Representation of Global Health Initiatives in Plastic Surgery Training: A Social Media Analysis.

INTRODUCTION: Over the last several years, various social media platforms have been used to increase collaboration, education, and research internationally. The purpose of this study was to evaluate how plastic surgery residency programs use social media to promote global surgery education, research, and collaboration. METHODS: A full list of active integrated residency programs was obtained from the American College of Academic Plastic Surgeons website. A total of 82 programs were identified. Instagram, Facebook, and Twitter were searched for active accounts. Only accounts dedicated to plastic surgery programs or had a significant amount of residency-related content were included. Inclusion criteria included posts relating to global health, global surgery, mission trips, international plastic surgery education, and global surgery research. Caption language was analyzed and classified as either "resident education in global surgery," "an individual's interest in global surgery," "research in global surgery," "visiting international professor," or "global collaboration." Image content was then assessed for "images with patients," "images with other surgeons/residents," "images of international location," a combination thereof, "other," or "none." RESULTS: Instagram was by far the most used by plastic surgery residency programs with a total of 76 programs having accounts compared with only 32 programs and 33 programs having Facebook and Twitter accounts, respectively. There was no significant difference in the proportional number of posts relating to global surgery across the 3 platforms (P = 0.1911). On all 3 social media platforms, the majority of posts fell into the category of "international collaboration" with 42.5%, 50.7%, and 48.8% on Instagram, Facebook, and Twitter, respectively. None of the caption categories examined showed a significantly different proportion of posts across the 3 platforms. Image analysis showed a significant difference in the proportional representation across the 3 platforms in the categories of "images with other surgeons/residents" (P = 0.0196) "images with patients" (P = 0.0082), combination (P = 0.0225), and other (P = 0.0114). CONCLUSIONS: Although social media offers programs an easy way to promote global surgery research, collaboration, and education with a wider audience, it is being underused for this purpose as evident by the relatively lower number of postings on each platform relating to this content.

Obstacles to diagnostic investigation of a child with comorbid psychiatric conditions.

Presented here is the unique case of diagnostic investigation for a 16 year old male presenting in an acute state of apparent psychosis. The patient had a long history of previous specialist work-ups, tentative diagnoses, multiple emergency department admissions, and medication trials, all of which failed to produce significant lasting relief. While initial encounters diagnostically centered on autoimmune encephalitis, comprehensive work-ups always drove the differential towards a likely psychiatric disorder. Despite this consistent professional opinion, tentative diagnosis of schizophrenia with underlying Autism Spectrum Disorder was delayed for many years, due to a variety of complicating factors. Overall, this case highlights many different considerations that might assist in avoiding a protracted road to diagnosis, including navigating the obstacles that parental interaction with a complex healthcare system can pose during diagnostic evaluation and recommended treatment as well as, the role of re-interpreting past test results within the context of new literature, and the complexities of diagnosing comorbid psychiatric conditions.

Do ring-necked snakes choose retreat sites based upon thermal preferences?

Biochemical reaction rates are highly sensitive to temperature, and the body temperatures of ectotherms covary with their immediate environment. Therefore, ectotherms should choose microhabitats that permit the maintenance of physiological function. While some previous studies have found that squamate reptiles choose retreat sites that allow them to maintain physiologically optimal body temperatures, this research has been limited in context and taxonomic scope. We sought to test these empirical patterns by studying the properties of retreat sites in the context of physiological preferences and tolerances in a population of semifossorial ring-necked snakes (Diadophis punctatus). We measured environmental temperature distributions of retreat sites, field body temperatures, thermal preferences, and both upper voluntary temperature and critical thermal minima of snakes. We found that ring-necked snakes are under larger and warmer rocks, but that body temperatures in the field do not match thermal preferences measured in the laboratory. Specifically, we found aggregated ring-necked snakes (those occurring with multiple conspecifics) select rocks providing environmental temperatures averaging 3°C higher than their preferred temperature. By contrast, solitary snakes select rocks that allowed them to maintain their body temperatures very close to their preferred temperatures. These results imply that there is substantial within and among-species variation in the role of thermal considerations in retreat-site selection. Our work also highlights the complex tradeoffs between physiological and ecological requirements that organisms must navigate in heterogeneous habitats.