Genetic diversity and evolutionary convergence of cryptic SARS- CoV-2 lineages detected via wastewater sequencing.

Wastewater-based epidemiology (WBE) is an effective way of tracking the appearance and spread of SARS-COV-2 lineages through communities. Beginning in early 2021, we implemented a targeted approach to amplify and sequence the receptor binding domain (RBD) of SARS-COV-2 to characterize viral lineages present in sewersheds. Over the course of 2021, we reproducibly detected multiple SARS-COV-2 RBD lineages that have never been observed in patient samples in 9 sewersheds located in 3 states in the USA. These cryptic lineages contained between 4 to 24 amino acid substitutions in the RBD and were observed intermittently in the sewersheds in which they were found for as long as 14 months. Many of the amino acid substitutions in these lineages occurred at residues also mutated in the Omicron variant of concern (VOC), often with the same substitutions. One of the sewersheds contained a lineage that appeared to be derived from the Alpha VOC, but the majority of the lineages appeared to be derived from pre-VOC SARS-COV-2 lineages. Specifically, several of the cryptic lineages from New York City appeared to be derived from a common ancestor that most likely diverged in early 2020. While the source of these cryptic lineages has not been resolved, it seems increasingly likely that they were derived from long-term patient infections or animal reservoirs. Our findings demonstrate that SARS-COV-2 genetic diversity is greater than what is commonly observed through routine SARS-CoV-2 surveillance. Wastewater sampling may more fully capture SARS-CoV-2 genetic diversity than patient sampling and could reveal new VOCs before they emerge in the wider human population.

A Comparison of Plastic Surgery Authorship Trends Under Single Versus Double-Blinded Review.

INTRODUCTION: Research is key to academic advancement in plastic surgery. However, access to publication opportunities may be inequitable as seen in other fields. We compared authorship trends of plastic surgery manuscripts that underwent single-blinded review (SBR) versus double-blinded review (DBR) to identify potential disparities in publication opportunities. METHODS: Publications from two plastic surgery journals using SBR and two using DBR from September 2019 to September 2021 were evaluated. Name and institution of the article's first and senior author and journal's editor-in-chief (EIC) were recorded. Chi-squared and Fisher's exact analyses were used to compare author characteristics between SBR and DBR articles. RESULTS: Of 2500 manuscripts, 65.7% underwent SBR and 34.3% underwent DBR. SBR articles had higher percentages of women as first authors (31.9% versus 24.3%, P < 0.001) but lower percentages of first (50.7% versus 71.2%, P < 0.001) and senior (49.6% versus 70.3%, P < 0.001) authors from international institutions. First (26.0% versus 12.9%, P < 0.001) and senior (27.9% versus 18.0%, P = 0.007) authors of SBR articles tended to have more plastic surgery National Institutes of Health funding. Journals using SBR tended to have higher rates of authorship by EICs or authors sharing institutions with the EIC (P ≤ 0.005). CONCLUSIONS: While associated with greater female first authorship suggesting potential efforts toward gender equity in academia, SBR of plastic surgery articles tends to favor authors from institutions with higher National Institutes of Health funding and disadvantage authors from international or lower-resourced programs. Careful consideration of current peer-review proceedings may make publication opportunities more equitable.

Considerations and Opportunities for Probe Capture Enrichment Sequencing of Emerging Viruses from Wastewater.

Until recently, wastewater-based monitoring for pathogens of public health concern primarily used PCR-based quantification methods and targeted sequencing for specific pathogens (e.g., SARS-CoV-2). In the past three years, researchers have expanded sequencing to monitor a broad range of pathogens, applying probe capture enrichment to wastewater. The goals of those studies included (1) monitoring and expanding fundamental knowledge of disease dynamics for known pathogens and (2) evaluating the potential for early detection of emerging diseases resulting from zoonotic spillover or novel viral variants. Several studies using off-the-shelf probe panels designed for clinical and environmental surveillance reported that enrichment increased virus relative abundance but did not recover complete genomes for most nonenteric viruses. Based on our experience and recent results reported by others using these panels for wastewater, clinical, and synthetic samples, we discuss challenges and technical factors that affect the rates of false positive and false negative results. We identify trade-offs and opportunities throughout the workflow, including in wastewater sample processing, probe panel design, and bioinformatic analysis. We suggest tailored methods of virus concentration and background removal, carefully designed probe panels, and multithresholded bioinformatics analysis.

Evaluation of the Impact of Concentration and Extraction Methods on the Targeted Sequencing of Human Viruses from Wastewater.

Sequencing human viruses in wastewater is challenging due to their low abundance compared to the total microbial background. This study compared the impact of four virus concentration/extraction methods (Innovaprep, Nanotrap, Promega, and Solids extraction) on probe-capture enrichment for human viruses followed by sequencing. Different concentration/extraction methods yielded distinct virus profiles. Innovaprep ultrafiltration (following solids removal) had the highest sequencing sensitivity and richness, resulting in the successful assembly of several near-complete human virus genomes. However, it was less sensitive in detecting SARS-CoV-2 by digital polymerase chain reaction (dPCR) compared to Promega and Nanotrap. Across all preparation methods, astroviruses and polyomaviruses were the most highly abundant human viruses, and SARS-CoV-2 was rare. These findings suggest that sequencing success can be increased using methods that reduce nontarget nucleic acids in the extract, though the absolute concentration of total extracted nucleic acid, as indicated by Qubit, and targeted viruses, as indicated by dPCR, may not be directly related to targeted sequencing performance. Further, using broadly targeted sequencing panels may capture viral diversity but risks losing signals for specific low-abundance viruses. Overall, this study highlights the importance of aligning wet lab and bioinformatic methods with specific goals when employing probe-capture enrichment for human virus sequencing from wastewater.

Perceptions of African American Youth and Adults Regarding Tobacco Use-Related Factors in Their Community: A Mixed-Methods Approach in Richmond, Virginia.

INTRODUCTION: The US Food and Drug Administration is poised to restrict the availability of menthol cigarettes and flavored cigars, products disproportionately used by Black/African American (B/AA) individuals. We examined B/AA youth and adult perceptions regarding factors contributing to tobacco use, as well as prevention/cessation resources. METHODS: In 2 mixed-methods studies in Richmond, Virginia, we conducted cross-sectional surveys among youth (n = 201) and adult (n = 212) individuals who were primarily B/AA and reported past 30-day cigar smoking or nontobacco use, followed by focus groups with a subset (youth: n = 30; adults: n = 24). Focus groups were analyzed using a thematic analysis framework, and descriptive survey data provided context to themes. RESULTS: Among focus group participants, 20% of youth and 75% of adults reported current cigar smoking. Six themes emerged across the groups: advertising/brands, sensory experiences, costs, social factors, youth-related factors, and dependence/cessation. Youth and adults perceived cigars as popular; cigar use was attributed to targeted advertising, flavors, affordability, and accessibility. While adults expressed concern regarding youth tobacco use, youth did not perceive tobacco prevention programs as helpful. Adults and youth reported limited access to community tobacco prevention/cessation programs. DISCUSSION: Expanded tobacco prevention and cessation resources for B/AA people who smoke could leverage federal regulatory actions to ban tobacco products targeted toward this group and decrease disparities in tobacco-related morbidity and mortality.

Compassionate care during the COVID-19 pandemic.

BACKGROUND: There was a substantial documented call for healthcare professionals to provide compassionate care during the COVID-19 pandemic and significant criticism voiced when it was lacking. This study aimed to explore perspectives on compassionate care among healthcare professionals providing care during the COVID-19 pandemic. The study focuses on healthcare professionals who participated in a wide range of COVID-19 measures, including testing, quarantine, diagnosis, and care provision (patients with COVID-19 or patients with other illnesses and comorbid with COVID-19). METHODS: A qualitative design with an interpretative phenomenological analysis approach was used. Twenty frontline healthcare professionals (15 nurses and five physicians) who had worked in COVID-19 facilities in China were interviewed individually. RESULTS: Participants stated that a commitment to 'offering oneself' and 'balancing the advantages/disadvantages' in providing care during the pandemic were key to alleviate population-level suffering. On a personal level, they described a desire for obtaining 'mutual support' and improving 'professional competencies' to safeguard their physical and mental well-being. Two professional competencies were notable: coping with grief and implementing infection control across the organization. Additionally, they emphasized the importance of receiving support from the health care organization, the public, and leaders in creating an 'environment conducive to fostering compassionate care.' CONCLUSION: Healthcare professionals recognized the centrality of compassionate care during the pandemic which entailed a commitment to offering themselves, the balancing of advantages and disadvantages in order to find the best solution, as well as the need to safeguard themselves using professional competencies. Such findings can enrich the contemporary understanding of compassion, including when it is lacking. Support from the healthcare organization, the public, and leadership were crucial in fostering compassionate care in healthcare professionals during the pandemic and in moving the field forward in the future.

Effects of mind-body exercise on physical and psychosocial well-being of stroke patients: A systematic review and network meta-analysis.

This study conducted pairwise and network meta-analysis to evaluate the effectiveness of three mind-body exercise interventions (Tai Chi, Qigong, and yoga) on physical capacity, psychological well-being, and quality of life in stroke patients. The research encompassed 30 studies involving 2107 participants and utilized the Risk of Bias 2.0 tool for quality assessment. Pairwise analysis revealed that all three mind-body exercises significantly enhanced patients' quality of life. Tai Chi demonstrated the most comprehensive improvements in balance, limb motor function, activities of daily living, and depression. Network meta-analysis indicated that Qigong was the most effective in improving balance and quality of life for post-stroke patients, followed by Tai Chi. These findings underscore the positive impact of mind-body exercises on both physical and psychosocial outcomes in stroke patients. However, further research involving rigorously designed and adequately powered trials is necessary to enhance the level of evidence in this area.

Level of self-efficacy among skill-based allied health students in the University of Santo Tomas-Enriched Virtual Mode of learning: A cross-sectional study.

Background: Self-efficacy expresses a learner's perception of how well they can do in the online academic setting. Although students' academic successes can be measured by online learning self-efficacy, there is a scarcity of evidence targeted toward allied health students. Objective: The primary aim of this study is to determine the level of online self-efficacy among students from skill-based allied health programs. The secondary aim is to correlate online self-efficacy with age, sex, year level, and program of the students. Methods: This cross-sectional analytic study utilized the Online Learning Self-Efficacy Scale (OLSE) to determine students' level of self-efficacy via a survey conducted with students who underwent the Enriched Virtual Mode of learning. Descriptive statistics was used to characterize the study participants, describe the level of self-efficacy, and compare the subscales of OLSE. Inferential statistics using Spearman's rho was performed to determine the correlation. Results: A total of 117 respondents with a mean age ± SD of 20.59 ± 0.11 years old, predominantly female (71%) were included in the study. The students from allied health programs had an online self-efficacy overall mean score of 3.83 (SD=0.05; range 2.64-5.00) with the use of technology subscales weighted the highest mean score (4.24). Females have a higher average OLSE score (M=3.92, SD=0.05) compared to males. Significant correlation was found between OLSE scores to sex (r=0.260, p=0.005) and year level (r=-0.199, p=0.031) while nonsignificant correlation was found between OLSE scores to the program (r=-0.048, p=0.604) and age (r=-0.123, p=0.185). Conclusion: Students of allied health programs generally have a very good level of online self-efficacy. This study assists educators in developing proactive strategies and approaches to promote students' self-confidence across all domains and encourage them to adopt a dynamic remote learning-based approach. Educational institutions should use this opportunity to assess how well they have implemented remote learning to ensure educational continuity, especially in times of crisis.

Urban-rural disparities in geographic accessibility to care for people living with HIV.

In the United States, people living with HIV (PLWH) in rural areas fare worse along the HIV care continuum than their urban counterparts; this may be due in part to limited geographic access to care. We estimated drive time to care for PLWH, focusing on urban-rural differences. Adult Medicaid enrollees living with HIV and their usual care clinicians were identified using administrative claims data from 14 states (Medicaid Analytic eXtract, 2009-2012). We used geographic network analysis to calculate one-way drive time from the enrollee's ZIP code tabulation area centroid to their clinician's practice address, then examined urban-rural differences using bivariate statistics. Additional analyses included altering the definition of rurality; examining subsamples based on the state of residence, services received, and clinician specialty; and adjusting for individual and county characteristics. Across n = 49,596 PLWH, median drive time to care was 12.8 min (interquartile range 26.3). Median drive time for rural enrollees (43.6 (82.0)) was nearly four times longer than for urban enrollees (11.9 (20.6) minutes, p < 0.0001), and drive times exceeded one hour for 38% of rural enrollees (versus 12% of urban, p < 0.0001). Urban-rural disparities remained in all additional analyses. Sustained efforts to circumvent limited geographic access to care are critical for rural areas.

Correlation between wastewater and COVID-19 case incidence rates in major California sewersheds across three variant periods.

Monitoring for COVID-19 through wastewater has been used for adjunctive public health surveillance, with SARS-CoV-2 viral concentrations in wastewater correlating with incident cases in the same sewershed. However, the generalizability of these findings across sewersheds, laboratory methods, and time periods with changing variants and underlying population immunity has not been well described. The California Department of Public Health partnered with six wastewater treatment plants starting in January 2021 to monitor wastewater for SARS-CoV-2, with analyses performed at four laboratories. Using reported PCR-confirmed COVID-19 cases within each sewershed, the relationship between case incidence rates and wastewater concentrations collected over 14 months was evaluated using Spearman's correlation and linear regression. Strong correlations were observed when wastewater concentrations and incidence rates were averaged (10- and 7-day moving window for wastewater and cases, respectively, ρ = 0.73-0.98 for N1 gene target). Correlations remained strong across three time periods with distinct circulating variants and vaccination rates (winter 2020-2021/Alpha, summer 2021/Delta, and winter 2021-2022/Omicron). Linear regression revealed that slopes of associations varied by the dominant variant of concern, sewershed, and laboratory (ß = 0.45-1.94). These findings support wastewater surveillance as an adjunctive public health tool to monitor SARS-CoV-2 community trends.

Palliative Care for Older Adults Hospitalized for Stroke From the Informal Caregivers' Perspectives: A Qualitative Study.

BACKGROUND: International guidelines have promoted palliative care (PC) for stroke survivors, but definition and implementation have been less than ideal. This practice gap is more prominent in China, where discussion of death remains taboo. AIM: The aim of this study was to explore the perspectives of PC among caregivers of hospitalized patients with stroke. DESIGN AND SETTING: A descriptive qualitative study design was used. Seventeen in-depth interviews with bedside caregivers in a first-rank tertiary hospital (general hospital with bed capacity exceeding 500) in China were analyzed thematically. RESULTS: "Promoting comfort" stands at the core of PC and was operationalized by "meeting physical care needs," "ensuring communication," "providing psychoemotional care," "providing cognitive stimulation," and "avoiding discussion on death and dying." Caregivers who took care of older adults for a long time have described the use of "cognitive stimulation" to promote patients' positive emotional and cognitive reactions. All interviewees avoided mentioning "death" to protect patients' feelings, because they believed discussion of death was hurtful. CONCLUSIONS: The high care demand for patients with stroke is a defining feature of stroke PC and should be recognized in addition to its prognosis estimation to promote this concept. The healthcare system should integrate PC as part of the regular service for patients with severe stroke to shift the focus of care from survival to promotion of comfort. A discussion of the dying process requires sensitivity and should be approached in a discussion of advanced PC planning, which views death as a meaningful transition.

Perception of eHealth Programs for Cardiovascular Health: Qualitative Systematic Review and Meta-synthesis.

BACKGROUND: Despite emerging evidence on the effectiveness of eHealth interventions in improving cardiovascular health, little is known about the perception of use and efficacy of these interventions and real-world application. OBJECTIVE: We sought to develop an in-depth understanding of the perceptions of eHealth interventions in improving cardiovascular health. METHODS: This is a systematic review and meta-synthesis of qualitative studies. A comprehensive search of multiple databases and a manual search of the references list were conducted. Meta-synthesis of qualitative data was performed to review and interpret the findings. The study report followed the ENTREQ checklist. RESULTS: Four themes emerged regarding perceptions of eHealth interventions: preferred eHealth intervention design features, enabling healthcare professionals' support, eHealth engagement for health benefits, and barriers to eHealth engagement. Intervention design features should integrate motivational elements, use an eHealth literacy lens, and enhance cultural relevance. Healthcare professionals appreciated these new working methods but voiced concern about competency building. Real-world usage initiation was driven by perceived needs and usefulness, whereas persistent engagement was inspired by intrinsic motivation in participants. CONCLUSIONS: eHealth interventions were appreciated as a valuable opportunity for providing alternative/supplementary cardiac care for health optimization. Participants commented on the need for more explicit and accurate health information presentation, and they appreciated the motivational elements in empowering them with self-determination over daily self-care behaviors. Professionals raised the need for specific guidance to enhance competency and intervention fidelity when delivering eHealth care.

Promoting Publications Through Plastic Surgery Journal Instagram Accounts: Is It Worth It?

PURPOSE: Journals are increasingly using social media to increase article engagement. We aim to determine the impact of Instagram promotion on, and identify social media tools that effectively enhance, plastic surgery article engagement and impact. METHODS: Instagram accounts for Plastic and Reconstructive Surgery , Annals of Plastic Surgery , Aesthetic Surgery Journal , and Aesthetic Plastic Surgery were reviewed for posts published by February 8, 2022. Open access journal articles were excluded. Post caption word count and number of likes, tagged accounts, and hashtags were recorded. Inclusion of videos, article links, or author introductions was noted. All articles from journal issues published between the dates of the first and last posts promoting articles were reviewed. Altmetric data approximated article engagement. Citation numbers from the National Institutes of Health iCite tool approximated impact. Differences in engagement and impact of articles with and without Instagram promotion were compared by Mann-Whitney U tests. Univariate and multivariable regressions identified factors predictive of more engagement (Altmetric Attention Score, ≥5) and citations (≥7). RESULTS: A total of 5037 articles were included, with 675 (13.4%) promoted on Instagram. Of posts featuring articles, 274 (40.6%) included videos, 469 (69.5%) included article links, and 123 included (18.2%) author introductions. Promoted articles had higher median Altmetric Attention Scores and citations ( P < 0.001). On multivariable analysis, using more hashtags predicted higher article Altmetric Attention Scores (odds ratio [OR], 1.85; P = 0.002) and more citations (OR, 1.90; P < 0.001). Including article links (OR, 3.52; P < 0.001) and tagging more accounts (OR, 1.64; P = 0.022) predicted higher Altmetric Attention Scores. Including author introductions negatively predicted Altmetric Attention Scores (OR, 0.46; P < 0.001) and citations (OR, 0.65; P = 0.047). Caption word count had no significant impact on article engagement or impact. CONCLUSIONS: Instagram promotion increases plastic surgery article engagement and impact. Journals should use more hashtags, tag more accounts, and include manuscript links to increase article metrics. We recommend that authors promote on journal social media to maximize article reach, engagement, and citations, which positively impacts research productivity with minimal additional effort in designing Instagram content.

The Medical Student Race to Research: Who Presents More at National Plastic Surgery Conferences?

BACKGROUND: presentations increase research output and facilitate networking for medical students applying to plastic surgery. We aim to determine predictors of increased medical student presentation at national plastic surgery conferences, identifying disparities in access to research opportunities. METHODS: Abstracts presented at the 2 most recent meetings of the American Society of Plastic Surgeons, American Association of Plastic Surgeons, and Plastic Surgery Research Council were extracted from online archives. Presenters without MDs or other professional credentials were classified as medical students. Presenter gender, medical school ranking, plastic surgery division/department, National Institutes of Health funding, number of total and first-author publications, H-index, and research fellowship completion status were recorded. Students with 3 or more (>75th percentile) presentations were compared with those with less by χ2 tests. Univariate and multivariable regressions identified factors associated with 3 or more presentations. RESULTS: Of 1576 abstracts, 549 (34.8%) were presented by 314 students. The gender distribution was 46.5% male and 53.5% female. Most were from the Northeast (36.9%), 35% came from top 20 medical schools, and 85% attended schools with home plastic surgery programs. While 61.8% presented once, 14.6% presented 3 or more times. Those who previously presented, completed research fellowships or had more publications or higher H-indices were likely to present more ( P ≤ 0.007). On multivariable-adjusted analysis, completing research fellowships (odds ratio [OR], 2.34-2.52; P = 0.028-0.045), affiliation with institutions having higher National Institutes of Health funding (OR, 3.47-3.73; P = 0.004-0.006), or having more total number of publications (OR, 3.81; P = 0.018) or first-author publications (OR, 3.84; P = 0.008) was associated with 3 or more presentations. Presenter gender, geographic region, medical school ranking, home program status, and H-indices were not significant predictors on multivariable analysis. CONCLUSIONS: There are several potential inequities in access to research opportunities for medical students, disadvantaging those with less well-funded plastic surgery programs and existing research experience. Improving the equitability of these opportunities is crucial for limiting bias in trainee recruitment and diversifying representation in the field.

Sunflower and rapeseed meal as alternative feed materials to soybean meal for sustainable egg production, using aged laying hens.

1. This study assessed the impact of replacing two thirds of a soybean meal (SBM) based diet with an alternative protein (AP) based diet (sunflower and rapeseed meal), when fed to end of production Hy-Line Brown laying hens.2. Diets were fed in seven cages, each containing six birds aged from 75 to 83 weeks old. Measured variables included bird performance, egg production, quality variables of fresh eggs, total tract digestibility of dry matter (DMD), neutral detergent fibre (NDFD), fat (FD), and nitrogen corrected apparent metabolisable energy (AMEn).3. No significant differences were observed (P > 0.05) for egg production, egg composition or egg quality. However, birds fed the AP diet had darker yolks (P < 0.05), possibly linked to natural pigments in AP.4. The SBM diet had higher AMEn, DMD and NDFD (P < 0.05), although FD was higher in the AP diet (P < 0.05).5. Diets based on AP sources can be fed to aged laying hens without deteriorating productive performance, providing care is taken in formulating diets (e.g. amino acid levels, balance etc). Using AP sources may reduce reliance on SBM associated with land use change, contributing towards sustainability for the egg industry.

Refining the metabolisable energy value of field beans for turkeys.

1. This study examined the feeding value of ten UK grown field bean (Vicia faba L. var. minor) cultivar samples from the same harvest year on nitrogen corrected apparent metabolisable energy (AMEn) and nutrient retention coefficients when fed to young female turkeys.2. A balancer feed (BF) was formulated to contain 12.39 MJ/kg ME and 269 g/kg crude protein. Ten nutritionally complete, mash diets were prepared by mixing 200 g/kg of each ground field bean cultivar with 800 g/kg of the BF, totalling eleven diets. Diets were fed to female BUT Premium turkeys from 40 to 50 d of age. Each diet was fed to eight raised floor pens, housing two birds, following randomisation. The AMEn was determined by the total collection technique over the last 4 d of the study. Relationships were examined between AMEn, chemical composition and quality variables of the field bean samples.3. The overall determined AMEn value of the beans ranged from 7.72 MJ/kg DM to 9.87 MJ/kg DM, giving an average AMEn of 8.80 MJ/kg DM (P < 0.05). The soluble non-starch polysaccharide (NSP) content of the beans negatively correlated with their determined AMEn (r = -0.730; P < 0.05). Bean flour lightness-darkness degree (L*) correlated positively with the AMEn (r = -0.643; P < 0.05)4. A positive correlation was observed between the degree of yellowness-blueness of bean flour and condensed tannins content (r = 0.696; P < 0.05). Step-wise regression indicated that soluble NSP + L* of field beans provided explanatory variables suitable for estimating the AMEn value for turkeys (r2 = 0.737; P < 0.05).

Research Productivity of Integrated Plastic Surgery Residents: Does Reputation Matter?

INTRODUCTION: It is unknown whether the ranking of plastic surgery residency programs influences resident research output. This study aims to determine whether program reputation and other factors are associated with integrated plastic surgery resident academic productivity. MATERIALS AND METHODS: Programs were divided into four tiers based on Doximity reputation rankings. Residents from 2019 to 2020 were found through program websites and social media accounts. Works published during residency were identified through PubMed and Scopus from July 1 of each resident's intern year to August 10, 2020. Variables included resident demographics and medical school, residency reputation ranking, geographic region, and medical school affiliation. 'High research output' was defined as having ≥75th percentile of publications adjusted by training year. RESULTS: In total, 921 residents in 80 programs were identified. The median (IQR) number of total publications and original articles was 3 (1-6) and 2 (0-4), respectively. On multivariable analysis, residents in top-20 ranked programs (OR = 2.31, 95% CI [1.55; 3.43], P < 0.001) or from programs associated with top-20 medical schools (OR = 1.61, 95% CI [1.08; 2.41], P = 0.020) were more likely to have higher research output. On the other hand, coming from a top-50 in research medical school (OR = 1.80, 95% CI [1.31; 2.47], P < 0.001) or being in a program affiliated with a top-20 medical school (OR = 2.52, 95% CI [1.69; 3.78], P < 0.001) were associated with higher original article output. Gender and geographic location were not associated with higher research output. CONCLUSIONS: Program reputation and affiliated medical school research rankings are associated with research productivity during integrated plastic surgery residency. Applicants with a particular interest in research careers may consider this as they apply to residency.

Interest in Plastic Surgery Residency: A Google Trends Analysis.

BACKGROUND: Since 2010, the number of programs and available positions for integrated plastic surgery residency has increased, yet the match rate remains one of the lowest of all specialties, and the applicant pool remains one of the most competitive. We sought to investigate whether this increased interest in integrated programs has translated to increased online search volume regarding plastic surgery residency. METHODS: Our study uses Google Trends, a powerful online tool that analyzes changes in Google search volume over time and across various regions, to study temporal and geographic trends in search interest for terms related to plastic surgery residency from July 2009 to 2020 in the United States. RESULTS: Terms related to plastic surgery research, step 1 and 2 scores, and residency interviews had the most search results, whereas terms related to away rotations and Alpha Omega Alpha had the least. "Independent plastic surgery track" had more total search results on Google than "integrated plastic surgery residency," and "plastic surgery fellowship" declined in search interest from July 2009 to March 2010. There was a rise in search volume for a plastic surgeon's salary and a fall in search volume for plastic surgery research between July 2009 and July 2020. However, other terms related to residency or residency applications showed no sustained trends over time. "Plastic surgery residency" was most searched in Pennsylvania, New York, Ohio, and Missouri, whereas "plastic surgeon salary" was most searched in Louisiana, Texas, Arizona, and Georgia. CONCLUSIONS: This Google Trends analysis showed discordance between the upward trend in integrated plastic surgery residency positions offered through the National Residency Match Program and relatively unchanging search interest in factors related to the plastic surgery residency application. However, interest in a plastic surgeon's salary has increased over time, but this is not specific to plastic surgery. Although online search tools can be of important predictive value, this study demonstrates that there are clearly other factors that influence medical students' interest in plastic surgery residency besides Internet research.

A Social Media Analysis of Wellness Culture in Plastic Surgery Residency.

BACKGROUND: Burnout, "a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment", afflicts approximately one third of plastic surgery attending surgeons and residents. Burnout can be detrimental to resident training and patient outcomes. Therefore, cultivating wellness during residency is essential. In fact, the Accreditation Council for Graduate Medical Education requires residency programs to create learning and working environments that optimize faculty and resident wellness. With increasing social media use by plastic surgery residency programs, this study aimed to analyze their posts for wellness-related content. METHODS: Integrated plastic surgery residency programs were obtained from the American Council of Academic Plastic Surgeons Web site, and their associated social media accounts were identified. The authors reviewed all post images, captions, and comments made by the program's account, until July 3, 2021. Any hashtags relating to wellness were also recorded. RESULTS: Of 82 programs, 76 (92.7%) had active Instagram accounts, 31 (37.8%) had active Facebook accounts, and 30 (36.6%) had active Twitter accounts. Instagram had higher rates of engagement than Facebook and Twitter (P < 0.001). Across all platforms, the mean percent of total posts related to wellness was 18.87%. The most common wellness content showcased resident work-life balance (48.73%), followed by educational events incorporating wellness activities (27.61%), attention to physical health (17.71%), healthy work environments (5.29%), wellness-specific activities (3.25%), team building activities (2.40%), and images implying but not directly showing resident wellness (1.46%). Programs did not vary significantly in percentages of total posts related to wellness by geographic region, ranking, or accreditation length. In total, 1893 wellness-related hashtags were used on Instagram, 253 on Facebook, and 72 on Twitter. The most used wellness-related hashtag was #residentlife. Only 40.8% to 50.8% of posts using wellness hashtags met at least 1 wellness criterion. CONCLUSION: Despite the importance of burnout prevention during plastic surgery residency, less than a quarter of residency program social media content promote wellness. Social media can demonstrate how residency programs are incorporating wellness into their curricula, but whether residencies lack sufficient wellness initiatives or are not advertising such programming on their social media accounts remains to be studied.

Are Opioids Out? Assessing Prescription Patterns in Plastic Surgery Using Medicare Part D Beneficiary Data.

INTRODUCTION: Since 1999, nearly 841,000 individuals have died from overdoses, 29% involving prescription opioids. Use of opioids for postoperative pain lacks evidence-based guidelines, and despite studies showing the efficacy of nonopioid agents in reducing postoperative morbidity, opioids are still routinely prescribed. However, multiple states are adopting prescription drug monitoring programs and prescription drug laws. The authors sought to investigate recent opioid prescription patterns among plastic surgeons. METHODS: This cross-sectional study used "Medicare Provider Utilization and Payment Data: Part D Prescriber" provided by the Centers for Medicare & Medicaid Services from 2016 to 2018. Entries were filtered to include plastic surgeons. Demographic variables included surgeon sex, geographic region and state, board certification status, and length of experience. The surgeon's practice was designated as academic, private, or both. Outcomes included total opioid claims, opioid prescriber rate, and days per claim. Kruskal-Wallis tests were used for statistical comparison (α = .05). RESULTS: From 2016 to 2018, plastic surgeons wrote 289,525 opioid prescriptions for 1,729,523 days (6.0 days per prescription), totaling $3,346,979.39. In 2018, 62.2% of plastic surgeons prescribed 0 to 10 opioids, 36.5% prescribed 11 to 50 opioids, and 1.3% prescribed more than 50. Furthermore, 99.5% of plastic surgeons prescribing opioids are practicing in metropolitan areas (rural-urban commuting area codes 1-3). Plastic surgeons who were male or were board certified had significantly lower opioid prescriber rates (P < 0.001). There were no significant variations in outcomes by length of surgeon experience. Geographic region was significantly associated with opioid prescription rates and days per claim, with Southern plastic surgeons having lower rates (P < 0.001) and those Northeastern ones prescribing shorter courses (P = 0.004). The number of opioid claims, days per claim, and opioid prescriber rates were all significantly lower in 2018 than in 2017 and 2016 (P < 0.001). CONCLUSIONS: Prescriptions written by plastic surgeons may have contributed to the opioid epidemic, but 2018 data suggest opioids are becoming less routine in postoperative pain control. Further studies are warranted to assess factors related to reduced and shorter opioid prescriptions by plastic surgeons in the South and Northeast, respectively. Such insight, if adopted into law and implemented into clinical practice, may help reduce the burden of the opioid epidemic.