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Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The mainstay treatment for postfacial paralysis synkinesis (PFPS) is chemodenervation and physiotherapy, which requires long-term maintenance neurotoxin injections. This can lead to treatment resistance. Selective neurectomy of the distal branches of the facial nerve has been suggested as an effective surgical treatment of PFPS. This study aims to provide a comprehensive systematic review evaluating the efficacy of selective neurectomy for patients presenting with PFPS. Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL were searched from inception until July 2022. Studies that investigated postoperative outcomes of pediatric and/or adult patients who underwent selective neurectomy as a treatment for PFPS were included. The database search identified 1,967 studies, and 11 were ultimately included based on inclusion and exclusion criteria. These 11 studies represented 363 patients. Studies reported on outcomes following selective neurectomy with or without adjuvant therapies for patients with PFPS. The main outcome categories identified were clinician-reported outcomes and patient-reported outcomes. The studies that used clinician-reported outcomes found an improvement in both synkinesis and facial nerve paralysis (FNP) outcomes following selective neurectomy according to their respective grading systems. Three studies looked at patient-reported outcomes and found increased patient-reported quality of life and satisfaction following selective neurectomy. The most reported complications were upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence. Selective neurectomy has demonstrated stable or improved synkinesis, FNP, and quality of life outcomes in patients with PFPS. This approach should be considered for patients with PFPS, particularly for patients with refractory symptoms or those who are unable to undergo continued medical management. [ABSTRACT FROM AUTHOR]

Health care leaders have a critical role to play to restore trust in our health institutions., The political backlash to the COVID-19 pandemic response has demonstrated the deep fissures in our social fabric. While societal division has been a growing issue for many years, the pandemic [...]

This article examines the history of road planning in the decades following the Second World War on the Navajo Nation. Federal highway planners and Navajo residents had conflicting ideas about the role of roads in the Nation's postwar development. The planners' support for highways near uranium mines undermined efforts towards Navajo selfdevelopment and modernization. Federally planned and subsidized highways granted extractive industries control over large portions of the Nation. Those highways locked in a regime of environmental exploitation that caused severe and debilitating public health consequences for Navajo communities. [ABSTRACT FROM AUTHOR]

Nasal septal perforation is an uncommon pathology that is difficult to surgically repair and may significantly impact patients' quality of life. Existing treatments have high complication and failure rates. The use of polydioxanone (PDS) plates to repair septal perforations is an innovative approach that has demonstrated superior outcomes to the conventional techniques. This study aimed to review the literature on PDS plates for nasal septal perforation reconstruction. PubMed, OVID Medline, and OVID Embase databases were searched for relevant articles in June 2021. Search terms included nasal septal perforation, polydioxanone, septal perforation, septal repair, nasal septum, and PDS plate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to for this systematic review. Database searches yielded 80 articles. Seven articles were included representing 74 patients. All studies reported the use of PDS plates in addition to other materials. They all reported closure rates of at least 80%. The majority of studies reported no postoperative complications. Nasal septal perforation reconstruction with PDS plates is a promising approach that has demonstrated positive outcomes. Further larger studies are required to evaluate the long-term efficacy of using PDS plates on patients with septal perforations. [ABSTRACT FROM AUTHOR]

The interaction of flow with steep island and ridge topography at the Palau island chain leads to rich vorticity fields that generate a cascade of motions. The energy transfer to small scales removes energy from the large-scale mean flow of the equatorial current systems and feeds energy to the fine and microstructure scales where instability mechanisms lead to turbulence and dissipation. Until now, direct assessments of the turbulence associated with island wakes have received only minimal attention. Here, we examine data collected from an ocean glider equipped with microstructure sensors that flew in the island wake of Palau. We use a combination of submesoscale modeling and direct observation to quantify the relationship between vorticity and turbulence levels. We find that direct wind-driven mixing only accounts for about 10% of the observed turbulence levels, suggesting that most of the energy for mixing is extracted from the shear associated with the vorticity field in the island's wake. Below the surface layer, enhanced turbulence correlates with the phase and magnitude of the relative vorticity and strain levels of the mesoscale flow. [ABSTRACT FROM AUTHOR]

The need to support innovation in health care delivery was prompted by payment reforms and access to digital tools and has been accelerated by the shift to virtual care as part of the COVID-19 pandemic response. Prior to the pandemic, a growing number of health systems set up innovation centers to focus on creating new services and exploring new business models relevant to value-based care. This is distinct from process improvement or implementation science, and often needs a different set of incentives to succeed within a large organization. We used a national survey to identify a diverse sample of innovation centers, and interviewed leaders to describe their aims, organizational structures, and activities. They all aim to improve patient outcomes and experience while reducing costs, but their strategic focus may differ. The centers also vary in their reporting structure, how they build internal capacity, and how they measure success. We highlight the range of strategies through examples of projects that improve quality, reduce costs, and generate new revenue. While the optimal forms and impact of innovation centers are still emerging, the fiscal pressures and the rapid uptake of digital technologies present opportunities for the redesign of health services in the postpandemic era. The experiences of these centers illustrate a set of approaches to increase any organization's capacity for innovation. J Med Internet Res 2022;24(2):e33961 doi:10.2196/33961 [ABSTRACT FROM AUTHOR]