COVID-19 Elective Surgery Shutdown and Operative Experience for Graduating Plastic Surgery Independent Residents.

INTRODUCTION: The initial wave of the COVID-19 pandemic led to a temporary shutdown of elective procedures. The purpose of this study is to evaluate how the elective surgery shutdown impacted case log numbers for graduating plastic surgery independent residents. METHODS: The Accreditation Council of Graduate Medical Education graduate self-reported case logs were retrospectively compiled for graduating independent track plastic surgery residents for the year before the pandemic (2019), 4 months into the pandemic (2020) and 16 months into the pandemic (2021). Procedures were grouped into resident review committee area and totals for each area were used for analysis. Average number of cases and standard deviations were compiled. Percent change was calculated comparing each year to the prepandemic baseline. Statistical significance was determined with Student t tests comparing average number of cases. Coefficients of variation were calculated to assess for changes in interprogram variation. Average case numbers were then compared with minimum case requirements necessary for graduation. RESULTS: The Accreditation Council of Graduate Medical Education graduation case log statistics were available for 238 independent residents. There were no statistically significant differences in average case number for graduating independent residents for total reconstructive breast, trunk, hand and upper extremity, or total reconstructive procedures between graduation years. The average case number of total lower extremity reconstruction increased from 2019 to 2020 (average = 83-97.4, P = 0.02). The average total number of breast aesthetic cases increased between all years (average = 92, 98, 114), with the average increase from 2019 to 2021 being statistically significant ( P = 0.02). Differences in head and neck aesthetic deformities and trunk and extremity deformities between years were not statistically significant. The average case number for all graduating plastic surgery independent residents exceeded the minimum case log requirements. CONCLUSIONS: The temporary hold on elective procedures during the pandemic decreased the opportunity for plastic surgery trainees to meet minimum case log requirements. Case log data for graduating plastic surgery independent residents demonstrate that despite the temporary suspension, the pandemic did not greatly impact the average resident case numbers.

University-Associated SARS-CoV-2 Omicron BA.2 Infections, Maricopa County, Arizona, USA, 2022.

We investigated a university-affiliated cohort of SARS-CoV-2 Omicron BA.2 infections in Arizona, USA. Of 44 cases, 43 were among students; 26 persons were symptomatic, 8 sought medical care, but none were hospitalized. Most (55%) persons had completed a primary vaccine series; 8 received booster vaccines. BA.2 infection was mild in this young cohort.

Project STARLIT: protocol of a longitudinal study of habitual sleep trajectories, weight gain, and obesity risk behaviors in college students.

BACKGROUND: Obesity in the United States is a serious and preventable health concern. Previous research suggests that habitual short sleep may influence obesity-risk behaviors, such as increased caloric intake, decreased physical activity and increased engagement in sedentary activities (e.g., media consumption, computer usage). Given that existing longitudinal research studies have methodological concerns preventing conclusive interpretations, Project STARLIT was designed to address these limitations and identify future intervention targets. METHODS: A sample of young adults (n = 300) will be recruited during the summer prior to entering college. Participants will be screened for eligibility requirements prior to the inclusion in the Time 1 assessment though phone and in-person interviews. Once enrolled, participants will complete four assessments over a two year period (i.e., approximately 8, 16 and 24 months after Time 1). Each assessment will consist of one week of data collection including both objective (i.e., habitual sleep, physical activity, body fat composition) and subjective (i.e., sleep diary, 24-h food recall, technology use, and sleep-related beliefs/behaviors) measures. DISCUSSION: Project STARLIT is designed to address methodological concerns of previous research. In addition to clarifying the relationship between habitual short sleep and weight gain among young adults, the proposed study will identify problematic obesity risk behaviors associated with habitual short sleep (e.g., increased caloric intake, physical/sedentary activity). The results will identify prevention or intervention targets related to obesity risk. TRIAL REGISTRATION: ClinicalTrials.gov NCT04100967, 9/23/19, Retrospectively registered.

Modified McCash Technique for Management of Dupuytren Contracture.

Despite recent advancements in the nonsurgical treatment for Dupuytren contracture, a number of patients remain poor nonsurgical candidates or elect for surgical management. The traditional McCash technique releases contractures while leaving open palmar wounds. Although successful in alleviating contractures, these wounds are traditionally large, transverse incisions across the palm. A modification of this technique has been performed that permits the surgeon to utilize smaller wounds while eliminating debilitating contractures.

The comparison of brief, online mindfulness and relaxation interventions to reduce stress and improve sleep-related outcomes in college students.

OBJECTIVE: The current study aimed to examine whether brief online stress reduction exercises supplemented with sleep improvement strategies would reduce stress, arousal, and sleep difficulties in college students who were not required to use the sleep improvement strategies for participation. PARTICIPANTS: A sample of 114 college student participants were enrolled because they were experiencing stress and/or wanted to improve their sleep. METHODS: Participants were randomized into an abbreviated progressive muscle relaxation, a mindful breathing, or a self-monitoring control condition for the 4-week intervention. Measures of physical relaxation, mindfulness, perceived stress, pre-sleep arousal, and insomnia symptom severity were collected. RESULTS: The APMR group improved on five of the six dependent measures and was significantly different than the SM group at posttest, but not different than the MB group. CONCLUSION: The results suggests promise for brief, online, scaled back stress reduction interventions to reduce stress, arousal, and sleep difficulties in college students.

Compartment Syndrome of the Hand Induced by Peripherally Extravasated Phenylephrine.

Background: Compartment syndrome of the hand is a rare and devastating complication of peripheral intravenous extravasation. With changes in critical care research, vasoactive medications are now more frequently administered through peripheral lines in the acute setting. Methods: We present the case of a patient diagnosed with compartment syndrome of the hand secondary to phenylephrine extravasation in the setting of hypovolemic shock. Results: The use of fasciotomy compartment release and intraoperative phentolamine resulted in significant improvement in tissue perfusion postoperatively. Conclusion: With incraesed incidence of peripherally administered vasoactive medications, the hand surgeon should be aware of potential complications and treatment of compartment syndrome with urgent fasciotomy and phentolamine administration.

Necrotizing Soft Tissue Infections of the Upper Extremity.

Necrotizing soft tissue infections of the upper extremity have varying microbiologies and etiologies. Risk factors for development include diabetes mellitus, intravenous drug use, peripheral arterial disease, smoking, alcohol abuse, and immunocompromised state. Although clinical examination is the mainstay of diagnosis, laboratory tests and imaging can aid in diagnosis. Surgical débridements usually are needed for treatment, with resultant defects that often require reconstruction. Rates of amputation are reported as 22% to 37.5% and mortality from necrotizing soft tissue infections of the upper extremity from 22% to 34%. Prompt surgical and antimicrobial treatment is necessary to decrease risk of loss of limb or life.

Knowledge, attitudes, and practices among veterinarians during an outbreak of canine leptospirosis-Maricopa County, Arizona, 2017.

Leptospirosis, caused by Leptospira spp., is a zoonotic bacterial disease important to both human and animal health. Six pathogenic serovars are currently known to commonly infect and cause disease in dogs in the United States. While canine leptospirosis infection is historically rare in Arizona (≤5 cases reported annually) (ADHS unpublished data) several clusters were reported in Maricopa County (MC) during February 2016-January 2017. Public health initiated an outbreak response and developed a knowledge, attitudes, and practices survey for veterinarians. The goals were to determine awareness and general attitudes about canine leptospirosis and to identify gaps in veterinarians' knowledge in treatment and prevention. We distributed a 40-question self-administered online survey to 1058 Arizona Veterinary Medical Association members, made available during February 9-May 15, 2017. We analyzed the results using Pearson's Chi-squared or Fisher's exact test; a P-value <0.05 was considered statistically significant. We analyzed 202 complete responses. Veterinarians from 10 (66%) of 15 Arizona counties were represented. MC practices were more likely to stock leptospirosis vaccine (80%) than other counties combined (58%) (P = 0.004). The average composite knowledge score was 24.4 out of 38 (range 12-37, median 24); 49% of respondents demonstrated higher knowledge as defined by authors, largely in identification of leptospirosis risk factors (86%) and routes of exposure (73%). Fewer than half (45%) of respondents correctly identified the length of time bacteria can be shed in dogs' urine. Eighty-one percent of respondents demonstrated lower knowledge about clinical signs associated with leptospirosis; only 47% of respondents identified eight clinical signs commonly associated with leptospirosis. Sixty-one percent of MC respondents agreed that leptospirosis is an important canine disease in their geographic area, while only 40% of other county respondents agreed (P=0.03). Seventy percent of respondents identified diagnostic testing options. The majority correctly selected infection-control practices in line with recommendations from 2 national clinical guidelines. More respondents would recommend leptospirosis vaccination if dogs traveled or lived in rural areas (87-96%) than if dogs attended day care or were boarded (63%). We identified opportunities for education, including the local epidemiology of leptospirosis, transmission prevention strategies, vaccine safety, testing, clinical identification, and emerging risk factors. Our findings will help guide the design of educational materials for small animal veterinarians in Arizona regarding recommendations for prevention of animal and human leptospirosis infections; these efforts could also shift the culture of reporting companion animal diseases to improve future One Health collaborations.

Relevance of spirituality for people with mental illness attending consumer-centered services.

Spirituality has been cited in the literature as having a positive effect on mental health outcomes. This paper explores the relationship of spirituality to demographic, psychiatric illness history and psychological constructs for people with mental illness (N=1835) involved in consumer-centered services (CCS-Clubhouses and Consumer run drop-in centers). Descriptive statistics indicate that spirituality is important for at least two thirds of the members in the study. Members primarily indicated participation in public spiritual activities (i.e., church, bible study groups), followed by private activities (prayer, reading the bible, and meditation) (both of which were centered on belief in the transcendent). A logistic regression analysis was done to explore variables related to spirituality (i.e., demographics, psychiatric illness history, and psychological constructs). Results suggest that age, gender, having psychotic symptoms, having depressive symptoms, and having a higher global quality of life, hope and sense of community were all significant correlates of spirituality.

Emotion regulation as a moderator between anxiety symptoms and insomnia symptom severity.

Insomnia is a common concern with many associated negative consequences. Previous research has established bivariate relationships between anxiety symptoms, emotion regulation, and insomnia symptom severity; however, limited research has examined how the interaction between emotion regulation and anxiety symptoms may be associated with insomnia symptom severity. A sample of 468 undergraduate participants and a subsample of 136 participants meeting a self-reported cutoff score for insomnia, completed questionnaires assessing anxiety, insomnia symptom severity, and emotion regulation difficulties. Among the general sample of all participants, the interaction between anxiety symptoms and both overall emotion regulation difficulties and limited access to emotion regulation strategies were associated with insomnia symptom severity. However, among the insomnia subsample, emotion regulation moderated this relationship, such that insomnia symptom severity increased as anxiety symptoms increased among those with high emotion regulation difficulties, but were unaffected by changes in anxiety symptoms among those with low emotion regulation difficulties. These findings suggest that maladaptive emotion regulation may be necessary for anxiety symptoms to have a negative influence on sleep difficulties, meaning that during treatment, it may be important to address both an individual's anxiety symptoms and emotion regulation difficulties, particularly among those with clinical levels of insomnia.

Bridging the gap: providing health care to newly released men.

Men who are incarcerated have higher morbidity rates than the general U.S. population and upon release most rely on the public sector to get their medical needs met. However, little is known about the health care needs, service utilization patterns, and costs of providing primary care to released inmates in an ambulatory setting. Using data from a primary care health center for uninsured men, health profiles and service use over a 12-month period is described for men newly released from prison (n=221). Health care needs and utilization were measured by medical diagnosis and primary care consultation rates. The results show that the newly released men studied had different service use patterns from that of the general population. The average cost of providing care was slightly higher than the center's average cost per individual for a man newly released from prison. The findings demonstrate the need for future research to support program planning of organizations seeking to meet the needs of people newly released from prison.

Immunochemical pulsed-labeling characterization of intermediates during hen lysozyme oxidative folding.

Previous studies have shown that reduced hen egg white lysozyme refolds and oxidizes according to a linear model, in which the number of disulfide bonds increases sequentially. In this study, we describe the kinetics of native tertiary structure formation during the oxidative-renaturation of reduced hen egg white lysozyme, as monitored using an immunochemical pulsed-labeling method based on enzyme-linked immunosorbent assay (ELISA) in conjunction with two monoclonal antibodies (mAb). Each of these antibodies recognizes a separate face of the native lysozyme surface and, more importantly, each epitope is composed of discontinuous regions of the polypeptide chain. Renaturation kinetics were studied under the same refolding conditions as previous investigations of the kinetics of the regain of far-UV CD, fluorescence, enzymatic activity, and disulfide bonds. Comparison of our results with the results from those studies showed that the immunoreactivity (i.e., the native fold) of the alpha-domain appeared in intermediates containing two SS bonds only (C6-C127 and C30-C115), while the immunoreactivity of the beta-domain appeared together with the formation of the third SS bond (C64-C80). Thus, the alpha-domain folds before the beta-domain during the oxidative folding of reduced lysozyme.

Access to health care and religion among young American men.

In order to elucidate cultural correlates of utilization of primary health services by young adult men, we investigated religion in which one was raised and service utilization. Using data from a national survey we tested the hypothesis that religion raised predicts access to and utilization of a regular medical care provider, examinations, HIV and other STD testing and counseling at ages 18-44 years in men born between 1958 and 1984. We also hypothesized that religion raised would be more predictive of utilization for Hispanic Americans and non-Hispanic Black Americans than for non-Hispanic White Americans. The study included a national sample of 4276 men aged 18-44 years. Descriptive and multivariate statistics were used to assess the hypotheses using data on religion raised and responses to 14 items assessing health care access and utilization. Compared to those raised in no religion, those raised mainline Protestant were more likely (p < 0.01) to report a usual source of care (67% vs. 79%), health insurance coverage (66% vs. 80%) and physical examination (43% vs. 48%). Religion raised was not associated with testicular exams, STD counseling or HIV testing. In multivariate analyses controlling for confounders, significant associations of religion raised with insurance coverage, a physician as usual source of care and physical examination remained which varied by race/ethnicity. In conclusion, although religion is a core aspect of culture that deserves further study as a possible determinant of health care utilization, we were not able to document any consistent pattern of significant association even in a population with high rates of religious participation.

Smokeless tobacco use and religiousness.

Although smoking shows a strong negative association with religiousness, no studies have appeared of use of smokeless tobacco (ST) and religiousness. To assess an association of use of ST and religiousness, data from 9,374 men aged 17 years and over with complete data on self-reported frequency of attendance at religious services and use of smokeless tobacco were analyzed. Among men aged 17-29 years, 4.9% of frequent attenders (>or=24 times/y) and 9.4% of others (<24 times/y) were current users of ST (p=0.002). After adjusting for multiple confounders by logistic regression, infrequent attenders were twice as likely as frequent attenders to be ST users: odds ratio 2.09, 95% confidence limits 1.12-3.92, p=0.02. This negative association suggests a protective effect of early-life religiousness on ST use, which might be taken into account in planning ST prevention efforts.

Stages and sequences of initiation and regular substance use in a longitudinal cohort of black and white male adolescents.

OBJECTIVE: This study examined whether developmental sequences and stages of substance-use initiation and regular use differed and, if so, whether they varied for black and white adolescent males. METHOD: The analyses were based on a cohort of inner-city boys in the Pittsburgh public schools, who had been followed prospectively from ages 7 to 19 across 18 data waves (N = 412). RESULTS: Blacks were most likely to end initiation of any use and regular use with marijuana, whereas alcohol and tobacco were the most common end stage drugs for whites. Whites were also more likely than blacks to initiate and to become regular users of hard drugs. For both races, the typical developmental sequence for substance-use initiation and regular use was alcohol and/or tobacco, then marijuana, and then hard drugs. However, blacks were more likely to deviate from this sequence than were whites. Participants who initiated any substance use faced a high probability of becoming a regular user of at least one substance. CONCLUSIONS: There were differences in the sequences and stages of substance-use initiation and regular use by race. Further research is needed to identify the antecedents of escalation to regular use and progression of regular use across substances and to delineate the cultural and environmental factors that affect substance-use progression.

Building effective programs to improve men's health.

Historically, the health care needs of poor men and men of color have been neglected in the United States, resulting in significant disparities in health and health outcomes. Dedicated resources to address the particular needs of men are necessary to eliminate the health disparities that afflict underserved men. The following article compiles and shares some of the lessons learned as experienced by three Community Voices sites that have been active in men's health. Community Voices Miami's Overtown Men's Health Study, Denver Health Men's Health Initiative, and Baltimore Men's Health Center are working to address the health needs of men in some of the most vulnerable communities in the United States. Examples of community-specific assessment of men's needs, community engagement, service delivery, service to special populations, marketing, addressing sustainability, and advances in public policy to improve men's health are presented.