Hougaardhutchinson4919

Estimates of high-resolution greenhouse gas (GHG) emissions have become a critical component of climate change research and an aid to decision makers considering GHG mitigation opportunities. The "Vulcan Project" is an effort to estimate bottom-up carbon dioxide emissions from fossil fuel combustion and cement production (FFCO2) for the U.S. landscape at space and time scales that satisfy both scientific and policy needs. Here, we report on the Vulcan version 3.0 which quantifies emissions at a resolution of 1 km2/hr for the 2010-2015 time period. We estimate 2011 FFCO2 emissions of 1,589.9 TgC with a 95% confidence interval of 1,367/1,853 TgC (-14.0%/+16.6%), implying a one-sigma uncertainty of ~ ±8%. Per capita emissions are larger in states dominated by electricity production and industrial activity and smaller where onroad and building emissions dominate. The U.S. FFCO2 emissions center of mass (CoM) is located in the state of Missouri with mean seasonality that moves on a near-elliptical NE/SW path. Comparison to ODIAC, a global gridded FFCO2 emissions estimate, shows large total emissions differences (100.4 TgC for year 2011), a spatial correlation of 0.68 (R2), and a mean absolute relative difference at the 1 km2 scale of 104.3%. The Vulcan data product offers a high-resolution estimate of FFCO2 emissions in every U.S. city, obviating costly development of self-reported urban inventories. The Vulcan v3.0 annual gridded emissions data product can be downloaded from the Oak Ridge National Laboratory Distributed Active Archive Center (Gurney, Liang, et al., 2019, https//doi.org/10.3334/ORNLDAAC/1741).

With the labeling of Coronavirus Disease 2019 (COVID-19) as a pandemic by the World Health Organization, national directives were issued instructing to close all cosmetic clinics, suspend all cosmetic procedures, and only operate on an emergency basis. As a result, many plastic surgeons faced challenges sustaining their practice. We aimed to investigate the effect of these national directive instructions on the surgeons and to review their strategies for adapting their practices during this new pandemic.

A cross-sectional descriptive study was conducted using an online questionnaire. It was constructed to assess the attitudes and practices of plastic surgeons in the Gulf Cooperation Council countries during the COVID-19 lockdown. It also explored their strategies on reopening their practice, as well as their plans on modifications of practice during and after the lockdown.

In total, 197 surgeons responded to the survey. The majority were from Saudi Arabia (42.1%), followed by the United Arab Emirates (37.6%), with relatively smaller participation from the remaining countries. Over two-thirds (69.5%) indicated that the pandemic had affected their practice. Surgeons in private practices were significantly affected (

< 0.001) compared with those in the public sector. Thiostrepton Only 39% of respondents mentioned COVID-19 testing as part of their post-pandemic surgical protocol.

Surgeons' responses to the pandemic varied. Fear and future uncertainty significantly led to a surge in the utilization of different technical means to maintain the patient pool. Surgeons' education about post-pandemic precautions is essential to maintain high standards of care in the region.

Surgeons' responses to the pandemic varied. Fear and future uncertainty significantly led to a surge in the utilization of different technical means to maintain the patient pool. Surgeons' education about post-pandemic precautions is essential to maintain high standards of care in the region.An unprecedented number of health care providers have been infected and many have died during the COVID-19 pandemic. Reconstructive microsurgeons from different surgical backgrounds often are involved in the care of known COVID-19 and high-risk patients. The need for a magnification loupe/microscope makes it difficult for them to wear recommended personal protection equipment, increasing the risk of exposure. Although advanced technologies are available, they have not been exploited effectively. To date, no safety guidelines are available for safe reconstructive microsurgical procedures in high-risk operations/known COVID-19 patients-particularly, to address operations risk and COVID-19 status of the patients, who would operate, how many should be involved, how to equip the surgeons for the procedure, when to operate as the procedure unfolds, how to adapt surgical techniques to reduce exposure risk, and can advanced technology be used to minimize exposure. A set of safety recommendations were thus developed based on literature review and firsthand knowledge of safety procedures during the COVID-19 pandemic. Current understanding of COVID-19 virology can optimize surgical team buildup and dynamics. Operating smaller teams (in a sequential style), minimizing the use of aerosols-generating devices, and modifying surgical plan and flap selection could aid in diminishing the risk of exposure and in conserving resources. Modifications in loupes design, and the combined wear of surgical mask and N95 respirators, and efficient use of "buddy system" could aid in protecting surgeons during donning and doffing. "Remote operating" is a novel concept of using a surgical robot to maximize surgeons' safety during COVID-19 pandemic.[This corrects the article DOI 10.1097/GOX.0000000000001240.].The United States's overdue awakening on systemic and structural racism has triggered global dialogue regarding racial inequities. Historically, discrimination and practitioner bias have resulted in poorer health and health outcomes in minority communities. To address racial and ethnic disparities in healthcare, it is imperative that plastic surgeons, trainees, and staff understand definitions to create a socially conscious environment in the workplace. We explore various measures that can be implemented to develop antiracist practices in the field of plastic surgery and ultimately to provide a foundation to improve diversity within our discipline and beyond.

In March 2020, the Saudi Ministry of Health implemented mitigation measures to control the Coronavirus Disease 2019 (COVID-19) pandemic, including media campaigns, a nationwide lockdown, and closures of plastic surgery clinics. The aim of this study was to explore the public's knowledge of COVID-19, their willingness to undergo cosmetic surgery during the pandemic, and the factors influencing their decisions.

An internet-based cross-sectional survey was conducted. We collected data on demographic information, knowledge about COVID-19, and willingness to undergo cosmetic procedures. Participants also completed the cosmetic procedure screening questionnaire to assess body dysmorphic disorder.

The sample included a total of 1643 participants (women, n = 1002; 61%). A total of 613 (37.3%) participants were aged between 30 and 40 years. The majority (n = 1472; 89.6%) referred to official government accounts for information regarding COVID-19. Most participants (n = 1451; 88.3%) felt that the pandemic was serh an increased willingness to undergo procedures, which may help design awareness initiatives.

Following primary repair of a cleft lip, patients present with many facial deformities. One of the commonly observed sequelae of cleft lip repair is a whistling deformity. This retrospective study was carried out to evaluate the outcomes following correction of whistling deformities in secondary cleft lip reconstruction.

We retrospectively reviewed the hospital records of patients with various whistling deformities who underwent repair from April 1989 to March 2018; 2 surgeons performed the repair using either the double movable mucomuscular complex flaps technique, modified Abbe flap technique, or Abbe flap technique. The postoperative anatomical structure and aesthetic effects of the surgery were evaluated.

In total, 136 patients were included in this study. Among these patients, 60 (44.2%) had a grade I whistling deformity and 47 (34.5%) had a grade II deformity and repair was performed using the double movable mucomuscular complex flaps technique and modified Abbe flap transfer technique, respectively, whereas the Abbe flap transfer technique was used in 16 patients (11.8%) and 13 patients (9.5%) with a grade III and grade IV whistling deformity, respectively. All patients were found to have normal postoperative anatomical structures and aesthetic effects of the upper lip, with all patients experiencing mild to moderate postoperative edema of the upper lip, and 29 cases (21.3%) developed an inconspicuous scar.

The repair technique should be chosen based on the type of whistling deformity.

The repair technique should be chosen based on the type of whistling deformity.We present a case report of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) that was mistaken as disseminated silicosis after multiple percutaneous biopsies. The correct diagnosis of BIA-ALCL was confirmed only after a pathologic examination of the capsulectomy specimens. A review of the literature of percutaneous biopsies of ALCL showed a diagnostic yield of only 63%. Although percutaneous biopsies may be facile to obtain and may be diagnostic, in our case, biopsies were not sufficient to exclude the diagnosis of BIA-ALCL.The authors describe a surgical treatment that optimally combined the use of the hydrosurgical system and a free multiperforator anterolateral thigh flap to prevent lower limb amputation in a severe case of necrotizing fasciitis. A 43-year-old woman was diagnosed with necrotizing fasciitis, and amputation was performed at the level of the metatarsal shafts with an emergency debridement using the hydrosurgical system. In the second reconstructive surgery, a free anterolateral thigh flap measuring 28 × 8 cm2 was harvested using the left thigh as the donor site and the vascular pedicle was made up of a total of 3 vessels, 2 perforating arteries from the descending branch of the lateral circumflex femoral artery, and 1 oblique branch from the lateral circumflex femoral artery. To thin the flap, we first resected as much subcutaneous fat as possible in the distal part of the flap (which would eventually cover the ankle joint) and ensured adequate residual volume of the proximal part of the flap (which would cover the metatarsal stumps). We then sutured the flap to the tissue defect on the left foot and then end-to-side anastomosing the lateral femoral circumflex artery and posterior tibial artery while the 2 veins were anastomosed to the posterior tibial veins under a microscope. Six months after the surgery, adequate flap volume was maintained over the metatarsal stumps with no postoperative complications such as infection or ulcer formation, and there were no other complications such as motor dysfunction at the donor site on the left thigh.Advanced mandibular osteoradionecrosis is arguably among the most challenging cases for reconstructive head and neck surgeons. Several reconstructive methods for complex mandibular defects have been reported; however, for advanced mandibular osteoradionecrosis, a safe option that minimizes the risk of renewed fistulation and infections is needed. For this purpose, we present a new technique using a fascia-sparing vertical rectus abdominis musculocutaneous flap as protection for a vascularized free fibula graft (FFG). This technique also optimizes recipient site healing and functionality while minimizing donor site morbidity. Our initial experiences from a 4 patient case series are included. Mean operative time was 551 minutes (SD 81 minutes). All donor sites were closed primarily. Mean time to discharge was 13 days (SD 7 days), and mean time to full mobilization was 2 days (SD 1 days). This double free flap technique completely envelops the FFG and plate with nonirradiated muscle. It allows for the transfer of an FFG without a skin island, thus avoiding the need for split skin graft closure.