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Intimate partner violence (IPV) has been recognized as a preventable public health crisis for over 20 years. Craniomaxillofacial (CMF) injuries are exceedingly common among victims of IPV. The objective of this study was to determine whether assault due to IPV is different than other types of assault. A retrospective cohort study using data from the Nationwide Inpatient Sample data sets from 2016 to 2018. Additionally, the case control was matched for age, sex, and race for patients within the initial sample of assault patients (n = 52,632). Our final study sample consisted of 1,114 patients. Patients with IPV were less likely to have concussions (1.7 vs 3.6%; P <.01) and traumatic subarachnoid hemorrhages (2.1 vs 4.1%; P <.01), but more likely to have diffuse traumatic brain injuries (26.1 vs 18.7%; P <.01). Patients with IPV were less likely to have schizoaffective disorder (1.5 vs 2.8%; P <.05) but were more likely to have depressive episodes (19.8 vs 13.6%; P <.01), major depressive disorder (10.7 vs 5.3%; P <.01), and adjustment disorder (4.8 vs 2.2%; P <.01). We found that victims of IPV would be more likely to be female, delay care, have a mental health diagnosis, and present with worse intracranial injuries than other forms of assault. We hope our study informs and empowers maxillofacial surgeons to be a vigilant member of the interdisciplinary team. [ABSTRACT FROM AUTHOR]

Purpose: Le Fort III fractures are the most severe subtype of the Le Fort fractures and are associated with adverse clinical outcomes. The purpose of this study was to identify risk factors for mortality among patients who suffer Le Fort III fractures.Materials and Methods: A retrospective cohort study was completed using the 2016-2018 National Inpatient Sample. Patients with isolated Le Fort III fractures were selected. Patients who incurred bone fractures or organ injuries outside the head and neck were excluded. There were multiple, heterogenous predictor variables. The primary outcome variable was mortality. Relative risk was used to determine independent risk factors of mortality. Statistical significance was deemed for P values less than .05.Results: The final sample consisted of 559 patients (mean age, 45.9 years) who suffered a Le Fort III fracture, of whom 15 patients (2.68%) died. Most patients were male (82.7%) middle-aged adults (42.9%) of White race (66.5%) within the lowest income quartile (31.7%) that lived in large metro areas (54.9%). Relative to males, females were nearly 62 times more likely to die (P < .01). Relative to privately insured subjects, uninsured subjects were 23 times (P < .05) more likely to die. Relative to weekday admissions, weekend admissions increased the risk of mortality by 8 times (P < .05). Cranial vault fractures (odds ratio, 7.24; P < .05) and upper cervical fractures (odds ratio, 63.27; P < .05) were risk factors for mortality. Relative to males, females were at an increased risk for mortality (relative risk [RR] 7.14, 95% confidence interval [CI] 2.60, 19.61). Skull base fracture (RR 2.99, 95 CI 1.04, 8.63), cranial vault fracture (RR 3.04, 95 CI 1.07, 8.65), subdural hemorrhage (RR 2.98, 95 CI 1.10, 8.05), subarachnoid hemorrhage (RR 6.73, 95 CI 2.34, 19.35), and injury of blood vessels at neck level (RR 13.24, 95 CI 2.46, 71.16) were each risk factors for mortality.Conclusions: Intracranial injury was not a risk factor for mortality. Instead, cranial vault fractures and skull base fractures increased the risk for mortality. In addition, uninsured patients and female patients were each at an increased risk for mortality. [ABSTRACT FROM AUTHOR]

Purpose: The geriatric population is a constantly growing population that is especially vulnerable to trauma. The primary purpose of this study was to determine what factors are associated with increased rates of hospital admission in geriatric patients who sustain craniomaxillofacial fractures secondary to falls.Materials and Methods: This is a 5-year retrospective cross-sectional study that was conducted using the NEISS database. There were several, heterogenous predictor variables. The primary outcome variable was admission rate, which was used as a proxy to the severity of injury. Patient and injury characteristics were compared using chi-square and independent-sample t-tests. Binary logistic regression was conducted to determine the risk of hospital admission.Results: The final sample included 2,879 cases in total. The mean age of the study sample was 78.8 years (SD, 8.6 years). Most patients were white (51.6%) females (64.2%) who were injured at their respective homes (58.7%). Relative to injuries that took place at a sports center, injuries that took place at the patient's home (OR, 2.52; P < .05) independently increased the risk for admission. Relative to maxilla fracture, orbital bone fracture (OR, 3.91; P < .05) was an independent risk factor for admission. Relative to lacerations, intracranial injuries (OR, 3.76; P < .01) increased the risk of admission.Conclusions: Craniomaxillofacial fractures that took place at the patients' home were at increased risk for admission. Orbital bone fractures and intracranial injuries were at increased risk for admission. From our, and other studies findings, screening and fall prevention interventions should be implemented amongst the geriatric population. [ABSTRACT FROM AUTHOR]

Indocyanine green has been used for fluorescence-guided surgery of liver metastasis and labeling of liver segments. However, indocyanine green is nonspecific, and indocyanine green labeling does not always clearly outline tumor margins. In addition, it is difficult to distinguish between a tumor and its adjacent liver segment colored with indocyanine green alone. In the present study, we performed fluorescence-guided surgery in an orthotopic colon-cancer liver metastasis mouse model by labeling the metastatic liver tumor with an anti-carcinoembryonic antigen fluorescent antibody and with indocyanine green restricted to the adjacent liver segment. A liver metastasis model was established with human LS174T colon cancer tumor fragments. To label the tumor, mice received SGM-101, an anti-carcinoembryonic antigen antibody conjugated to a near-infrared fluorophore (700 nm), currently in clinical trials, 3 days before surgery. Indocyanine green (800 nm) was injected after ligation of the tumor-bearing Glissonean pedicle with fluorescence labeling restricted to the liver segment adjacent to the tumor. Bright-light surgery and fluorescence-guided surgery were performed to resect the liver metastasis. To assess recurrence, mice underwent necropsy 3 weeks after surgery and the tumor was weighed. Fluorescence-guided anatomic left lateral lobectomy and fluorescence-guided partial liver resection were both performed with color-coded double labeled imaging. Tumor weight 3 weeks after surgery was significantly lower with fluorescence-guided surgery compared to bright-light surgery (38 ± 57 mg vs 836 ± 668 mg, P =.011) for partial liver resection. The present study provides a proof-of-concept that color-coded and double labeling of the tumor and adjacent liver segment has the potential to improve liver metastasectomy. [ABSTRACT FROM AUTHOR]

Purpose: Successful orthognathic surgery is fundamentally based on accurately carrying out the intended surgical plan intraoperatively. The purpose of this study was to evaluate the accuracy of bone-borne patient-specific maxillary cutting guides and 3-dimensional (3D)-printed plates in repositioning the maxilla during bimaxillary orthognathic surgery.Materials and Methods: This was a retrospective case series consisting of patients who had undergone Le Fort I osteotomy with a patient-specific cutting guide and 3D-printed plate as well as a bilateral sagittal split osteotomy and had 6-week postoperative cone-beam computed tomography studies. The primary outcome variable was the difference between the position of the postoperative maxilla and the virtually planned maxilla measured at 10 landmarks in 3 dimensions. Other study variables included the preoperative diagnosis and planned surgical movement at each landmark. Descriptive statistics were tabulated, and bivariate analyses were performed.Results: A total of 10 patients were included in this study. The mean age was 25.7 ± 8.1 years, and there were 5 female patients. The median planned surgical movement was 0.350 mm on the x-axis (right-left), 3.750 mm on the y-axis (anterior-posterior), and 1.704 mm on the z-axis (superior-inferior). The median absolute discrepancy between the postoperative position and the planned position on the x-axis, y-axis, and z-axis was 0.638, 0.798, and 0.481 mm, respectively. There was no significant difference in the discrepancies between the x-axis and y-axis (P = .575), x-axis and z-axis (P = .332), and y-axis and z-axis (P = .114).Conclusions: Using a patient-specific cutting guide and 3D-printed plate when performing Le Fort I osteotomy allows for accurate 3-dimensional positioning of the maxilla in accordance with the surgical plan. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to compare complication rates and functional outcomes in patients with bilateral mandibular fractures treated with different degrees of internal fixation rigidity.Patients and Methods: This international, multicenter randomized controlled trial included adults with bilateral mandibular fractures located at either the angle and body, angle and symphysis, or body and symphysis. Patients were treated with either a combination of rigid fixation for the anterior fracture and nonrigid fixation for the posterior fracture (mixed fixation) or nonrigid fixation for both fractures. The primary outcome was complications within 6 weeks after surgery. Secondary outcomes were complications within 3 months, Helkimo dysfunction index, and mandibular mobility at 6 weeks and 3 months after surgery.Results: Of the 315 patients enrolled, 158 were randomized to the mixed fixation group and 157 to the nonrigid fixation group. The overall complication rate at 6 weeks in the intention-to-treat population was 9.6% (95% confidence interval [CI], 5.3% to 15.6%) in the mixed fixation group and 7.8% (95% CI, 4.0% to 13.5%) in the nonrigid fixation group. With an unadjusted odds ratio of 1.25 (95% CI, 0.51 to 3.17), there were no statistically significant differences in complication rates between the 2 groups (P = .591). A multivariable model for complication risk at 6 weeks found no significant differences between treatment groups, but patients with moderate or severe displacement had a higher complication rate than those with no or minimal displacement (adjusted odds ratio, 4.58; 95% CI, 1.16 to 18.06; P = .030). There were no significant between-group differences in complication rates at 3 months. Moreover, no significant differences in Helkimo dysfunction index and mandibular mobility index at 6 weeks and 3 months were found between groups according to treatment allocated and treatment received.Conclusions: A combination of rigid and nonrigid fixation in patients with bilateral mandibular fracture has similar complication rates and functional outcomes to nonrigid fixation for both fractures. [ABSTRACT FROM AUTHOR]

Background: Gait impairments following anterior cruciate ligament reconstruction (ACLR) may contribute to reinjury or future osteoarthritis development. Recently, plantar cutaneous sensation deficits have been reported post-ACLR. These sensory deficits may influence gait and represent a mechanism through which to improve gait.Research Question: Can established sensory interventions change sensation and gait in patients after ACLR and compared to healthy adults?Methods: Twenty-two adults (n = 11 post-ACLR, age:20.5 ± 1.9years, body mass index[BMI]:24.5 ± 3.6 kg/m2; n = 11 healthy, age:20.7 ± 1.4years, BMI:23.3 ± 2.7 kg/m2) completed two sessions separated by 48 h. Gait and plantar cutaneous sensation were assessed pre- and post-intervention (massage or textured insoles). Gait analysis was completed using 3D motion capture at 1.4 m/s ± 5% and standard inverse dynamics analysis. Plantar cutaneous sensation was assessed using Semmes Weinstein Monofilaments with a 4-2-1 stepping algorithm at the plantar aspect of the first metatarsal head, base of the fifth metatarsal, and lateral and medial malleoli. Plantar massage was a 5-minute massage to both feet. Textured insoles (coarse grit sandpaper) were worn while walking. Biomechanical data were assessed via mixed-models, repeated measures ANOVAs and 90 % confidence intervals. Wilcoxon Signed Rank tests and Mann-Whitney U tests evaluated plantar cutaneous sensation within and between groups, respectively.Results: Knee adduction moment was lower in the ACLR versus the contralateral limb pre-massage. The vGRF was lower during the first half of stance but greater during the second half of stance in the ACLR versus the control group post-massage. Massage improved ACLR limb sensation over the first metatarsal head (P = 0.042) and medial malleolus (P = 0.027). Textured insole application improved ACLR limb sensation over the first (P = 0.043) and fifth (P = 0.027) metatarsals and medial malleolus (P = 0.028).Significance: Plantar massage and textured insoles improved plantar cutaneous sensation in the ACLR limb. Neither intervention influenced gait. Improving plantar sensation may be beneficial for patients after ACLR; however, sensory interventions to improve gait are necessary. [ABSTRACT FROM AUTHOR]

Several studies have demonstrated that minorities and Hispanic ethnicities have disproportionally greater burden of morbid obesity in the United States. However, the majority of bariatric procedures are performed in the non-Hispanic white population. The objective of this study was to investigate the weight loss and remission of obesity-related co-morbidities based on race and ethnicity. The Longitudinal Assessment of Bariatric Surgery prospective, multicenter, observational study was used to collect patients from 10 different health centers across the United States. Retrospective analysis of a prospective, multicenter, observational study over a 5-year follow-up. All patients who underwent primary gastric bypass and provided racial/ethnic information were included in the study (n = 1695). Regardless of race or ethnicity, total weight loss was maintained over a 5-year follow-up, which included 87% of the original cohort. However, whites had on average 1.94% higher adjusted total weight loss compared with blacks (P <.0001). After adjusting for confounders there were no significant differences in resolution of co-morbidities, including diabetes. All patients regardless of race or ethnicity have significant and sustained total weight loss and resolution of co-morbidities after gastric bypass at 5-year follow-up. • All cohorts had significant weight loss maintained over 5-year follow up. • Majority of gastric bypasses were performed in the white, non-Hispanic cohort. • Patterns in outcomes are slightly different between races. • Accounting for severity of disease there is no difference in diabetes resolution. [ABSTRACT FROM AUTHOR]

Before the introduction of the vaccine, mumps was the most common salivary gland disease and was one of the most common infectious diseases in children globally. Following the introduction of the mumps vaccine in 1967, the disease was almost nonexistent in the United States and was only found to occur in nonvaccinated patients, and even then, it did not present in epidemic portions because of the extent of vaccination in the population at large. Beginning in the early 2000s, viral mumps began to present itself in vaccinated populations, and currently, outbreaks are continuing to increase in number. This article presents information on the various outbreaks, a review of the virus and the disease, including symptoms and comorbidities, and new recommendations for management. Dental practitioners should be aware of the increasing incidence and prevalence of this disease, be able to recognize it, and make appropriate referrals for management. [ABSTRACT FROM AUTHOR]

Background: Maternal nutrition may influence intrauterine fetal development. To date, the relationship between contemporary European dietary guidelines and fetal growth has not been examined.Aims: To develop a novel Periconceptual Nutrition Score (PENS) to assess maternal dietary quality in early pregnancy and examine its relationship with fetal growth.Study Design: Women were recruited conveniently at their first clinic visit and completed a supervised four day retrospective diet history. The PENS was developed using European Food Safety Authority recommended dietary intakes for pregnancy. The relationship between PENS and fetal growth was examined.Subjects: Women with a singleton pregnancy.Outcome Measures: Birthweight, small for gestational age (SGA), neonatal head circumference.Results and Conclusions: Of the 202 women, the mean age was 32.2 ± 5.0 years and 44.6% were nulliparas. The mean PENS was 9.4 ± 3.1. On multivariable regression, there was a positive relationship between the PENS and birthweight (beta = 45.3, 95%CI 14.8-75.9, P = 0.002) and neonatal head circumference (beta = 0.12, 95%CI 0.01-0.23, P = 0.03). Compared with the lowest PENS quartile, the mean birthweight was increased in the highest quartile (Mean difference 328 g, P = 0.02). The incidence of SGA was 16.4% (n = 10/61) in the lowest PENS quartile compared to 6.5% (n = 9/139) in the top three quartiles (P = 0.03). Thus, higher maternal dietary quality was associated with increased intrauterine fetal growth. The PENS is potentially useful in identifying those women before or during pregnancy who may benefit from dietary interventions that may optimise fetal growth. It may also be useful in tracking maternal dietary quality during pregnancy. [ABSTRACT FROM AUTHOR]

We aim to tackle the challenge of generating unstructured high-order meshes of complex three-dimensional bodies, which remains a significant bottleneck in the wider adoption of high-order methods. In particular we show that by adopting a variational approach to the generation process, many of the current popular high-order generation methods can be encompassed under a single unifying framework. This allows us to compare the effectiveness of these methods and to assess the quality of the meshes they produce in a systematic fashion. We present a detailed overview of the theory and formulation of the variational framework, and we highlight how such formulation can be effectively exploited to yield a highly-efficient parallel implementation. The effectiveness of this approach is examined by considering a number of two- and three-dimensional examples, where we show how the proposed approach can be used for both mesh quality optimisation and untangling of invalid high-order meshes. [ABSTRACT FROM AUTHOR]

Biotherapeutics is a rapidly growing drug class, and over 200 biotherapeutics have already obtained approval, with about 50 of these being approved in 2015 and 2016 alone. Several hundred protein therapeutic products are still in the pipeline, including interesting new approaches to treatment. Owing to patients' convenience of at home administration and reduced number of hospital visits as well as the reduction in treatment costs, subcutaneous (SC) administration of biologics is of increasing interest. Although several avenues for treatment using biotherapeutics are being explored, there is still a sufficient gap in knowledge regarding the interplay of formulation conditions, immunogenicity, and pharmacokinetics (PK) of the absorption of these compounds when they are given SC. This review seeks to highlight the major concerns and important factors governing this route of administration and suggest a holistic approach for effective SC delivery. [ABSTRACT FROM AUTHOR]

We present a pipeline of state-of-the-art techniques for the generation of high-order meshes that contain highly stretched elements in viscous boundary layers, and are suitable for flow simulations at high Reynolds numbers. The pipeline uses CADfix to generate a medial object based decomposition of the domain, which wraps the wall boundaries with prismatic partitions. The use of medial object allows the prism height to be larger than is generally possible with advancing layer techniques. CADfix subsequently generates a hybrid straight-sided (or linear) mesh. A high-order mesh is then generated a posteriori using NekMesh, a high-order mesh generator within the Nektar++ framework. During the high-order mesh generation process, the CAD definition of the domain is interrogated; we describe the process for integrating the CADfix API as an alternative backend geometry engine for NekMesh, and discuss some of the implementation issues encountered. Finally, we illustrate the methodology using three geometries of increasing complexity: a wing tip, a simplified landing gear and an aircraft in cruise configuration. [ABSTRACT FROM AUTHOR]

Objective to explore routine weighing in antenatal care and weight management in pregnancy with women who have been weighed during pregnancy. Design a qualitative study utilising semi-structured telephone interviews, and thematic analysis. Setting participants resided in Dublin, Ireland and had been weighed during pregnancy. Participants individual telephone interviews conducted with ten postpartum women (nine months postpartum). Findings experiences of routine weighing were positive, and participants believed it should be part of standard antenatal care. Several benefits to routine weighing were cited, including providing reassurance and minimising postpartum weight retention. It was felt that there was a lack of information provided on gestational weight gain and healthy lifestyle in pregnancy, and that healthcare professionals are ideally placed to provide this advice. Increased information provision was seen as a method to improve healthy lifestyle behaviours in pregnancy. Key conclusions and implications for practice these findings contribute to the current debate about the re-introduction of routine weighing throughout pregnancy (Allen-Walker et al., 2016). Women stated that they expected to be weighed during pregnancy and, contrary to previous claims, there was no evidence that routine weighing during antenatal care caused anxiety. From discussions it was clear that women desired more information on gestational weight gain and a healthy lifestyle, and felt that health professionals should provide this. [ABSTRACT FROM AUTHOR]

In the current study, we contend that to enhance their competitiveness and performance, hotel properties need to develop and implement internal policies and procedures such as strategic management accounting that are consistent with their business strategies and account for changing competitive demands. We employ a sample composed of 80 hotel properties to investigate the key precursor of hotel property strategic management accounting use and its impact on hotel property customer and financial performance. The results highlight that market orientation business strategy is a key determinant of hotel property strategic management accounting use and illuminate the mediating influence of hotel property strategic management accounting use and hotel property customer performance on the relationship between hotel property market orientation business strategy use and hotel property financial performance. Recommendations are provided for both researchers and hotel managers concerning their future study of, or use of, strategic management accounting. [ABSTRACT FROM AUTHOR]

A principal-agent relationship exists between hotel owners and the management companies which often operate their hotels. In addition, they both act as principals to a mutual agent, the hotel's General Manager, who is tasked with trying to achieve each parties' objectives. Extensive research on hotel management agreements which govern the owner-operator relationship has demonstrated that these objectives are often incongruent. However, the property-level managerial and performance implications of their goal incongruence has not been empirically examined. This study analyzes these issues using a matched sample of surveys from both owners and operators across 64 hotels operated under hotel management agreements. Using structural equations modeling, we demonstrate that owner-operator goal congruence positively impacts hotel performance and that this relationship is both mediated and moderated by the hotel General Manager's autonomy. [ABSTRACT FROM AUTHOR]

The generation of sufficiently high quality unstructured high-order meshes remains a significant obstacle in the adoption of high-order methods. However, there is little consensus on which approach is the most robust, fastest and produces the ‘best’ meshes. We aim to provide a route to investigate this question, by examining popular high-order mesh generation methods in the context of an efficient variational framework for the generation of curvilinear meshes. By considering previous works in a variational form, we are able to compare their characteristics and study their robustness. Alongside a description of the theory and practical implementation details, including an efficient multi-threading parallelisation strategy, we demonstrate the effectiveness of the framework, showing how it can be used for both mesh quality optimisation and untangling of invalid meshes. [ABSTRACT FROM AUTHOR]