancreatic areas (13.3 vs 11.6, P < 0.001).
The long-term oncological outcomes were comparable between the two groups.

Conclusions:
The results of this multicenter study demonstrate that RG is a safe and effective treatment for gastric cancer when performed by experienced surgeons, although longer operation time and higher costs are still concerns about RG. This study provides evidence suggesting that RG may represent an alternative surgical treatment to LG.
The Imperative of Assessing Quality of Life in Patients Presenting to a Pancreaticobiliary Surgery Clinic
Authors: Yeo Theresa P. , Fogg Ryan W. , Shimada Ayako , Marchesani Nicole , Lavu Harish , Nevler Avinoam , Hegarty Sarah , Brody Jonathan R. , Yeo Charles J. 
Published: July 2021

Objective:
The objective of this study was to determine baseline health-related quality of life (QoL) in patients with pancreatic adenocarcinoma, periampullary cancers, and benign pancreaticobiliary (PB) conditions at the time of the first visit to a PB surgery clinic, and to explore the relationship between QoL, demographics, clinical parameters, complications, and survival.

Summary Background Data:
Few studies have examined baseline QoL measures, the impact of comorbidities, age, sex, and smoking on subsequent postoperative complications and survival in patients with pancreatic adenocarcinoma, related PB cancers, and with benign PB conditions.

Methods:
Data were collected from scheduled patients at a PB surgery clinic between 2013 and 2018. The Brief Pain Inventory, Fact-Hepatobiliary Scale, and Facit-Fatigue questionnaires were administered. QoL parameters were compared between PB cancer patients and those with benign disease.

Results:
A total of 462 individuals with PB cancers and benign diseases exhibited baseline physical well-being, functional well-being, fatigue, and overall QoL at or below the 75th percentile of wellness at the time of the first office visit. Younger age, smoking, and mental health comorbidities contributed significantly to decreased QoL. PA patients were 7 times more likely to die in the follow-up period than the benign disease group. Black patients had higher pain scores and were 3 times more likely to have a postsurgery complication. Sex differences were identified regarding fatigue, pain, and overall QoL.

Conclusions:
This large cohort of PB cancer and benign disease patients exhibited significantly impaired baseline QoL. GI problems, weight loss, smoking, cardiovascular, pulmonary disease, and history of anxiety and depression contributed significantly to reduced QoL. The study sheds a cautionary light on the burden of PB disease at the time of surgical evaluation and its relationship to diminished QoL.