The Use and Outcomes of 3D Printing in Pediatric Craniofacial Surgery: A Systematic Review.

Three-dimensional (3D) printing has demonstrated efficacy in multiple surgical specialties. As accessibility improves, its use in specific fields deserves further attention. We conducted a systematic review of the implementation and outcomes of 3D printing in pediatric craniofacial surgery, as none has been performed. A systematic review was conducted according to Cochrane and PRISMA guidelines. PubMed, Embase, Cochrane library, and Clinicaltrials.gov were queried with combinations of the terms: "3D printing," "craniofacial," "surgery," and "pediatric." Original human studies containing patients <18 years old implementing 3D printing to aid in craniofacial surgery were included. Study selection, grading, and data extraction were performed independently by multiple authors. After screening 120 articles, 7 (3 case series and 4 case reports) were included, published from 2017 to 2022. All studies addressed patients with different disease processes including craniosynostosis, cleft lip/palate, and mandibular hypoplasia. 3D printing was used to create mock surgical models in 2 studies, intraoperative cutting guides/molds (CGs) in 6 studies, and cranioplasty implants in 2 studies. Two case series determined the accuracy of the CGs was acceptable within historical comparison, while 4 articles included subjective statements on improved accuracy. Five studies noted reduced operating time, 2 noted reduced intraoperative blood loss, and 1 felt the use of 3D printed materials was responsible for shorter hospitalization duration. No adverse events were reported. Despite the limitations of the current literature, all studies concluded that the use of 3D printing in pediatric craniofacial surgery was beneficial. Definitive conclusions cannot be made until further controlled research is performed.

Risk Factors for Pediatric Facial Trauma in an Appalachian Region: An Epidemiological Review at a Single Institution.

BACKGROUND: Rural and low-income pediatric populations are at higher risk for trauma. Craniomaxillofacial (CMF) trauma in this population has not been studied. PURPOSE: This study's purpose was to determine if rural populations or low-income populations are at higher risk for pediatric CMF trauma than urban or high-income populations, respectively, and to determine differences in mechanism of injury (MOI). STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study of CMF trauma patients younger than 17 years-old, living in the region served by one institution in Tennessee, and requiring oral and maxillofacial surgery consultation between January 2011 and December 2022 was performed. Exclusion criteria were incomplete medical records. PREDICTOR VARIABLE: The primary predictor variable was geographic residence of the patient grouped into two categories: rural or urban defined by the state of Tennessee. Secondary variables were postal code (PC) average median household income (MHI) and PC population density. MAIN OUTCOME VARIABLE(S): The main outcome variable was pediatric CMF injury rate per 100,000 people. MOI is a secondary outcome variable. COVARIATE(S): Covariates included sex, age, and race. ANALYSES: Frequencies and percentages, Fisher's exact test, and Poisson regression models were utilized. Statistical significance was assumed at P-value <.05. RESULTS: Rural or urban county designation was not associated with differing trauma rates (incident risk ratio (IRR) = 0.91; 95% confidence interval (CI) 0.78 to 1.05; P = .18) by itself. One standard deviation increase in MHI decreased CMF trauma rates in rural designation counties by 24% (IRR: 0.76, 95% CI: 0.66, 0.88) and 6% in urban designation counties (IRR: 0.94, 95% CI: 0.87, 1.02). Lower rates of CMF trauma were associated with residence in higher income PCs (IRR = 0.91; 95% (CI) 0.86 to 0.97; P = .004), and higher population density (IRR = 0.87; 95% CI 0.79 to 0.94; P < .001). Dog bites and falls were more common in infancy and early childhood. Interpersonal violence was more common in older patients. CONCLUSIONS AND RELEVANCE: Patients in PCs with lower population density or incomes were at highest risk for CMF injuries. MOI differences by age were similar to findings in other studies. Tennessee's urban/rural county designation has complex interactions with MHI and pediatric CMF trauma rates.

Preoperative Nutritional Laboratory Values, Demographics, and Wound Healing Following Facial Trauma Surgery: Which Variables Predict Postoperative Complications?

In individuals who have sustained maxillofacial trauma, inadequate nutrition is often a sequela and may lead to complications. The purpose of this study was to investigate the association between preoperative laboratory values and postoperative complications in patients with maxillofacial trauma requiring surgical intervention. A retrospective cohort study of patients with maxillofacial trauma requiring surgical repair from 2014 to 2020 was performed at a single academic Level I Trauma Center. The primary predictor variables were preoperative laboratory values including serum albumin, white blood cell count, absolute neutrophil count, and lymphocyte count. Complications related to surgical reconstruction of facial injuries represented the primary outcome variable. The patient cohort included 152 patients, of whom 50 (32.9%) were female. When controlling for all other variables, female gender (odds ratio=2.08, 95% confidence interval, 1.02-4.21; P =0.04) and number of procedures performed ( P =0.02) were the only statistically significant predictors of postoperative complications. There were no significant differences between the complication groups for age ( P =0.89), injury severity score ( P =0.59), hospital length of stay ( P =0.30), serum albumin ( P =0.86), hemoglobin ( P =0.06), white blood cell count ( P =0.20), absolute neutrophil count ( P =0.95), lymphocyte count ( P =0.23), or absolute neutrophil/lymphocyte count ratio ( P =0.09). In this study, it was found that only gender and the number of procedures performed significantly predicted postoperative complications, while preoperative nutritional laboratory values did not. Further study with a larger cohort of patients is likely required.

Scientific diasporas and the advancement of science diplomacy: The InFEWS US-China program in the face of confrontational "America First" diplomacy.

The challenges and consequences of climate change have brought together governments around the world to advance scientific knowledge and programmatic actions to develop mitigation strategies while promoting sustainable development. The United States and China-the countries with the highest science expenditures globally-have historically developed a range of joint international research collaborations. However, under the "America First" agenda put forth by the Trump Administration, bilateral diplomatic relations with China reached their highest confrontational peak. Under this scenario science diplomacy served as a catalyst to maintain scientific collaborations between both countries. In 2018, the US National Science Foundation and the China National Natural Science Foundation launched the InFEWS US-China program to promote collaborations to expand food, energy, and water nexus (FEW Nexus) research and applications. Over the past four years, 20 research projects have been awarded from the US side and 47 publications have been reported as research output. By carrying out a descriptive analysis of the InFEWS US-China research and scholarly outputs, we find evidence of the crucial role played by the Chinese scientific diaspora who led 65% of the projects awarded. We find that there is a generally good understanding of the interdependencies between FEW systems included in the project abstracts. However, in the InFEWS US-China scholarly outputs generated to date, there is a lack of usage of a clear FEW Nexus theoretical framework. Further research should address intentional policies that enhance the involvement of scientific diasporas in their home countries to better address climate, sustainability, and development challenges.

Hydrodiplomacy and adaptive governance at the U.S.-Mexico border: 75 years of tradition and innovation in transboundary water management.

The United States and Mexico have engaged in hydrodiplomacy-a practice of transboundary water management that blends water diplomacy and science diplomacy--for more than 75 years, since the adoption of the Treaty of 1944 and the creation of the International Boundary and Water Commission. We examine six major turning points in U.S.-Mexico hydrodiplomacy to ascertain the key factors in the region's history of resolving transboundary water issues. We find that recognized adaptive governance indicators-such as social learning, sustained relationships, flexible governance mechanisms, and state and non-state networks are essential elements of hydrodiplomacy. Our research suggests that robust and foundational institutions comprise another key indicator of adaptive governance specifically in transboundary contexts. A commitment to both science and diplomacy have been important components underlying the effectiveness of hydrodiplomacy in the border region. Binational networks involving diverse state and non-state actors at multiple scales have increasingly played a pivotal role in shaping desirable hydrodiplomatic outcomes in the region.

Dialogic science-policy networks for water security governance in the arid Americas.

Addressing wicked problems challenging water security requires participation from multiple stakeholders, often with conflicting visions, complicating the attainment of water-security goals and heightening the need for integrative and effective science-policy interfaces. Sustained multi-stakeholder dialogues within science-policy networks can improve adaptive governance and water system resilience. This paper describes what we define as "dialogic science-policy networks," or interactions -- both in structural and procedural terms -- between scientists and policy-makers that are: 1) interdisciplinary, 2) international (here, inter-American), 3) cross-sectoral, 4) open, 5) continual and iterative in the long-term, and 6) flexible. By fostering these types of interactions, dialogic networks achieve what we call the 4-I criteria for effective science-policy dialogues: inclusivity, involvement, interaction, and influence. Here we present several water-security research and action projects where some of these attributes may be present. Among these, a more comprehensive form of a dialogic network was intentionally created via AQUASEC, a virtual center and network initially fostered by a series of grants from the Inter-American Institute for Global Change Research. Subsequently, AQUASEC has significantly expanded to other regions through direct linkages and additional program support for the International Water Security Network, supported by Lloyd's Register Foundation and other sources. This paper highlights major scientific and policy achievements of a notable suite of science-policy networks, shared practices, methods, and knowledge integrating science and policy, as well as the main barriers overcome in network development. An important gap that remains for future research is the assessment and evaluation of dialogic science-policy networks' long-term outcomes.

Acute and Chronic Suppurative Osteomyelitis of the Jaws: A 10-Year Review and Assessment of Treatment Outcome.

PURPOSE: To review cases of suppurative osteomyelitis of the jaws treated at the Massachusetts General Hospital (Boston, MA) over a 10-year period, evaluate specifics of disease presentation, and answer the clinical question: are there identifiable variables associated with treatment outcome? MATERIALS AND METHODS: A retrospective cohort study was completed using patients treated for suppurative osteomyelitis of the jaws at the Massachusetts General Hospital from April 2006 to October 2016. Inclusion criteria were a diagnosis of suppurative osteomyelitis of the jaw, age older than 18 years, and complete medical records. Patients with nonsuppurative disease, radiation history, or antiresorptive exposure were excluded. Candidate variables included demographic information, medical and dental history, presenting signs and symptoms, and radiologic and laboratory findings. The outcome variable was successful treatment, defined as resolution of symptoms and radiographic evidence of healing after initial treatment. Appropriate statistical analyses were performed with significance set a P value less than .05. RESULTS: Forty-two patients met the inclusion criteria. Mean age was 53 years (range, 20 to 80 yr) and 26 were women (62%). Common comorbidities included cardiovascular disease (52%), tobacco use (45%), and psychiatric disorders (45%). Pain (90%), swelling (86%), and neurosensory change (50%) were the most common findings. Common microbacterial isolates included Streptococcus milleri (74%) and coagulase-negative Staphylococcus species (43%), which showed marked antibiotic resistance. Surgical debridement was the most common intervention (93%). Successful treatment was found in 86%. Of 6 persistent cases, 4 resolved with a second debridement and continued antibiotics and 2 required resection. Increased white blood cell (WBC) count at presentation (P = .005) and associated psychiatric diagnoses (P = .037) were statistically associated with unsuccessful initial treatment. CONCLUSION: The results of this study indicate that antibiotic resistance is commonly encountered in this patient population, although it was not associated with unsuccessful outcome. Patients presenting with increased WBC count and concurrent psychiatric comorbidities required protracted treatment.

Traffic-related trace elements in soils along six highway segments on the Tibetan Plateau: Influence factors and spatial variation.

The accumulation of traffic-related trace elements in soil as the result of anthropogenic activities raises serious concerns about environmental pollution and public health. Traffic is the main source of trace elements in roadside soil on the Tibetan Plateau, an area otherwise devoid of industrial emissions. Indeed, the rapid development of tourism and transportation in this region means it is becoming increasingly important to identify the accumulation levels, influence distance, spatial distribution, and other relevant factors influencing trace elements. In this study, 229 soil samples along six segments of the major transportation routes on the Tibetan Plateau (highways G214, S308, and G109), were collected for analysis of eight trace elements (Cr, Co, Ni, As, Cu, Zn, Cd, and Pb). The results of statistical analyses showed that of the eight trace elements in soils, Cu, Zn, Cd, and Pb were primarily derived from traffic. The relationship between the trace element accumulation levels and the distance from the roadside followed an exponential decline, with the exception of Segment 3, the only unpaved gravel road studied. In addition, the distance of influence from the roadside varied by trace element and segment, ranging from 16m to 144m. Background values for each segment were different because of soil heterogeneity, while a number of other potential influencing factors (including traffic volume, road surface material, roadside distance, land cover, terrain, and altitude) all had significant effects on trace-element concentrations. Overall, however, concentrations along most of the road segments investigated were at, or below, levels defined as low on the Nemero Synthesis index.

Sustained Empathic Focus and the Creation of a "We Space" Revisited in the Light of Recent Findings in Neurobiology.

This article is an attempt to expand our understanding of the curative process with an emphasis on the group therapy setting. It presents a self psychological approach that underlines the importance of a "sustained empathic focus" on each patient's subjective experience and the creation of what we have referred to as shared "vulnerable moments" and a "we-space." The relationship of our approach to recent findings in the field of neurobiology is then considered.