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Background Key to the US refugee resettlement effort is the role of non-governmental organizations (NGOs) who receive, place, and provide transitional programs and referrals to new and recently resettled refugees. Yet only one rapid assessment study thus far examined the impact of COVID-19 on service delivery systems of US refugee resettlement agencies. This exploratory study describes the capability and preparedness of US refugee resettlement agencies to provide services and care to clients during the COVID-19 pandemic. Methods Using both telephone interviews and an internet survey, we assessed the impact of COVID-19 on service delivery, agency capacity, and preparedness of 101 US refugee resettlement agencies. Descriptive statistics were used to describe the dataset, while chi-square (χ 2 ) tests were used to examine relationships by resettlement agency size (number of employees in each agency). Results Despite a temporary pause on refugee admissions, restrictive stay-at-home orders, and refugee travel restrictions, the majority of responding US refugee resettlement agencies continued to provide specialized services and care to resettled refugees and other immigrants. Among the more important findings was that agencies that continued to provide refugee services and care onsite in their existing facilities or office rather than moving such services offsite differed by agency size [χ 2 (9.494, n  = 101), p  < 0.05]. Almost all agencies (93.1%) strongly agreed or agreed that staff have timely access to COVID-19 information. Most of the refugee services were provided offsite ( n  = 72 agencies, some with multiple offices across the US). Conclusions US refugee resettlement agencies continued to perform admirably despite a lack of funding. Future research is underway to obtain a more balanced understanding of the impact of COVID-19 on practice or operations.

Goals/Purpose The nasal dorsum is a cornerstone of rhinoplasty aesthetics, playing a vital role in achieving facial harmony and balance. Achieving a smooth, refined nasal profile remains a significant challenge, particularly in thin-skinned patients who are more susceptible to contour irregularities. Many techniques are used to address this problem, including diced cartilage, fascia, acellular dermal matrices, and silicone implants. This study aims to evaluate the effectiveness of using morselized bone grafts (MBG)–specifically, unused bone rasp material that is typically discarded–as a technique for contouring and refining the nasal dorsum after dorsal reduction. Methods/Technique The senior surgeon exclusively utilizes an open approach to rhinoplasty, and all cases are performed under general anesthesia. After performing a dorsal hump reduction with a bone rasp, the MBG is stored on the back table for later use in the same case. After addressing other components of the rhinoplasty procedure, attention is turned back to the nasal dorsum, wherein any contour irregularities are filled with the MBG paste. A retrospective chart review of rhinoplasty cases in the senior author's practice was conducted between January 2021 and June 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases in which autologous MBG was used for dorsum refinement and contouring with a minimum of 12 months of follow-up. 953 patients met the inclusion criteria and were included in the study. Outcomes of interest included the rate of postoperative infection, defined as patients with signs of infection requiring antibiotics after completing their standard course of prophylactic antibiotics, and the rate of operative revisions. Results/Complications The mean age of our study group was 31.6 years old, with 869 female patients. 640 cases were primary rhinoplasties. The mean follow-up period was 23.5 months, with a minimum of 12 months of follow up for each patient. The rate of postoperative infection in our case series was 2.7%, with 26 patients requiring postoperative antibiotics. 17 (1.8%) patients required operative revision, among whom 4 (23.5%) patients were revision cases. There were no patients who sought revision rhinoplasty for concerns related to dorsal irregularities or contour defects. Conclusion MBG use for nasal dorsum aesthetics is a safe, convenient, and effective technique in camouflaging and concealing nasal dorsum irregularities in both primary and revision rhinoplasty. Additionally, as there is no additional equipment required and minimal operative time added when performing this technique, MBG use is an efficient alternative to other techniques for addressing dorsal aesthetics with no additional donor-site morbidity when paired with boney dorsal reduction. Future steps will involve performing a five-year follow-up on this cohort of patients to assess for long-term dorsal aesthetics following MBG use.

Goals/Purpose Smoking negatively impacts tissue perfusion and wound healing, raising concerns about infection and delayed recovery in surgical patients. While smoking remains a strict contraindication in some procedures with extensive dissection, such as abdominoplasty and facelift surgery, the risks of smoking in rhinoplasty patients are not well known. Given the nasal region's robust vascular supply, the risk of smoking complications may be less in rhinoplasty. This study explores whether smoking should be considered a contraindication for rhinoplasty by comparing postoperative infection rates and the need for revision surgery between smokers and nonsmokers. Using a decade of patient data, we aim to assess whether there is an increased risk of infection or revision surgery in smokers. The findings will provide valuable insights to guide plastic surgeons in making informed decisions and ensuring safe, successful outcomes for both smokers and nonsmokers. Methods/Technique A retrospective review was conducted on the senior author’s (R.G.R.) rhinoplasty cases from July 2014 to June 2022, including all patients treated in this period. The study was approved by the BRANY Institutional Review Board. All patients underwent open rhinoplasty under general anesthesia, prioritizing septal cartilage for reconstruction. If septal cartilage was inadequate, fresh frozen cartilage (FFCC) from MTF Biologics was used; no alloplastic materials were utilized. Patients were categorized as active smokers, former smokers, and non-smokers. Active smokers used any inhaled tobacco products (e.g., cigarettes, cigars, vaping) within 4 weeks before and/or after surgery. Former smokers had quit over 4 weeks prior to surgery with no intent to resume, and non-smokers had no history of tobacco use. Patients with less than one-year follow-up were excluded. After reviewing 2003 cases of rhinoplasty, 1884 patients were found to match both the inclusion and exclusion criteria. Patient demographics and surgical outcomes were collected through manual chart review. Primary outcomes included infection and revision rates, with infections identified by clinical signs requiring antibiotics or further intervention post-prophylactic antibiotics. Revision rhinoplasty was defined as any subsequent open procedure. Infection and revision rates were compared across active smokers, former smokers, and non-smokers, with subgroups for primary and revision rhinoplasty patients. Results/Complications A total of 1884 patients consisting of 1673 (88.80%) females and 211 (11.20%) males met inclusion criteria with an average age of 30.7 years and BMI of 22.47 kg/m2. Among these patients, 1421 (75.42%) were primary rhinoplasty cases and 463 (41.5%) were revisions. The average length of follow-up was 23.8 months. This study’s rhinoplasty patient population consists of 81 (4.30%) active smokers, 38 (2.02%) former smokers, and 1765 (93.68%) non-smokers (Table 1). In our patient population, we included patients who underwent both primary and revision rhinoplasty. In the overall population, there were 62 (3.29%) patients that underwent subsequent revision. 36 of 1421 (2.53%) of these patients belonged to the primary rhinoplasty group and 26 of 463 (5.62%) to the revision rhinoplasty population. In comparison, revisions were performed on 3 of 80 (3.75%) active smokers, 1 of 39 (2.56%) former smokers, and 58 of 1,765 (3.29%) non-smokers. Among these groups, all 3 of 71 (4.23%) revision patients were among primary rhinoplasty patients in the active smoker population, whereas in the non-smoker population, the distribution was 32 (2.42%) for primary and 26 (5.83%) for revision cases. No statistically significant difference was observed between groups (Table 2). Overall, 32 of 1884 (1.70%) of patients required 5-7 days of additional postoperative antibiotics for cellulitis. This was in addition to the standard postoperative antibiotic prophylaxis. 21 of 1421 (1.48%) of these patients belonged to the primary rhinoplasty group and 11 of 463 (2.38%) to the revision rhinoplasty patient population. 3 of 80 (3.75%) of patients requiring additional postoperative antibiotics were active smokers and 29 of 1765 (1.64%) were non-smokers. There was no incidence of use of additional postoperative antibiotics in the former smoker rhinoplasty population. Again, no statistically significant differences were found among the groups (Table 3). Conclusion The results of this study indicate that active smoking should not be considered a contraindication for rhinoplasty, as there is no significant increase in the need for revision surgeries in actively smoking patients compared to nonsmokers. While smoking is commonly associated with impaired wound healing and increased risk of infection due to its negative effects on tissue perfusion and immune response, our data demonstrate that these concerns can be managed effectively in the context of rhinoplasty. Among the 1884 patients included in this study, the revision rates for smokers (3.75%) and nonsmokers (3.29%) were comparable. This finding is particularly notable as it challenges the assumption that smokers are inherently at higher risk for suboptimal surgical outcomes. Despite the known systemic effects of smoking on vascular health and tissue healing, rhinoplasty in smokers appears to result in satisfactory outcomes when proper postoperative care is implemented.

The community-driven initiative Quality Assessment and Reproducibility for Instruments & Images in Light Microscopy (QUAREP-LiMi) wants to improve reproducibility for light microscopy image data through quality control (QC) management of instruments and images. It aims for a common set of QC guidelines for hardware calibration and image acquisition, management and analysis.

This study presents the results of a combined dendrological, macrobotanical, and dung spherulite analysis of flotation samples collected from Bronze Age, Late Assyrian, and post-Assyrian contexts at the site of Ziyaret Tepe, located on the southern bank of the Tigris River in southeastern Anatolia. The results of this study show shifting fuel resource exploitation between pre-urbanized phases of the site (ca. 3000–1600 BCE), the urbanized Late Assyrian occupation (882–611 BCE), and the ruralized post-Assyrian (ca. 611 BCE–1500 CE) re-occupations of the site. During the Late Assyrian period, Ziyaret Tepe is thought to have been the location of the city of Tušhan, an important provincial capital of the Neo-Assyrian empire. Evidence for local deforestation near the Tigris River and expanding reliance on dung fuel use during this period indicate overexploitation of fuel resources as larger populations and extractive imperial economic policies placed heavier pressure on local land use. Qualitative dendrological data provides evidence for the intensification of fuelwood harvesting during this period, while textual evidence documented an expansive program of timbering to the north of the site intended to fuel imperial construction projects in the Assyrian heartland. Following the abandonment of Tušhan and the collapse of the Neo-Assyrian empire, local fuel resource exploitation during subsequent occupations of the site shifted towards the direct management of wood fuel resources and increasing reliance on rural pastoralism.

BackgroundGiven the importance of infancy for establishing growth trajectories, with later-life health consequences, we investigated longitudinal body composition among infants from six economically and ethnically diverse countries.MethodsWe recruited mother-infant dyads using the WHO Multicenter Growth Reference Study criteria. We measured fat-free mass (FFM) in 1393 (49% female) infants from birth to 6 months of age (Australia, India, and South Africa; n = 468), 3–24 months of age (Brazil, Pakistan, South Africa, and Sri Lanka; n = 925), and derived fat mass (FM), fat mass index (FMI), and fat-free mass index (FFMI). Height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WHZ) Z-scores were computed. Sex differences were assessed using a t-test, and country differences using a one-way analysis of covariance. We further compared subsamples of children with average (−0.25 > HAZ < +0.25), below-average (≤−0.25) and above-average (≥+0.25) HAZ.ResultsHAZ performed well between 0 and 6 months, but less so between 3 and 24 months. The stunting prevalence peaked at 10.3% for boys and 7.8% for girls, at 24 months. By 24 months, girls had greater FMI (10%) than boys. There were significant differences in FFM (both sexes in all countries) and FM (Brazilian boys, Pakistani and South African girls) by 24 months of age between infants with average, above-average, and below-average HAZ.ConclusionIn a multi-country sample representing more ideal maternal conditions, body composition was heterogeneous even among infants who exhibited ideal length. Having a mean HAZ close to the median of the WHO standard for length reduced FFM between-country heterogeneity but not FM, suggesting that other factors may influence adiposity.

Background/ObjectivesTwo compartment (2 C) models of body composition, including Air Displacement Plethysmography (ADP) and Deuterium Dilution (DD), assume constant composition of fat-free mass (FFM), while 3-compartment (3 C) model overcomes some of these assumptions; studies are limited in infants. The objective of the present study is to compare 3 C estimates of body composition in 6-mo. old infants from Australia, India, and South Africa, including FFM density and hydration, compare with published literature and to evaluate agreement of body composition estimates from ADP and DD.MethodsBody volume and water were measured in 176 healthy infants using ADP and DD. 3C-model estimates of fat mass (FM), FFM and its composition were calculated, compared between countries (age and sex adjusted) and with published literature. Agreement between estimates from ADP and DD were compared by Bland–Altman and correlation analyses.ResultsSouth African infants had significantly higher % FM (11.5%) and density of FFM compared to Australian infants. Australian infants had significantly higher % FFM (74.7 ± 4.4%) compared to South African infants (71.4 ± 5.0) and higher FFMI (12.7 ± 0.8 kg/m2) compared to South African (12.3 ± 1.2 kg/m2) and Indian infants (11.9 ± 1.0 kg/m2). FFM composition of present study differed significantly from literature. Pooled three country estimates of FM and FFM were comparable between ADP and DD; mean difference of −0.05 (95% CI: −0.64, +0.55) kg and +0.05 (95% CI: −0.55, +0.64) kg.Conclusions3C-model estimates of body composition in infants differed between countries; future studies are needed to confirm these findings and investigate causes for the differences.

Providing all infants with the best start to life is a universal but challenging goal for the global community. Historically, the size and shape of infants, quantified by anthropometry and commencing with birthweight, has been the common yardstick for physical growth and development. Anthropometry has long been considered a proxy for nutritional status during infancy when, under ideal circumstances, changes in size and shape are most rapid. Developed from data collected in the Multicentre Growth Reference Study (MGRS), WHO Child Growth Standards for healthy infants and children have been widely accepted and progressively adopted. In contrast, and somewhat surprisingly, much less is understood about the ‘quality’ of growth as reflected by body composition during infancy. Recent advances in body composition assessment, including the more widespread use of air displacement plethysmography (ADP) across the first months of life, have contributed to a progressive increase in our knowledge and understanding of growth and development. Along with stable isotope approaches, most commonly the deuterium dilution (DD) technique, the criterion measure of total body water (TBW), our ability to quantify lean and fat tissue using a two-compartment model, has been greatly enhanced. However, until now, global reference charts for the body composition of healthy infants have been lacking. This paper details some of the historical challenges associated with the assessment of body composition across the first two years of life, and references the logical next steps in growth assessments, including reference charts.

BackgroundAccurate assessment of body composition during infancy is an important marker of early growth. This study aimed to develop anthropometric models to predict body composition in 3–24-month-old infants from diverse socioeconomic settings and ethnic groups.MethodsAn observational, longitudinal, prospective, multi-country study of infants from 3 to 24 months with body composition assessed at three monthly intervals using deuterium dilution (DD) and anthropometry. Linear mixed modelling was utilized to generate sex-specific fat mass (FM) and fat-free mass (FFM) prediction equations, using length(m), weight-for-length (kg/m), triceps and subscapular skinfolds and South Asian ethnicity as variables. The study sample consisted of 1896 (942 measurements from 310 girls) training data sets, 941 (441 measurements from 154 girls) validation data sets of 3–24 months from Brazil, Pakistan, South Africa and Sri Lanka. The external validation group (test) comprised 349 measurements from 250 (185 from 124 girls) infants 3–6 months of age from South Africa, Australia and India.ResultsSex-specific equations for three age categories (3–9 months; 10–18 months; 19–24 months) were developed, validated on same population and externally validated. Root mean squared error (RMSE) was similar between training, validation and test data for assessment of FM and FFM in boys and in girls. RMSPE and mean absolute percentage error (MAPE) were higher in validation compared to test data for predicting FM, however, in the assessment of FFM, both measures were lower in validation data. RMSE for test data from South Africa (M/F−0.46/0.45 kg) showed good agreement with validation data for assessment of FFM compared to Australia (M/F−0.51/0.33 kg) and India(M/F−0.77/0.80 kg).ConclusionsAnthropometry-based FFM prediction equations provide acceptable results. Assessments based on equations developed on similar populations are more applicable than those developed from a different population.

Shiga-toxin producing Escherichia coli (STEC) infections can cause from bloody diarrhea to Hemolytic Uremic Syndrome. The STEC intestinal infection triggers an inflammatory response that can facilitate the development of a systemic disease. We report here that neutrophils might contribute to this inflammatory response by secreting Interleukin 1 beta (IL-1β). STEC stimulated neutrophils to release elevated levels of IL-1β through a mechanism that involved the activation of caspase-1 driven by the NLRP3-inflammasome and neutrophil serine proteases (NSPs). Noteworthy, IL-1β secretion was higher at lower multiplicities of infection. This secretory profile modulated by the bacteria:neutrophil ratio, was the consequence of a regulatory mechanism that reduced IL-1β secretion the higher were the levels of activation of both caspase-1 and NSPs, and the production of NADPH oxidase-dependent reactive oxygen species. Finally, we also found that inhibition of NSPs significantly reduced STEC-triggered IL-1β secretion without modulating the ability of neutrophils to kill the bacteria, suggesting NSPs might represent pharmacological targets to be evaluated to limit the STEC-induced intestinal inflammation.