Gentrification drives patterns of alpha and beta diversity in cities.

While there is increasing recognition that social processes in cities like gentrification have ecological consequences, we lack nuanced understanding of the ways gentrification affects urban biodiversity. We analyzed a large camera trap dataset of mammals (>500 g) to evaluate how gentrification impacts species richness and community composition across 23 US cities. After controlling for the negative effect of impervious cover, gentrified parts of cities had the highest mammal species richness. Change in community composition was associated with gentrification in a few cities, which were mostly located along the West Coast. At the species level, roughly half (11 of 21 mammals) had higher occupancy in gentrified parts of a city, especially when impervious cover was low. Our results indicate that the impacts of gentrification extend to nonhuman animals, which provides further evidence that some aspects of nature in cities, such as wildlife, are chronically inaccessible to marginalized human populations.

Idiopathic Fistula in an Unrepaired Submucous Cleft Palate.

Palatal fistulae are a recognised complication in individuals who have undergone surgical repair of a cleft palate, however, congenital or idiopathic palatal fistulae are rare. This report discusses the presentation and treatment of a 16-year-old female with a submucous cleft palate, who presented with a recent onset change in speech and evidence of a new palatal fistula. There was no history of recent infection or known trauma, and the patient had not undergone any previous palatal surgery. This report discusses the clinical presentation, recommended management and relevant literature for this rare phenomenon.

The Cleft Lip Education with Augmented Reality (CLEAR) VR Phase 2 Trial: A Pilot Randomized Crossover Trial of a Novel Patient Information Leaflet.

BACKGROUND: The Cleft Lip Education with Augmented Reality (CLEAR) project centers around the use of augmented reality (AR) in patient leaflets, as a visual means to overcome the "health literacy" gap. This trial followed Virtual Reality (VR CORE) guidelines for VR Phase 2 (Pilot) trials. METHODS: Participants included families of children treated for Cleft Lip and Palate at the Royal Hospital for Children, Glasgow. Interventions were AR leaflet or Traditional Leaflet. Objectives were to calculate sample sizes, assess outcome instruments, trial design, and acceptability to patients. Primary outcome measure was Mental Effort Rating Scale, and secondary outcomes were Patient Satisfaction (Visual Analogue Scale), Usefulness Scale for Patient Information Material (USE) scale, and Instructional Materials Motivation Survey (IMMS). Randomization was by block randomization. The trial was single blinded with assessors blinded to group assignment. RESULTS: 12 Participants were randomized, with crossover design permitting analysis of 12 per group. Primary outcome with Mental Effort Rating Scale indicated higher mental effort with Traditional compared to AR Leaflet (4.75 vs 2.00, P = .0003). Secondary outcomes for Satisfaction were Traditional 54.50 versus AR 93.50 (P = .0001); USE scale 49.42 versus 74.08 (P = .0011); and IMMS 112.50 versus 161.75 (P = .0003). Subjective interviews noted overwhelmingly positive patient comments regarding the AR leaflet. Outcome instruments and trial design were acceptable to participants. No harms were recorded. CONCLUSIONS: The CLEAR pilot trial provides early evidence of clinical efficacy of AR leaflets in patient education. It is hoped that this will provide a future paradigm shift in the way patient education is delivered.

Landscape-scale differences among cities alter common species' responses to urbanization.

Understanding how biodiversity responds to urbanization is challenging, due in part to the single-city focus of most urban ecological research. Here, we delineate continent-scale patterns in urban species assemblages by leveraging data from a multi-city camera trap survey and quantify how differences in greenspace availability and average housing density among 10 North American cities relate to the distribution of eight widespread North American mammals. To do so, we deployed camera traps at 569 sites across these ten cities between 18 June and 14 August. Most data came from 2017, though some cities contributed 2016 or 2018 data if it was available. We found that the magnitude and direction of most species' responses to urbanization within a city were associated with landscape-scale differences among cities. For example, eastern gray squirrel (Sciurus carolinensis), fox squirrel (Sciurus niger), and red fox (Vulpes vulpes) responses to urbanization changed from negative to positive once the proportion of green space within a city was >~20%. Likewise, raccoon (Procyon lotor) and Virginia opossum (Didelphis virginiana) responses to urbanization changed from positive to negative once the average housing density of a city exceeded about 700 housing units/km2 . We also found that local species richness within cities consistently declined with urbanization in only the more densely developed cities (>~700 housing units/km2 ). Given our results, it may therefore be possible to design cities to better support biodiversity and reduce the negative influence of urbanization on wildlife by, for example, increasing the amount of green space within a city. Additionally, it may be most important for densely populated cities to find innovative solutions to bolster wildlife resilience because they were the most likely to observe diversity losses of common urban species.

Ballast Water Exchange Plus Treatment Lowers Species Invasion Rate in Freshwater Ecosystems.

The movement of ballast water by commercial shipping is a prominent pathway for aquatic invasions. Ships' ballast water management is now transitioning from open ocean exchange to a ballast water performance standard that will effectively require use of onboard treatment systems. Neither strategy is perfect, therefore, combined use of ballast water exchange plus treatment has been suggested to provide greatest protection of aquatic ecosystems. This study compared the performance of exchange plus treatment against treatment alone by modeling establishment rates of nonindigenous zooplankton introduced by ballast water across different habitat types (fresh, brackish, and marine) in Canada. Treatment was modeled under two efficacy scenarios (100% and 50% of ship trips) to consider the possibility that treatment may not always be successful. The model results indicate that exchange plus treatment will be more effective than treatment alone at reducing establishments when recipient ports are freshwater (58 140 vs 11 338 trips until ≥1 establishment occurs, respectively). Exchange plus treatment also serves as an important backup strategy if treatment systems are partially effective (50% of trips), primarily for freshwater recipient ecosystems (1442 versus 585 trips until ≥1 establishment occurs, respectively).

Improving the Signal-To-Noise Ratio When Monitoring Countermovement Jump Performance.

ABSTRACT: Kennedy, RA and Drake, D. Improving the signal-to-noise ratio when monitoring countermovement jump performance. J Strength Cond Res 35(1): 85-90, 2021-Countermovement jump (CMJ) performance has been routinely used to monitor neuromuscular status. However, the protocol used to establish the criterion score is not well documented. The purpose of this study was to examine how the protocol used would influence of the sensitivity of CMJ variables in rugby union players. Fifteen male (age: 19.7 ± 0.5 years) rugby union players performed 8 CMJs on 2 occasions, separated by 7 days. The between-session coefficient of variation (CV) was calculated using 2 techniques for treating multiple trials, the average, and the trial with the best jump height (JH), and then compared with the smallest worthwhile change (SWC). The signal-to-noise ratio was measured as the group mean change in a variable divided by the CV. Using the average value across multiple trials is superior to the best trial method, based on lower CVs for all variables. Only the average performance across 6 or more trials was classified as ideal (CV < 0.5 × SWC) for peak velocity (PV). In addition, the signal-to-noise ratio for peak concentric power (PCP), PV, and JH were classified as good, irrespective of the treatment method. Although increasing the number of trials can reduce the random error, it may be pragmatic to simply take the average from 2 to 3 trials, facilitating a CV < SWC for PV, PCP, and JH. Due to its simplicity, JH may be considered the principal variable to monitor neuromuscular fatigue.

Treatment Experiences in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom.

OBJECTIVES: Adults with cleft lip and/or palate (CL/P) may report dissatisfaction with aesthetic and/or functional outcomes and express desire for further treatment. Although medical intervention can improve quality of life, surgical procedures require complex decision-making and can invoke psychological distress. The aim of this study was to gain a better understanding of ongoing treatment-related support needs by examining self-reported treatment experiences of a sample of adults born with CL/P. DESIGN: An online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics. RESULTS: Although participants were satisfied with surgical and dental/orthodontic outcomes overall, many reported ongoing difficulties. Some stated they would seek further treatment while others felt conflicted about risks and benefits. Some had refused treatment, citing treatment fatigue, anxiety, and/or concerns that treatment would be unsuccessful. More than 40% of participants were unaware of their entitlement to cleft-related treatment provided by the National Health Service, and many others had experienced difficulties accessing care. CONCLUSIONS: Although advances in health care may offer opportunities for adults to improve their quality of life, treatment decisions should be weighed with the support of a clinical psychologist where available. Guidance for young adults considering future treatment is also recommended. Finally, training and resources for local practitioners may improve general awareness of CL/P services and increase access to specialist care for adults with ongoing CL/P-related concerns.

Patient Feedback on the Effectiveness of Auricular Acupuncture on Pain in Routine Clinical Care: The Experience of 11,406 Veterans.

OBJECTIVES: Veterans Health Administration (VHA) launched a national initiative to train providers in a specific, protocolized auricular acupuncture treatment (also called Battlefield Acupuncture or BFA) as a nonpharmacological approach to pain management. This evaluation assessed the real-world effectiveness of BFA on immediate pain relief and identified subgroups of patients for whom BFA is most effective. RESEARCH DESIGN: In a cross-sectional cohort study, electronic medical record data for 11,406 Veterans treated with BFA at 57 VHA medical centers between October 2016 and September 2018 was analyzed. The multivariate analysis incorporated data on pain history, change in pain level on an 11-point scale, complications, and demographic information. METHODS: A total of 11,406 Veterans were treated with BFA at 57 VHA medical centers between October 2016 and September 2018 and had effectiveness data recorded in their electronic medical record. RESULTS: More than 3 quarters experienced immediate decreases in pain following administration of BFA, with nearly 60% reported experiencing a minimal clinically important difference in pain intensity. The average decrease in pain intensity was -2.5 points (SD=2.2) at the initial BFA treatment, and -2.2 points (SD=2.0) at subsequent treatments. BFA was effective across a wide range of Veterans with many having preexisting chronic pain, or physical, or psychological comorbid conditions. Veterans with opioid use in the year before BFA experienced less improvement, with pain intensity scores improving more among Veterans who had not recently used opioids. CONCLUSION: VHA's rapid expansion of training providers to offer BFA as a nonpharmacological approach to pain management has benefited many Veterans.

Digital Pulley Reconstruction Using Pulley Allografts: A Comparison With Traditional Tendon-Based Techniques.

BACKGROUND: The safety and feasibility of sterile, acellular pulley allografts in reconstruction has been previously demonstrated. Comparisons with tendon-based techniques for pulley reconstruction have not been reported. We hypothesized that the use of allograft pulleys would result in reduced procedural time and equivalent clinical outcomes as compared with traditional tendon-based reconstructive techniques. METHODS: All cases of pulley reconstruction using either allograft pulleys or tendon-based pulley reconstruction between November 2013 and November 2015 were reviewed. Patients who underwent concomitant procedures were excluded. Patient demographics, comorbidities, operative details (tourniquet and total operative times, number of pulleys repaired), postoperative complications (surgical site infection, reoperation, stiffness, and persistent pain), disability of the arm, shoulder and hand scores, and follow-up data were recorded. A P value of <0.05 was considered significant. RESULTS: Fifteen pulleys in 10 patients were reconstructed: 5 tendon-based and 5 with allograft. Average length of follow-up was 12.5 ± 2.9 months. There was no difference in patient demographic factors or comorbidities between groups. The most common indication for surgery was trauma. Four of 5 patients in the allograft group had multiple pulleys reconstructed versus 1 in the tendon-based group. One patient in the tendon-based group required reoperation versus 0 in the allograft group. Total operative and tourniquet times were significantly reduced in the allograft group (46 ± 5.5 vs 89 ± 12.9 minutes and 34 ± 6.8 vs 63 ± 5.3 minutes; P = 0.015 and 0.014). Postoperative disability of the arm, shoulder and hand scores were lower in the allograft group (56.8 vs 3.6, P = 0.11). There was no significant difference in postoperative range of motion between groups. CONCLUSION: Pulley reconstruction with allograft is an efficient, technically feasible, reconstructive technique that adheres to the principle of replacing like with like, while eliminating donor site morbidity. Overall operative and tourniquet times were significantly shorter using allograft pulleys for pulley reconstruction.

Measuring what matters in isometric multi-joint rate of force development.

This study aimed to evaluate responsiveness (ability to detect change) of isometric force-time measures to neuromuscular fatigue in resistance-trained participants using two differing protocols that modified both the instructions provided to participants and the duration of the test. Both protocols were completed at two knee joint angles in the isometric squat test. Ten participants volunteered to take part in this study (age: 27.0 ± 4.5 years, strength training experience: 7.7 ± 2.6 years). Isometric peak force (ISqTpeak) and isometric explosive force (ISqTexp) test protocols were assessed at two joint angles (knee angle 100° and 125°) pre-high intensity strength training, immediately post strength training, 24-h post, 48-h post and analysed for peak and RFD performance. Participants completed eight sets of three repetitions of the back-squat exercise as the high-intensity strength training. Results showed the highest standardised response means (SRM) detected was peak force using the ISqTpeak 100, SRM -1.97 compared to an SRM of -1.31 for RFD 200 ms in the ISqTexp 125. Peak force was the most responsive variable using the ISqTpeak protocol, whereas the ISqTexp protocol was most responsive for RFD measures. Therefore, ISqTpeak and ISqTexp test protocols should not be used interchangeably to evaluate RFD variables.

Multi-joint rate of force development testing protocol affects reliability and the smallest detectible difference.

Isometric tests have been used to assess rate of force development (RFD), however variation in testing methodologies are known to affect performance outcomes. The aim of this study was to assess the RFD in the isometric squat (ISqT) using two test protocols and two testing angles. Eleven participants (age: 26.8 ± 4.5 years, strength training experience: 7.1 ± 3.03 years) completed test and retest sessions one week apart, whereby two test protocols with respect to duration and instructions were compared. Isometric peak force (ISqTpeak) and isometric explosive force (ISqTexp) tests were assessed at two joint angles (knee flexion angle 100° and 125°). Force-time traces were sampled and subsequently analysed for RFD measures. Average and instantaneous RFD variables did not meet reliability minimum criteria in ISqTpeak at 100° or 125°. The ISqTexp test at 100° met reliability criteria in the RFD 0-200 and 0-250ms variables. The ISqTexp test at 125° met reliability criteria in the RFD 0-150, 0-200 and 0-250ms variables. Force-time characteristics were optimized at the higher knee joint angle. Average and instantaneous RFD measures obtained using a traditional peak force test do not meet basic reliability criteria. Researchers assessing multi-joint RFD should employ the explosive RFD test protocol as opposed to the traditional isometric peak force protocol.

Familiarization, validity and smallest detectable difference of the isometric squat test in evaluating maximal strength.

Isometric multi-joint tests are considered reliable and have strong relationships with 1RM performance. However, limited evidence is available for the isometric squat in terms of effects of familiarization and reliability. This study aimed to assess, the effect of familiarization, stability reliability, determine the smallest detectible difference, and the correlation of the isometric squat test with 1RM squat performance. Thirty-six strength-trained participants volunteered to take part in this study. Following three familiarization sessions, test-retest reliability was evaluated with a 48-hour window between each time point. Isometric squat peak, net and relative force were assessed. Results showed three familiarizations were required, isometric squat had a high level of stability reliability and smallest detectible difference of 11% for peak and relative force. Isometric strength at a knee angle of ninety degrees had a strong significant relationship with 1RM squat performance. In conclusion, the isometric squat is a valid test to assess multi-joint strength and can discriminate between strong and weak 1RM squat performance. Changes greater than 11% in peak and relative isometric squat performance should be considered as meaningful in participants who are familiar with the test.

Dissociated Time Course of Recovery Between Strength and Power After Isoinertial Resistance Loading in Rugby Union Players.

Kennedy, RA and Drake, D. Dissociated time course of recovery between strength and power after isoinertial resistance loading in rugby union players. J Strength Cond Res 32(3): 748-755, 2018-There is a substantial amount of research on the responses to isometric and eccentric loading. However, only a paucity of literature exists on the responses to isoinertial loading, especially in trained athletic populations using realistic loading protocols. The purpose of this study was to examine the acute neuromuscular response to a bout of isoinertial resistance loading in elite rugby players. Seventeen male (age: 19.5 ± 2.3 years) rugby union players performed a conventional maximal isoinertial resistance loading protocol. Countermovement jump (CMJ) and maximal voluntary isometric contraction (MVC) squat performance were measured on 3 occasions: at baseline, immediately post, and 48 hour post. The results indicated that the decrease in MVC (9.7%) is greater than or comparable with the CMJ output variables (4.2-10.3%), immediately postexercise. Although isometric strength had demonstrated a full recovery at 48 hour post, many of the key CMJ output variables were still impaired (p ≤ 0.05). Similar findings were observed in the normalized CMJ curves. Complete recovery of the ability to rapidly produced force may require more than 48 hours in many athletes. Individual responses should, therefore, be monitored to help plan acute and chronic training loads. It is recommended that future fatigue studies should incorporate temporal phase analyses to consider the power-, force-, velocity-, and displacement-time curves.

Cleft Repair in Adults: A Report on a Case Series.

Speech defects and facial appearance due to untreated cleft lip and/or palate in the elderly population have associated life-long impacts on the quality of life for these patients. Treatment and rehabilitation in this patient group can be extensive and the problems not easily corrected. We report the outcomes of surgical repair of cleft in a series of elderly patients with unrepaired cleft lip and/or palate. Our results confirm an improvement in speech, quality of life and aesthetic outcomes after surgical repair in these patients. With this in mind, we advise cleft teams to consider surgical repair of untreated cleft lip and/or palate in the elderly population.

Are the mutans streptococci still considered relevant to understanding the microbial etiology of dental caries?

The mutans streptococci were once the primary focus of research dedicated to understanding the etiology of dental caries. That focus has now shifted to an emphasis on the ecological balances and complexities within the entirety of the plaque microbiome. Within that framework there are considerable differences of opinion regarding the importance and relative contributions of the mutans streptococci. This article explores the basis for the various viewpoints, the limitations of current knowledge, and the confounders that make it difficult to arrive at a consensus.

Abdominal Wall Allograft: Preclinical Biomechanical Investigation of a Novel Reconstructive Adjunct.

INTRODUCTION: Acellular dermal matrices have revolutionized abdominal wall reconstruction; however, device failure and hernia recurrence remain significant problems. Fascia grafts are a reconstructive adjunct with increased tensile strength compared with acellular dermal matrices; however, clinical use is limited by insufficient donor material and donor site morbidity. To this end, we investigate the biomechanical properties of human abdominal wall allografts (AWAs) consisting of the anterior rectus sheath from xiphoid to pubis. METHODS: After cadaveric procurement of 6 human AWAs, the tissue was divided horizontally and a matched-sample study was performed with specimens randomized to 2 groups: fresh, unprocessed versus processed with gamma irradiation and decellularization. Specimens were evaluated for physical properties, DNA content, tensile strength, and electron microscopy. RESULTS: All AWA donors were male, with a mean age of 55.2 years (range, 35-74 years). Procured AWAs had a mean length of 21.70 ± 1.8 cm, width of 14.30 ± 1.32 cm, and area of 318.50 cm, and processing resulted in a 98.3% reduction in DNA content. Ultimate tensile strength was significantly increased after tissue processing, and after subcutaneous implantation, processed AWA demonstrated 4-fold increased tensile strength compared with unprocessed AWAs. CONCLUSIONS: Acellular AWAs represent a novel reconstructive adjunct for abdominal wall reconstruction with the potential of replacing "like with like" without additional donor site morbidity or antigenicity.

Longitudinal Study Assessing Factors Associated with Mutans Streptococci Acquisition in Infants and Toddlers.

PURPOSE: To assess the role of sociodemographic, dietary, and clinical factors in early mutans streptococci (MS) colonization in children aged 6 to 24 months who were followed for 18 months. MATERIALS AND METHODS: Ninety-four children (mean age: 11.5 ± 4.99 months at baseline) were enrolled in the study from the Women, Infants and Children Supplemental Nutrition Program during 2003-2004. Salivary MS levels of the children were determined at baseline and at 18 months using a semi-quantitative method. Detailed information about the children's beverage consumption pattern, dietary behavior, and clinical information about oral health status was collected at baseline, 9 months, and 18 months. None of the children included in this study had detectable levels of MS at baseline. RESULTS: Of the 94 children at baseline, 36 (38%) had acquired MS by the 18-month follow-up. The presence of >5 teeth [OR = 3.55 (1.46-9.04); p = 0.0062] was a significant risk factor for MS acquisition among the baseline variables. At 9 months, sports drinks consumption [OR = 5.56 (1.39-26.26); p = 0.0143] and presence of caries [OR = 9.36 (2.55-40.90); p < 0.0001] were significantly associated with MS colonization at 18 months. Higher maternal education [OR = 0.3 (0.07-1.36); p = 0.0351] was a protective factor at all the time points. CONCLUSION: Sugared beverage consumption, tooth-related factors, and lower maternal education can predict MS acquisition in young children.

Protein Analysis of Sapienic Acid-Treated Porphyromonas gingivalis Suggests Differential Regulation of Multiple Metabolic Pathways.

UNLABELLED: Lipids endogenous to skin and mucosal surfaces exhibit potent antimicrobial activity against Porphyromonas gingivalis, an important colonizer of the oral cavity implicated in periodontitis. Our previous work demonstrated the antimicrobial activity of the fatty acid sapienic acid (C(16:1Δ6)) against P. gingivalis and found that sapienic acid treatment alters both protein and lipid composition from those in controls. In this study, we further examined whole-cell protein differences between sapienic acid-treated bacteria and untreated controls, and we utilized open-source functional association and annotation programs to explore potential mechanisms for the antimicrobial activity of sapienic acid. Our analyses indicated that sapienic acid treatment induces a unique stress response in P. gingivalis resulting in differential expression of proteins involved in a variety of metabolic pathways. This network of differentially regulated proteins was enriched in protein-protein interactions (P = 2.98 × 10(-8)), including six KEGG pathways (P value ranges, 2.30 × 10(-5) to 0.05) and four Gene Ontology (GO) molecular functions (P value ranges, 0.02 to 0.04), with multiple suggestive enriched relationships in KEGG pathways and GO molecular functions. Upregulated metabolic pathways suggest increases in energy production, lipid metabolism, iron acquisition and processing, and respiration. Combined with a suggested preferential metabolism of serine, which is necessary for fatty acid biosynthesis, these data support our previous findings that the site of sapienic acid antimicrobial activity is likely at the bacterial membrane. IMPORTANCE: P. gingivalis is an important opportunistic pathogen implicated in periodontitis. Affecting nearly 50% of the population, periodontitis is treatable, but the resulting damage is irreversible and eventually progresses to tooth loss. There is a great need for natural products that can be used to treat and/or prevent the overgrowth of periodontal pathogens and increase oral health. Sapienic acid is endogenous to the oral cavity and is a potent antimicrobial agent, suggesting a potential therapeutic or prophylactic use for this fatty acid. This study examines the effects of sapienic acid treatment on P. gingivalis and highlights the membrane as the likely site of antimicrobial activity.

Medical Student and Primary Care Physician Perception of the Surgical Management of Upper- and Lower-Extremity Peripheral Nerve Entrapment.

BACKGROUND: Upper- and lower-extremity peripheral neuropathies are commonly encountered in the primary care setting and account for 14.3 million specialist referrals in the United States annually. Despite the integral role of plastic surgeons in the development of the field of peripheral nerve surgery, plastic surgeons are not commonly recognized as peripheral nerve specialists. The purpose of this study was to investigate the pattern of diagnosis, treatment, and referral of upper- and lower-extremity peripheral nerve entrapment syndromes by both medical students and primary care providers. METHODS: An online survey including 5 peripheral nerve entrapment clinical scenarios (2 upper extremity and 3 lower extremity) was administered to medical students and primary care providers at a large academic medical center. Respondents were surveyed for level of training, prior clinical exposure, initial diagnostic studies of choice, initial therapeutic modalities of choice, need for subspecialty referral, and appropriate surgical subspecialists for management of the peripheral nerve entrapment. RESULTS: Overall, 248 medical students (38.3% response rate) and 54 primary care providers (13.5% response rate) completed the study. The majority of medical students and primary care providers indicated prior clinical experience with upper-extremity peripheral nerve entrapment in contrast to lower-extremity peripheral nerve entrapment with 26.2% and 39.9% of medical students and primary care physicians reporting prior clinical exposure, respectively. Medical students and primary care providers identified orthopedic surgery as the preferred choice for subspecialty referral for both upper- and lower-extremity peripheral nerve entrapment. Primary care physicians are more inclined to initially manage upper-extremity nerve entrapment without referral to other specialties than for the management of lower-extremity nerve entrapment; 38.0% and 61.1% of the primary care physicians surveyed would refer to another specialty for the initial management of carpal tunnel and cubital tunnel syndromes, in contrast to 83.0%, 90.0%, and 88.2% for the management of common peroneal nerve compression, sural nerve compression, and deep peroneal nerve compression, respectively. CONCLUSIONS: We contend that early education of medical students and primary care providers regarding the role of plastic surgeons as peripheral nerve specialists may improve future referral patterns.