Author ContributionsThe manuscript was written through contributions of all authors. NDT, LCP, MRK1 (Karver), and MDS designed TF-targeted peptide sequences. MKK performed all conventional TEM. MKK conceived and designed the rat experiments and performed the surgeries. HAK assisted with the rat hemorrhage model. MKK and RHL conceived and designed the mouse experiments, with laser injury performed by RHL. DCG and BRD provided assistance with tissue processing and handling. MKK conceived, designed, and performed the TEG experiments. DCG provided additional assistance with TEGs. MDS and TDC performed CD spectroscopy. TDC performed cryo-TEM, SAXS, and WAXS. MRK1 synthesized all PAs. WB, EBP, LCP, NDT, TAP, SIS, MRK2 (Kibbe) helped guide the research. MKK, NDT, MRK2 interpreted all results. EBP assisted with statistical analysis. EBP and JRR performed CAC measurements. MKK prepared the initial draft of the manuscript. NDT and MRK2 critically revised the manuscript. MRK2, SIS, and BG provided oversight and funding of the entire project. All authors have given approval to the final version of the manuscript. Supporting InformationA table of the three letter codes, amino acid sequences, and corresponding Factor VII residues for the peptides incorporated into PA molecules; crystal structure models of the putative interaction sites of the targeting peptides on TF; HPLC-MS traces showing purity of synthesized PAs; cryogenic TEM of 25% SFE and 75% SBC-2 PA nanofibers; WAXS analysis of backbone, 25% SFE, and 75% SBC-2 PA nanofibers; CD spectroscopy of FKD and TQD PA nanofibers; fluorescent quantification of tested ratios of SFE and SBC-2 PA nanofibers; the critical aggregation concentration determinations for the 75% SBC-2, 25% SFE, and backbone PAs; and real-time localization of 75% SBC-2 in a mouse laser injury model. This material is available free of charge via the internet at http:// pubs.acs.org.

Background: In 1993, the Family and Medical Leave Act (FMLA) mandated 12 weeks of unpaid, job-protected leave. The current impact of taking 12 weeks of leave during residency has not been evaluated. Methods: We examined the 2018 Accreditation Council for Graduate Medical Education (n ¼ 24) specialty leave policies to determine the impact of 6-and 12-week leave on residency training, board eligibility, and fellowship training. We compared our findings with a 2006 study. Results: In 2018, five (21%) specialties had policy language regarding parental leave during residency, and four (16%) had language regarding medical leave. Median leave allowed was 4 weeks (IQR 4-6). Six specialties (25%) decreased the number of weeks allowed for leave from 2006 to 2018. In 2006, a 6-week leave would cause a 1-year delay in board eligibility in six specialties; in 2018, it would not cause delayed board eligibility in any specialty. In 2018, a 12-week (FMLA) leave would extend training by a median of 6 weeks (mean 4.1, range 0-8), would delay board eligibility by 6-12 months in three programs (mean 2.25, range 0-12), and would delay fellowship training by at least 1 year in 17 specialties (71%). The impact of a 12-week leave was similar between medical and surgical specialties. Conclusions: While leave policies have improved since 2006, most specialties allow for 6 weeks of leave, less than half of what is mandated by the FMLA. Moreover, a 12-week,

Background: The aim of this review was to describe emerging therapies that could serve as a prehospital intervention to slow or stop noncompressible torso hemorrhage in the civilian and military settings. Hemorrhage accounts for 90% of potentially survivable military deaths and 30%-40% of trauma deaths. There is a great need to develop novel therapies to slow or stop noncompressible torso hemorrhage at the scene of the injury. Methods: A comprehensive literature search was performed using PubMed (1966 to present) for therapies not approved by the Food and Drug Administration for noncompressible torso hemorrhage in the prehospital setting. Therapies were divided into compressive versus intravascular injectable therapies. Ease of administration, skill required to use the therapy, safety profile, stability, shelf-life, mortality benefit, and efficacy were reviewed. Results: Multiple potential therapies for noncompressible torso hemorrhage are currently under active investigation. These include (1) tamponade therapies, such as gas insufflation and polyurethane foam injection; (2) freeze-dried blood products and alternatives such as lyophilized platelets; (3) nanoscale injectable therapies such as polyethylene glycol nanospheres, polyethylenimine nanoparticles, SynthoPlate, and tissue factoretargeted nanofibers; and (4) other injectable therapies such as polySTAT and adenosine, lidocaine, and magnesium. Although each of these therapies shows great promise at slowing or stopping hemorrhage in animal models of noncompressible hemorrhage, further research is needed to ensure safety and efficacy in humans. Conclusions: Multiple novel therapies are currently under active investigation to slow or stop noncompressible torso hemorrhage in the prehospital setting and show promising results.

Hepatic hemangiomas are the most common benign liver tumor of infancy and are divided into two main types: rapidly involuting congenital hemangiomas (RICH) and non-involuting congenital hemangiomas. RICH typically involute by 12 months and are often asymptomatic. Surgical resection is rare. Indications for surgical resection include rupture, rapid growth, consumptive coagulopathy, and abdominal pain. We present two patients from different institutions who both developed clinically significant ascites as the RICH involuted, prompting surgical resection. This is a new indication for resection.

Background: Federal initiatives have recently addressed the sex bias that exists in biomedical and clinical research. However, improvement to the inclusion of sex as a biological variable remains unknown. Methods: We performed a 5-year follow-up study of all clinical and biomedical research articles published in 5 surgical journals from January 1, 2017, through December 31, 2018. Human, animal, and cell subjects were analyzed for study/subject type, sex of participants, sex matching, and sex-based data reporting, analysis, and discussion. Results: Comparing 2017 to 2018 with 2011 to 2012, slightly more articles reported the sex of the human studied (87% vs 83%; P ¼ .001). Inclusion of both sexes remained high (94% vs 95%; P ¼ .22), but sex-based data reporting (36% vs 38%; P ¼ .17), analysis (35% vs 33%; P ¼ .39), and discussion of results (10% vs 23%; P < .0001) remained unchanged or worsened. Regarding animal research, the number of articles that stated the sex studied remained unchanged (79% vs 78%; P ¼ .67); if stated, slightly more included both sexes (7% vs 3%; P ¼ .002). Regarding cell research, fewer articles reported the sex of the cells studied (5% vs 24%; P ¼ .0001); if stated, more articles included both sexes, but the difference did not reach statistical significance (25% vs 7%; P ¼ .34). Sex matching remained poor with only 50% of human, 4% of animal, and 9% of cell studies matching the inclusion of both sexes by at least 50%. Conclusion: Sex bias persists in surgical research. The majority of articles failed to report, analyze, or discuss results based on sex, which will negatively affect clinical translatability and outcomes of evidence-based medicine.