bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Milk Portion Size or Energy Density Affect Preschool Children's Lunch Intake?
Authors: Kling Samantha MR , Roe Liane S , Rolls Barbara J 
Published: June 2021

Government‐sponsored programs, such as the Child and Adult Care Food Program, recommend serving age‐appropriate portions of lower‐energy‐dense milk in order to moderate energy intake while promoting a nutrient‐dense diet. It is unclear, however, to what extent changes in milk portion size and energy density (ED) affect children's intake of both milk and the accompanying foods. To evaluate these recommendations, controlled studies are needed to determine if these factors influence children's intake of a meal served in their usual eating environment. Using a 2‐by‐2 crossover design, we investigated the influence of typical variations in milk portion size and ED on intake when milk was served with a standard lunch. Experimental meals were served once a week for 4 weeks in childcare classrooms and was consumed ad libitum by 125 children aged 3–5 y (67 boys and 58 girls). Across the 4 meals, unflavored milk was varied in portion size (9 fl. oz. or 6 fl.oz. [recommended]) and ED (3.25% full‐fat [0.61 kcal/g] or 1% low‐fat [0.42 kcal/g; recommended]). The foods served at the meal (chicken, pasta, broccoli, and bananas) were not varied. The results showed that serving the larger portion of milk increased milk energy intake by 20±3 kcal (27%; P<0.0001) compared to serving the smaller portion, but had no significant effect on food intake or meal energy intake. Serving higher‐ED milk increased milk energy intake by 31±2 kcal (44%) and decreased food energy intake by 26±6 kcal (10%) compared to serving lower‐ED milk (both P<0.0001). Thus, across all children, the change in milk ED did not influence total energy intake at the meal. The effects of milk portion size and ED were not influenced by most child characteristics, such as age, body size, and parent‐reported eating behaviors; however, the effect of milk ED on intake did differ significantly by sex. For boys, serving higher‐ED milk decreased food energy intake by 43±8 kcal (16%; P<0.0001) and did not affect total energy intake compared to serving lower‐ED milk. For girls, consuming more energy from the higher‐ED milk did not lead to a significant compensatory reduction in food energy intake and an additional 24±10 kcal (7%; P=0.03) was consumed over the entire meal. This suggests that boys, but not girls, adjusted their food energy intake in response to changes in ED of milk consumed with lunch. These results showed that serving larger portions of milk could promote milk intake without affecting total energy intake at a meal. However, the provision of lower‐ED milk is appropriate for preschool nutrition programs, since some children did not fully adjust their intake in response to higher‐ED milk and increased their lunch energy intake.Support or Funding InformationUSDA NIFA Grant 2011‐67001‐30117 and National Institutes of Health Grant DK082580.
INSIGHT Study Parenting Intervention to Prevent Childhood Obesity Improves Patterns of Dietary Exposures in Infants
Authors: Hohman Emily E , Savage Jennifer S , Paul Ian M , Birch Leann L 
Published: June 2021

Composition of the infant diet changes rapidly throughout the first year of life, and caregiver decisions on when to introduce foods and what to feed an infant vary. Early dietary patterns have been associated with differing risk for obesity as well as food preferences and intake later in childhood. The objectives of this analysis were to 1) identify patterns of milk and complementary feeding among 40 week old infants participating in the INSIGHT study, an ongoing randomized, controlled trial designed to prevent childhood obesity, and 2) determine whether infants in the parenting intervention group consumed a wider variety of age‐appropriate, nutrient dense foods than control infants. Primiparous mother‐newborn dyads (n=291) were randomized to parenting intervention or a safety control group 2 weeks after birth. The parenting curriculum, built around a framework of responsive parenting in the domains of feeding, sleep, emotional/social regulation, and active social play, or a child safety control curriculum, was delivered at nurse home visits at 3, 16, 28, and 40 weeks after birth. Feeding guidance included messaging on responsive feeding, delayed introduction of solids, repeated exposure to novel foods, and age‐appropriate foods and portion sizes. Infant dietary intake was assessed by food frequency questionnaire at 40 weeks. Latent class analysis was used to identify patterns of dietary exposure encompassing both milk feeding type (formula vs. breast) and solid foods at 40 weeks. Dietary pattern class membership at 40 weeks was used to predict child weight outcomes measured at 1 year. Similar to previous work, five distinct patterns of dietary exposures were identified: 1) “Breastfed, Fruits and Vegetables (BFV)”, 2) “Breastfed, Low Variety (BLV)”, 3) “Formula, Fruits and Vegetables (FFV)”, 4) “Formula, Low Variety (FLV)”, and 5) “Formula, High Energy Density (FHED)”. Class membership probabilities differed between the control and parenting groups (p=0.002). A greater percentage of infants in the parenting group than control were predicted to be in the BFV and FFV classes (60.5% vs 38.5%, p=0.0004), classes characterized by higher fruit and vegetable intake and low intake of high energy‐dense foods. Among formula fed infants, a greater percentage of infants in the parenting group than control were predicted to be in the FFV class rather than the FLV or FHED classes (47.5% vs 19.0% of formula fed infants, p=0.0001). At 1 year, children in the FLV class had significantly higher average weight‐for‐length percentile than those in the BFV class (p=0.04). These results suggest that the parenting intervention improved patterns of dietary intake in 40 week‐old infants, particularly those being fed formula, by increasing fruit and vegetable intake, which may reduce later risk of obesity.Support or Funding InformationNIDDK R01DK088244 and The Childhood Obesity Training Grant #2011‐67001‐30117 from USDA
Adherence Monitoring Tool for Controlled Feeding Studies
Authors: Burnett Dustin J , Peerson Janet M , Miller Beverly , Welch Lucas C , Witbracht Megan G , Krishnan Sridevi , Keim Nancy L 
Published: June 2021

ObjectiveTo devise a dietary adherence monitoring tool for use in controlled human feeding trials involving free‐living study participants.MethodsA scoring tool was devised to measure and track dietary adherence for an 8‐wk randomized trial evaluating the effects of two different dietary patterns on metabolic health outcomes. One dietary pattern is based on the 2010 Dietary Guidelines for Americans; and the other using recent dietary intake data from the What We Eat In America (WWEIA) National survey. In our trial, all foods and beverages are provided to the study participants. The scoring system is a modified version of that used in the Dietary Approaches to Stop Hypertension (DASH) feeding study. Study volunteers maintain detailed daily food logs that are used to score their adherence in these categories. These scores are then adjusted using weigh‐backs of foods not consumed, when a discrepancy between self‐report and weigh backs arise. Adherence scores are assigned on a daily basis to four categories: 1) adherence to the provided study foods (SF), 2) intake of non‐study foods (NSF), 3) intake of coffee or tea that was not provided (C/T), and 4) addition of salt, pepper, herbs or other spices (S/P/S). A score of 0 indicates complete adherence in all categories. For the study and non‐study food categories, scores of 1, 2 or 3 represent deviations of <1, 1–2.9, or ≥ 3 servings/d. In the C/T or S/P/S categories, scores of 1 indicate that these items were added by the participant. A Wilcoxon's signed‐rank test was used to compare the difference in adherence between SF and NSF.ResultsScores for the first ten participants suggest that deviations from adhering to eating all of the study foods (0.6 ± 1.0) were greater than deviations from eating non‐study foods (0.1 ± 0.5) (p=0.002). There were only a total of 10 reported instances of C/T deviations and 4 of S/P/S deviations during the full 8‐wk study for these ten participants.ConclusionsThe scoring tool enables us to closely follow free‐living participants on a daily basis in controlled feeding trials and has the potential to improve adherence while the volunteer is actively enrolled in the study. In our study, this scoring tool will be paired with additional objective checks of adherence, including measurements of body weight and urinary nitrogen, sodium and potassium to more fully characterize dietary adherence.Support or Funding InformationSupported by National Dairy Council, Campbell Soup Company, and the USDA project number #2032‐51530‐022
A Validation of Automated Self‐Administered 24‐Hour Dietary Recalls(ASA24) Relative to Interviewer‐Administered Recalls using the Nutrition Data System for Research (NDSR)
Authors: Mitchell Diane C , Cheng Feon W , Still Christopher D , Jensen Gordon L 
Published: June 2021

IntroductionThe ASA24, an innovative internet‐based tool widely used by researchers, may be a valid and reliable alternative in research when cost or time constraints do not allow for telephone 24‐hr dietary recalls or when food frequency data is insufficient for the level of detail needed. Few studies have been conducted to evaluate, validate or test the feasibility and cost‐effectiveness of the ASA24 relative to standard methods in different populations. Our objective was to assess the relative validity of the ASA24 in middle aged adults residing in rural Pennsylvania.MethodsAdult men (n= 60) and women (n= 108) 50–65 years of age (mean age 57 ± 4.5 yrs.) were recruited and randomly assigned using a cross‐over design to complete both the internet‐based ASA24 and telephone interviewer‐administered NDSR assessments. Participants were either emailed or called on randomly selected, unannounced days to complete 1 weekend and 2 weekdays of intake. Of the 181 participants who were recruited, 3 participants dropped, 9 (5%) did not complete the ASA24 and 1 did not complete the NDSR assessments leaving 168 participants with complete assessments for both methods. Relative validity was assessed by Spearman correlation for energy and energy adjusted and deattenuated correlations for nutrients and food groups.ResultsThe ASA24 yielded higher energy intakes (1966 vs. 1853 kcal) with a correlation of 0.67. Correlations were higher for women (r=0.58) than men (r=0.48). Correlations coefficients for nutrients ranged from 0.21 to 0.84 for all nutrients examined. Correlations were lowest for polyunsaturated fat (r=0.21) and for zinc (r=0.33) and highest for fiber (r=0.84), vitamin A (r=0.80), magnesium (r=0.84), vitamin C (r=0.78) and potassium (r=0.78). For food groups correlations were highest for whole fruit (r=0.99) and total fruit (r=0.92) and lowest for total protein foods (r=0.48), total grains (r =0.61), and vegetables (r=0.66).ConclusionThis study provides inconclusive evidence of the validity of the ASA24 relative to standard telephone methods with relatively high correlations for some nutrients and food groups and low correlations for others. The use of the ASA24 may largely depend on specific research questions and on nutrient and food outcomes of interest. Further research will improve our understanding of the validity of ASA24 and its role in replacing standard interviewer‐administered methods.Support or Funding InformationSupported by the United States Department of Agriculture, #8050‐51530‐012‐01A.
Development of a Shared Decision-Making Tool for Adolescents With Scoliosis to Decide Between Observation Versus Fusion Surgery
Authors: Ifelayo Oluwatomilona I. , Brito Juan P. , Hargraves Ian G. , Larson A. Noelle 
Published: June 2021

Background:
Adolescent patients with moderate to severe idiopathic scoliosis who have completed their skeletal growth face a significant choice in their treatment path: watchful waiting or spinal fusion. Shared decision making (SDM) assists patients and clinicians to find treatments that make intellectual, practical and emotional sense. Our objective was to develop a tool that supports SDM for patients with scoliosis and their families.

Methods:
We used a user-centered design approach that included collaboration between patients, surgeons and SDM experts, observation of clinician encounters, and literature review. We focused on adolescent idiopathic scoliosis patients 13 or more years of age with less than 1 year of growth remaining (Risser stage 3 or greater) and curves between 40 and 65 degrees.

Results:
We included 22 patients, and collected 22 video recordings. From these videos, we identified salient patient priorities for decision making including treatment benefits, surgical complications, pain, scheduling and recovery, and cost. For each theme, we conducted a focused review to obtain the best estimate of effect. Then, an expert SDM designer developed an electronic prototype called Scoliosis Choice.

Conclusions:
The initial prototype of the scoliosis SDM was finalized and is currently being field tested in clinic. Scoliosis Choice may help patients and surgeons better understand the potential risks and benefits of spinal fusion vs. observation for scoliosis treatment and improve validated measures of quality in patient-parent-surgeon communication.
Has the Threshold for Epiphysiodesis Versus Lengthening Changed in the Era of Magnetically Controlled Nails?
Authors: Nichols L. Reid Boyce 
Published: June 2021

Introduction:
Limb length discrepancy (LLD) is common in both the pediatric and adult population. Length inequalities can be due to a multitude of etiologies including congenital, developmental, and acquired causes. There has been little consensus on the morbidity of LLD and, as a result, the threshold necessary for treatment of LLD to prevent morbidity. Advances in magnetically controlled lengthening devices achieve greater accuracy and patient satisfaction and create an opportunity to lower the threshold for limb lengthening.

Discussion:
Asymptomatic LLD is relatively common in both pediatric and adult populations. Only ~10% of the population has equal leg length. LLD of <5 cm may lead to long-term morbidities such as scoliosis, lower back pain, gait abnormalities, stress on hip or knee joint, and lower extremity symptomatic versus asymptomatic osteoarthritis. The teaching in most orthopaedic textbooks is to adjust the shoe if symptomatic for discrepancies up to 2 cm; consider an orthotic, epiphysiodesis, or skeletal shortening for 2.5 to 5 cm; and possible limb reconstruction for >5 cm. The assumption is that there are no long-term consequences of mild LLD. However, data in recent literature show that small discrepancies may contribute to pathologic changes such as pain, gait abnormalities, and osteoarthritis. Major advances have been made in limb lengthening over the past 40 years. The increased accuracy and superior patient satisfaction of the magnetically controlled lengthening nail versus external fixation methods argue for including lengthening for LLD of <5 cm.

Conclusion:
If mild LLD can cause long-term pathology, it is important to counsel families on the full range of options for limb equalization no matter the size of the discrepancy. The evolution in technology and understanding of limb lengthening has provided additional safe surgical options. Therefore, the historic treatment protocol for addressing limb differences may need to include lengthening for smaller discrepancies even <2 cm.
Orthopaedic Problems in 35 Patients With Organic Acid Disorders
Authors: Prasad Niyathi , Gottlich Caleb , Nhan Derek , Hamosh Ada , Sponseller Paul D. 
Published: June 2021

Introduction:
Organic acid disorders (OADs) are a subset of inborn errors of metabolism that result in a toxic accumulation of organic acids in the body, which can lead to metabolic derangements and encephalopathy. Patients with these disorders are managed by a team of biochemical geneticists and metabolic nutritionists. However, subspecialists such as neurologists and orthopaedic surgeons are often needed to help manage the sequelae of the metabolic derangements. The breadth of orthopaedic sequelae of these disease states is poorly understood. Herein, we describe orthopaedic problems associated with 5 types of OAD most commonly seen at our institution: maple syrup urine disease, methylmalonic aciduria, propionic aciduria, pyruvate dehydrogenase deficiency, and glutaric aciduria type 1.

Methods:
We retrospectively reviewed medical records of 35 patients with an OAD who were seen at our academic tertiary care center from May 1999 to May 2020. Patients were grouped into cohorts according to OAD type and analyzed for orthopaedic presentations of hip, knee, or foot disorders, presence and severity of scoliosis, history of fracture, movement disorders, and osteopenia/osteoporosis.

Results:
Of the 35 patients, 13 had maple syrup urine disease, 12 had methylmalonic aciduria, 4 had propionic aciduria, 4 had pyruvate dehydrogenase deficiency, and 2 had glutaric aciduria type 1. Associated orthopaedic problems included spasticity causing neuromuscular scoliosis and/or hip subluxation or dislocation (10 patients), fractures (7 patients), and osteopenia/osteoporosis (7 patients). Overall, 22 of 35 patients had some orthopaedic condition.

Conclusions:
Most in this cohort of patients with OAD also had an orthopaedic abnormality. It is important for physicians treating these patients to understand their propensity for musculoskeletal problems. When treating patients with OAD, it is important to initiate and maintain communication with specialists in several disciplines and to develop collaborative treatments for this unique population.

Level of Evidence:
Level IV—prognostic study.
Screw Malposition: Are There Long-term Repercussions to Malposition of Pedicle Screws?
Authors: Amaral Terry D. , Hasan Sayyida , Galina Jesse , Sarwahi Vishal 
Published: June 2021

Background/Introduction:
Pedicle screws have long been part of the continued advancements in spine surgery. Despite the many techniques that have been devised for their safe placement, malposition of screws continues to occur. Studies have evaluated the possible safe limits of screw malposition, and have given some insight on anatomic variation in spinal deformity. Review of the literature reveals several cases of deleterious long-term sequelae of malpositioned screws.

Discussion:
With the current experience, proposed recommendations are provided to detect and avoid the potential long-term sequelae. Though the literature has helped to define possible concerning screws, there are no good studies predicting long-term risk.

Conclusion:
Improvements in technology and techniques, advancements in intraoperative confirmation and postoperative surveillance, studies that assist risk stratification, and expert consensus evaluations will help guide surgeons in their decision for addressing misplaced screws.
Early Experience with External Negative Pressure Delay in Free Anterolateral Thigh Perforator Flap Reconstruction
Authors: Brown Ciara A. , Ghareeb Paul A. 
Published: June 2021

Summary:
Negative pressure therapy has been utilized in the treatment of open and closed wounds to increase blood flow and improve wound healing. More recently, external negative pressure has been shown to induce a noninvasive delay phenomenon in animal models by increasing vessel size and density within a planned flap, leading to improvement in flap survival. Although successful in animal models, this new method of delay has not been demonstrated in clinical practice. We present our initial experience with preoperative external negative pressure delay of free anterolateral thigh flaps in upper extremity reconstruction to detail the technique and safety profile of this innovative new technique. External negative pressure delay has the potential to provide results similar to those of traditional surgical delay, while being cost effective, safer, and more convenient for patients. More research is needed to investigate the clinical benefit and cost effectiveness of external negative pressure delay.
Comparing Plastic Surgeon Operative Time for DIEP Flap Breast Reconstruction: 2-stage More Efficient than 1-stage?
Authors: Issa Christopher J. , Lu Stephen M. , Boudiab Elizabeth M. , DeSano Jeffrey , Sachanandani Neil S. , Powers Jeremy M. , Chaiyasate Kongkrit 
Published: June 2021

Background:
The deep inferior epigastric perforator flap for breast reconstruction is associated with lengthy operative times that remain an issue for plastic surgeons today. The main objective of this study was to determine if a 2-stage deep inferior epigastric perforator flap reconstruction resulted in a shorter total plastic surgeon operative time compared with an immediate reconstruction.

Methods:
A retrospective chart review was conducted on all patients who underwent deep inferior epigastric perforator flap breast reconstruction from February 2013 to July 2020 by the senior author. Patient demographics, medical comorbidities, mastectomy characteristics, expander placement, reconstructive procedures, operative time, and complications were tabulated.

Results:
The study included a total of 128 patients. For immediate/1-stage flap reconstruction, average operative times for the plastic surgeon were 427.0 minutes for unilateral procedures, and 506.3 minutes for bilateral procedures. For delayed/2-stage reconstruction, average combined plastic surgeon operative times were 351.1 minutes for unilateral expander followed by flap reconstruction (75.9 minutes shorter than immediate unilateral, P = 0.007), and 464.8 minutes for bilateral reconstruction (41.5 minutes shorter than immediate bilateral, P = 0.04). Total patient time under anesthesia was longer for 2-staged bilateral reconstruction (P = 0.0001), but did not differ significantly for unilateral reconstruction. Complications between immediate and delayed groups were not significantly different.

Conclusions:
We found that staged reconstruction over 2 procedures resulted in a significant reduction in operative time for the plastic surgeon for both unilateral and bilateral reconstruction. With amenable breast surgeons and patients, the advantages of controlling scheduling and the operating room may encourage plastic surgeons to consider performing free flap reconstruction in a delayed fashion.