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Background: Historical concerns over bone resorption and malunion of the osteocutaneous radial forearm free flap (OCRFFF) limited its widespread adoption for head and neck reconstruction, despite lack of outcomes data evaluating this notion., Methods: A retrospective cohort study was performed including patients 18 years or older who underwent reconstruction of the mandible using an OCRFFF. Linear modeling and logistic regression were used to evaluate the change in bone volume and union over time., Results: One hundred and twenty-one patients were included in the study. A mixed effects linear model incorporating age, sex, treatment type, and number of bone segments did not demonstrate a significant loss of bone volume over time. A logistic regression model identified lack of adjuvant treatment and time to be significantly associated with complete union., Conclusion: This study supports that the OCRFFF is a stable form of osseus reconstruction for defects of the head and neck., (© 2021 Wiley Periodicals LLC.)

Importance: Inefficiency in the operating room (OR) is detrimental to the patient, the hospital, and the surgeon. Head and neck procedures requiring microvascular reconstruction are complex, lengthy operations in which prolonged operative time is associated with higher complication rates and increased costs., Objective: To use Lean methodology to identify potential OR efficiency improvement opportunities for head and neck surgical cases involving free tissue transfer, to implement an intervention, the free flap plan of the day, and to evaluate OR times after implementation., Design, Setting, and Participants: Phase 1: In 2015, with the assistance of the Lean Promotion Office at our institution, a tertiary academic medical center, we identified efficiency-improvement opportunities for 10 patients undergoing free flap reconstruction. Phase 2: A single intervention, the free flap plan of the day, was implemented on February 1, 2016. A retrospective medical record review of head and neck free flap reconstructions beginning 2 years before the implementation of the intervention and ending 2 years after the intervention was performed from February 1, 2014 until February 1, 2018 to analyze OR times, cost, and complications. Mean OR times were compared using the t test., Main Outcomes and Measures: In-room-to-incision time and total OR time., Results: Phase 1: The surgical procedures of 10 patients undergoing free flap reconstruction were observed by Lean specialists, and a time study with a process map was completed. Using this framework, major opportunities for decreasing intraoperative time waste were identified. Multiple communication breakdowns were seen to drive intraoperative time waste; therefore, a free flap plan of the day was created to improve communication between team members. Phase 2: 200 patients were included in the study and were categorized into 2 groups, no plan group (n = 104) and plan group (n = 96), based on whether the plan of the day was used or not. The age and sex distributions of the study participants were not collected. Mean in-room-to-incision time was 54.3 minutes for the no plan group and 47.2 minutes for the plan group (difference, 7.1 minutes; 95% CI, 3.8-10.4 minutes). Mean total OR time was 524.1 minutes for the no plan group and 467.4 minutes for the plan group (difference, 56.7 minutes; 95% CI, 23.6-89.6 minutes)., Conclusions and Relevance: Lean methodology was used to identify efficiency-improvement opportunities for head and neck free flap reconstruction procedures and to design a focused intervention. A free flap plan of the day was used in this study to improve communication between the OR team and was found to improve efficiency and be associated with reduced OR times.

In the packaged food industry, Corporate Social Responsibility (CSR) is an informal requirement for which firms account through sustainability reporting. CSR behaviors are often reported and analyzed using the Triple Bottom Line (3BL) framework, which categorizes them as affecting people, planet, or profit. 3BL is useful in determining which of these categories is most elaborated upon by the firm, but has a limited scope and many documented criticisms. This paper aims to address the aforementioned insufficiencies by augmenting the 3BL framework with two important attributes of CSR practices: (1) the presence of change in core firm behavior of the firm itself or of others in the supply chain, and (2) whether the behavior qualifies as being outside of the firm's normal business practice or is something that they might have done anyway. We qualitatively analyze CSR behaviors described in sustainability reports and interviews from major players in the packaged food industry and categorize them using these attributes as a supplement to 3BL. This enables us to separate the behaviors from their framing and analyze them more critically. Our results demonstrate how the visible CSR efforts of a firm can be misleading at first glance. Using only 3BL, we find that the CSR focus of firms in this industry is people. We then discover that the codes focusing on people (as opposed to planet or profit) require the least amount of real structural change from a firm or its supply chain partners, and thus arguably, the least amount of effort. We also find that behaviors that focus on planet require the most effort within the firm itself, but for behaviors involving supply chain partners, effort is required for behaviors in all three categories. Finally, we find that CSR behavior that is related to planet tends to go beyond normal business practice.

Using immunohistochemical techniques, olfactory marker protein (OMP) was localized to the main (MOB) and accessory (AOB) olfactory bulbs of 30- and 45-day-old, and adult Brazilian opossums, Monodelphis domestica. Entire olfactory nerve and glomerular layers of the adult opossum MOB were darkly stained. In the adult AOB the rostral half of these two layers was stained more intensely than the caudal half, and both parts were less darkly stained than the MOB. This differential AOB staining was not present at 30 days of age, but was evident by postnatal day 45, although not as dramatic as in adults. This is the first report of differential OMP expression and may provide an approach to identifying the function of OMP.

Rat gastric cholecystokinin (CCK) receptors are localized to the circular muscle layer of the pyloric sphincter, and a role for these receptors in the mediation of CCK satiety has been proposed. To directly assess the contribution of this receptor population in CCK satiety, the area of the pyloric sphincter containing these receptors was surgically removed, and the behavioral responses to CCK were compared pre- and postpylorectomy. The presence of CCK receptors in the gastroduodenal junction was assessed by either in vitro CCK receptor autoradiography or in vitro contractile response to CCK. The results depended on the time after pylorectomy during which testing occurred. Two to 3 wk after pylorectomy rats demonstrated a significant attenuation of CCK satiety such that while the response to 1 and 2 micrograms/kg was intact, any additional inhibition by 4 and 8 micrograms/kg was eliminated. At this time, no evidence of CCK receptors around the gastroduodenal junction was found. In contrast, 2-3 mo after pylorectomy, the normal dose-response inhibition to CCK was intact. Evidence for the presence of CCK binding sites at the gastroduodenal junction was found by both autoradiography and physiological assessment. These results indicate a role for pyloric CCK receptors in the mediation of CCK satiety.

The developmental and hormonal determinants of the lateralized response to focal cortical suction lesions were examined in a series of experiments. In an initial study, Sprague-Dawley male rats 25, 30, 55 or 90 days of age, received right unilateral focal frontocortical suction lesions. Only 90-day-old rats developed hyperactivity, suggesting a specific role for maturational factors in the production of this response. Prepubertally castrated adult male rats receiving right frontocortical suction lesions at 90 days also failed to develop hyperactivity, suggesting that sexual maturational factors and/or the presence of testosterone are necessary for the expression of this response. Testosterone implants, producing physiological relevant levels of circulating testosterone reinstated the hyperactivity response to adult cortical lesions in prepubertally castrated male rats. Similar lesions in the left hemisphere, however, did not produce hyperactivity in castrated male rats with testosterone replacement. Finally, in ovariectomized adult female rats, testosterone did not allow the expression of a hyperactivity response to right frontocortical suction lesions. Together, these results demonstrate both an organizational and permissive role for sex steroids in the sexually dimorphic asymmetrical response to cortical injury.