bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Novel Classification of the Inframammary Fold for Use in Primary Breast Augmentation
Authors: Phillips Nicole A. , Millan Lincoln S. , Miroshnik Michael , Stradwick Luke , Layt Craig 
Published: October 2021

Background:
Previous aesthetic breast surgery algorithms have not addressed the importance of evaluating the native inframammary fold before primary breast augmentation. In the authors’ experience, assessment of native inframammary fold anatomy significantly impacts surgical planning and technique. Failure to adequately evaluate and manage the inframammary fold leads to many of the common problems of the lower pole, including double-bubble deformity.

Methods:
The authors assessed the inframammary fold preoperatively in 2192 consecutive patients undergoing primary breast augmentation between June of 2014 and December of 2018. A novel classification of inframammary fold morphology was devised based on review of standardized preoperative photographs. Outcome assessment was performed postoperatively at 3-month intervals.

Results:
The authors identified four clear inframammary fold subtypes based on their clinical appearance, ranging from the nonexistent type F0 to the well-formed and fixed type F3. The key outcome measure examined was the presence of double-bubble deformity postoperatively. There were three total cases of double-bubble deformity identified in our cohort (<1 percent of patients). All cases of double-bubble deformity occurred in patients with a type 3 fold.

Conclusions:
The inframammary fold defines the inferior boundary of the lower pole of the breast and is a critical landmark to the aesthetic breast surgeon. The authors describe a unique and simple inframammary fold classification system that assists in selection of the appropriate approach to the inframammary fold in addition to implant dimensional planning. The authors have found that this system—in particular, the identification of the type F3 inframammary fold—has minimized the risk of inframammary fold–associated complications in over 2000 cases.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Prevalence of Adverse Childhood Experiences, Body Shame, and Revision Request Rate in 218 Plastic Surgery Patients: What Drives Postoperative Dissatisfaction?
Authors: Constantian Mark B. , Zaborek Nick 
Published: October 2021

Background:
What drives patients who are unhappy despite good results? Adverse childhood experiences are common, can impair adult health, and can cause body shame. Neither adverse childhood experiences nor body shame has been studied in surgical patients. The authors report adverse childhood experience prevalences in a plastic surgical population and investigate associations from adverse childhood experiences to body shame and to postoperative dissatisfaction.

Methods:
Two hundred eighteen consecutive patients (86 percent aesthetic and 14 percent reconstructive) completed the Adverse Childhood Experiences Survey and the Experience of Shame Scale. A one-sample test of proportions, logistic regression, and mediation analysis assessed outcomes.

Results:
Compared to the Kaiser/Centers for Disease Control and Prevention medical population, our patients had higher overall adverse childhood experience prevalences (79.8 percent versus 64 percent), emotional abuse (41 percent versus 11 percent), emotional neglect (38 percent versus 15 percent), family substance abuse (36 percent versus 27 percent), and family mental illness (29 percent versus 19 percent, all p < 0.001). Fifty-two percent of our patients had body shame. Adverse Childhood Experiences score predicted body shame (OR, 1.22; p = 0.003). Compared to unshamed patients, body shame was associated with more adverse childhood experiences (85 percent versus 72 percent), higher median Adverse Childhood Experiences score (3.5 versus 2), more cosmetic operations (three versus zero), more health problems (three versus two), higher antidepressant use (39 percent versus 19 percent), substance abuse history (16 percent versus 5 percent), and demands for additional pain medication (18 percent versus 5 percent). Body shame predicted requests for surgical revision (49 percent versus 17 percent; OR, 4.61; all p ≤ 0.0001).

Conclusions:
Adverse childhood experience were common in our patients. Adverse Childhood Experiences score predicted body shame, which predicted revision requests. If body shame preceded and drove surgery, revision requests were likely. Patients desiring revisions had recognizable characteristics.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Flying Without a Net: Space Radiation Cancer Risk Predictions without a Gamma-Ray Basis
Authors: Cucinotta Francis A. 
Published: October 2021

ABSTRACTIt is well known that the spatial distribution of ionization in cells and tissue from heavy ions and other high linear energy transfer (LET) radiation leads to qualitative and quantitative differences in biological effects compared to low LET radiation such as gamma-rays. However, models used to estimate risks involve extensive use of gamma-ray data, including low LET radiation epidemiology, the role of gamma-rays in estimates of quality factors (QF), and the dose and dose-rate reduction effectiveness factor (DDREF). In tumor induction studies, high LET radiation typically have demonstrable dose responses in many animal strains and tissue, while gamma-ray exposures often lead to a weak or poorly determined dose response at low to moderate doses (<2 Gy) leading to large uncertainties in QF estimates. Here we consider an alternate risk prediction approach, avoiding low epidemiology, the QF and DDREF, by formulating a fluence based track structure model of excess relative risk (ERR) with parameters estimated from animal studies with heavy ions and neutrons for the induction for lung and breast cancer in females and liver cancer in males. The ERR model is applied directly with cancer rates for the US population to predict lifetime risks to astronauts at solar minimum. Results for male liver and female breast cancer risk show that the ERR model agrees fairly well with estimates of a QF model with estimates of non-targeted effects (NTE), and is about 2-fold higher than the QF model that ignores NTE. The effective damage area derived by the ERR model for breast and liver tumors is several times that of a mammalian cell nucleus, which suggests NTE likely contribute to cancer risk. For female lung cancer risk, the ERR model predicts 2-fold and 5-fold lower risk compared to the QF models with or without NTE, respectively. We suggest that the direct ERR approach when coupled with improved experimental models of tissue specific cancers representing human risks would lead to large reductions in the uncertainties in space radiation risk projections by avoiding low LET uncertainties.
Antimicrobial consumption in pediatric intensive care units during the first year of COVID-19 pandemic
Authors: Porto MFM , de Oliveira CSM , Pires MEO , Santos RRQ , Teixeira CH , Souza CV , Araujo da Silva AR 
Published: October 2021

AbstractIntroductionThe absence of standardized treatment for critical children admitted in pediatric intensive care units (PICUs) with COVID could lead to an increase in antimicrobial consumption, as indirect effect.AimTo describe trends of antimicrobial consumption in two PICUs before and during the COVID pandemic year.MethodsWe did a retrospective study in children admitted in two PICUs of Rio de Janeiro city, between March 2019 and March 2021. The first year represented the pre-pandemic period and the last one the pandemic period. Trends of antimicrobial consumption were measured by days of therapy (DOT/1000 patient-days) and analyzed by linear regression for antibiotics, antivirals and antifungalsResultsNumber of patients-days in the PICU 1 was 3495 in the pre-pandemic period and 3600 in the pandemic period. The overall DOT/1000 PD of antibiotics, antivirals and antifungal was 15,308.1, 942.8 and 1,691.1, respectively in the pre-pandemic period and 13,481.5, 1,335.4 and 1,243.7, respectively in pandemic period. It was verified trend of reduction of antibiotic and antifungals and increase in antivirals consumption. Number of patients-days in the PICU 2 was 5029 in the pre-pandemic period and 4557 in the pandemic period and the overall DOT/1000 PD of antibiotics, antivirals and antifungal was 16,668.5, 1,385 and 1,966.7, respectively in the pre-pandemic period and 10,896.5, 830.7 and 677.3 in pandemic period. It was verified trend of reduction of antibiotic, antivirals and antifungals consumption.ConclusionTrends of antimicrobial consumption reduction were verified for antibiotics and antifungals in two PICUs and reduction for antiviral in one of them
Trans-ancestry genome-wide association study of gestational diabetes mellitus highlights genetic links with type 2 diabetes
Authors: Pervjakova Natalia , Moen Gunn-Helen , Borges Maria-Carolina , Ferreira Teresa , Cook James P , Allard Catherine , Beaumont Robin N , Canouil Mickaël , Hatem Gad , Heiskala Anni , Joensuu Anni , Karhunen Ville , Kwak Soo Heon , Lin Frederick TJ , Liu Jun , Rifas-Shiman Sheryl , Thorleifsson Gudmar , Andrew Toby , Auvinen Juha , Bhowmik Bishwajit , Bonnefond Amélie , Delahaye Fabien , Demirkan Ayse , Froguel Philippe , Haller-Kikkatalo Kadri , Hardardottir Hildur , Hummel Sandra , Hussain Akhtar , Kajantie Eero , Keikkala Elina , Khamis Amna , Lahti Jari , Lekva Tove , Mustaniemi Sanna , Sommer Christine , Tagoma Aili , Tzala Evangelia , Uibo Raivo , Vääräsmäki Marja , Villa Pia M , Birkeland Kåre I , Bouchard Luigi , Duijn Cornelia M , Finer Sarah , Groop Leif , Hämäläinen Esa , Hayes Geoffrey M , Hitman Graham A , Jang Hak C , Järvelin Marjo-Riitta , Jenum Anne Karen , Laivuori Hannele , Melander Olle , Oken Emily , Park Kyong Soo , Perron Patrice , Prasad Rashmi B , Qvigstad Elisabeth , Sebert Sylvain , Stefansson Kari , Steinthorsdottir Valgerdur , Tuomi Tiinamaija , Hivert Marie-France , Franks Paul W , McCarthy Mark I , Lindgren Cecilia M , Freathy Rachel M , Lawlor Deborah A , Morris Andrew P , Mägi Reedik 
Published: October 2021

ABSTRACTGestational diabetes mellitus (GDM) is associated with increased risk of pregnancy complications and adverse perinatal outcomes. GDM often reoccurs and is associated with increased risk of subsequent diagnosis of type 2 diabetes (T2D). To improve our understanding of the aetiological factors and molecular processes driving the occurrence of GDM, including the extent to which these overlap with T2D pathophysiology, the GENetics of Diabetes In Pregnancy (GenDIP) Consortium assembled genome-wide association studies (GWAS) of diverse ancestry in a total of 5,485 women with GDM and 347,856 without GDM. Through trans-ancestry meta-analysis, we identified five loci with genome-wide significant association (p<5×10−8) with GDM, mapping to/nearMTNR1B(p=4.3×10−54),TCF7L2(p=4.0×10−16),CDKAL1(p=1.6×10−14),CDKN2A-CDKN2B(p=4.1×10−9) andHKDC1(p=2.9×10−8). Multiple lines of evidence pointed to genetic contributions to the shared pathophysiology of GDM and T2D: (i) four of the five GDM loci (notHKDC1) have been previously reported at genome-wide significance for T2D; (ii) significant enrichment for associations with GDM at previously reported T2D loci; (iii) strong genetic correlation between GDM and T2D; and (iv) enrichment of GDM associations mapping to genomic annotations in diabetes-relevant tissues and transcription factor binding sites. Mendelian randomisation analyses demonstrated significant causal association (5% false discovery rate) of higher body mass index on increased GDM risk. Our results provide support for the hypothesis that GDM and T2D are part of the same underlying pathology but that, as exemplified by theHKDC1locus, there are genetic determinants of GDM that are specific to glucose regulation in pregnancy.
Nutrition Policies in Germany: A Systematic Assessment with the Food Environment Policy Index (Food-EPI)
Authors: von Philipsborn Peter , Geffert Karin , Klinger Carmen , Hebestreit Antje , Stratil Jan , Rehfuess Eva ,   for the PEN Consortium
Published: October 2021

AbstractObjectiveTo systematically assess Germany’s nutrition policies, to benchmark them against international best practices, and to identify priority policy actions to improve population-level nutrition in Germany.DesignWe applied the Food Environment Policy Index (Food-EPI), a methodological framework developed by the INFORMAS network. Qualitative content analysis of laws, directives and other documents formed the basis of a multi-staged, structured consultation process.SettingGermany.ParticipantsThe expert consultation process included 55 experts from academia, public administration, and civil society.ResultsGermany lags behind international best practices in several key policy areas. For 18 policy indicators, the degree of implementation compared to international best practices was rated as very low, for 21 as low, for 8 as intermediate, and for none as high. In particular, indicators on food taxation, regulation of food marketing, and retail and food service sector policies were rated as very low to low. Identified priority actions included the binding implementation of nutrition standards for schools and kindergartens, a reform of the value added tax on foods and beverages, a sugar-sweetened beverage tax and stricter regulation of food marketing directed at children.ConclusionsThe results show that Germany makes insufficient use of the potential of evidence-informed health-promoting nutrition policies. Adopting international best practices in key policy areas could help to reduce the burden of nutrition-related chronic disease and related inequalities in nutrition and health in Germany. Implementation of relevant policies requires political leadership, a broad societal dialogue, and evidence-informed advocacy by civil society, including the scientific community.
Impact of Recent Job Loss on Sleep, Energy Consumption and Diet
Authors: Batool-Anwar Salma , Mayer Candace , Haynes Patricia L. , Liu Yilin , Thomson Cynthia A. , Quan Stuart F. 
Published: October 2021

AbstractTo examine how sleep quality and sleep duration affect caloric intake among those experiencing involuntary job loss.MethodsAdequate sleep and self reported dietary recall data from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study was analysed. Primary sleep indices used were total sleep time, time spent in bed after final awakening, and sleep quality as measured by the Daily Sleep Diary (DSD). Mean Energy consumption (MEC) was the primary nutritional index. Secondary indices included diet quality using the Health Eating Index 2015 (HEI), and self-reported intake of protein, carbohydrates and fats.ResultsThe study participants were comprised mainly of women (61%) and non-Hispanic white. The participants had at least 2 years of college education and mean body mass index of 30.2±8.08 (kg/m 2). The average time in bed was 541.8±77.55 minutes and total sleep time was 461.1±56.49 minutes. Mean sleep efficiency was 91±6%, self-reported sleep quality was 2.40±0.57 (0-4 scale, 4 = very good), and minutes earlier than planned morning awakening were 14.36±24.15. Mean HEI score was 47.41±10.92. Although the MEC was below national average for both men and women, male sex was associated with higher MEC. In a fully adjusted model sleep quality was positively associated with MEC.ConclusionDaily overall assessments of sleep quality among recently unemployed persons were positively associated with mean energy consumption. Additionally, the diet quality of unemployed persons was found to unhealthier than the average American and consistent with the relationship between poor socioeconomic status and lower diet quality.
Comparison of endoscopic activity before and during the covid pandemic at a tertiary care hospital in South Punjab
Authors: Din Chaudhary Farooq Mohyud , Gul Muhammad Asif , Hameed Nouman , Hameed Rizwan , Zaidi Yasir , Kanju Shehryar , Tameez-ud-din Ahsan , Altaf Syeda Manal , Ud Din Asma Tameez 
Published: October 2021

ABSTRACTIntroductionCoronavirus disease 2019 (COVID-19) has resulted in dramatic changes to health-care delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity.MethodsThis retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back.ResultsFive hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period.ConclusionCOVID pandemic resulted in considerable reduction in all type of endoscopic procedures. Majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection was significantly reduced.
SPECIFIC DETECTION OF SARS-COV-2 VARIANTS B.1.1.7 (ALPHA) AND B.1.617.2 (DELTA) USING A ONE-STEP QUANTITATIVE PCR ASSAY
Authors: Erster Oran , Mendelson Ella , Kabat Areej , Levy Virginia , Menasheh Batya , Asraf Hadar , Azar Roberto , Ali Yaniv , Bucris Efrat , Bar-Ilan Dana , Mor Orna , Elul Michal , Mandelboim Michal , Sofer Danit , Fleishon Shai , Zuckerman Neta S , Bar-Or Itay 
Published: October 2021

ABSTRACTIn this report, we describe the development of an RT-qPCR assay, termed Alpha Delta assay, which can detect SARS-COV-2 (SC-2) and distinguish between the Alpha (B.1.1.7) and Delta (B.1.617.2) variants. The Alpha- and Delta-specific reactions in the assay target mutations that are strongly linked to the target variant. The Alpha reaction targets the D3L substitution in N gene, and the Delta reaction targets the spike gene 156-158 mutations. Additionally, we developed a second Delta-specific assay, used as a confirmatory test for the Alpha Delta assay that targets the 119-120 deletion in the Orf8 gene. Both reactions have similar sensitivities of 15-25 copies per reaction, similar to the sensitivity of commercial SC-2 detection tests. The Alpha Delta assay and the Orf8-119del assay were successfully used to classify clinical samples that were subsequently analyzed by whole genome sequencing. Lastly, we show that the Alpha Delta and Orf8-119del assays correctly identified the presence of Alpha and Delta lineages RNA in wastewater samples. This study provides a rapid, sensitive and cost-effective tool for detecting and classifying two worldwide dominant SC-2 variants. It also highlights the importance of a timely diagnostic response to the emergence of new SC-2 variants with significant consequences on global health.
The GenoDiabMar registry. A collaborative research platform of “real world” type 2 diabetes patients
Authors: Sierra Adriana , Otero Sol , Rodríguez Eva , Faura Anna , Vera María , Riera Marta , Palau Vanesa , Durán Xavier , Costa-Garrido Anna , Sans Laia , Márquez Eva , Poposki Vladimir , Franch-Nadal Josep , Mundet Xavier , Oliveras Anna , Crespo Marta , Pascual Julio , Barrios Clara 
Published: October 2021

AbstractThe GenoDiabMar registry is a prospective study aims to provide data on demographic, biochemical and clinical changes, from a “real-world” population of Type 2 DM (T2D) patients. This registry is addressed to find new biomarkers related to the micro and macrovascular complications of T2D, especially focused on diabetic nephropathy. The registry includes longitudinal serum and urine samples, DNA bank, as well as data on 227 metabolomics profiles, 77 Immunoglobulin G glycomics traits and others emerging biomarkers. 650 patients aged 69.56 ±9.31 with different grades of chronic kidney disease; (G1-2 50.3%, G3 31.4%, G4 10.8% and G5 7.5%) were followed up for 4.96 (±0.43) years. Regardless of albuminuria, women lost 0.93 (0.40-1.46) glomerular filtration units per year less than men. 17% of the participant experienced rapid progression of renal function, 75.2% men, with differential risk factors between sexes; severe macroalbuminuria >300mg/g for men OR[IQ] 2.40 [1.29:4.44] and concomitant peripheral vascular disease 3.32 [1.10:9.57] for women. An overall mortality of 23% was detected (38% due to Cardiovascular aetiology).This cohort is postulated as a great tool for scientific collaboration for studies, whether they are focused on T2D, or whether they are interested in comparing differential markers between diabetic and non-diabetic populations.
COVID-19 and Mental Health: Predicted Mental Health Status is Associated with Clinical Symptoms and Pandemic-Related Psychological and Behavioral Responses
Authors: Chung Joyce Y. , Gibbons Alison , Atlas Lauren , Ballard Elizabeth , Ernst Monique , Japee Shruti , Farmer Cristan , Shaw Jacob , Pereira Francisco 
Published: October 2021

AbstractBackgroundThe COVID-19 pandemic led to dramatic threats to health and social life. Study objectives - develop a prediction model leveraging subsample of known Patient/Controls and evaluate the relationship of predicted mental health status to clinical outcome measures and pandemic-related psychological and behavioral responses during lockdown (spring/summer 2020).MethodsOnline cohort study conducted by National Institute of Mental Health Intramural Research Program. Convenience sample of English-speaking adults (enrolled 4/4–5/16/20; n=1,992). Enrollment measures: demographics, clinical history, functional status, psychiatric and family history, alcohol/drug use. Outcome measures (enrollment and q2 weeks/6 months): distress, loneliness, mental health symptoms, and COVID-19 survey. NIMH IRP Patient/Controls survey responses informed assignment of Patient Probability Scores (PPS) for all participants. Regression models analyzed the relationship between PPS and outcome measures.OutcomesMean age 46.0 (±14.7), female (82.4%), white (88.9 %). PPS correlated with distress, loneliness, depression, and mental health factors. PPS associated with negative psychological responses to COVID-19. Worry about mental health (OR 1.46) exceeded worry about physical health (OR 1.13). PPS not associated with adherence to social distancing guidelines but was with stress related to social distancing and worries about infection of self/others.InterpretationMental health status (PPS) was associated with concurrent clinical ratings and COVID-specific negative responses. A focus on mental health during the pandemic is warranted, especially among those with mental health vulnerabilities. We will include PPS when conducting longitudinal analyses of mental health trajectories and risk and resilience factors that may account for differing clinical outcomes.FundingNIMH (ZIAMH002922); NCCIH (ZIAAT000030)