Combining slow-release fertilizer and plastic film mulching reduced the carbon footprint and enhanced maize yield on the Loess Plateau.

Agricultural practices significantly contribute to greenhouse gas (GHG) emissions, necessitating cleaner production technologies to reduce environmental pressure and achieve sustainable maize production. Plastic film mulching is commonly used in the Loess Plateau region. Incorporating slow-release fertilizers as a replacement for urea within this practice can reduce nitrogen losses and enhance crop productivity. Combining these techniques represents a novel agricultural approach in semi-arid areas. However, the impact of this integration on soil carbon storage (SOCS), carbon footprint (CF), and economic benefits has received limited research attention. Therefore, we conducted an eight-year study (2015-2022) in the semi-arid northwestern region to quantify the effects of four treatments [urea supplied without plastic film mulching (CK-U), slow-release fertilizer supplied without plastic film mulching (CK-S), urea supplied with plastic film mulching (PM-U), and slow-release fertilizer supplied with plastic film mulching (PM-S)] on soil fertility, economic and environmental benefits. The results revealed that nitrogen fertilizer was the primary contributor to total GHG emissions (≥71.97%). Compared to other treatments, PM-S increased average grain yield by 12.01%-37.89%, water use efficiency by 9.19%-23.33%, nitrogen accumulation by 27.07%-66.19%, and net return by 6.21%-29.57%. Furthermore, PM-S decreased CF by 12.87%-44.31% and CF per net return by 14.25%-41.16%. After eight years, PM-S increased SOCS (0-40 cm) by 2.46%, while PM-U decreased it by 7.09%. These findings highlight the positive effects of PM-S on surface soil fertility, economic gains, and environmental benefits in spring maize production on the Loess Plateau, underscoring its potential for widespread adoption and application.

Rapid detection of colored and colorless macro- and micro-plastics in complex environment via near-infrared spectroscopy and machine learning.

To better understand the migration behavior of plastic fragments in the environment, development of rapid non-destructive methods for in-situ identification and characterization of plastic fragments is necessary. However, most of the studies had focused only on colored plastic fragments, ignoring colorless plastic fragments and the effects of different environmental media (backgrounds), thus underestimating their abundance. To address this issue, the present study used near-infrared spectroscopy to compare the identification of colored and colorless plastic fragments based on partial least squares-discriminant analysis (PLS-DA), extreme gradient boost, support vector machine and random forest classifier. The effects of polymer color, type, thickness, and background on the plastic fragments classification were evaluated. PLS-DA presented the best and most stable outcome, with higher robustness and lower misclassification rate. All models frequently misinterpreted colorless plastic fragments and its background when the fragment thickness was less than 0.1mm. A two-stage modeling method, which first distinguishes the plastic types and then identifies colorless plastic fragments that had been misclassified as background, was proposed. The method presented an accuracy higher than 99% in different backgrounds. In summary, this study developed a novel method for rapid and synchronous identification of colored and colorless plastic fragments under complex environmental backgrounds.

Sources and types of plastic caps and properties characterization of plastic ropes produced from different types of plastic caps.

Bangladesh produces massive amounts of plastic products to meet the huge population demand. Jashore (Bangladesh) is well-known for discarding huge numbers of plastic caps (PCs). PCs are made up of hard polymer of polypropylene (PP) and high-density polyethylene (HDPE). Jashore was chosen as the study area because huge quantities of PCs are produced here and plastic rope (PR) is prepared using PCs. About 70 % of PCs came from drinking items, 20 % from toiletries items, 7 % from kitchen items, and rest 3 % from unidentified sectors. About 44.0 % of caps were blue, 35.0 % were red, 11.0 % were green, 5.0 % were yellow, 3.0 % were white, and 2.0 % were ash color. About 52 % of caps were prone to damage, 26.0 % were discolored, 15.0 % were slightly damaged, and about 7.0 % were intake. Additionally, different types of ropes (ash color; red color; yellow color, white color, blue color, rasmi, nylon, cotton, jute, and polyester rope) were collected and some mechanical characterization were performed to determine their sustainability. The internal structure of the ash, red, and yellow color PC rope, silk, jute, and cotton rope did not have any structural deformation, but the blue color rope, nylon, and polyester showed a wide range of structural deformation. Tensile strength (TS) was determined using a Universal Testing Machine (UTM), the internal structure was determined using Scanning Electron Microscopy (SEM), and chemical characterization was determined using Fourier Transform Infrared Spectroscopy (FTIR). The characteristics of PR were compared with the characteristics of other ropes. The highest strength was in silky (5315 Mpa) and nylon (2461.5) ropes. FTIR results showed that the chemical structure of C[bond, double bond]O stretching was in 1800 cm-1, and O[bond, double bond]C[bond, double bond]O stretching was in 2349 cm-1 spectrum in PC samples. It can be said that the strength could be dependent on the chemical composition of the ropes.

Selective Hydrogenolysis Conversion of Polyethylene into Alkyl Oil over Iridium-based Catalyst.

Plastic not only brings convenience but also places a great burden on the environment. Utilizing plastic as low-cost feed-stock for producing valuable chemicals and fuels is one of the most attractive directions. Among the huge types of plastics, polyolefins (PO), especially polyethylene (PE), were the most abundant type and the most difficult to upgrade. Hydrocracking and hydrogenolysis operate at relatively low reaction temperatures which show promising applications. Herein, Iridium-based catalysts were developed and proved to be effective in PE hydrogenolysis under relatively mild conditions. A highest 92.7% percent of liquid products could be obtained under 250°C, 3 MPa of H2 in 8 hours with Ir/γ-Al2O3 catalyst. The Ir catalysts showed better selectivity for liquid products than Ru under similar conversions. The support could also affect the performance, including Lewis acid amount, surface areas, and morphology.

First attempt to measure macroplastic fragmentation in rivers.

Direct field measurements of macroplastic fragmentation during its transport in rivers are currently unavailable, and there is no established method to perform them. Previous studies have showed that macroplastic fragmentation results in the production of harmful microplastics, and river channels can be hotspots for this process. Therefore, obtaining information about this process is crucial for quantifying the production of secondary microplastics in rivers and assessing the related risks for riverine biota and human health. Here, we propose a simple low-cost methodology for quantifying riverine macroplastic fragmentation by conducting repeated measurements of the mass of tagged macroplastic items before and after their transport in the river. As a proof-of-concept for this method, we conducted a 52-65 day experiment that allowed us to measure a median fragmentation rate of 0.044 ± 0.012 g for 1-liter PET bottles during their transport at low to medium flow in the middle mountain Skawa River in the Polish Carpathians. Using the obtained data (n = 42), we extrapolated that during low to medium flows, the median yearly mass loss of PET bottles in the study section is 0.26 ± 0.012 g/year (0.78 ± 0.036 % of bottle mass), and the median rate of bottle surface degradation is 3.13 ± 0.14 µm/year. These estimates suggest a relatively high fragmentation rate for a PET bottle in a mountain river even under low to medium flow conditions without high-energy transport. We discuss how our simple and relatively low-cost methodology can be flexibly adapted and future optimized to quantify macroplastic fragmentation in various types of rivers and their compartments, informing future mitigation efforts about the rates of formation and dispersion of secondary microplastics.

Experimental detection of marine plastic litter in surface waters by 405 nm LD-based fluorescence lidar.

Plastic pollution has become a global challenge, affecting water quality and health. Plastics including polystyrene (PS), polyvinyl chloride (PVC), polypropylene (PP), polyethylene terephthalate (PET), and high-density polyethylene (HDPE), are significant contributors to environmental pollution. With the growing need for investigation and detection of plastics found in natural waters, we propose the use of a portable laser diode (LD)-based fluorescence lidar system for in-situ detection of plastic litters in surface waters based on excitation-emission fluorescence spectroscopic data. The experiments were carried out in a controlled environment using a fluorescence lidar system with 405 nm excitation wavelength to determine the fluorescence signals of several plastics at 470 nm emission wavelength. Simultaneous detection of PET plastic and Chlorella vulgaris were also observed to determine the fluorescence influence of chlorophyll in surface waters. Attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy was employed to study the chemical composition of the plastics used before and after being submerged in the water. Scanning electron microscopy (SEM) and high-resolution camera microscopy were used to analyze the morphology of the submerged PET samples. This study provides a basis for a new in-situ technique using a fluorescence lidar system for submerged or transparent plastics in surface waters.

Towards Design Optimization of Compliant Mechanisms: A Hybrid Pseudo-Rigid-Body Model-Finite Element Method Approach and an Accurate Empirical Compliance Equation for Circular Flexure Hinges.

Innovative designs such as morphing wings and terrain adaptive landing systems are examples of biomimicry and innovations inspired by nature, which are actively being investigated by aerospace designers. Morphing wing designs based on Variable Geometry Truss Manipulators (VGTMs) and articulated helicopter robotic landing gear (RLG) have drawn a great deal of attention from industry. Compliant mechanisms have become increasingly popular due to their advantages over conventional rigid-body systems, and the research team led by the second author at Toronto Metropolitan University (TMU) has set their long-term goal to be exploiting these systems in the above aerospace applications. To gain a deeper insight into the design and optimization of compliant mechanisms and their potential application as alternatives to VGTM and RLG systems, this study conducted a thorough analysis of the design of flexible hinges, and single-, four-, and multi-bar configurations as a part of more complex, flexible mechanisms. The investigation highlighted the flexibility and compliance of mechanisms incorporating circular flexure hinges (CFHs), showcasing their capacity to withstand forces and moments. Despite a discrepancy between the results obtained from previously published Pseudo-Rigid-Body Model (PRBM) equations and FEM-based analyses, the mechanisms exhibited predictable linear behavior and acceptable fatigue testing results, affirming their suitability for diverse applications. While including additional linkages perpendicular to the applied force direction in a compliant mechanism with N vertical linkages led to improved factors of safety, the associated increase in system weight necessitates careful consideration. It is shown herein that, in this case, adding one vertical bar increased the safety factor by 100N percent. The present study also addressed solutions for the precise modeling of CFHs through the derivation of an empirical polynomial torsional stiffness/compliance equation related to geometric dimensions and material properties. The effectiveness of the presented empirical polynomial compliance equation was validated against FEA results, revealing a generally accurate prediction with an average error of 1.74%. It is expected that the present investigation will open new avenues to higher precision in the design of CFHs, ensuring reliability and efficiency in various practical applications, and enhancing the optimization design of compliant mechanisms comprised of such hinges. A specific focus was put on ABS plastic and aluminum alloy 7075, as they are the materials of choice for non-load-bearing and load-bearing structural components, respectively.

Characteristics of low-temperature plasma for activation of plastic-degrading microorganisms.

Plastic pollution is a problem that threatens the future of humanity, and various methods are being researched to solve it. Plastic biodegradation using microorganisms is one of these methods, and a recent study reported that plastic-degrading microorganisms activated by plasma increase the plastic decomposition rate. In contrast to microbial sterilization using low-temperature plasma, microbial activation requires a stable plasma discharge with a low electrode temperature suitable for biological samples and precise control over a narrow operating range. In this study, various plasma characteristics were evaluated using SDBD (Surface Dielectric Barrier Discharge) to establish the optimal conditions of plasma that can activate plastic-degrading microorganisms. The SDBD electrode was manufactured using low-temperature co-fired ceramic (LTCC) technology to ensure chemical resistance, minimize impurities, improve heat conduction, and consider freedom in designing the electrode metal part. Plasma stability, which is important for microbial activation, was investigated by changing the frequency and pulse width of the voltage applied to the electrode, and the degree of activation of plastic-degrading microorganisms was evaluated under each condition. The results of this study are expected to be used as basic data for research on the activation of useful microorganisms using low-temperature plasma.

An Umbrella Review of Meta-Analyses Evaluating Associations between Human Health and Exposure to Major Classes of Plastic-Associated Chemicals.

Background: Epidemiological research investigating the impact of exposure to plastics, and plastic-associated chemicals, on human health is critical, especially given exponentially increasing plastic production. In parallel with increasing production, academic research has also increased exponentially both in terms of the primary literature and ensuing systematic reviews with meta-analysis. However, there are few overviews that capture a broad range of chemical classes to present a state of play regarding impacts on human health. Methods: We undertook an umbrella review to review the systematic reviews with meta-analyses. Given the complex composition of plastic and the large number of identified plastic-associated chemicals, it was not possible to capture all chemicals that may be present in, and migrate from, plastic materials. We therefore focussed on a defined set of key exposures related to plastics. These were microplastics, due to their ubiquity and potential for human exposure, and the polymers that form the matrix of consumer plastics. We also included plasticisers and flame retardants as the two classes of functional additive with the highest concentration ranges in plastic. In addition, we included bisphenols and per- and polyfluoroalkyl substances (PFAS) as two other major plastic-associated chemicals with significant known exposure through food contact materials. Epistemonikos and PubMed were searched for systematic reviews with meta-analyses, meta-analyses, and pooled analyses evaluating the association of plastic polymers, particles (microplastics) or any of the selected groups of high-volume plastic-associated chemicals above, measured directly in human biospecimens, with human health outcomes. Results: Fifty-two systematic reviews were included, with data contributing 759 meta-analyses. Most meta-analyses (78%) were from reviews of moderate methodological quality. Across all the publications retrieved, only a limited number of plastic-associated chemicals within each of the groups searched had been evaluated in relevant meta-analyses, and there were no meta-analyses evaluating polymers, nor microplastics. Synthesised estimates of the effects of plastic-associated chemical exposure were identified for the following health outcome categories in humans: birth, child and adult reproductive, endocrine, child neurodevelopment, nutritional, circulatory, respiratory, skin-related and cancers. Bisphenol A (BPA) is associated with decreased anoclitoral distance in infants, type 2 diabetes (T2D) in adults, insulin resistance in children and adults, polycystic ovary syndrome, obesity and hypertension in children and adults and cardiovascular disease (CVD); other bisphenols have not been evaluated. Phthalates, the only plasticisers identified, are associated with spontaneous pregnancy loss, decreased anogenital distance in boys, insulin resistance in children and adults, with additional associations between certain phthalates and decreased birth weight, T2D in adults, precocious puberty in girls, reduced sperm quality, endometriosis, adverse cognitive development and intelligence quotient (IQ) loss, adverse fine motor and psychomotor development and elevated blood pressure in children and asthma in children and adults. Polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) but not other flame retardants, and some PFAS were identified and are all associated with decreased birth weight. In general populations, PCBs are associated with T2D in adults and endometriosis, bronchitis in infants, CVD, non-Hodgkin's lymphoma (NHL) and breast cancer. In PCB-poisoned populations, exposure is associated with overall mortality, mortality from hepatic disease (men), CVD (men and women) and several cancers. PBDEs are adversely associated with children's cognitive development and IQ loss. PBDEs and certain PFAS are associated with changes in thyroid function. PFAS exposure is associated with increased body mass index (BMI) and overweight in children, attention deficit hyperactive disorder (ADHD) in girls and allergic rhinitis. Potential protective associations were found, namely abnormal pubertal timing in boys being less common with higher phthalate exposure, increased high-density lipoprotein (HDL) with exposure to mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) and reduced incidence of chronic lymphocytic lymphoma (a subtype of NHL) with PCB exposure. Conclusions: Exposure to plastic-associated chemicals is associated with adverse outcomes across a wide range of human health domains, and every plastic-associated chemical group is associated with at least one adverse health outcome. Large gaps remain for many plastic-associated chemicals. Recommendations: For research, we recommend that efforts are harmonised globally to pool resources and extend beyond the chemicals included in this umbrella review. Priorities for primary research, with ensuing systematic reviews, could include micro- and nanoplastics as well as emerging plastic-associated chemicals of concern such as bisphenol analogues and replacement plasticisers and flame retardants. With respect to chemical regulation, we propose that safety for plastic-associated chemicals in humans cannot be assumed at market entry. We therefore recommend that improved independent, systematic hazard testing for all plastic-associated chemicals is undertaken before market release of products. In addition because of the limitations of laboratory-based testing for predicting harm from plastic in humans, independent and systematic post-market bio-monitoring and epidemiological studies are essential to detect potential unforeseen harms.

Comparing environmental fate and ecotoxicity of conventional and biodegradable plastics: A critical review.

Plastic pollution is a consequential problem worldwide, prompting the widespread use of biodegradable plastics (BPs). However, not all BPs are completely degradable under natural conditions, but instead produce biodegradable microplastics (BMPs), release chemical additives, and absorb micropollutants, thus causing toxicity to living organisms in similar manners to conventional plastics (CPs). The new problems caused by biodegradable plastics cannot be ignored and requires a thorough comparison of the differences between conventional and biodegradable plastics and microplastics. This review comprehensively compares their environmental fates, such as biodegradation and micropollutant sorption, and ecotoxicity in soil and water environments. The results showed that it is difficult to determine the natural conditions required for the complete biodegradation of BPs. Some chemical additives in BPs differ from those in CPs and may pose new threats to ecosystems. Because of functional group differences, most BMPs had higher micropollutant sorption capacities than conventional microplastics (CMPs). The ecotoxicity comparison showed that BMPs had similar or even greater adverse effects than CMPs. This review highlights several knowledge gaps in this new field and suggests directions for future studies.

Lymphatic Imaging and Intervention in Congenital Heart Disease.

The lymphatic system plays a central role in some of the most devastating complications associated with congenital heart defects. Diseases like protein-losing enteropathy, plastic bronchitis, postoperative chylothorax, and chylous ascites are now proven to be lymphatic in origin. Novel imaging modalities, most notably, noncontrast magnetic resonance lymphangiography and dynamic contrast-enhanced magnetic resonance lymphangiography, can now depict lymphatic anatomy and function in all major lymphatic compartments and are essential for modern therapy planning. Based on the new pathophysiologic understanding of lymphatic flow disorders, innovative minimally invasive procedures have been invented during the last few years with promising results. Abnormal lymphatic flow can now be redirected with catheter-based interventions like thoracic duct embolization, selective lymphatic duct embolization, and liver lymphatic embolization. Lymphatic drainage can be improved through surgical or interventional techniques such as thoracic duct decompression or lympho-venous anastomosis.

Floating microplastics in Svalbard fjords: High spatial variability requires methodological consistency in estuarine systems.

Microplastic pollution was studied in surface waters of Isfjorden, Svalbard in July 2021 as a part of an international regional harmonisation exercise. Surface microplastics (0.5-5 mm) were sampled with a neuston net in triplicate per study site in several branches of Isfjorden, covering populated and unpopulated fjords. High spatial variability of microplastic abundance (0-32,700 items/km2) was observed within a single fjord resulting from the hydrodynamic pattern formed through the interaction of surface currents, freshwater runoff, and wind conditions. Maximum microplastic abundance was not correlated with the distance from the local source and was instead defined by local small-scale hydrodynamics. Future recommendations for correct assessment of surface microplastics concentration in estuarine environments are presented.

Novel use of the rectus abdominus muscle flap for vaginal reconstruction in complex obstetric fistula repair: A case series.

OBJECTIVE: Globally, obstetric fistula is a tragic outcome following obstructed labour. Failure of complex repair and post-operative incontinence are common. We describe an innovative surgical technique incorporating the rectus abdominus flap at the time of fistula repair. DESIGN: Retrospective case series. SETTING: Malawi, Fistula Care Centre. METHODS: Patients were followed for 3 months after discharge to determine continence and healing. RESULTS: Five of six patients were continent at 3 months and one was lost to follow-up by dry at a one month post-operative phone call. There were no major complications. CONCLUSIONS: The rectus abdominus flap may be a useful adjunct to repair of complex obstetric fistula.

First Evidence of Microplastic Ingestion by Riverine Fish From the Freshwater of Northwest Peninsular Malaysia.

In a baseline study, we investigated microplastic contamination in fish from the Pinang and Kerian Rivers in Northwest Peninsular Malaysia. In recognition of the growing concern over microplastic pollution in aquatic environments, we aimed to assess the abundance and characteristics of microplastics ingested by various fish species. Fish samples were collected from local fishermen, followed by a digestion process using 10% potassium hydroxide (KOH). Microplastics were isolated and analyzed through visual examination and attenuated total reflectance Fourier transform infrared spectroscopy. The results revealed a high prevalence of microplastics, with Johnius borneensis and Oreochromis sp. exhibiting the highest abundance, averaging 48.6 and 42.8 microplastics/g, respectively. The predominant shapes were fibers (55.6%) and fragments (25.9%), with colors primarily transparent (48.19%) and black (30.12%). Our results indicate significant contamination levels in freshwater fish, emphasizing the need for further research and effective mitigation strategies. These findings provide crucial baseline data on microplastics in Malaysian freshwater ecosystems. Environ Toxicol Chem 2024;00:1-10. © 2024 SETAC.

Biofilm mitigation in hybrid chemical-biological upcycling of waste polymers.

Introduction: Accumulation of plastic waste in the environment is a serious global issue. To deal with this, there is a need for improved and more efficient methods for plastic waste recycling. One approach is to depolymerize plastic using pyrolysis or chemical deconstruction followed by microbial-upcycling of the monomers into more valuable products. Microbial consortia may be able to increase stability in response to process perturbations and adapt to diverse carbon sources, but may be more likely to form biofilms that foul process equipment, increasing the challenge of harvesting the cell biomass. Methods: To better understand the relationship between bioprocess conditions, biofilm formation, and ecology within the bioreactor, in this study a previously-enriched microbial consortium (LS1_Calumet) was grown on (1) ammonium hydroxide-depolymerized polyethylene terephthalate (PET) monomers and (2) the pyrolysis products of polyethylene (PE) and polypropylene (PP). Bioreactor temperature, pH, agitation speed, and aeration were varied to determine the conditions that led to the highest production of planktonic biomass and minimal formation of biofilm. The community makeup and diversity in the planktonic and biofilm states were evaluated using 16S rRNA gene amplicon sequencing. Results: Results showed that there was very little microbial growth on the liquid product from pyrolysis under all fermentation conditions. When grown on the chemically-deconstructed PET the highest cell density (0.69 g/L) with minimal biofilm formation was produced at 30°C, pH 7, 100 rpm agitation, and 10 sL/hr airflow. Results from 16S rRNAsequencing showed that the planktonic phase had higher observed diversity than the biofilm, and that Rhodococcus, Paracoccus, and Chelatococcus were the most abundant genera for all process conditions. Biofilm formation by Rhodococcus sp. And Paracoccus sp. Isolates was typically lower than the full microbial community and varied based on the carbon source. Discussion: Ultimately, the results indicate that biofilm formation within the bioreactor can be significantly reduced by optimizing process conditions and using pure cultures or a less diverse community, while maintaining high biomass productivity. The results of this study provide insight into methods for upcycling plastic waste and how process conditions can be used to control the formation of biofilm in bioreactors.

Analysis of Additional Degrees in Academic Plastic Surgery Faculty.

Background: As plastic surgery continues to evolve, an increasing number of surgeons are attaining additional degrees (ADs). Prior studies illustrate this trend of increased AD attainment among plastic surgery faculty within the United States. Yet, no such study has documented AD attainment variability and influence within Canadian plastic surgery faculty. Objectives: Our objective was to investigate the relationship between AD attainment and gender, alongside research productivity, and academic rank of Canadian plastic surgery faculty members. Methods: All Canadian academic plastic surgery faculty members were identified and information regarding gender, academic rank, research productivity, timing of AD attainment was recorded. AD was defined as any degree beyond a medical degree or equivalent. Results: A total of 299 faculty members were identified. Of these, 33% (N = 99) attained an AD. A higher percentage of females (40%) obtained ADs compared to males (30%) (P = .0402). When controlling for number of years in practice, there was a significantly larger proportion of females than males with ADs as assistant and associate professor (P = .033). Faculty with ADs were associated with higher research productivity and higher academic rank than those with MDs (P < .05). ADs were commonly obtained post-residency (38%) and most common ADs were MSc (51%) and PhDs (21%). It was found that the Canadian plastic surgeons were less likely to pursue MBAs than US plastic surgeons (P = .002). Conclusion: One-third of Canadian academic plastic surgeons had ADs. Those with ADs present with higher research productivity and academic rank. When segmented by gender, there were significant differences among AD holders. The results of this study will lend support to ongoing endeavors voicing the need for gender equity in academic plastic surgery.

Historique : Tandis que la chirurgie plastique continue d'évoluer, de plus en plus de chirurgiens obtiennent des diplômes supplémentaires (DS). Des études antérieures démontrent cette tendance des professeurs en chirurgie plastique des États-Unis à obtenir des DS. Pourtant aucune étude n'a évalué la variabilité et l'influence des DS chez les professeurs de chirurgie plastique au Canada. Objectifs : Les chercheurs avaient comme objectif d'explorer la relation entre l'obtention de DS et le genre, conjointement avec la productivité de la recherche et le rang universitaire des professeurs de chirurgie plastique canadiens. Méthodologie : Les chercheurs ont répertorié tous les professeurs de chirurgie plastique canadiens et ont consigné l'information relative à leur genre, à leur rang universitaire, à la productivité de leur recherche, au moment de l'obtention des DS. Le DS était défini comme tout diplôme obtenu après un diplôme en médecin ou un diplôme équivalent. Résultats : Au total, 299 professeurs ont été répertoriés. De ce nombre, 33 % (N = 99) ont obtenu un DS. Un plus fort pourcentage de femmes (40 %) que d'hommes (30 %) (P = ,0402) a obtenu des DS. Après avoir tenu compte du nombre d'années d'exercice, une proportion beaucoup plus importante de femmes que d'hommes ayant des DS étaient professeurs adjoints et agrégés (P = 0,033). Les professeurs qui possèdent des DS étaient associés à une plus grande productivité de la recherche et à un rang universitaire plus élevé que ceux qui possédaient un diplôme en médecine (P < 0,05). Les DS étaient souvent obtenus après la résidence (38 %), et les plus courants étaient des maîtrises (51 %) et des doctorats (21 %). Il a été établi que les chirurgiens plasticiens canadiens étaient moins susceptibles de faire un MBA que les chirurgiens des États-Unis (P =0 ,002). Conclusion : Le tiers des chirurgiens plasticiens universitaires canadiens possédaient des DS. Ceux qui en détenaient présentaient une plus grande productivité en recherche et un meilleur rang universitaire. Lorsqu'ils étaient divisés par genre, les détenteurs de DS présentaient des différences importantes. Les résultats de la présente étude appuient les initiatives en cours soulignant la nécessité de respecter l'égalité des genres en chirurgie plastique universitaire.

Dear Program Directors: There Are Numerous Entrustable Professional Activities on a Burns Rotation!

Background: Burn care has long been an integral part of the scope of plastic surgery, but the time allocated to exposure for plastic surgery residents is under threat due to the range of sub-specialities competing for their time. As part of the Competence by Design approach to plastic surgical training, residents are provided with a list of 52 "Entrustable professional activities' (EPA's) to ensure that core skills and knowledge are acquired. Methods: This survey, distributed via email using a link to Survey MonkeyTM, sought to determine which EPA's were available for completion by plastic surgeons in training during the burn rotation at a major academic burn centre in Canada. Via investigator consensus, 26 of the 52 EPA's were included for assessment; the remaining 26 were not regarded as relevant to the burn centre rotation and therefore better acquired elsewhere. Results: Thirty two residents who underwent a burn rotation between 1 January 2015 and 31 December 2021 completed the anonymous survey. Seventeen of the 26 EPA's evaluated were judged by more than 75% of respondents as being readily amenable to completion during the burn rotation. Most of these EPA's relate to the comprehensive care of patients with acute burn injuries, the management of an in-patient plastic surgery service, and associated quality improvement processes. Residents who completed rotations less than three months in duration had less opportunity to complete a further 8 EPA's in comparison to those who had longer rotations, especially with respect to the care of patients undergoing complex wound care and burn reconstruction. Conclusions: In addition to threatening seamless service delivery at burn centres, reduced resident exposure to the burn rotation may compromise the delivery of burn care in the community. The results of this survey refute any argument that the burn service is a "low yield" rotation from an EPA acquisition perspective.

Historique: Les soins aux grands brûlés font partie intégrante de la chirurgie plastique depuis longtemps, mais le temps alloué à y exposer les résidents en chirurgie plastique est menacé en raison de l'éventail de surspécialités. Dans le cadre de l'approche de compétence par conception à la formation en chirurgie plastique, les résultats reçoivent une liste de 52 « activités professionnelles confiables ¼ (APC) pour assurer qu'ils acquièrent les compétences et le savoir de base. Méthodologie : Ce sondage, distribué par courriel grâce à un lien vers la plateforme Survey MonkeyMD, visait à déterminer quelles APC étaient offertes aux chirurgiens plastiques en formation pendant leur rotation dans un grand centre universitaire pour grands brûlés du Canada. Par consensus des chercheurs, 26 des 52 APC ont été incluses dans l'évaluation. Les 26 autres n'ont pas été considérées comme pertinentes pour la rotation au centre pour grands brûlés, mais mieux à même d'être acquises ailleurs. Résultats:  Au total, 32 résidents qui ont participé à une rotation auprès des grands brûlés entre le 1er janvier 2015 et le 31 décembre 2021 ont rempli le sondage anonyme. Selon plus de 75% d'entre eux, 17 des 26 APC évaluées peuvent facilement être effectuées pendant la rotation auprès des grands brûlés. La plupart de ces APC portent sur les soins complets aux patients atteints de brûlures aiguës, la gestion d'un service de chirurgie plastique aux patients hospitalisés et les processus d'amélioration de la qualité qui s'y associent. Les résidents qui ont effectué leur rotation en moins de trois mois avaient moins l'occasion d'effectuer huit APC de plus par rapport à ceux qui avaient vécu des rotations plus longues, particulièrement à l'égard des soins des plaies complexes aux patients et de la reconstruction après leurs brûlures. Conclusions : En plus de menacer la prestation harmonieuse des services dans les centres pour grands brûlés, la moins grande exposition des résidents à la rotation des grands brûlés peut compromettre la prestation des soins aux grands brûlés dans la communauté. Les résultats de ce sondage réfutent toute prétention selon laquelle les services aux grands brûlés est une rotation « à faible rendement ¼ selon le point de vue de l'acquisition des APC.

Costs Versus Complications: Public Perspectives on International Cosmetic Surgery Tourism.

Introduction: The purpose of this study was to understand the perceptions of potential complications and motivations among patients willing to travel internationally for cosmetic surgery and to gain insight into public perceptions of cosmetic surgery tourism by surveying a large, cross-sectional sample of the general public. Methods: A cross-sectional survey was performed through Amazon Mechanical Turk regarding cosmetic surgery tourism in adults 18 years and older and currently residing in the United States (US). Results: A total of 484 responses were analyzed. Of those, 45.2% of participants would consider having plastic surgery. Among these participants, 67.1% would consider traveling outside of the US to receive cosmetic surgery. Participants who reported Hispanic or Latino ethnicity had increased odds of considering surgery abroad (OR 3.1, 95% CI 1.1-8.7, P = .030). Participants reported that the top advantages of traveling outside of the US for surgery were the price of surgery internationally, a shorter waiting list for surgery, and privacy during recovery. The top disadvantages were the risk of complications, lack of follow-up or continuity care after surgery, and distance from home. Although the risk of complications was acknowledged as the top disadvantage, the perceived safety of receiving plastic surgery abroad was not related to willingness to consider having surgery abroad (P = .268). Conclusion: These findings support the need for continued awareness of patients considering international travel for cosmetic surgery and increased education of the general public regarding the safety of cosmetic surgery tourism and the importance of selecting board-certified plastic surgeons and accredited facilities.

Introduction: La présente étude visait à comprendre les perceptions des complications potentielles et les motivations chez les patients désireux de se rendre à l'étranger pour subir des chirurgies esthétiques et à connaître les perceptions du public à l'égard du tourisme esthétique au moyen d'un sondage auprès d'un vaste échantillon représentatif du grand public. Méthodologie: Les chercheurs ont procédé à un sondage transversal par l'entremise de la plateforme Amazon Mechanical Turk au sujet du tourisme esthétique chez des adultes de 18 ans et plus qui habitent actuellement aux États-Unis. Résultats: Les chercheurs ont analysé 484 réponses. Au total, 45,2% des participants envisageraient la chirurgie plastique et, de cette proportion, 67,1% envisageraient de sortir des États-Unis pour ce faire. Les participants qui se disaient Hispaniques ou Latinos étaient plus susceptibles d'envisager de se rendre à l'étranger (rapport de cotes 3,1, IC à 95%, 1,1 à 8,7, P = 0030). Les participants indiquaient que le tourisme esthétique hors des États-Unis avait comme principaux avantages le prix des opérations, une liste d'attente plus courte et le respect de la vie privée pendant la convalescence. Le risque de complications, l'absence de suivi ou de continuité des soins après l'opération et la distance de la maison en étaient les principaux désavantages. Même si le risque de complications était reconnu comme le principal désavantage, la perception de sécurité liée à la chirurgie esthétique à l'étranger n'était pas associée à la volonté d'envisager une opération à l'étranger (P = 0268). Conclusion: Ces observations appuient la nécessité de sensibiliser constamment les patients qui envisagent le tourisme esthétique et de mieux informer le grand public de la sécurité du tourisme esthétique et de l'importance de privilégier des plasticiens agréés par l'Ordre et des établissements agréés.

The Burden of Plastic Surgery Related Disease in Canada: A Perspective Based on the 2019 Global Burden of Disease Study.

Purpose: Identifying the burden of disease related to plastic and reconstructive surgery in Canada will provide timely population-based data, inform policy, and generate support for research funding. Methods and Patients: Data on the burden of disease (ie, prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years [DALYs]), were extracted from the Global Burden of Disease 2019 results tool for all available and relevant plastic surgery diseases. The economic burden of disease in Canadian dollars was calculated based on prior studies. Data are presented as either rates (per 100 000) or counts with the associated uncertainty interval. Results: In 2019, plastic surgery related conditions in Canada had an overall age-standardized DALY rate of 556 per 100 000 [463-664]. Of these conditions, breast cancer was responsible for approximately 50% of the overall burden of disease, with an age-standardized DALY rate of 268 per 100 000 [244-294] followed by squamous cell carcinoma (66 per 100 000 [45-94]) and thermal burns (61 per 100 000 [46-82]). Age-standardized incidence rates were highest for cellulitis (2654 per 100 000 [2502-2812]). Breast cancer had the highest age-standardized cost of care of all plastic surgery related diseases, at $5.1 billion, approximately half of the total age-standardized cost of $10.6 billion for included plastic surgery diseases. Conclusion: Plastic and reconstructive surgery related diseases, particularly breast cancer, thermal burns, and malignant melanoma, are responsible for a high burden of disease and significant cost to the Canadian healthcare system. These results will help guide national healthcare policy and should provide support to directing funding and research efforts toward impactful diseases facing the Canadian healthcare system.

Objectif: L'identification de la morbidité des maladies liées à la chirurgie plastique et reconstructrice au Canada fournira des données en temps opportun reposant sur la population, permettra de renseigner les politiques et générer un soutien pour le financement de la recherche. Méthodes et patients: Des données sur la morbidité des maladies (c.-à-d. prévalence, incidence, mortalité, années de vie perdues [YLL], années vécues avec une invalidité [YLD], et années de vie corrigées pour l'invalidité [AVCI ou DALY]) ont été extraites de l'outil de résultats sur la morbidité mondiale des maladies 2019 pour toutes les affections disponibles et pertinentes pour la chirurgie plastique. Le poids économique de la maladie en dollars canadiens (CAD) a été calculé sur la base d'études antérieures. Les données sont présentées sous forme de taux (pour 100 000) ou de nombres avec les intervalles d'incertitude (IdI) associés. Résultats: En 2019, les troubles liés à la chirurgie plastique au Canada avaient un taux d'AVCI global standardisé pour l'âge de 556 pour 100 000 (463-664). Parmi ces affections, le cancer du sein était responsable d'environ 50% du fardeau global de la maladie avec un taux d'AVCI standardisé pour l'âge de 268 pour 100 000 (244-294) suivi du cancer épidermoïde (carcinome à cellules squameuses) (66 pour 100 000 [45-94]) et des brûlures thermiques (61 pour 100 000 [46-82]). Les incidences standardisées pour l'âge étaient les plus élevées pour la cellulite (2 654 pour 100 000 [2 502-2 812]). Le cancer du sein avait le coût des traitements standardisé pour l'âge le plus élevé de toutes les maladies liées à la chirurgie plastique, avec 5,1 milliards de dollars, soit environ la moitié des dépenses totales standardisées pour l'âge de 10,6 milliards de dollars pour les maladies incluses liées à la chirurgie plastique. Conclusion: Les maladies liées à la chirurgie plastique et reconstructrive, et plus particulièrement le cancer du sein, les brûlures thermiques et le mélanome malin, sont responsables d'une importante morbidité et de coûts significatifs pour le système de santé canadien. Ces résultats aideront à guider la politique nationale de soins de santé et devraient fournir un soutien pour orienter le financement et les efforts de recherche vers des maladies ayant les plus grandes répercussions sur le système de soins de santé canadien. Mots-clés: chirurgie plastique, morbidité, années de vie corrigées pour l'invalidité, fardeau global de la maladie, coût des soins, morbidité de la maladie.