bluuebunny/crossref_metadata_2025 huggingface dataset:
Skills for Healthy Sleep
Authors: Steffen Ann M. , Dick-Siskin Leah P. , Bilbrey Ann Choryan , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

Clinical depression can disrupt sleep patterns, and chronic insomnia contributes to the development of depressive symptoms in later-life. This personalized workbook module of Treating Later-Life Depression: A Cognitive Behavioral Therapy Approach promotes skills to regulate sleep patterns and develop healthy sleep habits. Easy-to-read, large-print Learn pages are selected by behavioral health clinicians to support psychoeducation about sleep to shape expectations and help aging clients use circadian rhythms to support healthy sleep, build sleep debt, and reduce nightime arousal. Practice forms are provided for use between sessions to practice, remember, and use these skills. Sleep routines are embedded within social contexts and environments. Practitioners are encouraged to apply strategies that are responsive to the needs of culturally diverse aging clients.
Module 2: Skills for Feeling: Recognizing and Managing Strong Emotions
Authors: Steffen Ann M. , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

This chapter supports practitioners as they help older clients develop emotional literacy and emotional regulation strategies. Module 2: Skills for Feeling: Recognizing and Managing Strong Emotions contains material to help aging clients understand and describe their feelings and moods, nurture positive emotions, reduce anxiety through relaxation skills, and defuse unhelpful reactions to anger and frustration. This chapter also describes the Practice forms provided for clients’ use between sessions to remember and use these affective skills. Cultural and generational norms and beliefs impact the type of emotions that aging clients experience, how these emotions are expressed, and the degree to which these emotions influence behaviors. Clinicians can use recommended strategies from this chapter to respond to the needs of culturally diverse aging clients, including within telehealth clinical practice.
Session 2: Relax Your Self and Your World
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

Chapter 2 (Session 2) will help youth understand how and why the body responds to stress in certain ways. Youth will learn about the fight or flight response, how it can keep us safe in dangerous situations, and how sometimes our bodies and minds may react strongly even when we are not in situations that are truly dangerous. Youth learn different ways of dealing with the body’s response to stress, including ways to Relax Your Self (i.e., relax your body using deep breaths and by tensing and relaxing the muscles, and relax your mind using a technique called guided imagery) and Relax Your World (i.e., improve mood by doing things that are fun and relaxing). This chapter includes handouts and worksheets to help youth identify how their own body responds to stress and develop a relaxation plan for the week.
Experiences of Psychological Therapy as an Autistic Person
Authors: Mason David , Stark Eloise , Musich Francisco M. , Spain Debbie
Published: February 2022

There is increasing empirical evidence to suggest that psychological therapies can be effective for targeting mental health symptoms experienced by autistic adults. However, relatively little is known about what autistic adults think about the structure and content of psychological therapies and which elements of the therapeutic process are more or less accessible, meaningful, and subjectively important for facilitating hope, change, and resilience. The focus in this chapter is on the personal experiences of autistic adults who have had individual or group therapy. As in all clinical work, therapists are encouraged to adopt an open, curious, and reflective stance and to engage in active conversations with autistic clients about how to adapt the therapeutic context so as to maximize intervention accessibility and effectiveness.
Easing the Transition to Adulthood
Authors: Tomaszewski Brianne , Klinger Laura Grofer , Osborne Glenna , Klein Claire Brito
Published: February 2022

The majority of autistic adolescents transitioning to adulthood have average (or higher) intellectual skills. However, outcome research suggests that even those who earn general education high school diplomas struggle with a successful transition from school to postsecondary and employment settings. This chapter reviews the autism-specific challenges that may lead to poor postsecondary and employment outcomes including executive functioning, emotion regulation, social skills, adaptive behavior, and self-determination. While there are few randomized control trials providing an evidence base for transition interventions, there are a growing number of pilot programs targeting these skills. This chapter reviews the current literature and provides a case study outlining the challenges faced by autistic transition-aged youth. Additionally, future recommendations are provided for creating comprehensive transition programs, capitalizing on recent United States federal government mandates for transition-aged services.
University-Focused Interventions
Authors: Schena David , Simmons Grace Lee , Hillier Ashleigh , White Susan W.
Published: February 2022

The number of college students with autism/ASD is on a steep upward trajectory. These students often face challenges related to age-appropriate adaptive skills, independent living, and co-occurring mental health problems, which can make success in college elusive. Unfortunately, the availability of research-supported services and interventions to support these students is limited. This chapter describes seven different programs developed to support postsecondary students with autism/ASD, summarizes the research supporting their use, and suggests future directions in this area. These programs are designed to either help students transition into postsecondary education or to assist enrolled postsecondary students. The chapter also includes a discussion of commonalities between these programs (such as the frequent use of a “mentorship” method) as well as a case study.
Emotion-Focused Therapies
Authors: Robinson Anna , Conner Caitlin M.
Published: February 2022

Autistic adults are more likely to experience emotion-related difficulties, such as lacking awareness of their emotions, difficulties recognizing others’ emotional experiences, atypical emotional expression, and difficulties in regulating their emotions. Prevalence of co-occurring psychiatric conditions such as depression and anxiety disorders are also higher among adults on the spectrum; however, treatments that specifically focus upon and impact emotional outcomes are nascent for autistic adults. This chapter reviews research on emotional difficulties in autistic adults; treatments that directly target emotion-focused outcomes, such as emotion-focused therapy (including a case study example), emotion recognition training, and interventions for emotion regulation; and treatments that target emotion-related outcomes (such as anxiety and mood disorders). Lastly, future directions for the field are outlined.
Crisis Work and Safety Planning
Authors: Bevington Rebecca , McGuinness Ashleigh , Sampson Mark
Published: February 2022

This chapter outlines the core features of a structured clinical management (SCM) safety plan and the processes involved in its development, and how to conduct safety assessments and manage current crises during sessions. Safety planning is as important for service users diagnosed with borderline personality disorder (BPD) as with any other mental health presentation. Safety planning in SCM requires an initial period of stabilization and crisis containment through a structured approach. The SCM safety plan focuses on the service user’s previous crises and triggers in order to provide a robust plan to work preventatively rather than reactively to potential future crises.
Models of SCM Implementation: Europe
Authors: Aalders Helga , Björling Peder , Sundström Niki
Published: February 2022

This chapter describes how implementation and adaptation of structured clinical management (SCM) was made in a Dutch and a Swedish mental health service setting. In both countries, SCM treatment caters for people diagnosed with personality disorder, not exclusively borderline personality disorder (BPD), and they have integrated SCM into a range of treatments provided. The Personality Disorders Program (PDP) is one of the programmes at the Psychiatric Clinic of Karolinska University Hospital of Huddinge in Sweden. The other has resulted in GIT–PD (Guideline-Informed Treatment–Personality Disorders), developed in 2015 by the Dutch Expertise Centre Personality Disorders (ECPD). The chapter describes the key experiences of implementing SCM from the Swedish and Dutch experience.
Subsonic wind accretion
Authors: Gruzinov Andrei
Published: February 2022

The rate of subsonic wind accretion (accretion on a point Newtonian mass moving through uniform gas) is shown to be independent of the wind velocity and equal to the spherical Bondi rate – for the adiabatic index equal to 5/3. A (very accurate) numerical calculation of the accretion flow, confirming this result, is also presented.
Comparison of the association between six different frailty scales and clinical events in patients on hemodialysis
Authors: Imamura Keigo , Yamamoto Shohei , Suzuki Yuta , Yoshikoshi Shun , Harada Manae , Osada Shiwori , Kamiya Kentaro , Matsuzawa Ryota , Matsunaga Atsuhiko
Published: February 2022

Background

Frailty is associated with adverse outcomes in patients undergoing hemodialysis (HD). However, no study has used various frailty assessments in patients on HD to examine their association with clinical events. In this study, we investigated the association between clinical events and six frailty scales.

Methods

Outpatients who underwent HD between 2018 and 2020 were retrospectively enrolled. Frailty was defined using the Fried Frailty Phenotype, Study of Osteoporotic Fractures (SOF) Index, Short Physical Performance Battery (SPPB), Frail Screening Index, FRAIL scale and Clinical Frailty Scale. Outcomes were clinical events, including a composite of multiple (i.e. recurrent) all-cause hospitalizations, fractures and/or all-cause mortality. The association of clinical events and the frailty scales were investigated using negative binomial regression analysis.

Results

Fried Frailty Phenotype [incident rate ratio (IRR), 1.62; 95% confidence interval (CI), 1.49–1.76], SOF Index (IRR, 1.42; 95% CI, 1.10–1.83), SPPB (IRR, 1.79; 95% CI, 1.11–2.88) and Clinical Frailty Scale (IRR, 1.65; 95% CI, 1.04–2.61) were significantly associated with clinical events. However, Frail Screening Index (IRR, 1.38; 95% CI, 0.60–3.18) and FRAIL scale (IRR, 1.30; 95% CI, 0.88–1.92) showed no significant association with clinical events.

Conclusions

Objective frailty assessments (SPPB) and medical staff impression-based frailty (Clinical Frailty Scale) may be useful prognostic predictors for patients on HD. Questionnaire-based frailty assessment should be carefully considered when used as a measurement of frailty.
The Role of TRP Channels in Nicotinic Provoked Pain and Irritation from the Oral Cavity and Throat: Translating Animal Data to Humans
Authors: Arendt-Nielsen Lars , Carstens Earl , Proctor Gordon , Boucher Yves , Clavé Pere , Albin Nielsen Kent , Nielsen Thomas A , Reeh Peter W
Published: February 2022

Tobacco smoking-related diseases are estimated to kill more than 8 million people/year and most smokers are willing to stop smoking. The pharmacological approach to aid smoking cessation comprises nicotine replacement therapy (NRT) and inhibitors of the nicotinic acetylcholine receptor, which is activated by nicotine. Common side effects of oral NRT products include hiccoughs, gastrointestinal disturbances and, most notably, irritation, burning and pain in the mouth and throat, which are the most common reasons for premature discontinuation of NRT and termination of cessation efforts. Attempts to reduce the unwanted sensory side effects are warranted, and research discovering the most optimal masking procedures is urgently needed. This requires a firm mechanistic understanding of the neurobiology behind the activation of sensory nerves and their receptors by nicotine. The sensory nerves in the oral cavity and throat express the so-called transient receptor potential (TRP) channels, which are responsible for mediating the nicotine-evoked irritation, burning and pain sensations. Targeting the TRP channels is one way to modulate the unwanted sensory side effects. A variety of natural (Generally Recognized As Safe [GRAS]) compounds interact with the TRP channels, thus making them interesting candidates as safe additives to oral NRT products. The present narrative review will discuss (1) current evidence on how nicotine contributes to irritation, burning and pain in the oral cavity and throat, and (2) options to modulate these unwanted side-effects with the purpose of increasing adherence to NRT. Nicotine provokes irritation, burning and pain in the oral cavity and throat. Managing these side effects will ensure better compliance to oral NRT products and hence increase the success of smoking cessation. A specific class of sensory receptors (TRP channels) are involved in mediating nicotine’s sensory side effects, making them to potential treatment targets. Many natural (Generally Recognized As Safe [GRAS]) compounds are potentially beneficial modulators of TRP channels.
Art Crime
Authors: Oosterman Naomi
Published: February 2022

Defined simply as “criminally punishable acts that involve works of art” in Art Crime by J. E. Conklin (Westport, CT: Praeger, 1994: 3), art crime was initially classified into four broad categories: theft of art and antiquities, looting and plunder of antiquities, vandalism, and fakery and forgery. Art crime is not an unambiguous term: it does not consist of a single definition and it encompasses many different types of crime, also outside of the categories mentioned in the aforementioned Art Crime. Many authors nowadays use the term “art and heritage crime” to provide a definition that further stresses the intangible properties of heritage. Art crime has been considered a victimless crime, but as the works presented here show very clearly, the damages that these types of crimes do are often severely threatening to local communities, ecologies, national heritage, and people’s identity. Art crime is a serious crime that has therefore seen increasing involvement of law enforcement to counteract it. Different countries implement different strategies to counteract this crime, ranging from law enforcement interventions, the development of policy and legislation, toolkits, public awareness campaigns, and automated identification systems. However, the diversity in definitions and categories of art crime make this often transnational crime difficult to police and prevent. Additionally, art crime, and especially the trafficking of illegally excavated and looted antiquities, fuels global inequality between what authors consider to be “source” and “market” countries, a discussion that is omnipresent within this bibliography. More recently, authors investigated parallels between different types of art crime, and organized crime, with scholarship focusing on undermining, money laundering, and smuggling and trafficking. This article presents an overview of key sources, from a criminological perspective, on art crime. It is divided between the initial classifications of art crimes in Conklin 1994 (cited under General Overviews of Art Crime with added citations of distinct categories, such as graffiti and illicit street art, manuscript and rare book theft, human remains trafficking, wildlife trafficking, and fossils. And since art crime often triggers the public imagination, this bibliography presents an overview of some of the most striking narratives around highly publicized art crime cases. This bibliography presents articles from a predominantly criminological perspective, so readers interested in the legal discussion around art and heritage crime should consult the Oxford Bibliographies in Classics article Looting and the Antiquities Market.
Developing and Sustaining Police–researcher Partnerships
Authors: Stephens Darrel W
Published: February 2022

Developing and sustaining partnerships between the police and researchers has long been a challenge. There have been national federal grant programmes aimed at developing these partnerships and they have been helpful. In most cases, the partnerships lapsed when the funds are expended. Nevertheless, progress has been made over the years and there are examples of police–researcher partnerships but relatively few are sustained long-term relationships. These partnerships have become increasingly important as community advocates make demands for police reforms; many of which are not evidence based. This article identifies and discusses some of the challenges the police face and various reform proposals. It also identifies several long-term successful partnerships and includes a more detailed description of two of them—University of Cincinnati/Cincinnati Police and Arizona State University/Phoenix Police. The article discusses the author’s experience with police–researcher partnerships as a police chief and researcher over his 53-year career in policing. Finally, the article encourages police and researchers to think more deeply about three areas: funding, community engagement, and communications strategy. Funding is fundamental to sustaining the partnerships and supporting them without a total reliance on external resources is crucial. Transparency has become an essential part of establishing public trust and researchers must begin engaging the community in the process. Finally, a communications strategy as a part of the study would enhance the understanding of findings and reinforce the value of investing in research.
Implementing a multisite efficacy trial to facilitate maternal disclosure to children: the TRACK HIV Disclosure Intervention
Authors: Armistead Lisa , Marelich William D , Murphy Debra A , Schulte Marya T , Goodrum Nada , Kim Sae-Jin
Published: February 2022

HIV remains prevalent, stigmatized, and requires parents to decide whether and how to disclose to their serostatus to their children. Teaching Raising And Communicating with Kids (TRACK), an intervention to support maternal disclosure of HIV status to children, demonstrated efficacy through a pilot and a full-scale multisite trial. In response to the limited availability of best practices for conducting multisite research and recognizing the importance of identification of key intervention components, the current manuscript presents the traditional elements of an implementation paper along with secondary data analyses to identify drivers of the intervention’s effects. Black, Latinx, and White mothers living with HIV (mean age = 39.27, SD = 7.89) and their children (51% female, mean age = 9.65, SD = 2.48) were recruited in Southern California and Atlanta (N = 176 dyads). Following baseline assessments, half were randomized to the intervention. Follow-up assessments occurred at 3, 9, and 15 months. Implementation and quality assurance protocols revealed the need for a broad range of recruitment and retention strategies, ongoing assessment of participants’ psychological distress, and joint initial training of study personnel with ongoing supervision. Based on linear growth modeling, key intervention components (i.e., parent–child communication, positive parent involvement and reinforcement, family routines) significantly contributed to disclosure self-efficacy, the primary intervention target. Lessons learned emphasized the need to balance fidelity to the research protocol with strategies for managing site-based differences and the importance of including all key intervention components for future implementation at clinical or community-based sites.
Reach and effectiveness of the NCI Cancer Moonshot-funded Cancer Center Cessation Initiative
Authors: D’Angelo Heather , Hohl Sarah D , Rolland Betsy , Adsit Robert T , Pauk Danielle , Fiore Michael C , Baker Timothy B
Published: February 2022

Smoking cessation results in improved cancer treatment outcomes. However, the factors associated with successful implementation of cessation programs in cancer care settings are not well understood. This paper presents the reach the reach and effectiveness of cessation programs implemented in NCI-Designated Cancer Centers in the Cancer Center Cessation Initiative (C3I). An observational, cross-sectional study was conducted among C3I Cancer Centers from July 1, 2019 and December 31, 2019 (N = 38). Reach was calculated as the proportion of patients reporting current smoking that received cessation treatment and was analyzed overall and by organizational characteristics. Smoking abstinence rates were determined by the proportion of participants self-reporting smoking abstinence in the previous 7 and 30 days at 6 months after treatment. On average, nearly 30% of patients who smoked received any cessation treatment. In-person counseling was most implemented but reached an average of only 13.2% of patients who smoked. Although less frequently implemented, average reach was highest for counseling provided via an interactive voice response system (55.8%) and telephone-based counseling (18.7%). Reach was higher at centers with more established programs, electronic health record referral systems, and higher smoking prevalence. At 6-month follow-up, about a fifth of participants on average had not smoked in the past 7 days (21.7%) or past 30 days (18.6%). Variations in reach by organizational characteristics suggest that leadership engagement and investment in technology-facilitated programs may yield higher levels of reach. Understanding which implementation and intervention strategies facilitate greater cessation treatment reach and effectiveness could lead to improved outcomes among cancer patients who smoke.
The “Opening of the Clackamas”: Log Trucks, Access Roads, and Multiple-Use Infrastructure in Oregon’s National Forests
Authors: Rose Taylor
Published: February 2022

Driving mountain roads is a fundamental part of the modern experience in Oregon’s national forests. Building, maintaining, and overseeing forest access roads has been at the core of U.S. Forest Service land management policy since World War II. Beginning in 1942, demand for wartime lumber and the newly industrial scale of logging, particularly after the advent of log trucking, together precipitated a period of rapid infrastructure development in the previously remote resource hinterlands of the Pacific Northwest. Although initially a boon for public relations, timber productivity, and management itself, the roads quickly became fiscal and regulatory burdens for the federal agency. This article examines the story of public-lands logging and recreation—typically told as a narrative of environmental politics—through the lens of automobility. Mass road development, I argue, gradually produced a popular expectation—shared across political divisions and enduring more strongly than ever in the 2020s—that national forests were and forever should be places of easy automotive access. However, this expectation belies what it has taken to develop and maintain that access: namely, logging revenue. By following the political-economic, cultural, and environmental history of one notoriously busy road in northwest Oregon, the Clackamas River Road, historians may better understand the context in which multiple-use infrastructure took shape, as well as the difficult budgetary position in which USFS officials find themselves today, three decades after the spotted owl controversy all but ended a half century of national-forest log trucking.
Leveraging predictive analytics to reduce influenza and COVID-19-related adverse events
Authors: Annolino Heather
Published: February 2022

Optimizing technology can help healthcare facilities better manage the risks from a potential “twindemic” of COVID-19 and influenza. This article explores the use of predictive analytics and artificial intelligence to address these risks and improve overall patient care and safety amid a simultaneous pandemic and flu season.
Updated AHA Basic and Advanced Cardiac Life Support guidance with COVID-19 considerations
Authors: Brangan Karen , Day Mary Patricia
Published: February 2022

The American Heart Association released an updated Basic and Advanced Cardiac Life Support guidance that incorporates the latest knowledge regarding COVID-19 and its transmissibility. This article details the new guidance, including strategies for reducing provider risk and exposure and for special patient-care situations.
Association Between Family History of Surgically Treated Low Back Pain and Adolescent Low Back Pain
Authors: Heikkala Eveliina , Karppinen Jaro , Mikkola Ilona , Hagnäs Maria , Oura Petteri
Published: February 2022

Study Design.

Cross-sectional.

Objective.

To study the associations between a family history of surgically treated low back pain (LBP) and adolescent LBP.

Summary of Background Data.

A family history of LBP is related to adolescent LBP, but whether a family history of back surgery is relevant to adolescent LBP is not known.

Methods.

A subpopulation of the Northern Finland Birth Cohort 1986 was contacted when they were aged between 18 and 19years. The postal questionnaire asked the participants to report their LBP and a relative's (mother, father, sibling) LBP and back surgery, and to provide data on potential covariates. The association between a family history of LBP (“no family history of LBP,” “family history of LBP but no surgery,” and “family history of LBP and surgery”) and adolescent LBP (no LBP, occasional LBP, and frequent LBP) were evaluated using logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for sex, smoking, and psychological distress.

Results.

Of the 1374 adolescents in the study, 33% reported occasional LBP and 9% frequent LBP. Both the “family history of LBP but no surgery” and “family history of LBP and surgery” categories were associated with frequent LBP (adjusted OR [aOR] 2.09, 95% CI 1.38–3.16; aOR 2.23, 95% CI 1.02–4.90, respectively). Occasional LBP was associated with the “family history of LBP and surgery” category. A subgroup analysis of adolescents with a family history of LBP found no statistically significant associations between family history of back surgery and adolescent LBP.

Conclusion.

Our findings suggest that adolescents who report a family history of LBP have higher odds of frequent LBP irrespectively of a family history of back surgery.

Level of evidence: 4
Granulation process analysis technologies and potential applications in traditional Chinese medicine
Authors: Cui Tongcan , Hou Yizhe , Feng Huimin , Wu Sijun , Li Wenlong , Li Zheng
Published: February 2022

Pharmaceutical production is changing from batch production to continuous production, during which granulation is one of the most important unit operations. The quality of mass-produced products is traditionally guaranteed by conducting off-line testing, which cannot meet the demand of continuous production for real-time monitoring of critical process parameters and critical quality attributes (CQAs) of the pharmaceutical granulation technology. Since the U.S. Food and Drug Administration proposed process analytical technology (PAT) in 2004, many PAT tools have been developed to monitor the granulation process and provide information regarding the granulation operation conditions and endpoint determination. In this article, we review the recent research and application of two PAT modes in the granulation process, namely, single CQA and multi-CQA PAT, with the aim to provide references for comprehensively improving the technological level of the pharmaceutical granulation process. Furthermore, the potential applications in traditional Chinese Medicine are discussed.
Pain, opioid use, depressive symptoms, and mortality in adults living in precarious housing or homelessness: a longitudinal prospective study
Authors: Jones Andrea A. , Cho Lianne L. , Kim David D. , Barbic Skye P. , Leonova Olga , Byford Alexandra , Buchanan Tari , Vila-Rodriguez Fidel , Procyshyn Ric M. , Lang Donna J. , Vertinsky A. Talia , MacEwan G. William , Rauscher Alexander , Panenka William J. , Thornton Allen E. , Barr Alasdair M. , Field Thalia S. , Honer William G.
Published: February 2022

Pain and related consequences could contribute to comorbid illness and premature mortality in homeless and precariously housed persons. We analyzed longitudinal data from an ongoing naturalistic prospective study of a community-based sample (n = 370) to characterize risk factors and consequences of bodily pain. The aims were to describe bodily pain and associations with symptoms and psychosocial function, investigate factors that may increase or ameliorate pain, and examine the consequences of pain for symptoms, functioning, and all-cause mortality. Bodily pain severity and impact were rated with the 36-item Short Form Health Survey Bodily Pain Scale monthly over 5 years. Mixed-effects linear regression models estimated the effects of time-invariant and time-varying risk factors for pain, verified by reverse causality and multiple imputation analysis. Regression models estimated the associations between overall person-mean pain severity and subsequent functioning and suicidal ideation, and Cox proportional hazard models assessed association with all-cause mortality. Bodily pain of at least moderate severity persisted (>3 months) in 64% of participants, exceeding rates expected in the general population. Greater pain severity was associated with depressive symptom severity and month-to-month opioid use, overlaid on enduring risk associated with age, arthritis, and posttraumatic stress disorder. The frequency of prescribed and nonprescribed opioid use had nonlinear relationships with pain: intermittent use was associated with severe pain, without reverse association or change with the overdose epidemic. Greater longitudinal mean pain severity was associated with premature mortality, poorer functioning, and suicidal ideation. Considering the relationships between pain, intermittent opioid use, and depressive symptoms could improve health care for precariously housed patients.
Extramuscular and Intramuscular Course of the Nerve Innervating the Abdominal Part of the Pectoralis Major Muscle: An Anatomical Study with Regard to Transaxillary Endoscopic Subpectoral Breast Augmentation
Authors: Pretterklieber Bettina , Metka Susanne , Klöppel Markus , Pretterklieber Michael L.
Published: February 2022

Background:

During transaxillary endoscopic subpectoral breast augmentation, the innervation of the abdominal part of the pectoralis major muscle can be injured. The question has been raised whether this could even be of value, as for a better result, the caudal fibers of the pectoralis major muscle have to be detached from their origin. The authors’ aim was to identify the exact position and the intramuscular course and target of these nerve branches.

Methods:

Fifty pectoralis major muscles and their supplying nerve branches from 27 formalin-fixed anatomical specimens were studied using macroscopic dissection and anthropometry. Furthermore, eight muscles underwent the modified Sihler procedure to determine the intramuscular course and target of the supplying nerve branches.

Results:

The branches for the abdominal part of the pectoralis major muscle pierced the pectoralis minor muscle or coursed around its lower border 3.2 to 8.4 cm from the tip of the coracoid process. Within the muscle, at least one small nerve branch, innervating the abdominal part, ascended into the lowermost portion of the sternocostal head, and anastomosed with the lowest small branch of its supplying nerve branches.

Conclusions:

Because of the variable position of the nerve branches, they may often cross the operative field during transaxillary endoscopic breast augmentation. However, their interruption can be of value, because weakening of the lower part of the pectoralis major muscle is desired to keep the implant in place, and to avoid animation deformity.
Revising Prepectoral Breast Reconstruction
Authors: Goodreau Adam M. , Driscoll Cassandra R. , Nye Anthony , Nigro Lauren C. , Blanchet Nadia P.
Published: February 2022

Prepectoral prosthetic breast reconstruction continues to gain popularity, largely due to its decreased postoperative pain, animation deformity, and operative time as compared to subpectoral reconstruction. Widespread use has led to opportunities for surgical revisions. While some techniques for submuscular reconstruction revisions, such as implant exchange and fat grafting, also apply to prepectoral revisions, others require modification for the prepectoral space. The prosthesis’ unique reliance on the mastectomy flaps and acellular dermal matrix for support leads to a progressive alteration of the breast footprint, conus, envelope, and nipple-areola complex position. To date, revisions of prepectoral reconstructions have not been addressed in the literature. This article presents the senior author’s (N.P.B.) techniques for (1) revising prepectoral breast reconstructions, including staged and direct-to-implant reconstructions, with a special focus on nipple-sparing reconstruction, and (2) minimizing undesirable outcomes of prepectoral reconstruction.
A Prospective, Comparative Study (before and after) for the Evaluation of Cryothermogenesis’ Efficacy in Body Contouring: Abdomen and Saddlebags
Authors: Suvaddhana Loap Sarin , SidAhmed-Mezi Mounia , Meningaud Jean Paul , Hersant Barbara
Published: February 2022

Background:

Cryolipolysis is a noninvasive method that allows selective reduction of adipose tissue. The aim of the present study was to evaluate the efficacy of cryothermogenesis, the repetitive applications of cryotherapy, in body contouring of the abdomen and saddlebag areas.

Methods:

Thirty participants were included in the study. Premenopausal women with an overload of subcutaneous abdominal and saddlebag adipose tissue were enrolled. For each participant, five cryothermogenesis sessions were carried out using a medical device equipped with two cooling probes. The primary endpoint was metric measurement. The secondary endpoints were the measurement of subcutaneous fat mass using a Lunar iDXA whole-body scanner (GE Healthcare, Madison, Wis.) and a metabolic assessment conducted before treatment and 15 days after treatment.

Results:

The mean age of participants was 36.72 ± 7 years. Participants had different phototypes and an average body mass index of 23.0 ± 1.41 kg/m2. A decrease in body mass index was observed 3 months after the last session; the body mass index dropped to 20.5 ± 2.1 kg/m2 (p = 0.004 compared to baseline). Waist measurements showed a significant decrease, with an average loss of 4.1 cm after 15 days and 4.62 cm after 3 months. Concerning the circumference of saddlebags, a decrease was observed 3 months after treatment. These results were confirmed by iDXA computed tomographic measurements, showing a significant fat mass reduction in the treated areas.

Conclusion:

The results indicate that subcutaneous fat in the abdomen and saddlebags was reduced after five successive cryothermogenesis sessions, without any complications, in a cohort of participants with different phototypes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Facial Artery Musculomucosal Flap Operative Techniques
Authors: Rabbani Cyrus C. , Lee Andrew H. , Desai Shaun C.
Published: February 2022

Regional flaps are an important component of the reconstructive ladder and represent a versatile option in reconstructing various oral cavity defects. An axial buccal flap based on the facial artery, the facial artery musculomucosal flap, was first described by Pribaz et al. and has been shown to have good functional outcomes with minimal morbidity. Indeed, other surgeons have praised its favorable arc of rotation, reliability, and role as an alternative to free tissue transfer, with shorter duration of general anesthesia and allowance for earlier postoperative mobilization. The facial artery musculomucosal flap has significant versatility, as it can be superiorly or inferiorly based and can be performed in either single- or two-stage fashion. It is of particular advantage for reconstruction of the oral cavity (retromolar trigone, hard palate, alveolar ridge, lip, tongue, and floor of mouth), oropharynx (tongue base, lateral pharynx, and soft palate), and sinonasal structures. Despite its advantages, its widespread use has been limited by a lack of familiarity and difficulty in safely raising a reliable flap consistently. The senior author (S.C.D.) has successfully utilized a high volume of facial artery musculomucosal flaps with a low complication rate in a broad array of oral cavity and oropharyngeal defects. In this article, the authors share technical details on how to harvest and inset this flap by incorporating key landmarks in a reliable fashion.
Pediatric Juxtaepiphyseal Phalangeal Fractures Are Distinct from Salter-Harris Type II Fractures and More Frequently Need Operative Fixation
Authors: Stash Bryce D. , Xu Kyle Y. , Posorske Alyx , Plikaitis Christina M.
Published: February 2022

Background:

Salter-Harris type II fractures are the most common pediatric phalangeal fracture. A juxtaepiphyseal fracture is a distinct fracture pattern that, although similar in radiographic appearance, occurs 1 to 2 mm distal to the growth plate. Although subtle, there are important differences in the behavior and management of these fracture types. The purpose of this study was to compare these two fracture patterns in terms of clinical features and treatment.

Methods:

An institutional review board–approved retrospective chart review was conducted of patients presenting to our tertiary care pediatric hospital. One hundred fifty-eight patients with either Salter-Harris type II or juxtaepiphyseal phalangeal fractures were identified. Primary outcomes analyzed included angulation at initial presentation, stability of reduction if attempted in the emergency department, and need for operative fixation with and without Kirschner wire fixation, with final angulation measurements.

Results:

Salter-Harris type II fractures were more common than juxtaepiphyseal fractures (83 percent versus 17 percent, respectively). There was no significant difference between the two fracture types in the patient’s age, sex, or mechanism of injury. Juxtaepiphyseal fractures were radiographically more angulated on presentation than Salter-Harris type II fractures (p = 0.02). Juxtaepiphyseal fractures required significantly more operative fixation by closed reduction and percutaneous pinning compared to Salter-Harris type II fractures (42.9 percent versus 10.8 percent, respectively; p = 0.002). There was no difference in final outcomes obtained between the two groups.

Conclusions:

Juxtaepiphyseal phalangeal fractures are a distinct entity from Salter-Harris type II fractures. Presenting with significantly more radiographic angulation and clinical instability, juxtaepiphyseal fractures more frequently required operative fixation. Recognizing the differences between these pediatric fracture types is important to help guide clinical management for successful healing.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Three-Dimensional Printing Model Enhances Craniofacial Trauma Teaching by Improving Morphologic and Biomechanical Understanding: A Randomized Controlled Study
Authors: Nicot Romain , Druelle Charles , Chazard Emmanuel , Roland-Billecart Thomas , Nuytten Alexandra , Richard Florence , Dupré Aurélie , Raoul Gwénaël , Ferri Joël , Lacroix Dominique , Gosset Didier , Schlund Matthias , Truffert Patrick
Published: February 2022

Background:

Teaching about craniofacial traumas is challenging given the complexity of the craniofacial anatomy and the necessity for good spatial representation skills. To solve these problems, three-dimensional printing seems to be an appropriate educative material. In this study, the authors conducted a randomized controlled trial. The authors’ main objective was to compare the performance of the undergraduate medical students in an examination based on the teaching support: three-dimensionally printed models versus two-dimensional pictures.

Methods:

All participants were randomly assigned to one of two groups using a random number table: the three-dimensionally–printed support group (three-dimensional group) or the two-dimensionally–displayed support group (two-dimensional group). All participants completed a multiple-choice question evaluation questionnaire on facial traumatology (first, a zygomatic bone fracture; then, a double mandible fracture). Sex and potential confounding factors were evaluated.

Results:

Four hundred thirty-two fifth-year undergraduate medical students were enrolled in this study. Two hundred six students were allocated to the three-dimensional group, and 226 were allocated to the two-dimensional group. The three-dimensionally printed model was considered to be a better teaching material compared with two-dimensional support. The global mean score was 2.36 in the three-dimensional group versus 1.99 in the two-dimensional group (p = 0.008). Regarding teaching of biomechanical aspects, three-dimensionally–printed models provide better understanding (p = 0.015). Participants in both groups exhibited similar previous student educational achievements and visuospatial skills.

Conclusions:

This prospective, randomized, controlled educational trial demonstrated that incorporation of three-dimensionally–printed models improves medical students’ understanding. This trial reinforces previous studies highlighting academic benefits in using three-dimensionally–printed models mostly in the field of understanding complex structures.
Buttocks Volume Augmentation with Submuscular Implants: 100 Cases Series
Authors: Petit François , Colli Mattia , Badiali Valerio , Ebaa Sabri , Salval André
Published: February 2022

Background:

Permanent aesthetic augmentation of the gluteal region can be achieved with fat graft and/or implants. Implant-based augmentations have been proposed since the late 1960s. Buttock implants can be placed in four different planes according to distinct surgical techniques: subcutaneous, subfascial, intramuscular, and submuscular.

Methods:

In this retrospective analysis, a 100 case series of patients seeking volume and shape amelioration of the gluteal region were studied. All of them had primary gluteoplasty performed with a submuscular implant placement by first author (F.P.) with a new technique, as described in the article.

Results:

Data on surgery time, implant volume selection, and postoperative complications were collected. The most frequent complications were delayed healing of the incision and implant flipping.

Conclusions:

Submuscular implant positioning is a safe and reliable technique for buttock augmentation with implants. Whatever the implant volume, submuscular gluteal augmentation carries the benefit of perfectly covering, protecting, and hiding the implant, making it almost impalpable and invisible.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Accreditation Council for Graduate Medical Education Milestones in Integrated Plastic Surgery Programs: How Competency-Based Assessment Has Been Implemented
Authors: Kearney Aaron M. , Rokni Alex M. , Gosain Arun K.
Published: February 2022

Background:

The plastic surgery milestones are a central component of resident assessment. The authors performed a survey to evaluate how milestones have been implemented across integrated plastic surgery programs and how faculty perceive the Milestones Project has impacted their program.

Methods:

A 25-question survey was directed to the head of the clinical competency committee of all 82 integrated plastic surgery programs through the American Council of Academic Plastic Surgeons. The survey queried the composition of the committee, how ratings are generated, and the data used in generating these ratings.

Results:

Committee leaders from 57 programs (69.5 percent) responded to the survey. For most programs (73 percent), one faculty member completed milestone ratings for each resident and reviewed them with the residents. To determine milestone ratings, 92 percent utilized resident assessment after every rotation, and 63 percent utilized in-service examination scores. For documented resident assessment overall, 96 percent of programs assess residents after every rotation; 37 percent asses after every procedure. Feedback is most frequently provided to residents after every rotation (52 percent), rather than only during committee reviews (32 percent) or after every documented assessment (16 percent). Sixty-four percent of respondents did not believe that milestones have helped in the mentorship role.

Conclusions:

Implementation of the milestones has varied among integrated plastic surgery programs. Structured training for core faculty directed to methods of assessment will make milestones a more effective a tool by which to improve resident evaluation and education. These findings provide a key data set by which to revise the milestones for their second iteration.
Reproducible Research Practices in the Plastic Surgery Literature
Authors: Ascha Mona , Katabi Leila , Stevens Erica , Gatherwright James , Vassar Matthew
Published: February 2022

Background:

Reproducible research—defined as the ability to replicate a study with its published materials and procedures—is integral to ensuring the validity of published studies and promoting scientific advancement. The primary aim of this study was to quantitatively evaluate the reproducibility and transparency of research in the plastic surgery literature.

Methods:

A cross-sectional study was performed. Articles published in 12 plastic surgery journals over a 5-year period were randomly selected. Reproducibility-related and transparency-related variables were blindly and independently collected by two reviewers using previously published methods. Descriptive statistics and univariate analysis were performed for outcomes of interest.

Results:

The initial search yielded 18,461 publications, from which 400 were randomly selected. A total of 397 publications met inclusion criteria, of which 203 were empirical studies eligible for analysis of reproducibility-related and transparency-related variables. Among the empirical studies, most did not have a data availability statement (97.0 percent; 95 percent CI, 93.7 to 98.9). Only seven (3.4 percent; 95 percent CI, 1.4 to 7.0) were linked to an accessible protocol, four (2.0 percent; 95 percent CI, 0.5 to 5.0) were preregistered, and no studies provided analysis scripts or claimed to replicate another study. Of the 202 studies evaluated for material availability, only 17 (8.4 percent; 95 percent CI, 5.0 to 13.1) had a material availability statement.

Conclusions:

There is an evident lack of reproducible research practices in plastic surgery literature. The majority of plastic surgery publications do not provide information and raw materials necessary to reproduce empirical studies. Increasing awareness at the individual and institutional levels can improve research quality and transparency.