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The use of appearance manipulating applications on our smartphones has increased in popularity. As the aim of this study is to determine the impact of self-directed appearance manipulation on perceptions of personality and examine the influence of respondent age and gender on the various personality domains. This cross-sectional cohort study included 20 subjects between the ages of 18 to 34 who had headshots taken and were provided an introduction on the use of the Facetune2 app. After 1 week of engaging in digital appearance manipulation, subjects submitted their self-determined most attractive edited photograph. Four surveys were constructed with 10 sets of photographs each. Each of these surveys were then sent to lay people via a web-based survey tool. Anonymous blinded respondents used a 7-point Likert scale to rate their perception of each patient's aggressiveness, likeability, sociability, trustworthiness, attractiveness, authenticity, and masculinity or femininity. A multivariate linear mixed effect model was applied to analyze the overall patient trait data as well as to assess the impact of rater age and gender. A total of 288 respondents (mean age range, 25–34 years [43%]; 202 [70%] female) completed a survey. Overall, digitally enhanced photographs were perceived as more attractive (0.22; 95% CI, 0.06–0.38). Analysis based on gender of the study subjects revealed increased attractiveness scores for men (0.19; 95% CI, 0.07–0.33). Females were also perceived as being more attractive (0.16; 95% CI, 0.03–0.40), but less authentic (−0.24; 95% CI, −0.36 to −0.12). Females rated enhanced photographs of men as less masculine (−0.23; 95% CI, −0.46 to −0.04). Raters aged 35 to 64 rated altered photos as less attractive (0.31; 95% CI, 0.09–0.52), authentic (0.20; 95% CI, 0.01–0.38), and gender enhancing (0.42; 95% CI, 0.24–0.61) compared with individuals aged 18 to 34. Patients and surgeons should be aware of the ways in which self-enhanced photographs may affect social perception.

Objective: To compare quantitative Nasal Obstruction Symptom Evaluation (NOSE) scores for ACG and Latera implants for nasal valve repair. Methods: Retrospective chart review of patients who underwent ACG or Latera placement between January 2016 through May 2019 by a single surgeon. Patients who had completed NOSE surveys pre- and post-operatively were identified and eligible for inclusion. Data regarding baseline demographic characteristics, adjunctive surgical procedures, NOSE scores at 1, 3, and 6-month post-operative visits, complications, and total operative time were collected. Unpaired t-tests and linear mixed models were performed to analyze differences between study groups. Results: There were 24 and 39 patients who underwent ACG and Latera, respectively, who met eligibility criteria. There were no differences in demographic characteristics or pre-operative baseline NOSE scores (ACG: 65.1 and Latera: 64.4; P = .92) between groups. Mean operative times were not significantly different between groups (ACG: 113 minutes and Latera: 102 minutes; P = .76). Within each group, NOSE scores were significantly improved at each post-operative visit compared to pre-operative baselines. Between groups, mean NOSE scores were lower at each post-operative visit for ACG compared to Latera (1-month ACG: 21.7 and Latera: 45.9, P = .002 ; 3-month ACG: 14.5 and Latera: 39.9, P = .034; 6-month ACG: 8.4 and Latera: 44.2, P = .003). Conclusions: Both ACG and Latera offer significant improvements in patient-reported nasal obstruction severity; however, ACG may yield more favorable subjective symptom scores.

Background: Social media has gained significant popularity over the last decade. We now have the opportunity to digitally enhance our physical appearance using a variety of applications in the palm...

Rhinoplasty is known to increase attractiveness; however, the influence of observer age and gender are largely undetermined. This retrospective cross-sectional study included 20 women who underwent cosmetic rhinoplasty between January 1st, 2012, and December 31st, 2019. A total of 4 surveys were constructed with 10 sets of photographs each (5 preoperative and 5 postoperative). Surveys were designed such that photographs of the same patient were not placed in the same survey to avoid recall bias. Each of these surveys were then sent to at least 30 lay people via a web-based survey tool. Anonymous blinded respondents used a 7-point Likert scale to rate their perception of each patient’s aggressiveness, likeability, sociability, trustworthiness, attractiveness, femininity, intelligence and confidence. A multivariate linear mixed effect model was applied to analyze the overall patient trait data as well as to assess age and gender differences. This survey study included photographs of 20 women (mean age, 28.2 years) before and after cosmetic rhinoplasty. A total of 174 respondents (mean age range, 25–34 years [41%]; 108 [62%] were female) completed the survey. Overall, postoperative photographs were perceived as significantly more sociable (0.13; 95% CI, 0.01–0.25), attractive (0.21; 95% CI, 0.09–0.34), feminine (0.18; 95% CI, 0.05–0.30), and confident (0.15; 95% CI, 0.02–0.27). When analyzed by sex, men rated women as less aggressive (−0.42, 95% CI, −0.65,−0.17) and more likeable (+0.45, 95% CI, 0.21–0.69), sociable (+0.38, 95% CI, 0.14–0.62), trustworthy (+0.37, 95% CI, 0.13–0.61), attractive (+0.60, 95% CI, 0.35–0.84), feminine (+0.23, 95% CI, 0.07–0.41) and intelligent (+0.29, 95% CI, 0.04–0.53). In contrast, female respondents indicated an increase in perceived attractiveness (+0.16, 95% CI, 0.06–0.22) and femininity (+0.18, 95% CI, 0.03–0.32) for women after rhinoplasty. Raters aged 25–34 indicated improvements across all traits analyzed. Almost all age ranges rated post-operative photographs as more attractive (18–24: +0.32, 95% CI, 0.19–0.46; 25–34: +0.52, 95% CI, 0.33–0.72; 35–44: +0.29, 95% CI, 0.12–0.51; 45–54: +0.50, 95% CI, 0.11–0.89) while individuals over age 55 only indicated increased trustworthiness (+0.51, 95% CI, 0.03–0.99). These findings suggest that cosmetic rhinoplasty improves perceptions of personality and physical traits of women with males and individuals aged 25–34 indicating the greatest benefit. Level IV.

Purpose Determine the impact of upper eyelid weight placement at 3 months post onset of idiopathic facial paralysis (IFP) on the recovery of facial function in patients with lagophthalmos. Methods This is a retrospective review of patients with incomplete recovery of IFP—defined as a Sunnybrook Facial Grading Scale (FGS) score of less than 100, 3 months after onset. Only patients with FGS and Facial Clinimetric Evaluation (FaCE) scores recorded at 3 and 12 months were included. Patients were categorized into 3 groups: Group A, lagophthalmos with eyelid weight placement; Group B, lagophthalmos without eyelid weight placement; Group C, complete eye closure (CEC) without eyelid weight placement. The eye comfort domain and composite score of the FaCE questionnaire were analyzed. Voluntary eye closure, synkinesis with eye closure, overall synkinesis and the composite score of the FGS were also analyzed. Paired two-tailed t-test was used to evaluate the data comparing the 3 and 12 month FaCE and FGS scores within and between the 3 groups. Results The change in composite FGS score significantly increased from month 3 to month 12 in Group A as compared to Group B (37 vs 4.25, P = 0.01). While Group A had significantly lower eye comfort (−12.5, P = 0.01), voluntary eye closure (−1.75, P = 0.05) and overall FGS scores (−28.75, P = 0.04) at 3 months compared to those in Group C, there were no differences between these two groups at 12 month follow-up. Conclusions For patients with lagophthalmos at 3 months, early eyelid weight placement may lead to improved facial function at 12 months.

Leptin signaling pathways, stemming primarily from the hypothalamus, are necessary for maintaining normal energy homeostasis and body weight. In both rodents and humans, dysregulation of leptin signaling leads to morbid obesity and diabetes. Since leptin resistance is considered a primary factor underlying obesity, understanding the regulation of leptin signaling could lead to therapeutic tools and provide insights into the causality of obesity. While leptin actions in some hypothalamic regions such as the arcuate nuclei have been characterized, less is known about leptin activity in the hypothalamic ventromedial nuclei (VMN). Recently, pituitary adenylate cyclase-activating polypeptide (PACAP) has been shown to reduce feeding behavior and alter metabolism when administered into the VMN in a pattern similar to that of leptin. In the current study, we examined whether leptin and PACAP actions in the VMN share overlapping pathways in the regulation of energy balance. Interestingly, PACAP administration into the VMN increased STAT3 phosphorylation and SOCS3 mRNA expression, both of which are hallmarks of leptin receptor activation. In addition, BDNF mRNA expression in the VMN was increased by both leptin and PACAP administration. Moreover, antagonizing PACAP receptors fully reversed the behavioral and cellular effects of leptin injections into the VMN. Electrophysiological studies further illustrated that leptin-induced effects on VMN neurons were blocked by antagonizing PACAP receptors. We conclude that leptin dependency on PACAP signaling in the VMN suggests a potential common signaling cascade, allowing a tonically and systemically secreted neuropeptide to be more precisely regulated by central neuropeptides.

The use of filters and editing tools for perfecting selfies is increasing. While some aesthetic experts have touted the ability of this technology to help patients convey their aesthetic goals, others have expressed concerns about the unrealistic expectations that may come from the ability for individuals to digitally alter their own photos in these so-called “super-selfies.” The aim of the study is to determine the changes that individuals seek when enhancing selfies. Twenty subjects participated in this study between July 25 and September 24, 2019. Subjects had two sets of headshots taken (neutral and smile) and were provided an introduction on the use of the Facetune2 app. Subjects received a digital copy of their photographs and were asked to download the free mobile app. After 1 week of trialing the different tools for enhancing their appearance, subjects submitted their self-determined most attractive edited photographs. Changes in marginal reflex distance (MRD) 1 and 2, nose height and width, eyebrow height, facial width, skin smoothness, skin hue, and saturation as well as overall image brightness were recorded. Paired two-tailed t-test was used to evaluate pre- and post-facial measurements. There were no statistically significant changes identified in the analysis of the altered photos in neutral expression. Analysis of all smiling photographs revealed that subjects increased their smile angle (right: +2.92 mm, p = 0.04; left: +3.58 mm, p

Rhinoplasty is known to increase attractiveness; however, the influence of observer age and gender are largely undetermined.This retrospective cross-sectional study included 20 women who underwent cosmetic rhinoplasty between January 1st, 2012, and December 31st, 2019. A total of 4 surveys were constructed with 10 sets of photographs each (5 preoperative and 5 postoperative). Surveys were designed such that photographs of the same patient were not placed in the same survey to avoid recall bias. Each of these surveys were then sent to at least 30 lay people via a web-based survey tool. Anonymous blinded respondents used a 7-point Likert scale to rate their perception of each patient's aggressiveness, likeability, sociability, trustworthiness, attractiveness, femininity, intelligence and confidence. A multivariate linear mixed effect model was applied to analyze the overall patient trait data as well as to assess age and gender differences.This survey study included photographs of 20 women (mean age, 28.2 years) before and after cosmetic rhinoplasty. A total of 174 respondents (mean age range, 25-34 years [41%]; 108 [62%] were female) completed the survey. Overall, postoperative photographs were perceived as significantly more sociable (0.13; 95% CI, 0.01-0.25), attractive (0.21; 95% CI, 0.09-0.34), feminine (0.18; 95% CI, 0.05-0.30), and confident (0.15; 95% CI, 0.02-0.27). When analyzed by sex, men rated women as less aggressive (-0.42, 95% CI, -0.65,-0.17) and more likeable (+0.45, 95% CI, 0.21-0.69), sociable (+0.38, 95% CI, 0.14-0.62), trustworthy (+0.37, 95% CI, 0.13-0.61), attractive (+0.60, 95% CI, 0.35-0.84), feminine (+0.23, 95% CI, 0.07-0.41) and intelligent (+0.29, 95% CI, 0.04-0.53). In contrast, female respondents indicated an increase in perceived attractiveness (+0.16, 95% CI, 0.06-0.22) and femininity (+0.18, 95% CI, 0.03-0.32) for women after rhinoplasty. Raters aged 25-34 indicated improvements across all traits analyzed. Almost all age ranges rated post-operative photographs as more attractive (18-24: +0.32, 95% CI, 0.19-0.46; 25-34: +0.52, 95% CI, 0.33-0.72; 35-44: +0.29, 95% CI, 0.12-0.51; 45-54: +0.50, 95% CI, 0.11-0.89) while individuals over age 55 only indicated increased trustworthiness (+0.51, 95% CI, 0.03-0.99).These findings suggest that cosmetic rhinoplasty improves perceptions of personality and physical traits of women with males and individuals aged 25-34 indicating the greatest benefit.Level IV.

IMPORTANCE: Facial cosmetic surgery has previously focused on improvements in perceived physical attractiveness and youthfulness. However, human beings are judged throughout life based on many other characteristics and personal qualities that are conveyed by their faces. OBJECTIVE: To examine the association of facial cosmetic surgery in men with perceptions of attractiveness, masculinity, and personality traits. DESIGN, SETTING, AND PARTICIPANTS: Cohort study with retrospective evaluation by blinded raters of preoperative and postoperative photographs of 24 male patients who underwent facial cosmetic surgery between January 1, 2009, and January 31, 2016. A total of 6 surveys were constructed with 8 sets of photographs each (4 preoperative and 4 postoperative). Each of these surveys was then sent to at least 36 lay people via the web-based survey tool Survey Monkey. Additional invites were sent for individual surveys until a minimum of 24 responses were received for each survey. Preoperative and postoperative photographs of the same patient were not placed in the same survey to avoid recall bias. Anonymous raters used a 7-point Likert scale to rate their perception of each patient’s personality traits (aggressiveness, extroversion, likeability, risk seeking, sociability, and trustworthiness), attractiveness, and masculinity based on photographs in their assigned survey. Raters were blinded to study intent. Data analysis was performed between August 2018 and March 2019. MAIN OUTCOMES AND MEASURES: Ratings of personality, attractiveness, and masculinity. RESULTS: This survey study included photographs of 24 men who underwent facial cosmetic surgery; the mean (SD) age of the patients was 49.3 (16.4) years. A total of 145 participants completed the survey; the majority of respondents were men (n = 81; 56%) between the ages of 25 and 34 years (n = 116; 80%). Score increases were significant for perceived attractiveness (0.29; 95% CI, 0.13-0.46), likeability (0.41; 95% CI, 0.24-0.57), social skills (0.25; 95% CI, 0.08-0.40), and trustworthiness (0.27, 95% CI, 0.11-0.44) when evaluating all facial cosmetic procedures together (upper blepharoplasty, lower blepharoplasty, face-lift, brow-lift, neck-lift, rhinoplasty, and/or chin implant). Upper blepharoplasty was associated with positive changes in perceived likeability (0.72; 95% CI, 0.06-1.50) and trustworthiness (0.74; 95% CI, 0.22-1.25). Lower blepharoplasty was associated with decreased perception of risk seeking (−0.78; 95% CI, −1.45 to −0.10). Face-lift was associated with increased perception of likeability (0.69; 95% CI, 0.08-1.30) and trustworthiness (0.66; 95% CI, 0.05-1.27). Neck-lift was associated with increased perception of extroversion (0.60; 95% CI, 0.10-1.09) and masculinity (0.70; 95% CI, 0.21-1.19). Patients who underwent rhinoplasty had improvements in perceived attractiveness (0.51; 95% CI, 0.03-1.00) and likeability (0.40; 95% CI, 0.03-1.00). Chin augmentation did not show any significant improvements. CONCLUSIONS AND RELEVANCE: The results of this study suggest that men undergoing facial cosmetic surgery may experience changes in perceived attractiveness, masculinity, and a variety of personality traits. These findings complement those from a previous study on female patients, which together broaden the understanding of the association of cosmetic surgery with societal perceptions of persona. LEVEL OF EVIDENCE: NA.

Key Points Question How is facial paralysis associated with the perception of attractiveness, femininity or masculinity, and personality, and do patient-reported outcome measures correlate with how patients are perceived by others? Findings In this cross-sectional study including 20 patients with facial paralysis and 122 survey respondents, respondents rated photographs of patients with facial paralysis significantly lower in likeability, trustworthiness, attractiveness, and femininity or masculinity compared with the digitally edited images of patients without facial paralysis. Higher social function and total Facial Clinimetric Evaluation scores were associated with increased trustworthiness and attractiveness scores. Meaning These results broaden understanding of how facial paralysis is associated with societal perceptions of persona., This cross-sectional study examines how facial paralysis is associated with perception of attractiveness, femininity or masculinity, and personality., Importance Facial paralysis has a significant effect on affect display, with the most notable deficit being patients’ the inability to smile in the same way as those without paralysis. These impairments may result in undesirable judgements of personal qualities, thus leading to a significant social penalty in those who have the condition. Objective To quantify the association of facial paralysis with the way smiling patients are perceived by others with respect to personality traits, attractiveness, and femininity or masculinity and to evaluate the potential association of facial palsy–related patient-reported outcome measures with how patients are perceived by others. Design, Setting, and Participants This retrospective cross-sectional study used 20 images of smiling patients with facial paralysis evaluated between January 1, 2014, and December 31, 2016. Using photograph editing software, the photographs were edited to create a simulated nonparalysis smiling facial appearance. A total of 40 photographs were split into 4 groups of 10 photographs, each with 5 altered and 5 unaltered photographs. The surveys were designed such that altered and unaltered photographs of the same patient were not placed in the same survey to avoid recall bias. Anonymous raters used a 7-point Likert scale to rate their perception of each patient’s personality traits (ie, aggressiveness, likeability, and trustworthiness), attractiveness, and femininity or masculinity based on photographs in their assigned survey. Raters were blinded to study intent. Scores from the Facial Clinimetric Evaluation questionnaire were included to assess self-perception. Data were analyzed from November 11, 2019, to February 20, 2020. Main Outcomes and Measures Ratings of personality traits, attractiveness, and femininity or masculinity. Social function domain scores and overall scores were analyzed from the Facial Clinimetric Evaluation questionnaire. Results This study included photographs of 20 patients with facial paralysis (mean [range] age, 54 [28-69] years; 15 [75%] women). A total of 122 respondents completed the survey (71 [61%] women). Most respondents were between the ages of 25 and 34 years (79 participants [65%]). Overall, smiling photos of patients with facial paralysis were perceived as significantly less likeable (difference, −0.29; 95% CI, −0.43 to −0.14), trustworthy (difference, −0.25; 95% CI, −0.39 to −0.11), attractive (difference, −0.47; 95% CI, −0.62 to −0.32), and feminine or masculine (difference, −0.21; 95% CI, −0.38 to −0.03) compared with their simulated preparalysis photographs. When analyzed by sex, smiling women with facial paralysis experienced lower ratings for likeability (difference, −0.34; 95% CI, −0.53 to −0.16), trustworthiness (difference, −0.24; 95% CI, −0.43 to −0.06), attractiveness (difference, −0.74; 95% CI, −0.94 to −0.55), and femininity (difference, −0.35; 95% CI, −0.58 to −0.13). However, smiling men with facial paralysis only received significantly lower ratings for likeability (difference, −0.24; 95% CI, −0.47 to −0.01) and trustworthiness (difference, −0.30; 95% CI, −0.53 to −0.07). As patients’ self-reported social function and total Facial Clinimetric Evaluation scores increased, there was an increase in perceived trustworthiness (rs[480] = 0.11; P = .02) and attractiveness (rs[478] = 0.10; P = .04) scores by raters. Conclusions and Relevance In this study, photographs of patients with facial paralysis received lower ratings for several personality and physical traits compared with digitally edited images with no facial paralysis. These findings suggest a social penalty associated with facial paralysis.

IMPORTANCE: Social media platforms and photograph (photo) editing applications are increasingly popular sources of inspiration for individuals interested in cosmetic surgery. However, the specific associations between social media and photo editing application use and perceptions of cosmetic surgery remain unknown. OBJECTIVE: To assess whether self-esteem and the use of social media and photo editing applications are associated with cosmetic surgery attitudes. DESIGN, SETTING, AND PARTICIPANTS: A population-based survey study was conducted from July 1 to September 19, 2018. The web-based survey was administered through online platforms to 252 participants. MAIN OUTCOMES AND MEASURES: Each participant’s self-esteem was measured using the Rosenberg Self-esteem Scale (scores range from 0-30; higher scores indicate higher self-esteem) and the Contingencies of Self-worth Scale (scores range from 1-7; higher scores indicate higher self-worth). Cosmetic surgery attitude was measured using the Acceptance of Cosmetic Surgery Scale (scores range from 1-7; higher scores indicate higher acceptance of cosmetic surgery). Unpaired, 2-tailed t tests were used to assess the significance of self-esteem and cosmetic surgery attitude score differences among users of various social media and photo editing applications. Structural equation modeling was used to assess the association between social media investment and cosmetic surgery attitudes. RESULTS: Of the 252 participants, 184 (73.0%) were women, 134 (53.2%) reported themselves to be white, and the mean age was 24.7 (range, 18-55) years. Scores on the Rosenberg Self-esteem Scale from users and nonusers across applications were compared, with lower self-esteem scores noted in participants who reported using YouTube (difference in scores, −1.56; 95% CI, −3.01 to −0.10), WhatsApp (difference in scores, −1.47; 95% CI, −2.78 to −0.17), VSCO (difference in scores, −3.20; 95% CI, −4.98 to −1.42), and Photoshop (difference in scores, −2.92; 95% CI, −5.65 to −0.19). Comparison of self-esteem scores for participants who reported using other social media and photo editing applications yielded no significant differences. Social media investment had a positive association with consideration of cosmetic surgery (R, 0.35; 95% CI, 0.04-0.66). A higher overall score on the Acceptance of Cosmetic Surgery Scale was noted in users of Tinder (difference in means, 0.79; 95% CI, 0.34-1.23), Snapchat (difference in means, 0.39; 95% CI, 0.07 to 0.71), and/or Snapchat photo filters (difference in means, 0.44; 95% CI, 0.16-0.72). Increased consideration of cosmetic surgery but not overall acceptance of surgery was noted in users of VSCO (difference in means, 0.84; 95% CI, 0.32-1.35) and Instagram photo filters (difference in means, 0.38; 95% CI, 0.01-0.76) compared with nonusers. CONCLUSIONS AND RELEVANCE: This study’s findings suggest that the use of certain social media and photo editing applications may be associated with increased acceptance of cosmetic surgery. These findings can help guide future patient-physician discussions regarding cosmetic surgery perceptions, which vary by social media or photo editing application use.

To date, the conversation about facial rejuvenation surgery has focused on one goal: youthfulness. However, human beings are judged throughout life based on many other characteristics and personal qualities conveyed by their faces. The term facial profiling has been used to describe this act of determining personality attributes through visual observation.To introduce the concept of facial profiling to the surgical literature and to evaluate and quantify the changes in personality perception that occur with facial rejuvenation surgery.This study was a retrospective evaluation of preoperative and postoperative photographs of 30 white female patients who underwent facial rejuvenation surgery between January 1, 2009, and December 31, 2013. Procedures included rhytidectomy (face-lift), upper blepharoplasty, lower blepharoplasty, eyebrow-lift, neck-lift, and/or chin implant. The 60 photographs (30 preoperative and 30 postoperative) of these patients were split into 6 groups, each with 5 preoperative and 5 postoperative photographs. The same patient's preoperative and postoperative photographs were not included in any single group to avoid any recall bias. At least 24 individuals rated each photograph for 6 personality traits (aggressiveness, extroversion, likeability, trustworthiness, risk seeking, and social skills), as well as for attractiveness and femininity. The raters were blinded as to the intent of the study.Ratings of personality traits, attractiveness, and femininity.Of the 8 traits that were evaluated, analysis revealed 4 traits with statistically significant improvements when comparing preoperative and postoperative scores: likeability (+0.36, P .01), social skills (+0.38, P = .01), attractiveness (+0.36, P = .01), and femininity (+0.39, P = .02). Improvement in scores for perceived trustworthiness (+0.22, P = .06), aggressiveness (-0.14, P = .32), extroversion (+0.19, P = .14), and risk seeking (+0.10, P = .27) did not demonstrate statistically significant changes.Facial plastic surgery changes the perception of patients by those around them. Traditionally, these interventions have focused on improvements in youthful appearance, but this study illuminates the other dimensions of a patient's facial profile that are influenced by facial rejuvenation surgery. The data in this sample population demonstrate an increase in the perception of likeability, social skills, attractiveness, and femininity. To our knowledge, this is the first study in the surgical literature to evaluate these broader outcome measures after facial rejuvenation surgery.NA.

ObjectivesThis study aimed to examine a range of factors influencing the long-term recovery of New York City residents affected by Hurricane Sandy.MethodsIn a series of logistic regressions, we analyzed data from a survey of New York City residents to assess self-reported recovery status from Hurricane Sandy.ResultsGeneral health, displacement from home, and household income had substantial influences on recovery. Individuals with excellent or fair health were more likely to have recovered than were individuals with poor health. Those with high and middle income were more likely to have recovered than were those with low income. Also, individuals who had not experienced a decrease in household income following Hurricane Sandy had higher odds of recovery than the odds for those with decreased income. Additionally, displacement from the home decreased the odds of recovery. Individuals who applied for assistance from the Build it Back program and the Federal Emergency Management Agency had lower odds of recovering than did those who did not apply.ConclusionsThe study outlines the critical importance of health and socioeconomic factors in long-term disaster recovery and highlights the need for increased consideration of those factors in post-disaster interventions and recovery monitoring. More research is needed to assess the effectiveness of state and federal assistance programs, particularly among disadvantaged populations. (Disaster Med Public Health Preparedness. 2018;12:172–175)

Introduction:Recent mass shooting events remind us of the importance of hospitals’ preparedness to manage a large number of patients in a short period of time. While prehospital systems triage for field interventions and priority of transport, they were not designed to triage for the scarce resources of a hospital. Therefore, upon arrival to hospital, clinicians must then quickly determine how to best assess and provide life-saving interventions based on their limited resources.Methods:In collaboration with the Greater New York Hospital Association (GNYHA), the Center for Disaster Medicine at New York Medical College piloted an interactive and intensive eight-hour course at four New York State hospitals that covered critical areas such as: current literature on Mass Casualty Events and Triage, review of hospital emergency management, hospital-based triage principles, a MCI exercise in the emergency department, a surge capacity tabletop exercise, and use of ultrasound. While targeted towards physicians to foster team-based care and learning, nurses, physician assistants, and hospital administrators also participated in the pilot course.Results:Sixty persons from four hospitals participated in the pilot phase. Preliminary findings post-training reveal the following: 58% of participants expressed greater confidence in distinguishing between emergency department triage and triage during disasters; 59% of participants expressed greater confidence in performing initial triage of victims; 49% of participants expressed greater confidence in describing the use of ultrasound-guided triage; and 95% of participants reported an enhancement in their ability to perform their clinical role.Discussion:Preliminary findings reiterate the ongoing need for hospitals to provide training to their staff in the unique aspects of hospital triage and surge management using tools specifically designed in order to be prepared for the rapid influx of a large number of patients. A multipronged training model is a positive approach to help hospitals prepare for large-scale disasters.

Hospital plans often vary when it comes to the specific functional roles that are included in emergency and incident management positions.Bioterrorism coordinators and emergency managers for 31 hospitals in a seven-county region outside of a major metropolitan area, with urban, suburban, and rural demographics were surveyed to determine which specific functional roles were considered “essential” to their hospital's emergency operations plans. Furthermore, they were asked to estimate the percentage of their “essential” staff trained to perform the functional roles delineated in the hospital's plan. Responses were entered into a database and descriptive statistical computations were performed. Only three categories of hospital personnel were reported to be “essential” by all hospitals to their emergency preparedness plans: emergency department physicians, nurse, and support staff. Training for overall “essential” staff ranged by hospital 73.6–83.3%. Some hospitals reported that these staff members have received no training in their anticipated role based on the hospital emergency response plan. Allied health professionals and emergency medical technicians/paramedics (that are employed by hospitals) had the least amount of training on their role in the hospital preparedness and response plan, 33.3% and 22.2% respectively.Without improved guidance on benchmarks for preparedness from regulators and professional organizations, hospitals will continue to lack the capacity to effectively respond to disasters and public health emergencies.

Human noroviruses are the major cause of nonbacterial epidemic gastroenteritis worldwide. However, little is known regarding their pathogenesis or the immune responses that control them because until recently there has been no small animal model or cell culture system of norovirus infection. We recently reported the discovery of the first murine norovirus, murine norovirus 1 (MNV-1), and its cultivation in macrophages and dendritic cells in vitro. We further defined interferon receptors and the STAT-1 molecule as critical in both resistance to MNV-1-induced disease in vivo and control of virus growth in vitro. To date, neither histopathological changes upon infection nor viral replication in wild-type mice has been shown. Here we extend our studies to demonstrate that MNV-1 replicates and rapidly disseminates to various tissues in immunocompetent mice and that infection is restricted by STAT1-dependent interferon responses at the levels of viral replication and virus dissemination. Infection of wild-type mice is associated with histopathological alterations in the intestine (mild inflammation) and the spleen (red pulp hypertrophy and white pulp activation); viral dissemination to the spleen, liver, lung, and lymph nodes; and low-level persistent infection in the spleen. STAT-1 inhibits viral replication in the intestine, prevents virus-induced apoptosis of intestinal cells and splenocytes, and limits viral dissemination to peripheral tissues. These findings demonstrate that murine norovirus infection of wild-type mice is associated with initial enteric seeding and subsequent extraintestinal spread, and they provide mechanistic evidence of the role of STAT-1 in controlling clinical norovirus-induced disease.

The Late Silurian-Early Devonian (418 ± 1 Ma) Lincoln syenite, exposed discontinuously over a distance of 75 kilometers in south-central and mid-coastal Maine, represents one of the most unusual igneous rocks in the Appalachian orogen. Detailed field and petrographic study reveals that most of the exposed syenites have been variably affected by post-magmatic recrystallization. However, a small proportion of the syenites in south-central Maine preserve original igneous minerals and textures and allow for an unobstructed study of the igneous petrogenesis. The syenites are characterized by large dark colored alkali feldspar megacrysts set in a finer grained matrix dominated by alkali feldspar + clinopyroxene + orthopyroxene + biotite + oxides. The rocks are intermediate in terms of SiO2 content (55–59 wt. %), yet are ultrapotassic (6–7 wt. % K2O) and relatively primitive in terms of their MgO (Mg# > 67), Cr (> 400 ppm), and Ni (> 150 ppm) concentrations. Additionally, the rocks exhibit large ion lithophile element enrichment relative to the high field strength elements along with elevated concentrations of light rare earth elements (200–300 chondritic abundances). The syenites show limited radiogenic isotopic variability with relatively high initial 87Sr/86Sr values (0.707 to 0.710), relatively low initial eNd values (−4.8 to −6.7), and initial Pb isotopic compositions characteristic of igneous rocks in central Maine (for example, 207Pb/204Pb = 15.577 to 15.639). The geochemical characteristics of these rocks are most consistent with a model involving the partial melting of a mantle wedge previously metasomatized by subduction derived fluids. Crystallization of this magma was influenced by the presence of significant amounts of water that suppressed plagioclase feldspar crystallization, facilitated the crystallization of Mg-rich biotite, and ultimately resulted in the nucleation and growth of the alkali feldspar megacrysts. Correlation with the geochemically similar Parks Pond pluton in eastern Maine extends the distribution of Late Silurian-Early Devonian ultrapotassic magmatism in Maine to an orogen-parallel distance of over 150 km. Comparisons with rocks of similar composition in known tectonic environments suggest the Lincoln syenite (and by association the Parks Pond pluton) formed as a result of lithospheric extension superimposed on a sub-continental lithospheric mantle source region previously modified by subduction-driven metasomatism. The timing and structural position of this ultrapotassic magmatism is consistent with a geodynamic model involving slab-break off or the convective removal of lithospheric mantle (delamination) in association with Acadian convergence. Both processes facilitate a brief period of crustal extension and decompression melting of source rocks previously modified by subduction related processes.

Disasters, whether resulting from terrorism or natural events, have a dramatic impact on the health and well-being of children. Studies after the terror attacks of September 11, 2001, in New York City and the 1995 Oklahoma City bombing and countless reports on the impact of natural disasters on children show that a child's mental health can suffer from direct and indirect exposure to these events. Children may react to a disaster or act of terrorism in a variety of ways. These reactions are influenced by age, developmental level, intellectual capacity, individual and family support systems, personality, and other factors. Common manifestations of psychological trauma in young children include regression, clinging behavior, inattentiveness, aggressiveness, bed-wetting, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer-lasting effects may include depression, anxiety, adjustment disorders, posttraumatic stress disorder, and interpersonal or academic difficulties. Some children are particularly vulnerable to postdisaster trauma because of preexisting psychosocial stressors (homelessness, foster care, exposure to violence, etc), low socioeconomic status, or special needs (including cognitive delays and prior mental illness). These postdisaster reactions may not manifest until well after the event and could persist for years. The National Center for Disaster Preparedness (NCDP) at Columbia's Mailman School of Public Health gathered key staff to discuss the appropriate response to the needs in the Gulf Coast region. Over the following few days, talks were held with federal, state, and local public officials to assess immediate needs and determine what resources could be offered to the affected areas. Necessary clearances to provide medical care were obtained from the Louisiana, Mississippi, and Texas departments of health. Permission was also necessary (and obtained) for access to gasoline and necessary supplies including pharmaceuticals and to travel after curfew. The Children's Health Fund and the NCDP launched Operation Assist, a collaborative effort to organize programs … Address correspondence to Paula A. Madrid, PsyD, 707A W 171st St, Ground Floor, Suite East, New York, NY 10032. E-mail: paulamadridpsyd{at}hotmail.com

Objective: To determine the utility of treating facial palsy with mirror book therapy in conjunction with facial physical rehabilitation. Methods: We randomly selected and reviewed the charts of 25 patients with idiopathic facial palsy. 10 of these patients received facial physical rehabilitation including manual therapy and postural exercises. 15 of these patients received mirror book therapy in conjunction with standard facial rehabilitation. Before and after treatment, patients in both groups were rated using the Facial Grading System (FGS) score, the Facial Disability Index--Physical (FDIP) score, and the Facial Disability Index--Social (FDIS) score. Differences in response to therapy were analyzed. Results: Patients in the facial physical rehabilitation group without mirror book therapy group showed on average a 20.8% increase in the FGS score, a 19% increase in the FDIP score, and a 14.6% increase in the FDIS score. Patients in the mirror book therapy group showed an average of 24.9% increase in the Facial Grading System (FGS) score, a 21.6% increase in the Facial Disability Index--Physical (FDIP) score, and a 24.5% increase in the Facial Disability Index--Social (FDIS) score. Conclusion: The addition of mirror book therapy to standard facial rehabilitation treatments does significantly improve outcomes in the treatment of idiopathic facial palsy.

ObjectiveThis study assessed disaster medicine knowledge and competence and perceived self-efficacy and motivation for disaster response among medical, nursing, and dental students.MethodsSurvey methodology was used to evaluate knowledge, comfort, perceived competency, and motivation. Also, a nonresponder survey was used to control for responder bias.ResultsA total of 136 responses were received across all 3 schools. A nonresponder survey showed no statistical differences with regard to age, gender, previous presence at a disaster, and previous emergency response training. In spite of good performance on many knowledge items, respondent confidence was low in knowledge and in comfort to perform in disaster situations. Knowledge was strong in areas of infection control, decontamination, and biological and chemical terrorism but weak in areas of general emergency management, role of government agencies, and radiologic events. Variations in knowledge among the different health professions were slight, but overall the students believed that they required additional education. Finally, students were motivated not only to acquire more knowledge but to respond to disaster situations.ConclusionsHealth care students must be adequately educated to assume roles in disasters that are a required part of their professions. This education also is necessary for further disaster medicine education in either postgraduate or occupational education. As students’ performance on knowledge items was better than their perceived knowledge, it appears that a majority of this education can be achieved with the use of existing curricula, with minor modification, and the addition of a few focused subjects, which may be delivered through novel educational approaches. (Disaster Med Public Health Preparedness. 2013;7:499-506)

The nose plays a central role in determining overall facial aesthetics. Not only does the nose occupy the geographic center of the face, but its prominent relationship to neighboring structures creates a visual emphasis to the observer. For these reasons, surgical alteration of the nose is one of the most common elective facial cosmetic procedures. For many patients, this surgical pursuit comes from a desire for a more “Caucasian” nose. One must be careful when considering the established paradigm for rhinoplasty. Worldwide, there is an emphasis on achieving the classically Caucasian features of a thin nasal bridge, slender nostrils, and straight or slightly convex nasal profile. These standards of beauty have been established by a primarily Caucasian-dominated medical literature and world economy. With this caveat in mind, we will discuss the considerations and techniques utilized to expertly address the female Caucasian rhinoplasty patient, a population with a great deal of nasal variability. In this chapter, the Caucasian patient will refer to those of European ancestry, although the anthropological definition may be extended to some of Middle Eastern and North African descent.

Objective To elucidate the sequential changes in protein expression that play a role in the clinically beneficial results seen with fractional carbon dioxide (CO(2)) laser resurfacing of the face and neck. Methods Nine healthy volunteers were recruited for participation from the senior author's facial plastic surgery practice. After informed consent was obtained, each volunteer underwent a 2-mm punch biopsy from a discrete area of infra-auricular neck skin prior to laser treatment. Patients then immediately underwent laser resurfacing of photodamaged face and neck skin at a minimal dose (30 W for 0.1 second) with the Pixel Perfect fractional CO(2) laser. On completion of the treatment, another biopsy specimen was taken adjacent to the first site. Additional biopsy specimens were subsequently taken from adjacent skin at 2 of 3 time points (day 7, day 14, or day 21). RNA was extracted from the specimens, and reverse transcriptase-polymerase chain reaction and protein microarray analysis were performed. Comparisons were then made between time points using pairwise comparison testing. Results We found statistically significant changes in the gene expression of several matrix metalloproteinases (MMPs). The data demonstrate a consistent up-regulation of MMPs 1, 3, 9, and 13, all of which have been previously reported for fully ablative CO(2) laser resurfacing. There was also a statistically significant increase in MMP-10 and MMP-11 levels in this data set. Conclusion This study suggests that the molecular mechanisms of action are similar for both fractional and fully ablative CO(2) laser resurfacing.

While many hospitals have developed preliminary emergency department and in-patient surge plans, the ability to surge is often limited by critical resources. The resource which is often the most limited is usually the human resource and within this category the limiting factor is almost universally nursing. As a result, nursing shortages can result in an inability of a hospital or emergency department to create surge capacity to deal with large numbers of ill or injured patients. Utilizing paramedics in acute-care hospitals or at alternate care sites could serve as expansion staff to supplement existing nursing staff allowing fewer nurses to care for a larger numbers of patients during a disaster, act of terrorism, or public health emergency. While the procedures performed for nursing do vary from hospital to hospital, there are national certifications for both emergency nursing (CEN) and critical care nursing (CCRN) that can be used to establish a standard for comparison.A detailed review and curriculum mapping of the specific educational objectives and competencies of the U.S. Department of Transportation National Standard Curriculum for the Emergency Medical Technician-Paramedic as well as the competencies and criteria for board certification as a Certified Emergency Nurse (CEN) and Critical Care Registered Nurse (CCRN) was performed.Approximately 90 percent of the CEN and CCRN knowledge skills and competencies are met or exceeded by the National Standard Paramedic Curriculum.With appropriate training and orientation, paramedics may be used in an in-patient setting to augment emergency and critical care nursing staff during a disaster, act of terrorism, or public health emergency.

Background:A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning.Methods:We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data.Results:Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care.Conclusions:Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for decontamination after a major incident.(Disaster Med Public Health Preparedness. 2010;4:226-231)

International audience; Stable integration of foreign DNA into the frog genome has been the purpose of several studies aimed at generating transgenic animals or producing mutations of endogenous genes. Inserting DNA into a host genome can be achieved in a number of ways. In Xenopus, different strategies have been developed which exhibit specific molecular and technical features. Although several of these technologies were also applied in various model organizms, the attributes of each method have rarely been experimentally compared. Investigators are thus confronted with a difficult choice to discriminate which method would be best suited for their applications. To gain better understanding, a transgenesis workshop was organized by the X-omics consortium. Three procedures were assessed side-by-side, and the results obtained are used to illustrate this review. In addition, a number of reagents and tools have been set up for the purpose of gene expression and functional gene analyses. This not only improves the status of Xenopus as a powerful model for developmental studies, but also renders it suitable for sophisticated genetic approaches. Twenty years after the first reported transgenic Xenopus, we review the state of the art of transgenic research, focusing on the new perspectives in performing genetic studies in this species.

To compare an open vs a closed approach to the nasal pyramid for the initial repair of nasal fractures.Retrospective medical record review of 49 patients with acute nasal fractures treated by a single surgeon during a 5-year period. Patients underwent a closed approach to the nasal pyramid (Boise elevator only) or an open approach using rhinoplasty techniques, including rasping, osteotomies, and cartilaginous resection or augmentation. Patients were further categorized based on whether septoplasty was performed. The primary outcome measure was the revision rate (RR).All 49 patients with acquired nasal deformities underwent repair within 3 weeks of the date of injury. The cohort was filtered into the following 5 groups: group 1 (closed approach to the nasal pyramid; RR, 1/15 [6.7%]), group 2 (closed approach to the nasal pyramid with septoplasty; RR, 3/4 [75.0%]), group 3 (open approach to the nasal pyramid; RR, 0/10 [0.0%]), group 4 (open approach to the nasal pyramid with septoplasty; RR, 1/15 [6.7%]), and group 5 (prior cosmetic septorhinoplasty; RR, 5/5 [100.0%]).In patients with nasal fractures and associated septal deviation requiring septoplasty, RRs may be notably reduced by using an open approach to the nasal pyramid at the time of the initial repair.

Background:Numerous studies have suggested that emergency medical services (EMS) providers areill-prepared in the areas of training and equipment for response to events due to weapons of mass destruction(WMD) and other public health emergencies (epidemics, etc.).Methods:A nationally representative sample of basic and paramedic EMS providers in the United States wassurveyed to assess whether they had received training in WMD and/or public health emergencies as part of their initial provider training and as continuing medical education within the past 24 months. Providers also were surveyed as to whether their primary EMS agency had the necessary specialty equipment to respond to these specific events.Results:More than half of EMS providers had some training in WMD response. Hands-on training was associated with EMS provider comfort in responding to chemical, biological, and/or radiological events and public health emergencies (odds ratio (OR) = 3.2, 95% confidence interval (CI) 3.1, 3.3). Only 18.1% of providers surveyed indicated that their agencies had the necessary equipment to respond to a WMD event. Emergency medical service providers who only received WMD training reported higher comfort levels than those who had equipment, but no training.Conclusions:Lack of training and education as well as the lack of necessary equipment to respond to WMD events is associated with decreased comfort among emergency medical services providers in responding to chemical, biological, and/or radiological incidents. Better training and access to appropriate equipment may increase provider comfort in responding to these types of incidents.

Introduction:Over-triage of patients by emergency medical services (EMS) dispatch is thought to be an acceptable alternative to under-triage, which may delay how quickly life-saving care reaches a patient. Previous studies have looked at advanced life support (ALS) misutilization in urban- and county-based EMS systems and have attempted to analyze how dispatch methods either contribute to or alleviate this problem.1–5Objective:The purpose of this study is to assess the relationship between dispatches of a cardiac nature in a Medical Priority Dispatch (MPD) system, and the actual clinical diagnosis as determined by an emergency department physician.Methods:Calls for emergency medical assistance in a suburban community outside of a major metropolitan area were surveyed over a three-month period. Medical Priority Dispatch protocols determined that 104 of these calls were cardiac-related. Of these emergency calls, 56 (53.8%) patients were transported to the local community hospital and treated by the emergency physician. A retrospective review of the medical records was conducted to determine whether the patient had a cardiac-related discharge diagnosis from the emergency department.Results:Sixteen (28.6%) of the patients in this cohort were diagnosed with a cardiac-related condition upon discharge from the emergency department. Forty (71.4%) were diagnosed with a non-cardiac-related condition. The positive, predictive value of the dispatch protocol for the detection of an actual cardiac emergency in this EMS system was 28.6%.Conclusion:In this suburban community, the MPD system may over-triage emergency medical responses to cardiac emergencies. This can result in the only ALS (paramedic) unit in the community being unavailable in certain situations. Future studies should be conducted to determine what level (in any) of over-triage is appropriate in EMS systems using a MPD system.

HYPOTHESIS: The public health system has a specialized body of knowledge and expertise in bioterrorism and public health emergency management that can assist in the development and delivery of continuing medical education programs to meet the needs of emergency medical service providers. METHODS: A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in weapons of mass destruction, bioterrorism, chemical terrorism, radiological terrorism, and/or public health emergencies, and how the training was provided. RESULTS: Local health departments provided little in the way of training in biologic, chemical, or radiological terrorism to responders (7.4%-14.9%). State health departments provided even less training (6.3%-17.3%) on all topics to emergency medical services providers. Training that was provided by the health department in bioterrorism and public health emergency response was associated with responder comfort in responding to a bioterrorism event (OR = 2.74, 95% CI = 2.68, 2.81). CONCLUSIONS: Local and state public health agencies should work with the emergency medical services systems to develop and deliver training with an all-hazards approach to disasters and other public health emergencies.

Pilot forward genetic screens in Xenopus tropicalis have isolated over 60 recessive mutations. Here we present a simple method for mapping mutations to chromosomes using gynogenesis and centromeric markers. When coupled with available genomic resources, gross mapping facilitates evaluation of candidate genes as well as higher resolution linkage studies. Using gynogenesis, we have mapped the genetic locations of the 10 X. tropicalis centromeres, and performed fluorescence in situ hybridization to validate these locations cytologically. We demonstrate the use of this very small set of centromeric markers to map mutations efficiently to specific chromosomes. Developmental Dynamics 238:1398-1406, 2009. (c) 2009 Wiley-Liss, Inc.