bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is There a Difference in the Contamination Rates of Urine Samples Obtained by Bladder Catheterization and Clean-Catch Collection in Preschool Children?
Authors: Bogie Amanda L. , Sparkman Amy , Anderson Michael , Crittenden-Byers Cathy , Barron Michael 
Published: November 2021

Objective
The objective of this study was to compare contamination rates in urine samples obtained by transurethral catheterization and clean-catch methods in preschool children aged 2 to 5 years.

Methods
A retrospective, chart review was performed on patients evaluated in our emergency department over a 6-month period who had a urine culture obtained by either transurethral catheterization or clean-catch methods. The charts were reviewed for urine bacterial colony counts and divided into positive, negative, or contaminated cohorts. Demographic data were collected as well.

Results
Four hundred sixty patients met inclusion for this study. Of these patients, there were 120 samples collected by catheter (26.1%) and 340 samples collected by clean-catch method (73.9%).
Female patients comprised 73% of the eligible samples (n = 336), and 27% were male (n = 124). Contamination rates significantly varied by collection method (P < 0.0001), with only 9 contaminated catheter samples (7.5%) and 125 contaminated clean-catch samples (36.76%). Contaminated samples were found in 122 of 336 female urine samples (36.3%), and 12 of 124 male urine samples (9.7%). There were no associations found between contamination rates and age within either sex.

Conclusions
Our study demonstrated a higher urine culture contamination rate in preschool age children in the clean-catch method group compared with the transurethral catheterization group. This finding was particularly strong within the female subset, which could partially be accounted for by the small male sample size.
Application of myoelectric elbow flexion assist orthosis in adult traumatic brachial plexus injury: a retrospective clinical study
Authors: Pulos Nicholas , van den Berg Catherine , Kaufman Kenton R. , Shin Alexander Y. 
Published: November 2021

Background:
Adult traumatic brachial plexus injuries (BPIs) can result in severe impairment following penetrating wounds, falls, and motor vehicle accidents or other high-energy trauma.

Objective:
Quantify functional outcomes of adult patients with a BPI using a myoelectric orthosis to restore elbow flexion.

Study design:
Retrospective review.

Methods:
A clinic specializing in the BPI treatment at a large academic medical center tested nineteen adult patients with BPI. These patients had failed to achieve antigravity elbow flexion following their injury and observation or surgical reconstruction. They were provided a myoelectric elbow orthosis (MEO) if they had detectable electromyography signals.

Results:
There was significant improvement in strength and significant reductions in function and pain when using an MEO. Following initiation of the MEO, 12 of the 19 patients had clinical improvements in muscle strength, 15 patients showed improvement in their DASH, and 13 patients reported improvements in their Visual Analog Scale.

Conclusion:
The use of an MEO improves elbow flexion strength, increases function, and reduces pain in the majority of patients with BPI and inadequate elbow flexion following observation or surgical reconstruction.
Walking while talking: validation in older adults with lower-limb amputation
Authors: Misaghi Ehsan , Miller William C , Imam Bita , Payne Michael W.C. , Lindstrom Heather 
Published: November 2021

Background:
Walking while talking (WWT) is a dual-task (cognitive and motor) performance test that has not yet been validated in older adults with lower-limb amputation (LLA). WWT is composed of two sections: WWT-simple (walking while reciting every letter of the alphabet) and WWT-complex (walking while reciting every other letter of the alphabet).

Objective:
To determine the validity, and provide normative data and a new scoring system for the WWT test in older adults with LLA.

Study design:
Baseline cross-sectional data were collected from 56 community-living older adults (≥50 years old) with LLA at rehabilitation hospitals in Vancouver, BC, London, ON, and Edmonton, AB, Canada.

Methods:
Time and number of recited letters and errors during both sections were recorded. A new score was developed based on all these variables. Correlations of the recorded times with the Activities-specific Balance Confidence (ABC) scale and the 2-Minute Walk Test (2MWT) score were used to evaluate the validity of the WWT test.

Results:
As hypothesized, the times for both sections of the WWT were negatively correlated with both the ABC and 2MWT scores. Positive correlations were observed between the scores developed for both WWT sections with the 2MWT score.

Conclusion:
Times taken to complete each section of the WWT test were correlated with the 2MWT and the ABC scale scores, providing evidence for the validity of the WWT test. We also provided a scoring method that is more objective and in line with the dual-task nature of the test.
And Miles to Go Before We Sleep: EAST Diversity and Inclusivity Progress and Remaining Challenges
Authors: Tseng Esther S. , Weaver Jessica L. , Sangosanya Ayodele T. , Gelbard Rondi B. , Martin Matthew J. , Tung Lily , Santos Ariel P. , McCunn Maureen , Bonne Stephanie , Joseph Bellal , Zakrison Tanya L. ,   the Eastern Association for the Surgery of Trauma Equity, Diversity, and Inclusion in Trauma Surgery Practice Committee (#EAST4ALL)
Published: November 2021

Objective:
The aim of this study was to examine the diversity, equity, and inclusion landscape in academic trauma surgery and the EAST organization.

Summary Background Data:
In 2019, the Eastern Association for the Surgery of Trauma (EAST) surveyed its members on equity and inclusion in the #EAST4ALL survey and assessed leadership representation. We hypothesized that women and surgeons of color (SOC) are underrepresented as EAST members and leaders.

Methods:
Survey responses were analyzed post-hoc for representation of females and SOC in academic appointments and leadership, EAST committees, and the EAST board, and compared to the overall respondent cohort. EAST membership and board demographics were compared to demographic data from the Association of American Medical Colleges.

Results:
Of 306 respondents, 37.4% identified as female and 23.5% as SOC. There were no significant differences in female and SOC representation in academic appointments and EAST committees compared to their male and white counterparts. In academic leadership, females were underrepresented (P < 0.0001), whereas SOC were not (P = 0.08). Both females and SOC were underrepresented in EAST board membership (P = 0.002 and P = 0.043, respectively). Of EAST's 33 presidents, 3 have been white women (9%), 2 have been Black, non-African American men (6%), and 28 (85%) have been white men. When compared to 2017 AAMC data, women are well-represented in EAST's 2020 membership (P < 0.0001) and proportionally represented on EAST's 2019-2020 board (P > 0.05).

Conclusions:
The #EAST4ALL survey suggests that women and SOC may be underrepresented as leaders in academic trauma surgery. However, lack of high-quality demographic data makes evaluating representation of structurally marginalized groups challenging. National trauma organizations should elicit data from their members to re-assess and promote the diversity landscape in trauma surgery.
Out-of-pocket Costs for Commercially-insured Patients in the Years Following Bariatric Surgery
Authors: Chao Grace F. , Yang Jie , Thumma Jyothi R. , Chhabra Karan R. , Arterburn David E. , Ryan Andrew M. , Telem Dana A. , Dimick Justin B. 
Published: November 2021

Objective:To compare out-of-pocket (OOP) costs for patients up to 3 years after bariatric surgery in a large, commercially-insured population.Summary of Background Data:More information on OOP costs following bariatric surgery may affect patients’ procedure choice.Methods:Retrospective study using the IBM MarketScan commercial claims database, representing patients nationally who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) January 1, 2011 to December 31, 2017. We compared total OOP costs after the surgical episode between the 2 procedures using difference-in-differences analysis adjusting for demographics, comorbidities, operative year, and insurance type.Results:Of 63,674 patients, 64% underwent SG and 36% underwent RYGB. Adjusted OOP costs after SG were $1083, $1236, and $1266 postoperative years 1, 2, and 3. For RYGB, adjusted OOP costs were $1228, $1377, and $1369. In our primary analysis, SG OOP costs were $122 (95% confidence interval [CI]: –$155 to –$90) less than RYGB year 1. This difference remained consistent at –$119 (95%CI: –$158 to –$79) year 2 and –$80 (95%CI: –$127 to –$35) year 3. These amounts were equivalent to relative differences of –7%, –7%, and –5% years 1, 2, and 3. Plan features contributing the most to differences were co-insurance years 1, 2, and 3.The largest clinical contributors to differences were endoscopy and outpatient care year 1, outpatient care year 2, and emergency department use year 3.Conclusions:Our study is the first to examine the association between bariatric surgery procedure and OOP costs. Differences between procedures were approximately $100 per year which may be an important factor for some patients deciding whether to pursue SG or gastric bypass.
Outcomes of Surgery for Endograft Infection in the Abdominal Aorta and Iliac Artery
Authors: Hosaka Akihiro , Kumamaru Hiraku , Usune Shiyori , Miyata Hiroaki , Goto Hitoshi 
Published: November 2021

Objective:
This study aimed to clarify the clinical features, postoperative outcomes, and prognostic factors in patients with endograft infection in the abdominal aorta and iliac artery.

Summary Background Data:
Endograft infection in the abdominal aorta and iliac artery is a potentially fatal condition. However, due to its rarity, clinical characteristics and optimal treatment strategy remain to be established.

Methods:
In this nationwide retrospective cohort study, we investigated 112 patients who underwent surgical treatment for endograft infection in the abdominal aorta and/or iliac artery between 2011 and 2017 using a Japanese clinical registry. We examined the relationships between the preoperative and operative factors and the outcomes after surgery including persistent or recurrent infection related to the endograft and 90-day and 3-year mortality.

Results:
The median period between the index endograft placement and surgery for infection was 369.5 days. Persistent or recurrent endograft-related infection occurred in 34 patients (30.4%). The cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years, and 5 years were 90.2%, 76.5%, 66.7%, 50.9%, and 31.5%, respectively. Partial removal or total preservation of the infected endograft was independently associated with short-term and late mortality. Preoperative anemia and imaging findings suggestive of fistula development to the gastrointestinal tract also showed an independent association with late mortality.

Conclusions:
Surgical intervention for endograft infection in the abdominal aorta and iliac artery was associated with a high risk of postoperative morbidity and mortality. Total removal of the infected endograft should be attempted because partial removal or total preservation can lead to a poor prognosis.
Posttransplant Hepatocellular Carcinoma Surveillance
Authors: Hessheimer Amelia J. , Vargas-Martínez Ana Magdalena , Trapero-Bertrán Marta , Navasa Miquel , Fondevila Constantino 
Published: November 2021

Objective:
Assess cost-effectiveness and -utility associated with posttransplant HCC surveillance compared to standard follow-up.

Summary of Background Data:
Despite lack of prospective clinical data, expert consensus recommends posttransplant surveillance to detect HCC recurrence in a latent phase, while it might be amenable to curative-intent therapy.

Methods:
A Markov-based transition model was created to estimate life expectancy and quality-of-life among liver transplant patients undergoing HCC surveillance. Models were built for 2 cohorts: 1 undergoing HCC surveillance with contrast-enhanced computed tomography of chest and abdomen and serum alpha-fetoprotein analysis and the other receiving standard posttransplant follow-up. Primary model outputs included LY and QALY gains, incremental cost-effectiveness ratio, and incremental cost-utility ratio. Willingness-to-pay for a QALY gain (cost-effectiveness threshold) was used to estimate efficiency.

Results:
Surveillance was marginally more effective versus no surveillance, resulting in means of 0.069 LYs and 0.026 QALYs gained. Costs for surveillance were increased by an average of 988.32€, resulting in incremental cost-effectiveness ratio 14,410.15€/LY and incremental cost-utility ratio 37,547.97€/QALY. Surveillance did not seem cost-effective in our setting, considering willingness-to-pay threshold of 25,000€/QALY. Probabilistic sensitivity analysis indicated surveillance might be cost-effective in 42% of cases, but degree of uncertainty in the analysis was high.

Conclusions:
Performing posttransplant HCC surveillance offers marginal clinical benefits and increases costs. Although expert consensus supports surveillance, results of this decision analysis raise doubt regarding the utility of such recommendations and support ongoing need for prospective clinical trials.
Comparing Urine Specimen Collection Methods for Urinalysis and Culture Agreement: A Paired Sample Design
Authors: Hubb Alexander J. , Heit Michael H. 
Published: November 2021

Objectives
The primary aim of this study was to determine if results from clean catch urine specimens agree with results from catheterized specimens in a urogynecology patient population. The secondary aim was to identify clinical scenarios in which catheterized specimens are preferred over clean catch specimens.

Methods
Both a midstream clean catch and a catheterized specimen were obtained for each participant. Dipstick urinalysis was performed. If either specimen was positive for nitrites, leukocyte esterase, or blood then both were sent for urine culture.
Kappa statistics were calculated to measure agreement between the paired specimen data for the total sample and for stratified samples. We agreed to accept clean catch results as preferable to catheterized results if the κ statistic was 0.7 or greater.

Results
Three hundred forty-two participants were enrolled. For all participants, the agreement between the paired samples was strong for nitrite (κ = 0.884), moderate for blood and colony count (both κ = 0.656), weak for culture species (κ = 0.566), and minimal for leukocyte esterase (κ = 0.382). When data were stratified for menopause, vaginal estrogen use, body mass index, and prolapse, there were no clinical scenarios in which the κ values were consistently greater than our accepted value of 0.7.

Conclusions
Our data indicate that catheterized urine specimens should be used in the evaluation of urinary tract infection or microscopic hematuria in the typical patient presenting to a urogynecology office who is often menopausal, overweight, and may have prolapse.
Biofilm Production by Uropathogens in Postmenopausal Women with Recurrent and Isolated Urinary Tract Infection
Authors: Falk Kerac N. , Satola Sarah W. , Chassagne François , Northington Gina M. , Quave Cassandra L. 
Published: November 2021

Objectives
The aims of this study were to assess the in vitro biofilm-producing capabilities of uropathogens grown from a postmenopausal urogynecologic population with isolated and recurrent urinary tract infection (UTI) and to determine whether the biofilm-producing bacterial phenotype was associated with recurrent infection.

Methods
This was an institutional review board–approved cross-sectional analysis within a large academic referral center. Uropathogens were cultured from postmenopausal women with either isolated or recurrent acute UTI and then screened for in vitro biofilm formation using crystal violet microtiter assays. Demographic and clinical variables, including pelvic floor symptoms and surgical history were collected and analyzed. A multivariate model was developed to determine whether recurrent UTI was independently associated with biofilm production.

Results
Eighty-nine women were included: 67.4% White, 25.8% Black, 3.4% Asian, and 1.1% Hispanic with a mean age of 72 ± 10.5 years. Ninety-five uropathogen strains were isolated. Most uropathogens produced biofilm (n = 53, 55.8%). Uropathogens from women with recurrent UTI were significantly more likely to produce biofilm (70%) than uropathogens collected from women with isolated UTI (38.6%, P = 0.0033). Adjusting for age, prior pelvic reconstructive surgery, and body mass index, recurrent UTI bacteria were more likely to produce biofilm, compared with isolated UTI (odds ratio, 5.37; 95% confidence interval, 2.0–14.4; P = 0.001).

Conclusions
In this cohort of postmenopausal urogynecology patients, in vitro biofilm formation was more frequently observed in uropathogens isolated from women with recurrent UTI compared with women with isolated UTI. Further study is needed to assess the role of biofilms in recurrent UTIs in postmenopausal women.
When New York City was the COVID-19 pandemic epicenter: The impact on trauma care
Authors: Liveris Anna , Stone Melvin E. , Markel Harley , Agriantonis George , Bukur Marko , Melton Sherry , Roudnitsky Valery , Chao Edward , Reddy Srinivas H. , Teperman Sheldon H. , Meltzer James A. 
Published: November 2021

BACKGROUND
During early spring 2020, New York City (NYC) rapidly became the first US epicenter of the COVID-19 pandemic. With an unparalleled strain on health care resources, we sought to investigate the impact of the pandemic on trauma visits and mortality in the United States' largest municipal hospital system.

METHODS
We conducted a retrospective multicenter cohort study of the five level 1 trauma centers in NYC's public health care system, New York City's Health and Hospitals Corporation. Clinical characteristics, mechanism of injury, and mortality of trauma patients presenting during the early pandemic (March 1, 2020, to May 31, 2020) were compared with a similar period in the previous 2 years. To account for important patient and hospital-level confounding variables, we created a propensity score for treatment and applied inverse probability weighting.

RESULTS
In March to May 2020, there was a 25% decrease in median number of monthly trauma visits (693 vs. 528; p = 0.02) but a 50% increase (15% vs. 22%; p = <0.001) in patients presenting for penetrating injuries, compared with the same period for 2018 and 2019. Injured patients with COVID were significantly more likely to die compared with those without COVID-19 (10.5% vs. 3.6%; p < 0.001). Overall, there was no significant difference in mortality for non–COVID-injured New Yorkers cared for in 2020 compared with 2018 and 2019. Less severely injured non-COVID patients (Injury Severity Score, <15), however, were significantly more likely to die compared with this same subgroup in 2018 and 2019 (adjusted relative risk, 2.7 [95% confidence interval, 1.5–4.7]).

CONCLUSION
Despite a decline in overall trauma visits during the early part of the COVID pandemic in NYC, there was a significant increase in the proportion of penetrating mechanisms. Less-injured non-COVID patients experienced an increase in mortality in the early pandemic, possibly from a depletion of human and hospital resources from the large influx of COVID patients. These data lend support to the safeguarding of trauma system resources in the event of a future pandemic.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level III.
Stromal remodeling regulates dendritic cell abundance and activity in the tumor microenvironment
Authors: Papadas Athanasios , Deb Gauri , Officer Adam , Cicala Alexander , Hope Chelsea , Emmerich Philip , Wiesner Joshua , Pagenkopf Adam , Arauz Garrett , Bansal Varun , Matkowskyj Kristina A. , Deming Dustin , Politi Katerina , Abrams Scott I. , Harismendy Olivier , Asimakopoulos Fotis 
Published: November 2021

SUMMARYStimulatory dendritic cells (SDC), enriched within Batf3-DC (cDC1), engage in productive interactions with CD8+ effectors along tumor-stroma boundaries. The paradoxical accumulation of “poised” cross-presenting Batf3-DC within stromal sheets, distal to tumoral nests, is unlikely to simply reflect passive exclusion away from immunosuppressive tumor cores. Drawing parallels with embryonic morphogenesis, we hypothesized that invasive margin stromal remodeling may generate developmentally conserved cell-fate cues that regulate Batf3-DC behavior. We find that CD8+ T-cells massively infiltrate tumor matrices undergoing proteoglycan versican (VCAN) proteolysis, an essential organ-sculpting modification in development and adult tissue-plane forging. VCAN proteolysis releases a bioactive fragment (matrikine), versikine, that is necessary and sufficient for Batf3-DC accumulation. Versikine does not influence tumor-seeding pre-DC differentiation; rather, it orchestrates a distinctive activation program conferring exquisite sensitivity to DNA-sensing, coupled with survival support from atypical innate lymphoid cells. Thus, homeostatic signals from stroma invasion regulate SDC survival and activity to promote T- cell inflammation.HIGHLIGHTSTumor stroma remodeling generates cross-presenting DC survival and activation cues.Stromal-activated Batf3-DC are hypersensitive to dsDNA-sensing.Stromal signals promote atypical innate lymphoid cells (GM-CSFhi/ IFNγlo).T-cell repriming by stroma-licensed Batf3-DC may overcome exclusion at tumor margins.
Allelopathic effects ofEpichloëfungal endophytes: experiment and meta-analysis
Authors: Hager Heather A. , Gailis Maija , Newman Jonathan A. 
Published: November 2021

AbstractHost-specificEpichloë spp.endophytic fungal symbionts of pooid grasses that produce herbivore-deterring alkaloids and alter the grass host’s metabolite and protein profiles. Early observations suggested thatEpichloëmay have negative allelopathic effects on neighbouring plant species, particularlyTrifolium spp. clovers, but subsequent allelopathy tests produced variable results. We examined two hypotheses: (1)Epichloëstrains differ in allelopathic effect, and (2)Epichloëallelopathy negatively affects other plant species. We performed a greenhouse experiment using root exudates from Lolium perenne L. hosting differentE. festucaevar.lolii(Latch, M.J. Chr. & Samuels) C.W. Bacon & Schardl strains to compare their allelopathic effects on native legumes and forbs. We then used meta-analysis to examine the evidence to date for allelopathic effects ofEpichloëendophytes. We found little difference in effect amongE. festucaevar.loliistrains and very little evidence for negative allelopathic effects ofEpichloëin cool-season grasses across a range of methodologies, target plant species, and response measures. Negative allelopathic effects were detected only for root hair measures, which were from a single study. Positive effects on biomass were found for some experimental subgroups, including legumes. However, the majority of response variables showed no evidence forEpichloëallelopathy. Although there is currently little evidence for negativeEpichloëallelopathic effects, our meta-analysis identified several research gaps. Experiments testing the functional belowground effects ofEpichloëpresence may help to determine its effects on non-host plant performance via plant-soil feedbacks.