bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathophysiology and management of depth-related disorders
Authors: Radermacher Peter , Muth Claus-Martin
Published: April 2016

Decompression illness comprises decompression sickness resulting from tissue inert gas super-saturation and pulmonary barotraumas due to alveolar or airway over-distension. Gas bubbles can cause vascular obstruction or tissue compression, resulting in tissue ischaemia and oedema. Interactions between the blood–gas interface and the endothelium will result in further tissue damage, and trigger an inflammatory cascade with capillary leakage and haemoconcentration. Decompression illness may mimic any other emergency pathology and any emergency coinciding with decompression is ‘due to’ decompression. Pulmonary barotrauma-induced arterial gas embolism and decompression sickness can be discriminated according to the onset of symptoms, with gas embolism predominantly developing within a few minutes after or even during decompression. Specific treatment consists of hyperbaric oxygen treatment, using several empirically-derived hyperbaric oxygen treatment schedules. Currently, there is no recognized pharmacological treatment, but fluid resuscitation is useful to counteract haemoconcentration and dehydration. Early treatment initiation is mandatory, and certain technical issues must be considered for the management of critically-ill patients in a hyperbaric chamber.
Pathophysiology and management of rhabdomyolysis
Authors: Grau Josep M. , Poch Esteban
Published: April 2016

Rhabdomyolysis is a potentially life-threatening syndrome characterized by the breakdown of skeletal muscle. It is associated with myalgia, muscle tenderness, swelling, and/or stiffness, accompanied by weakness and raised levels of creatine kinase (CK), myoglobin, phosphate and potassium, sometimes with acute kidney injury (AKI). There are multiple causes of this syndrome, traumatisms and myotoxic effect of drugs being the most frequent in developed countries. The pathophysiology involves direct trauma, as well as energy (ATP) depletion with disruption of sarcolemma integrity and muscle destruction. The sequestration of plasma water leads to hypovolaemic shock, while the release of muscle content, mainly myoglobin and potassium lead to the most severe complications of this syndrome, acute kidney injury/hyperkalaemia. The kidney injury is driven both by renal ischaemia due to vasoconstriction and to the toxic effects of myoglobin. The local oedema produced by the release of muscle content remains trapped within the fascia and can lead to compartment syndrome. Volume repletion with saline is essential to avoid hypovolaemic shock and acute kidney injury (AKI). With respect to compartment syndrome, close monitoring of clinical signs and compartment pressures is essential, since it can evolve to a surgical emergency. The prognosis of rhabdomyolysis is determined by age, baseline conditions and, most importantly, whether or not severe AKI develops.
Intensive care management in lung transplantation
Authors: Rajagopal Keshava , Griffith Bartley P.
Published: April 2016

Lung transplant recipients are among the most complex critically-ill patients in the peri-transplant phase. In this chapter, a comprehensive multi-organ system review of lung transplant recipient management is undertaken, after a brief summary of the pre-implantation donor organ management and the conduct of the transplantation procedures themselves. Specific issues addressed that are unique to the transplant recipient include technical complications, primary allograft dysfunction, and hyperacute and acute allograft rejection. Since issues in heart and lung transplantation are reviewed separately, heart-lung transplantation is not discussed as an independent topic.
Management of the dying patient
Authors: Nelson Judith E. , Hope Aluko A.
Published: April 2016

Withdrawal or withholding of life-supporting therapies in anticipation of death has become common in intensive care units around the world. Knowledge and skill related to limitation of life support, including processes of communication, decision-making, and implementation, are essential for the delivery of high-quality intensive care. This chapter synthesizes existing relevant evidence and provides recommendations based on the best available data. Approaches to anticipated or actual conflict over the use of life support are reviewed. Discussion then focuses on key aspects of practice—preparing the patient and family, optimizing the setting, discontinuing various therapies, and controlling symptoms. The need for mutual support and collaboration by the interdisciplinary team is emphasized.
Management of panfacial injuries: bottom up or top down?
Authors: Burnham Richard , Bridle Christopher
Published: April 2016

Much controversy exists regarding the management of panfacial injuries. Significant variations exist regarding timing of repair and the methodology employed. We present a case of a complex panfacial injury following a road traffic collision. Initial life-saving management is discussed followed by planning of facial reconstruction and rehabilitation. A top-down method of fixation of the facial fractures was utilized in this case with associated evidence for this and other techniques. Differing surgical access to the facial skeleton are presented with associated management of the airway. Finally current technology to aid in the management of these complex cases is also discussed with a view to improving patient outcome measures.
Cranial vault reconstruction following decompressive craniectomy
Authors: Williams Luke , Ryba Francine , Bentley Robert
Published: April 2016

Decompressive craniectomy is effective in controlling intractable raised intracranial pressure and improves survival and neurological outcome. Significant cranial defects are created by this procedure mandating reconstruction. A case history of cranial reconstruction using a custom-made titanium implant following decompressive craniectomy as a result of middle cerebral artery infarction is presented with commentary from an expert in cranial reconstruction. The evidence and rationale for decompressive craniectomy are discussed followed by an account of current biomaterials in use for cranioplasty and surgical technique. Outcome following cranioplasty is discussed including complications and how these can be minimised. The benefits of cranial reconstruction are discussed particularly cosmesis and neurological improvement.
Posterior calvarial osseodistraction for syndromic craniosynostosis
Authors: Opie Neil , Evans Martin
Published: April 2016

The craniosynostoses present a significant challenge to the multidisciplinary team with the most significant being insufficient skull growth. Subsequent cephalocranial disproportion is a major factor in the development of raised intracranial pressure (ICP). We describe a case of a two-month-old male with Pfeiffer’s syndrome. He underwent posterior distraction at the age of nine months due to the high risk of future development of raised ICP. The patient was subsequently distracted to increase the head circumference from 45 cm to 50 cm. The procedure has been used to a limited degree thus far but has shown to be safe and efficient with a shorter operating time than conventional procedures.
The anterior open bite
Authors: Gerber Barbara , Currie Andrew
Published: April 2016

The anterior open bite presents a challenge to the orthognathic surgeon and the risk of relapse is always a concern. Careful assessment in a joint orthognathic clinic is imperative to enable appropriate treatment planning. We present a case of a 14-year-old boy with an anterior open bite (AOB) on a Class II skeletal base and incompetent lip seal and the subsequent management. Careful attention is paid to the aetiology and extent of the AOB and how this may affect treatment outcomes. Different methods of surgical intervention and the evidence for stability are presented with reference to mandibular surgery alone. Overall there is no general consensus on management of the AOB and each case must be assessed on its merits.
Osteochondroma of the mandibular condyle / temporomandibular joint
Authors: Attard Alan , Green Jason
Published: April 2016

Osteochondromas are one of the most common benign bone tumours. Condylar osteochondromas are typically situated on the anteromedial surface of the condylar head. They can present with progressive deviation of the mandible to the opposite side with restriction of function. We present a case of a 37-year-old patient with pre-auricular pain and a progressive mandibular deformity secondary to a left sided osteochondroma. The evidence for the diagnosis of progressive mandibular enlargement on imaging is presented. Subsequent management as a series of surgical steps is discussed with consideration given to the many treatment objectives.
Keratocystic odontogenic tumours (KCOT) and orthokeratinized odontogenic cysts (OKOC)
Authors: Parbhoo Alan , Simpson Mike
Published: April 2016

Some controversy exists regarding the naming of these jaw lesions. Reference is made to keratocystic odontogenic tumours (KCOT), orthokeratinized odontogenic cysts (OKOC), and keratocyst where the distinction is unknown. The evidence for and against marsupialisation is discussed and reference to how histological subtype affects management and outcome. We present a case of an 82-year-old patient with a recurrent KCOT in the left posterior mandible. It was initially managed with enucleation and had demonstrated appropriate bony infill radiographically. The value of adequate imaging and histological diagnosis to help make an appropriate treatment plan are highlighted. The relevance of Carnoy’s solution in treating these lesions is also discussed as a method to prevent recurrence.
Paediatric temporomandibular joint ankylosis
Authors: McMillan Kevin , Williams Rhodri
Published: April 2016

Ankylosis of the temporomandibular joint can be either intra- or extra-articular. It may affect bone, fibro-osseous or fibrous tissue. In addition it may be complete or incomplete. This relatively rare condition requires close management by a multidisciplinary team versed in such complex disease processes. It is acknowledged to be caused by trauma, otitis media, odontogenic and skin infections, autoimmune disease, and following radiotherapy. We present a case of a four-year-old boy with severe trismus that had developed over a period of 18 months following an ear infection. The evidence for the current management strategy of this condition is discussed and the need for close follow-up to establish early on if re-ankylosis is occurring.
Cleft palate related velopharyngeal incompetence
Authors: Sweet Christopher , Eeden Simon Van
Published: April 2016

Primary cleft palate repair surgery is directed at closure of the cleft without any fistulae and the subsequent development of normal speech. In cleft patients the velum is shorter than in non-cleft patients and the muscles of the soft palate are abnormally orientated. Without correction of this deformity it may lead to the development of velopharyngeal incompetence (VPI). We present a case of a female with bilateral cleft lip and palate where the primary surgery was carried out at three months for the lip, five months for the hard palate, and nine months for the soft palate. However, at three years detailed assessment demonstrated VPI. The further management is described and a comprehensive algorithm is presented.
Early Predictors of Mortality in Geriatric Patients With Trauma
Authors: Wilson Matthew S. , Konda Sanjit R. , Seymour Rachel B. , Karunakar Madhav A. ,   the Carolinas Trauma Network Research Group
Published: April 2016

Objective:

To identify variables that predict mortality in geriatric patients with trauma.

Design:

Retrospective review.

Setting:

Level I trauma center.

Patients/Participants:

A total of 147 geriatric patients with trauma (age ≥65) with a predicted probability of survival of 10%–75% based on the Trauma Score-Injury Severity Score (TRISS).

Main Outcome Measurements:

Patients were divided into 2 cohorts: survivors and nonsurvivors. The following variables available at presentation were analyzed: age, mechanism of injury, temperature, systolic blood pressure, pulse rate, shock index, respiratory rate, Glasgow Coma Scale (GCS) score, base deficit, and hematocrit (HCT). The Injury Severity Score (ISS) and TRISS were calculated for both cohorts.

Results:

Of the 147 patients analyzed, 84 (57%) died during the index hospitalization and 63 (43%) survived. The mean age of nonsurvivors was significantly higher than that of survivors (78.6 vs. 76.1 years; P < 0.04). A greater number of nonsurvivors (72.6%) sustained injuries as a result of a low-energy mechanism compared with survivors (54%; P = 0.02). GCS, temperature, and respiratory rate were significantly lower for nonsurvivors, whereas base deficit was higher (P < 0.05). The TRISS was predictive of survival (TRISS 0.27 vs. 0.53, P < 0.001), but the distinguishing capacity of the TRISS to predict mortality was limited (area under the receiver operator curve; 0.67; 95% confidence interval 0.58–0.76; P < 0.0001).

Conclusions:

Older age, lower GCS, and a low-energy mechanism of injury are associated with a higher mortality rate in this at-risk geriatric trauma population. Early identification of predictors of mortality may help care providers more accurately assess injury burden in geriatric patients.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Some GCR Polymorphisms (N363S, ER22/23EK, and Bcl-1) May Influence Steroid-induced Toxicities and Survival Rates in Children With ALL
Authors: Eipel Oliver , Hegyi Márta , Csordás Katalin , Németh Krisztina , Luczay Andrea , Török Dóra , Csóka Monika , Erdélyi Dániel , Kovács Gábor
Published: April 2016

We investigated whether an altered individual glucocorticoid sensitivity due to particular glucocorticoid receptor single-nucleotide polymorphisms (SNPs) (N363S, ER22/23EK, and Bcl-1) influences the susceptibility to steroid-related toxicities, prognostic factors, and survival rates in children with acute lymphoblastic leukemia. In total, 346 pediatric patients with acute lymphoblastic leukemia were enrolled in our study. Their carrier status was investigated by allele-specific polymerase chain reaction analysis. Clinical and laboratory signs of glucocorticoid-related toxicities, day-8 prednisone response, 5-year event-free survival, and 5-year overall survival rates were analyzed and compared retrospectively. Hepatotoxicity occurred significantly more often in 363S carriers (P=0.004), and glucose metabolism abnormalities were more common in 363S carriers (P=0.001), but did not occur in patients with the ER22/23EK SNP. Hypertension and central nervous system/behavioral changes did not occur in patients with the ER22/23EK SNP. None of the patients with the N363S SNP, the ER22/23EK polymorphism, or the GG genotype for the Bcl-1 polymorphism had a poor prednisone response. The 363S carriers had significantly better 5-year event-free survival (P=0.012) and 5-year overall survival (P=0.013) rates compared with noncarriers. The Bcl-1 SNP was not associated with any of the toxicities investigated or survival. Children with the N363S polymorphism in the glucocorticoid receptor gene were more prone to steroid-related toxicities, whereas those with the ER22/23EK polymorphism were less susceptible. Children with the N363S polymorphism may have more favorable survival rates.
Spontaneous Regression of Pulmonary Nodules Presenting as Epstein-Barr Virus-related Atypical Infectious Mononucleosis
Authors: Shinozuka Jun , Awaguni Hitoshi , Tanaka Shin-ichiro , Makino Shigeru , Maruyama Rikken , Inaba Tohru , Imashuku Shinsaku
Published: April 2016

Background:

Pulmonary nodules associated with Epstein-Barr virus (EBV)-related atypical infectious mononucleosis have rarely been described.

Observations:

A 12-year-old Japanese boy, upon admission, revealed multiple small round nodules (a total of 7 nodules in 4 to 8 mm size) in the lungs on computed tomography. The hemorrhagic pharyngeal tonsils with hot signals on 18F-fluorodeoxyglucose-positron emission tomography-computed tomography were biopsied revealing the presence of EBV-encoded small nuclear RNA (EBER)-positive cells; however, no lymphoma was noted. The patient was diagnosed as having atypical EBV-infectious mononucleosis associated with primary EBV infection. Pulmonary nodules markedly reduced in numbers and sizes spontaneously over a 2-year period.

Conclusions:

Differential diagnosis of pulmonary nodules in childhood should include atypical EBV infection.
DIC Complicating APL Successfully Treated With Recombinant Thrombomodulin Alfa
Authors: Saito Aki , Okamoto Yasuhiro , Seki Yuko , Matsunaga Manaka , Nakagawa Shunsuke , Kodama Yuichi , Nishikawa Takuro , Tanabe Takayuki , Kawano Yoshifumi
Published: April 2016

An 8-year-old boy developed anorexia, fatigue, and fever. Laboratory examination revealed a high white blood cell (WBC) count of 145×103/μL with 97.5% abnormal promyelocytic cells that contained Auer bodies. Faggot cells were seen. He was diagnosed with acute promyelocytic leukemia. Later, a chromosome analysis showed 46,XY,t(15;17)(q22;q12). Promyelocytic Leukemia-retinoic acid receptor α-fused gene and chimeric mRNA were confirmed by fluorescence in situ hybridization and reverse transcriptase polymerase chain reaction, respectively. He was complicated with disseminated intravascular coagulation (DIC) and his fibrin and fibrinogen degradation product at the onset was 37.6 μg/mL. Human recombinant thrombomodulin (rTM) was started for DIC. After dexamethasone was administered at a dose of 8 mg/m2 to prevent all-trans retinoic acid syndrome on day 1, all-trans retinoic acid was started at a dose of 45 mg/m2 on day 4. Cytarabine (100 mg/m2/d) and daunorubicin (45 mg/m2/d) were started on day 9. The WBC count gradually increased to 270×103/μL on day 8, and then decreased beginning on day 9. DIC improved after the initiation of chemotherapy and only minor petechia was noted. DIC did not become worse even after rTM was stopped on day 8. The risk of DIC and bleeding is high in the early stage of treatment for acute promyelocytic leukemia, especially in patients with a high WBC count. In our patient, rTM may have prevented fatal DIC and made it possible to safely administer induction chemotherapy.
Wound Healing and Angiogenesis through Combined Use of a Vascularized Tissue Flap and Adipose-Derived Stem Cells in a Rat Hindlimb Irradiated Ischemia Model
Authors: Yoshida Shuhei , Yoshimoto Hiroshi , Hirano Akiyoshi , Akita Sadanori
Published: April 2016

Background:

Treatment of critical limb ischemia is sometimes difficult because of the patient’s condition, and some novel approaches are needed.

Methods:

The hindlimbs of Sprague-Dawley rats, after 20-Gy x-ray irradiation and surgical occlusion, were divided into four groups: with a superficial fascial flap, 5.0 × 106 adipose-derived stromal/stem cells, and both combined. The rats were tested for laser tissue blood flow, immunohistologic blood vessel density, and foot paw punch hole wound healing. Green fluorescent protein–tagged Sprague-Dawley rats were used for further investigation by cell tracking for 2 weeks.

Results:

Laser tissue blood flow demonstrated a significant increase in the combined treatment of flap and adipose-derived stem cells at both 1 and 2 weeks. There were no significant differences between the treatment groups treated with flaps alone and those treated with adipose-derived stem cells alone. Wound healing was significantly increased following combined treatment at 1 week, and there was no wound by 2 weeks except for the no-flap and no–adipose-derived stem cell group. The number of vessels depicted by von Willebrand factor showed a significant increase in the combined treatment group, at both 1 week and 2 weeks. In the cell tracking group, at 2 weeks, the green fluorescent protein–tagged adipose-derived stem cells were significantly more positive in the no-flap group than in the flap group.

Conclusions:

Adipose-derived stem cells may be a potent cell source in irradiated and occluded limbs by enhancing tissue blood flow and blood vessel density. Adipose-derived stem cells may play an important role in some difficult ischemic conditions in terms of wound healing.
The Transverse Musculocutaneous Gracilis Free Flap: Virtual Animation–Assisted Dissection and Application in Breast Reconstruction
Authors: Gabert Pierre-Elliott , Bodin Frederic , Aljudaibi Nawaf , Duquennoy-Martinot Veronique , Guerreschi Pierre
Published: April 2016

The transverse musculocutaneous gracilis free flap is a valuable choice for autologous tissue, unilateral or bilateral breast reconstruction. This procedure is an excellent and customized option for immediate or delayed breast reconstruction in patients with small to moderate size breasts. Few descriptions of flap dissection and breast mound shaping are available. In this first educational video, the authors report the original dissection of the transverse musculocutaneous gracilis free flap used for breast reconstruction. Virtual animations insist on surgical key points and relevant details of the harvesting of the flap.
Promotion of Osteogenesis and Angiogenesis in Vascularized Tissue-Engineered Bone Using Osteogenic Matrix Cell Sheets
Authors: Nakano Kenichi , Murata Keiichi , Omokawa Shohei , Akahane Manabu , Shimizu Takamasa , Kawamura Kenji , Kawate Kenji , Tanaka Yasuhito
Published: April 2016

Background:

The regeneration of large, poorly vascularized bone defects remains a significant challenge. Although vascularized bone grafts promote osteogenesis, the required tissue harvesting causes problematic donor-site morbidity. Artificial bone substitutes are promising alternatives for regenerative medicine applications, but the incorporation of suitable cells and/or growth factors is necessary for their successful clinical application. The inclusion of vascular bundles can further enhance the bone-forming capability of bone substitutes by promoting tissue neovascularization. Little is known about how neovascularization occurs and how new bone extends within vascularized tissue-engineered bone, because no previous studies have used tissue-engineered bone to treat large, poorly vascularized defects.

Methods:

In this study, the authors developed a novel vascularized tissue-engineered bone scaffold composed of osteogenic matrix cell sheets wrapped around vascular bundles within β-tricalcium phosphate ceramics.

Results:

Four weeks after subcutaneous transplantation in rats, making use of the femoral vascular bundle, vascularized tissue-engineered bone demonstrated more angiogenesis and higher osteogenic potential than the controls. After vascularized tissue-engineered bone implantation, abundant vascularization and new bone formation were observed radially from the vascular bundle, with increased mRNA expression of alkaline phosphatase, bone morphogenetic protein-2, osteocalcin, and vascular endothelial growth factor-A.

Conclusion:

This novel method for preparing vascularized tissue-engineered bone scaffolds may promote the regeneration of large bone defects, particularly where vascularization has been compromised.
Increased Osteoid Formation in BMP-2–Loaded Silk-Based Screws
Authors: Koolen Pieter G. L. , Haas Dylan , Kim Kuylhee , Fox Sharon , Ibrahim Ahmed M. S. , Kim Peter , Kaplan David L. , Lin Samuel J.
Published: April 2016

Background:

Resorbable osteosynthesis systems are used to treat craniofacial fractures. However, conventional synthetic polyester materials are potentially associated with inflammatory reaction and negative host response and may result in incomplete bone remodeling. The authors have developed a resorbable silk fibroin–based osteosynthesis system and propose that silk screws loaded with bone morphogenetic protein-2 (BMP-2) may exhibit biocompatibility and promote bone remodeling.

Methods:

Resorbable silk screws were prepared and loaded with BMP-2. The BMP-2–loaded and nonloaded silk screws were inserted into the distal femora in 15 Sprague-Dawley rats by self-tapping, similar to conventional metal systems. Animals were euthanized after 1, 3, and 6 months. The femora were explanted at the designated time points, dissected for histologic evaluation, and compared regarding osteoid formation and inflammatory response.

Results:

Increasing organization of newly formed bone tissue was observed over time in both groups. No appreciable difference in inflammation was noted between the BMP-2–loaded and nonloaded silk screws. Notably, mineralized collagen around the periphery of the screw appears to be greatest and more organized in the BMP-2–loaded samples. There was greater recruitment of osteoclasts and osteoblasts around the perimeter of the BMP-2–loaded screws at 3 and 6 months.

Conclusions:

The BMP-2–loaded silk-based fixation device in this study exhibited characteristics comparable to the current nonloaded silk screws with regard to integration and biocompatibility. However, functionalization of silk screws with BMP-2 appeared to allow for more organized collagen and osteoid deposition after 3 and 6 months and may increase the potential of successful remodeling.
The Efficacy of Intense Pulsed Light Therapy in Postoperative Recovery from Eyelid Surgery
Authors: Linkov Gary , Lam Vincent B. , Wulc Allan E.
Published: April 2016

Background:

The purpose of this study was to evaluate the efficacy of postoperative intense pulsed light therapy on patients who undergo bilateral eyelid surgery.

Methods:

Patients presenting over a 3-month period for bilateral eyelid surgery were asked to participate in an institutional review board–approved study. Intense pulsed light therapy was administered three times to the same randomly assigned side on postoperative days 1 to 2, 5 to 7, and 10 to 12. Sham light therapy was administered to the contralateral side. Patient surveys and physician ratings were obtained based on photographic evaluation of ecchymosis, edema, and erythema. Three physicians, including the senior author (A.E.W.), submitted ratings, and these ratings were assessed for interobserver reliability.

Results:

Twenty-eight patients who underwent bilateral eyelid surgery followed by intense pulsed light therapy were enrolled. The mean age of the patients was 66 years (range, 44 to 81 years). Eighty-six percent of patients were female. The change in ratings between postoperative days 1 to 2 and 10 to 12, in the treatment and control groups, was statistically significant for severity of bruising by both patient and physician assessment and for color of bruising only by patient assessment. The interobserver reliability reached the greatest agreement in the ecchymosis category at each time point for the treatment group.

Conclusion:

In a series of patients who underwent eyelid surgery, intense pulsed light therapy decreased the degree of ecchymosis compared with sham treatment in postoperative eyelid surgery patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
An Algorithm for Managing Syndromic Craniosynostosis Using Posterior Vault Distraction Osteogenesis
Authors: Swanson Jordan W. , Samra Fares , Bauder Andrew , Mitchell Brianne T. , Taylor Jesse A. , Bartlett Scott P.
Published: April 2016

Background:

The authors hypothesize that early posterior vault distraction osteogenesis safely confers considerable cranial vault remodeling, sufficient to enable fronto-orbital advancement to be delayed to a later age, with improved outcomes.

Methods:

The authors conducted a retrospective cohort study of children with syndromic craniosynostosis treated before (2003 to 2008) or after (2009 to 2014) implementation of posterior vault distraction osteogenesis.

Results:

Sixty children with syndromic craniosynostosis presented during the study period. Forty met inclusion criteria with care continuity and complete records: 22 before and 18 after implementation of posterior vault distraction osteogenesis. Only 11 patients (61 percent) who underwent initial posterior vault distraction osteogenesis required frontal advancement, at a mean follow-up of 4.0 years of age, compared with 22 patients (100 percent) before implementation of posterior vault distraction osteogenesis. Kaplan-Meier survival analysis indicated significant delay of first fronto-orbital advancement in the posterior vault distraction osteogenesis cohort compared with the pre–posterior vault distraction osteogenesis cohort (p = 0.011). Comparing treatment in the first 5 years of life among posterior vault distraction osteogenesis versus non–posterior vault distraction osteogenesis subcohorts of patients older than 5 years, there were significantly fewer fronto-orbital advancements performed (0.6 versus 1.5 per patient; p = 0.023).

Conclusion:

Using early posterior vault distraction osteogenesis for patients with syndromic craniosynostosis significantly reduces the average number of fronto-orbital advancement procedures in the first 5 years of life, delays initial fronto-orbital advancement, and is likely to reduce the total number of major craniofacial procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Current Applications of Facial Volumization with Fillers
Authors: Wilson Anthony J. , Taglienti Anthony J. , Chang Catherine S. , Low David W. , Percec Ivona
Published: April 2016

Learning Objectives:

After reading this article and watching the accompanying videos, the participant should be able to: 1. Assess patients seeking facial volumization and correlate volume deficiencies anatomically. 2. Identify appropriate fillers based on rheologic properties and anatomical needs. 3. Recognize poor candidates for facial volumization. 4. Recognize and treat filler-related side effects and complications.

Facial volumization is widely applied for minimally invasive facial rejuvenation both as a solitary means and in conjunction with surgical correction. Appropriate facial volumization is dependent on patient characteristics, consistent longitudinal anatomical changes, and qualities of fillers available. In this article, anatomical changes seen with aging are illustrated, appropriate techniques for facial volumization are described in the setting of correct filler selection, and potential complications are addressed.
Rilpivirine and Doravirine Have Complementary Efficacies Against NNRTI-Resistant HIV-1 Mutants
Authors: Smith Steven J. , Pauly Gary T. , Akram Aamir , Melody Kevin , Ambrose Zandrea , Schneider Joel P. , Hughes Stephen H.
Published: April 2016

Background:

Rilpivirine (RPV) is the latest non-nucleoside reverse transcriptase inhibitor (NNRTI) to be approved by Food and Drug Administration to combat HIV-1 infections. NNRTIs inhibit the chemical step in viral DNA synthesis by binding to an allosteric site located about 10 Å from the polymerase active site of reverse transcriptase (RT). Although NNRTIs potently inhibit the replication of wild-type HIV-1, the binding site is not conserved, and mutations arise in the binding pocket. Doravirine (DOR) is a new NNRTI in phase III clinical trials.

Methods:

Using a single round HIV-1 infection assay, we tested RPV and DOR against a broad panel of NNRTI-resistant mutants to determine their respective activities. We also used molecular modeling to determine if the susceptibility profile of each compound was related to how they bind RT.

Results:

Several mutants displayed decreased susceptibility to DOR. However, with the exception of E138K, our data suggest that the mutations that reduce the potency of DOR and RPV are non-overlapping. Thus, these 2 NNRTIs have the potential to be used together in combination therapy. We also show that the location at which DOR and RPV bind with the NNRTI binding pocket of RT correlates with the differences in their respective susceptibility to the panel of NNRTI-resistance mutations.

Conclusions:

This shows that (1) DOR is susceptible to a number of well-known NNRTI resistance mutations and (2) an understanding of the mutational susceptibilities and binding interactions of NNRTIs with RT could be used to develop pairs of compounds with non-overlapping mutational susceptibilities.
Optimality of general lattice transformations with applications to the Bain strain in steel
Authors: Koumatos K. , Muehlemann A.
Published: April 2016

This article provides a rigorous proof of a conjecture by E. C. Bain in 1924 on the optimality of the so-called Bain strain based on a criterion of least atomic movement. A general framework that explores several such optimality criteria is introduced and employed to show the existence of optimal transformations between any two Bravais lattices. A precise algorithm and a graphical user interface to determine this optimal transformation is provided. Apart from the Bain conjecture concerning the transformation from face-centred cubic to body-centred cubic, applications include the face-centred cubic to body-centred tetragonal transition as well as the transformation between two triclinic phases of terephthalic acid.
Expanding the measurement of police integrity
Authors: Hickman Matthew J. , Piquero Alex R. , Powell Zachary A. , Greene Jack
Published: April 2016

Purpose

– Klockarset al.use scenario methodology to measure perceived seriousness, level of discipline warranted, and willingness to report fellow officers engaged in various negative behaviors. These data are used to characterize the occupational culture of integrity in a given agency, relative to other agencies. What remains unclear is whether these agency-level findings mask important meso- and micro-level variation in the data (i.e. at the precinct/district and officer levels) that may contribute to a more complete understanding of an agency’s culture of integrity. The paper aims to discuss these issues.

Design/methodology/approach

– This study replicates and extends Klockarset al.’s work using data from a survey administered to 499 Philadelphia police officers, with the goal of both validating their methodological approach and exploring the need for multi-level theory in the study of police integrity. In addition to comparing the results from Philadelphia to those obtained by Klockarset al., the authors test for differences across officer demographics, and explore variance in the willingness to report various behaviors at both the officer- and district-levels.

Findings

– Results indicate that bivariate relationships between officer-level demographics and willingness to report fellow officers are negated when controlling for theoretically relevant attitudinal variables such as cynicism and, consistent with Klockarset al., perceived seriousness of the underlying behavior. In addition, there is significant district-level variation in the average willingness to report fellow officers, and this variation can be explained by both organizational and environmental variables. On balance, the findings provide support for a multi-level approach to the study of police integrity.

Originality/value

– While the Klockarset al.approach addresses macro-level variation in police integrity, this study contributes important findings at the meso- and micro-levels.
Exploring the viability of an attitudes toward ethical behavior scale in understanding police integrity outcomes
Authors: Hickman Matthew J. , Powell Zachary A. , Piquero Alex R. , Greene Jack
Published: April 2016

Purpose

– Relying on a moral development theoretical framework, the purpose of this paper is to argue that the perceived seriousness of a particular behavior is a reflection of one’s broader attitudes toward ethical behaviors. Attitudes toward ethical behavior should provide both an elaborated explanation for the relationship between the perceived seriousness of a behavior and the likelihood of reporting a fellow officer for that behavior, as well as an alternative approach to the measurement and assessment of police integrity outcomes.

Design/methodology/approach

– Using data from a sample of 499 Philadelphia police officers, the current study uses a modified fifteen item ethics scale first developed by Hyams (1990) and used by others, in order to examine its relation to integrity outcomes. The paper provides a full descriptive and measurement analysis of the scale and then explores its utility in understanding integrity outcomes through a variety of hypothetical scenarios.

Findings

– While the perceived seriousness of a behavior is strongly predictive of the likelihood of reporting a fellow officer who engages in that behavior, the findings suggest that seriousness may be a proxy for attitudes toward ethical behaviors.

Originality/value

– While Klockarset al.’s approach to the measurement of police integrity has been an important contribution to integrity research, other measures of police integrity such as attitudes toward ethical behavior are also useful as they move us conceptually from assessing attitudes toward ethical behavior to their antecedents – the strength of underlying value premises shaping subsequent attitudes.
Factors that explain placement decisions for students with multiple disabilities: findings from national data
Authors: Banerjee Rashida , Sundeen Todd , Hutchinson Susan R. , Jackson Lewis
Published: April 2016

The Special Education Elementary Longitudinal Study data set was utilised to examine the potential influences on placement decisions for students with multiple disabilities in the US. The sample consisted of 415 students. Specifically, the study investigated whether factors including students’ prior special education experiences, parental involvement, parental expectations and educational risk factors explain the placement of students in classrooms. Results indicate significant relations between the explanatory variables and the hours spent daily in general education classrooms. However, only two variables, parents’ education and receipt of early childhood special education services, were significantly associated with the dichotomised outcome of whether or not a child received any academic instruction in a general education classroom. Research limitations and implications for future research, policy and practice in the international context are discussed.
Accidental Trauma Mimicking Homicidal Violence
Authors: Prahlow Samuel P. , Arendt Alexander , Cameron Thomas , Prahlow Joseph A.
Published: April 2016

Homicide investigations represent an important function of death investigators. Although recognizing nonobvious homicides is crucial, an equally important role involves the identification of cases that initially present as possible homicides, but are ultimately discovered to not represent homicides. Failure to recognize such cases results in wasted time, squandered resources, false allegations, and potential life‐altering consequences. The authors review a series of cases wherein initial investigation suggested a possibility that the deaths represented homicides. By carefully considering additional information, including scene findings, history, and postmortem examination, each was determined to represent an accidental traumatic death. In addition to highlighting the importance of recognizing accidental traumatic deaths that initially present as homicides, the cases serve to highlight the fact that forensic pathology cannot be practiced without knowledge of appropriate ancillary information. Although guarding against cognitive bias is important in all forensic disciplines, including forensic pathology, access to vital case‐related ancillary information is an essential component of practicing medicine as a forensic pathologist.
Faculty of Radiation Oncology Position Paper on the use of Image–Guided Radiation Therapy
Authors: Tiong Albert , Lao Louis , MacKean James , Goonetilleke Madhavi , Kron Tomas
Published: April 2016

The development of technology such as intensity‐modulated radiotherapy (IMRT), volumetric arc therapy (VMAT) and stereotactic ablative body radiotherapy (SABR) has resulted in highly conformal radiotherapy treatments. While such technology has allowed for improved dose delivery, it has also meant that improved accuracy in the treatment room is required. Image‐guided radiotherapy (IGRT), the use of imaging prior to or during treatment delivery, has been shown to improve the accuracy of treatment delivery and in some circumstances, clinical outcomes. Allied with the adoption of highly conformal treatments, there is a need for stringent quality assurance processes in a multidisciplinary environment. In 2015, the Royal Australian and New Zealand College of Radiologist (RANZCR) updated its position paper on IGRT. The draft document was distributed through the membership of the Faculty of Radiation Oncology (FRO) for review and the final version was endorsed by the board of FRO. This article describes issues that radiotherapy departments throughout Australia and New Zealand should consider. It outlines the role of IGRT and reviews current clinical evidence supporting the benefit of IGRT in genitourinary, head and neck, and lung cancers. It also highlights important international publications which provide guidance on implementation and quality assurances for IGRT. A set of key recommendations are provided to guide safe and effective IGRT implementation and practice in the Australian and New Zealander context.
How Does International Law Condition Responses to Conflict and Negotiation?
Authors: O'Donoghue Aoife
Published: April 2016

This article explores the role law plays in defining conflict and its consequences. Two elements of law's categorisations are critical; first law's cataloguing of activities fixing actions into particular classifications and second law's choosing of temporal points from which to analyse conflict, looking both forward and backward at events. The article uses two case studies to demonstrate these two features; Rwanda and Ukraine. Both examples, one historical the other contemporary, are replete with examples of law's categorisations of events and temporal points while demonstrating the tremendous impact that these choices have upon our understanding of how negotiations ought to proceed. This article does not call for a withdrawal of law from these situations but rather cognisance that heavy reliance on law can serve to mask both events and actors critical to successful negotiation and parties must bare this in mind when dealing with conflict.
Implementing Data Definition Consistency for Emergency Department Operations Benchmarking and Research
Authors: Yiadom Maame Yaa A. B. , Scheulen James , McWade Conor M. , Augustine James J.
Published: April 2016

Objectives

The objective was to obtain a commitment to adopt a common set of definitions for emergency department (ED) demographic, clinical process, and performance metrics among the ED Benchmarking Alliance (EDBA), ED Operations Study Group (EDOSG), and Academy of Academic Administrators of Emergency Medicine (AAAEM) by 2017.

Methods

A retrospective cross‐sectional analysis of available data from three ED operations benchmarking organizations supported a negotiation to use a set of common metrics with identical definitions. During a 1.5‐day meeting—structured according to social change theories of information exchange, self‐interest, and interdependence—common definitions were identified and negotiated using the EDBA's published definitions as a start for discussion. Methods of process analysis theory were used in the 8 weeks following the meeting to achieve official consensus on definitions. These two lists were submitted to the organizations’ leadership for implementation approval.

Results

A total of 374 unique measures were identified, of which 57 (15%) were shared by at least two organizations. Fourteen (4%) were common to all three organizations. In addition to agreement on definitions for the 14 measures used by all three organizations, agreement was reached on universal definitions for 17 of the 57 measures shared by at least two organizations. The negotiation outcome was a list of 31 measures with universal definitions to be adopted by each organization by 2017.

Conclusion

The use of negotiation, social change, and process analysis theories achieved the adoption of universal definitions among the EDBA, EDOSG, and AAAEM. This will impact performance benchmarking for nearly half of US EDs. It initiates a formal commitment to utilize standardized metrics, and it transitions consistency in reporting ED operations metrics from consensus to implementation. This work advances our ability to more accurately characterize variation in ED care delivery models, resource utilization, and performance. In addition, it permits future aggregation of these three data sets, thus facilitating the creation of more robust ED operations research data sets unified by a universal language. Negotiation, social change, and process analysis principles can be used to advance the adoption of additional definitions.
Perceptions of crop raiding: effects of land tenure and agro‐industry on human–wildlife conflict
Authors: Mc Guinness S. K.
Published: April 2016

Human–wildlife conflict (HWC) is an increasingly recognized threat to successful conservation and development efforts through reducing support for conservation effort or threatening the livelihoods of marginalized human populations residing adjacent to protected areas. Although much research is conducted on characterizing these conflicts, such as quantifying crop damage or identifying proximal causes and correlates, there is little effort in identifying the wider, distal drivers of potential conflict. These wider factors may often play as much a part in defining exposure to loss through HWC as local ecological or socioeconomic factors. Using a mixed methods approach, the current study assessed the role of distal factors in defining perceived exposure to crop raiding around a central African protected area; Volcanoes National Park (VNP) in northern Rwanda. Although harbouring critically endangered biodiversity, this transboundary protected area also lies in a region experiencing significant social pressures and struggles for natural resources. This study found that land tenure limitations and restrictions on agricultural autonomy, often driven by neoliberal trade, significantly impact on perceptions of conflict with VNP. Additionally, the lack of adequate revenue sharing with communities most exposed to conflict continues to foster ill feeling towards conservation efforts by failing to counterbalance losses through crop raiding. This study has shown the importance of considering national and regional policy revisions in addressing the drivers of conflict, while the value of a holistic approach to establish the relative importance of distal and proximal factors in HWC has been shown.
Invisible Support: Effects on the Provider's Positive and Negative Affect
Authors: König Claudia , Stadler Gertraud , Knoll Nina , Ochsner Sibylle , Hornung Rainer , Scholz Urte
Published: April 2016

Background

Social support that goes unnoticed by receivers (i.e. invisible support) seems to be most beneficial for the receivers' well‐being. The providers' well‐being, however, has been neglected so far. This study examines how invisible support is related to the providers' well‐being and whether this association is dependent on the providers' relationship satisfaction.

Methods

Overall, 97 non‐smoking partners of smokers who were about to quit smoking were examined. Invisible support was assessed dyadically: partners' reports on smoking‐specific provided social support together with smokers' reports on received support were assessed at baseline. Partners' relationship satisfaction was also assessed at baseline. Partners' positive and negative affect were measured at baseline and six‐week follow‐up.

Results

No main effects of invisible instrumental or emotional support occurred. However, partners' relationship satisfaction moderated the association between invisible instrumental support and change in partners' negative and positive affect: For partners with lower relationship satisfaction more invisible instrumental support was related to increased negative affect and decreased positive affect, whereas for partners with higher relationship satisfaction the inverse effects occurred.

Conclusions

The study's results emphasise that invisible instrumental support might have emotional costs for the providers. Relationship satisfaction seems to serve as a protective factor.