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Social media has become a dominant educational resource for breast reconstruction patients. Rather than passively consuming information, patients interact directly with other users and healthcare professionals. While online information for breast reconstruction has been analyzed previously, a robust analysis of patient questions on online forums has not been conducted. In this study, the authors used a machine learning approach to analyze and categorize online patient questions regarding breast reconstruction. Realself.com was accessed and questions pertaining to breast reconstruction were extracted. Data collected included the date of question, poster's location, question header, question text, and available tags. Questions were analyzed and categorized by two independent reviewers. 522 preoperative questions were analyzed. Geographic analysis is displayed in Figure 1. Questions were often asked in the pre-mastectomy period (38.3%); however, patients with tissue expanders currently in place made up 28.5%. Questions were often related to reconstructive methods (23.2%), implant selection (19.5%), and tissue expander concerns (16.7%). Questions asked in the post-lumpectomy period were significantly more likely to be related to insurance/cost and reconstructive candidacy (p < 0.01). The "Top 6″ patient questions were determined by machine learning analysis, and the most common of which was "Can I get good results going direct to implant after mastectomy?" Analysis of online questions provides valuable insights and may help inform our educational approach toward our breast reconstruction patients. Our findings suggest that questions are common throughout the reconstructive process and do not end after the initial consultation. Patients most often want more information on the reconstructive options, implant selection, and the tissue expansion process. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ydbio.2009.09.026 Byline: Lin Jin (a), Lingyun Long (a), Michael A. Green (b), Brett T. Spear (a)(b) Keywords: Albumin; Alpha-fetoprotein; Transcription; Liver; Mammalian development; Enhancers; Gene targeting; Chromatin immunoprecipitation; RNA Polymerase II Abstract: The four members of the albumin gene family encode the serum transport proteins albumin, [alpha]-fetoprotein, [alpha]-albumin, and vitamin D-binding protein. These genes are transcribed primarily in the liver with each having a different pattern of developmental expression. The tight linkage of these genes, particularly that of albumin, [alpha]-fetoprotein and [alpha]-albumin, and their liver-specific expression, has led to the suggestion that these genes share common regulatory elements. To directly examine whether the [alpha]-fetoprotein enhancer region could regulate the albumin gene family, expression of these genes was monitored in mice in which this region was deleted by homologous recombination. Our data indicate that this enhancer region is required for [alpha]-fetoprotein and albumin activation early in liver development and [alpha]-fetoprotein reactivation during liver regeneration, but that albumin, [alpha]-albumin, and vitamin D-binding protein expression later in hepatic development is not affected by the absence of these enhancers. We also demonstrate that RNA polymerase II loading on the [alpha]-fetoprotein and albumin promoters is reduced in the absence of this enhancer region, indicating a direct role for these enhancers in the assembly of the RNA Polymerase II complex during liver development. Author Affiliation: (a) Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, Lexington, KY 40536-0298, USA (b) Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536-0298, USA Article History: Received 29 July 2009; Revised 15 September 2009; Accepted 15 September 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2009.06.004 Byline: Brett T. Hagman (a), Alexis N. Kuerbis (a), Jon Morgenstern (b), Donald A. Bux (a), Jeffrey T. Parsons (c), Bram E. Heidinger (a) Keywords: Item Response Theory; Reliability; Validity; Alcohol use; Drug use Abstract: The Short Inventory of Problems-Alcohol and Drugs (SIP-AD) is a 15-item measure that assesses concurrently negative consequences associated with alcohol and illicit drug use. Current psychometric evaluation has been limited to classical test theory (CTT) statistics, and it has not been validated among non-treatment seeking men-who-have-sex-with-men (MSM). Methods from Item Response Theory (IRT) can improve upon CTT by providing an in-depth analysis of how each item performs across the underlying latent trait that it is purported to measure. The present study examined the psychometric properties of the SIP-AD using methods from both IRT and CTT among a non-treatment seeking MSM sample (N =469). Participants were recruited from the New York City area and were asked to participate in a series of studies examining club drug use. Results indicated that five items on the SIP-AD demonstrated poor item misfit or significant differential item functioning (DIF) across race/ethnicity and HIV status. These five items were dropped and two-parameter IRT analyses were conducted on the remaining 10 items, which indicated a restricted range of item location parameters (-.15 to -.99) plotted at the lower end of the latent negative consequences severity continuum, and reasonably high discrimination parameters (1.30 to 2.22). Additional CTT statistics were compared between the original 15-item SIP-AD and the refined 10-item SIP-AD and suggest that the differences were negligible with the refined 10-item SIP-AD indicating a high degree of reliability and validity. Findings suggest the SIP-AD can be shortened to 10 items and appears to be a non-biased reliable and valid measure among non-treatment seeking MSM. Author Affiliation: (a) Research Foundation for Mental Hygiene, Columbia Addiction Services and Psychotherapy Interventions Research, 1775 Broadway, Suite 1404, New York, NY 10019, United States (b) Research Foundation for Mental Hygiene and Columbia University College of Physicians and Surgeons, Harkness Pavilion, Rm 236, 180 Ft. Washington Ave., New York, NY 10032, United States (c) Hunter College and the Graduate Center of the City University of New York, Center for HIV/AIDS Educational Studies and Training, 695 Park Avenue, HN611C, New York, NY 10065, United States Article Note: (footnote) [star] Parts of this manuscript were presented at the Research Society on Alcoholism's (RSA) annual 2008 conference hosted in Washington, D.C. and at the Association for Behavioral-Cognitive Therapy's (ABCT) 2008 annual conference hosted in Orlando, FL. The study was supported by grant DA015971, from the National Institute on Drug Abuse awarded to Jon Morgenstern.

In recent years, indocyanine green angiography (ICG-A) has been used increasingly to assist tissue perfusion assessments during plastic and reconstructive surgery procedures, but no guidelines exist regarding its use. We sought to identify areas of consensus and non-consensus among international experts on the use of ICG-A for tissue-perfusion assessments during plastic and reconstructive surgery. A two-round, online Delphi survey was conducted of 22 international experts from four continents asking them to vote on 79 statements divided into five modules: module 1 = patient preparation and contraindications (n = 11 statements); module 2 = ICG administration and camera settings (n = 17); module 3 = other factors impacting perfusion assessments (n = 10); module 4 = specific indications, including trauma debridement (n = 9), mastectomy skin flaps (n = 6), and free flap reconstruction (n = 8); and module 5 = general advantages and disadvantages, training, insurance coverage issues, and future directions (n = 18). Consensus was defined as ≥70% inter-voter agreement. Consensus was reached on 73/79 statements, including the overall value, advantages, and limitations of ICG-A in numerous surgical settings; also, on the dose (0.05 mg/kg) and timing of ICG administration (∼20–60 seconds preassessment) and best camera angle (61-90o) and target-to-tissue distance (20–30 cm). However, consensus also was reached that camera angle and distance can vary, depending on the make of camera, and that further research is necessary to technically optimize this imaging tool. The experts also agreed that ambient light, patient body temperature, and vasopressor use impact perfusion assessments. ICG-A aids perfusion assessments during plastic and reconstructive surgery and should no longer be considered experimental. It has become an important surgical tool. [ABSTRACT FROM AUTHOR]

• COVID-19-related stressors have impacted the population. • CBT strategies used with clinical disorders can assist in public health prevention. • Indicated prevention is used to prevent serious clinical problems post-disaster. • We present heuristics and intervention strategies to support indicated prevention. The COVID-19 pandemic has universally threatened the building blocks of mental health, well-being, and quality of life, namely, expectations of safety, connectedness, hope, and individual and societal efficacy. Consequently, unprecedently large numbers of individuals are significantly stressed and many are at risk for relapse of mental health problems, exacerbations of existing mental and behavioral health problems, and new onset clinical problems. Because of the scope of the problem, a population-based public health perspective is needed, which in the context of disasters has well-established theories and prevention approaches. Public health approaches to disasters and pandemics focus on preventing subclinical problems from becoming clinical disorders, in comparison to clinical care approaches that focus on treating established disorders. Fortunately, specialty care clinicians who typically think about assessing and treating established disorders have the training and clinical competencies to deliver prevention-focused interventions. This paper is designed to help specialty care clinicians who use cognitive-behavioral strategies to understand the biopsychosocial impacts and resource deficits associated with COVID-19-related stressors and the public health perspective to address them. We also provide ways clinicians can help people who are suffering from significant stress and resource deficits bounce back and regain functioning. We describe psychological first aid, stress management, repeated ecological assessment, writing about stressors, problem-solving, and behavioral activation approaches to assist individuals at risk for enduring stress-linked problems. [ABSTRACT FROM AUTHOR]