Zafar S.N.,Houston Methodist Hospital |
Seminars in Plastic Surgery | Year: 2015
Autologous breast reconstruction is capable of creating a breast that closely resembles a natural breast. Reduction and mastopexy in this type of reconstruction yields several challenges to the reconstructive surgeon. Revision surgery is common to achieve symmetry; however, reduction, mastopexy, and other revision techniques are sparse in the current literature. Often, these techniques are passed from mentor to student during plastic surgery training or are learned with experience in managing one's own patients. Reviewing anatomical principles unique to this subset of patients is essential. We must also consider factors unique to this group including the effects of delayed reconstruction, radiation, skin paddle size, and flap volume. In this article, the authors describe some of the common principles used by experienced reconstructive surgeons to perform reduction and mastopexy in autologous breast reconstruction to achieve a natural, aesthetically pleasing breast reconstruction. In addition, they have included several case examples to further illustrate these principles. © 2015 by Thieme Medical Publishers, Inc.
Kambesis P.N.,Mississippi State University |
Boletin Geologico y Minero | Year: 2016
The Sac Actun system, located in northeast Quintana Roo, Mexico, is among the most extensive underwater cave systems located along the Caribbean coast of the Yucatan Peninsula. The cave is composed of linear phreatic conduits that have two forms. The coastal sections of the Sac Actun system are characterized by low horizontal tunnels that form mazes paralleling the coast and rudimentary conduits broken by fracture-controlled rooms. Inland passages are fault/fracture controlled, have a linear, anastomotic configuration, and align perpendicular to the coast. Access to the cave system is gained through cenotes which are the portals into the Yucatan underwater cave systems. The occurrence of drowned speleothems in many parts of the cave system, and sections of air-filled upper level passages are indicative of major fluctuations in sea level. The Sac Actun system is part of one of the most extensive and significant eogenetic karst aquifers in the world. The development of the Sac Actun system, as well as the many other caves systems along the Yucatan Caribbean Coast is controlled by the coastal hydrologic regime, driven by glacio-eustatics, and influenced by stratigraphic and structural controls. The karstic permeability of the aquifer makes it and the Sac Actun system vulnerable to the anthropogenic impacts of increased population growth, quarries, and infrastructure development associated with the burgeoning tourist industry that dominates land use in the region. © 2016, Instituto Geologico y Minero de Espana. All rights reserved.
Tu P.,University of Delaware |
Hall W.A.,IV |
Johnston M.V.,University of Delaware
Analytical Chemistry | Year: 2016
In this work, highly oxidized multifunctional molecules (HOMs) in fresh and aged secondary organic aerosol (SOA) derived from biogenic precursors are characterized with high-resolution mass spectrometry. Fresh SOA was generated by mixing ozone with a biogenic precursor (β-pinene, limonene, α-pinene) in a flow tube reactor. Aging was performed by passing the fresh SOA through a photochemical reactor where it reacted with hydroxyl radicals. Although these aerosols were as a whole not highly oxidized, molecular analysis identified a significant number of HOMs embedded within it. HOMs in fresh SOA consisted mostly of monomers and dimers, which is consistent with condensation of extremely low-volatility organic compounds (ELVOCs) that have been detected in the gas phase in previous studies and linked to SOA particle formation. Aging caused an increase in the average number of carbon atoms per molecule of the HOMs, which is consistent with particle phase oxidation of (less oxidized) oligomers already existing in fresh SOA. HOMs having different combinations of oxygen-to-carbon ratio, hydrogen-to-carbon ratio and average carbon oxidation state are discussed and compared to low volatility oxygenated organic aerosol (LVOOA), which has been identified in ambient aerosol based on average elemental composition but not fully understood at a molecular level. For the biogenic precursors and experimental conditions studied, HOMs in fresh biogenic SOA have molecular formulas more closely resembling LVOOA than HOMs in aged SOA, suggesting that aging of biogenic SOA is not a good surrogate for ambient LVOOA. © 2016 American Chemical Society.
Journal of Green Building | Year: 2014
In planning the George W. Bush Presidential Center in Dallas, Texas, former First Lady Laura Bush presented a very clear vision of what the Center should epitomize: “Because George was the first president of the new millennium, I wanted it to be forward and modern.”1 For the president and Mrs. Bush this meant making the building and landscape environmentally responsible, beautiful, and welcoming. In particular, their love of native Texas landscapes was an important framework for transforming the project’s urban site into a park that was sustainable and experientially rich for visitors. Sustainability was addressed from the start with smart planning that privileged contiguous parkland over impermeable surfaces and structures. Simultaneous consideration of every landscape component—-stormwater, plants, soil, topography, and more—netted cohesive natural systems that are better able to succeed with short-term establishment and provide enduring long-term health, the ultimate goals for a sustainable landscape. © 2009, College Publishing. All rights reserved.
McKenna K.M.,Oregon Health And Science University |
Academic Medicine | Year: 2016
Awareness of the risks of burnout, depression, learner mistreatment, and suboptimal learning environments is increasing in academic medicine. A growing wellness and resilience movement has emerged in response to these disturbing trends; however, efforts to address threats to physician resilience have often emphasized strategies to improve life outside of work, with less attention paid to the role of belonging and connection at work. In this Commentary the authors propose that connection to colleagues, patients, and profession is fundamental to medical learners’ resilience, highlighting “social resilience” as a key factor in overall well-being. They outline three specific forces that drive disconnection in medical education: the impact of shift work, the impact of the electronic medical record, and the impact of “work–life balance.” Finally, the authors propose ways to overcome these forces in order to build meaningful connection and enhanced resilience in a new era of medicine. © 2016 by the Association of American Medical Colleges