First year of COVID-19 in Brazil: Factors associated with the spread of COVID-19 in small and large cities.

AIM: To test the association between sociodemographic and social characteristics with COVID-19 cases and deaths in small and large Brazilian cities. METHODS: This ecological study included COVID-19 data available in State Health Secretaries (managed by brasil.io API) and three national databases (IBGE, DATASUS and Embrapa). Temporal spread of COVID-19 in Brazil during the first year considered as outcome: a) days until 1st case in each city since 1st in the country; b) days until 1,000 cases/100,000 inhabitants since 1st case in each city; c) days until 1st death until 50 deaths/100,000 inhabitants. Covariates included geographic region, city social and environmental characteristics, housing conditions, job characteristics, socioeconomic and inequalities characteristics, and health services and coverage. The analysis were stratified by city size into small (<100,000 inhabitants) and large cities (≥100,00 inhabitants). Multiple linear regressions were performed to test associations of all covariates to adjust to potential confounders. RESULTS: In small cities, the first cases were reported after 82.2 days and 1,000 cases/100,000 were reported after 117.8 days, whereas in large cities these milestones were reported after 32.1 and 127.7 days, respectively. For first death, small and large cities took 121.6 and 36.0 days, respectively. However, small cities were associated with more vulnerability factors to first case arrival in 1,000 cases/100,000 inhabitants, first death and 50 deaths/100,000 inhabitants. North and Northeast regions positively associated with faster COVID-19 incidence, whereas South and Southeast were least. CONCLUSION: Social and built environment characteristics and inequalities were associated with COVID-19 cases spread and mortality incidence in Brazilian cities.

Quantifying Disparities in Air Pollution Exposures across the United States Using Home and Work Addresses.

While human mobility plays a crucial role in determining ambient air pollution exposures and health risks, research to date has assessed risks on the basis of almost solely residential location. Here, we leveraged a database of ∼128-144 million workers in the United States and published ambient PM2.5 data between 2011 and 2018 to explore how incorporating information on both workplace and residential location changes our understanding of disparities in air pollution exposure. In general, we observed higher workplace exposures relative to home exposures, as well as increased exposures for nonwhite and less educated workers relative to the national average. Workplace exposure disparities were higher among racial and ethnic groups and job types than by income, education, age, and sex. Not considering workplace exposures can lead to systematic underestimations in disparities in exposure among these subpopulations. We also quantified the error in assigning workers home instead of a weighted home-and-work exposure. We observed that biases in associations between PM2.5 and health impacts by using home instead of home-and-work exposure were the highest among urban, younger populations.

Revisiting the outcome of adult wild-type Htt inactivation in the context of HTT-lowering strategies for Huntington's disease.

Huntingtin-lowering strategies are central to therapeutic approaches for Huntington's disease. Recent studies reported the induction of age- and cell type-specific phenotypes by conditional huntingtin knockout, but these experimental conditions did not precisely mimic huntingtin-lowering or gene-editing conditions in terms of the cells targeted and brain distribution, and no transcriptional profiles were provided. Here, we used the adeno-associated delivery system commonly used in CNS gene therapy programmes and the self-inactivating KamiCas9 gene-editing system to investigate the long-term consequences of wild-type mouse huntingtin inactivation in adult neurons and, thus, the feasibility and safety of huntingtin inactivation in these cells. Behavioural and neuropathological analyses and single-nuclei RNA sequencing indicated that huntingtin editing in 77% of striatal neurons and 16% of cortical projecting neurons in adult mice induced no behavioural deficits or cellular toxicity. Single-nuclei RNA sequencing in 11.5-month-old animals showed that huntingtin inactivation did not alter striatal-cell profiles or proportions. Few differentially expressed genes were identified and Augur analysis confirmed an extremely limited response to huntingtin inactivation in all cell types. Our results therefore indicate that wild-type huntingtin inactivation in adult striatal and projection neurons is well tolerated in the long term.

Limitations of Dual-Single Guide RNA CRISPR Strategies for the Treatment of Central Nervous System Genetic Disorders.

Huntington's disease (HD) is a fatal neurodegenerative disorder caused by a toxic gain-of-function CAG expansion in the first exon of the huntingtin (HTT) gene. The monogenic nature of HD makes mutant HTT (mHTT) inactivation a promising therapeutic strategy. Single nucleotide polymorphisms frequently associated with CAG expansion have been explored to selectively inactivate mHTT allele using the CRISPR/Cas9 system. One of such allele-selective approaches consists of excising a region flanking the first exon of mHTT by inducing simultaneous double-strand breaks at upstream and downstream positions of the mHTT exon 1. The removal of the first exon of mHTT deletes the CAG expansion and important transcription regulatory sites, leading to mHTT inactivation. However, the frequency of deletion events is yet to be quantified either in vitro or in vivo. Here, we developed accurate quantitative digital polymerase chain reaction-based assays to assess HTT exon 1 deletion in vitro and in fully humanized HU97/18 mice. Our results demonstrate that dual-single guide RNA (sgRNA) strategies are efficient and that 67% of HTT editing events are leading to exon 1 deletion in HEK293T cells. In contrast, these sgRNA actively cleaved HTT in HU97/18 mice, but most editing events do not lead to exon 1 deletion (10% exon 1 deletion). We also showed that the in vivo editing pattern is not affected by CAG expansion but may potentially be due to the presence of multiple copies of wildtype (wt)/mHTT genes HU97/18 mice as well as the slow kinetics of AAV-mediated CRISPR/Cas9 delivery.

Hyperlocal environmental data with a mobile platform in urban environments.

Environmental data with a high spatio-temporal resolution is vital in informing actions toward tackling urban sustainability challenges. Yet, access to hyperlocal environmental data sources is limited due to the lack of monitoring infrastructure, consistent data quality, and data availability to the public. This paper reports environmental data (PM, NO2, temperature, and relative humidity) collected from 2020 to 2022 and calibrated in four deployments in three global cities. Each data collection campaign targeted a specific urban environmental problem related to air quality, such as tree diversity, community exposure disparities, and excess fossil fuel usage. Firstly, we introduce the mobile platform design and its deployment in Boston (US), NYC (US), and Beirut (Lebanon). Secondly, we present the data cleaning and validation process, for the air quality data. Lastly, we explain the data format and how hyperlocal environmental datasets can be used standalone and with other data to assist evidence-based decision-making. Our mobile environmental sensing datasets include cities of varying scales, aiming to address data scarcity in developing regions and support evidence-based environmental policymaking.

A simple, low cost and fast sample preparation method for fluorine determination by ISE in leguminous seeds and oilseeds.

This work presents the first report of the application of microwave-induced combustion in disposable vessels (MIC-DV) as a simple and fast sample preparation step for fluoride determination by ion-selective electrode (ISE) in leguminous seeds and oilseeds samples. Several experimental conditions of MIC-DV were evaluated, such as sample mass, absorbing solution, volume of combustion igniter, purging time with oxygen, and the use of successive combustion cycles. The accuracy of MIC-DV/ISE method was evaluated by comparing the results obtained by microwave-induced combustion and determination by ion chromatography, with agreements ranged from 94 to 106%. The method allowed to achieve relatively low limits of quantification (8.3 to 16 µg g-1) comparing to AOAC method (40 µg g-1), besides the use of small amounts of reagents, less handling of digests, making the method greener and with portable features comparing to other methods.

Determination of Cl and S in crude oil by ICP-OES after sample digestion by microwave-induced combustion in disposable vessels.

A simple, fast and promising sample preparation method based on microwave-induced combustion in disposable vessels (MIC-DV) was developed for Cl and S determination in crude oil by inductively coupled plasma optical emission spectrometry (ICP-OES). The MIC-DV consists of a new approach of conventional microwave-induced combustion (MIC). For the combustion, crude oil was pipetted on a disk of filter paper and placed on a quartz holder, followed by the addition of igniter solution (40 µL of 10 mol L-1 NH4NO3). The quartz holder was inserted into a commercial 50 mL disposable polypropylene vessel containing the absorbing solution, which was then inserted in an aluminium rotor. The combustion occurs under atmospheric pressure in a domestic microwave oven not compromising the operator's safety. The following parameters of combustion were evaluated: type, concentration and volume of absorbing solution, sample mass and the possibility of performing consecutive combustion cycles. Using MIC-DV, up to 10 mg of crude oil were efficiently digested, using 2.5 mL of ultrapure H2O as absorbing solution. Moreover, up to 5 consecutive combustion cycles were possible without analyte losses, reaching a total sample mass of 50 mg. The MIC-DV method was validated according to Eurachem Guide recommendations. Results obtained for Cl and S by MIC-DV were in agreement with those obtained using conventional MIC, as well as those obtained for S in a certified reference material of crude oil (NIST 2721). Analyte spike recovery experiments were performed and recoveries at three concentration levels ranged from 99 to 101% for Cl and from 95 to 97% for S, indicating a good accuracy. The limit of quantification achieved by ICP-OES after MIC-DV were 73 and 50 µg g-1 for Cl and S respectively, applying 5 consecutive combustion cycles.

Key Themes, Trends, and Drivers of Mobile Ambient Air Quality Monitoring: A Systematic Review and Meta-Analysis.

Mobile ambient air quality monitoring is rapidly changing the current paradigm of air quality monitoring and growing as an important tool to address air quality and climate data gaps across the globe. This review seeks to provide a systematic understanding of the current landscape of advances and applications in this field. We observe a rapidly growing number of air quality studies employing mobile monitoring, with low-cost sensor usage drastically increasing in recent years. A prominent research gap was revealed, highlighting the double burden of severe air pollution and poor air quality monitoring in low- and middle-income regions. Experiment-design-wise, the advances in low-cost monitoring technology show great potential in bridging this gap while bringing unique opportunities for real-time personal exposure, large-scale deployment, and diversified monitoring strategies. The median value of unique observations at the same location in spatial regression studies is ten, which can be used as a rule-of-thumb for future experiment design. Data-analysis-wise, even though data mining techniques have been extensively employed in air quality analysis and modeling, future research can benefit from exploring air quality information from nontabular data, such as images and natural language.

New urban habits in Stockholm following COVID-19.

During the COVID-19 pandemic, physical distancing, mobility restrictions and self-isolation measures were implemented around the world as the primary intervention to prevent the virus from spreading. Urban life has undergone sweeping changes, with people using spaces in new ways. Stockholm is a particularly relevant case of this phenomenon since most facilities, such as day care centres and schools, have remained open, in contrast to cities with a broader lockdown. In this study, we use Twitter data and an online map survey to study how COVID-19 restrictions have impacted the use of different locations, services and amenities in Stockholm. First, we compare the spatial distribution of 87,000 geolocated tweets pre-COVID-19 and during the COVID-19 pandemic. Second, we analyse 895 survey responses asking people to identify places they 'still visit', 'use more', 'avoid' and self-report reasons for using locations. The survey provides a nuanced understanding of whether and how restrictions have affected people. Service and seclusion were found to be important; therefore, the accessibility of such amenities was analysed, demonstrating how changes in urban habits are related to conditions of the local environment. We find how different parts of the city show different capacities to accommodate new habits and mitigate the effects of restrictions on people's use of urban spaces. In addition to the immediate relevance to COVID-19, this paper thus contributes to understanding how restrictions on movement and gathering, in any situation, expose more profound urban challenges related to segregation and social inequality.

Semi-automated workflows to quantify AAV transduction in various brain areas and predict gene editing outcome for neurological disorders.

One obstacle to the development of gene therapies for the central nervous system is the lack of workflows for quantifying transduction efficiency in affected neural networks and ultimately predicting therapeutic potential. We integrated data from a brain cell atlas with 3D or 2D semi-automated quantification of transduced cells in segmented images to predict AAV transduction efficiency in multiple brain regions. We used this workflow to estimate the transduction efficiency of AAV2/rh.10 and AAV2.retro co-injection in the corticostriatal network affected in Huntington's disease. We then validated our pipeline in gene editing experiments targeting both human and mouse huntingtin genes in transgenic and wild-type mice, respectively. Our analysis predicted that 54% of striatal cells and 7% of cortical cells would be edited in highly transduced areas. Remarkably, in the treated animals, huntingtin gene inactivation reached 54.5% and 9.6%, respectively. These results demonstrate the power of this workflow to predict transduction efficiency and the therapeutic potential of gene therapies in the central nervous system.

Tracking stolen bikes in Amsterdam.

Crime has major influences in urban life, from migration and mobility patterns, to housing prices and neighborhood liveability. However, urban crime studies still largely rely on static data reported by the various institutions and organizations dedicated to urban safety. In this paper, we demonstrate how the use of digital technologies enables the fine-grained analysis of specific crimes over time and space. This paper leverages the rise of ubiquitous sensing to investigate the issue of bike theft in Amsterdam-a city with a dominant cycling culture, where reportedly more than 80,000 bikes are stolen every year. We use active location tracking to unveil where stolen bikes travel to and what their temporal patterns are. This is the first study using tracking technologies to focus on two critical aspects of contemporary cities: active mobility and urban crime.

New sustainable and robust catalytic supports for palladium nanoparticles generated from chitosan/cellulose film and corn stem biochar.

The production of sustainable catalytic supports for palladium nanoparticles is always desired, even more so through the recovery of biomass residues. In this sense, two different solids were investigated - chitosan/cellulose film and corn stem biochar - as catalytic supports of palladium nanoparticles. The solids were carefully characterized and tested in the Suzuki-Miyaura reaction, a typical cross-coupling reaction. The developed catalytic systems proved to be efficient and sustainable, promoted the formation of target products very well, and demanded green reactants under environmentally appropriate conditions. With the results shown in the manuscript, it is expected to contribute to the valorization of biomass and agro-industrial residues in the development of new catalysts for the chemical industry.

Rice Bran and Its Potential To Complement the Nutritional Needs of Children and Elderly.

Rice bran is an agro-industrial by-product of low added value that can be used to complement human nutritional needs. In this work, the profile of minerals, fatty acids and amino acids in brown rice bran was determined, aiming to evaluate its potential to complement the nutritional needs of different age groups, according to recommendations of regulatory agencies. The brown rice bran was supplied by a rice processing industry located in the south of the state of Rio Grande do Sul. Minerals were quantified using an emission spectrometer; the fatty acid profile was determined by gas chromatography and the amino acids were quantified by high-performance liquid chromatography with fluorescence (HPLC-FL). The main minerals were phosphorus (P), magnesium (Mg), potassium (K) and calcium (Ca) (2,933, 1,029, 211 and 56 mg / 100 g of rice bran). Saturated, monounsaturated and polyunsaturated fatty acids in rice bran were 22.4, 36.2 and 34.5% of lipid content, respectively. The polar, neutral and charged amino acids represented 8.8, 9.3 and 12.8% of the protein content, respectively. The composition of this co-product of rice supply chain is a good alternative to the new demand on plant-based food supplying the recommended daily intake (RDI) of national and international food polices.

MicrobiomeCensus estimates human population sizes from wastewater samples based on inter-individual variability in gut microbiomes.

The metagenome embedded in urban sewage is an attractive new data source to understand urban ecology and assess human health status at scales beyond a single host. Analyzing the viral fraction of wastewater in the ongoing COVID-19 pandemic has shown the potential of wastewater as aggregated samples for early detection, prevalence monitoring, and variant identification of human diseases in large populations. However, using census-based population size instead of real-time population estimates can mislead the interpretation of data acquired from sewage, hindering assessment of representativeness, inference of prevalence, or comparisons of taxa across sites. Here, we show that taxon abundance and sub-species diversisty in gut-associated microbiomes are new feature space to utilize for human population estimation. Using a population-scale human gut microbiome sample of over 1,100 people, we found that taxon-abundance distributions of gut-associated multi-person microbiomes exhibited generalizable relationships with respect to human population size. Here and throughout this paper, the human population size is essentially the sample size from the wastewater sample. We present a new algorithm, MicrobiomeCensus, for estimating human population size from sewage samples. MicrobiomeCensus harnesses the inter-individual variability in human gut microbiomes and performs maximum likelihood estimation based on simultaneous deviation of multiple taxa's relative abundances from their population means. MicrobiomeCensus outperformed generic algorithms in data-driven simulation benchmarks and detected population size differences in field data. New theorems are provided to justify our approach. This research provides a mathematical framework for inferring population sizes in real time from sewage samples, paving the way for more accurate ecological and public health studies utilizing the sewage metagenome.

Leaching of rare earth elements from phosphogypsum.

High amounts of phosphogypsum (PG) are generated in the production of phosphoric acid. Previous literature demonstrates that obtaining rare earth elements (REE) from PG is a promising alternative to managing this waste. However, the reported leaching efficiencies are low in most cases, or drastic leaching conditions are required. Therefore, this work aimed to study the leaching conditions of REE from PG to obtain high leaching efficiency values. Initially, a 24 factorial experimental design investigated the factors that affect the conventional acid leaching of REE from PG (leaching acid (citric and sulfuric acid), solid/liquid ratio, acid concentration, and temperature). Better leaching efficiency values of the sum of all REE (62.0% and 89.7% for citric and sulfuric acid, respectively) were obtained using an acid concentration of 3 mol L-1, solid/liquid ratio of 1/20 g mL-1, and temperature of 80 °C. Subsequently, the experiments optimization, performed through a central composite rotational design, indicated that the maximum leaching efficiency was achieved using a sulfuric acid concentration of 2.9 mol L-1, solid/liquid ratio of 1.7/20 g mL-1, and 55 °C. Under these conditions, the leaching efficiency of the sum of all REE was 90.0%. Leaching kinetics results showed that the equilibrium was reached in about 20 min for most REE. The mechanism investigation suggested that surface chemical reaction and diffusion through the boundary layer controlled the leaching.

Vortex-assisted matrix solid-phase dispersion: An eco-friendly alternative for the determination of halogens in edible seaweed.

Edible seaweed has been widely consumed around the world through oriental cuisine and it is important to monitor the levels of some elements, especially halogens. This study proposes, for the first time, the development of an analytical method using the vortex-assisted matrix solid-phase dispersion (VA-MSPD) combined with alkaline extraction of halogens (F, Cl, Br, and I) in edible seaweed for further determination by ion chromatography. The proposed method was evaluated using edible seaweed of the Nori (Porphyra spp.) type and applied to samples of the Wakame (Undaria pinnatifida), Kombu (Laminaria ochroleuca), and Hijiki (Hizikia fusiformis) types. Important VA-MSPD parameters were investigated and using 0.1 g sample, 1 g sea sand as solid support, 50 mmol L-1 (NH4)2CO3 as extraction solution, and 5 min of maceration, higher extraction efficiencies were obtained. The method was linear within the evaluated range (R2 > 0.99) for all elements and no matrix effect was observed. The detection limits of the method were 27, 26, 19, and 28 µg g-1 for F, Cl, Br, and I, respectively. The accuracy was evaluated by a recovery test (ranging from 92 to 108%) and analysis of certified reference materials for apple leaves (NIST 1515) and peach leaves (NIST 1547), which had a good agreement (ranging from 97 to 101%) with the certified values. Comparing the results with those obtained by inductively coupled plasma-mass spectrometry after microwave-induced combustion, no significant difference was found between the results, and the relative standard deviations were lower than 12%. The proposed method proved to be efficient for the determination of halogens in different algae species, showing advantages such as simplicity and low cost, combined to the use of a material from renewable sources (sea sand) as a solid support, contributing to the principles of Green Analytical Chemistry.

Microwave-induced self-ignition: An efficient approach for high purity graphite digestion and multitechnique halogen determination.

In this work, high purity graphite, a high chemically stable material, was effectively digested using a single method allowing compatible solutions for the further multitechnique determination of halogens by: ion chromatography (F and Cl), inductively coupled plasma mass spectrometry (Cl, Br and I) and by ion selective electrode (only for F). The recent system using microwave-induced self-ignition (MISI) is based on the strong interaction between microwave radiation and graphite in a closed system pressurized with oxygen (Maxwell-Wagner effect). Carbon-based materials present intense and specific interfacial polarization when exposed to microwave electromagnetic field resulting in a fast heating rate. This effect associated to a pressurized oxygen system, provides a quick self-ignition of carbon-based materials and consequent combustion/digestion of organic matrices. Under optimized conditions, sample masses up to 600 mg were fully digested in a quartz vessel under 20 bar of oxygen pressure and using just a diluted solution (100 mmol L-1 NH4OH) for the quantitative absorption of all the analytes. MISI method was validated, and the accuracy (better than 94%) was evaluated by comparison of results obtained by pyrohydrolysis for two coal certified reference materials as well as with subsequent analytes determination by the three techniques: IC, ICP-MS and ISE. It is important to point out that no filter paper disks, electrical connections or other ignition aids are required as in the case of previous or classical combustion methods. Moreover, just a diluted absorbing solution was used resulting in negligible blanks and relatively low limits of detection. The digestion efficiency was higher than 99%, making the proposed method a suitable and powerful alternative for the quasi complete digestion of graphite and determination of halogens virtually free of interferences.

The cost of non-coordination in urban on-demand mobility.

Over the last 10 years, ride-hailing companies (such as Uber and Grab) have proliferated in cities around the world. While generally beneficial from an economic viewpoint, having a plurality of operators that serve a given demand for point-to-point trips might induce traffic inefficiencies due to the lack of coordination between operators when serving trips. In fact, the efficiency of vehicle fleet management depends, among other things, density of the demand in the city, and in this sense having multiple operators in the market can be seen as a disadvantage. There is thus a tension between having a plurality of operators in the market, and the overall traffic efficiency. To this date, there is no systematic analysis of this trade-off, which is fundamental to design the best future urban mobility landscape. In this paper, we present the first systematic, data-driven characterization of the cost of non-coordination in urban on-demand mobility markets by proposing a simple, yet realistic, model. This model uses trip density and average traffic speed in a city as its input, and provides an accurate estimate of the additional number of vehicles that should circulate due to the lack of coordination between operators-the cost of non-coordination. We plot such cost across different cities-Singapore, New York (limited to the borough of Manhattan in this work), San Francisco, Vienna and Curitiba-and show that due to non-coordination, each additional operator in the market can increase the total number of circulating vehicles by up to 67%. Our findings could support city policy makers to make data supported decisions when regulating urban on-demand mobility markets in their cities. At the same time, our results outline the need of a more proactive government participation and the need for new, innovative solutions that would enable a better coordination of on-demand mobility operators.

Evaluating the Meteorological Effects on the Urban Form-Air Quality Relationship Using Mobile Monitoring.

Predictive models based on mobile measurements have been increasingly used to understand the spatiotemporal variations of intraurban air quality. However, the effects of meteorological factors, which significantly affect the dispersion of air pollution, on the urban-form-air-quality relationship have not been understood on a granular level. We attempt to fill this gap by developing predictive models of particulate matter (PM) in the Bronx (New York City) using meteorological and urban form parameters. The granular PM data was collected by mobile low-cost sensors as the ground truth. To evaluate the effects of meteorological factors, we compared the performance of models using the urban form within fixed and wind-sensitive buffers, respectively. We find better predictive power in the wind-sensitive group (R = 0.85) for NC10 (number concentration for particles with diameters of 1 µm-10 µm) than the control group (R = 0.01), and modest improvements for PM2.5 (R = 0.84 for the wind sensitive group, R = 0.77 for the control group), indicating that incorporating meteorological factors improved the predictive power of our models. We also found that urban form factors account for 62.95% of feature importance for NC10 and 14.90% for PM2.5 (9.99% and 4.91% for 3-D and 2-D urban form factors, respectively) in our Random Forest models. It suggests the importance of incorporating urban form factors, especially for the uncommonly used 3-D characteristics, in estimating intraurban PM. Our method can be applied in other cities to better capture the influence of urban context on PM levels.

Mastopexy with an Implant and the Making of a Horizontal Flap of the Upper Pedicle, Simulating an Internal Bra.

INTRODUCTION: Mastopexy with an implant is undoubtedly one of the most challenging surgeries in cosmetic surgery since it involves two overlapping procedures. The aim of this study was to demonstrate that by using horizontal glandular flaps in the sulcus in mastopexy with implants, it is possible to reduce the number of postoperative complications. METHODS: Sixty-three female breast surgery patients with some degree of flaccidity who underwent surgery from July 2018 to January 2020 were selected. All surgeries were performed in one procedure with an initial resection of the excess skin associated with a horizontal flap of the upper pedicle that promoted the protection of the implants and decreased the surgical wound tension. RESULTS: Forty-seven patients were included in the sample, for a total of 94 breasts. The motivation of the surgery was esthetic in all cases. Related to complications, we had 1 (1.06%) case of seroma, 1 (1.06%) case suffering from areola necrosis, 6 (6.3%) cases with scar revisions, 10 (10.6%) cases with complications in the transition from the "T" and no case of hematoma, infection or extrusion of the implants. The follow-up time was 12 months. CONCLUSION: This technique allows the surgeon to perform a resection of excess skin and place the implants in one procedure, thereby decreasing the tension in the suture line, protecting the implants and forming a protective stabilizing brace in the mammary groove. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .