bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural Hazards Identification and Hazard Management Systems
Authors: Leahy P. Patrick
Published: November 2016

Society expects to have a safe environment in which to live, prosper, and sustain future generations. Generally, when we think of threats to our well-being, we think of human-induced causes such as overexploitation of water resources, contamination, and soil loss, to name just a few. However, natural hazards, which are not easily avoided or controllable (or, in many cases, predictable in the short term), have profound influences on our safety, economic security, social development, and political stability, as well as every individual’s overall well-being.

Natural hazards are all related to the processes that drive our planet. Indeed, the Earth would not be a functioning ecosystem without the dynamic processes that shape our planet’s landscapes over geologic time. Natural hazards (or geohazards, as they are sometimes called) include such events as earthquakes, volcanic eruptions, landslides and ground collapse, tsunamis, floods and droughts, geomagnetic storms, and coastal storms.

A key aspect of these natural hazards involves understanding and mitigating their impacts, which require that the geoscientist take a four-pronged approach. It must include a fundamental understanding of the processes that cause the hazard, an assessment of the hazard, monitoring to observe any changes in conditions that can be used to determine the status of a potential hazardous event, and perhaps most important, delivery of information to a broader community to evaluate the need for action.

A fundamental understanding of processes often requires a research effort that typically is the focus of academic and government researchers. Fundamental questions may include: (a) What triggers an earthquake, and why do some events escalate to a great magnitude while most are small-magnitude events?; (b) What processes are responsible for triggering a landslide?; (c) Can we predict the severity of an impending volcanic eruption? (d) Can we predict an impending drought or flood?; (e) Can we determine the height of a storm surge or storm track associated with coastal storm well in advance of landfall so that the impact can be mitigated?

Any effective hazard management system must strive to increase resilience. The only way to gain resiliency is to learn from past events and to decrease risk. To successfully increase resiliency requires having strong hazard identification programs with adequate monitoring and research components and very robust delivery mechanisms that deliver timely, accurate, and appropriate hazard information to a broad audience that will use the information is a wide variety of ways to meet their specific goals.
Collaboration and Cross-Sector Coordination for Humanitarian Assistance in a Disaster Recovery Setting
Authors: Sanderson David
Published: November 2016

While known to be important and essential for improved effectiveness and efficiency, cross-sector coordination and collaboration among different actors engaged in postdisaster recovery is fraught with complications. Among the challenges are (a) who leads, and how; (b) the capacity and roles of the host government; (c) governance structures within organizations (which may differ a great deal); (d) assumptions of power; (e) the trade-off between valuing relationships and “getting the job done”; and (f) the varying constraints (and opportunities) of accountability. Recognizing the need to improve joint actions for a better response, the Humanitarian Reform Agenda (HRA), begun in 2005, led to the remolding of collective models of disaster response and the adoption of the global cluster system, which is essentially organized around the delivery of goods and services (sectors) by traditional aid actors such as the United Nations (UN), nongovernmental organizations (NGOs), and the International Red Cross and Red Crescent Movement. While the cluster system has largely been acknowledged as an improvement in collaboration among actors, a perennial challenge of cross-sector coordination remains. One of the opportunities for improvement lies in better and more predictable leadership, one of the key areas identified by the HRA. Another opportunity lies in changing the focus from a supply-driven approach of prioritizing what aid providers deliver to a demand-driven understanding, such as that offered by area-based approaches, wherein sectors are more closely aligned.

A common form of collaboration within aid is partnership between various actors (e.g., the United Nations or NGOs). Partnerships assume more than a constructing relationship: Effective partnerships emphasize the need for transparency and equity, along with being results-oriented and competent. Recognizing this, the Grand Bargain, resulting from the World Humanitarian Summit, noted that aid providers should engage with local and national responders in a spirit of partnership and aim to reinforce rather than replace local and national capacities.

Partnerships, however, fall short all too often, especially when one partner has power over the other, which is often the case. The report Time to Let Go, by the Overseas Development Institute (ODI), notes, for instance, that “the relationships between donor and implementer, aid provider and recipient, remain controlling and asymmetrical, and partnerships and interactions remain transactional and competitive, rather than reciprocal and collective.” The challenge remains to achieve the task at hand, while at the same time engaging in effective collaborative mechanisms that value the nature of the relationship. If this is not achieved, effective postdisaster recovery can be jeopardized.
Systems Approaches for Coastal Hazard Assessment and Resilience
Authors: Hagen Scott C. , Passeri Davina L. , Bilskie Matthew V. , DeLorme Denise E. , Yoskowitz David
Published: November 2016

The framework presented herein supports a changing paradigm in the approaches used by coastal researchers, engineers, and social scientists to model the impacts of climate change and sea level rise (SLR) in particular along low-gradient coastal landscapes. Use of a System of Systems (SoS) approach to the coastal dynamics of SLR is encouraged to capture the nonlinear feedbacks and dynamic responses of the bio-geo-physical coastal environment to SLR, while assessing the social, economic, and ecologic impacts. The SoS approach divides the coastal environment into smaller subsystems such as morphology, ecology, and hydrodynamics. Integrated models are used to assess the dynamic responses of subsystems to SLR; these models account for complex interactions and feedbacks among individual systems, which provides a more comprehensive evaluation of the future of the coastal system as a whole. Results from the integrated models can be used to inform economic services valuations, in which economic activity is connected back to bio-geo-physical changes in the environment due to SLR by identifying changes in the coastal subsystems, linking them to the understanding of the economic system and assessing the direct and indirect impacts to the economy. These assessments can be translated from scientific data to application through various stakeholder engagement mechanisms, which provide useful feedback for accountability as well as benchmarks and diagnostic insights for future planning. This allows regional and local coastal managers to create more comprehensive policies to reduce the risks associated with future SLR and enhance coastal resilience.
Earthquakes in Political, Economic, and Cultural History
Authors: Robinson Andrew
Published: November 2016

The immediate aftermath of a great urban earthquake is a dramatic and terrible event, comparable to a massive terrorist attack. Yet the shocking impact soon fades from the public mind and receives surprisingly little attention from historians, unlike wars and human atrocities. In 1923, the Great Kanto earthquake and its subsequent fires demolished most of Tokyo and Yokohama and killed around 140,000 Japanese: a level of devastation and fatalities comparable with the atomic bombing of Hiroshima and Nagasaki in 1945. But the second event has infinitely more resonance in public consciousness and historical studies than the first. Indeed, most people would be challenged to name a single earthquake with an indisputable historical impact, including even the most famous of all earthquakes: the San Francisco earthquake and fire of 1906.

In truth, however, great earthquakes, from ancient times—as recorded by Greek and biblical writers—to the present day, have had major cultural, economic, and political consequences—often a combination of all three—some of which were beneficial. Thus, the current prime minister of India owes his election in 2014 to an earthquake that devastated part of his home state of Gujarat in 2001, which led to its striking economic growth. The martial law imposed on Tokyo and Yokohama after the 1923 earthquake gave new authority to the Japanese army, which eventually took over the Japanese government and led Japan to war with China and the world. The destruction of San Francisco in 1906 produced a boom in rebuilding and financial and technological development of the surrounding area on the San Andreas Fault, including what became Silicon Valley. A great earthquake in Venezuela in 1812 was the principal cause of the temporary defeat of its leader Simon Bolivar by the Spanish colonial regime, but his subsequent exile led to his permanent freeing of Bolivia, Colombia, Ecuador, Peru, and Venezuela from Spanish rule. The catastrophic Lisbon earthquake of 1755—as well known in the early 19th century as the 1945 atomic bombings are today—was a pivotal factor in the freeing of Enlightenment science from Catholic religious orthodoxy, as epitomized by Voltaire’s satirical novel Candide, written in response to the earthquake. Even the minor earthquakes in Britain in 1750, the so-called Year of Earthquakes, produced the earliest scientific understanding of earthquakes, published by the Royal Society: the beginning of seismology.

The long-term impact of a great earthquake depends on its epicenter, magnitude, and timing—and also on human factors: the political, social, intellectual, religious, and cultural resources specific to a region’s history. Each earthquake-struck society offers its own particular lesson, and yet, taken together, such earth-shattering events have important shared consequences for the history of the world.
Policy Process Theory and Natural Hazards
Authors: Birkland Thomas A.
Published: November 2016

Natural disasters pose important problems for societies and governments. Governments are charged with making policies to protect public safety. Large disasters, then, can reveal problems in government policies designed to protect the public from the effects of such disasters. Large disasters can serve as focusing events, a term used to describe large, sudden, rare, and harmful events that gain a lot of attention from the public and from policy makers. Such disasters highlight problems and, as the public policy literature suggests, open windows of opportunity for policy change. However, as a review of United States disaster policy from 1950 through 2015 shows, change in disaster policy is often, but not always, driven by major disasters that act as focusing events. But the accumulation of experience from such disasters can lead to learning, which can be useful if later, even more damaging and attention-grabbing events arise.
Environmental Impacts of Tropical Soybean and Palm Oil Crops
Authors: Carlson Kimberly M. , Garrett Rachael D.
Published: November 2016

Oil crops play a critical role in global food and energy systems. Since these crops have high oil content, they provide cooking oils for human consumption, biofuels for energy, feed for animals, and ingredients in beauty products and industrial processes. In 2014, oil crops occupied about 20% of crop harvested area worldwide. While small-scale oil crop production for subsistence or local consumption continues in certain regions, global demand for these versatile crops has led to substantial expansion of oil crop agriculture destined for export or urban markets. This expansion and subsequent cultivation has diverse effects on the environment, including loss of forests, savannas, and grasslands, greenhouse gas emissions, regional climate change, biodiversity decline, fire, and altered water quality and hydrology. Oil palm in Southeast Asia and soybean in South America have been identified as major proximate causes of tropical deforestation and environmental degradation. Stringent conservation policies and yield increases are thought to be critical to reducing rates of soybean and oil palm expansion into natural ecosystems. However, the higher profits that often accompany greater yields may encourage further expansion, while policies that restrict oil crop expansion in one region may generate secondary “spillover” effects on other crops and regions. Due to these complex feedbacks, ensuring a sustainable supply of oil crop products to meet global demand remains a major challenge for agricultural companies, farmers, governments, and civil society.
Subsurface (Tile) Agricultural Drainage
Authors: Sands Gary R. , Ale Srinivasulu , Christianson Laura E. , Utt Nathan
Published: November 2016

Agricultural (tile) drainage enables agricultural production on millions of hectares of arable lands worldwide. Lands where drainage or irrigation (and sometimes both) are implemented, generate a disproportionately large share of global agricultural production compared to dry land or rain-fed agricultural lands and thus, these water management tools are vital for meeting the food demands of today and the future. Future food demands will likely require irrigation and drainage to be practiced on an even greater share of the world’s agricultural lands. The practice of agricultural drainage finds its roots in ancient societies and has evolved greatly to incorporate modern technologies and materials, including the modern drainage plow, plastic drainage pipe and tubing, laser and GPS-guided installation equipment, and computer-aided design tools. Although drainage brings important agricultural production and environmental benefits to poorly drained and salt-affected arable lands, it can also give rise to the transport of nutrients and other constituents to downstream waters. Other unwanted ecological and hydrologic environmental effects may also be associated with the practice. The goal of this article is to familiarize the reader with the practice of subsurface agricultural drainage, the history and extent of its application, and the benefits commonly associated with it. In addition, environmental effects associated with subsurface drainage including hydrologic and water quality effects are presented, and conservation practices for mitigating these unwanted effects are described. These conservation practices are categorized by whether they are implemented in-field (such as controlled drainage) versus edge-of-field (such as bioreactors). The literature cited and reviewed herein is not meant to be exhaustive, but seminal and key literary works are identified where possible.
Soil Quality as Affected by Intensive Versus Conservative Agricultural Managements
Authors: Badalucco Luigi
Published: November 2016

Soils, the earth’s skin, are at the intersection of the lithosphere, hydrosphere, atmosphere, and biosphere. The persistence of life on our planet depends on the maintenance of soils as they constitute the biological engines of earth. Human population has increased exponentially in recent decades, along with the demand for food, materials, and energy, which have caused a shift from low-yield and subsistence agriculture to a more productive, high-cost, and intensive agriculture. However, soils are very fragile ecosystems and require centuries for their development, thus within the human timescale they are not renewable resources. Modern and intensive agriculture implies serious concern about the conservation of soil as living organism, i.e., of its capacity to perform the vast number of biochemical processes needed to complete the biogeochemical cycles of plant nutrients, such as nitrogen and phosphorus, crucial for crop primary production. Most practices related to intensive agriculture determine a deterioration even in the short-middle term of their physical, chemical, and biological properties, which all together contribute to soil quality, along with an overexploitation of soils as living organisms. Recent trends are turning toward styles of agriculture management that are more sustainable or conservative for soil quality.

Usually, use of soils for agricultural purposes deflect them at various degrees from the “natural” soil development processes (pedogenesis), and this shift may be assumed as a divergence from soil sustainability principles. For decades, the misuse of land due to intensive crop management has deteriorated soil health and quality. A huge plethora of microorganisms inhabits soils, thus acting as “the biological engine of the earth”; indeed, this microbiota serves the soil ecosystem, performing several fundamental functions. Therefore, management practices might be planned looking at the safeguard of soil microbial diversity and resilience. In addition, each unexpected alteration in numberless soil biochemical processes, being regulated by microbial communities, may represent an early and sensible signal of soil homeostasis weakening and, consequently, warn about soil conservation. Within the vast number of soil biochemical processes and connected features (bioindicators) virtually effective to measure the sustainable soil exploitation, those related to the mineralization or immobilization of the main nutrients (C and N), including enzyme activity (functioning) and composition (diversity) of microbial communities, exert a fundamental role because of their involvement in soil metabolism. Comparing the influence of many cropping factors (tillage, mulching and cover crops, rotations, mineral and organic fertilization) under both intensive and sustainable managements on soil microbial diversity and functioning, through both chemical and biological soil quality indicators, makes it possible to identify the most hazardous diversions from soil sustainability principles.
Ecotourism
Authors: Jackson Giles
Published: November 2016

Ecotourism is responsible travel to natural areas that educates and inspires through interpretation—increasingly paired with practical action—that helps conserve the environment and sustain the well-being of local people. Ecotourism is the fastest-growing segment of the travel and tourism industry, and its economic value is projected to exceed USD$100 billion by 2027. Ecotourism emerged in the 1960s as a response to the destructive effects of mass tourism and has been embraced by an increasing number of governments, especially in the developing world, as a vehicle for achieving the UN Sustainable Development Goals. As an emerging, interdisciplinary field of study, ecotourism has reached a critical inflection point, as scholars reflect on the achievements and shortcomings of several decades of research and set out the research agenda for decades to come. The field has yet to achieve consensus on the most basic questions, such as how ecotourism is, or should be, defined; what makes it different from nature-based and related forms of tourism; and what factors ultimately determine the success or failure of ecotourism as a vehicle for sustainable development. This lack of consensus stems in part from the different perspectives and agendas within and between the academic, policy, and industry communities. Because it is based on measured and observed phenomena, empirical research has a critical role to play in advancing the theory and practice of ecotourism. However, scholars also recognize that to fulfill this role, methodologies must evolve to become more longitudinal, scalable, inclusive, integrative, and actionable.
The Life Satisfaction Approach to Environmental Valuation
Authors: Fleming Christopher , Ambrey Christopher
Published: November 2016

The method and practice of placing monetary values on environmental goods and services for which a conventional market price is otherwise unobservable is one of the most fertile areas of research in the field of natural resource and environmental economics. Initially motivated by the need to include environmental values in benefit–cost analysis, practitioners of nonmarket valuation have since found further motivation in national account augmentation and environmental damage litigation. Despite hundreds of applications and many decades of refinement, shortcomings in all of the techniques remain, and no single technique is considered superior to the others in all respects. Thus, techniques that expand the suite of options available to the non-market valuation practitioner have the potential to represent a genuine contribution to the field.

One technique to recently emerge from the economics of happiness literature is the “experienced preference method” or “life satisfaction approach.” Simply, this approach entails the inclusion of non-market goods as explanatory variables within micro-econometric functions of life satisfaction along with income and other covariates. The estimated coefficient for the nonmarket good yields, first, a direct valuation in terms of life satisfaction and, second, when compared to the estimated coefficient for income, the implicit willingness to pay for the non-market good in monetary terms.

The life satisfaction approach offers several advantages over more conventional non-market valuation techniques. For example, the approach does not ask individuals to directly value the non-market good in question, as is the case in contingent valuation. Nor does it ask individuals to make explicit trade-offs between market and non-market goods, as is the case in discrete choice modeling. The life satisfaction approach nonetheless has some potential limitations. Crucially, self-reported life satisfaction must be regarded as a good proxy for an individual’s utility. Furthermore, in order to yield reliable non-market valuation estimates, self-reported life satisfaction measures must: (1) contain information on respondents’ global evaluation of their life; (2) reflect not only stable inner states of respondents, but also current affects; (3) refer to respondents’ present life; and (4) be comparable across groups of individuals under different circumstances. Despite these conditions, there is growing evidence to support the suitability of individual’s responses to life satisfaction questions for non-market valuation. Applications of the life satisfaction approach to the valuation of environmental goods and services to date include the valuation of air quality, airport noise, green space, scenic amenity, floods, and drought.
Health Literacy
Authors: Jackson Vivian , Jones Wendy
Published: November 2016

The revised NASW Standards and Indicators for Cultural Competence in Social Work Practice (2015) requires social workers to “provide and advocate for effective communication with clients of all cultural groups, including people of limited English proficiency or low literacy skills, people who are blind or have low vision, people who are deaf or hard of hearing, and people with disabilities” (p. 43). This article focuses on one component of this standard—literacy, specifically health literacy. It presents a summary overview of health literacy and its implications for social work practice. It also presents the history of the concept and provides various definitions and types of health literacy as described in the literature. The authors describe the association between health literacy levels of the population, the intricacies of health systems, and their impact on health outcomes. The negative impact for marginalized populations including persons with limited English proficiency and immigrants and refugees—a major focus of the social work profession—signals the need for action at multiple levels. The authors explore a multifaceted approach to health literacy at the clinical, organizational, and policy levels with reference to the role of the social work profession.
SarConfoCal: simultaneous sarcomere length and cytoplasmic calcium measurements for laser scanning confocal microscopy images
Authors: Pasqualin Côme , Gannier François , Yu Angèle , Malécot Claire O , Bredeloux Pierre , Maupoil Véronique
Published: November 2016

Simultaneous recordings of myocytes contractility and their cytoplasmic calcium concentration allow powerful studies, particularly on heart failure and other cardiac dysfunctions. Such studies require dedicated and expensive experimental devices that are difficult to use. Thus we propose SarConfoCal, the first and only software to simultaneously analyse both cytoplasmic calcium variations (from fluorescence signal) and myocytes contractility (from sarcomere length measurement) on laser scanning confocal microscopy images. SarConfoCal is easy to set up and use, especially by people without programming skills.

Availability and implementation

The software is freely distributed under the GNU General Public License. Download and setup instructions are available at http://pccv.univ-tours.fr/ImageJ/SarConfoCal. It is provided as a toolset for ImageJ (the open-source program for image analysis provided by the National Institutes of Health). SarConfoCal has been tested under Windows, Mac and Linux operating systems.

Supplementary information

Supplementary data are available at Bioinformatics online.
Statistical inference of protein structural alignments using information and compression
Authors: Collier James H , Allison Lloyd , Lesk Arthur M , Stuckey Peter J , Garcia de la Banda Maria , Konagurthu Arun S
Published: November 2016

Motivation

Structural molecular biology depends crucially on computational techniques that compare protein three-dimensional structures and generate structural alignments (the assignment of one-to-one correspondences between subsets of amino acids based on atomic coordinates). Despite its importance, the structural alignment problem has not been formulated, much less solved, in a consistent and reliable way. To overcome these difficulties, we present here a statistical framework for the precise inference of structural alignments, built on the Bayesian and information-theoretic principle of Minimum Message Length (MML). The quality of any alignment is measured by its explanatory power—the amount of lossless compression achieved to explain the protein coordinates using that alignment.

Results

We have implemented this approach in MMLigner, the first program able to infer statistically significant structural alignments. We also demonstrate the reliability of MMLigner’s alignment results when compared with the state of the art. Importantly, MMLigner can also discover different structural alignments of comparable quality, a challenging problem for oligomers and protein complexes.

Availability and Implementation

Source code, binaries and an interactive web version are available at http://lcb.infotech.monash.edu.au/mmligner.

Supplementary information

Supplementary data are available at Bioinformatics online.
Balearic Islands boat seine fisheries: the transparent goby fishery an example of co-management
Authors: Morales-Nin Beatriz , Grau Antoni María , Aguilar Juan Salvador , Gil María del Mar , Pastor Elena
Published: November 2016

An economically important, small-scale fishery operates during the winter months in Mallorca. Using a special surrounding net that is hauled over the sand and gravel bottoms of bays at depths reaching 30 m, it primarily targets Aphia minuta and Pseudaphya ferreri, but other goby species and juveniles of the Pagellus spp are also caught. Similar fisheries are operated on the Spanish coast and in Italy. This fishery is run with specific licenses, equipment controls, and closed seasons (based on species availability). In cooperation with local fishermen, the administration has in recent years established a daily quota for sustaining the sales prices 22of the species caught. A management plan was set up in 2013 in accordance with European Union rules to ensure the sustainability of the fishery. Its sustainable quotas have been set at 30 kg/day/boat for A. minuta and 50 kg/day/boat for P. ferreri, and the by-catch cannot exceed 10% of the total catch. Landings are permitted in 11 fixed ports and only 35 boats can fish with the regulated nets from December 15 to April 30. A co-management committee was created with the participation of the public administration, fishermen’s associations, researchers, and certain non-governmental organizations. The co-management process was revised and fishermen’s opinions were obtained in a successful enquiry that was answered by the majority of the operating fleet, and their views on the management rules will be considered in future regulations. The co-management of the small-scale boat seine fishery in the Balearic Islands is thus an ongoing collaborative and communicative process in a local community that continues to evolve over time. Although the fishermen are represented by their port guilds, communication efforts are necessary in the near future to ensure the success of the co-management process.
Help for patients with borderline personality disorder
Authors: Lockhart Lisa , Davis Charlotte , Miller Latha Diane
Published: November 2016

As nurses, we encounter mental health disorders in every practice area. Learn how to properly identify and manage BPD to ensure that your patients' needs are safely and effectively met.
Something isn't right
Authors: Crowe Sarah , Ewart Lisa , Derman Sarah
Published: November 2016

Using a systems approach to assessment can help you identify common signs and symptoms of a patient's deteriorating condition, leading to appropriate care and improved outcomes.
Rhinitis: adherence to treatment and new technologies
Authors: Braido Fulvio , Baiardini Ilaria , Puggioni Francesca , Garuti Silvia , Pawankar Ruby , Walter Canonica G.
Published: November 2016

Purpose of review

Nonadherence to treatment is a major issue in approximately 50% of patients suffering from chronic diseases. The availability of new technologies could represent a possible way to improve patients’ engagement and adherence in a real-life setting. Research and technology tools made available or in process of being made available to patients with allergic diseases and their physicians could potentially improve the management of these disease in daily life by improving adherence. In this review, we sought to outline many of the recent advances in these technological approaches.

Recent findings

Short Message Service (SMS) reminder, social networks, wearable devices, mobile applications (Apps), monitoring systems of inhaled device use, often presented as ‘serious game’ are changing the way of approaching to chronic disease, such as rhinitis, management.

Studies of the role played by various technologies in improving adherence to treatment in rhinitis are still limited as compared with other diseases such as asthma, but the results are encouraging. Further studies in this area may lead to the discovery of novel management approaches that is easy to be integrated in patients’ daily life.
A biomechanical comparison of conventional versus cable pin fixation for transverse patellar fractures
Authors: Schrayer Aaron , Morris Randal P. , Patton Andrew G. , Buford William L. , Lindsey Ronald W.
Published: November 2016

Background:

Transverse patellar fractures require fixation that anatomically restores continuity of the knee extensor complex and resiliency to the loads of early postoperative knee mobilization. The objective of this study was to evaluate the biomechanical fixation strength of three patellar osteosynthesis techniques.

Methods:

Transverse osteotomies were created in 24 custom fourth-generation composite left patellae, randomized into three equal groups for osteosynthesis fixation: group I, modified anterior tension wiring; group II, cannulated lag screws with anterior tension wiring; group III, cable pin fixation system. All patellae were loaded in simulated 60-degree knee flexion at 15 mm/min until complete failure.

Results:

Mean load to failure for group I (415.14±150.10 N) was significantly less than the load for group II (814.37±281.98 N), P=0.023 and group III (1103.64±358.70 N), P<0.0001. Mean stiffness for group II and group III were 51.60±5.01 N/mm and 46.53±3.09 N/mm, respectively, and statistically higher (P<0.0001) than group I (23.86±7.02 N/mm). Mean medial gapping in group III (10.33±6.50 mm) was statistically higher (P=0.041) than that in group II (4.59±3.19 mm).

Conclusions:

Greater compression across the fracture site was likely in the more robust constructs of cannulated lag screws with anterior tension wiring (group II) and cable pin fixation (group III), which may allow more timely and aggressive postoperative mobilization.
The Role of Dedicated Musculoskeletal Urgent Care Centers in Reducing Cost and Improving Access to Orthopaedic Care
Authors: Anderson Travis J. , Althausen Peter L.
Published: November 2016

Objectives:

Over the past few years, the United States has seen the rapid growth of dedicated musculoskeletal urgent care centers owned and operated by individual orthopaedic practices. In June of 2014, our practice opened the first dedicated orthopaedic urgent care in the region staffed by physician assistants and supervised by orthopaedic surgeons. Our hypothesis is that such centers can safely improve orthopaedic care for ambulatory orthopaedic injuries, decrease volume for overburdened emergency departments (EDs), reduce wait times and significantly decrease the cost of care while improving access to orthopaedic specialists.

Design:

Retrospective review.

Setting:

Level 2 trauma center and physician-owned orthopaedic urgent care.

Patients:

Consecutive series of patients seen in the hospital ED (n = 87,629) and orthopaedic urgent care (n = 12,722).

Intervention:

None.

Outcomes:

ED wait time, total visit time, time until being seen by provider, time until consultation with orthopaedic surgeon, total visit charges, and effect on orthopaedic practice revenue.

Results:

During the 12 months of study, 12,722 patients were treated in our urgent care. The average urgent care wait time until being seen by a provider was 17 minutes compared with 45 minutes in hospital ED. Total visit time was 43 minutes in the urgent care and 156 minutes in the hospital ED. Time to being seen by an orthopaedic specialist was 1.2 days for urgent care patients compared with 3.4 days for ED patients. The average charge for an urgent care visit was $461 compared with $8150 in hospital ED. During the course of study, urgent care treatment reduced charges to health care system by $97,819,458. Hospital ED orthopaedic volume did decrease as expected but total ED patient volume remained the same. There was no measureable effect on hospital ED wait times. Hospital surgical case volume did not change over the period of study and the orthopaedic census remained stable. Urgent care construction, marketing, administration, imaging, and labor costs totaled $1,664,445. Urgent care revenue from evaluation and management, imaging, durable medical equipment, and casting totaled $2,577,707. Practice revenue from follow-up care of patients who entered practice through the urgent care totaled $7,657,998.

Conclusion:

Dedicated musculoskeletal urgent care clinics operated by orthopaedic surgery practices can be extremely beneficial to patients, physicians, and the health care system. They clearly improve access to care, whereas significantly decreasing overall health care costs for patients with ambulatory orthopaedic conditions and injuries. In addition, they can be financially beneficial to both patients and orthopaedic surgeons alike without cannibalizing local hospital surgical volumes.

Level of Evidence:

Therapeutic Level III.
Operating Room Supply Costs in Orthopaedic Trauma: Cost Containment Opportunities
Authors: Gurnea Taylor P. , Frye Wesley P. , Althausen Peter L.
Published: November 2016

In the current health care environment, cost containment is more important than ever. Most physicians currently are unaware of the cost of operating room supplies. A large amount of waste occurs secondary to lack of knowledge and absence of physician incentives for cost saving. Many of the decisions for supply use can be based on good scientific evidence, which supports specific cost saving measures. Careful attention to blood utilization and use of tranexamic acid has the potential to save millions in the hip fracture treatment and arthroplasty treatments. Standardization of surgical preparation and draping can decrease costs and prevent costly surgical site infections. Following protocols and guidelines for bone graft and orthobiologics is critical. The clinical and legal repercussions of retained instruments and costs associated with dropped implants is a huge source of wasted health care dollars. Reprocessing programs for external fixators and tourniquets have been extremely successful. A myriad of opportunities for intraoperative cost savings exist that could be applied to nearly every orthopaedic surgery performed in the United States. It is incumbent on all surgeons to put aside the choices made out of habit and take part in reducing operating room waste for the benefit of hospitals, patients, and the health care system. When applied to the 5.3 million orthopaedic surgeries performed annually in the United States, billions of dollars could easily be saved with no adverse effect on patient care.
Cutaneous Sebaceous Lesions in a Patient With MUTYH-Associated Polyposis Mimicking Muir-Torre Syndrome
Authors: Kacerovska Denisa , Drlik Lubomir , Slezakova Lenka , Michal Michal , Stehlik Jan , Sedivcova Monika , Hadravsky Ladislav , Kazakov Dmitry V.
Published: November 2016

A 76-year-old white male with a history of adenocarcinoma of the rectosigmoideum and multiple colonic polyps removed at the age of 38 and 39 years by an abdominoperitoneal amputation and total colectomy, respectively, presented with multiple whitish and yellowish papules on the face and a verrucous lesion on the trunk. The lesions were surgically removed during the next 3 years and a total of 13 lesions were investigated histologically. The diagnoses included 11 sebaceous adenomas, 1 low-grade sebaceous carcinoma, and 1 squamous cell carcinoma. In some sebaceous lesions, squamous metaplasia, intratumoral heterogeneity, mucinous changes, and peritumoral lymphocytes as sometimes seen in sebaceous lesions in Muir–Torre syndrome were noted. Mutation analysis of the peripheral blood revealed a germline mutation c.692G>A,p.(Arg231His) in exon 9 and c.1145G>A, p.(Gly382Asp) in exon 13 of the MUTYH gene. A KRAS mutation G12C (c.34G>T, p.Gly12Cys) was detected in 1 sebaceous adenoma and a NRAS mutation Q61K (c.181C>A, p.Gln61Lys) was found in 2 other sebaceous adenomas. No germline mutations in MLH1, MSH2, MSH6 and PMS2 genes, no microsatellite instability, no aberrant methylation of MLH1 promoter, and no somatic mutations in MSH2 and MSH6 were found. An identical MUTYH germline mutation was found in the patient's daughter. Despite striking clinicopathological similarities with Muir–Torre syndrome, the molecular biologic testing confirmed the final diagnosis of MUTYH-associated polyposis.
Aggressive Digital Papillary Adenocarcinoma With Multiple Organ Metastases: A Case Report and Review of the Literature
Authors: Kobayashi Tadahiro , Hiura Azusa , Oishi Kyosuke , Maeda Shintaro , Le Pavoux Andres James , Ohara Kuniaki , Uruga Hironori
Published: November 2016

Aggressive digital papillary adenocarcinoma (ADPA) is a rare sweat gland neoplasm with a high recurrence rate and metastatic potential. In this study, the authors describe a case that originally appeared to benign spiradenoma, but took an ominous course eventually resulting in the diagnosis of ADPA. A 73-year-old woman developed a gradually growing nodule on the second toe of her left foot, which she had first noticed 4 years previously. An excisional biopsy was performed followed by histological examination. The authors initially considered the tumor to be a benign spiradenoma and did not perform reexcision. However, she experienced local recurrence 24 months later, and multiple pulmonary metastasis 31 months later. On histological examination, both the primary and locally recurrent tumors were found to be composed of discrete and well-circumscribed solid nodules, lacking cystic space. All tumors (the primary tumor, locally recurrent tumor, and lung metastases) presented with a pattern of fused back-to-back tubular structures and myoepithelial differentiation confirmed by immunohistochemical examination. On the basis of these findings, the authors finally diagnosed ADPA with multiple pulmonary metastases. The patient underwent chemotherapy, but died of disease 49 months later. This case highlights the importance of high clinical suspicion of ADPA when digital lesions present.
Targeting β3-Adrenergic Receptors in the Heart: Selective Agonism and β-Blockade
Authors: Cannavo Alessandro , Koch Walter J.
Published: November 2016

Cardiac diseases, such as heart failure, remain leading causes of morbidity and mortality worldwide, with myocardial infarction as the most common etiology. HF is characterized by β-adrenergic receptor (βAR) dysregulation that is primarily due to the upregulation of G protein–coupled receptor kinases that leads to overdesensitization of β1 and β2ARs, and this clinically manifests as a loss of inotropic reserve. Interestingly, the “minor” βAR isoform, the β3AR, found in the heart, lacks G protein–coupled receptor kinases recognition sites, and is not subject to desensitization, and as a consequence of this, in human failing myocardium, the levels of this receptor remain unchanged or are even increased. In different preclinical studies, it has been shown that β3ARs can activate different signaling pathways that can protect the heart. The clinical relevance of this is also supported by the effects of β-blockers which are well known for their proangiogenic and cardioprotective effects, and data are emerging showing that these are mediated, at least in part, by enhancement of β3AR activity. In this regard, targeting of β3ARs could represent a novel potential strategy to improve cardiac metabolism, function, and remodeling.
Reconstruction of the Ptotic Breast Using Wise Pattern Skin Deepithelialization
Authors: Newman Michael K.
Published: November 2016

Reconstruction of ptotic or large breasts is challenging due to skin redundancy after skin-sparing mastectomy. Skin reduction can be performed with a long horizontal ellipse, but this often flattens the breast and leaves conspicuous scars medially on the chest. Wise pattern skin reduction is an effective technique for shaping, but excision of skin within the Wise pattern can lead to high rates of skin necrosis and implant exposure or infection. This study describes a technique where the Wise pattern skin is preserved, but deepithelialized, allowing apparent reduction of the skin with preservation of the subdermal plexus. This study reviews data for case series of 26 breasts in 15 patients who have undergone this technique with simultaneous prosthetic reconstruction using an expander.
Microvascular Compromise Develops Following Nerve Fiber Layer Damage in Normal-Tension Glaucoma Without Choroidal Vasculature Involvement
Authors: Lee Eun Jung , Kim Sibum , Hwang Sungsoon , Han Jong Chul , Kee Changwon
Published: November 2016

Purpose:

To investigate capillary densities in patients with unilateral normal-tension glaucoma (NTG) and normal controls using optical coherence tomography-angiography.

Materials and Methods:

We recruited 13 patients with unilateral NTG and 13 healthy controls. Optical coherence tomography-angiography was performed and pure peripapillary retinal capillary density was calculated after manually excluding large vessels and the optic disc. Paired comparison of capillary densities was performed among 3 categories of eye: NTG eye, fellow eye, and normal eye. Through vascular layer stratification we investigated differences in the retinal and choroidal circulation.

Results:

In total, 33 eyes of 11 unilateral NTG patients and 11 controls were analyzed. Capillary densities of NTG eyes were significantly lower than those of fellow eyes or control eyes (both P=0.013). No significant differences were found between fellow eyes and control eyes (P=0.328). Area of capillary compromise was identical to the area of retinal nerve fiber layer (RNFL) defect in all 11 eyes. In layer analysis, a decrease in capillary plexus was demonstrated only in the inner retina and no definite changes were found in the outer retina and choroid. Optic nerve head microvasculature did not show areas of capillary dropout.

Conclusions:

In patients with unilateral NTG, we could observe significant retinal capillary compromise in the area of RNFL defect. No changes were demonstrated in the choroid and optic disc area. We speculated on a possibility of secondary microvascular changes in the retina to nerve damage from the wedge-shaped but not geographic shaped capillary compromise corresponding to RNFL defect area. Further studies on the optic nerve head microvasculature and blood flow are warranted to assess their relationship to glaucoma pathogenesis.
Development and validation of a short-form Pain Medication Attitudes Questionnaire (PMAQ-14)
Authors: Elander James , Said Omimah , Maratos Frances A. , Dys Ada , Collins Hannah , Schofield Malcolm B.
Published: November 2016

Attitudes to pain medication are important aspects of adjustment to chronic pain. They are measured by the 47-item Pain Medication Attitudes Questionnaire (PMAQ). To measure those attitudes more quickly and easily, we developed and evaluated a 14-item PMAQ using data from 3 separate surveys of people with pain in the general population. In survey 1, participants (n = 295) completed the 47-item PMAQ and measures of pain, analgesic use, analgesic dependence, and attitudes to self-medication. For each of the 7 PMAQ scales, the 2 items that best preserved the content of the full parent scales were identified using correlation and regression. The 2-item and full parent scales had very similar relationships with other measures, indicating that validity had been maintained. The resulting 14-item PMAQ was then completed by participants in survey 2 (n = 241) and survey 3 (n = 147), along with the same other measures as in survey 1. Confirmatory factor analysis showed that the 14-item PMAQ retained the 7-factor structure of the 47-item version, and correlations with other measures showed that it retained the validity of the 47-item version. The PMAQ scale Need was the most significant independent predictor of analgesic dependence in each of 4 separate multiple regression analyses. This short form of the PMAQ allows attitudes to pain medications to be measured in a valid and more efficient way.