bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Illness Severity With Family Outcomes Following Pediatric Septic Shock
Authors: Killien Elizabeth Y. , Zimmerman Jerry J. , Di Gennaro Jane L. , Watson R. Scott 
Published: June 2022

IMPORTANCE:
It is unknown which families are at risk for poor outcomes following a child’s critical illness.

OBJECTIVES:
To evaluate if pediatric septic shock severity is associated with caregiver distress and family dysfunction throughout the year postadmission and if caregiver outcomes are associated with child health-related quality of life (HRQL).

DESIGN, SETTING, AND PARTICIPANTS:
Secondary analysis of the Life After Pediatric Sepsis Evaluation prospective cohort study among children less than 18 years old with community-acquired septic shock requiring vasoactive-inotropic support and invasive or noninvasive ventilation in 12 academic U.S. PICUs.

MAIN OUTCOMES AND MEASURES:
Caregivers reported personal psychologic distress (Brief Symptom Inventory), family functioning (Family Assessment Device), and child HRQL (Pediatric Quality of Life Inventory, Functional Status II-Revised) at baseline and 1, 3, 6, and 12 months following PICU admission.

RESULTS:
Among 276 caregivers, psychologic distress prevalence initially decreased then rose to 15.3%, whereas prevalence of family dysfunction increased steadily to 30.9% at 12 months. On multivariable logistic regression adjusting for patient age, medical complexity, and immunosuppression, higher Pediatric Risk of Mortality and vasoactive-inotropic scores and longer PICU and hospital stay were associated with greater caregiver distress at 1 month. Higher Pediatric Logistic Organ Dysfunction (PELOD) score, longer ventilation, and longer PICU stay were associated with lower odds of family dysfunction at 1, 3, and 6 months (average PELOD vs new 6-mo dysfunction: odds ratio [OR], 0.73 [95% CI, 0.55–0.96]). Caregiver distress was associated with child HRQL decline from baseline to 1 month (OR, 2.92 [1.27–6.75]), 3 months (OR, 2.34 [1.01–5.42]), and 12 months (OR, 3.94 [1.54–10.06]).

CONCLUSIONS AND RELEVANCE:
Family dysfunction becomes increasingly prevalent over the year following pediatric septic shock and is less likely following higher severity illness. Caregiver psychologic distress is associated with worse child HRQL. Both patients and families may benefit from ongoing psychosocial support following survival from pediatric septic shock.
Congestive heart failure and sepsis: a retrospective study of hospitalization outcomes from a rural hospital in Southwest Missouri
Authors: Skovran Alexandra , Hinke Mason , Sloan Shelly N. B. , Stahl Greg , Johnson Kerry , Goade Scott , Arnce Robert 
Published: June 2022

Abstract

Background
Sepsis is the leading cause of death in hospitalized patients and significant effort has been made to facilitate early diagnosis and management. However, aggressive treatment can have negative effects, especially in patients with unstable volume status, such as those with congestive heart failure.

Methods
We used electronic medical records to perform a retrospective study looking at hospital outcomes in patients from Southwest Missouri who were admitted with sepsis and had a comorbid diagnosis of hypertensive heart failure. Our primary outcome was in-hospital mortality.

Results
We studied a total of 184 patients with the diagnosis of hypertensive heart failure with sepsis, and 348 patients with the diagnosis of sepsis that served as the baseline group. There was a total of 37 (20%) deaths in the hypertensive heart failure group and a total of 94 (27%) deaths in the baseline group.

Conclusion
Our study showed no significant difference between the baseline group and those with hypertensive heart disease with heart failure.
Orthostatic hypotension and mortality risk in geriatric outpatients: the impact of duration and magnitude of the blood pressure drop
Authors: Wiersinga Julia H.I. , Muller Majon , Rhodius-Meester Hanneke F.M. , De Kroon Renske M. , Peters Mike J.L. , Trappenburg Marijke C. 
Published: June 2022

Introduction:
Orthostatic hypotension is a common condition associated with an increased mortality risk. This study investigates this association specifically in geriatric outpatients and additionally focuses on the duration and magnitude of orthostatic hypotension.

Methods:
In this observational prospective cohort study with geriatric outpatients from the Amsterdam Ageing cohort, we differentiated orthostatic hypotension in early orthostatic hypotension (EOH) and delayed/prolonged orthostatic hypotension (DPOH). The magnitude of drop in both SBP and DBP after either 1 or 3 min was quantified. Mortality data was obtained from the Dutch municipal register. Cox proportional hazard models were used to determine the association between orthostatic hypotension and mortality, adjusted for sex and age (model 1), additionally adjusted for orthostatic hypotension-inducing drugs + SBP (model 2) and the presence of cardiovascular disease and diabetes (model 3). Stratified analyses in patients with geriatric deficits were performed.

Results:
We included 1240 patients (mean age 79.4 ± 6.9 years, 52.6% women). Prevalence of orthostatic hypotension was 443 (34.9%); 148 (11.9%) patients had EOH and 285 (23%) DPOH. DPOH was associated with a higher mortality risk [hazard ratio, 95% CI 1.69 (1.28–2.22)] whereas EOH was not associated with mortality risk. This association did not differ in patients with geriatric deficits. Furthermore, the magnitude of drop in both SBP and DBP was associated with a higher mortality risk.

Conclusion:
The presence of DPOH and the magnitude of both systolic and diastolic orthostatic hypotension are related to an increased mortality risk in geriatric outpatients. Whether the duration of orthostatic hypotension and magnitude of the drop in blood pressure is causally related to mortality risk or whether it is a sign of decreased resilience remains to be elucidated.
Association between genetic risk of high SBP and hypertension control: the CoLaus|PsyColaus study
Authors: Marques-Vidal Pedro , Chekanova Valeriya , Vaucher Julien 
Published: June 2022

Objective:
To assess whether a genetic risk score (GRS) for high SBP is associated with poor control of hypertension.

Methods:
Data from the four waves of a population-based, prospective study conducted in Lausanne, Switzerland. Control of hypertension was defined based on SBP less than 140 mmHg and DBP less than 90 mmHg. A weighted GRS was computed from 362 SNPs.

Results:
Overall, 1097 (51% men, mean age 61 years), 1126 (53% men, age 65 years), 1020 (52% men, age 69 years) and 809 (50% men, age 71 years) participants treated for hypertension were selected from the baseline (2003–2006), first (2009–2012), second (2014–2017) and third (2018–2021) surveys. Hypertension control rates were 50, 58, 52 and 59% for the baseline, first, second and third surveys, respectively. No association was found between GRS and hypertension control: multivariate-adjusted mean ± standard error for controlled vs. uncontrolled participants: 9.30 ± 0.09 vs. 9.50 ± 0.09 (P = 0.12); 9.32 ± 0.08 vs. 9.53 ± 0.10 (P = 0.10); 9.17 ± 0.08 vs. 9.34 ± 0.11 (P = 0.22), and 9.18 ± 0.09 vs. 9.46 ± 0.11 (P = 0.07) for the baseline, first, second and third surveys, respectively. Power analysis showed that a minimum of 3410 people treated for hypertension would be necessary to detect an association between the GRS and hypertension control rates. Notably, positive associations between the GRS and SBP levels were found among participants not treated for hypertension, with Spearman correlations ranging between 0.05 and 0.09 (all P < 0.05).

Conclusion:
Using a GRS associated with SBP levels is not predictive of hypertension control. The use of GRS for hypertension management is not warranted in clinical practice.

Graphical abstract:

http://links.lww.com/HJH/C26
Household Secondary Transmission of the Severe Acute Respiratory Syndrome Coronavirus 2 Alpha Variant From a Community Cluster in a Nursery in Japan
Authors: Ikuse Tatsuki , Aizawa Yuta , Shobukawa Yugo , Tomiyama Nobuko , Nakayama Hitoshi , Takahashi Masako , Muto Kensuke , Hasegawa Satoshi , Takahashi Masashi , Kon Miyako , Tamura Tsutomu , Matsumoto Haruki , Saito Reiko , Saitoh Akihiko 
Published: June 2022

Background:
Spread of variants of concerns (VOCs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an increase in children with coronavirus disease 2019 (COVID-19). In February 2021, clusters of the Alpha variant of SARS-CoV-2 started to be reported in Niigata, Japan, including a large nursery cluster. We investigated the transmission routes and household secondary attack rates (SARs) in this cluster.

Methods:
Epidemiologic data related to a nursery cluster in Niigata, Japan, particularly child-origin and adult-origin SARs, were analyzed. VOCs were confirmed by whole-genome sequencing of virus from patients.

Results:
In total, 42 persons (22 children and 20 adults) in the cluster were infected with the Alpha variant. In the nursery, 13 of 81 children (16.0%) and 4 of 24 teachers (16.7%) were infected. SARS-CoV-2 later spread to 25 persons (10 children and 15 adults) outside the nursery. Child-origin and adult-origin household SARs were 27.7% (13/47) and 47.0% (8/17) (P = 0.11), respectively, which were higher than rates attributable to non-VOCs in previous studies.

Conclusions:
As compared with non-VOCs, the Alpha variant of SARS-CoV-2 exhibited high transmissibility among children and adults and may pose a high risk for household secondary transmission from SARS-CoV-2–infected children. Increased transmissibility of current or future VOCs could lead to greater transmission from children to adults or other children.
Provider Perspectives on Factors Affecting the PrEP Care Continuum Among Black Cisgender Women in the Midwest United States: Applying the Consolidated Framework for Implementation Research
Authors: Johnson Amy K. , Pyra Maria , Devlin Samantha , Uvin A. Ziggy , Irby Shemeka , Blum Cori , Stewart Eric , Masinter Lisa , Haider Sadia , Hirschhorn Lisa R. , Ridgway Jessica P. 
Published: June 2022

Background:
To End the HIV Epidemic and reduce the number of incident HIV infections in the United States by 90%, pre-exposure prophylaxis (PrEP) uptake and persistence among cisgender women, particularly racial and ethnic minority women, must be increased. Medical providers play a pivotal role across the PrEP care continuum.

Methods:
In this qualitative study, guided by the Consolidated Framework for Implementation Research, we explored health care provider perspectives on facilitators and barriers to PrEP implementation strategies for Black cisgender women in the Midwest United States. Data were analyzed using a deductive thematic content analysis approach.

Results:
A total of 10 medical providers completed individual qualitative interviews. Using the Consolidated Framework for Implementation Research framework, we identified intervention characteristics (cost, dosing, and adherence), individual patient and provider level factors (self-efficacy, knowledge, and attitudes), and systematic barriers (inner setting and outer setting) that ultimately lead to PrEP inequalities. Implementation strategies to improve the PrEP care continuum identified include provider training, electronic medical record optimization, routine patient education, and PrEP navigation.

Conclusion:
This study provides (1) medical provider insight into implementation factors that can be modified to improve the PrEP care continuum for Black cisgender women and (2) an implementation research logic model to guide future studies.
Board Certification in Cosmetic Surgery
Authors: Chen Shirley , Makhoul Alan T. , Janis Jeffrey E. , Perdikis Galen , Drolet Brian C. 
Published: June 2022

Background
Aesthetic surgery patients commonly use online resources to select a surgeon. The American Board of Plastic Surgery is the American Board of Medical Specialties member board that certifies plastic surgeons. The American Board of Cosmetic Surgery (ABCS) provides aesthetic surgery credentials through a non–American Board of Medical Specialties–recognized process. This study examines use of the phrases “plastic surgery” and “plastic surgeon” by ABCS-certified surgeons when advertising online.

Methods
Diplomates of the ABCS were identified from the ABCS Web site. Professional Web sites, Facebook business pages, and Instagram profiles were located by online search. Use of the descriptor “plastic” and ABCS board certification on practice Web sites, Facebook business page categorization, and plastic surgery–related hashtag use on Instagram were recorded.

Results
A total of 298 non–American Board of Plastic Surgery–certified ABCS diplomates were included. One hundred eighty-nine (69.5%) categorized their Facebook business page as “plastic surgeon.” Within Instagram posts, 123 (57.2%) used #plasticsurgeon, and 172 (80.0%) used #plasticsurgery. On professional Web sites, 90 (30.4%) identified themselves as a “plastic surgeon,” 123 (41.6%) characterized their practice as “plastic surgery,” and 196 (68.5%) used their ABCS credential to identify as a “board-certified” cosmetic surgeon.

Conclusions
Diplomates of the ABCS frequently use “plastic surgeon” and “plastic surgery” in online advertisements despite a lack of accredited plastic surgery training or board certification. Furthermore, most ABCS diplomates use their ABCS credentials to market themselves as “board-certified” cosmetic surgeons, potentially violating American Medical Association–supported truth in advertising laws in some states and increasing public confusion regarding different board certifications.
Gender-Affirming Surgeries
Authors: Scott Kiandra B. , Thuman Jenna , Jain Abhishek , Gregoski Matthew , Herrera Fernando 
Published: June 2022

Background
Gender affirmation surgery is an exponentially growing field within plastic surgery. The aim of our study is to analyze demographics, procedure type, trends, and outcomes in the surgical management of gender identity disorder in the past few years.

Methods
The American College of Surgeons NSQIP database was queried for the years 2015 to 2019. International Classification of Diseases codes were used to identify all gender-affirming cases. Patients were categorized by procedure type using Current Procedural Terminology codes for feminizing/masculinizing top, bottom and head/neck procedures. Patient demographics, comorbidities, and postoperative complications were analyzed using SPSS statistics software. A comparative analysis was performed among the procedure type.

Results
From 2015 to 2019, 4114 patients underwent a gender-affirming surgery (GAS) increasing the number of surgeries by over 400%, according to the NSQIP database. Demographics include age (mean = 32 years), body mass index (mean = 28 kg/m2), race (60% White, 22% unknown, 13% African American, 4% Asian, 1% other). Female to male procedures represented the most commonly performed (n = 2647; 64%), followed by male to female (n = 1278; 31%) with head/neck procedures representing 5% (n = 189) of all procedures. Top surgeries were also the most common (n = 2347, 57%), followed by bottom surgeries (n = 1578, 38%). The overall complication rate was 6% (n = 247), 2.1% (n = 4) for head/neck procedures, 8% (n = 134) for bottom procedures, and 3.5% (n = 84) for top surgeries.
A reoperation within 30 days and related to the initial GAS occurred for 52 patients. Postoperative complication rates were statistically different between bottom surgeries compared with the top and head/neck procedure groups (P < 0.001). Increasing age and body mass index showed a significantly higher odds of having a complication.

Conclusions
Gender-affirming procedures have significantly increased over the past 5 years. Increased exposure through literature and research, as well as an improvement in social climates, including increasing insurance coverage have contributed to the expansion of these procedures. Low serious complication rates within 30 days prove GAS to be safe.
Symmetry of Nipple Position After Bilateral Nipple-Sparing Mastectomy and Implant-Based Reconstruction
Authors: Mercury Oblaise , Nores Gabriella Garcia , Carlson Grant W. 
Published: June 2022

Purpose
Asymmetry of nipple position is common in the female population. There are scant data on the impact of bilateral nipple-sparing mastectomy (NSM) and immediate implant-based reconstruction on nipple asymmetry.

Methods
A retrospective review was performed of an institutional review board approved prospective database of NSM and immediate implant-based reconstruction was performed. BCCT.core software was used to examine preoperative and postoperative nipple asymmetry. It directly calculates the quantitative differences in nipple position between the breasts expressed as breast retraction assessment (BRA). Nipple to sternal notch (N-SN) asymmetry was calculated from the collected data.

Results
Sixty-eight patients undergoing bilateral NSM and implant reconstruction were reviewed. Reconstructive methods were tissue expander (TE) 39 (57.4%) and direct to implant (DTI) (prepectoral 13, submuscular 16) 29 (42.6%). The TE group had greater body mass index (BMI) (23.5 vs 22.1, P = 0.02), mastectomy weight (390.7 vs 243.8, P = 0.001) and higher preoperative N-SN asymmetry (TE 0.89 vs DTI 0.59, P = 0.02). Ten patients received radiation (TE group 4, DTI group 6). The TE group had larger implant size (479.1 vs 375.0, P = 0.0001). Overall, TE reconstruction resulted in an increase in nipple asymmetry (mean BRA: preoperative, 1.50 vs postoperative, 1.65), which was not significant. Direct to implant reconstruction increased nipple asymmetry: mean N-SN asymmetry preoperative 0.59 versus postoperative 0.97 (P = 0.04) and mean BRA scores 1.40 and 1.82 (P = 0.06). Both implant locations in the DTI group resulted in an increase in postoperative asymmetry but was significant for the prepectoral group: mean BRA preoperative 1.19 versus postoperative 1.85, P = 0.02 and mean N-SN asymmetry preoperative 0.48 vs postoperative 0.94, P = 0.04. Radiation impacted the final mean BRA score: radiation 2.24 versus no radiation 1.63 (P = 0.05).

Conclusions
Patients who underwent TE reconstruction had significantly larger breasts and greater preoperative N-SN asymmetry than the DTI group. Despite this, the TE group resulted in mild increase in nipple asymmetry. Both implant locations in DTI reconstruction resulted in increased postoperative asymmetry but was significant for the prepectoral group. Radiation therapy has a significant impact of nipple asymmetry.
The Impact of Preoperative Breast Volume on Development of Mastectomy Skin Flap Necrosis in Immediate Breast Reconstruction
Authors: Andersen Emily S. , Weintraub Collin , Reuter Muñoz Katherine D. , Wolfe Luke G. , Shah Priti , Chandora Agni , Powers Jeremy M. , McGuire Kandace P. , Luppens Daniel P. 
Published: June 2022

Background
Mastectomy skin flap necrosis (MSFN) can significantly impact outcome after immediate breast reconstruction. Several techniques exist to predict MSFN, but these may require additional testing and information, and they are often not available before surgery. We aim to identify whether breast volume, as calculated from preoperative mammography, can be used as a preoperative predictor of MSFN.

Methods
A retrospective chart review from 2010 to 2020 resulted in 378 patients who underwent immediate implant-based breast reconstruction. Complete imaging data were available for 278 patients and 441 reconstructed breasts. Demographic, perioperative, and outcomes data were collected. Measurements from preoperative diagnostic mammograms were used to calculate breast volume. Univariate and multivariate analyses were used to evaluate the association of variables available preoperatively, including breast volume from mammogram and MSFN. Secondary analyses were performed for need for reoperation and loss of reconstruction.

Results
On univariate analysis of MSFN development, demographic variables found to be significantly associated with MSFN included body mass index (P = 0.04), diabetes (P = 0.03), and breast volume calculated from routine mammography (P ≤ 0.0001). Average preoperative breast volume via mammography without and with MSFN was 970.6 mL (95% confidence interval [CI], 908.9–1032.3) and 1298.3 mL (95% CI, 1140.0–1456.5) (P < 0.0001), respectively. Statistically significant intraoperative variables for MSFN development included prolonged operative time (P = 0.005), greater initial tissue expander fill volumes (P ≤ 0.001), and prepectoral implant location (P = 0.02). Higher initial tissue expander fill volumes in implant-based reconstructions were associated with increased rates of MSFN, 264.1 mL (95% CI, 247.2–281.0) without MSFN and 349.9 mL (95% CI, 302.0–397.8) in the group with MSFN, respectively (P < 0.001). On multivariate analysis, preoperative imaging volume (P = 0.02) was found to be significant, whereas body mass index and diabetes lost significance (P = 0.40) in association with MSFN.

Conclusions
The results of this study establish an association between larger breast volume on preoperative imaging and development of MSFN. This may be useful as a tool for more appropriate patient selection and guidance in the setting of immediate breast reconstruction.
The Safety of Fat Grafting: An Institutional Retrospective Review
Authors: Fang Hua Amanda , Soto Edgar , Pigg Ricky , Smith Metta , Boyd Carter J. , Ananthasekar Shivani , Fix R. Jobe , Kilic Ali , Denney Brad , Patcha Prasanth , Myers René P. , de la Torre Jorge I. , Collawn Sherry 
Published: June 2022

Background
Autologous fat grafting is a popular technique for volume replacement in the breast and face. The efficacy, safety, and complication rate of this technique at the division of plastic surgery at the University of Alabama at Birmingham will be described in this review.

Methods
An institutional review board–approved retrospective review of patients undergoing fat grafting procedures from January 2015 to July 2018 was performed. Records were reviewed for fat graft recipient site, donor site, amount grafted, and complications. Continuous variables were compared using either a t test or one-way analysis of variance test. Categorical data were compared using χ2 test. A P value of 0.05 or less was considered statistically significant for all comparisons.

Results
A total of 396 patients who underwent fat grafting procedures of the face and body from January 2015 through July 2018 met inclusion criteria. Average amount of fat grafted for all grafts was 124.4 +/− 6.74 grams. Two hundred fifty of the grafts (62.7%) involved the bilateral breasts with an average of 140.6 +/− 93.97 g used, 70 per side. Of the 396 patients, 110 (27.8%) experienced complications. Forty three of the complications (10.9%) were considered to be major, which included hematomas/seromas, fat necrosis, dermatitis/cellulitis, and infection. No statistical differences were seen among recipient site complication rate. Types of minor complications were statistically significant per recipient sites with bilateral breasts more likely to experience asymmetry than the other recipient sites (20% for bilateral breasts vs 16% overall, P < 0.05). Fifty nine of the 110 patients (53.6%) had the complications reported to be resolved.

Conclusions
Fat grafting is a reliable method for volumization of the breasts and face. Minor complications were not infrequent in this case series; however, no life-threatening complications were observed. Continued work needs to be done to use fat grafting beyond traditional measures.