Publications by authors named "Andrew Cohen"

247 Publications

Association of Social Isolation With Disability Burden and 1-Year Mortality Among Older Adults With Critical Illness.

JAMA Intern Med 2021 Sep 7. Epub 2021 Sep 7.

Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut.

Importance: Disability and mortality are common among older adults with critical illness. Older adults who are socially isolated may be more vulnerable to adverse outcomes for various reasons, including fewer supports to access services needed for optimal recovery; however, whether social isolation is associated with post-intensive care unit (ICU) disability and mortality is not known.

Objectives: To evaluate whether social isolation is associated with disability and with 1-year mortality after critical illness.

Design, Setting, And Participants: This observational cohort study included community-dwelling older adults who participated in the National Health and Aging Trends Study (NHATS) from May 2011 through November 2018. Hospitalization data were collected through 2017 and interview data through 2018. Data analysis was conducted from February 2020 through February 2021. The mortality sample included 997 ICU admissions of 1 day or longer, which represented 5 705 675 survey-weighted ICU hospitalizations. Of these, 648 ICU stays, representing 3 821 611 ICU hospitalizations, were eligible for the primary outcome of post-ICU disability.

Exposures: Social isolation from the NHATS survey response in the year most closely preceding ICU admission, which was assessed using a validated measure of social connectedness with partners, families, and friends as well as participation in valued life activities (range 0-6; higher scores indicate more isolation).

Main Outcomes And Measures: The primary outcome was the count of disability assessed during the first interview following hospital discharge. The secondary outcome was time to death within 1 year of hospital admission.

Results: A total of 997 participants were in the mortality cohort (511 women [51%]; 45 Hispanic [5%], 682 non-Hispanic White [69%], and 228 non-Hispanic Black individuals [23%]) and 648 in the disability cohort (331 women [51%]; 29 Hispanic [5%], 457 non-Hispanic White [71%], and 134 non-Hispanic Black individuals [21%]). The median (interquartile range [IQR]) age was 81 (75.5-86.0) years (range, 66-102 years), the median (IQR) preadmission disability count was 0 (0-1), and the median (IQR) social isolation score was 3 (2-4). After adjustment for demographic characteristics and illness severity, each 1-point increase in the social isolation score (from 0-6) was associated with a 7% greater disability count (adjusted rate ratio, 1.07; 95% CI, 1.01-1.15) and a 14% increase in 1-year mortality risk (adjusted hazard ratio, 1.14; 95% CI, 1.03-1.25).

Conclusions And Relevance: In this cohort study, social isolation before an ICU hospitalization was associated with greater disability burden and higher mortality in the year following critical illness. The study findings suggest a need to develop social isolation screening and intervention frameworks for older adults with critical illness.
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http://dx.doi.org/10.1001/jamainternmed.2021.5022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424527PMC
September 2021

Immediate Artificial Urinary Sphincter (AUS) Reactivation at the Time of Urethral Cuff Exchange is Not Associated with Increased Erosion Rate.

Urology 2021 Jul 31. Epub 2021 Jul 31.

Objective: To retrospectively evaluate the outcomes of immediate artificial urinary sphincter (AUS) reactivation in patients after urethral cuff replacement. It is common practice to delay reactivation of an AUS for four to six weeks following surgery to replace a failed urethral cuff. This is due to concerns about local tissue edema risking obstruction and concerns for urethral erosion. Despite these concerns, there are no published data to support this practice.

Methods: Retrospective chart review of single surgeon procedures performed from 2005-2020. Patients with urethral cuff replacement for recurrent stress incontinence due to compression or mechanical failure were included.

Results: Thirty-four patients were identified who had immediate reactivation of the AUS following urethral cuff exchange. Thirty of these patients (88.2%) had radical prostatectomy and five patients also underwent further radiation therapy (14.7%). At 6 months follow-up, there was no reported events of erosion. Likewise, 32/34 (94%) of patients had no complications and reported expected urinary function of the AUS. Urinary retention was not observed. One patient required further re-exploration for a complication within his AUS system (2.9%), and another was ultimately unsatisfied with their unchanged baseline continence despite a fully functioning AUS (2.9%).

Conclusion: In this series, we observe that immediate reactivation of the AUS after urethral cuff exchange is a safe and reasonable management approach. Limitations of this analysis include a single institution, retrospective study. However, early AUS reactivation after device revision has not been reported in the literature and warrants further investigation given the impact on patient quality of life.
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http://dx.doi.org/10.1016/j.urology.2021.07.021DOI Listing
July 2021

Human Serum Enhances Biomimicry of Engineered Tissue Models of Bone and Cancer.

Front Bioeng Biotechnol 2021 13;9:658472. Epub 2021 Jul 13.

Department of Biomedical Engineering, Columbia University, New York, NY, United States.

For decades, fetal bovine serum (FBS) has been used routinely for culturing many cell types, based on its empirically demonstrated effects on cell growth, and the lack of suitable non-xenogeneic alternatives. The FBS-based culture media do not represent the human physiological conditions, and can compromise biomimicry of preclinical models. To recapitulate the features of human bone and bone cancer, we investigated the effects of human serum and human platelet lysate on modeling osteogenesis, osteoclastogenesis, and bone cancer in two-dimensional (2D) and three-dimensional (3D) settings. For monitoring tumor growth within tissue-engineered bone in a non-destructive fashion, we generated cancer cell lines expressing and secreting luciferase. Culture media containing human serum enhanced osteogenesis and osteoclasts differentiation, and provided a more realistic mimic of human cancer cell proliferation. When human serum was used for building 3D engineered bone, the tissue recapitulated bone homeostasis and response to bisphosphonates observed in native bone. We found disparities in cell behavior and drug responses between the metastatic and primary cancer cells cultured in the bone niche, with the effectiveness of bisphosphonates observed only in metastatic models. Overall, these data support the utility of human serum for bioengineering of bone and bone cancers.
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http://dx.doi.org/10.3389/fbioe.2021.658472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313998PMC
July 2021

Unmet financial burden of infertility care and the impact of state insurance mandates in the United States: analysis from a popular crowdfunding platform.

Fertil Steril 2021 Jul 7. Epub 2021 Jul 7.

Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address:

Objective: To examine infertility-related fund-raising campaigns on a popular crowdfunding website and to compare campaign characteristics across states with and without legislative mandates for insurance coverage for infertility-related care.

Design: Retrospective cohort study.

Setting: Online crowdfunding platform (GoFundMe) between 2010 and 2020.

Patient(s): GoFundMe campaigns in the United States containing the keywords "fertility" and "infertility."

Intervention(s): State insurance mandates for infertility treatment coverage.

Main Outcome Measure(s): Primary outcomes included fund-raising goals, funds raised, campaign location, and campaigns per capita.

Result(s): Of the 3,332 infertility-related campaigns analyzed, a total goal of $52.6 million was requested, with $22.5 million (42.8%) successfully raised. The average goal was $18,639 (standard deviation [SD] $32,904), and the average amount raised was $6,759 (SD $14,270). States with insurance mandates for infertility coverage had fewer crowdfunding campaigns per capita (0.75 vs. 1.15 campaigns per 100,000 population than states without insurance mandates.

Conclusion(s): We found a large number of campaigns requesting financial assistance for costs associated with infertility care, indicating a substantial unmet financial burden. States with insurance mandates had fewer campaigns per capita, suggesting that mandates are effective in mitigating this financial burden. These data can inform future health policy legislation on the state and federal levels to assist with the financial burden of infertility.
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http://dx.doi.org/10.1016/j.fertnstert.2021.05.111DOI Listing
July 2021

Multicenter urethroplasty outcomes for urethral stricture disease for patients with neurogenic bladder or bladder dysfunction requiring clean intermittent catheterization.

Transl Androl Urol 2021 May;10(5):2035-2042

Department of Urology, Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, CA, USA.

Background: Our objective is to better comprehend treatment considerations for urethral stricture disease (USD) in patients requiring long-term clean intermittent catheterization (CIC). Patient characteristics, surgical outcomes and complications are unknown in this population.

Methods: Six members of the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) participated in a prospective (2009 to present) and retrospective (prior to 2009) database recording patient demographics, surgical approach and outcomes. We included all patients undergoing urethroplasty who perform CIC. Descriptive statistics were used to analyze results.

Results: A total of 37 patients with 39 strictures were included. Bladder dysfunction was characterized as detrusor failure in 35% and neurogenic etiology in 65%. Median stricture length was 3 cm (IQR: 1.5-5.5) with 28% repaired with dorsal onlay buccal mucosal graft, 26% excision and primary anastomosis, 8% dorsal inlay, 8% ventral and dorsal, 8% flap based 8% non-transecting and 15% other. Functional success was 90%: 4 patients required DVIU or dilation due to recurrence, with 2 of those ultimately requiring repeat urethroplasty. 86% of patients returned to CIC; no patients reported new pad use for urinary leakage after urethroplasty. During a median follow-up period of 3.1 years (IQR: 1.0-5.3), no patients underwent urinary diversion.

Conclusions: Urethroplasty is suitable, safe and effective for patients dependent on CIC suffering from USD. The effect of continual CIC on long-term outcomes remains uncertain.
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http://dx.doi.org/10.21037/tau-20-988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185657PMC
May 2021

Characterizing online crowdfunding campaigns for patients with kidney cancer.

Cancer Med 2021 07 8;10(13):4564-4574. Epub 2021 Jun 8.

Department of Urology, University of California-San Francisco, San Francisco, CA, USA.

Background: Cancer patients incur high care costs; however, there is a paucity of literature characterizing unmet financial obligations for patients with urologic cancers. Kidney cancer patients are particularly burdened by costs associated with novel systemic treatments. This study aimed to ascertain the characteristics of GoFundMe® crowdfunding campaigns for patients with kidney cancer, in order to better understand the financial needs of this population.

Methods: We performed a cross-sectional, quantitative, and qualitative analysis of all kidney cancer GoFundMe® campaigns since 2010. Fundraising metrics such as goal funds and amount raised, were extracted. Eight independent investigators collected patient, disease and campaign-level variables from campaign stories (κ = 0.72). In addition, we performed a content analysis of campaign narratives spotlighting the primary appeal of the patient's life story.

Results: A total of 486 GoFundMe® kidney cancer campaigns were reviewed. The median goal funds were 10,000USD [IQR = 5000, 20,000] and the median amount raised was 1450USD [IQR = 578, 4050]. Most campaigns were for adult males (53%) and 62% of adults had children. A minority were for pediatric patients (17%). Thirty-seven percent of adult patients were primary wage earners and 43% reported losing their job or substantially reducing hours due to illness. Twenty-nine percent reported no insurance or insufficient coverage. Campaigns most frequently sought funds for medical bills (60%), nonmedical bills (27%), and medical travel (23%). Qualitative campaign narratives mostly emphasized patients' hardship (46.3%) or high moral character (35.2%). Only 8% of campaigns achieved their target funds.

Conclusions: Despite fundraising efforts, patients with kidney cancer face persistent financial barriers, incurring both medical and nonmedical cost burdens. This may be compounded by limited or no insurance. Cancer care providers should be aware of financial constraints placed on kidney cancer patients, and consider how these may impact treatment regimens.
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http://dx.doi.org/10.1002/cam4.3974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267118PMC
July 2021

Collective ERK/Akt activity waves orchestrate epithelial homeostasis by driving apoptosis-induced survival.

Dev Cell 2021 Jun 2;56(12):1712-1726.e6. Epub 2021 Jun 2.

Institute of Cell Biology, University of Bern, Baltzerstrasse 4, 3012 Bern, Switzerland. Electronic address:

Cell death events continuously challenge epithelial barrier function yet are crucial to eliminate old or critically damaged cells. How such apoptotic events are spatio-temporally organized to maintain epithelial homeostasis remains unclear. We observe waves of extracellular-signal-regulated kinase (ERK) and AKT serine/threonine kinase (Akt) activity pulses that originate from apoptotic cells and propagate radially to healthy surrounding cells. This requires epidermal growth factor receptor (EGFR) and matrix metalloproteinase (MMP) signaling. At the single-cell level, ERK/Akt waves act as spatial survival signals that locally protect cells in the vicinity of the epithelial injury from apoptosis for a period of 3-4 h. At the cell population level, ERK/Akt waves maintain epithelial homeostasis (EH) in response to mild or intense environmental insults. Disruption of this spatial signaling system results in the inability of a model epithelial tissue to ensure barrier function in response to environmental insults.
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http://dx.doi.org/10.1016/j.devcel.2021.05.007DOI Listing
June 2021

Paleo-ENSO influence on African environments and early modern humans.

Proc Natl Acad Sci U S A 2021 Jun;118(23)

Institute of Geosciences, University of Potsdam, 14469 Potsdam, Germany.

In this study, we synthesize terrestrial and marine proxy records, spanning the past 620 ky, to decipher pan-African climate variability and its drivers and potential linkages to hominin evolution. We find a tight correlation between moisture availability across Africa to El Niño Southern Ocean oscillation (ENSO) variability, a manifestation of the Walker Circulation, that was most likely driven by changes in Earth's eccentricity. Our results demonstrate that low-latitude insolation was a prominent driver of pan-African climate change during the Middle to Late Pleistocene. We argue that these low-latitude climate processes governed the dispersion and evolution of vegetation as well as mammals in eastern and western Africa by increasing resource-rich and stable ecotonal settings thought to have been important to early modern humans.
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http://dx.doi.org/10.1073/pnas.2018277118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8201937PMC
June 2021

How should advance care planning be done when a surrogate is making decisions?

J Am Geriatr Soc 2021 Aug 17;69(8):2103-2105. Epub 2021 May 17.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

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http://dx.doi.org/10.1111/jgs.17222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373712PMC
August 2021

Trochlear Dysplasia as Shown by Increased Sulcus Angle Is Associated With Osteochondral Damage in Patients With Patellar Instability.

Arthroscopy 2021 May 5. Epub 2021 May 5.

Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.; Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A.

Purpose: The primary study objective was to describe the incidence of osteochondral damage (OD) in our cohort of patients with patellar instability (PI). The secondary objective was to assess for associations between patient demographic characteristics, duration of PI, and quantitative radiographic measurements of anatomic risk factors for PI and OD in this cohort.

Methods: A retrospective chart review identified patients treated for PI at a tertiary referral center between 2013 and 2018. Patients were evaluated for osteochondral injury with either magnetic resonance imaging if treated nonoperatively or operative reports if treated surgically. The Caton-Deschamps ratio, proximal tibial tubercle-to-trochlear groove (pTT-TG) distance, distal tibial tubercle-to-trochlear groove (dTT-TG) distance, lateral trochlear inclination (LTI) angle, lateral patellar inclination (LPI) angle, and sulcus angle were calculated from magnetic resonance imaging scans. Trochlear dysplasia is an important risk factor for PI that can be reliability quantified by the pTT-TG distance, dTT-TG distance, LTI angle, sulcus angle, and LPI angle. Demographic data including age at first instability event, sex, body mass index, symptom duration, and number of dislocations were documented.

Results: A total of 125 knees in 118 patients (average age, 13.9 ± 3.4 years; 48% female patients) with PI were identified. Within this cohort, 67% were treated surgically and 53% had OD. No association was identified between osteochondral injury and age, sex, body mass index, symptom duration, LTI angle, LPI angle, dTT-TG distance, pTT-TG distance, or number of dislocations. An increased sulcus angle (more dysplasia) showed a statistically significant association with osteochondral pathology (P = .021), and higher sulcus angles were statistically significantly associated with acute osteochondral fracture compared with chondral injury (P = .001).

Conclusions: Using quantitative analysis of trochlear dysplasia, this study identified a significant association between trochlear dysplasia (sulcus angle) and the incidence of OD in our cohort of patients with PI. The frequency of dislocation or subluxation and patient demographic characteristics were not significantly associated with OD.

Level Of Evidence: Level III, retrospective prognostic study.
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http://dx.doi.org/10.1016/j.arthro.2021.04.054DOI Listing
May 2021

Early human impacts and ecosystem reorganization in southern-central Africa.

Sci Adv 2021 May 5;7(19). Epub 2021 May 5.

Ministry of Civic Education and National Unity, Lilongwe, Malawi.

Modern engage in substantial ecosystem modification, but it is difficult to detect the origins or early consequences of these behaviors. Archaeological, geochronological, geomorphological, and paleoenvironmental data from northern Malawi document a changing relationship between forager presence, ecosystem organization, and alluvial fan formation in the Late Pleistocene. Dense concentrations of Middle Stone Age artifacts and alluvial fan systems formed after ca. 92 thousand years ago, within a paleoecological context with no analog in the preceding half-million-year record. Archaeological data and principal coordinates analysis indicate that early anthropogenic fire relaxed seasonal constraints on ignitions, influencing vegetation composition and erosion. This operated in tandem with climate-driven changes in precipitation to culminate in an ecological transition to an early, pre-agricultural anthropogenic landscape.
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http://dx.doi.org/10.1126/sciadv.abf9776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099189PMC
May 2021

Rates of Serious Surgical Errors in California and Plans to Prevent Recurrence.

JAMA Netw Open 2021 May 3;4(5):e217058. Epub 2021 May 3.

Department of Urology, University of California, San Francisco.

Importance: Despite widespread recognition and known harms, serious surgical errors, known as surgical never events, endure. The California Department of Public Health (CDPH) has developed an oversight system to capture never events and a platform for process improvement that has not yet been critically appraised.

Objectives: To examine surgical never events occurring in hospitals in California and summarize recommendations to prevent future events.

Design, Setting, And Participants: This cross-sectional study identified 386 CDPH hospital administrative penalty reports, of which 142 were ascribable to never events occurring during surgery. These never events were identified and summarized from January 1, 2007, to December 31, 2017. A directed qualitative approach was used to analyze CDPH-mandated corrective steps to reduce future errors in this multicenter study of all accredited hospitals in California. Inclusion of surgical never event records was based on definitions established by the US Department of Health and Human Services National Quality Forum. Data analysis was performed from January 1, 2019, to November 30, 2020.

Exposures: Never events include death or disability of an American Society of Anesthesiologists class I patient, wrong site or wrong surgery, retained foreign objects, burns, equipment failure leading to intraoperative injury, nonapproved experimental procedures, insufficient surgeon presence or privileges, or fall from the operating room table.

Main Outcomes And Measures: Incident rates, consequences, and improvement plans to prevent additional never events were outcomes of interest.

Results: A total of 142 never events were reported to the CDPH (1 per 200 000 operations). Annual surgical volume for hospitals with events was 9203 vs 3251 cases for hospitals without events (P < .001). A total of 94 of 142 events (66.2%) were retained foreign objects ranging from Kocher clamps to drain sponges. Wrong site or patient surgery accounted for 22 events (15.5%), surgical burns for 11 (7.7%), and other for 15 (10.6%). Other included insufficient surgeon presence, equipment failure, or falls in the operating room. Improvement plans included 18 unique categories of recommendations from regulators, many focusing on proper use of checklists. Regulators mandated a mean (SD) of 13 (7) corrective actions in the improvement plans. Policy adherence monitoring (119 [90.2%]), revision of existing policy (84 [63.6%]), and education regarding policy (83 [62.9%]) were common action items, whereas disciplinary action toward staff was rare (11 [8.3%]).

Conclusions And Relevance: Surgical never events are a rare issue in California. Numerous strategies have evolved to reduce errors, many involving the thorough and proper use of intraoperative checklists.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.7058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094010PMC
May 2021

Characteristics of Older Adults Who Cannot Identify a Healthcare Agent.

J Gen Intern Med 2021 Apr 26. Epub 2021 Apr 26.

Department of Medicine, Yale School of Medicine, P.O. Box 208025, New Haven, CT, 06520-8025, USA.

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http://dx.doi.org/10.1007/s11606-021-06798-2DOI Listing
April 2021

3D Image Analysis of the Complete Ventricular-Subventricular Zone Stem Cell Niche Reveals Significant Vasculature Changes and Progenitor Deficits in Males Versus Females with Aging.

Stem Cell Reports 2021 Apr 8;16(4):836-850. Epub 2021 Apr 8.

Neural Stem Cell Institute, Rensselaer, NY 12144, USA. Electronic address:

With age, neural stem cell (NSC) function in the adult ventricular-subventricular zone (V-SVZ) declines, reducing memory and cognitive function in males; however, the impact on females is not well understood. To obtain a global view of how age and sex impact the mouse V-SVZ, we constructed 3D montages after multiplex immunostaining, and used computer-based 3D image analysis to quantify data across the entire niche at 2, 18, and 22 months. We discovered dramatic sex differences in the aging of the V-SVZ niche vasculature, which regulates NSC activity: females showed increased diameter but decreased vessel density with age, while males showed decreased diameter and increased tortuosity and vessel density. Accompanying these vascular changes, males showed significant decline in NSC numbers, progenitor cell proliferation, and more disorganized migrating neuroblast chains with age; however, females did not. By examining the entire 3D niche, we found significant sex differences, with females being relatively spared through very old age.
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http://dx.doi.org/10.1016/j.stemcr.2021.03.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072131PMC
April 2021

Demographic Characteristics Driving Disparities in Receipt of Long-term Services and Supports in the Community Setting.

Med Care 2021 06;59(6):537-542

Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, CT.

Background: Research suggests that growth in Black and Hispanic (minority) older adults' nursing home (NH) use may be the result of disparities in access to community-based and alternative long-term services and supports (LTSS).

Objective: We aimed to determine whether minority groups receiving care in NHs versus the community had fewer differences in their functional needs compared with the differences in nonminority older adults, suggesting a disparity.

Methods: We identified respondents aged 65 years or above with a diagnosis of Alzheimer disease or dementia in the 2016 Health and Retirement Study who reported requiring LTSS help. We performed unadjusted analyses to assess the difference in functional need between community and NH care. Functional need was operationalized using a functional limitations score and 6 individual activities of daily living. We compared the LTSS setting for minority older adults to White older adults using difference-in-differences.

Results: There were 186 minority older adults (community=75%, NH=25%) and 357 White older adults (community=50%, NH=50%). Between settings, minority older adults did not differ in education or marital status, but were younger and had greater income in the NH versus the community. The functional limitations score was higher in NHs than in the community for both groups. Functional needs for all 6 activities of daily living for the minority group were greater in NHs compared with the community.

Conclusion: Functional need for minority older adults differed by setting while demographics varied in unexpected ways. Factors such as familial and financial support are important to consider when implementing programs to keep older adults out of NHs.
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http://dx.doi.org/10.1097/MLR.0000000000001544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119333PMC
June 2021

Dynamic Contrast Enhanced-MR CEST Urography: An Emerging Tool in the Diagnosis and Management of Upper Urinary Tract Obstruction.

Tomography 2021 03 2;7(1):80-94. Epub 2021 Mar 2.

The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA.

Upper urinary tract obstructions (UTOs) are blockages that inhibit the flow of urine through its normal course, leading to impaired kidney function. Imaging plays a significant role in the initial diagnosis of UTO, with anatomic imaging (primarily ultrasound (US) and non-contrast computed tomography (CT)) serving as screening tools for the detection of the dilation of the urinary collecting systems (i.e., hydronephrosis). Whether hydronephrosis represents UTO or a non-obstructive process is determined by functional imaging (typically nuclear medicine renal scintigraphy). If these exams reveal evidence of UTO but no discernable source, multiphase contrast enhanced CT urography and/or dynamic contrast enhanced MR urography (DCE-MRU) may be performed to delineate a cause. These are often performed in conjunction with direct ureteroscopic evaluation. While contrast-enhanced CT currently predominates, it can induce renal injury due to contrast induced nephropathy (CIN), subject patients to ionizing radiation and is limited in quantifying renal function (traditionally assessed by renal scintigraphy) and establishing the extent to which hydronephrosis is due to functional obstruction. Traditional MRI is similarly limited in its ability to quantify function. DCE-MRU presents concerns regarding nephrogenic systemic fibrosis (NSF), although decreased with newer gadolinium-based contrast agents, and regarding cumulative gadolinium deposition in the basal ganglia. DCE-MR CEST urography is a promising alternative, employing new MRI contrast agents and imaging schemes and allowing for concurrent assessment of renal anatomy and functional parameters. In this review we highlight clinical challenges in the diagnosis and management of UTO, identify key advances in imaging agents and techniques for DCE-MR CEST urography and provide perspective on how this technique may evolve in clinical importance.
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http://dx.doi.org/10.3390/tomography7010008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103243PMC
March 2021

Contemporary Trends and End-Results of National Institutes of Health Grant Funding to Departments of Urology in the United States: A 10-year Analysis.

J Urol 2021 08 29;206(2):427-433. Epub 2021 Mar 29.

Department of Urology, University of California San Francisco, San Francisco, California.

Purpose: We explored the patterns and distribution of National Institutes of Health grant funding for urological research in the United States.

Materials And Methods: The National Institutes of Health RePORTER database was queried for all grants awarded to urology departments between 2010 and 2019. Information regarding the value of the grant, funded institution, successful publication of the research, and the category of urological subspecialty were collected. Data on principal investigators were extracted from publicly available information.

Results: There were 509 grants awarded to Urology between 2010 and 2019 for a total value of $640,873,867, and a median per-project value of $675,484 (IQR 344,170-1,369,385). Over the study period, total funding decreased by 15.6% and was lower compared to other surgical subspecialties. Most grants were awarded by the National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases (85%) to Western or North Central institutions (52.5%), and had principal investigators specialized in urologic oncology (56.4%), followed by general urologists (21.5%). Female principal investigators led 21.6% of Urology grants and were more likely PhD basic scientists than males (64.4% vs 38.2%, p=0.001). In total, 10,404 publications linked to the 509 grants were produced, of which 28.5% were published in journals with an impact factor ≥10.

Conclusions: Urology is underrepresented in National Institutes of Health grant funding compared to other surgical fields. During the past decade there was a further decrease in the total budget of National Institutes of Health grants to Urology.
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http://dx.doi.org/10.1097/JU.0000000000001751DOI Listing
August 2021

Relationship Between Patellar Morphology and Known Anatomic Risk Factors for Patellofemoral Instability.

Orthop J Sports Med 2021 Mar 5;9(3):2325967120988690. Epub 2021 Mar 5.

University of Connecticut Health and School of Medicine, Farmington, Connecticut, USA.

Background: Patellar instability (PI) is a common problem among pediatric, adolescent, and young adult patients. Recent literature has shown a correlation between pathoanatomy and PI.

Purpose/hypothesis: The purpose of this study was to determine if there is any difference in patellar shape in patients with and without PI and if there is any association between the shape of the patella and the shape of the trochlea. Our hypothesis was that there would be no association between the shape of the patella and the likelinhood of having PI and that the shape of the trochlea would not be associated with patellar morphology.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Magnetic resonance imaging (MRI) scans were analyzed for 97 study patients with PI and 100 control patients with anterior cruciate ligament tears. Radiologic measurements of trochlear morphology were collected via MRI; 15 measurements of patellar morphology were then measured using axial MRI scans. Comparisons between the control and PI groups were performed using a 2-tailed test. Regression analysis was performed to determine if associations existed between the 15 patellar morphology measurements and the trochlear dysplasia measurements.

Results: There were no statistically significant differences between the PI and control groups for the majority of patellar morphology measurements. With regression analysis, there were no statistically significant associations between the majority of patellar morphology measurements and the trochlear dysplasia measurements.

Conclusion: Patellar morphology is highly variable in knees with and without PI. There was a minimal association between measurements of patellar morphology and trochlear dysplasia.
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http://dx.doi.org/10.1177/2325967120988690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940750PMC
March 2021

Calcium-vesicles perform active diffusion in the sea urchin embryo during larval biomineralization.

PLoS Comput Biol 2021 02 22;17(2):e1008780. Epub 2021 Feb 22.

Marine Biology Department, Charney School of Marine Sciences, the University of Haifa, Haifa, Israel.

Biomineralization is the process by which organisms use minerals to harden their tissues and provide them with physical support. Biomineralizing cells concentrate the mineral in vesicles that they secret into a dedicated compartment where crystallization occurs. The dynamics of vesicle motion and the molecular mechanisms that control it, are not well understood. Sea urchin larval skeletogenesis provides an excellent platform for investigating the kinetics of mineral-bearing vesicles. Here we used lattice light-sheet microscopy to study the three-dimensional (3D) dynamics of calcium-bearing vesicles in the cells of normal sea urchin embryos and of embryos where skeletogenesis is blocked through the inhibition of Vascular Endothelial Growth Factor Receptor (VEGFR). We developed computational tools for displaying 3D-volumetric movies and for automatically quantifying vesicle dynamics. Our findings imply that calcium vesicles perform an active diffusion motion in both, calcifying (skeletogenic) and non-calcifying (ectodermal) cells of the embryo. The diffusion coefficient and vesicle speed are larger in the mesenchymal skeletogenic cells compared to the epithelial ectodermal cells. These differences are possibly due to the distinct mechanical properties of the two tissues, demonstrated by the enhanced f-actin accumulation and myosinII activity in the ectodermal cells compared to the skeletogenic cells. Vesicle motion is not directed toward the biomineralization compartment, but the vesicles slow down when they approach it, and probably bind for mineral deposition. VEGFR inhibition leads to an increase of vesicle volume but hardly changes vesicle kinetics and doesn't affect f-actin accumulation and myosinII activity. Thus, calcium vesicles perform an active diffusion motion in the cells of the sea urchin embryo, with diffusion length and speed that inversely correlate with the strength of the actomyosin network. Overall, our studies provide an unprecedented view of calcium vesicle 3D-dynamics and point toward cytoskeleton remodeling as an important effector of the motion of mineral-bearing vesicles.
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http://dx.doi.org/10.1371/journal.pcbi.1008780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932551PMC
February 2021

Prevalence of Asymptomatic SARS-CoV-2 Infection.

Ann Intern Med 2021 02;174(2):284-285

John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.

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http://dx.doi.org/10.7326/L20-1284DOI Listing
February 2021

Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study.

Lancet Rheumatol 2021 Feb 24;3(2):e131-e137. Epub 2020 Dec 24.

Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.

Background: As the COVID-19 pandemic continues worldwide, severe COVID-19 outcomes remain a major concern for patients with rheumatic and musculoskeletal diseases. We aimed to investigate temporal trends in COVID-19 outcomes in patients with rheumatic and musculoskeletal diseases over the course of the pandemic.

Methods: Using a large, multicentre, electronic health record network (TriNetX), we did a comparative cohort study of patients with rheumatic and musculoskeletal diseases who were diagnosed with COVID-19 (by International Classification of Diseases, Tenth Revision code or positive PCR test) during the first 90 days of the pandemic (early cohort) compared with the second 90 days of the pandemic (late cohort), matched (1:1) for demographics, comorbidities, laboratory results, glucocorticoid use, and previous hospitalisations using an exposure score method. Outcomes were assessed within 30 days of COVID-19 diagnosis, including hospitalisation, intensive care unit admission, invasive mechanical ventilation, renal failure, and death. We did a subgroup analysis among patients with rheumatic and musculoskeletal diseases who were hospitalised with COVID-19.

Findings: We identified 8540 patients with rheumatic and musculoskeletal diseases who were diagnosed with COVID-19 during the 6-month study period, including 2811 in the early cohort and 5729 in the late cohort. In the exposure score matched analysis, the risk of hospitalisation was lower in the late cohort than in the early cohort (874 [32·4%] of 2701 patients 1227 [45·4%] of 2701 patients; relative risk [RR] 0·71, 95% CI 0·67-0·76). The risks of intensive care unit admission (214 [7·9%] 385 [14·3%]; RR 0·56, 95% CI 0·47-0·65), mechanical ventilation (96 [3·6%] 247 [9·1%]; 0·39, 0·31-0·49), acute kidney injury (372 [13·8%] 560 [20·7%]; 0·66, 0·59-0·75), renal replacement therapy (17 [0·6%] 32 [1·2%]; 0·53, 0·30-0·96), and death (122 [4·5%] 252 [9·3%]; 0·48, 0·39-0·60) were lower in the late cohort compared with the early cohort. Among the hospitalised subgroup, the risk of the composite outcome of intensive care unit admission, mechanical ventilation, and death was lower in the late cohort than in the early cohort (334 [30·7%] of 1089 patients 450 [41·3%] of 1089 patients; RR 0·74, 95% CI 0·67-0·83).

Interpretation: The risks of severe COVID-19 outcomes have improved over time in patients with rheumatic and musculoskeletal disease but remain substantial. These findings might reflect ascertainment of milder cases in the later cohort and improvements in treatment and supportive care.

Funding: None.
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http://dx.doi.org/10.1016/S2665-9913(20)30422-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758725PMC
February 2021

COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases Compared to the General Population: A US Multicenter, Comparative Cohort Study.

Arthritis Rheumatol 2021 06 1;73(6):914-920. Epub 2021 May 1.

Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.

Objective: Patients with systemic autoimmune rheumatic diseases (ARDs) continue to be concerned about risks of severe coronavirus disease 2019 (COVID-19) outcomes. This study was undertaken to evaluate the risks of severe outcomes in COVID-19 patients with systemic ARDs compared to COVID-19 patients without systemic ARDs.

Methods: Using a large multicenter electronic health record network, we conducted a comparative cohort study of patients with systemic ARDs diagnosed as having COVID-19 (identified by diagnostic code or positive molecular test result) compared to patients with COVID-19 who did not have systemic ARDs, matched for age, sex, race/ethnicity, and body mass index (primary matched model) and additionally matched for comorbidities and health care utilization (extended matched model). Thirty-day outcomes were assessed, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation, acute renal failure requiring renal replacement therapy, ischemic stroke, venous thromboembolism, and death.

Results: We initially identified 2,379 COVID-19 patients with systemic ARDs (mean age 58 years; 79% female) and 142,750 comparators (mean age 47 years; 54% female). In the primary matched model (2,379 patients with systemic ARDs and 2,379 matched comparators with COVID-19 without systemic ARDs), patients with systemic ARDs had a significantly higher risk of hospitalization (relative risk [RR] 1.14 [95% confidence interval (95% CI) 1.03-1.26]), ICU admission (RR 1.32 [95% CI 1.03-1.68]), acute renal failure (RR 1.81 [95% CI 1.07-3.07]), and venous thromboembolism (RR 1.74 [95% CI 1.23-2.45]) versus comparators but did not have a significantly higher risk of mechanical ventilation or death. In the extended model, all risks were largely attenuated, except for the risk of venous thromboembolism (RR 1.60 [95% CI 1.14-2.25]).

Conclusion: Our findings indicate that COVID-19 patients with systemic ARDs may be at a higher risk of hospitalization, ICU admission, acute renal failure, and venous thromboembolism when compared to COVID-19 patients without systemic ARDs. These risks may be largely mediated by comorbidities, except for the risk of venous thromboembolism.
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http://dx.doi.org/10.1002/art.41619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169514PMC
June 2021

Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up.

Orthop J Sports Med 2020 Nov 19;8(11):2325967120964471. Epub 2020 Nov 19.

Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, USA.

Background: Significant variation exists in the published rates of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). Functional outcomes and psychological response to injury have been implicated as factors that influence return to sport. Most studies focus on patients aged in the mid-20s, and less is known about this topic in adolescents.

Purpose: To report midterm ACLR results for adolescent patients with regard to return to primary sport, patient-reported outcomes, and reinjury rate.

Study Design: Case-control study; Level of evidence, 3.

Methods: Adolescent athletes were contacted at a minimum of 2 years after ACLR. Patients completed 2 patient-reported outcome measures, the ACL--Return to Sport After Injury (ACL-RSI) and the International Knee Documentation Committee (IKDC) subjective form, and responded to questions regarding preinjury primary sport and level of competition, post-ACLR return to primary sport status, and reinjury.

Results: A total of 74 patients (mean ± SD surgical age, 15.9 ± 1.5 years; follow-up age, 19.9 ± 2.0 years; response rate, 24.5%) completed the surveys at a mean of 4.0 ± 2.0 years after primary ACLR. Outcome scores averaged 90.3 ± 12.3 for IKDC and 81.6 ± 20.4 for ACL-RSI. Questionnaire responses indicated that 27.0% of patients did not return to or sustain primary sport participation after ACLR; the principal reasons were poor knee function, team/training change, and fear of another injury. Both IKDC and ACL-RSI scores were statistically lower in patients who did not successfully return to their primary sport in contrast to patients who successfully resumed their primary sport (IKDC, = .026; ACL-RSI, < .001). IKDC and ACL-RSI scores were moderately positively correlated with one another ( = 0.60). There were 18 patients (reinjury rate, 24.3%) who suffered another ACL injury; 8 of these injuries included ipsilateral ACL graft tear (retear rate, 10.8%).

Conclusion: In our cohort, 73% of adolescent patients successfully returned to their primary preinjury sport at a minimum of 2 years after ACLR. Both knee function and psychological responses to injury were important in determining an adolescent athlete's return to sport. The findings support the use of the IKDC and ACL-RSI at midterm follow-up, with higher scores associated with a greater likelihood of adolescent patients returning to sport after ACLR.
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http://dx.doi.org/10.1177/2325967120964471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686622PMC
November 2020

Cognitively Impaired Older Persons' and Caregivers' Perspectives on Dementia-Specific Advance Care Planning.

J Am Geriatr Soc 2021 04 20;69(4):932-937. Epub 2020 Nov 20.

Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Background/objectives: Advance care planning (ACP) traditionally involves asking individuals about their treatment preferences during a brief period of incapacity near the end of life. Because dementia leads to prolonged incapacity, with many decisions arising before a terminal event, it has been suggested that dementia-specific ACP is necessary. We sought to elicit the perspectives of older adults with early cognitive impairment and their caregivers on traditional and dementia-specific ACP.

Design: Qualitative study with separate focus groups for patients and caregivers.

Setting: Memory disorder clinics.

Participants: Twenty eight persons aged 65+ with mild cognitive impairment or early dementia and 19 caregivers.

Measurements: Understanding of dementia trajectory and types of planning done; how medical decisions would be made in the future; thoughts about these decisions.

Results: No participants had engaged in any written form of dementia-specific planning. Barriers to dementia-specific ACP emerged, including lack of knowledge about the expected trajectory of dementia and potential medical decisions, the need to stay focused in the present because of fear of loss of self, disinterest in planning because the patient will not be aware of decisions, and the expectation that involved family members would take care of issues. Some patients had trouble engaging in the discussion. Patients had highly variable views on what the quality of their future life would be and on the leeway their surrogates should have in decision making.

Conclusions: Even among patients with early cognitive impairment seen in specialty clinics and their caregivers, most were unaware of the decisions they could face, and there were many barriers to planning for these decisions. These issues would likely be magnified in more representative populations, and highlight challenges to the use of dementia-specific advance directive documents.
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http://dx.doi.org/10.1111/jgs.16953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300881PMC
April 2021

End-of-Life Care for Persons Under Guardianship.

J Pain Symptom Manage 2021 07 16;62(1):81-90.e2. Epub 2020 Nov 16.

VA Boston Healthcare System, Boston, Massachusetts, USA; Center for Healthcare Organization and Implementation Research, Boston and Bedford, Massachusetts, USA; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.

Context: Guardians are surrogate decision makers appointed by a court when other health care decision-makers are unable, unwilling, or unavailable to make decisions. Prior studies suggest that persons under guardianship may experience delays in transitions of care.

Objectives: To compare quality of end-of-life care for persons under guardianship to a matched group on objective indicators and to identify narrative themes characterizing potential obstacles to quality end-of-life care.

Methods: One hundred sixty-seven persons under guardianship who died between 2003 and 2019 within the Veterans Healthcare Administration in Massachusetts and Connecticut matched on a 1:1 basis to persons without guardians. The groups were compared on treatment specialty at death, days of hospice and intensive care unit care, and receipt of palliative care consultation. Additionally, patient narratives for those under guardianship with extended lengths in intensive care unit were subjected to qualitative analysis.

Results: Overall, <1% were under guardianship. Within this sample of persons who died within the Veterans Health Administration, persons under guardianship were as likely as patients in the comparison group to receive palliative care consultation (odds ratio [CI] = 0.93 [.590-1.46], P = .359), but were more likely to have ethics consultation (odds ratio [CI] = 0.25 [0.66-0.92], P = .036) and have longer lengths of ICU admission (β = -.34, t = -2.70, P = .009). Qualitative findings suggest that issues related to family conflict, fluctuating medical course, and limitations in guardian authority may underlie extended lengths of stay.

Conclusion: Guardianship appears to be rare, and as a rule, those under guardianship have equal access to hospice and palliative care within Veterans Health Administration. Guardianship may be associated with health-care challenges in a small number of cases, and this may drive perceptions of adverse outcomes.
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http://dx.doi.org/10.1016/j.jpainsymman.2020.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124075PMC
July 2021

Novel measurement tool and model for aberrant urinary stream in 3D printed urethras derived from human tissue.

PLoS One 2020 11;15(11):e0241507. Epub 2020 Nov 11.

Department of Urology, University of California San Francisco, San Francisco, CA, United States of America.

Background: An estimated 10% of male adults have split or dribbled stream leading to poor hygiene, embarrassment, and inconvenience. There is no current metric that measures male stream deviation.

Objective: To develop a novel method to measure spray in normal and abnormal anatomical conformations.

Design, Setting, And Participants: We developed a novel platform to reliably describe spray. We used cadaveric tissues and 3D Printed models to study the impact of meatal shape on the urinary stream. Cadaveric penile tissue and 3D printed models were affixed to a fluid pump and used to simulate micturition. Dye captured on fabric allowed for spray detection.

Outcome Measurements And Statistical Analysis: Spray pattern area, deviation from normal location, and flowrates were recorded. Computational fluid dynamic models were created to study fluid vorticity.

Results And Limitations: Obstructions at the penile tip worsened spray dynamics and reduced flow. Ventral meatotomy improved flowrate (p<0.05) and reduced spray (p<0.05) compared to tips obstructed ventrally, dorsally or in the fossa navicularis. 3D models do not fully reproduce parameters of their parent cadaver material. The average flowrate from 3D model was 10ml/sec less than that of the penis from which it was derived (p = 0.03). Nonetheless, as in cadavers, increasing obstruction in 3D models leads to the same pattern of reduced flowrate and worse spray. Dynamic modeling revealed increasing distal obstruction was correlated to higher relative vorticity observed at the urethral tip.

Conclusions: We developed a robust method to measure urine spray in a research setting. Dynamic 3D printed models hold promise as a methodology to study common pathologies in the urethra and corrective surgeries on the urine stream that would not be feasible in patients. These novel methods require further validation, but offer promise as a research and clinical tool.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241507PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657556PMC
December 2020

Guardianship and End-of-Life Care for Veterans with Dementia in Nursing Homes.

J Am Geriatr Soc 2021 02 10;69(2):342-348. Epub 2020 Nov 10.

Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.

Background/objectives: Experts have suggested that patients represented by professional guardians receive higher intensity end-of-life treatment than other patients, but there is little corresponding empirical data.

Design: Retrospective cohort study.

Setting And Participants: Among veterans aged 65 and older who died from 2011 to 2013, we used Minimum Data Set assessments to identify those who were nursing home residents and had moderately severe or severe dementia. We applied methods developed in prior work to determine which of these veterans had professional guardians. Decedent veterans with professional guardians were matched to decedent veterans without guardians in a 1:4 ratio, according to age, sex, race, dementia severity, and nursing facility type (VA based vs non-VA).

Measurements: Our primary outcome was intensive care unit (ICU) admission in the last 30 days of life. Secondary outcomes included mechanical ventilation and cardiopulmonary resuscitation in the last 30 days of life, feeding tube placement in the last 90 days of life, three or more nursing home-to-hospital transfers in the last 90 days of life, and in-hospital death.

Results: ICU admission was more common among patients with professional guardians than matched controls (17.5% vs 13.7%), but the difference was not statistically significant (adjusted odds ratio = 1.33; 95% confidence interval = .89-1.99). There were no significant differences in receipt of any other treatment; nor was there a consistent pattern. Mechanical ventilation and cardiopulmonary resuscitation were more common among patients with professional guardians, and feeding tube placement, three or more end-of-life hospitalizations, and in-hospital death were more common among matched controls.

Conclusion: Rates of high-intensity treatment were similar whether or not a nursing home resident with dementia was represented by a professional guardian. This is in part because high-intensity treatment occurred more frequently than expected among patients without guardians.
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http://dx.doi.org/10.1111/jgs.16900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902349PMC
February 2021

AUTHOR REPLY.

Urology 2020 Nov;145:267-268

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Urology, University of California, San Francisco, San Francisco, CA.

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http://dx.doi.org/10.1016/j.urology.2020.05.111DOI Listing
November 2020

Clinical and Radiographic Factors Associated With Failed Renal Angioembolization: Results From the Multi-institutional Genitourinary Trauma Study (Mi-GUTS).

Urology 2021 Feb 28;148:287-291. Epub 2020 Oct 28.

Department of Urology, University of California-San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA. Electronic address:

Objective: To find clinical or radiographic factors that are associated with angioembolization failure after high-grade renal trauma.

Material And Methods: Patients were selected from the Multi-institutional Genito-Urinary Trauma Study. Included were patients who initially received renal angioembolization after high-grade renal trauma (AAST grades III-V). This cohort was dichotomized into successful or failed angioembolization. Angioembolization was considered a failure if angioembolization was followed by repeat angiography and/or an exploratory laparotomy.

Results: A total of 67 patients underwent management initially with angioembolization, with failure in 18 (27%) patients. Those with failed angioembolization had a larger proportion ofgrade IV (72% vs 53%) and grade V (22% vs 12%) renal injuries. A total of 53 patients underwent renal angioembolization and had initial radiographic data for review, with failure in 13 cases. The failed renal angioembolization group had larger perirenal hematoma sizes on the initial trauma scan.

Conclusion: Angioembolization after high-grade renal trauma failed in 27% of patients. Failed angioembolization was associated with higher injury grade and a larger perirenal hematoma. Likely these characteristics are associated with high-grade renal trauma that may be less amenable to successful treatment after a single renal angioembolization.
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http://dx.doi.org/10.1016/j.urology.2020.10.027DOI Listing
February 2021
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