bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing Leadership Behaviors in a Public Health Agency Through Coaching and Multirater Feedback
Authors: Dean Hazel D. , Myles Ranell L. , Porch Tichelle , Parris Stephanie , Spears-Jones Crystal
Published: November 2019

Context:

Public health managers' leadership skills can be improved through multirater feedback and coaching.

Objective:

To explore to what extent participation in a coaching intervention influences leadership behaviors of first- and second-level leaders in a federal public health agency.

Design:

Team leads and branch chiefs in the Centers for Disease Control and Prevention's (CDC's) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) were invited to participate in the Coaching and Leadership Initiative (CaLI), which incorporates the US Office of Personnel Management (OPM) Leadership 360 assessment, 6 coaching sessions, and 2 in-depth interviews.

Setting:

NCHHSTP is one of 16 CDC national centers, institute, and offices.

Participants:

Staff serving as team leads or branch chiefs.

Main Outcome Measures:

Two in-depth interviews explored CaLI's influence on leadership behaviors regarding the government-wide Leading People executive core qualification.

Results:

A total of 103 (93%) CaLI participants completed the OPM 360 feedback, 82 (80%) completed leadership coaching; 71 of 82 (87%) completed phase 1 interview, and 46 of 71 (65%) completed phase 2 interview. Eighty unique participants completed 1 or more interviews; all indicated that CaLI helped provide new perspectives, practices, and approaches that led to better communication and relationships, different approaches to conflict resolution, and awareness of individual leadership practices. Of the 71 participants who completed phase 1 evaluation, 66 (93%) said they made changes in developing others, 56 (79%) completed conflict management and team building, and 16 (23%) completed leveraging diversity. Of the 46 participants who completed both phase 1 and phase 2 interviews and among those who made changes post-CaLI, 23 of 26 (88%) sustained those leadership changes in developing others, 21 of 27 (78%) in team building; 24 of 34 (71%) in conflict management; and 5 of 10 (50%) in leveraging diversity.

Conclusions:

This study demonstrates the benefits and effectiveness of using multirater feedback and leadership coaching for first- and midlevel public health leaders.
Risk Factors for and Trends in Isoniazid Monoresistance at Diagnosis of Tuberculosis—United States, 1993-2016
Authors: Iqbal Shareen A. , Armstrong Lori R. , Kammerer J. Steve , Truman Benedict I.
Published: November 2019

Context:

Resistance to isoniazid (INH) only (monoresistance), with drug susceptibility to rifampin, pyrazinamide, and ethambutol at diagnosis of tuberculosis (TB) disease, can increase the length of treatment.

Objective:

To describe US trends in INH monoresistance and associated patient characteristics.

Design:

We performed trend and cross-sectional analyses of US National Tuberculosis Surveillance System surveillance data. We used Joinpoint regression to analyze annual trends in INH monoresistance and logistic regression to identify patient characteristics associated with INH monoresistance.

Participants:

Culture-positive cases reported to National Tuberculosis Surveillance System during 1993-2016 with drug susceptibility test results to INH, rifampin, pyrazinamide, and ethambutol.

Main Outcome Measures:

(1) Trends in INH monoresistance; (2) odds ratios for factors associated with INH monoresistance.

Results:

Isoniazid monoresistance increased significantly from 4.1% of all TB cases in 1993 to 4.9% in 2016. Among US-born patients, INH monoresistance increased significantly from 2003 onward (annual percentage change = 2.8%; 95% confidence interval: 1.4-4.2). During 2003-2016, US-born persons with INH-monoresistant TB were more likely to be younger than 65 years; to be Asian; to be human immunodeficiency virus–infected; or to be a correctional facility resident at the time of diagnosis. Among non–US-born persons, INH resistance did not change significantly during 1993-2016 (annual percentage change = −0.3%; 95% confidence interval: –0.7 to 0.2) and was associated with being aged 15 to 64 years; being Asian, black, or Hispanic; or having a previous history of TB.

Conclusions:

INH-monoresistant TB has been stable since 1993 among non–US-born persons; it has increased 2.8% annually among US-born persons during 2003-2016. Reasons for this increase should be further investigated.
Core Competency Gaps Among Governmental Public Health Employees With and Without a Formal Public Health Degree
Authors: Taylor Heather L. , Yeager Valerie A.
Published: November 2019

Objectives:

To examine the role of a formal public health degree as it relates to core competency needs among governmental public health employees.

Design:

This cross-sectional study utilizes the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). Bivariate relationships were analyzed by conducting χ2 tests of respondents' supervisory level and reported skill gaps. Multivariate logistic regressions of reported skill gaps were performed holding gender, age, race/ethnicity, highest degree attained, current employer, role type, tenure in current agency, and public health certificate attainment constant.

Setting:

Nationally representative sample of government public health employees.

Participants:

A total of 30 276 governmental public health employees.

Main Outcome Measure:

Self-reported competency skills gaps.

Results:

Among nonsupervisors, those with a public health degree had significantly lower odds of reporting a competency gap for 8 of the 21 skills assessed. Among supervisors/managers, those who had a formal public health degree had significantly lower odds of reporting a competency gap in 3 of the 22 skills assessed. Having a degree in public health was not significantly related to an executive's likelihood of reporting a skill gap across any of the 22 skills assessed. Regardless of supervisory level, having a public health degree was not associated with a reduced likelihood of reporting skill gaps in effective communication, budgeting and financial management, or change management competency domains.

Conclusions:

Possessing a formal public health degree appears to have greater value for skills required at the nonsupervisor and supervisor/manager levels than for skills needed at the executive level. Future work should focus on longitudinal evaluations of skill gaps reported among the public health workforce as changes in public health curricula may shift over time in response to newly revised accreditation standards. In addition, public health education should increase emphasis on communication, budgeting, systems thinking, and other management skills among their graduates.
A Surveillance Data-Based Model System for Assessing the Effects of HIV Intervention and Prevention Strategies
Authors: Song Ruiguang , Green Timothy A. , Hall H. Irene
Published: November 2019

Objective:

Build a dynamic model system to assess the effects of HIV intervention and prevention strategies on future annual numbers of new HIV infections, newly diagnosed cases of HIV infection, and deaths among persons infected with HIV.

Design and Setting:

Model parameters are defined to quantify the putative effects of HIV prevention strategies that would increase HIV testing, thereby diagnosing infection earlier; increase linkage to care and viral suppression, thereby reducing infectiousness; and increase the use of preexposure prophylaxis, thereby protecting persons at risk of infection. Surveillance data are used to determine the initial values of the model system's variables and parameters, and the impact on the future course of various outcome measures of achieving either specified target values or specified rates of change for the model parameters is examined.

Participants:

A hypothetical population of persons with HIV infection and persons at risk of acquiring HIV infection.

Main Outcome Measures:

HIV incidence, HIV prevalence, proportion of persons infected with HIV whose infection is diagnosed, and proportion of persons with diagnosed HIV infection who are virally suppressed.

Results:

A model system based on the basic year-to-year algebraic relationships among the model variables and relying almost exclusively on HIV surveillance data was developed to project the course of HIV disease over a specified time period. Based on the most recent HIV surveillance data in the United States—which show a relatively high proportion of infections having been diagnosed but a relatively low proportion of diagnosed persons being virally suppressed—increasing the proportion of diagnosed persons who are virally suppressed and increasing preexposure prophylaxis use appear to be the most effective ways of reducing new HIV infections and accomplishing national HIV prevention and care goals.

Conclusions:

Both having current and accurate information regarding the epidemiologic dynamics of HIV infection and knowing the potential impact of prevention strategies are critical in order for limited HIV prevention resources to be optimally allocated.
Pain from torture: assessment and management
Authors: Amris Kirstine , Jones Lester E. , Williams Amanda C de C.
Published: November 2019

Introduction:

Survivors of torture are for many reasons at particularly high risk for inadequate assessment and management of pain. Among the many health problems associated with torture, persistent pain is frequent, particularly pain in the musculoskeletal system. The pathophysiology underlying post-torture pain is largely unknown, but pain inflicted in torture may have profound effects on neurophysiology and pain processing.

Methods:

A narrative review of assessment and treatment studies, informed by clinical experience, was undertaken.

Results:

The clinical presentation in survivors of torture shares characteristics with other chronic primary pain syndromes, including chronic widespread pain. Unfortunately, such pain is often misunderstood and dismissed as a manifestation of psychological distress, both in specialist psychosocially oriented torture services and in mainstream health care. This means that pain is at risk of not being recognized, assessed, or managed as a problem in its own right.

Conclusions:

The available research literature on rehabilitation for torture survivors is predominantly targeted at mental health problems, and studies of effectiveness of pain management in torture survivors are lacking. Rehabilitation is identified as a right in the UN Convention on Torture, aiming to restore as far as possible torture survivors' health and capacity for full participation in society. It is therefore important that pain and its consequences are adequately addressed in rehabilitative efforts. This article summarizes the current status on assessment and management of pain problems in the torture survivor.
The Impact of Plastic Surgery Training on Family Planning and Prenatal Health
Authors: Bourne Debra A. , Chen Wendy , Schilling Benjamin K. , Littleton Eliza Beth , Washington Kia M. , De La Cruz Carolyn
Published: November 2019

Background:

Plastic surgery trainees who wish to start a family face challenges. This is the first study to collect data directly from residents and fellows to understand issues surrounding childbearing and to propose solutions.

Methods:

Following institutional review board approval, an anonymous survey was distributed to all current plastic surgery residents and fellows in the United States. Data regarding demographics, obstetrical complications, parental leave, breastfeeding, and use of assisted reproductive technology were collected.

Results:

The survey was completed by 307 trainees, for a resident response rate of 27.0 percent. Mean age of the respondents was 31.7 ± 3.8 years, 58.6 percent were married, and 35.3 percent reported at least one pregnancy for themselves or for their partner. Both male (67.4 percent) and female (76.5 percent) respondents intentionally postponed having children because of career. Women were significantly more likely to report negative stigma attached to pregnancy (70.4 percent versus 51.1 percent; p = 0.003) and plan to delay childbearing until after training. Fifty-six percent of female trainees reported an obstetrical complication. Assisted reproductive technology was used by 19.6 percent of trainees. Mean maternity leave was 5.5 weeks, with 44.4 percent taking less than 6 weeks. Mean paternity leave was 1.2 weeks. Sixty-two percent of women and 51.4 percent of men reported dissatisfaction with leave. Sixty-one percent of female trainees breastfed for 6 months and 19.5 percent continued for 12 months. Lactation facilities were available near operating rooms for 29.4 percent of respondents.

Conclusions:

Plastic surgery training may negatively impact fertility, obstetrical health, and breastfeeding practices. The data presented in this article provide the groundwork for identifying areas of concern and potential solutions.
Outcomes of Breast Reduction Surgery Using the BREAST-Q: A Prospective Study and Comparison with Normative Data
Authors: Crittenden Tamara A. , Watson David I. , Ratcliffe Julie , Griffin Philip A. , Dean Nicola R.
Published: November 2019

Background:

This study aimed to assess breast-related satisfaction and well-being in women with breast hypertrophy before and after breast reduction surgery, and to compare these scores with Australian general population norms, using the BREAST-Q Reduction module.

Methods:

A prospective cohort study was conducted between March of 2010 and February of 2016. Participants self-completed the BREAST-Q preoperatively and 12 months postoperatively. Normative BREAST-Q data were generated from women aged 18 years and older for comparison. Statistical analysis was performed and values of p < 0.05 were considered significant.

Results:

The BREAST-Q was completed by 132 participants preoperatively and 12 months postoperatively. Statistically significant improvements were found following surgery in Satisfaction with Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being. In comparison with normative data, patients with breast hypertrophy had significantly lower scores preoperatively, with scores significantly increasing postoperatively to levels representative of the general population. Satisfaction with outcome was not significantly different between patients who were eligible by traditional insurance requirements (Schnur sliding scale/500-g minimum rule) and those who were not. The presence of surgical complications did not affect change in BREAST-Q scores or postoperative satisfaction with outcome. Differences were observed in mean BREAST-Q scores when comparing generated Australian norms to published U.S. norms.

Conclusions:

Breast reduction surgery significantly improves the satisfaction and quality of life in women with breast hypertrophy to a level that is at least equivalent to that of the normative population. Surgery is of benefit to all women, including those who do not meet traditional insurance requirements.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Breast-Related Quality of Life in Young Reduction Mammaplasty Patients: A Long-Term Follow-Up Using the BREAST-Q
Authors: Krucoff Kate B. , Carlson Anna R. , Shammas Ronnie L. , Mundy Lily R. , Lee Hui-Jie , Georgiade Gregory S.
Published: November 2019

Background:

Reduction mammaplasty is the most effective means of improving symptoms of macromastia. Although studies have shown lasting benefits in adult patients, there is a paucity of data that explore this topic in young patients. In this study, the long-term satisfaction and well-being of young reduction mammaplasty patients was assessed.

Methods:

A retrospective review was performed for all female patients younger than 25 years who underwent reduction mammaplasty performed by a single surgeon from 1980 to 2003. Demographic characteristics, comorbidities, surgical details, and length of follow-up were recorded. Participants completed the postoperative version of the BREAST-Q Reduction module. Responses were scored on a scale of 0 to 100. Scores were summarized with descriptive statistics and compared to normative values.

Results:

Thirty-seven of 52 eligible participants completed the survey (response rate, 71.2 percent). Median age at surgery was 21 years (range, 12.4 to 24.6 years), and median follow-up was 21.4 years (range, 11.4 to 32.4 years). Overall, participants demonstrated high satisfaction and well-being. Mean Q-Scores for Satisfaction with Breasts and Sexual Well-being were significantly higher than normative values (p = 0.0012 and p < 0.0001, respectively), and were as follows: Satisfaction with Breasts, 66.6 ± 16.5 (normative, 57 ± 16); Psychosocial Well-being, 75.9 ± 21.3 (normative, 68 ± 1 9); Sexual Well-being, 72 ± 18.2 (normative, 55 ± 19); and Physical Well-being, 81.1 ± 13.6 (normative, 76 ± 11).

Conclusions:

Young reduction mammaplasty patients experience excellent breast-related quality of life decades after surgery. Compared with normative values, young reduction mammaplasty patients reported higher satisfaction with breasts and sexual well-being. Surgeons and third-party payers should be aware of these data and advocate for young patients to gain access to care.
The Effects of Facial Lipografting on Skin Quality: A Systematic Review
Authors: van Dongen Joris A. , Langeveld Mirte , van de Lande Lara S. , Harmsen Martin C. , Stevens Hieronymus P. , van der Lei Berend
Published: November 2019

Background:

Autologous lipografting for improvement of facial skin quality was first described by Coleman in 2006. The current dogma dictates that adipose tissue–derived stromal cells that reside in the stromal vascular fraction of lipograft contribute to skin rejuvenation (e.g., increased skin elasticity), a more homogenous skin color, and softening of skin texture. Nowadays, many studies have been reported on this “skin rejuvenation” effect of autologous fat grafting. This systematic review was undertaken to assess the efficacy of autologous lipografting on skin quality.

Methods:

The MEDLINE, Embase, Cochrane Central, Web of Science, and Google Scholar databases were searched for studies evaluating the effect of autologous lipografting on facial skin quality (May 11, 2018). Outcomes of interest were skin texture, color, and elasticity in addition to histologic outcomes and number of complications.

Results:

Nine studies were included, with 301 patients treated in total. No meta-analysis could be performed because of heterogeneity of the metrics and outcomes. Eight studies reported increased skin elasticity; improvement in skin texture; and a more homogeneous skin color after treatment with lipografting, cellular stromal vascular fraction, or nanofat. One study reported no increased skin elasticity after lipografting. Histologic improvement was seen after lipografting and adipose tissue–derived stromal cell injections. However, in general, the level of evidence of the included studies was low. No serious complications were reported.

Conclusion:

Autologous facial lipografting and cellular stromal vascular fraction and adipose tissue–derived stromal cell injections hardly seem to improve facial skin quality but can be considered a safe procedure.
Factor Structure of the Disabilities of the Arm, Shoulder and Hand Questionnaire in Upper Extremity Nerve Injury
Authors: Novak Christine B. , Mackinnon Susan E. , Anastakis Dimitri J. , McCabe Steven J.
Published: November 2019

Background:

This study evaluated the validity of the factor structure of the Disabilities of the Arm, Shoulder and Hand questionnaire to assess upper extremity disability in patients with upper extremity nerve injury.

Methods:

Data were used from previous cross-sectional studies of patients with upper extremity nerve injuries. Research ethics approval was obtained for secondary data analyses. Descriptive and factor analyses were performed.

Results:

Patients (n = 242; 170 men and 72 women) with upper extremity nerve injury included distal nerve (n = 131), brachial plexus (n = 88), and single proximal shoulder nerve (n = 23). The mean Disabilities of the Arm, Shoulder and Hand questionnaire score was 47.3 ± 22. For the questionnaire, a three-factor structure had the highest variance and no overlap between factors. The factors related to (1) light effort tasks, (2) greater effort tasks, and (3) work/social activity limitations and pain. Brachial plexus injuries had significantly higher overall questionnaire scores compared to distal and single proximal nerve injuries. The light effort factor scores were significantly lower in single proximal nerve injuries compared with brachial plexus and distal nerve injuries. Nondominant compared to dominant hand involvement revealed no difference in overall questionnaire scores but significantly higher dominant hand scores in the light effort factor (p = 0.001).

Conclusions:

In patients with nerve injury, the factor analysis of the Disabilities of the Arm, Shoulder and Hand questionnaire indicated a multifactor construct. These domains should be considered when using the questionnaire and may be helpful to assess disability related to specific tasks in different nerve injuries and with dominant hand involvement.
Perioperative Risks Are Similar for Normal versus Selected High–Body Mass Index Patients Undergoing Outpatient Hand and Elbow Surgery
Authors: Warrender William , Jones Christopher , Selverian Stephen , Lutsky Kevin , Banner Lauren , Beredjiklian Pedro K.
Published: November 2019

Background:

Many ambulatory surgery centers use body mass index as a screening tool to make admissions decisions because of complication risks associated with high–body mass index patients. The objective of this investigation was to evaluate perioperative complications in a cohort of high–body mass index patients undergoing hand and elbow surgery at an ambulatory surgery center. The authors’ hypothesis was that anesthesia-related complications for this cohort would be similar to those of a normal–body mass index group.

Methods:

The authors retrospectively reviewed data from all hand and elbow procedures performed on patients with a high body mass index (>40 kg/m2). One hundred eighty-nine high–body mass index patients and 189 normal–body mass index patients were included in the analysis.

Results:

The average weight-based dosage of propofol was similar in both groups but was lower in the high–body mass index group for midazolam and fentanyl. Two high–body mass index patients had oxygen desaturations in the postanesthesia care unit. No patients developed complications related to anesthesia. In the high–body mass index group, one patient developed hypotension in the postanesthesia care unit, was admitted to the emergency room for monitoring, but was discharged the following morning.

Conclusions:

Outpatient hand surgical care of high–body mass index patients can be performed safely. Body mass index alone should not be considered as an absolute contraindication for surgery. Careful patient selection, evaluation of comorbidities, and close involvement of the anesthesia and medical teams are critical.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Wound Complications, Additional Ventilation Requirement, Prolonged Stay, and Readmission in Primary Palatoplasty: A Risk Factor Analysis of 3616 Patients
Authors: Blough Jordan T. , Purnell Chad A. , Chow Ian , Gosain Arun K.
Published: November 2019

Background:

The present study examined risk factors associated with 30-day palatoplasty complications based on analysis of national data.

Methods:

Primary palatoplasties were identified in the 2012 to 2015 Pediatric National Surgical Quality Improvement Program database. Cases were analyzed with multivariate regression to investigate predictors for wound healing complications, additional ventilation requirement, prolonged stay (>3 days), and readmission.

Results:

In 3616 operations, mean age was 12.2 months and operative time was 135.4 minutes. The 30-day complication rate was 7.6 percent overall, including wound dehiscence/infection (3.4 percent), additional ventilation requirement (2.0 percent), and readmission (2.4 percent); 5.1 percent of patients required prolonged stays. Wound healing complications were not predicted by comorbidities. American Society of Anesthesiologists class 3 or greater (OR, 2.8; p = 0.033), neuromuscular disorder (OR, 3.5; p = 0.029), and nutritional support (OR, 2.9; p = 0.035) predicted additional ventilation requirement. Prolonged stays were predicted by requiring additional ventilation (OR, 14.7; p < 0.001) or American Society of Anesthesiologists class 3 or greater (OR, 1.8; p = 0.047), but preoperative ventilator dependence was protective (OR, 0.1; p = 0.012). Mean hospital stay was 1.6 days without an airway complication versus 5.0 days with. Readmissions were increased for patients requiring nutritional support (OR, 2.6; p = 0.025).

Conclusions:

This study represents one of the largest cohorts of palatoplasty patients analyzed to date. It identifies what can be learned from a nonspecific 30-day registry regarding cleft outcomes and, from its limitations, discusses what the future of cleft outcomes research might entail.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following Radical Parotidectomy
Authors: Hasmat Shaheen , Low Tsu-Hui , Krishnan Aparna , Coulson Susan , Ch’ng Sydney , Ashford Bruce G. , Croxson Glen , Clark Jonathan R.
Published: November 2019

Background:

Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors’ experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy.

Methods:

A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database. The return of dynamic midface movement was the primary outcome investigated. Electronic, clinician-graded facial function scale grades were used to formally assess postoperative outcomes.

Results:

A total of 27 patients were included in the study with an average age of 72 years (range, 31 to 88 years). Thirteen patients (48 percent) had developed dynamic function by the end of the study period. Young age predicted a more rapid return to dynamic function (p = 0.018). Both being a woman and having an intact facial nerve before surgery improved dynamic midface movement (p = 0.005 and p = 0.036, respectively). On multivariable analysis, superior midface dynamic function was associated with neurotization using midface facial nerve branches as opposed to using nerve-to-masseter alone (p = 0.05).

Conclusion:

The chimeric vastus lateralis and anterolateral thigh flap is a suitable option for restoring defects and dynamic function following radical parotidectomy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Relation of Optimism to Relative Telomere Length in Older Men and Women
Authors: Kim Eric S. , Tindle Hilary A. , Kubzansky Laura D. , Liu Simin , Duncan Meredith S. , Manson JoAnn E. , Springfield Sparkle , Salmoirago-Blotcher Elena , Shadyab Aladdin H. , Liu Buyun , Grodstein Francine , De Vivo Immaculata
Published: November 2019

Objective

Mounting evidence suggests that higher optimism is associated with reduced risk of age-related morbidities and premature mortality. However, possible biological mechanisms underlying these associations remain understudied. One hypothesized mechanism is a slower rate of cellular aging, which in turn delays age-related declines in health.

Methods

We used data from two large cohort studies to test the hypothesis that higher optimism is associated with longer leukocyte telomere length. With cross-sectional data from the Health and Retirement Study (HRS; n = 6417; mean age = 70 years) and the Women’s Health Initiative (WHI; N = 3582; mean age = 63 years), we used linear regression models to examine the association of optimism with relative telomere length (assessed in leukocytes from saliva [HRS] or plasma [WHI]). Models adjusted for sociodemographics, depression, health status, and health behaviors.

Results

Considering both optimism and telomere length as continuous variables, we found consistently null associations in both cohorts, regardless of which covariates were included in the models. In models adjusting for demographics, depression, comorbidities, and health behaviors, optimism was not associated with mean relative telomere length (HRS: β = −0.002, 95% confidence interval = −0.014 to 0.011; WHI: β = −0.004, 95% confidence interval = −0.017 to 0.009).

Conclusions

Findings do not support mean telomere length as a mechanism that explains observed relations of optimism with reduced risk of chronic disease in older adults. Future research is needed to evaluate other potential biological markers and pathways.
Effective Radiation Dose Reduction in Computed Tomography With Iterative Reconstruction in Patients With Urinary Stone
Authors: Kim See Hyung
Published: November 2019

Purpose

This study aimed to prospectively compare the image quality and visibility of urinary stone on computed tomographic (CT) images at multiple radiation exposure levels from the same patient reconstructed with sinogram-affirmed iterative reconstruction (SAFIRE).

Methods

This study included 760 patients with urinary stone who underwent CT with simultaneous acquisition at 6 exposures per patient (100% filtered back projection, 75%, 50%, 37.5%, 25%, and 12.5% SAFIRE). Two radiologists independently assessed overall image quality, noise, and stone visibility by using a 5-point scale. Quantitative measurements, including the CT number, image noise, signal-to-noise ratio, contrast-to-noise ratio (CNR), and corresponding figure of merit (FOM), were compared for 100% versus 5 other radiation doses.

Results

Qualitative overall image quality, noise, and stone visibility according to the location were not inferior at 37.5% exposure compared with 100% exposure, except for the visualization of smaller stones <3 mm. The signal-to-noise ratio and CNR of CT images were increased at 50% exposure compared with 100% exposure. Computed tomographic images at 37.5% exposure reconstructed with SAFIRE had significantly more noise and a lower CNR compared with CT images reconstructed with filtered back projection, based on FOMnoise and FOMCNR. The size-specific dose estimation was 4.1 ± 0.8 mGy at 37.5% exposure.

Conclusion

Computed tomography performed at 37.5% exposure with SAFIRE may be diagnostically acceptable for the detection of clinically relevant stone.
Scientific Productivity in Rheumatology Among Countries of the Organisation for Economic Co-operation and Development and Its Correlation to National Economic Indicators
Authors: Lerman Tsahi T. , Reitblat Olga , Reitblat Tatiana
Published: November 2019

Background

The purpose of this study was to examine the correlation between research productivity in the field of rheumatology and various updated economic indicators of Countries of the Organisation for Economic Co-operation and Development (OECD).

Methods

The number of documents published, number of citable documents, number of citations, citations per document, and the H-index for the 36 OECD countries in the field of rheumatology between 1996 and 2017 were obtained from the The Scimago Journal and Country rank source. The recent data regarding gross domestic product (GDP) per capita, total health spending as percent of GDP, and the gross domestic expenditure on research and development as percent of GDP were collected from the World Bank, OECD, and United Nations Educational, Scientific, and Cultural Organization Web sites, accordingly. The relationship between economic indicators and scientific productivity for each of the OECD countries was analyzed.

Results

A total of 132,314 documents were analyzed. A moderate to strong significance correlation was found between health expenditure and the number of documents published (r = 0.67, p < 0.001), number of citable documents (r = 0.68, p < 0.001), number of citation (r = 0.76, p < 0.001), and H-index (r = 0.77, p < 0.001).

Conclusions

This study provides a current highlight on the relationship between academic productivity in rheumatology and economic indicators of OECD countries. We showed a positive moderate to strong significant correlation between total health expenditure as percent of GDP and different bibliometric indicators, implying another possible advantage of national investment in this filed.
Burkitt’s Lymphoma Involving Multiple Hormone-Producing Organs on FDG PET/CT
Authors: Wen Zhe , Zhuang Hongming
Published: November 2019

Lymphoma involving many different organs can be occasionally observed. However, lymphoma involvement of multiple hormone-producing organs is rare. In this report, we described our FDG PET/CT findings in a 21-year-old man whose Burkitt's lymphoma involved not only lymph nodes, the spleen, the brain, and the bones, but also 4 organs in the endocrine system, including the thyroid, right adrenal, the pancreas, and the right testicle.
A Machine-Learning Approach Using PET-Based Radiomics to Predict the Histological Subtypes of Lung Cancer
Authors: Hyun Seung Hyup , Ahn Mi Sun , Koh Young Wha , Lee Su Jin
Published: November 2019

Purpose

We sought to distinguish lung adenocarcinoma (ADC) from squamous cell carcinoma using a machine-learning algorithm with PET-based radiomic features.

Methods

A total of 396 patients with 210 ADCs and 186 squamous cell carcinomas who underwent FDG PET/CT prior to treatment were retrospectively analyzed. Four clinical features (age, sex, tumor size, and smoking status) and 40 radiomic features were investigated in terms of lung ADC subtype prediction. Radiomic features were extracted from the PET images of segmented tumors using the LIFEx package. The clinical and radiomic features were ranked, and a subset of useful features was selected based on Gini coefficient scores in terms of associations with histological class. The areas under the receiver operating characteristic curves (AUCs) of classifications afforded by several machine-learning algorithms (random forest, neural network, naive Bayes, logistic regression, and a support vector machine) were compared and validated via random sampling.

Results

We developed and validated a PET-based radiomic model predicting the histological subtypes of lung cancer. Sex, SUVmax, gray-level zone length nonuniformity, gray-level nonuniformity for zone, and total lesion glycolysis were the 5 best predictors of lung ADC. The logistic regression model outperformed all other classifiers (AUC = 0.859, accuracy = 0.769, F1 score = 0.774, precision = 0.804, recall = 0.746) followed by the neural network model (AUC = 0.854, accuracy = 0.772, F1 score = 0.777, precision = 0.807, recall = 0.750).

Conclusions

A machine-learning approach successfully identified the histological subtypes of lung cancer. A PET-based radiomic features may help clinicians improve the histopathologic diagnosis in a noninvasive manner.
Decreased GABA-A Receptor Binding in Association With β-Lactam Antibiotic Use
Authors: Flaus Anthime , Riaño Barros Daniela Alexandra , Hinz Rainer , Myers James F. , Lingford-Hughes Anne , Koepp Matthias J. , Hammers Alexander , McGinnity Colm Joseph
Published: November 2019

β-Lactam antibiotics are proconvulsive. In laboratory animals, this effect seems to be predominantly mediated through inhibition of GABA-A receptors, but it has not been demonstrated in humans in vivo. We report images of a [11C]Ro15-4513 PET from a 40-year-old man who had completed a 1-week course of flucloxacillin before it. Relative to healthy controls, the participant had significantly lower mean gray matter binding. These novel data suggest that, in humans, the proconvulsive effect of β-lactam antibiotics is mediated via either competition for the same benzodiazepine-binding site as [11C]Ro15-4513 or downregulation of GABA-A receptor expression.
Incidental Detection of Iliac Artery Occlusion on 3-Phase Bone Scintigraphy
Authors: Kim Myoung Hyoun , Kim Dae-Weung
Published: November 2019

Our patient was a 72-year-old man with absent activity of the right femoral artery and mildly decreased 99mTc-DPD activity on the right leg as indicated on the blood pool and delayed images, respectively. Subsequent peripheral angiography revealed a total occlusion of the right external iliac artery with good collateral flow. Careful review of blood flow and blood pool images of 3-phase bone scintigraphy could provide additional information about peripheral vascular disease.
Management of Intravenous Infiltration Injuries
Authors: Massand Sameer , Carr Logan , Schneider Emily , Johnson T. Shane
Published: November 2019

Background

Intravenous (IV) lines are ubiquitous in hospital settings. These lines can malfunction, leaking noxious contents into subcutaneous tissue. Existing literature describes invasive intervention and complex treatment protocols. These persist despite significant changes in the composition and administration of IV agents. The purpose of this study is to examine the consequences of IV infiltrations at a tertiary medical center to update protocols and treatment algorithms.

Materials and Methods

This study is an observational, retrospective chart review performed at a tertiary care medical center. All inpatient plastic surgery consultations for IV infiltration were reviewed from 2011 to 2017. Patients were included if IV infiltration was suspected or documented. Data were collected for each injury regarding patient demographics, substance, and intervention.

Results

The plastic surgery service evaluated 381 IV infiltration injuries from 2011 to 2017, with 363 meeting the criteria. Injuries per year progressively increased, with 32 consultations in 2011 and 102 consultations in 2017. The vast majority of injuries identified (91%) were treated with only elevation and observation. The minority consisted of wound care (7%) performed by nursing or any form of incision, aspiration, or antidote injection (2%) performed by the physician. Of the 363 injuries, the most common infiltrates were noncytotoxic (35%), radiographic contrast (27%), and known vesicants (18%). Interestingly, a large portion of consultations were requested by other surgical services (32%).

Conclusions

Although there is an increase in expert involvement for cases of IV infiltration injuries, the vast majority of these injuries are managed with minimal intervention. This is most likely owing to recent changes that have decreased the potential for harmful infiltration. Contrary to existing literature, invasive intervention is almost never indicated.
Unilateral Cleft Lip Repair
Authors: Ramly Elie P. , Eisemann Bradley S. , Kantar Rami S. , Alfonso Allyson R. , Wang Maxime , Diaz-Siso Jesus Rodrigo , Staffenberg David A. , Flores Roberto L.
Published: November 2019

Background

There is no quantitative evidence supporting one unilateral cleft lip (UCL) repair technique over the other with regard to scarring. We sought to evaluate the difference between the extended Mohler and Millard techniques, using 3 scar assessment scales.

Methods

Postoperative frontal and basal photographs of patients undergoing UCL repair were reviewed. Three validated scar assessment scales were used: the Manchester Scar Scale (MSS), modified scar-rating scale (MSRS), and Stony Brook Scar Evaluation Scale. Lip and nose scars were rated by 5 independent raters using each of the scales. Interrater reliability was assessed using the intraclass correlation coefficient (ICC).

Results

Assessment of 116 images for 58 consecutive patients undergoing UCL repair (36 extended Mohler, 22 Millard) was performed. Interrater reliability was excellent for lip scars (ICCs, 0.903 [0.857–0.938] for MSS, 0.913 [0.872–0.944] for MSRS, and 0.850 [0.775–0.902] for SBES) and moderate for nose scar assessment (ICCs, 0.714 [0.579–0.816] for MSS, 0.693 [0.548–0.802] for MSRS, and 0.565 [0.359–0.720] for SBES). No statistically significant difference was found between the extended Mohler and Millard repairs in mean lip scar scores (MSS, 6.983 ± 1.469 vs 6.772 ± 1.175, P = 0.571; MSRS, 5.433 ± 1.530 vs 5.481 ± 1.290, P = 0.902; SBES, 3.633 ± 0.977 vs 3.446 ± 0.995, P = 0.483) or nose scar scores (MSS, 5.644 ± 1.131 vs 5.491 ± 0.689, P = 0.523; MSRS, 4.233 ± 0.987 vs 3.991 ± 0.705, P = 0.320; SBES, 3.933 ± 0.750 vs 4.018 ± 0.486, P = 0.603).

Conclusions

Using 3 validated scar assessment scales, no significant difference was found between the extended Mohler and Millard techniques in terms of lip or nose scars.
Meltblown Polylactic Acid Nanowebs as a Tissue Engineering Scaffold
Authors: Gazzola William H. , Benson Roberto S. , Carver Wayne
Published: November 2019

Polylactic acid (PLA) nanofiber nonwovens have recently come under more vigorous investigation for their use as tissue engineering scaffolds owing to its ability to mimic the physical properties of naturally occurring human extracellular matrix in a variety of host tissues. Currently, the majority of available research on PLA nanowebs has focused on their creation through electrospinning. The goal of this study was to evaluate meltblown nonwoven webs made of nanodiameter PLA fibers for their application as a tissue engineering scaffold. Meltblown PLA fabrics were produced with a variety of different crystallinities, tensile moduli, and pore diameters. One fabric with mechanical properties similar to human dermis was selected as a scaffold to study attachment, proliferation, and migration of human dermal fibroblasts over 1, 3, 7, and 14 days without the use of additional cell adhesion molecules. The 3-(4,5-dimethylthiazol-2-yl)-diphenyltetrazolium bromide assay showed good proliferation from day 1 to 3 (P = 0.026) and up to 7 days of culture (P = 0.005) but without increase from day 7 to 14. Electron microscopy demonstrated adequate cellular attachment and surface migration at 1, 3, 7, and 14 days. Finally, confocal microscopy was used to investigate cellular penetration into the scaffolds. The investigation found that cells were able to penetrate fully through the thickness of the scaffold. The successes of this initial experiment are promising and confirm that meltblown nanofiber nonwovens are a viable avenue for tissue engineering scaffolds. Hopefully, these conclusions will open the door for others to pursue research in this exciting field.
New Insights Into 3-Dimensional Anatomy of the Facial Mimetic Muscles Related to the Nasolabial Fold
Authors: Chen Guo Cheng , Sun Min , Yin Ningbei
Published: November 2019

Background

This study aimed to introduce a novel approach to study the facial mimetic muscles (FMMs) related to the nasolabial fold (NLF) and realize the visualization of complex 3-dimensional (3D) structures of the FMM.

Methods

Micro–computed tomography (micro-CT) and iodine staining technique were used to obtain the 2-dimensional radiographs of the FMM. Materialise Mimics software was then used to reconstruct the 3D model of the FMM.

Results

The zygomaticus major muscle was not directly connected to the orbicularis oris muscle (OOM). The terminal fibers of the zygomaticus major muscle were located in the levator anguli oris. The surface of the FMM was covered with some unknown muscle fibers in the NLF. The terminal fibers of the zygolabialis ended in the middle of the ipsilateral OOM rather than the edge of the OOM. At the same anatomical level, the FMM fibers were so closely connected to each other that they were not separated by adipose tissue. A detailed 3D sequence of the muscle fibers in the modiolus at the corner of the mouth was determined. The muscle fibers in the modiolus were organized rather than disorganized. The terminal fibers of the levator anguli oris were located at the terminal fibers of the musculus depressor anguli oris at the corner of mouth.

Conclusions

Although the micro-CT had many disadvantages, the micro-CT combined with iodine staining technique enabled the 3D anatomical study of the FMM related to NLF. We imported the 2-dimensional images obtained by micro-CT scanning into Mimics software, successfully reconstructed the FMM related to the NLF, and finally obtained images of complex 3D structures of the FMM related to the NLF. The shapes, positions, and 3D spatial relationships between the FMM related to the NLF were clearly visualized. The novel insights into the 3D anatomy of the FMM related to NLF may help understand the formation of the NLF. Finally, the results of this study may help improve rejuvenation surgery of the NLF in the near future.
Postmastectomy Pain Syndrome
Authors: Kraft Casey T. , O'Brien Andrew L. , Skoracki Roman J.
Published: November 2019

Postmastectomy pain syndrome (PMPS) is defined as chronic pain after breast cancer surgery lasting greater than 3 months and has been shown to affect up to 60% of breast cancer patients. Substantial research has been performed to identify risk factors and potential treatment options, although the exact cause of PMPS remains elusive. As breast reconstruction becomes increasingly popular, plastic surgeons are likely to encounter more patients presenting with PMPS. This article summarizes current evidence on risk factors and treatment options for PMPS and highlights further areas of study.
Plastic Surgery Training and the Problematic Resident
Authors: Ovadia Steven A. , Zoghbi Yasmina , Thaller Seth R.
Published: November 2019

Introduction

Plastic surgery resident education is a significant commitment by both programs and residents. Unfortunately, problematic resident behavior may occur and be difficult to manage. This study was designed to survey plastic surgery program directors to elucidate their experience with problematic resident behavior.

Methods

A electronic survey was prepared using the online platform, qualtrics. The survey was distributed by email to all plastic surgery program directors. Questions were designed to evaluate frequency of problematic behavior and methods to manage the behaviors. A reminder was sent 3 weeks after initial distribution. Responses were collected for an additional 3 weeks. Responses were pooled separately for integrated and independent program directors.

Results

Thirty-eight program directors responded including 10 independent and 28 integrated program directors. Integrated and independent program directors estimated prevalence of problematic behavior at 17.5 ± 14.4% and 11.8 ± 7.9%, respectively. Poor clinical skills/judgment and unprofessional behavior were the most commonly reported problematic behaviors by integrated program directors at 21% each. These were also the most commonly reported behaviors by independent program directors at 20.8% and 16.7%, respectively. Fourteen integrated program directors and 5 independent program directors reported having dismissed a resident. Only 5 integrated and 2 independent program directors reported warning signs in hindsight during the resident's initial application. Nine integrated program directors and 4 independent program directors reported at least sometimes reviewing applicant social media accounts.

Conclusions

Prevalence of problematic behavior is estimated between 10% and 20% of plastic surgery residents. Type of problematic behavior are similar between integrated and independent residents. Warning signs on initial application are uncommon. As such, understanding problematic behaviors and methods to manage them are essential.