Religion and drinking: Differences between two campuses.

Levels of religiousness vary by geographic location, but studies of the relationship between religiousness and alcohol are often limited to one region. For our participants (N = 1124; 57.5% female), location was significantly associated with both religiousness and alcohol use. Active religiousness was associated with drinking outcomes. The indirect effects of location on drinks per week through active religiousness were significant. At Campus S, subjective religiousness was associated with more drinks per week, whereas active religiousness was associated with fewer drinks per week. Findings indicate active religiousness is especially relevant when exploring drinking, and location is important when exploring religiousness and alcohol use.

Topical α-Gal Nanoparticles Enhance Wound Healing in Radiated Skin.

PURPOSE: Surgery within radiated tissue is associated with increased complication rates. It is hypothesized that impaired wound healing may result from aberrant inflammatory responses that occur in previously radiated tissues. Previous work has demonstrated that the topical application of naturally occurring antigen α-gal (Galα1-3Galß1-(3)4GlcNAc-R) nanoparticles (AGNs) within wounds accelerates macrophage recruitment and subsequent healing in both normal and diabetic wounds. Herein, we hypothesize that application of this antigen would similarly enhance wound healing in irradiated tissues. METHODS: To simulate human physiology, α-1,3-galactosyltransferase knockout (KO) mice were exposed to the antigen to produce anti-α-gal antibodies (anti-Gal). Ten days prior to wounding, the dorsal skin was irradiated with 1 session of 40 Gy. Bilateral dorsal 6-mm splinted full-thickness wounds were created within the radiated skin and treated with 50 µL of AGNs (50 mg/mL) immediately after wounding and again on postoperative day 1. A control KO group underwent similar irradiation and wounding protocols but was treated with phosphate-buffered saline (PBS) vehicle. Wild-type (WT) mice, which do not produce anti-Gal, went through the same irradiation and wounding. RESULTS: Histologic analysis demonstrated enhanced epithelial migration in the radiated/AGN-treated KO wounds, which was significantly elevated in comparison to radiated/PBS-treated KO wounds beginning by day 15 and continuing until the end of the study (p < 0.01). In WT mice, treatment with AGNs showed no effect on epithelial migration. CONCLUSIONS: Topical application of AGNs onto irradiated wounds significantly ameliorates the delayed wound healing classically seen in radiated skin and results in faster wound closure with only transient application.

Examining Cross-Country and Sex Differences on a Comprehensive Assessment of Protective Behavioral Strategies for Alcohol.

OBJECTIVE: Use of protective behavioral strategies (PBS) has been associated with reduced alcohol-related harms among college students. However, most of this research has been conducted among U.S. samples. The present study examines the use of PBS in an international context. METHOD: Participants (n = 1512) were recruited from universities in Spain (n = 298), Argentina (n = 439), and the U.S. (n = 775) to determine if there are differences in PBS use across countries and/or across sex. Further, we examined whether the association between PBS use and negative consequences differ across country and sex. RESULTS: We found that U.S. students reported the most frequent use of Stopping/Limiting Drinking PBS (M = 3.32, SD = 1.23) compared to Argentine (M = 2.89, SD = 0.97) and Spanish (M = 2.83, SD = 0.94) students. Argentine students reported the least frequent use of Serious Harm Reduction PBS (M = 4.57, SD = 0.99) compared to U.S. (M = 5.09, SD = 0.98) and Spanish (M = 5.03, SD = 0.78) students. Elastic net regression analyses stratified by country indicated most individual PBS predicted decreased negative alcohol-related consequences, although two items consistently predicted increased consequences and we observed some variability in the most predictive specific strategies in each country. Across each subscale and for 32 of 40 individual items, females reported more frequent use of PBS than males (ps<.05). CONCLUSIONS: From the perspective of developing and adapting interventions, we recommend the cultural context in which PBS are used is taken into account. Although future work is needed to delineate cultural factors underlying the country-level differences we found, these findings have implications for the most promising PBS to target for college students in each country.

Alcohol and marijuana protective behavioral strategies mediate the relationship between substance use identity and use-related outcomes: A multi-sample examination.

Substance use identity has been consistently associated with problematic substance use. Limited attention has considered mechanisms of this association. This research examined whether greater identification as a drinker or marijuana user would be associated with the use of fewer alcohol/marijuana protective behavioral strategies (PBS; e.g., avoiding drinking games/avoiding using marijuana in public places). Further, PBS have been associated with lower levels of negative alcohol/marijuana-related outcomes (i.e., frequency, quantity, consequences). In the current multi-sample study, PBS were examined as a mediator of the relationship between drinking/marijuana identity and alcohol/marijuana-related outcomes across three studies. Study 1 was an intervention study with heavy drinking college students (N = 605), Study 2 was a multisite study of marijuana outcomes among college students (N = 2,077), and Study 3 was a study of substance use in a community sample (n = 369alcohol; n = 146marijuana). Cross-sectional and/or longitudinal data were collected across studies. Substance use identity, PBS, and use-related outcomes were measured across the three studies. Indirect effects were evaluated by Monte Carlo confidence intervals. Manner of Drinking PBS were found to be the only statistically significant mediator of the relationship between drinking identity and alcohol-related outcomes (i.e., quantity and consequences) cross-sectionally. These significant cross-sectional mediation effects for alcohol were replicated in one of three longitudinal models. Marijuana PBS were also found to mediate the relationship between marijuana identity and all marijuana-related outcomes examined in the current study. Study findings may help to inform the development of identity-based and PBS-based interventions that aim to reduce negative alcohol/marijuana-related outcomes.

Surgical Treatment for Capsular Contracture: A New Paradigm and Algorithm.

BACKGROUND: Capsular contracture following breast augmentation is prone to recurrence with conventional surgical therapy. Adding acellular dermal matrix improves results but significantly increases operating time and cost. This study tested a new treatment algorithm that uses acellular dermal matrix selectively to optimize success rates while minimizing its drawbacks. METHODS: All patients surgically treated by the authors for Baker grade III/IV capsular contracture between 2007 and 2018 were included in this retrospective cohort study. Data were collected on patient, breast augmentation, capsular contracture, and surgical treatment characteristics, in addition to follow-up findings. Treatment success was defined as Baker grade II or better. RESULTS: One hundred eighty patients underwent 217 surgical treatments for capsular contracture. Conventional treatment was used in 185 cases and acellular dermal matrix in 32. Twenty-six patients were treated for a second occurrence and four were treated for a third. The average follow-up was 2.4 years. Conventional treatment was successful in 72.5 percent of first occurrences, 62.5 percent of second occurrences, and 50.0 percent of third occurrences. Acellular dermal matrix was successful in 96.9 percent of cases. The odds of failure were increased by bilateral capsular contracture (3.9 times) and previous treatment failure (3.5 times). When acellular dermal matrix was used selectively for bilateral capsular contracture or in unilateral cases with a previous treatment failure, the overall treatment success rate improved to 85.6 percent compared with 64.2 percent when this algorithm was not followed (p < 0.001). CONCLUSION: This study demonstrates that selective acellular dermal matrix use can increase success rate to over 85 percent in the overall treatment of capsular contracture, and to nearly 100 percent in individual cases.

Muscle Flap Closure following Complex Spine Surgery: A Decade of Experience.

BACKGROUND: Advances in surgical technology and adjuvant therapies along with an aging and increasingly morbid U.S. population have led to an increase in complex spine surgery. With this increase comes an elevated risk of complications, including those related to the surgical wound, with some studies demonstrating wound complication incidences approaching 45 percent. The authors hypothesize that immediate muscle flap closure improves outcomes in high-risk patients. METHODS: Three hundred one consecutive index cases of spinal wound closure using local muscle flaps performed by the senior author at a single institution between 2006 and 2018 were reviewed. The primary outcome was major wound complication (reoperation and/or readmission because of surgical-site infection, late infection, dehiscence, seroma, or hematoma). Logistic regression analysis was performed to identify predictors of this endpoint. RESULTS: Major wound complications occurred in 6.6 percent of patients (reoperation, 3.6 percent; readmission, 3.0 percent), with a 6.0 percent infection rate and five cases requiring instrumentation removal because of infection. Risk factors identified included radiotherapy (OR, 5.9; p = 0.004), age 65 years or older (OR, 2.8; p = 0.046), and prior spine surgery (OR, 4.3; p = 0.027). The incidence of major wound complication increased dramatically with each additional risk factor. Mean drain dwell duration was 21.1 ± 10.0 days and not associated with major wound complications, including infection (OR, 1.04; p = 0.112). CONCLUSIONS: Immediate local muscle flap closure following complex spine surgery on high-risk patients is associated with an acceptable rate of wound complications and, as these data demonstrate, is safe and effective. Consideration should be given to immediate muscle flap closure in appropriately selected patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Stressful life events and gambling: The roles of coping and impulsivity among college students.

Substantial research has found a robust relationship between stressful life events and increased negative health outcomes and a greater predisposition to various forms of substance use and gambling behavior; however, less is known about the individual factors that explain this relationship. The present study examines the moderating factors of gambling to cope and individual impulsivity factors (e.g., perseverance, premeditation, and negative urgency) on the relationship between stressful life events over the past year and gambling problems among a sample of college students. Participants included 653 total students (48.57% female; M = 26.31 years old; SD = 8.35 years) enrolled in universities across the United States who scored three or higher on the South Oaks Gambling Screen, an indicator of risk for problematic gambling. We found a positive relationship between stressful life events and gambling problems. Gambling to cope moderated the link between stressful life events and gambling problems such that for those higher in gambling to cope, stressful life events had little impact on gambling problems while those at lower to moderate levels of gambling to cope saw a positive relationship between stressful life events and gambling problems. Moreover, we found two significant three-way interactions between stressful life events, gambling to cope, and impulsivity factors of perseverance and premeditation in predicting problems. These findings suggest that prevention and/or treatment strategies should consider how gambling to cope and impulsivity factors in conjunction with an individual's report of stressful life events relate to problematic gambling and associated consequences.

The Price of Aesthetics After Nipple-Sparring Mastectomy: A Cost-Minimization Analysis of Skin Banking With Deep Inferior Epigastric Perforator Flap.

BACKGROUND: Skin necrosis after nipple-sparing mastectomy (NSM) and deep inferior epigastric perforator (DIEP) breast reconstruction impacts cosmesis and patient satisfaction. Skin grafting might mitigate these sequelae, but oftentimes creates a color and texture mismatch with native breast skin. In contrast, abdominal skin on the DIEP flap is an excellent match and can be banked. The purposes of this study are to review our experience with skin banking of DIEP flaps and determine the cost-benefit of skin banking compared with other reconstructive options. METHODS: This was a retrospective review study conducted from 2011 to 2014 to examine patients undergoing staged DIEP reconstruction immediately after NSM. Medicare reimbursement costs using Current Procedural Terminology codes, and provider and facilities fees for conventional reconstructions options versus skin banking were obtained with subsequent cost-minimization and sensitivity analyses. RESULTS: The proportion of patients who developed mastectomy skin necrosis was 12.1%, and that of those who had a positive retroareolar biopsy corresponding to an average surface area of 58.3 cm was 3.0%. Average per patient cost of skin banking was $1224, $844 more than split-thickness skin graft (STSG) without Integra, $420 more than STSG with Integra, and $839.01 more than full-thickness skin graft. Sensitivity analysis demonstrates that skin banking was less than managing mastectomy skin loss with STSG and Integra when the incidence of necrosis >10 cm exceeded 25.3%. CONCLUSIONS: Skin banking maximizes aesthetic outcomes after skin loss from either positive margins or skin flap necrosis. Use of this technique should occur especially in select patients at increased risk of mastectomy skin flap/nipple-areola complex (NAC) necrosis and/or suspicion for occult NAC carcinoma. Furthermore, among reconstructive plastic surgeons whose rate of mastectomy flap/NAC necrosis >10 cm exceeds 25.3%, sensitive analysis favors undergoing a staged reconstruction after NSM.

Cognitive factors and addiction.

The present paper provides a brief review of cognitive factors related to addiction. Five representative cognitive constructs were selected from the current literature. These include the distinction between implicit and explicit cognitions; metacognitions; expectancies; motives; and social norms. For each of these a general overview is provided along with specific findings from selected recent studies. The intention is to provide the reader with a succinct but reasonable view of how each construct is currently studied in relation to the use of alcohol and other substances and to become aware of some of the strengths and limitations corresponding to the study of these constructs.

The Relationship Between Risk Factors and Alcohol and Marijuana Use Outcomes Among Concurrent Users: A Comprehensive Examination of Protective Behavioral Strategies.

OBJECTIVE: Among college samples, both alcohol and marijuana protective behavioral strategies (PBS) have been shown to mediate the effects of known risk factors (i.e., sex, age at substance use onset, college substance use beliefs, substance use motives, and impulsivity-like traits) on alcohol and marijuana outcomes. However, it is unknown whether PBS use would operate similarly for both substances among concurrent users. The present study examined which risk factors relate to alcohol/marijuana outcomes via alcohol/marijuana PBS use among a large group of concurrent alcohol/marijuana users. METHOD: Participants were college students who consumed both alcohol and marijuana at least 1 day in the previous month (n = 2,034; 69.08% female). RESULTS: Across both substances, PBS use significantly mediated the effects of sex (women reported higher PBS use), age at first use (having an older age at first use was associated with more PBS use), and college substance use beliefs (higher beliefs was associated with lower PBS use). Unique to alcohol outcomes, alcohol PBS use significantly mediated the effects of negative urgency, social motives, and enhancement motives (all associated with lower PBS use). Unique to marijuana outcomes, marijuana PBS use mediated the effects of coping, expansion (both associated with lower PBS use), and conformity motives (associated with more PBS use). CONCLUSIONS: Our results suggest that PBS for both alcohol and marijuana can help explain why some risk factors are associated with alcohol/marijuana outcomes. Taken together, PBS use seems to be an important intervention target for alcohol/marijuana concurrent users.

A Pilot Study of the Effect of an Educational Web Application on Asthma Control and Medication Adherence.

BACKGROUND: An Asthma Adherence Pathway (AAP) application, which is an Internet application that combines patient and clinician education strategies to promote adherence to asthma therapy, has been developed. OBJECTIVE: The primary objective of this pilot study was to evaluate the effectiveness of the AAP application with electronic adherence monitors on asthma control. Secondary objectives evaluated the effect of AAP and monitors on medication adherence, asthma symptoms, quality of life, psychosocial factors, and barriers to treatment. METHODS: Adult patients with asthma were randomly assigned either to intervention (n = 19) or control (n = 20) groups in this 3-month prospective study, and they completed the Asthma Control Questionnaire (ACQ). Intervention patients completed the AAP software and were given barrier-specific motivational interviewing adherence strategies and a SmartTrack device to monitor mometasone furoate/formoterol (MF/F) use. Clinicians in the interventional group received adherence management training. Interventional patients were given feedback regarding adherence findings at each visit. Treatment adherence was determined by the mean of 4 measures of doses taken over 3 months. Control patients were not monitored for MF/F adherence. RESULTS: The mean MF/F adherence in the intervention group was 81%. The intervention and control groups did not differ on the mean baseline ACQ. Thirteen intervention patients achieved the minimal important difference (defined as an improvement ≥0.5 units on the ACQ) compared with 6 control patients (P = .016). The intervention group showed greater improvement in the ACQ (0.75) than the control group (0.19) representing a moderate-to-large effect size of d = 0.638. CONCLUSIONS: The AAP was effective in promoting adherence and helped to improve asthma control. These findings provide preliminary validation of the AAP model.

The importance of indocyanine green near-infrared fluorescence angiography in perfusion assessment in vascularized omentum lymphatic transplant.

BACKGROUND AND OBJECTIVE: Vascularized omentum lymphatic transplant (VOLT) for treatment of lymphedema has become popular because of no risk of iatrogenic lymphedema and abundant lymphatic tissue. However, perfusion to the omentum can be difficult to assess clinically. The purpose of this study was to clarify the incidence and degree of ischemia in the omentum. METHODS: A retrospective study was conducted to review indocyanine green perfusion findings on patients undergoing VOLT. Patients were placed into 4 categories based on the percentage surface area of omentum that was ischemic: normal, less than 25%, between 25% and 50%, and greater than 50% ischemic. Spearman correlation was performed to determine whether an association exists between prior abdominal surgery and the presence of ischemia. RESULTS: Twenty-six patients underwent VOLT for treatment of extremity lymphedema. Twelve (46.2%) patients had normal perfusion, 8 patients (30.8%) had less than 25% ischemia, and 6 patients (23.1%) had 25% to 50% ischemia. Prior abdominal surgery was not significantly associated with the presence of ischemia. CONCLUSIONS: Normal flap perfusion is a requisite for successful VOLT harvest. However, over half the patients had some degree of abnormal perfusion irrespective of prior abdominal surgery. Indocyanine green angiography is an important tool in ensuring a healthy lymphatic reconstruction.

Intraoperative Comparison of Anatomical versus Round Implants in Breast Augmentation: A Randomized Controlled Trial.

BACKGROUND: The purpose of this randomized controlled trial was to determine whether anatomical implants are aesthetically superior to round implants in breast augmentation. METHODS: Seventy-five patients undergoing primary breast augmentation had a round silicone implant of optimal volume, projection, and diameter placed in one breast and an anatomical silicone device of similar volume and optimal shape placed in the other. After intraoperative photographs were taken, the anatomical device was replaced by a round implant to complete the procedure. A survey designed to measure breast aesthetics was administered to 10 plastic surgeon and 10 lay reviewers for blind evaluation of the 75 cases. RESULTS: No observable difference in breast aesthetics between anatomical and round implants was reported by plastic surgeons in 43.6 percent or by lay individuals in 29.2 percent of cases. When a difference was perceived, neither plastic surgeons nor lay individuals preferred the anatomical side more often than the round side. Plastic surgeons judged the anatomical side superior in 51.1 percent of cases and the round side superior in 48.9 percent of cases (p = 0.496). Lay individuals judged the anatomical side superior in 46.7 percent of cases and the round side superior in 53.3 percent (p = 0.140). Plastic surgeons identified implant shape correctly in only 26.5 percent of cases. CONCLUSIONS: This study provides high-level evidence supporting no aesthetic superiority of anatomical over round implants. Given that anatomical implants have important and unique disadvantages, a lack of proven aesthetic superiority argues against their continued use in breast augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.