Risk of postoperative mesh exposure following sacrocolpopexy with supracervical versus total concomitant laparoscopic hysterectomy.

INTRODUCTION AND HYPOTHESIS: The primary objective was to compare rates of mesh exposure in women undergoing minimally invasive sacrocolpopexy with concurrent supracervical vs total hysterectomy. We hypothesized there would be a lower risk of mesh exposure for supracervical hysterectomy. METHODS: This was a retrospective cohort study using the Premier Healthcare Database. Women undergoing sacrocolpopexy with supracervical or total hysterectomy between 2010 and 2018 were identified using Current Procedural (CPT) codes. Complications were identified using CPT and diagnosis codes; reoperations were identified using CPT codes. Mesh exposures were measured over a 2-year period. A multivariable logistic regression was performed with a priori defined predictors of mesh exposure. RESULTS: This study includes 17,111 women who underwent minimally invasive sacrocolpopexy with concomitant supracervical or total hysterectomy (6708 (39%) vs 10,403 (61%)). Women who underwent supracervical hysterectomy were older (age 60 ± 11 vs 53 ± 13, p < 0.01) and less likely to be obese (4% vs 7%, p < 0.01). Postoperative mesh exposures within 2 years were similar (supracervical n = 47, 0.7% vs total n = 65, 0.62%, p = 0.61). On logistic regression, obesity significantly reduced the odds of mesh exposure (OR 0.2, 95% CI 0.01, 0.8); concomitant slings increased odds (OR 1.91, 95% CI 1.28, 2.83). Supracervical hysterectomy was associated with higher rates of port site hernias (1.3% vs 0.65%, p < 0.01), but lower surgical site infections within 3 months (0.81% vs 1.2%, p = 0.03). Reoperation for recurrent prolapse within 24 months was similar (supracervical n = 94, 1.4% vs total n = 150, 1.4%, p = 0.88). CONCLUSIONS: Postoperative mesh exposure rates do not significantly differ based on type of concomitant hysterectomy in this dataset.

Evaluation of taurine and carnitine concentrations in whole blood, plasma, skeletal muscle and cardiac muscle in dogs.

Little is known about how plasma and whole blood taurine and plasma carnitine correlate to concentrations in skeletal and cardiac muscle and the effects of diet in dogs. The purpose of this study was to evaluate the correlation among plasma, skeletal and cardiac muscle carnitine and taurine and whole blood taurine and determine the effect of diet. The study protocol was approved by the Pet Food Solutions Institutional Animal Care and Use Committee. Thirty-three mixed-breed hounds and 32 beagles were evaluated at Day 0 then removed from their baseline diet and randomized to a test diet: high animal protein, grain-inclusive (HA-GI), low animal protein, grain-free (LA-GF), low animal protein, grain-inclusive (LA-GI), or high animal protein, grain-free (HA-GF). Blood was drawn every 30 days and endomyocardial (mixed breeds only) and skeletal muscle biopsies were collected at Days 0 and 180. The correlations between plasma and whole blood taurine, or plasma carnitine and skeletal and cardiac muscle concentrations were weak (p < 0.01-0.05). Mixed-breed hounds had increased (p = 0.029) whole blood taurine compared to beagles. Plasma taurine was lower with diet HA-GF, (p = 0.009) however, all diets had increased taurine from Day 0 and were, on average within the laboratory reference range. Dogs fed the HA-GI diet had increased cardiac muscle carnitine esters (p = 0.014). Increased carnitine esters were also appreciated in cardiac muscle in all diets from Day 0 to 180 (p = 0.0001). On Day 180 mixed-breed hounds had increased skeletal total carnitine (p < 0.001) compared to all time points and breeds. This study observed no correlation between plasma, whole blood, skeletal and cardiac muscle taurine concentrations but noted some effects between time, breed and diet.

Telehealth survey of providers and caregivers of children on peritoneal dialysis during the COVID-19 pandemic.

BACKGROUND: There has been growing support for the adoption of telehealth (TH) services in pediatric populations. Children on chronic peritoneal dialysis (PD) represent a vulnerable population that could benefit from increased use of TH. The COVID-19 pandemic prompted rapid adoption of TH services in the population among pediatric centers participating in The Children's Hospital Association's Standardizing Care to Improve Outcomes in Pediatric ESKD (SCOPE) Collaborative. METHODS: We developed a survey to explore the experience of both pediatric PD providers and caregivers of patients receiving PD care at home and using TH services during the COVID-19 pandemic. RESULTS: We obtained responses from 27 out of 53 (50.9%) SCOPE centers that included 175 completed surveys from providers and caregivers. Major challenges identified by providers included inadequate/lack of physical exam, inability to visit with the patient/family in-person, and inadequate/lack of PD catheter exit site exam. Only 51% of caregivers desired future TH visits; however, major benefits of TH for caregivers included no travel, visit takes less time, easier to care for other children, more comfortable for patient, and no time off from work. Providers and caregivers agreed that PD TH visits are family centered (p = 0.296), with the lack of a physical exam (p < 0.001) and the inability to meet in-person (p = 0.002) deemed particularly important to caregivers and providers, respectively. CONCLUSIONS: TH is a productive and viable visit option for children on PD; however, making this a successful, permanent part of routine care will require an individualized approach with standardization of core elements. A higher resolution version of the Graphical abstract is available as Supplementary information.

Surgical cost of robotic-assisted sacrocolpopexy: a comparison of two robotic platforms.

IMPORTANCE: Robotic assistance in pelvic organ prolapse surgery can improve surgeon ergonomics and instrument dexterity compared with traditional laparoscopy but at increased costs. OBJECTIVE: To compare total costs for robotic-assisted sacrocolpopexy (RSC) between two robotic platforms at an academic medical center. METHODS: Retrospective cohort of Senhance (Ascensus) RSC between 1/1/2019 and 6/30/21 who were matched 2:1 with DaVinci (Intuitive) RSC. Primary outcome was total costs to hospital system; secondarily we evaluated cost sub-categories. Purchase costs of the robotic systems were not included. T-test, chi-square, and Fisher's exact tests were used. A multivariable linear regression was performed to model total costs adjusting for potential confounders. RESULTS: The matched cohort included 75 subjects. The 25 Senhance and 50 DaVinci cases were similar overall, with mean age 60.5 ± 9.7, BMI 27.9 ± 4.7, and parity 2.5 ± 1.0. Majority were white (97.3%) and postmenopausal (86.5%) with predominantly stage III prolapse (64.9%). Senhance cases had longer OR times (Δ = 32.1 min, p = 0.01). There were no differences in concomitant procedures, intraoperative complications, or short-term postoperative complications between platforms (all p > 0.05). On univariable analysis, costs were similar (Senhance $5368.31 ± 1486.89, DaVinci $5741.76 ± 1197.20, p = 0.29). Cost subcategories (medications, supplies, etc.) were also similar (all p > 0.05). On multivariable linear regression, total cost was $908.33 lower for Senhance (p = 0.01) when adjusting for operative time, estimated blood loss, concomitant mid-urethral sling, and use of the GelPoint mini port system. CONCLUSIONS: Despite longer operating times, total cost of robotic-assisted sacrocolpopexy was significantly lower when using the Senhance compared to the DaVinci system.

Home urinary tract infection testing: patient experience and satisfaction with polymerase chain reaction kit.

INTRODUCTION AND HYPOTHESIS: We sought to evaluate patient satisfaction with a novel multiplex PCR UTI home collection kit for symptomatic UTI in a urogynecologic population. We secondarily sought to characterize reported uropathogens and resistance profiles of uropathogens in this population. We hypothesized that patients would be satisfied. METHODS: This was a cross-sectional study of women who were surveyed later about their experience undergoing evaluation for a UTI with a home UTI test at a large tertiary care urogynecology practice in 2020. Symptomatic patients were sent a home UTI kit. We assessed patient satisfaction at a later time with a 5-point Likert scale and collected baseline information. The primary outcome was patient satisfaction with this experience. Secondary outcomes included type and number of uropathogens on testing. RESULTS: A total of 30 patients [73% white race, mean age 71.9 (SD 12.0) years] were surveyed. Patients responded with a mean score of 4.7/5 to all satisfaction questions. Overall, 86% (26/30) of patients would choose this test again. Of those asked if they would choose this test again outside of the COVID-19 pandemic, 86% responded affirmatively. The most common symptoms reported included dysuria (53%), urgency (37%) and frequency (30%). The most common pathogens identified included Escherichia coli (70%), Enterococcus faecalis (60%) and Aerococcus urinae (43%). CONCLUSIONS: Patients were satisfied with home UTI PCR testing and the majority would choose this option again. Home UTI PCR testing revealed common uropathogens for a population with a high proportion of recurrent UTI, but additional research comparing home versus in-office urine PCR testing is necessary.

Team USA injury and illness incidence at the 2022 Beijing Winter Olympic and Paralympic Games.

OBJECTIVE: The purpose of this study was to determine the injury and illness incidence from Team USA athletes from the 2022 Beijing Winter Olympic and Paralympic Games and assess any sex-based differences or differences between Olympic and Paralympic athletes. METHODS: Team USA Olympic (n=231, 48.5% female) and Team USA Paralympic (n=63, 22.2% female) athletes had medical encounters documented during the Games. Injuries and illnesses were defined according to the 2020 International Olympic Committee Consensus Statement and reviewed for accuracy by a physician. Incidence rates were calculated per 1000 athlete-days and further analysed by sex, sport, anatomical location, type of illness, injury event and injury mechanism, with incident rate ratios (IRRs) used for group comparisons. RESULTS: There were no differences in illness (Olympic illness, IRR=0.99 (95% CI 0.48 to 2.07), p=0.998; Paralympic illness, IRR=1.43 (95% CI 0.41 to 4.97), p=0.572) or injury rates (Olympic injury, IRR=0.63 (95% CI 0.39 to 1.03), p=0.062; Paralympic injury, IRR=1.01 (95% CI 0.43 to 2.35), p=0.988) between male and female (reference group) athletes. However, Olympic athletes had significantly lower illness (IRR=0.41 (95% CI 0.22 to 0.76), p=0.003) and injury (IRR=0.56 (95% CI 0.37 to 0.87), p=0.009) risks compared with Paralympic athletes. CONCLUSION: No significant sex-related differences in injury or illness were detected in Team USA Olympic or Paralympic participating in the 2022 Beijing Winter Games. However, Paralympic athletes exhibited higher rates of injury and illness compared with their Olympic counterparts. This study highlights delegation-specific epidemiological data which may facilitate more focused approaches for injury and illness prevention.

Sacrocolpopexy experience with a novel robotic surgical platform.

INTRODUCTION AND HYPOTHESIS: The objective was to describe early experience performing sacrocolpopexy using a novel robotic surgical platform. METHODS: This is a case series of all women who underwent robotic-assisted sacrocolpopexy using a new robotics platform (TransEnterix Senhance) between January 2019 and July 2021. All sacrocolpopexies were performed by a single Female Pelvic Medicine and Reconstructive surgeon at a large academic institution. Perioperative information including complications was abstracted from the medical record. Anatomical recurrence was defined as any anatomical point at or past the hymen (≥0). Data are descriptive, with Mann-Whitney U test used for comparison of operative time between the first and second half of the patients. RESULTS: A total of 25 sacrocolpopexies were performed using the new robotics platform. Mean age was 62.3 years (±9.2) and mean BMI was 26.5 (±3.8). Ten (40.0%) patients had a prior hysterectomy. Most (n = 21, 84.0%) had stage III or IV prolapse preoperatively. Mean operative time was 210.2 min (±48.6) and median estimated blood loss was 35 ml (IQR 25-50). Mean operative time decreased between the first and second half of the patients (231.7 min vs 190.3 min, p = 0.047). There were no major intraoperative complications. Median follow-up time was 16 weeks (IQR 4-34) and there were no subjective recurrences or retreatments during this period. Two patients (8.0%) had anatomical recurrence without subjective bother. There were two postoperative readmissions (8.0%) within 30 days for small bowel obstruction, one treated surgically and the other with nonsurgical management. CONCLUSIONS: Our case series demonstrates feasibility and successful early adoption of a new robotics platform for robotic sacrocolpopexy.

Reducing pelvic floor injury by induction of labor.

INTRODUCTION AND HYPOTHESIS: We hypothesized that elective induction of labor (eIOL) at 39 weeks is protective of levator ani muscle injury (LAMI) and is associated with decreased pelvic symptoms at 6 weeks postpartum compared to expectant management of labor. METHODS: Prospective cohort pilot study of uncomplicated, primiparous women with a singleton, vertex gestation enrolled immediately post-vaginal delivery (VD). Subjects were dichotomized into two groups based on labor management: eIOL without complication defined by the ARRIVE trial versus spontaneous VD between 39 weeks0/7 and 42 weeks5/7 or no indication for IOL prior to 40 weeks5/7. The primary outcome was LAMI at 6 weeks postpartum as evidenced by any of the following ultrasound measures: (1) increased levator hiatal area (LHA) > 2500 mm2, (2) increased elasticity index (EI, > 75th quartile) or (3) levator enthesis avulsion. RESULTS: Analysis represents 45/102 consented women from July 2019-October 2020 (eIOL n = 22 and spontaneous VD, n = 23). Neither maternal, clinical, sociodemographic characteristics nor pelvic symptoms differed between groups. Fewer women had LAMI as defined by the primary outcome with eIOL (n = 5, 23.8%) compared to spontaneous VD (n = 15, 65.2%), p = 0.008. Levator enthesis was more deformable (increased EI) with spontaneous VD as compared to the eIOL [10.66 (8.99) vs. 5.68 (2.93), p = 0.046]. On univariate logistic regression women undergoing spontaneous VD had unadjusted OR of 6.0 (1.6-22.5, p = 0.008) of sustaining LAMI compared to those undergoing eIOL. CONCLUSIONS: Composite measures of LAMI though not pelvic floor symptoms were markedly increased in women undergoing spontaneous VD compared to those undergoing eIOL at 39 weeks.

Operative Time for Minimally Invasive Sacrocolpopexy: Comparison of Conventional Laparoscopy versus Robotic Platform.

STUDY OBJECTIVE: To evaluate the operative time for minimally invasive sacrocolpopexy using conventional laparoscopy vs robotic assistance. In addition, we sought to compare intraoperative complications, mesh complications, anatomic prolapse recurrence, and retreatment. DESIGN: Retrospective cohort study. SETTING: Academic hospital. PATIENTS: All 142 women who underwent minimally invasive sacrocolpopexy between January 1, 2019, and December 31, 2019. INTERVENTION: We compared operative time between laparoscopic and robotic-assisted sacrocolpopexies. MEASUREMENTS AND MAIN RESULTS: A total of 142 women were included. Mean age was 61.8 ± 9.6 years and mean body mass index 27.1 ± 4.4 kg/m2. A total of 86 (60.6%) sacrocolpopexies were performed laparoscopically and 56 (39.4%) with robotic assistance. There were no significant differences in baseline demographic variables. A higher proportion of concomitant hysterectomies were performed with robotic assistance as compared with laparoscopic cases (n = 42, 73.7% robotic vs n = 43, 50.6% laparoscopic; p <.01). Mean operative times were significantly different between robotic and laparoscopic groups (176.3 ± 45.5 minutes and 195.0 ± 45.4 minutes, p = .02). On linear regression, the variables predicting significant change in operative time were robotic assistance, concomitant hysterectomy, age, body mass index, and no resident involvement. There were no differences in intraoperative bladder or bowel injury, anatomic recurrence beyond the hymen, retreatment, or mesh complications (all p >.05). CONCLUSIONS: Contrary to previous research, the use of robotic assistance does not appear to increase operative time for patients undergoing minimally invasive sacrocolpopexy in a large academic practice.

High voltage atmospheric cold plasma inactivation of Listeria monocytogenes in fresh Queso Fresco cheese.

Listeria (L.) monocytogenes is a significant pathogen found in ready-to-eat meat and dairy products. Soft cheeses, such as Queso Fresco cheese (QFC), are particularly sensitive to Listeria contamination, and occasionally serve as a source of food-borne illness outbreaks. In the present study, clinical and cheese isolates of L. monocytogenes were assayed for phenotypic characteristics following sub-lethal high voltage atmospheric cold plasma (HVACP) treatment. Reductions in biofilm formation, swimming motility, and growth dynamics were observed following HVACP treatment. Microbial enumeration of 1-, 10-, and 100-g fresh QFC following 0, 1, 2, or 3 min of HVACP demonstrated significant reductions in L. monocytogenes after 1 min (P-value <0.05), with increasing efficacy with prolonged exposure. A mass-dependent effect was observed between treatments of 1-, 10-, and 100-g QFC in regard to treatment efficacy. This result indicates that greater L. monocytogenes reduction on a larger QFC mass requires greater exposure of the L. monocytogenes to the reactive gas species. Optical absorption spectroscopy confirmed a reduction in reactive gas species for each log increase in QFC mass, however, an equivalent volume of inert foam resulted in increased reactive gas generation compared to QFC. In conclusion, we demonstrate both the application and limitations of HVACP treatments of QFC in the currently defined experimental parameters.

Self-Collected Saline Gargle Samples as an Alternative to Health Care Worker-Collected Nasopharyngeal Swabs for COVID-19 Diagnosis in Outpatients.

We assessed the performance, stability, and user acceptability of swab-independent self-collected saliva and saline mouth rinse/gargle sample types for the molecular detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults and school-aged children. Outpatients who had recently been diagnosed with COVID-19 or were presenting with suspected COVID-19 were asked to have a nasopharyngeal (NP) swab collected and provide at least one self-collected sample type. Participants were also asked about sample acceptability using a five-point Likert scale. For those previously diagnosed with COVID-19, all samples underwent real-time PCR testing using a lab-developed assay, and the majority were also tested using an FDA-authorized assay. For those presenting with suspected COVID-19, only those with a positive nasopharyngeal swab sample went on to have other samples tested. Saline mouth rinse/gargle and saliva samples were tested daily at time zero, day 1, and day 2 to assess nucleic acid stability at room temperature. Fifty participants (aged 4 to 71 years) were included; of these, 40 had at least one positive sample and were included in the primary sample yield analysis. Saline mouth rinse/gargle samples had a sensitivity of 98% (39/40), while saliva samples had a sensitivity of 79% (26/33). Both saline mouth rinse/gargle and saliva samples showed stable viral RNA detection after 2 days of room temperature storage. Mouth rinse/gargle samples had the highest (mean, 4.9) and health care worker (HCW)-collected NP swabs had the lowest acceptability scores (mean, 3.1). In conclusion, saline mouth rinse/gargle samples demonstrated higher combined user acceptability ratings and analytical performance than saliva and HCW-collected NP swabs. This sample type is a promising swab-independent option, particularly for outpatient self-collection in adults and school-aged children.

Omentectomy reduces the need for peritoneal dialysis catheter revision in children: a study from the Pediatric Nephrology Research Consortium.

BACKGROUND: There are no multi-center studies examining omentectomy and peritoneal dialysis (PD) catheter revision in the pediatric dialysis population. METHODS: We performed a retrospective study at eight centers within the Pediatric Nephrology Research Consortium (PNRC). Data review included all incident tunneled PD catheters placed between 1/1/2011 and 12/31/2016 in pediatric stage 5 chronic kidney disease (CKD 5) patients. The primary outcome was the need for catheter revision and/or replacement. Multivariable logistic regression was performed to evaluate predictors for catheter revision/replacement. RESULTS: Data from 184 children (62.5% male; median age 7.4 years) were analyzed. Omentectomy was completed in 63.6% (n = 117). Revision/replacement occurred in 34.2% (n = 63); median time to revision/replacement was 38.5 days after insertion. PD catheter revision/replacement catheter occurred in 23.9% who underwent omentectomy versus 52.2% without omentectomy (p = 0.0005). Children ≥ 6 years at the time of catheter insertion experienced fewer revisions/replacements (18.2% age ≥ 6 vs. 56.5% age < 6 years, p <0.001). After adjusting for covariates, omentectomy reduced the need for revision by 63%; revision was 3.66 times more likely in those < 6 years of age. CONCLUSIONS: This multi-center study demonstrates that omentectomy at the time of PD catheter insertion in pediatric patients is strongly associated with reduced likelihood of PD catheter revision. Omentectomy should be considered at the time of PD catheter insertion, especially in young children who are at high risk for PD catheter malfunction. A higher resolution version of the Graphical abstract is available as Supplementary information.

Process scale-up and technoeconomic analysis of phospholipid extraction from a dairy byproduct (whey protein phospholipid concentrate).

Dairy byproducts such as whey protein phospholipid concentrate (WPPC) and buttermilk contain phospholipids (PL). A solvent extraction process (simultaneous texturization and extraction of phospholipids, STEP method) to extract PL present in WPPC, using ethanol, recovers about 70% of PL in the raw material. To understand the commercial feasibility of this technology, we simulated a scaled-up version of the process to industrial production of 3.26 kt/yr in the SuperPro Designer (version 10, http://www.intelligen.com) process simulation platform. Economic analysis revealed that PL can be produced at a minimum selling price (MSP) of $92.98/kg, using the scaled-up STEP method. The total investment on capital and annual operating costs were $15.51 million and $14.49 million, respectively. The uncertainty in product cost due to variations in process variables, including PL composition in raw material, product recovery, labor, and raw material costs was analyzed through sensitivity analysis. Phospholipids MSP was most sensitive to product recovery and its composition in WPPC. A reduction of almost 5% in MSP was achieved by improving either of the process parameters by 10%. By increasing the plant size 1.5 times, the product MSP could be decreased by 30% to $65.14/kg. Finally, based on our analysis, recommendations were made for scale-up and commercialization of PL extraction using the STEP method.

Fibromyalgia Pain and Fatigue Symptoms in Spanish and U.S. Men.

BACKGROUND AND AIMS: Fibromyalgia Syndrome (FMS) is a chronic centralized pain disorder characterized by widespread pain and fatigue. Of those affected by FMS, the majority are women, and minimal research exists involving men. The purpose of this paper is to describe the pain and fatigue experiences of men with FMS from two Western countries, Spain and the United States, in order to support more accurate and earlier recognition and diagnosis in men. DESIGN AND METHODS: We used individual and focus group interviews with qualitative and quantitative assessments. SETTINGS AND PARTICIPANTS/SUBJECTS: Ten men in Spain and seven men in the United States provided information about their symptoms, psychosocial and health-seeking behaviors, and gender experiences with FMS. RESULTS: Men articulated types, trends, and triggers of pain and fatigue that enrich an understanding of their symptoms. For example, men report more localized pain than generalized pain. Employment status and activities, among other contextual factors, impacted men's pain and fatigue experiences. CONCLUSIONS: Men experience distinct facets of pain and fatigue compared with women, with notable similarities and differences across the Spanish and U.S. SAMPLES: Cross-cultural comparisons highlight contextual factors that may inspire future inquiries about determinants of men's experiences with FMS. CLINICAL IMPLICATIONS: The present study could be useful for anyone treating men suffering from FMS, especially care providers in nursing, medical, and psychology fields. These initial findings may prompt a closer examination of recommendations for assessment and diagnostic criteria used internationally for patients with FMS with better recognition of men's experience.

The association of pretransplant dialysis exposure with transplant failure is dependent on the state-specific rate of dialysis mortality.

Longer pretransplant dialysis exposure is associated with a higher risk of transplant failure. Whether patients who receive dialysis in a region with a higher rate of dialysis mortality are a higher risk for transplant failure is unknown. Adjusted state-specific hemodialysis mortality rates were determined in 3-year intervals among prevalent dialysis patients in the United States between 1995 and 2012. The effect of state- and period-specific dialysis mortality on the association of pretransplant dialysis exposure with transplant survival through December 2017 was determined using multivariable models. Dialysis mortality within states ranged from 128 deaths/1000 patient-years to 330 deaths/1000 patient-years. Each additional year of dialysis was associated with a 4% higher risk of transplant failure in states within the lowest quartile of dialysis mortality, compared with an 8% higher risk in states within the highest quartile of dialysis mortality. Patients who received pretransplant dialysis treatment in a state with a high rate of dialysis mortality are at a higher risk for transplant failure compared with patients with the same duration of pretransplant dialysis treatment in a state with a lower mortality rate. The findings may have implications for dialysis care in transplant candidates and the design of future outcome metrics.

Sporadic compared to recurrent urinary tract infections: Considerations for urogynecologic patients.

AIMS: To describe the uropathogens and antimicrobial resistance patterns in women with singular, sporadic urinary tract infection (UTI) vs those with recurrent UTI (rUTI) in a urogynecologic population. METHODS: This was a cross-sectional analysis of women treated for a UTI by a urogynecologic provider in a 1-year timeframe. Subjects were divided into two groups: (a) sporadic UTI-no history of rUTI and a single infection in the study timeframe and (b) rUTI-history of rUTI and ≥2 UTIs in the study timeframe. Our primary outcome was the difference in uropathogens between groups. Secondary aims were to investigate host characteristics associated with recurrent Escherichia coli infections and resistant uropathogens in the rUTI cohort. RESULTS: We had 265 women with 163 (61.5%) in the sporadic UTI group and 102 (38.5%) in the rUTI group. The most common uropathogens were E. coli (57.3%) and Klebsiella (11.7%). In the rUTI group, only 27 of 102 (26.5%) had all E. coli infections. There were differences between groups regarding age (P = .03) and proportion of neurogenic bladder (P = .01), intermittent self-catheterization (P < .01), antibiotic suppression (P < .01), and vaginal estrogen therapy (P < .01). In the rUTI cohort, there were no risk factors that were significantly associated with recurrent E.coli UTIs and vaginal estrogen therapy was associated with a higher odds of sensitive uropathogens (adjusted odds ratio, 3.12; confidence interval, 1.28-7.56). CONCLUSIONS: In those with rUTI, it was uncommon to have recurring E. coli UTIs and consistently sensitive uropathogens. Pretreatment urine cultures are important to verify causative uropathogens in this population.

Characterization of Maca (Lepidium meyenii/Lepidium peruvianum) Using a Mass Spectral Fingerprinting, Metabolomic Analysis, and Genetic Sequencing Approach.

Maca (Lepidium meyenii, synonym L. peruvianum) was analyzed using a systematic approach employing principal component analysis of flow injection mass spectrometry fingerprints (no chromatographic separation) to guide the selection of samples for metabolite profiling and DNA next generation sequencing. Samples consisted of 39 commercial maca supplements from 11 manufacturers, 31 unprocessed maca tubers grown in Peru and China, and a historic non-tuber maca sample from Peru. Principal component analysis of flow injection mass spectrometry fingerprints initially placed all the maca samples in three classes with similar chemical composition: commercial maca samples, tubers grown in Peru, and tubers grown in China. Metabolite profiling identified 67 compounds in the negative mode and 51 compounds in the positive mode. Compounds identified by metabolite profiling (macamides, glucosinolates, amino acids, fatty acids, polyunsaturated fatty acids, saccharides, imidazoles) were then used to identify ions in the flow injection mass spectrometry fingerprints. The tuber fingerprints were analyzed by factorial multivariate analysis of variance revealing that black, red, and yellow maca from Peru and black and yellow maca from China were compositionally different with respect to color and country. Critical ions were identified that allowed for the differentiation of maca between colors from the same country or between two countries with the same color. Genetically, all samples were confirmed to be L. meyenii based on next generation sequencing at three gene regions (ITS2, psbA, and trnL) and comparison to recorded sequences of vouchered standards.

Use of auctions to assess consumer value for fresh and end-of-code milk.

The objective of this study was to survey consumers' milk purchasing behavior and investigate the effect of sensory experiences and an educational message on the perceived value of fluid milk at the beginning and near the end of code. Eleven auction sessions were carried out (n = 100 consumers), which included an explanation of the experiment, a survey about demographics and milk purchasing and consumption, sensory evaluation, an educational message, and 3 rounds of nth price auctions. Consumers were blindly served 2 pairs of milk samples from white-pigmented high-density polyethylene [2% and skim milk within 2 to 3 d of production (fresh) and 2% and skim milk with 2 to 3 d until the end of code (near-end)], and asked to indicate their preference and the level of acceptability for each sample using a 7-point hedonic scale. All samples were simultaneously evaluated by a panel of 8 judges who were trained to evaluate milk quality attributes on a 15 cm unstructured line scale. Results from the consumer panel acceptability rating session, trained panel descriptive analysis, and consumer auction bids were analyzed using multivariate factor analysis of variance. Subjecting pre- and post-survey responses to k means cluster analysis revealed 4 bidding populations in each round. Most participants (82%) indicated that they check the code date on milk every time they shop; 77% said they reached for the code date that was farthest out every time. However, on blind tasting, consumers did not prefer fresh over near-end milk. These findings were in agreement with their acceptability scores for fresh 2% (5.0/7.0), near-end 2% (5.2/7.0), fresh skim (4.5/7.0), and near-end skim (4.6/7.0) milks. Trained panelists did not detect a difference in "lacks freshness" flavor in fresh skim (1.9 cm/15.0 cm) or near-end skim milk (1.3 cm). Surprisingly, trained panelists did detect higher "lacks freshness" flavor in 1 lot of fresh 2% (2.3 cm) compared with near-end 2% milk (0.3 cm). When consumers bid on half gallons of milk with visible code dates, fresh skim was valued $0.27 higher than near-end skim, and fresh 2% was valued $0.29 higher than near-end 2%. After blind sensory evaluation, the margin between the fresh and near-end bids decreased to almost zero (fresh skim was valued only $0.03 more than near-end skim; near-end 2% was valued $0.01 more than fresh 2%). After the educational message about the meaning of code dates, consumer bids for near-end ($0.63) and fresh milk ($0.81) decreased compared with the first round of bidding ($0.74 and $1.01, respectively). Additionally, the margin in bids for fresh milk remained numerically higher than those for near-end milk ($0.15 for 2% and $0.21 for skim). The educational message about code date did not have the intended result of increasing consumer value for milk. Although consumers go out of their way to buy the freshest milk, they cannot necessarily distinguish fresh milk from milk at the end of code; consumers appear to value a code date that was farther out more than superior taste, even after a sensory experience and educational message.

Use of auctions to assess consumer value for milk from different packaging.

The objective of this study was to evaluate the effect of a sensory experience and educational message on consumer value for fluid milk in different containers: translucent high-density polyethylene (HDPE), white-pigmented HDPE (light-block), and paperboard. We carried out 11 auction sessions (n = 100). Sessions included an explanation of the experiment process; a survey about demographics and milk purchasing and consumption behaviors; a sensory evaluation; an educational message; and 3 rounds of nth price auctions. Consumers were blindly served 2 pairs of milk samples-2% milk from paperboard and translucent HDPE, and skim milk from paperboard and translucent HDPE-and asked to indicate their preference and level of acceptability for each, using a 7-point hedonic scale. Consumers were asked to ascribe a monetary value to each sample. Consumers were also asked to taste and assess a value for 2% and skim milk from light-block HDPE. All milk samples were evaluated simultaneously by a panel of 9 judges who were trained to evaluate milk quality attributes on a 15 cm unstructured line scale. All milk was from the same industry source, processed and stored on the same timeline for each session. Results from the consumer panel on acceptability, trained panel descriptive analysis and consumer bids were analyzed using multi-factor ANOVA. Subjecting responses to pre- and post-surveys to k means cluster analysis revealed 4 bidding populations in each round. Trained panelists detected higher levels of light-oxidized off-flavor in skim milk from translucent HDPE (5.8 cm) than from light-block HDPE (2.42 cm) and in 2% milk from translucent HDPE (5.1 cm) than from paperboard (0.32 cm). Although 84% of participants regularly purchased milk in plastic containers, consumers' acceptability scores for milk of the same fat content but from different packaging were not different. However, consumers gave higher acceptability scores to 2% milk from paperboard (5.2/7.0) than skim milk from paperboard (4.7/7.0). We found no differences in consumer value (US$) for 2% or skim milk in paperboard or translucent HDPE. However, after consumers received an educational message and tasted "Certified Fresh Taste" samples, they were willing to pay more for 2% milk in paperboard ($0.31 more) or HDPE ($0.38 more) packaging with a "Certified Fresh Taste" seal and for skim milk in paperboard ($0.15 more) or HDPE ($0.21 more) packaging with a "Certified Fresh Taste" seal than for milk in packaging without such labeling. Although consumers could not detect a difference in the milk from different packages, they indicated that they would pay more for a "Certified Fresh Taste" seal after hearing about the effects of light on milk in different packaging, demonstrating the importance to consumers of external cues about freshness.

Application of zinc and calcium acetate to precipitate milk fat globule membrane components from a dairy by-product.

There has been a great deal of interest in developing isolated dairy lipid fractions that are rich in phospholipids (PL), due to their health benefits and functional properties. Dairy by-products that contain elevated levels of PL and milk fat globule membrane (MFGM) proteins can be an excellent source for these isolates. The ß stream, a by-product of anhydrous milk fat production, is an excellent candidate because it contains a higher concentration of PL than many other dairy by-products. In this study, we investigated an economically feasible processing method to obtain these valuable components from the ß stream. The use of zinc acetate and calcium acetate, along with mild heat treatment and pH adjustment, was effective in precipitating PL and proteins into a pellet fraction. With an additional extraction from the pellet using ethanol (90% at 70°C), a PL-enriched lipid fraction was obtained. The effective precipitation conditions were zinc acetate of 25 mM concentration at pH greater than 6.5 at 30°C, and calcium acetate of greater than 75 mM concentration at pH greater than 6.5 at 60°C. With ethanol extraction, PL recovery of 97.7 ± 1.7% from the zinc acetate precipitate and 94.9 ± 3.7% from calcium acetate precipitate were achieved.