Contemporary Prophylactic Antibiotic Practices and Adjunct Therapies in Autologous Fat Grafting Procedures: A Survey of The Aesthetic Society Members.

Background: Autologous fat grafting (AFG) is a widely used surgical technique that involves extracting a patient's own adipose tissue and transferring it to different areas of the body. This practice is still evolving. Guidelines for antibiotic prophylaxis and use of adjuncts in plastic surgery are currently limited, with a notable absence of standardized guidelines for AFG. Objectives: In this survey, we assess contemporary antibiotic practices and adjuncts in AFG procedures. Methods: A 52-question survey was emailed to 3106 active members of The Aesthetic Society. Two hundred and ninety-three responses were recorded, representing a 9% response rate. Results: We analyzed 288 responses. The most common AFG procedures were facial (38%), gluteal (34%), and breast (27%) augmentation. Preoperative antibiotics were used by 84.0% overall, with rates of 74.3%, 88.0%, and 92.7% in face, breast, and gluteal AFG, respectively. Lipoaspirate-antibiotic mixing was reported by 19.8%, mainly during gluteal AFG (46.9%), and less so in face (2.8%) and breast (8%) AFG. Notably, 46.9% of surgeons administered prolonged prophylaxis for 72 h or more. Tranexamic acid was utilized by 39.9% of the surveyed surgeons. Platelet-rich plasma was used by 5.6%. Doppler ultrasound was incorporated by 16.7% in AFG, with 21.5% in gluteal AFG, 14% in the face, and 19% in breast procedures. Conclusions: In this survey, we offer insights into antibiotic practices and adjunct therapies in AFG, especially intraoperative antibiotic mixing. Practices among members of The Aesthetic Society vary from guidelines. It is crucial to standardize practices and conduct further research to pave the way for evidence-based guidelines in AFG.

Chromosomal instability can favor macrophage-mediated immune response and induce a broad, vaccination-like anti-tumor IgG response.

Chromosomal instability (CIN), a state in which cells undergo mitotic aberrations that generate chromosome copy number variations, generates aneuploidy and is thought to drive cancer evolution. Although associated with poor prognosis and reduced immune response, CIN generates aneuploidy-induced stresses that could be exploited for immunotherapies. In such contexts, macrophages and the CD47-SIRPα checkpoint are understudied. Here, CIN is induced pharmacologically induced in poorly immunogenic B16F10 mouse melanoma cells, generating persistent micronuclei and diverse aneuploidy while skewing macrophages towards an anti-cancer M1-like phenotype, based on RNA-sequencing profiling, surface marker expression and short-term antitumor studies. These results further translate to in vivo efficacy: Mice bearing CIN-afflicted tumors with wild-type CD47 levels survive only slightly longer relative to chromosomally stable controls, but long-term survival is maximized when combining macrophage-stimulating anti-tumor IgG opsonization and some form of disruption of the CD47-SIRPα checkpoint. Survivors make multi-epitope, de novo anti-cancer IgG that promote macrophage-mediated phagocytosis of CD47 knockout B16F10 cells and suppress tumoroids in vitro and growth of tumors in vivo . CIN does not greatly affect the level of the IgG response compared to previous studies but does significantly increase survival. These results highlight an unexpected therapeutic benefit from CIN when paired with maximal macrophage anti-cancer activity: an anti-cancer vaccination-like antibody response that can lead to more durable cures and further potentiate cell-mediated acquired immunity.

Disaster and public health emergency health data collection and management: A scoping review.

OBJECTIVE: The World Health Organization (WHO) developed the Emergency Medical Team (EMT) Minimum Data Set (MDS) to provide a structured, data-based approach to health data collection and management during disasters and public health emergencies. Given recent creation of the EMT MDS, we conducted a scoping review to gauge current practices surrounding health data collection and sharing in emergent settings. DESIGN: An English-based scoping review of PubMed and Embase databases of publications before June 28, 2021. MAIN OUTCOME MEASURES: The review aimed to identify facilitators and barriers to the implementation of the WHO-standardized health data collection systems in the context of disasters and public health emergencies; characterize best practices regarding implementation of an MDS to improve health data collection capacity in differing settings; and highlight internationally accepted, standardized tools or methods for setting up essential public health data for disaster response. RESULTS: A total of 8,038 citations from PubMed and Embase were imported into Covidence with 46 duplicates removed. Among these, 7,992 citations underwent title screening and abstract review, with 161 articles proceeding to full-text article review where an additional 109 articles were excluded. Fifty-two citations were included in final data abstraction. CONCLUSIONS: Findings revealed a range of critical operational, structural, and functional insights of relevance to implementation of the EMT MDS. The literature identified facilitators and barriers to collecting and storing disaster-based datasets, gaps in standardization of data collection resulting in poor data quality during the transition from the acute to post-acute phase, and best practices in the collection of EMT MDS.

Providing Quality of Care in Fragile and Vulnerable Settings: Lessons from South Sudan.

BACKGROUND: In 2020, the World Health Organization (WHO) released a report concerning planning and actions to provide quality of care in fragile, conflict-affected, and vulnerable areas. South Sudan, the world's newest country, has encountered both natural and man-made disasters in recent years that have posed marked challenges to delivery of care. The Southern Sudan Healthcare Organization (SSHCO) operates as a non-governmental organization (NGO) in this setting, delivering and improving healthcare through war, flooding, and infectious outbreaks. OBJECTIVE: The goal of this paper is to highlight the challenges faced in providing care in South Sudan from an NGO perspective and apply the recent WHO guidelines on quality of care to optimize practical implementation. METHOD: Each of the WHO's eight elements for quality of care in South Sudan were examined in relation to the experience of SSHCO from 2013-2021. Analysis included: 1. summary of the WHO element; 2. examples of successful implementation; 3. barriers to implementation; and 4. recommendations to improve implementation. FINDINGS: The team found that communication and coordination were the most important aspects of improving quality of care in South Sudan. These should be prioritized and include intergovernmental partners, the local and national Ministry of Health (MOH), NGOs, and community stakeholders. Communication and coordination should foster community engagement, improved data collecting and reporting, and sharing of publicly accessible information. Better clinical staff training and governance are also required to ensure the most effective use of limited resources. CONCLUSION: South Sudan faces many barriers to quality of care with communication and coordination identified among the foremost issues. Practical application of the WHO elements of quality of care can assist NGOs in effectively identifying areas for improvement to deliver better quality essential health services.

Using mind mapping technology for personal preparedness planning.

OBJECTIVE: Organizing key information for personal disaster preparedness in an efficient and accessible format is critical to ensure practical utility. The authors examine the use of mind mapping technology to organize personal disaster preparedness information and explore the potential of mind mapping software as a tool to create individual and family preparedness resources. DESIGN: The general features of mind maps are considered and a sample family preparedness plan was created using TheBrain, a mind mapping software. RESULTS: Mind maps are a promising tool to organize personal preparedness plans with the ability to include significant amounts of varied information in a structure that emphasizes relationships between topics and enables collaborative sharing.

Push-to-talk apps for disaster communications: Hurricane season brings technology adaptation.

Effective communication during disasters is essential for emergency management, responders, and impacted populations. Recent hurricanes have drawn attention to the potential utility of push-to-talk (PTT) applications with some such as Zello, garnering over 6 million downloads during the week prior to Hurricane Irma. PTT technology integrates a two-way radio system to transmit and receive messages via point-to-point communication lines. With rapid implementation of newer technology and applications often driven by anecdotal reports and the media, the actual performance impact of such technology in the face of disasters is challenging to assess. This article attempts to characterize advantages and limitations of PTT in the context of hurricanes through primary news article sources.