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Weight a minute: investigating the impact of body mass index on early outcomes after breast augmentation
No full textBackground
The relationship between body mass index (BMI) and postoperative morbidity in breast augmentation remains poorly defined. This gap limits evidence-based decision-making amid rising BMI trends. Our study aims to establish a BMI-based risk threshold and quantify its impact on 30-day morbidity following aesthetic breast augmentation.
Methods
We retrospectively analyzed the American College of Surgeons National Quality Improvement Program database (2009–2023). Adult female patients undergoing elective primary breast augmentation for aesthetic purposes were included. BMI cut point determination employed cubic spline modeling followed by Youden Index optimization. Propensity score matching and multivariable logistic regression were utilized to evaluate the association between BMI and 30-day postoperative outcomes.
Results
Among 6,515 patients analyzed, we identified BMI ≥25.2 kg/m2 as a statistically derived risk threshold, with 21.0% (n=1,363) of patients exceeding this cut-point. Patients above this threshold demonstrated significantly higher baseline comorbidity burden, including hypertension (6.0% vs 2.3%, p < 0.001) and diabetes mellitus (2.2% vs 0.5%, p < 0.001). Overall 30-day morbidity was markedly elevated in the higher BMI cohort (4.3% vs 1.3%, p < 0.001), with corresponding increases in reoperation rates (1.9% vs 0.8%, p = 0.014) and unplanned readmissions (1.1% vs 0.2%, p < 0.001). Multivariable analysis confirmed BMI ≥ 25.2 kg/m2 as an independent predictor of adverse outcomes (adjusted OR 3.13, p < 0.001). Propensity score matching validated this association with similar effect magnitude (OR 3.35, p < 0.001).
Conclusion
This analysis establishes BMI ≥25.2 kg/m2 as a clinically actionable threshold associated with a more than threefold increase in perioperative complications following aesthetic breast augmentation. These findings provide an evidence-based foundation for BMI-stratified risk assessment and informed consent protocols in breast augmentation. Implementation of enhanced perioperative surveillance and risk mitigation strategies should be considered for patients exceeding this threshold to optimize surgical outcomes and patient safety
Heat, health and inequalities in the WHO European region – a scoping review with an intersectional lens
No full textBackground
Climate change exerts diverse impacts on human health, with heatwaves emerging as a substantial concern. Social and health inequalities play a decisive role in this. Older people, children, and people experiencing homelessness or with low socioeconomic status, among others, are particularly affected by the health effects of heat and heatwaves. There is little evidence on the burden of being affected by multiple determinants of inequalities in the context of heat events. We aimed to map the research evidence on inequalities in heat-related health outcomes and their determinants in the World Health Organization (WHO) European region, applying an intersectional lens. This means considering how interlocking systems of power and oppression interact to affect the health and wellbeing of people differentially based on their varying and diverse social positions and identities.
Methods
To this end, we undertook a scoping review of reviews. In 7/2023 and 8/2023, we systematically searched Pubmed and Epistemonikos and updated our searches in 9/2025. We mapped included studies based on methodology and determinants of inequalities considered in the analysis of heat impacts on health.
Results
We screened 968 unique records and ultimately included 28 reviews. Included reviews cover all parts of Europe. Age and sex/gender were the most frequently assessed determinants of inequalities in this body of evidence. Only one meta-analysis presented disaggregated data for subgroups. Intersectionality or related terms were only explicitly mentioned in four reviews, and no review applied intersectionality as a foundational paradigm.
Discussion
The findings suggest that age and sex/gender are more broadly assessed in the literature on heat-related health outcomes than other determinants. Whether authors assessed sex or gender is mostly not explicitly stated, impeding categorization as either a structural (gender) or intermediary (sex) determinant. Overall, intermediary determinants were more frequently assessed than structural determinants. Less frequently assessed determinants such as ability, income or education require further investigation in terms of their effects on health outcomes, as well as their amenability through generic or tailored measures. Intersectionality is only minimally reflected in the included literature. Future studies should employ mixed-methods approaches that seek to not only quantify heat-related health inequalities but also establish why they arise and whether and to what extent they are policy-amenable
Antipsychotic co-medication and treatment response to rTMS and iTBS in depression: data from clinical records from two independent clinical sites
No full textRationale: Transcranial magnetic stimulation (TMS) is a well-established, noninvasive method for modulating cortical activity and has demonstrated efficacy in the treatment of depression. This study investigated potential interaction effects between antipsychotic augmentation and TMS efficacy using clinical records from two independent sites. In addition, exploratory analyses examined the association between resting motor threshold (RMT) and treatment outcomes.
Methods: We analyzed naturalistic data from patients with depressive symptoms treated at the TMS outpatient departments in Augsburg (n = 53) and Regensburg (n = 120). Depressive symptom severity was assessed using the Beck Depression Inventory, Hamilton Rating Scale for Depression-17, and Major Depression Inventory at baseline, during treatment, and upon treatment completion. Patients were grouped according to whether or not they received antipsychotic augmentation. Group comparisons were conducted using Mann-Whitney U tests. For secondary analyses, scatter plots explored associations between baseline RMT and improvements in depressive symptoms, and correlation coefficients were calculated.
Results: At the Augsburg site, 2 weeks after treatment initiation, patients not receiving antipsychotic augmentation exhibited significantly greater improvement in depressive symptom severity. However, differences between groups were not significant at treatment initiation or upon completion. Further, RMT analysis at Augsburg indicated a numerical but nonsignificant correlation with treatment outcome. At the Regensburg site, no consistent interaction effects were observed, and RMT analyses revealed nonsignificant correlations.
Conclusions: Taken together, these findings suggest that TMS can remain effective in patients receiving concomitant antipsychotic augmentation alongside antidepressant and TMS treatment. Future research could usefully examine whether TMS remains effective in patients receiving different kinds of antipsychotic medication
Online knapsack with removal and recourse
No full textWe analyze the competitive ratio of the proportional online knapsack problem with removal and limited recourse. In contrast to the classical online knapsack problem, packed items can be removed and a limited number of removed items can be re-inserted to the knapsack. The variant with removal only was analyzed by Iwama and Taketomi (ICALP, 2002). We show that even a single use of recourse can improve the performance of an algorithm. We give lower bounds for a constant number of k ≥ 1 uses of recourse in total, matching upper bounds for 1 ≤ k ≤ 3, and a general upper bound for any value of k. For a variant where a constant number of k ≥ 1 uses of recourse can be used per step, we give tight bounds for all k ≥ 1. We further look at a scenario where an algorithm is informed when the instance ends and give improved upper bounds in both variants for this case
Impact of long-acting injectable versus oral antipsychotic treatment on all-cause discontinuation risk in people with early phase schizophrenia and comorbid substance use disorder: a secondary analysis of the EULAST randomized trial
No full textIndividuals with schizophrenia and comorbid substance use disorder (SUD) often experience poor treatment adherence, leading to worse clinical outcomes. However, high-quality evidence from randomized trials on the preferred mode of antipsychotic treatment in this population remains limited.
The aim was to examine whether long-acting injectable (LAI) antipsychotic treatment reduces the risk of all-cause discontinuation (ACD) compared with oral antipsychotics in individuals with early phase schizophrenia and comorbid SUD.
This study was a secondary analysis of the European Long-Acting Antipsychotics in Schizophrenia Trial (EULAST), a multisite, randomized, open-label trial conducted across multiple European healthcare settings. A total of 471 individuals with early phase schizophrenia were included in this secondary analysis, stratified by presence (n = 143) or absence (n = 328) of comorbid SUD. The observation period lasted 18 months. Participants were randomly assigned to second-generation LAI or oral second-generation antipsychotic treatment. The primary outcome was ACD, an indirect measure of treatment efficacy, defined as discontinuation of the initially assigned treatment for any reason. Hazard ratios (HRs) were estimated using Cox proportional hazards regression models, adjusted for relevant covariates.
Among 143 individuals with schizophrenia and SUD, LAI treatment was associated with a 36% lower risk of ACD compared with oral antipsychotics (adjusted HR = 0.641; 95% CI, 0.438–0.938; P = 0.022). Kaplan–Meier curves showed longer median time to ACD for LAI treatment (158 days) versus oral antipsychotics (97 days). By contrast, among the 328 individuals without SUD, LAI treatment did not significantly reduce ACD risk (P = 0.282). Crude HRs were also assessed, replicating the adjusted hazard findings.
LAI antipsychotics significantly delayed treatment discontinuation compared with oral antipsychotics in participants with early phase schizophrenia and comorbid SUD but not in those without SUD. While these findings provide robust evidence supporting the use of LAIs in people with schizophrenia and comorbid SUD, future studies are needed to more precisely quantify the potential clinical benefits and tolerability of LAIs in this high-risk population. EULAST was registered at ClinicalTrials.gov (NCT02146547)
GPU-accelerated multi-phase, multi-resolution SPH method with ray tracing for laser powder bed fusion
No full textThoracic aortic diseases: identification of diagnostic biomarkers using proteomic analysis
No full textAI in soil moisture remote sensing
No full textSoil moisture, a pivotal component of the hydrological cycle, exerts a profound influence on land surface exchange processes, but its spatial variability poses challenges for large-scale field observations, increasing reliance on satellite-based retrievals. However, spaceborne estimates face limitations due to model uncertainties and sensor-related constraints. Recent advances in artificial intelligence (AI) offer promising alternatives to traditional methods by enabling data-driven estimation of soil moisture without strong physical assumptions. Thus, a critical review of emerging AI-based soil moisture retrieval methods with respect to their advantages and disadvantages is vital to ensure the best utilization of such tools for soil moisture sensing, especially with novel sensors and data constantly being generated.
In this comprehensive review, we furnish the first structured overview of AI methods and their applications in soil moisture retrievals from remote sensing. AI is able to enhance soil moisture retrieval by learning complex (highly nonlinear) relationships between satellite observations and ground reference data, to support time series reconstruction by filling gaps in data sets, to estimate subsurface soil moisture conditions from surface signals and auxiliary inputs, to enable spatial scaling by translating soil moisture estimates across different resolutions using multi-resolution data, to predict temporal dynamics as a soil moisture forecast, and to contribute to broader assessments of the water cycle and beyond by integrating soil moisture with further hydrological variables. Future directions for each method are also identified to address the scientific challenges of soil moisture retrieval and help focus the research community on the key open questions in the new era of rapidly expanding AI applications
Surrogate decision-making for people with disorders of consciousness: considering the control-preferences of informal caregivers before implementing multimodal testing
No full textHistorically, individuals with disorders of consciousness (DoC) have often been subject to prognostic pessimism and therapeutic nihilism, leading to clinical decisions that became self-fulfilling prophecies. Recent advances in neurodiagnostics -particularly multimodal assessments of consciousness- offer new opportunities to reduce diagnostic ambiguity and to potentially improve rehabilitation outcomes. These developments have the potential to support more effective care planning. Given their central role in surrogate decision-making, informal caregivers are increasingly recognised as key participants in this evolving process. Yet, little is known about the distribution of their preferred roles in decision-making, especially in light of emerging, technology-informed models of diagnosis. Two research questions guided a multicenter study within the PerBrain project: (1) To what extent do informal caregivers differ in their preferences regarding control over decision-making and (2) does a majority of informal caregivers prefer a collaborative model over other forms of decision-making?
A cross-sectional survey using a modified version of the Control Preferences Scale (CPS) -which measures a person’s preferred level of control in medical decision-making- was conducted with informal caregivers of persons with DoC in three medical units in Italy and Germany between March 2021 and June 2023. The participating medical centers were part of the PerBrain project, which investigates multimodal consciousness assessment. Caregivers were recruited consecutively, and data were analysed using descriptive statistics, chi-square tests, and t-tests to assess cross-national differences.
Seventy caregivers completed the survey. Preferences regarding decision-making roles varied: 34 (48.6%) favoured a passive role, 26 (37.1%) preferred a shared or collaborative role, and 10 (14.3%) expressed a preference for an active role. When ranked across all six possible positions (from active to passive options), the collaborative approach was most frequently among the top three choices: 26 (37.1%) ranked it first, 20 (28.6%) second, and 19 (27.1%) third. Statistically significant cross-country differences emerged (χ²(2) = 7.408, p = .025), with German caregivers demonstrating a stronger preference for active participation than their Italian counterparts.
Healthcare professionals should be attentive to the diversity of decision-making preferences expressed by family caregivers of patients with DoC shortly after the transition from intensive to rehabilitation care. Although SDM is widely regarded as the normative standard in clinical practice, our findings reveal a discrepancy between this standard and the actual preferences of informal caregivers in two similar care settings in two different European countries. The findings add to the literature on uncertainty in surrogate health-care decision-making for people with DoC and raise questions of whether SDM should even be implemented, when it is not the preferred approach of (future) surrogate decision-makers