"The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medspa Directorship and Practitioner Trends in Florida".

BACKGROUND: The rapid proliferation of medical spas in the US has raised concerns over the continued shift of non-surgical aesthetic treatments away from traditional core specialty integration and supervision, potentially affecting the surgical treatment guidance and education of cosmetic surgery patients. This study aimed to assess the current trends in the growth of independent medspa facilities as well as practitioner supervision, licensing, and specialization in the state of Florida. METHODS: A comprehensive, statewide survey of all independent medspas in Florida, by municipality, employing Google and Yellow Pages search engines. Information gathered included the number of locations, business stakeholders, and director/practitioner licensing and certification obtained from the Florida Division of Corporations/Department of Health databases and respective medical boards. RESULTS: A total of 1,038 medspas were identified, revealing a 100% increase in number relative to 2021 estimates. Non-physician practitioners represented 84% of medspa providers, with core specialty medical director supervision present in only 22% of facilities and a large proportion of directors lacking specialty training (77%) or board certification (42%). Additionally, 25% of medspas appeared to disregard state guidelines pertaining to medical directorship, autonomous non-physician practice, and numerical/geographic restrictions on directorship, with 96% of facilities lacking licensing/registration with Florida's Agency for Health Care Administration. CONCLUSIONS: Medspa growth in Florida has been explosive, with continued departure from core supervision, increasingly limited specialty training/integration, and non-adherence to state guidelines. Enhanced regulation and integrated non-physician practitioner training are likely necessary to ensure patient safety and the cohesive practice of aesthetic medicine and surgery.

Practice-Based Learning in Aesthetic Medicine: Assessing Scientific Literacy Among Cosmetic Practitioners.

BACKGROUND: The field of aesthetic medicine has expanded substantially in the past decade, with significant practitioner diversification and departure from core-specialty supervision. The increased autonomy of nonphysician practitioners in a rapidly evolving field has raised accentuated the importance of scientific literacy and practice-based learning standards in the delivery of aesthetic medical care. OBJECTIVE: To assess the degree of scientific literacy among aesthetic medicine practitioners of different educational and training backgrounds in the United States and abroad. MATERIALS AND METHODS: A cross-sectional survey of 52 national and international aesthetic medicine practitioners employing a validated, 28-item, scientific literacy tool. RESULTS: The average score for all participants was 76% (SD = 18%, range = 43%-100%). Physician practitioners scored higher in all competencies compared non-physicians (86% vs 68%, p < 0.001), with a greater discrepancy among US practitioners (95% vs 71%, p < 0.001). Competencies relating to identification of bias/confounding variables, graphical data representation, and statistical inference/correlation showed the lowest proficiency. Practitioners with a doctorate or equivalent degree were significantly more likely to report frequent engagement with medical literature than non-physicians ( p = 0.02). CONCLUSION: There exists a significant disparity in scientific literacy between physician and nonphysician aesthetic medicine practitioners. This gap underscores the need for enhanced educational programs and continuous professional development to ensure safe and effective patient care in the evolving field of aesthetic medicine.

Readability of Online Materials in Spanish and English for Breast Reduction Insurance Coverage.

INTRODUCTION: Breast reduction surgery aims to alleviate physical discomfort and improve the quality of life for individuals with macromastia. Insurance coverage plays a crucial role in making this surgery accessible, but navigating the complex approval process can be challenging. Online resources have become a primary information source, but limited research exists on the adequacy of online materials, particularly for Spanish-speaking patients. This study evaluates the readability, actionability, and understandability of online educational materials on breast reduction insurance coverage for Spanish- and English-speaking patients. METHODS: We conducted an online search using the phrase "breast reduction insurance" and selected the first eight institutional or organizational websites that provided information on breast reduction insurance in both English and Spanish. We evaluated online materials using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), and Simplified Measure of Gobbledygook, Spanish (SOL). These tools were used to assess factors such as understandability and actionability, cultural sensitivity, and readability of the materials. RESULTS: Both English and Spanish materials scored high in understandability and actionability, with similar average scores between the languages. Cultural sensitivity scores indicated acceptable materials. However, Spanish materials had a higher reading grade level and more hard words compared to English materials. CONCLUSION: There is a need for accessible and understandable online resources on breast reduction insurance coverage, particularly for Spanish-speaking patients. While the assessed websites generally provided comprehensible information, improvements can be made to enhance visual aids and simplify language. These improvements can better educate patients, improve outcomes, and reduce healthcare costs. LEVEL OF EVIDENCE V: 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 .

Self-Assembly of Amyloid Fibrils into 3D Gel Clusters versus 2D Sheets.

The deposition of dense fibril plaques represents the pathological hallmark for a multitude of human disorders, including many neurodegenerative diseases. Fibril plaques are predominately composed of amyloid fibrils, characterized by their underlying cross beta-sheet architecture. Research into the mechanisms of amyloid formation has mostly focused on characterizing and modeling the growth of individual fibrils and associated oligomers from their monomeric precursors. Much less is known about the mechanisms causing individual fibrils to assemble into ordered fibrillar suprastructures. Elucidating the mechanisms regulating this "secondary" self-assembly into distinct suprastructures is important for understanding how individual protein fibrils form the prominent macroscopic plaques observed in disease. Whether and how amyloid fibrils assemble into either 2D or 3D supramolecular structures also relates to ongoing efforts on using amyloid fibrils as substrates or scaffolds for self-assembling functional biomaterials. Here, we investigated the conditions under which preformed amyloid fibrils of a lysozyme assemble into larger superstructures as a function of charge screening or pH. Fibrils either assembled into three-dimensional gel clusters or two-dimensional fibril sheets. The latter displayed optical birefringence, diagnostic of amyloid plaques. We presume that pH and salt modulate fibril charge repulsion, which allows anisotropic fibril-fibril attraction to emerge and drive the transition from 3D to 2D fibril self-assembly.

Genome Sequences of Akoni, Ashton, and Truong, Podoviridae Bacteriophages Isolated from Microbacterium foliorum.

Cluster EK2 Akoni, Ashton, and Truong are lytic Podoviridae actinobacteriophages that were isolated from soil in Florida using Microbacterium foliorum NRRL B-24224 as the host. The genomes are 54,307 bp, 54,560 bp, and 54,309 bp, respectively, and are 60% GC rich. Each genome contains a novel 13,464-bp gene that encompasses 25% of the genome.

Origin, toxicity and characteristics of two amyloid oligomer polymorphs.

There is compelling evidence that small oligomeric aggregates, emerging during the assembly of amyloid fibrils and plaques, are important molecular pathogens in many amyloid diseases. While significant progress has been made in revealing the mechanisms underlying fibril growth, understanding how amyloid oligomers fit into the fibril assembly process, and how they contribute to the pathogenesis of amyloid diseases, has remained elusive. Commonly, amyloid oligomers are considered to be metastable, early-stage precursors to fibril formation that are either on- or off-pathway from fibril growth. In addition, amyloid oligomers have been reported to colocalize with late-stage fibrils and plaques. Whether these early and late-stage oligomer species are identical or distinct, and whether both are relevant to pathogenesis remains unclear. Here we report on the formation of two distinct oligomer species of lysozyme, formed either during the early or late-stages of in vitro fibril growth. We further observe that the pH change from in vitro growth conditions to cell media used for toxicity studies induced distinct mesoscopic precipitates, two of which resemble either diffuse or neuritic plaques seen in Alzheimer's histology. Our biophysical characterization indicates that both oligomer species share morphological and tinctorial features considered characteristic for amyloid oligomers. At the same time, their sizes, morphologies, their immunostaining, detailed tinctorial profiles and, most prominently, their biological activity are clearly distinct from each other. Probing the conditions promoting the formation of these two distinct oligomer species suggests distinct roles of charge interactions, hydrophobicity and monomer flexibility in directing oligomer assembly.