bluuebunny/crossref_metadata_2025_split huggingface dataset:
Body contouring surgery improves long-term satisfaction with appearance and health-related quality of life after bariatric surgery: BODY-Q results from a Danish cohort study
Authors: Poulsen Lotte , Rae Charlene , Simonsen Nina , Klassen Anne F , Lorenzen Mike , Rose Michael , Juhl Claus B. , Støving René Klinkby , Cano Stefan J , Andries Alin , Pusic Andrea L , Sorensen Jens Ahm 
Published: February 2023

Background:
Patient-reported outcomes are crucial in bariatric surgery (BaS) and body contouring surgery (BC) since patients’ goals include improvement in appearance and health-related quality of life (HR-QOL). The BODY-Q is a patient-reported outcome measure developed to measure change in satisfaction with appearance and HR-QOL in BaS and BC patients.

Objectives:
The aim of this study was to examine BODY-Q scores over the entire weight loss journey, and to investigate the impact of BC after BaS.

Methods:
Patients completed the BODY-Q pre/post-BaS and BC at four hospital departments in Denmark between 2015 and 2019. Cross-sectional scores were analyzed by phase of weight loss journey using one-way ANOVA. Scores for patients who provided longitudinal assessments were analyzed using repeat measures ANOVA and paired T-test. The impact of BC was examined over time after BaS, using an Independent T-test from pre BaS through >7 years post BaS.

Results:
The study included 1527 patients who provided 2285 BODY-Q assessments. The cross-sectional analysis by phase of weight loss journey showed higher scores post-BaS, lower scores pre-BC and highest level scores post-BC. The longitudinal analysis showed higher post-surgery mean scores compared to pre-surgery scores for both BaS and BC. The analysis over time after BaS revealed lower mean scores in patients who did not receive BC.

Conclusion:
Our results provide evidence of the positive impact of BaS and BC on patients’ lives and underline the importance of considering BC to finalize the weight loss journey as it helps to maintain improvements in appearance and HR-QOL.
Racial Disparities in the Cost of Unplanned Hospitalizations After Breast Reconstruction
Authors: Nasser Jacob S. , Billig Jessica I. , Wang Chang , Wang Lu , Chung Kevin C. 
Published: February 2023

Background:
Given the national attention to disparities in healthcare, understanding variation provided to minorities becomes increasingly important. This study will examine the effect of race on the rate and cost of unplanned hospitalizations after breast reconstruction procedures.

Methods:
We performed an analysis comparing patients undergoing implant-based and autologous breast reconstruction in the Healthcare Cost and Utilization Project (HCUP). We evaluated the rate of unplanned hospitalizations and associated expenditures among patients of different races. Multivariable analyses were performed to determine the association among race and readmissions and healthcare expenditures.

Results:
The cohort included 17,042 patients. The rate of an unplanned visit was five percent. The rates of readmissions among Black patients (6%) and Hispanic patients (7%) in this study are higher compared to White patients (5%). However, after controlling for patient-level characteristics, race was not an independent predictor of an unplanned visit. In our expenditure model, Black patients (adjusted cost ratio, 1.35 [95% CI, 1.11-1.66]) and Hispanic patients (adjusted cost ratio, 1.34 [95% CI, 1.08-1.65]) experienced greater cost for their readmission compared to White patients.

Conclusion:
Although race is not an independent predictor of an unplanned hospital visit after surgery, racial minorities bear a higher cost burden after controlling for insurance status, further stimulating healthcare disparities. Adjusted payment models may be a strategy to reduce disparities in surgical care. Additionally, direct and indirect measures of disparities should be used when examining healthcare disparities to identify consequences of inequities more robustly.
“A Technique for Severe Lower Eyelid Retraction – The Fascia Lata Sling with Lateral Burr Hole”
Authors: Culver Abby J. , Gilliland Connor , Pulikkottil Benson , Gilliland Grant 
Published: February 2023

Background:
Lower eyelid retraction is a common and feared complication of both disease processes and aesthetic and cosmetic surgical procedures. A 4 finger approach has been previously described to determine adequate treatment of lid retraction.1 In our experience we have found even the most aggressive treatment of the approach, subperiosteal cheek lift with with canthopexy and interpositional graft, is inadequate to address severe lower lid retraction.

Methods:
We propose a technique of a lower lid fascial sling with a lateral burr hole for support to be used when all 5 fingers are needed to correct the lower lid retraction. Review of 134 patients who underwent the fascia lata sling with lateral burr hole for severe lower lid retraction was performed.

Results:
The fascia lata sling with lateral burr hole adequately corrected the lid retraction in all but 1 patient in one procedure. This patient had persistent lateral ectropion and underwent revision canthoplasty resulting in resolution the lateral ectropion.

Conclusion:
The fascia lata sling with lateral burr hole is a reliable procedure to correct lid retraction from a wide variety of etiologies.

Level of Evidence:
IV
Improving Breast Implant Safety through International Collaboration of National Registries – A Review of over 85000 Patients and 200000 Implants from Four Countries.
Authors: Becherer Babette E. , Hopper Ingrid , Cooter Rodney D. , Couturaud Benoît , von Fritschen Uwe , Mullen Erin , Perks A. Graeme B. , Pusic Andrea L. , Stark Birgit , Mureau Marc A.M. , Rakhorst Hinne A. 
Published: February 2023

Background
. Growing awareness about breast implant-related adverse events has stimulated the demand for large, independent data resources. For this, data from breast implant registries could be combined. However, that has never been achieved yet.

Methods
. Real-world data from four currently active national breast implant registries were used. All permanent breast implants from the Australian, Dutch, Swedish and American registries were included. A sub-population present across all registries between 2015-2018 was subsequently selected, including only permanent breast implants inserted during primary surgery for breast reconstruction or augmentation in patients without previous breast device surgery. Nationwide coverage, patient and implant characteristics, infection control measures, and revision incidences were analyzed.

Results
. A total of 207189 breast implants were registered. Nationwide coverage varied between 3-98 percent. The sub-population included 111590 implants (7 percent reconstruction, 93 percent augmentation). Across the registries, mean patient age varied between 41-49 years (P <0.001) for reconstruction and 31-36 years (P <0.001) for augmentation. Variation was observed in implant preferences across the countries and over the years. Infection control measures were most frequently registered in Australia. Cumulative revision incidence at two years ranged from 6-16 percent after reconstruction and 1-4 percent after augmentation.

Conclusion
. For the first time, independent, national, registry-based data from four breast implant registries were combined. This is a powerful step forward in optimizing international breast implant monitoring, evidence-based decision-making, and patient safety.
Examining Between-Group Differences in Social Network Density and High-Sensitivity C-Reactive Protein in Older Adults: Implications for the Hispanic Mortality Paradox
Authors: Flores Melissa , O’Neill Riley M. , Boyd Savannah M. , Uchino Bert N. , Ruiz John M. 
Published: February 2023

ABSTRACT

Objective
Hispanic/Latino(x) and African American/Black older adults experience disproportionate cardiometabolic disease burdens when compared with their non-Hispanic White counterparts. Sources of resilience such as social networks have been found to mitigate the risk of this disease and its end points like high-sensitivity C-reactive protein (hs-CRP). However, little is known about the social network infrastructure among these groups. Moreover, existing work has largely ignored the degree to which members of one’s network are connected to one another (network density), which may be important for navigating structural barriers within interdependent groups. The objective of this study was to understand the association between network density and 5-year hs-CRP (blood spot) and whether this association was moderated by race-ethnicity.

Methods
A subsample of Hispanic/Latino(x), African American/Black, and non-Hispanic White older adults (N = 1431) from the National Social Life Health and Aging Project was used. Multivariable regression was used to estimate the association between network density and its interaction with race-ethnicity, with hs-CRP 5 years later.

Results
Although no main effect of network density on 5-year hs-CRP was found, results revealed a significant network density by race-ethnicity interaction (Wald χ
2(2, 1242) = 3.31, p = .037). Simple slopes analyses revealed that Hispanic/Latino(x) older adults with high network density had significantly lower hs-CRP levels when compared with their same-ethnic counterparts with low network density (b = −0.73, standard error = 0.31, 95% confidence interval = −1.33 to −0.13, p = .018).

Conclusions
Results demonstrate population-level differences in social network structure and differential associations of this infrastructure with health. Implications for the Hispanic Mortality Paradox are discussed.
The Government as Plaintiff: An Analysis of Medical Litigation Against Healthcare Providers in the Eastern Province of the Kingdom of Saudi Arabia
Authors: AlMubarak Sama’a Hamed , Alshatti Fatimah Ali 
Published: February 2023

Objectives
The Saudi healthcare and medicolegal systems have seen several developments to improve quality of services and ensure patient safety. However, violation claims have seen an upward trend in the past few years. Several studies have analyzed medical litigation to better understand violations within healthcare sectors and address them accordingly. Such studies have focused extensively on medical litigations filed by patients against healthcare providers, overlooking other plaintiffs, such as governments. In this study, we examined violation claims filed by governmental entities against healthcare providers in the Eastern Province of the Kingdom of Saudi Arabia.

Methods
From 2016 to 2019, 718 healthcare providers were involved in violation claims that were referred to the Medical Offenses Committee. Two logistic regression analyses were performed to identify significant predictors of receiving a guilty verdict and the verdict type (for guilty verdicts), given defendant-related factors.

Results
Eighty-two percent of healthcare providers received a guilty verdict. Guilty verdicts were prevalent among non-Saudis and healthcare providers in the private sector. Healthcare providers working in the private sector were significantly more likely to receive a guilty verdict than healthcare providers working in the public sector. Nurses were significantly less likely to receive a guilty verdict than physicians. Being involved in violation claims with 5 or more codefendants decreased the likelihood of receiving a guilty verdict. In addition, non-Saudis being involved in violation claims with multiple defendants, working in the private sector, and working in pharmacies and medical complexes were significant predictors of the verdict type.

Conclusions
Results of the study extend the extant literature by analyzing medical litigation including plaintiffs other than patients. In addition, the study introduces implications for the government and policymakers as well as areas for future research The study’s findings emphasized the importance of employment sector and number of defendants as significant predictors of violation claims’ verdicts. Policymakers should take into consideration significant predictors to ensure healthcare providers’ compliance with respective rules and regulations. Tailored attention toward these predictors could minimize the prevalence of medical violation claims, ensure patient safety, and avoid associated negative consequences.
Linking Patient Safety Climate With Missed Nursing Care in Labor and Delivery Units: Findings From the LaborRNs Survey
Authors: Zhong Jie , Simpson Kathleen Rice , Spetz Joanne , Gay Caryl L. , Fletcher Jason , Landstrom Gay L. , Lyndon Audrey 
Published: February 2023

Objective
This study aimed to explore the association of nurses’ perceptions of patient safety climate with missed nursing care in labor and delivery (L&D) units.

Methods
We recruited nurse respondents via email distribution of an electronic survey between February 2018 and July 2019. Hospitals with L&D units were recruited from states with projected availability of 2018 state inpatient data in the United States. Measures included the Safety Attitudes Questionnaire Safety Climate Subscale and the Perinatal Missed Care Survey. We estimated the relationship between safety climate and missed care using Kruskal-Wallis tests and mixed-effects linear regression.

Results
The analytic sample included 3429 L&D registered nurses from 253 hospitals (response rate, 35%). A majority of respondents (65.7%) reported a perception of good safety climate in their units, with a mean score of 4.12 (±0.73) out of 5. The mean number of aspects of care occasionally, frequently, or always missed on respondents’ units was 11.04 (±6.99) out of 25. χ
2 Tests showed that six mostly commonly missed aspects of care (e.g., timely documentation) and three reasons for missed care (communications, material resources, and labor resources) were associated with safety climate groups (P < 0.001). The adjusted mixed-effects model identified a significant association between better nurse-perceived safety climate and less missed care (β = −2.65; 95% confidence interval, −2.97 to −2.34; P < 0.001) after controlling for years of experience and highest nursing education.

Conclusions
Our findings suggest that improving safety climate—for example, through better teamwork and communication—may improve nursing care quality during labor and birth through decreasing missed nursing care. Conversely, it is also possible that strategies to reduce missed care—such as staffing improvements—may improve safety climate.
Chronic obstructive pulmonary disease and the risk for myocardial infarction by type in people with HIV
Authors: Crothers Kristina , Nance Robin M. , Whitney Bridget M. , Harding Barbara N. , Heckbert Susan R. , Budoff Matthew J. , Mathews William C. , Bamford Laura , Cachay Edward R. , Eron Joseph J. , Napravnik Sonia , Moore Richard D. , Keruly Jeanne C. , Willig Amanda , Burkholder Greer , Feinstein Matthew J. , Saag Michael S. , Kitahata Mari M. , Crane Heidi M. , Delaney Joseph A.C. 
Published: February 2023

Objectives:
The relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular disease in people with HIV (PWH) is incompletely understood. We determined whether COPD is associated with risk of myocardial infarction (MI) among PWH, and if this differs for type 1 (T1MI) and type 2 (T2MI).

Design:
We utilized data from five sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort, a multisite observational study.

Methods:
Our primary outcome was an adjudicated MI, classified as T1MI or T2MI. We defined COPD based on a validated algorithm requiring COPD diagnosis codes and at least 90-day continuous supply of inhalers. We conducted time-to-event analyses to first MI and used multivariable Cox proportional hazards models to measure associations between COPD and MI.

Results:
Among 12 046 PWH, 945 had COPD. Overall, 309 PWH had an MI: 58% had T1MI (N = 178) and 42% T2MI (N = 131). In adjusted models, COPD was associated with a significantly increased risk of all MI [adjusted hazard ratio (aHR) 2.68 (95% confidence interval (CI) 1.99–3.60)] even after including self-reported smoking [aHR 2.40 (95% CI 1.76–3.26)]. COPD was also associated with significantly increased risk of T1MI and T2MI individually, and with sepsis and non-sepsis causes of T2MI. Associations were generally minimally changed adjusting for substance use.

Conclusion:
COPD is associated with a substantially increased risk for MI, including both T1MI and T2MI, among PWH. Given the association with both T1MI and T2MI, diverse mechanistic pathways are involved. Future strategies to decrease risk of T1MI and T2MI in PWH who have COPD are needed.
Participation of HIV-1 infected treatment-naive females in clinical trials and sex differences in efficacy and safety outcomes
Authors: Zhou Shuang , Qi Karen , Nugent Bridget M. , Bersoff-Matcha Susan J. , Struble Kimberly 
Published: February 2023

Objectives:
To examine female participation and the observed efficacy and safety by sex from phase 3 HIV-1 trials submitted to the United States Food and Drug Administration (FDA) to support approval or a major labeling change.

Design:
Our analyses were based on phase 3 trials in HIV-1 infected treatment-naive adults submitted to FDA since 2010.

Methods:
We evaluated enrollment of treatment-naive females in 18 clinical trials for HIV-1. Participation to prevalence ratio (PPR) was calculated as the percentage of females among trial participants divided by the percentage of females in the disease population. PPR between 0.8 and 1.2 reflects similar representation of females in the trial and the disease population. Sex differences in efficacy (virologic response rates) and selected safety events were evaluated.

Results:
United States (US) females, particularly US Black females were not adequately represented in clinical trials. The PPR for US females overall was 0.59 and for US Black females was 0.63. Statistically significant sex differences favoring males were observed for efficacy outcomes in both the global population and US participants. Statistically significant sex differences were observed for some safety outcomes.

Conclusions:
US females are underrepresented in phase 3 HIV-1 clinical trials. Underrepresentation was not likely due to enrollment criteria. Statistically significant sex differences were noted for efficacy and selected safety outcomes; however, some differences were not clinically relevant. The ability to detect sex differences was hindered by low numbers of female participants overall and within subgroups. Additional research into innovative approaches to recruit and retain females in clinical trials should continue.
Real world use of dolutegravir two drug regimens
Authors: Bowman Conor , Ambrose Alissa , Kanitkar Tanmay , Flores Katia , Simoes Pedro , Hart Jennifer , Hunter Alan , Akodu Jane , Barber Tristan J. 
Published: February 2023

Background:
Since 2015, we prescribed dolutegravir (DTG)-based two drug regimens (DTG-2DR) for 620 people [total cohort 3133 (19.8%)].

Method:
Clinic database search 1 January 15 to 31 October 21. Demographic, tolerability and HIV related data analysed.

Results:
In total, 620 people identified; 561 had complete data. 446 male (79.5%); median age 54 years (interquartile range 46, 59). 343 (61.1%) MSM. Nine people who initiated naïvely achieved viral suppression (100%). 546/552 (99.0%) switched or continued and were suppressed at data censor. 460/552 (83.3%) received DTG-lamivudine (DTG/3TC), 74/552 (13.4%) received DTG-rilpivirine (DTG/RPV) and 18/552 (3.3%) received DTG-emtricitabine (DTG/FTC). 70 (12.5%) switched off DTG-2DR (55 DTG/3TC, 13 DTG/RPV, two DTG/FTC) due to side-effects. 41 episodes of blip (1 off >50 copies/ml) occurred in 30 people (5.3%). 11/41 on DTG-RPV [n = 7 multi-tablet regimen (MTR), n = 4 single tablet regimen (STR)]. 27/41 DTG-3TC, 3/41 DTG/FTC (n = 26 MTR, n = 4 STR). Six people (1.1%) failed (confirmed viral load >200 copies/ml or persistent low level viraemia) (n = 4 DTG-3TC STR, n = 1 DTG-3TC MTR, n = 1 DTG-RPV MTR). Four failures due to low level viraemia, one due to non-adherence and one due to high viral load. Resistance tests performed for 5/6 – mutations detected only in latter person with high viral load failure (on DTG-3TC MTR) who developed triple class resistance.

Conclusion:
Majority of experience is in DTG/3TC stable switch. Minority of patients developed side-effects. Low number of virological failures, one developed integrase inhibitor resistance. Viral failure associated with MTR, commensurate with trial data showing no failure with resistance if DTG/3TC STR used. Overall DTG-2DR demonstrates high efficacy in real-world setting.
Auditory Function in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol Up Young Adults: A Pilot Study
Authors: Torre Peter , Zhang Zhongli J. , Hoffman Howard J. , Frederick Toni , Purswani Murli , Williams Paige L. , Yao Tzy-Jyun ,   for the Pediatric HIV/AIDS Cohort Study (PHACS)
Published: February 2023

Background:
To collect and compare selected hearing measures in a pilot study of young adults with perinatally acquired HIV (YAPHIV) and those with perinatal HIV exposure who are uninfected young adults with PHEU (YAPHEU).

Setting:
Cross-sectional hearing measures in YAPHIV and YAPHEU enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) for Participants 18 Years of Age and Older (AMP Up).

Methods:
Pure-tone air conduction audiometry and distortion product otoacoustic emission (DPOAE) data were collected in 1 visit. A low-frequency pure-tone average (PTA) (LFPTA, at 0.25, 0.5, 1, and 2 kHz), a speech-frequency PTA (SFPTA, at 0.5, 1, 2, and 4 kHz), and a high-frequency PTA (HFPTA, at 3, 4, 6, and 8 kHz) were calculated. Hearing loss was defined as worse ear SFPTA of ≥20 dB HL. Separate linear regression models were fit for worse ear LFPTA, SFPTA, and HFPTA to assess associations with PHIV status. DPOAE signal-to-noise ratios (SNRs) were obtained at 3 frequencies in each ear.

Results:
Forty-seven YAPHIV and 9 YAPHEU completed hearing testing. All adjusted mean PTAs were similar between YAPHIV and YAPHEU. Hearing loss occurred more in YAPHIV (7/47, 15.2%; 95% CI: 6.3%–28.9%), compared with YAPHEU (0/9, 0%). No associations were detected between HIV disease severity measures and worse ear SFPTA. DPOAE SNRs were similar between YAPHIV and YAPHEU.

Conclusions:
In this pilot study, peripheral hearing (ie, PTAs) and cochlear function (ie, DPOAEs) were similar between YAPHIV and YAPHEU. A larger study is warranted to confirm these findings.