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This study examines race/ethnicity and gender differences in drug use and abuse for substances other than alcohol among undergraduate college students. A probability-based sample of 4,580 undergraduate students at a Midwestern research university completed a cross-sectional Web-based questionnaire that included demographic information and several substance use measures. Male students were generally more likely to report drug use and abuse than female students. Hispanic and White students were more likely to report drug use and abuse than Asian and African American students prior to coming to college and during college. The findings of the present study reveal several important racial/ethnic differences in drug use and abuse that need to be considered when developing collegiate drug prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

BACKGROUND: Women with urinary incontinence (UI) report that the disease negatively impacts their quality of life but, paradoxically, under-report symptoms. METHOD: A predictive model using Orem's self-care deficit theory was developed exploring the effect of body experience on self-care agency to manage UI. A sample of postmenopausal women was drawn from a larger trial. Structural equation modeling was used to test the proposed model. RESULTS: Minor modification of the model produced a well-fitting model (chi(9) = 3.20, P = .96, n = 235). Results supported the positive effect of nursing agency on self-care agency. CONCLUSION: Group education about UI may increase self-care agency in postmenopausal women. [ABSTRACT FROM AUTHOR]

The authors investigated the medical use, illicit use, and diversion of 4 distinct classes of abusable prescription medication (sleeping medication, sedative or anxiety medication, stimulant medication, and pain medication) in a random sample of undergraduate students. In spring 2003, 9,161 undergraduate students attending a large, public, midwestern research university in the United States self-administered a Web-based survey. The prevalence rate for illicit use within the past year was highest for pain medication, followed by stimulant medication, sedative or anxiety medication, and sleeping medication. Women generally reported higher past-year medical use rates. However, undergraduate men reported higher illicit use rates. The illicit use-medical use ratio for stimulant medication was the highest among the 4 classes of prescription drugs. Medical users of stimulants for attention deficit hyperactivity disorder were the most likely to be approached to divert their medication. Multivariate results indicated that illicit users of prescription drugs were more likely to use other drugs than were students who did not use prescription drugs illicitly. The authors provide evidence that prescription drug abuse is a problem among college students. [ABSTRACT FROM AUTHOR]

To assess the prevalence and motives for illicit use of prescription stimulants and alcohol and other drugs (AODs), associated with these motives, the authors distributed a self-administered Web survey TO a random sample of 9,161 undergraduate college students. Of the study participants, 8.1% reported lifetime and 5.4% reported past-year illicit use of prescription stimulants. The most prevalent motives given for illicit use of prescription stimulants were to (1) help with concentration, (2) increase alertness, and (3) provide a high. Although men were more likely than women were to report illicit use of prescription stimulants, the authors found no gender differences in motives. Regardless of motive, illicit use of prescription stimulants was associated with elevated rates of AOD use, and number of motives endorsed and AOD use were positively related. Students appear to be using these prescription drugs non-medically, mainly to enhance performance or get high. [ABSTRACT FROM AUTHOR]

This study examined the feasibility of using a Web-based survey to collect alcohol and other drug use data from secondary school students in an urban school district in the Midwest. A Web-based survey was self-administered by a random sample of 6th through 11th grade students in the spring of 2002. The final sample consisted of 1,536 secondary school students (781 women and 755 men). The sample was 57% White, 40% African American, and 3% from other racial and ethnic groups. Several indicators of data quality were examined including response rate, absenteeism, refusals, substantive data, and data processing time. The study achieved a response rate of 89.1%. The results of the present study provide evidence that a Web-based survey can be successfully implemented in an economically and racially diverse urban sample of secondary students. While researchers conducting survey research within secondary schools should consider using Web-based survey approaches, additional research is needed to compare Web-based surveys to more traditional approaches to collecting data. [ABSTRACT FROM AUTHOR]

The prevalence and correlates of illicit methylphenidate use were examined within a nationally representative U.S. sample of 8th, 10th, and 12th graders. The annual prevalence of illicit methylphenidate use was 4%. Race, grade level, geographical region, grade point average, and substance use were all significantly associated with illicit methylphenidate use. [ABSTRACT FROM AUTHOR]

As part of a larger, federally funded study, the purpose of this preliminary, descriptive study was to describe the sexual feelings and sexual functioning of women who used large amounts of crack cocaine. A structured interview with questions pertaining to the effect of crack use on sexual feelings and sexual function was conducted with 100 African-American women who either were in treatment for crack abuse or were currently using the drug. The data did not support the commonly held notions that crack is an aphrodisiac for women and that crack makes women want sex. Furthermore, the women in this study had a higher level of sexual dysfunction than was found in a previous study of women who used alcohol. More research on the sexual experiences of women who use illicit drugs such as crack is needed if practitioners are to base their interventions on women's realities, not on stereotypes. [ABSTRACT FROM AUTHOR]

Toward the goal of furthering our understanding of the mother-daughter relationship, we investigated one aspect of the mother-daughter relationship, the mutual identification that occurs within it. Mutual identification was defined as the process by which a mother and her daughter internalize characteristics of each other. A convenience sample of 81 Polish and 81 Polish-American mother-daughter dyads was studied. Mother-daughter identification was measured using a semantic differential (SD) scale that included 12 concepts. Analyses using paired t tests revealed that there was no significant difference between the ratings of the Polish-American mothers and those of their daughters on 7 of the 12 concepts and no significant difference between the ratings of the Polish mothers and those of their daughters on 10 of the 12. There were, however, statistically significant differences between the Polish and Polish-American women's ratings of the concepts. These data are interpreted as support for the theory of mother-daughter identification. [ABSTRACT FROM AUTHOR]

Background: Breast implant illness (BII) has become a contentious subject in recent years. Although some studies have reported associations between breast implants and autoimmune diseases, others have failed to establish a definitive link., Objectives: The objective of this study was to provide a comprehensive, up-to-date evaluation of the literature surrounding BII, with an emphasis on identifying patient-related factors that may be associated with BII., Methods: A systematic review was performed following PRISMA guidelines by searching the PubMed (MEDLINE), Embase, and Cochrane databases for relevant studies published in the last 20 years., Results: Thirty-one studies were included, which covered 39,505 implant patients with a mean [standard deviation] age of 44.2 [9.30] years. Fifteen studies reported implant explantation status, with 72.4% patients choosing to remove their implants. Among these, 9 studies reported symptom improvement in 83.5% patients. Fifty-three percent of patients undergoing explantation had total capsulectomy. Twenty-eight studies documented total numbers of patients experiencing symptoms related to BII, with 31.3% patients reporting such symptoms. Among these, 16 studies of 4109 BII patients distinguished whether the reason for implantation was cosmetic augmentation or reconstruction. When specified, more patients experiencing BII-related symptoms received implants for "cosmetic" vs "reconstructive" reasons (cosmetic, 3864/4109 [94.0%] vs reconstruction, 245/4109 [5.96%]; P < .001)., Conclusions: This review provides an overview of the current state of knowledge regarding BII. The study highlights a potential relationship between BII and indication for implants (cosmetic vs reconstructive) among other variables, offering valuable insight on factors associated with BII and directions for future research., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Purpose: National studies examining alcohol and other drug use by sexual orientation have been primarily cross-sectional. Understanding changes in sexual orientation over time may further elucidate the mechanisms behind sexual orientation differences in alcohol and other drug use. This national longitudinal study examines changes in sexual orientation across four waves (2013-2019), and the associations with symptomatic alcohol and other drug use., Methods: Data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study were used to examine associations of sexual identity change/stability and sexual identity-attraction discordance/concordance from baseline to follow-up with symptomatic substance use at follow-up. We examined four outcomes: any symptomatic substance use, symptomatic alcohol use, symptomatic other drug use, and symptomatic alcohol + other drug use. Mixed effects logistic regression models were used and all analyses were weighted and stratified by sex., Results: In models adjusting for potential confounders, greater likelihood of symptomatic alcohol and other drug use outcomes was found among males and females experiencing a change from a heterosexual to sexual minority identity and among females with new or consistent sexual identity-attraction discordance., Conclusion: These findings highlight important sex differences and suggest that the period of transitioning to a sexual minority identity is a particularly vulnerable period for symptomatic alcohol and other drug use. For females, incongruent sexual identity and attraction is also a risk factor. Interventions that assist individuals during this transitional period and during a time when identity and attraction are incongruent, may reduce symptomatic substance use during this period., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Many national studies fail to account for discordance between sexual orientation dimensions (e.g. a mismatch between sexual identity and sexual attraction) or sexual identity fluidity (e.g. changes in sexual identity over time). Objective: To examine the longitudinal relationships among sexual identity fluidity/stability, sexual orientation discordance/concordance, and alcohol and other drug use disorder symptoms. Methods: The study used nationally representative longitudinal data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) study of US adolescents and adults ( N = 24,591). Results: Substance use disorder symptoms were most prevalent (45.8%) among bisexual-stable females relative to all other sexual identity subgroups. The adjusted odds ratios (AORs) of substance use disorder symptoms were significantly higher among bisexual-stable females vs. heterosexual-stable females in all models (AOR range: 1.94-2.32), while no such associations were found for males. Sexual identity-attraction discordant females had significantly greater AORs (17/20 instances) of substance use disorder symptoms compared to concordant females; this finding was not as consistent for males (6/20 instances). Conclusion: Sexual orientation discordance was significantly associated with substance use disorder symptoms, especially among females discordant in their sexual identity and attraction. Bisexual-stable and discordant females are at highest risk of developing symptomatic substance use; it is vital that they receive screening, no matter where they are in their coming out process. This study highlights pitfalls of relying solely on cross-sectional data using a single sexual orientation dimension to understand the relationship between sexual orientation and substance use disorder.

We aimed to assess the probability of past-year DSM-5 alcohol use disorder (AUD) and past-year moderate-to-severe DSM-5 AUD as a function of past-year ethnic discrimination among U.S. Latino/Hispanic adults and as a function of past-year discrimination types among Latino/Hispanic sexual minorities (SM). We used data from the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions-III ( n  = 36,309 U.S. adults aged ≥18 years). Our sample consisted of 6,954 Latino/Hispanic adults. Multivariable logistic regression analyses estimated the association of past-year ethnic discrimination with past-year AUD and past-year moderate-to-severe AUD among the overall Latino/Hispanic population. We tested the association between discrimination types (i.e. none, ethnic or sexual orientation discrimination, both) with AUD and moderate-to-severe AUD among Latino/Hispanic SM adults. Among Latino/Hispanic adults, 13.4% met criteria for past-year AUD and 6.4% met criteria for past-year moderate-to-severe AUD. Ethnic discrimination was significantly associated with AUD (AOR = 1.09, 95% CI = 1.07-1.12) and moderate-to-severe AUD (AOR = 1.10, 95% CI = 1.06-1.13). Latino/Hispanic SMs who experienced both ethnic and sexual orientation discrimination were more likely to meet criteria for AUD (AOR = 3.44, 95% CI = 1.97-6.03) and moderate-to-severe AUD (AOR = 2.69, 95% CI = 1.25-5.82) compared to those who did not experience discrimination. Discrimination is a risk factor for AUD and moderate-to-severe AUD among Latino/Hispanic overall and SM populations.

Objective: To evaluate the h- and m-indices of academic urologists across all U.S. accredited urology residency programs to determine the relationship between these metrics and an author's academic rank, academic degrees, and gender., Methods: A total of 136 urology residency programs with available faculty information on their websites were evaluated. The academic rank, academic degrees, and gender were recorded for each clinical and research faculty member. Each author's h-index was determined using the Scopus database. The m-indices for each author were then calculated. Statistical analysis was performed using the Wilcoxon rank-sum test., Results: This study demonstrated that the h- and m-indices positively correlate with an author's academic rank. Among the 2253 academic urologists evaluated, chairs/chiefs and professors had the highest median h- and m-indices (h-index 26, m-index 1.046 for chairs/chiefs; h-index 30, m-index 1.094 for professors). This was followed by associate professors (h-index 14, m-index 0.750), assistant professors (h-index 6, m-index 0.667), and clinical instructors (h-index 6, m-index 0.511). The median h- and m-indices were overall statistically higher for males than females. Faculty members with only a PhD were found to have the highest h- and m-indices followed by MD PhD, MD MBA, MD MPH, MD only, and DO only in descending order of index value., Conclusion: The h- and m-indices of academic urologists positively correlate with their academic rank. These metrics may serve as an additional tool in measuring an individual's academic productivity in consideration of job hirings, positional promotions, societal memberships, achievement awards, research grants, and more., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Background: Implant-based breast reconstruction after nipple-sparing mastectomy (NSM) presents unique benefits and challenges. The literature has compared outcomes among total submuscular (TSM), dual-plane (DP), and prepectoral (PP) planes; however, a dedicated meta-analysis relevant to NSM is lacking., Methods: We conducted a systematic review of studies on immediate breast reconstruction after NSM using TSM, DP, or PP prosthesis placement in PubMed, Embase, and Cochrane databases. In total, 1317 unique articles were identified, of which 49 were included in the systematic review and six met inclusion criteria for meta-analysis. Pooled descriptive outcomes were analyzed for each cohort for all 49 studies. Fixed-effects meta-analytic methods were used to compare PP with subpectoral (TSM and DP) reconstructions., Results: A total of 1432 TSM, 1546 DP, and 1668 PP reconstructions were identified for descriptive analysis. Demographics were similar between cohorts. Pooled descriptive outcomes demonstrated overall similar rates of reconstructive failure (3.3%-5.1%) as well as capsular contracture (0%-3.9%) among cohorts. Fixed-effects meta-analysis of six comparative studies demonstrated a significantly lower rate of mastectomy flap necrosis in the PP cohort compared with the subpectoral cohort (relative risk 0.24, 95% confidence interval [0.08-0.74]). All other consistently reported outcomes, including, hematoma, seroma, infection, mastectomy flap necrosis, nipple -areola complex necrosis, and explantation were comparable., Conclusions: A systematic review of the literature and meta-analysis demonstrated the safety of immediate prepectoral breast reconstruction after NSM, compared with submuscular techniques. Submuscular reconstruction had a higher risk of mastectomy flap necrosis, though potentially influenced by selection bias., Competing Interests: Dr. Salibian is a research consultant for Abbvie, Inc. All the other authors have no financial interest to declare in relation to the content of this article. Abbvie, Inc. did not have any involvement in the conception, design, or execution of this study., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Purpose: Merit-based incentive payment system (MIPS) is a payment model implemented to promote high-value care through performance-based adjustments of Medicare reimbursements. Higher scores indicate superior performance in healthcare quality, efficiency, and interoperability, which can result in financial advantages. Given the paucity of literature, we aimed to characterize plastic surgery performance in MIPS., Method: The Centers for Medicare and Medicaid Services (CMS) online data repository was queried for data on MIPS performance of plastic surgeons from 2019-2021. Descriptive analyses and multivariable logistic regression were conducted to identify predictors of receiving bonus payment for exceptional performance., Results: Approximately 1400 surgeons were sampled in each year. The median number of Medicare beneficiaries and percent of dually eligible beneficiaries-eligible for Medicare and Medicaid-were higher in 2019 (p<0.001). Beneficiary median HCC risk score, which measures expected healthcare costs and needs based on health status, was lower in 2021 (p<0.001). The most common reporting schema was reporting as a group. Total MIPS score increased from 2019 to 2020 to 2021 (90.2 vs 96.4 vs 98.3, p<0.001), but quality score progressively decreased (98.8 vs 95.5 vs 89.90, p<0.001). Fewer physicians received positive adjustment and bonus payments in 2020 and 2021. Predictors of receiving bonus payments were reporting as an alternative payment model, practice size >24, and having 10-49% of dually eligible beneficiaries (p<0.05)., Conclusion: Understanding performance of plastic surgeons in MIPS can guide future policy direction and ensure that high-quality care translates into improved patient outcomes across all fields and levels of social vulnerability., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Background: Plastic surgery training has undergone tremendous change and transitioned through many models over the years, including independent, combined, and integrated. This study evaluates how these changes and others have affected plastic surgery applicants' demographics and academic qualifications over the last 30 years., Methods: Data on applicant demographics and academic qualifications were extracted from multiple sources including the National Resident Matching Program, the American Association of Medical Colleges, and cross-sectional surveys of plastic surgery applicants for the years 1992, 2005, 2011, and 2022. Data were compared using pairwise χ2 goodness of fit tests., Results: The sex distribution of plastic surgery applicants changed significantly over the last 30 years: whereas men predominated in 1992 (86% male vs 14% female), by 2011, the distribution was nearly equal (54% male vs 46% female in both 2011 and 2022, P < 0.001).The racial makeup of applicants also changed over time (P < 0.05). White applicants decreased from 73% in 1992 to 55% in 2011, and 53% in 2022. While there was an increase in Asian (7% to > 17% to > 20%) and other (13% to > 14% to > 21%) applicants over time, whereas the proportion of Black applicants remained stagnant (5% to > 6% to > 8%).Applicants with prior general surgery experience declined precipitously over the years: 96% in 1992, 64% in 2005, 37% in 2011, and 26% in 2022 (P < 0.001). When compared with 1992, Alpha Omega Alpha status increased significantly in 2011 (36% vs 12%, P < 0.05) but did not change considerably in 2005 (22%) and 2022 (23%). Research experience increased dramatically over the years, with the proportion of applicants with at least one publication going from 43% in 1992, to 75% in 2005, to 89% in 2011, and to 99% in 2022 (P < 0.001). Applicant interest in academic plastic surgery did not change considerably over the years at roughly ranging from 30% to 50% of applicants (P = ns)., Conclusions: There has been a shift in the demographics and academic qualifications of plastic surgery applicants over the last 3 decades. Understanding this evolution is critical for reviewing and evaluating the makeup of our specialty, and enacting changes to increase representation where necessary., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Declaration of Competing Interest None declared.

Objective: The purpose of this proof-of-concept pilot study was to test the initial feasibility and limited efficacy of ArtSpective™ for perinatal substance use (PSU), a novel, arts-based intervention designed to decrease stigmatizing attitudes toward PSU., Methods: Using a pre-post mixed methods quasi-experimental design, ArtSpective™ for PSU was pilot tested for proof of concept among a convenience sample of 11 undergraduate and graduate students with experience in maternal-infant nursing from a Midwestern U.S. nursing school. As a proof-of-concept pilot study, we evaluated feasibility (acceptability, demand, and implementation) and limited efficacy. Participants completed presurveys and postsurveys that included satisfaction items, demographic items, and an adapted version of the Attitudes About Drug Use in Pregnancy Scale and participated in a focus group. Focus group data were analyzed using constant comparative methods, and survey data were analyzed using descriptive statistics and Wilcoxon signed rank tests., Results: Participants reported high demand and satisfaction with the intervention and provided recommendations to improve scalability. ArtSpective™ demonstrated significant improvement in stigma toward PSU (pre vs. post: p = .003; d = .633)., Conclusion: ArtSpective™ for PSU demonstrated initial feasibility and limited efficacy for improving nurse attitudes toward PSU. Efforts are needed to further test this novel intervention, adapt it to augment existing educational interventions, and improve its scalability., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2024 International Nurses Society on Addictions.)

Purpose: Nipple-areolar complex (NAC) viability remains a significant concern following prepectoral tissue expander (TE) reconstruction after nipple-sparing mastectomy (NSM). This study assesses the impact of intraoperative TE fill on NAC necrosis and identifies strategies for mitigating this risk., Methods: A chart review of all consecutive, prepectoral TEs placed immediately after NSM was performed between March 2017 and December 2022 at a single center. Demographics, mastectomy weight, intraoperative TE fill, and complications were extracted for all patients. Partial NAC necrosis was defined as any thickness of skin loss including part of the NAC, whereas total NAC necrosis was defined as full-thickness skin loss involving the entirety of the NAC. P < 0.05 was considered statistically significant., Results: Forty-six patients (83 breasts) with an average follow-up of 22 months were included. Women were on average 46 years old, nonsmoker (98%), and nondiabetic (100%) and had a body mass index of 23 kg/m2. All reconstructions were performed immediately following prophylactic mastectomies in 49% and therapeutic mastectomies in 51% of cases. Three breasts (4%) were radiated, and 15 patients (33%) received chemotherapy. Mean mastectomy weight was 346 ± 274 g, median intraoperative TE fill was 150 ± 225 mL, and median final TE fill was 350 ± 170 mL. Partial NAC necrosis occurred in 7 breasts (8%), and there were zero instances of complete NAC necrosis. On univariate analysis, partial NAC necrosis was not associated with any patient demographic or operative characteristics, including intraoperative TE fill. In multivariable models controlling for age, body mass index, mastectomy weight, prior breast surgery, and intraoperative TE fill, partial NAC necrosis was associated with lower body mass index (odds ratio, 0.53; confidence interval [CI], 0.29-0.98; P < 0.05) and higher mastectomy weight (odds ratio, 1.1; CI, 1.01-1.20; P < 0.05). Prior breast surgery approached significance, as those breasts had a 19.4 times higher odds of partial NAC necrosis (95% CI, 0.88-427.6; P = 0.06)., Conclusions: Nipple-areolar complex necrosis following prepectoral TE reconstruction is a rare but serious complication. In this study of 83 breasts, 7 (8%) developed partial NAC necrosis, and all but one were able to be salvaged., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This case report describes an 80-year-old man who presented with a growing erythematous nodule with erosion, measuring 0.6 cm × 0.6 cm, on his right temple. This lesion was later diagnosed as atypical fibroxanthoma (AFX). Instead of undergoing Mohs surgery, the gold standard treatment, the patient opted to pursue a topical treatment regimen because of financial costs associated with surgical removal and repair. This topical regimen consisted of tazarotene cream, imiquimod cream, and 5-fluorouracil solution, applied for 30 days. The patient was directed to use this combination 5 days per week for 6 weeks. The specified dosage for each medication was a fifth of a packet of imiquimod 5% cream, an equivalent amount of tazarotene 0.1% cream, and a single drop of 5-fluorouracil 2% solution. These were combined on a bandage and placed on the lesion overnight. Following the treatment, a 3-week post-application examination revealed an erosion, 1.0 cm × 0.9 cm, amidst erythema. A subsequent incisional biopsy with histopathology and stains for CD10 and CD99, 3 weeks after treatment, and three punch biopsies with histopathology and stains for CD10 and CD99, 1-year post-treatment, confirmed the absence of AFX. AFX is a superficial variant of pleomorphic dermal sarcoma (PDS), which shares histologic similarities, yet the exact relationship between AFX/PDS and undifferentiated pleomorphic sarcoma is still not well understood. Previous studies have indicated a genomic similarity between AFX/PDS and cutaneous squamous cell carcinoma (cSCC), which suggests the potential efficacy of cSCC-targeted treatments for AFX/PDS. This case marks the first recorded instance of successful topical medical treatment of AFX, offering an alternative for patients who may opt out of surgical intervention. Continued research to assess the broader efficacy of this approach is encouraged., (© 2024. The Author(s).)

There is a paucity of literature examining how preferences differ amongst various demographic groups. This study aimed to assess how perceptions of the ideal breast differ between respondents stratified by self-identified demographic factors. A cohort of 25 patients from the senior surgeon's practice presenting for breast surgery was assembled. Pre-operative anteroposterior photographs of these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents' impressions of 'breast attractiveness'. Respondents were asked to rate breasts on a Likert scale. Survey responses were analysed for differences in breast aesthetic preferences by sex, gender, sexual orientation, and race. Males rated all breasts higher on the Likert scale for attractiveness than females (2.8 vs 2.5, p < 0.001). Despite this discrepancy, ratings amongst male and female respondents were highly correlated with one another (R = 0.940; p < 0.0001). Considering sexual orientation, individuals attracted to women provided significantly higher attractiveness ratings to all breasts compared to individuals attracted to men only (2.8 vs 2.5, p < 0.001). White or Caucasian individuals ascribed significantly higher breast attractiveness ratings than Asian individuals (2.7 vs 2.2, p < 0.001), but not Black or African American individuals (2.7 vs 2.4, p = 0.23). Despite these racial discrepancies in mean breast attractiveness, ratings amongst the three groups were highly correlated. In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by demographic factors. These findings merit further investigation to understand these trends and observations., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Given the dialogistic properties of ChatGPT, we hypothesized that this artificial intelligence (AI) function can be used as a self-service tool where clinical questions can be directly answered by AI. Our objective was to assess the content, accuracy, and accessibility of AI-generated content regarding common perioperative questions for reduction mammaplasty., Methods: ChatGPT (OpenAI, February Version, San Francisco, Calif.) was used to query 20 common patient concerns that arise in the perioperative period of a reduction mammaplasty. Searches were performed in duplicate for both a general term and a specific clinical question. Query outputs were analyzed both objectively and subjectively. Descriptive statistics, t tests, and chi-square tests were performed where appropriate with a predetermined level of significance of P less than 0.05., Results: From a total of 40 AI-generated outputs, mean word length was 191.8 words. Readability was at the thirteenth grade level. Regarding content, of all query outputs, 97.5% were on the appropriate topic. Medical advice was deemed to be reasonable in 100% of cases. General queries more frequently reported overarching background information, whereas specific queries more frequently reported prescriptive information ( P < 0.0001). AI outputs specifically recommended following surgeon provided postoperative instructions in 82.5% of instances., Conclusions: Currently available AI tools, in their nascent form, can provide recommendations for common perioperative questions and concerns for reduction mammaplasty. With further calibration, AI interfaces may serve as a tool for fielding patient queries in the future; however, patients must always retain the ability to bypass technology and be able to contact their surgeon., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics and minimizing subsequent recurrence of capsular contracture. As new data emerge, close review of the data are merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture., Methods: A systematic review of the MEDLINE, Embase, and Cochrane Database of Systematic Reviews databases was conducted to characterize the surgical management of capsular contracture in revision breast augmentations. The primary endpoint was capsular contracture recurrence rate., Results: The review was conducted in November of 2021. Primary search revealed 14,163 results. Initial screening by title left 1223 articles. Abstract review left 90 articles for full-text review, of which 34 were ultimately included and were all observational in nature., Conclusions: Capsular contracture management remains an important topic, with limited high-level evidence for establishing clear evidence-based treatment guidelines. Although more evidence is required to assess the effects of capsulectomy, implant exchange, and plane change, these appear to be useful mechanisms for reducing recurrent capsular contracture. There is more evidence regarding the use of acellular dermal matrix, although this still requires long-term follow-up studies. New developments regarding textured implants limit the revision breast augmentation surgeon to smooth devices., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Competing Interests: Conflict of Interest None declared.

Background: Nipple-sparing mastectomy (NSM) has become widely available for breast cancer prophylaxis. There are limited data on its long-term oncologic safety. The objective of this study was to determine the incidence of breast cancer in patients who underwent prophylactic NSM., Methods: All patients undergoing prophylactic NSM at a single institution from 2006 through 2019 were retrospectively reviewed. Patient demographic factors, genetic predispositions, mastectomy specimen pathology, and oncologic occurrences at follow-up were recorded. Descriptive statistics were performed where necessary to classify demographic factors and oncologic characteristics., Results: A total of 871 prophylactic NSMs were performed on 641 patients, with median follow-up of 82.0 months (standard error 1.24). A total of 94.4% of patients ( n = 605) underwent bilateral NSMs, although only the prophylactic mastectomy was considered. The majority of mastectomy specimens (69.6%) had no identifiable pathology. A total of 38 specimens (4.4%) had cancer identified in mastectomy specimens, with ductal carcinoma in situ being the most common (92.1%; n = 35). Multifocal or multicentric disease was observed in seven cases (18.4%) and lymphovascular invasion was identified in two (5.3%). One patient (0.16%), who was a BRCA2 variant carrier, was found to have breast cancer 6.5 years after prophylactic mastectomy., Conclusions: Overall primary oncologic occurrence rates are very low in high-risk patients undergoing prophylactic NSM. In addition to reducing the risk of oncologic occurrence, prophylactic surgery itself may be therapeutic in a small proportion of patients. Continued surveillance for these patients remains important to assess at longer follow-up intervals., Clinical Question/level of Evidence: Risk, IV., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Background: Integrated plastic surgery residency positions are among the most difficult to obtain. We examine trends in the number of applicants, applications per applicant, and cost over the past five match cycles., Methods: In total, 2166 applicants to integrated plastic surgery programs were included. The American Association of Medical Colleges and Electronic Residency Application Service databases were examined to determine applicant trends for the years 2017 to 2021., Results: In 2017, there were 564 applicants for integrated plastic surgery residency positions, and in 2021, there were 416 (26% decrease). Across this same time period, the number of applications per applicant nearly doubled (97%) from 30 in 2017 to 59 in 2021, resulting in a 45% increase in the total number of applications. The largest increase in applications per applicant was seen between 2018 and 2019, a 70% increase. From 2017 to 2021, a 10% increase in the number of female applicants and a 43% decrease in the number of male applicants was observed. Cost of applications per applicant increased by 146%, from $514 in 2017 to $1265 in 2021. Total application costs in 2021 were $526,323, an 81% increase from 2017. The future value of these expenditures equals an economic burden of $801,855, assuming a 10-year term student loan at a conservative 4.3% interest rate., Conclusions: Despite substantial decreases in the number of applicants, the number of applications and resulting cost of applications have increased by large margins since 2017. This is representative of the increasingly competitive plastic surgery application process., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Introduction: With the advent of social media and the associated increase in connectivity between scientists and the lay public, the Altmetric Attention Score has been created as a way to measure these interactions between scholarly publications and media dissemination. Little is known, however, whether these types of media exchanges measured by Altmetrics may serve as a proxy for public engagement. As such, we have sought to determine whether or not an association exists between Altmetric scores and public engagement, as measured by article citation in a health policy document., Methods: The top 100 highest scoring articles in the medical and health sciences with respect to Altmetric Attention Scores were selected from each of 3 y (2014, 2015, and 2016). Each article was then matched to an article from the same year and journal with the highest Relative Citation Ratio (RCR) for comparison. Bivariate analysis compared article groups with respect to citation in a public policy document, open-access status, and funding status, as well as Altmetric and RCR scores. A multivariable model was then constructed to identify significant factors associated with citation in a public policy document. Finally, a contour plot was generated in order to estimate the interaction between Altmetric Scores and RCR and their comparative effects on the probability of inclusion in a health policy document., Results: Of the 600 articles included in the analysis, 286 (48%) had been cited by a public policy article. The only difference that existed between the cohorts was for funding status, with 55 articles (40%) in the RCR cohort having received funding compared to 81 (60%) in the Altmetric cohort (P = 0.011). On bivariate analysis, both Altmetric (P = 0.0018) and RCR (P < 0.0001) scores were independently predictive of policy citation. In a multivariable model, the interaction between Altmetric Scores and RCR with respect to policy inclusion was significant (OR = 1.22; 95% CI = 1.08-1.38) and a contour plot demonstrates that either high Altmetric score or RCR alone is sufficient to generate a high probability of policy inclusion., Conclusions: Scholarly article Altmetric Scores may serve as a novel means to explore public engagement in scientific research and health policy. In addition, journals that aim to impact public policy through article dissemination may benefit from engagement in social media avenues in addition to traditional citation pathways in order to encourage broader inclusion., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Surgical specialties represent the most competitive residency positions to obtain, and applicants for these spots may apply to increasingly more programs in an attempt to match. We describe trends in residency applications across all surgical specialties from 2017 to 2021 application cycles., Materials and Methods: This review of the 2017, 2018, 2019, 2020, and 2021 surgical residency application cycles used the American Association of Medical Colleges' Electronic Residency Application Service (ERAS) databases. Data from a total of 72,171 applicants to United States surgical residencies during the study's time period were included. The 2021 ERAS fee schedule was used to calculate the cost of applications., Results: The number of applicants across the study interval remains unchanged. Trends suggest more women and underrepresented minorities in medicine are applying to surgical residencies today compared to 5 years ago. The mean number of applications per applicant increased 32.0% from 39.3 in 2017 to 51.8 in 2021, resulting in an increased application fee cost of $329 per applicant. Mean total cost for application fees alone in 2021 were $1211 per applicant. In 2021, the cost of applying to surgical residency for all applicants was over $26 million, a nearly $8 million increase from 2017., Conclusions: There has been an increase in the number of applications per applicant in the past 5 residency application cycles. Increased applications create barriers and burdens for applicants, and residency program personnel. These rapid increases are unsustainable and require intervention, although a viable solution has yet to be elucidated., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.