bluuebunny/crossref_metadata_2025 huggingface dataset:
Cleft Lip Rhinoplasty
Authors: Smith Howard W.
Published: January 2017

Cleft lip rhinoplasty may be performed as an endonasal or an open rhinoplasty procedure. It is helpful for the rhinoplasty surgeon to know the type of lip closure and the extent of nasal surgery performed at the time of primary lip repair. Current methods of primary lip repair attempt to create an esthetic lip scar and leave a minimal degree of nasal tip deformity to allow the child to avoid secondary lip and nasal tip surgery at the preschool age.

Single cleft lip rhinoplasty has to deal more with asymmetry than double cleft lip rhinoplasty. The double cleft lip deformity has to deal with a true deficiency in the columella and the possible need for lip augmentation.

Closure of the alveolar cleft and the cleft palate in both types of cleft lip and palate often creates scar tissue that retards maxillary growth and introduces the need for cephalometric analysis and possible orthognathic surgery.
Revision Rhinoplasty
Authors: Pitanguy Ivo
Published: January 2017

The increasing number of secondary surgeries following rhinoplasty is generally due to excessive removal of cartilage, bone, and lining. The patient is often dissatisfied and demanding, and the surgeon must analyze an altered anatomy with inadequate tissues. A proper diagnosis will reveal specific problems; the functional, psychological, and cosmetic aspects of each case should be considered. The nasal deformity should be analyzed in the context of the face as an aesthetic unit. Surgery is usually deferred until resolution of healing and softening of tissues has occurred. In most cases secondary correction requires the placement of additional tissue, which should always be of autogenous origin. In some cases the drooping-tip deformity can be treated by the simple dissection and division of the dermocartilaginous or Pitanguy's ligament of the nose.
Anatomic-Radiologic Comparison of the Effects of Liposculpture on the Lymphatic System of the Lower Extremities
Authors: Leibaschoff Gustavo , Ferreira Julio , Ciucci Jose Luis
Published: January 2017

A study of the lymphatic anatomy of the leg was performed using lymphography. Methods of visualization of the lymphatic anatomy are discussed and include radiographic visualization during surgery and direct examination of tissues after injection of vital dyes. Using these methods, the effect of liposuction on the lymphatics of the leg was studied in a single patient. Results of this preliminary study indicate that liposuction of the lower extremity does not cause disruption of the lymphatic system of the leg.
Measurement of Normal Eyebrow, Eyelid, and Pretarsal Skin Heights
Authors: Cartwright Mont J. , Kurumety Usha R. , Nelson Christine C. , Frueh Bartley R. , Musch David C.
Published: January 2017

The anatomic relationships of the eyebrows and eyelids influence facial appearance. Restoration or preservation of the symmetry of the eyebrows and eyelids through surgical means can restore a normal appearance. To establish the normal relationships of these facial structures in 143 normal Caucasian individuals, measurements were taken of the eyebrow height, the upper eyelid crease height, and the amount of visible pretarsal skin. It was noted that with increasing age the variation of the mean estimates for eyelid and eyebrow measurements was increased. Aging affected the measurements in younger patients, but in the middle age range, 41–60 years, the mean estimates leveled off or decreased. A high degree of intereye correlation was observed. Eyebrow and pretarsal skin heights as well as eyelid crease height were greater in females than in males. Corrective or cosmetic procedures on the eyelid and eyebrow should take into account these normal anatomic relationships.
The Laser Dermal Implant™: A New Technique for Preparation and Implantation of Autologous Dermal Grafts for the Correction of Depressed Scars, Lip Augmentation, and Nasolabial Folds Using SilkTouch™ Laser Technology
Authors: Abergel R. Patrick , Schlaak Cindy M. , Garcia Lisa Deanne , Slatkine Michael , Mead Doug , Peng Shi Kaung
Published: January 2017

Autologous dermal grafting is a promising method for correction of depressed scars and rhytides and for lip augmentation. In this article, we describe an original technique to obtain and implant dermal grafts. Using SilkTouch™ laser technology and newly developed surgical instruments, autologous dermal grafting is becoming an efficient, fast, and reproducible procedure with practically no complications. The cosmetic results reported here allow us to forsee wide applications for the Laser Dermal Implant™.
Corrective Surgery for Mammary Hypertrophy on Ambulant Patients
Authors: Lieberman Clara
Published: January 2017

Mammary hypertrophy has always been a serious problem for women, frequently causing physical pain and deformity as well as psychological disorders associated with self-image. In search of a simple treatment to correct this condition, we have developed an ambulatory liposuction technique. Since the breast consists mainly of fatty tissue, the partial elimination thereof further permits a mastopexy with subsequent upward relocation of the nipple and areola. The resulting formation of internal scar tissue further firms the breast, lessening pressure at the site of the incision. No alteration in sensitivity of the nipple or of the areola results from this practice, and with proper surgical technique, necrosis is ruled out. Bleeding is minimal or nonoccurrent, and glandular function remains unimpaired, since it is not affected by this procedure.
Variation of Face-Lift Incision to Reduce Visible Scar
Authors: Nguyen Xuan Cuong
Published: January 2017

A variation on the traditional face-lift incision is described. The technique proposed is offered as a way to avoid the visible scar along the incision in front of the ear that results from traditional face-lift surgery.
Endoscopic Evaluation and Treatment of Late Breast Implant Hematoma: Case Report
Authors: Tobin Howard A. , Houting Thomas V.
Published: January 2017

This is a report of the occurrence of a hematoma that developed 4.5 years after breast augmentation in a patient who had an otherwise uneventful postoperative course.
Ultrapulse Carbon Dioxide Laser Rejuvenation of Facial Wrinkles and Scars
Authors: Weinstein Cynthia
Published: January 2017

The ultrapulsed (high energy, pulsed) carbon dioxide lasers have been shown to be extremely useful for resurfacing facial wrinkles due to actinic damage as well as acne scars, linear postsurgical and posttraumatic scars, and exophytic skin lesions. These lasers have some advantages over skin peeling and dermabrasion, and may be combined with other procedures, especially endoscopic forehead-lifting, laser blepharoplasty, neck liposuction, and platysmaplasty. Since 1992, 1643 patients have been treated with the ultrapulsed carbon dioxide laser. Excellent results have been achieved in patients with fine wrinkles, exophytic skin lesions, and linear postsurgical and posttraumatic scars. Acne scarring patients achieved fair to good results. Complication rate was low.
Megalipotherapy: Problems and Results
Authors: Sidor Vladimir
Published: January 2017

Megalipotherapy is a therapeutic concept that encompasses the global undertaking of treating the obese patient who has various problems induced by overweight and associated pathologies. Megaliposuction is a part of megalipotherapy and is used alone or in association with other surgical procedures. There are physiological problems associated with obesity that require careful evaluation preoperatively. These physiological problems can be worsened following megaliposuction, and there may be serious consequences. Obese patients can be treated with various aspects of megalipotherapy, and weight loss can be maintained without special diet or medication. Medical problems can also be improved.
The Viability of Human Adipocytes after Closed-Syringe Liposuction Harvest
Authors: Jones John K. , Lyles Mark E.
Published: January 2017

The notion of free-tissue transplantation of autologous adipose is not new, but has experienced a resurgence in interest due to the popularity of liposuction surgery. Literature review indicates a lack of predictability with previously described techniques, and various theories have been proposed to explain clinical findings. A requisite premise of autologous soft-tissue transplantation is that the tissue must survive the harvest. Recent advances in cell culture technique have allowed us to prove that adipocytes can survive harvesting by aspiration, at least by the method used in this investigation. A surprising finding was that the adipocytes maintained a mature phenotype in culture. This may provide a laboratory model for further investigation.
Liporecycling: Immediate and Delayed
Authors: Sattler Gerhard , Sommer Boris
Published: January 2017

Liposuction has become one of the most commonly performed cosmetic surgical procedures. A natural offspring of liposuction, liporecycling, has simultaneously been developed as an effective procedure in soft-tissue augmentation. The graft material for this procedure is collected during reduction liposuction performed with tumescent anesthesia. The tumescent solution allows for the use of specially designed microcannulas. In this way, pure fat cells are harvested that can easily be used immediately or frozen and kept for future subdermal reinjection through small syringes. The results in soft-tissue augmentation and facial rejuvenation are comparable to those of collagen injection but show a number of significant advantages.
Principles of Liposuction
Authors: Shiffman Melvin A.
Published: January 2017

Liposuction principles, updated from those established and followed in 1985, 1989, and 1991 are presented along with the early principles and commandments, some of which have been proven incorrect or only partially correct. Constant reevaluation of the science and techniques has resulted in changes to the principles of liposuction. Fourteen current principles of liposuction are listed in this article.
Splenic and Portal Vein Thrombosis following Liposuction
Authors: Spencer David M. , Spencer Thomas S. , Gibbs James S.
Published: January 2017

This article reports the first case of splenic and portal vein thrombosis evolving from tumescent liposuction. The patient was a 47-year-old white female. Within 48 hours of the surgery, the patient developed generalized abdominal cramping and discomfort without fever, diarrhea, or vomiting. Radiological analysis with ultrasound and CT could not differentiate between fat or blood emboli. Heparinization and hyaluronidase use are acknowledged as controversial measures, but surgeons should be alerted to the potential for a tumescent-liposuction-induced thromboembolic event and become sensitized to its signs and symptoms.
A Complication of Liposuction Surgery
Authors: Shiffman Melvin A.
Published: January 2017

Bowel perforation during liposuction surgery is usually preventable. This article presents the facts and decision in the case of Tillery v Pottle, No 94Cv2942, Superior Court, New Hanover County, North Carolina (1996). Perforation of the bowel is more likely to occur in the presence of an unrepaired hernia. Patients should be warned of the possibility of inadvertent bowel perforation through an undectable hernia if abdominal-wall scars are noticed during the preoperative examination.
What You Need to Know to Be a Credible Expert Witness
Authors: Davis Joseph A.
Published: January 2017

This article highlights legal procedures, rules, and concepts that will prepare the physician for the experience of offering expert testimony in a court of law. General and specific advice to the novice is offered. Many topics including marketing yourself as a provider of expert services through a broker, consultations, duties, responsibilities, and payment are discussed. Remaining a scientist and a neutral party towards the outcome of the specific case is emphasized. The various types of evidence are described. The experience of and motivation behind the impeachment of the expert witness and the Ad Hominem legal attack are explained. Ultimately, the expert should be prepared, knowledgeable and honest, objective, neutral, and disinterested.
The Nasolabial Triangle
Authors: Burres Steven
Published: January 2017

Because the nasolabial fold is located conspicuously in the center of the midface, its depth and length often indicate the progression of age. This paper describes a new technique for reducing the medial portion of the nasolabial fold by excising an area of labial skin called the nasolabial triangle and advancing the malar fold both inferiorly and along the lateral alar crease. Besides flattening the fold, this simple procedure shortens its length dramatically by eliminating the natural extension of the fold along the lateral alar rim. Several case examples are presented to demonstrate the excellent results and minimal scarring that are possible with this approach.
CO2 Laser-assisted Skin Resurfacing: Current Practices
Authors: Koch R. James
Published: January 2017

The author reports his current practices based upon a 2-year experience utilizing the NovaPulse™ CO2 laser and NovaScan™ handpiece (Luxar Corp., Bothell, Washington) for cosmetic skin resurfacing. Treatment practices have significantly evolved over this time period. Technical endpoints, routine postprocedure practices, problem measures, and current controversies are discussed.
Fat Transplantation and Facial Contour
Authors: Golcman R. , Camargo C. P. , Golcman B.
Published: January 2017

Injection of adipose tissue into corporal depressions to improve contour is not a new procedure. According to the literature, the grafted fat undergoes ischemia, producing a local inflammatory process and reabsorption of part of the injected volume, and the desired result is not achieved. Starting from the premise that vascular insufficiency occurs in the core of grafted tissue, leading to reabsorption, the authors of this paper studied the outcome of injection of small volumes of fat into facial depressions. The subjects, 16 patients with facial depressions (12 with Romberg's syndrome and 4 with lupus), were subjected to small volumes of adipose tissue grafting. Three to seven sessions of fat grafting were necessary to obtain a uniform facial contour. The interval between each procedure was 2–3 months. Ultrasonography and biopsies were performed. The cutaneous ultrasound demonstrated viable adipose tissue, confirming the pathological result.
A Tumescent Technique for Subperiosteal Endoscopic Forehead/Brow Lifts
Authors: Fidler John E. , Laney Thomas J.
Published: January 2017

Rejuvenation of the upper one-third of the face has undergone many changes in the past few years. The use of the coronal brow-lift has decreased, and the use of limited incision procedures has come to the forefront. Endoscopic techniques have improved and the results are now comparable to those of the open technique. Tumescent anesthesia has been used in both liposuction surgery and cervicofacial rhytidectomy. The use of tumescent anesthesia can be problematic when the plane of dissection is subperiosteal. This paper describes a technique for subperiosteal tumescent anesthesia and initial dissection in the endoscopic forehead-lift procedure.
Submental Recontouring: An Adjunctive Maxillofacial Aesthetic Procedure
Authors: Ziccardi Vincent B. , Schneider Ronald E.
Published: January 2017

Introduction:

The chin and submental region contribute to facial balance. Inadequate jaw projection and neck definition may compromise the aesthetic results of cosmetic surgical procedures. It was hypothesized that adjunctive mandibular setback procedures and reduction genioplasty would improve the aesthetic results of cosmetic surgery.

Materials and Methods:

A triangular excision for a V–Y advancement is outlined in the submental region using methylene blue. The triangle is oriented with the apex facing the chin and the base toward the thyroid cartilage in a natural neck crease. The triangle, oriented so that the base is toward the chin at the submental crease, left a small bulge at the apex of the vertical limb of the Y in the neck midline, which required a secondary excision to correct. Incisions in the shape of a pentagon or an ellipse can also be used. Local anesthetic with vascoconstrictor is deposited along the lines of the planned excision. The geometric skin is excised. If the platysma muscle is dehiscent, it can be sutured and platysmaplasty performed. The subplatysmal fat may be removed if visible only in the midline region with caution taken at this juncture not to be too aggressive to avoid potential profuse hemorrhage. The skin flaps are widely undermined. The fat excision is feathered. A two-layer closure is then performed.

Discussion:

In patients with adequate skin elasticity and thickness, liposuction may be indicated. Submental excision and direct lipectomy is another technique that can address the ptotic chin, lax skin, and submental lipomatosis. This technique is indicated for those patients in whom there is excess submental fat or skin laxity and in whom there is a contraindication or a lack of patient desire to undergo formal neck-lifting procedures.

Conclusion:

Submental recontouring is a useful adjunctive aesthetic procedure that can be readily performed in the office setting with instrumentation and technique currently available.
Varicosis, Aesthetics, and Pain
Authors: Parish Timothy D.
Published: January 2017

Introduction:

The aesthetic presentation and subsequent management of varicosis are well accepted. However, the association of pain and its impact on varicosis is less well understood. The purpose of this study is to define the interrelationship of pain with the anatomic and physiological presentation of patients with primary varicosis.

Materials and Methods:

This is an ongoing prospective demographic study of sequential patients presenting randomly at the Varicosis and Laser Center of Alabama for the evaluation of varicosis. All patients were given standard questionnaires to evaluate their reasons for presentation. Later in the study, those who selected pain were asked to identify the perceived intensity of their pain by the use of “smiley faces.” Patients were clinically divided into three groups: group 1, those with spider and reticular vein disease; group 2, those with mixed large- and small-vein disease; and group 3, those with large-vein disease (>4 mm).

Results:

Seventy-seven percent of patients presenting with varicosis had pain. The correlation of pain with varicosis may indicate a more prevalent association with chronic venous insufficiency. This association was of greater significance in those patients with large-vein disease (>4 mm). The use of smiley faces to monitor perceived intensity of pain revealed a significant result in all clinical groups. The character of the pain was described in multiple terms.

Discussion:

Pain is a prevalent condition in those patients presenting with primary varicosis. Pain is associated with a greater likelihood of chronic venous insufficiency, in large-vein disease. The association of varicosis with pain and chronic venous insufficiency allows categorization into four functional classes.
Eight Years of Fat Transplantation Experience
Authors: Jackson Robert F.
Published: January 2017

Introduction:

I have used fat as a transplantation filler following liposuction approximately 8 years. Six years ago, I began freezing fat to be used later. The results of both frozen and fresh fat as transplant material is dependent on many variables, not the least of which is technique. I describe the background of this procedure, its evolution, my personal techniques, and the results.

Materials and Methods:

For this study, only 30 randomly chosen patients who could be followed for at least 6 months were considered. Twenty-eight patients received fresh fat transferred at the time of surgery. Fourteen patients received frozen fat. Five patients received a second injection of frozen fat. Three received 3 or more injections. Two patients received frozen fat injected as the initial filler. One patient received a subsequent injection of frozen fat. My technique for harvesting fat either to be used as fresh transplant material or later as frozen transplant material is the same. Tumescent infiltration is carried out using the standard Klein solution, 0.05% lidocaine, in normal saline with 1:1000000 epinephrine. Originally a 2- or 2.5-mm cannula with a 35 mL or 60-mL syringe technique was used; however, recently, the Coleman harvesting needle and 10-mL syringe have been used. The fat is stored in 5- and 10 mL syringes.

Conclusion:

I have found fat to be an acceptable filler for both congenital and surgical defects as well as a good method for augmentation. I found frozen fat to survive as well as fresh fat.
Use of Autocollagen
Authors: Takasu Katsuya , Takasu Shizu
Published: January 2017

Introduction:

We developed an efficient procedure for separating autocollagen from adipose tissue. This involved the use of an electrical ultrasonic generator to break up fat cells and subsequent centrifugation. We have been using autocollagen as a dermal filler, substituting it for the popular bovine collagen, for the last 10 years. This study was performed to evaluate the actual amount of collagen content in autocollagen obtained with our method and to evaluate the clinical efficacy of our technique.

Materials and Methods:

Autologous fat harvested with liposuction is treated with ultrasonic homogenation for 2 minutes and then centrifuged at 1000 rpm for 3 minutes. The second layer of material present after centrifugation is autocollagen, which contains fragments of collagen fiber, elastic tissue, and disrupted fat cells. The extracted samples were subjected to hydroxyproline assay. One hundred sixty cases were followed after receiving autocollagen injections into the dermis to smooth out wrinkles.

Results:

The collagen content in our autocollagen was 4.0% (3.4–6.1%). Of the 169 patients treated with autocollagen injections, no infections or allergic reactions occurred during the follow-up. Most of the cases showed a recurrence of wrinkles after 6 months to 2 years. A few patients demonstrated a long-term improvement of their wrinkles (up to 6 years).

Discussion:

Autocollagen obtained by destroying fat tissue is a devitalized tissue and it is unlikely that it will survive after replantation in the human body. However, some patients showed pesistent corrections. Autocollagen is a safer and less expensive material and may provide a longer-term correction than bovine collagen implants for the correction of wrinkles.
Umbilicoplasty in Abdominoplasty: A Demonstration
Authors: Risk Benito B. , Prado Angel
Published: January 2017

Introduction:

The purpose of this paper is to demonstrate a new technique in performing umbilicoplasty at the time of abdominoplasty that avoids the formation of a thickened or contracted circular scar.

Materials and Methods:

After a routine abdominoplasty and isolation of the umbilical stalk with extra redundant skin surrounding the umbilicus, a V-incision is made in the abdominal wall skin at a site selected for the new umbilical site. The superior or cephalic part of the umbilicus is split and spread, creating the appearance of a wedge that has been removed. The umbilicus is brought through the abdominal wall opening. The inferior point created by the abdominal V is sutured to the slit point of the umbilicus, which is cephalic, and is also sutured to the fascia at the base of the stalk, thus rotating the point of the V deep into the umbilicus and avoiding a circular scar.

Results:

The resultant umbilicus has no scar superiorly, as the tip of the V is completely buried. Thus, a visible circular scar is avoided.

Discussion:

The described procedure is simple, and the results are cosmetically acceptable both to the patient and the surgeon.
Inside the Ghetto - Using a Table of Contingency and Cladisitic Methods for Definitional Purposes
Authors: Raynaud Dominique
Published: January 2017

This article aims at clarifying sociological definitions with the help of an original tool, the logical table of contingency, which has characteristics in common with both the statistical table of contingency and Carroll’s bilateral diagram. The unclear notion of ghetto is taken as a test-case. Successive tables of contingency are applied to various defining properties and various sociohistorical situations. Cladistic methods are then used to make the relationships between all ghetto-like situations explicit.
Natural disasters and healthcare
Authors: Francescutti Louis Hugo , Sauve Michel , Prasad Abhaya S.
Published: January 2017

Natural disasters are on the increase. How healthcare systems respond to their communities’ need for medical attention after such events will be very challenging. The situation is even more complicated when such facilities are forced to unexpectedly close and evacuate because they are in harm’s way. There are important lessons to be learned from these events, yet people are slow to share what they experienced.
Analytic Reviews : Aspiration Pneumonitis: Patient Risk Factors, Prevention, and Management
Authors: Hoyt John
Published: January 2017

Occurrence of aspiration pneumonitis, the morbid con dition that often follows aspiration of gastric contents, has been documented for over 40 years. A number of risk factors that predispose patients to acid aspiration have been identified. The acidity of the gastric fluid and the volume of the aspirate are high-risk factors that de termine the severity of the pneumonitis. In this review I discuss those conditions that predispose patients to as piration and subsequent development of pneumonitis as well as current strategies for prevention and treatment.
The Antisecretory Effects of Ranitidine Administered by Continuous Infusion
Authors: Moore John
Published: January 2017

Prevention of stress-induced upper gastrointestinal ul ceration and bleeding is an important issue for clinicians caring for critically ill patients. Although H2 blockers have been demonstrated as effective in treating patients with stress ulcers and bleeding, the ideal regimen of administration has not yet been devised. One method, continuous intravenous infusion, minimizes variation in drug effects by controlling for pharmacokinetic vari ables. Even with the use of continuous infusion, consis tent control of gastric pH may not be attained. Because of the pharmacokinetic, pharmacodynamic, and patient variables, there is often a discrepancy between H2 blocker dose and effects. Studies in healthy persons and patients with duodenal ulcers demonstrate a circadian variation in gastric acid production and in the effects of H2 blockers on gastric pH. In particular, H2 blockers may be less effective in the evening. To address this concern in intensive care patients, continuous intrave nous infusions of H2 blockers can be used, but variable rates of intravenous infusions may be more effective, allowing for the circadian variations in gastric acidity. Further study is needed to define patient groups that most require intravenous H2 blockers, to devise regi mens that are more effective in continuously controlling gastric pH in critically ill patients, and to clarify dose- response relationships for H2 blockers.
Academic Tracking, High-Stakes Tests, and Preparing Students for College: How Inequality Persists Within Schools
Authors: Giersch Jason
Published: January 2017

Academic tracking is a common feature of school organization, but it produces inequalities in student outcomes. High-stakes testing policies offer new opportunities for assessing students’ progress, but the instruments raise concerns about relying on such narrow measures of learning. This study utilizes a longitudinal data set that follows one cohort of North Carolina school students from public high school through the state university system to examine the difference in outcomes associated with academic track. Results show that upper track students do better in college even when controlling for achievement on high-stakes tests and that such tests are a stronger predictor of college success for upper track students than they are for lower track students. Interviews suggest that these differences can be attributed to different methods of instruction in each track.
Parkinson's Disease
Authors: Tortorice Kathryn L.
Published: January 2017

Parkinson's disease is a progressive neurological disorder with a usual age of onset between 40 and 70 years. It is characterized by a tetrad of symptoms: resting tremor, bradykinesia, rigidity, and postural abnormalities. In addition, patients may display varying degrees of autonomic dysfunction. The clinical course of the disease is unpredictable, with patients who exhibit minimal symptoms to those with rapid deterioration. Pharmacological therapy provides symptomatic relief in most patients, although adverse effects of medications are often intolerable. Recent advances have focused on the ability to eliminate or lessen fluctuations in symptom control, decrease the severity of adverse effects, and seek surgical interventions aimed at reversing the disease.
Antiemetic Therapy in the Outpatient Oncology Setting
Authors: Valley Amy W. , Morris Ashley K.
Published: January 2017

Nausea and vomiting (N/V) are well-recognized and potentially serious complications of cancer chemotherapy that can significantly impact therapeutic outcomes and overall quality of life. As the management of cancer patients moves to the outpatient setting, therapeutic strategies for N/V control must be adapted accordingly. The purpose of this article is to provide an overview of the pathophysiology and basic principles of N/V management and the available antiemetic agents, with an emphasis on applications in outpatient oncology. Development of antiemetic guidelines promotes selection of appropriate antiemetics to maximize N/V control, while minimizing associated cost. Use of oral antiemetics when possible also significantly reduces the cost of N/V management, without compromising therapeutic efficacy. In addition to designing an appropriate treatment regimen, measures for the early evaluation of N/V outcomes must also be instituted. Pharmacists can have an important role in ensuring optimal control of N/V in cancer patients.
Multi Inter-organizational Information Systems: Competitive Strategies for Teaching Hospitals in the 1990s
Authors: Michelman Jeffrey E. , Kim K. Kyu
Published: January 2017

As the environment surrounding the health care industry has changed, the ability of administrators to manage these relationships remains very limited due to their ever-increasing complexity. These organizational relationships offer both challenges and opportunities for innovative strategies that address the issues of coordination and control. As these environmental changes take place, the application of information systems technology becomes more important for managing these relationships and achieving competitive advantages. A theoretical model is presented to serve as a basis for empirical investigations into the role of information systems technology in health care organizations — more specifically teaching hospitals.
Hospital-Physician Integration: Case Studies of Community Hospitals
Authors: Lemieux-Charles Louise , Leatt Peggy
Published: January 2017

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables.

Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting.

Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.
Adopting an Information Management Approach to the Design and Implementation of Information Systems
Authors: Hepworth John B. , Griffin Elaine , Vidgen Grant A. , Woodward Tony
Published: January 2017

As the NHS adopts an information management approach to coordinated handling of total information resources, methods of systems analysis and design require assessment to ensure that they are appropriate. Mandatory use of Structured Systems Analysis and Design Methodology (SSADM) may be encouraging a damagingly narrow view of information systems.

Research is described in which an holistic view of information systems is applied, allowing the needs of information users to play a stronger role in determining how information will be supplied to them. The techniques may also assist the training activities associated with implementing new systems.
Institutions for Mental Diseases (IMDs): Facilities and Clients
Authors: Grazier Kyle L.
Published: January 2017

This paper describes a cross-sectional study of institutions for mental diseases (IMDs) and the clients they serve in one state. Primary and secondary data were collected to provide an in-depth look at the demographic, social, behavioral, medical, psychiatric and treatment attributes of a random sample of clients in IMDs. Detailed financial, service and operational data were collected on a 100% sample of facilities in the state. The findings indicated a client population dissimilar in age and behavioral attributes from a typical nursing home patient, but in keeping in many respects with the descriptions of nursing home clients with psychiatric disorders. Facilities appeared similar to nursing homes in their size and many operations. This unique database can be used to explore a predictive resource model of these institutions as well as to begin to examine the quality and effectiveness of this form of institutional care for the severely mentally ill.
Longitudinal Analysis of Patient Satisfaction among Medicare Beneficiaries in Different Models of Health Maintenance Organizations and Fee-for-Service Care
Authors: Boles Myde , Wan Thomas T. H.
Published: January 2017

Based on a randomly selected nationwide sample of Medicare beneficiaries, this study analyzes changes in patient satisfaction over a one year period for beneficiaries receiving care in a variety of delivery settings: fee for service, group model HMO, staff model HMO, and Independent Practice Association model HMO. The findings reveal the patient satisfaction changes significantly over a one year period, from lower levels of satisfaction to higher levels of satisfaction. The primary explanation for this change in satisfaction is a decline in health status over the same one year period. Additional differences in satisfaction with care were observed for Medicare beneficiaries served by different types of delivery settings with varying degrees of utilization controls.
Resource Management in Community Residential Facilities for Adults with Learning Disabilities
Authors: Shiell Alan , Wright Ken , Pettipher Catherine , Raynes Norma
Published: January 2017

The trend towards community living for people with learning disabilities puts pressure on traditional hierarchical lines of resource management. A sample of 150 community residential facilities is surveyed in order to describe the systems used to manage resources in the community and to assess the impact they have on the quality of service provided.

There are marked differences amongst provider agencies in the degree to which responsibility for resource management is devolved to facility managers and this has a direct effect on the quality of care. Residential homes which operate under centralised management systems are more institutional in their care practices and less responsive to individual clients' needs. In contrast, homes in which responsibility is delegated to the facility manager provide a service more in keeping with current philosophies of care.

The results of this survey suggest that more responsibility for resource management can be delegated to facility managers without losing control of expenditure and with improvements in the efficiency and effectiveness of care.
Workload in Trauma and Orthopaedic Surgery: Use of Linked Statistics to Profile a Specialty
Authors: Ferguson Joyce A. , Goldacre Michael J. , Bulstrode Christopher J.K.
Published: January 2017

We have used linked hospital morbidity statistics to construct a basic profile of the demographic and epidemiological features of trauma and orthopaedic surgery in a defined population. This paper reports on this profile and illustrates trends in the specialty between 1976–86. During this period episode-based inpatient admission rates rose by about 20%. Multiple admissions per person varied with age but did not increase over time. Thus the increase in admission rates in this specialty represented an increase in numbers of people who received treatment. Average length of stay per episode of inpatient care and the total time spent in hospital per person declined over time. New outpatient attendance rates increased by 19% in the 11-year period. The ratio of follow-up outpatient appointments to new appointments fell from 2.68:1 to 2.24:1; the number of inpatient beds fell by about 13% and bed occupancy remained stable at about 80%. We describe some of the major components of clinical workload in the specialty, with emphasis on conditions for which admission rates changed over time, relating the data to numbers of people treated as well as to episodes of care.
Comparative Attributes of Effective Health Services Managers and Definitions of Organizational Effectiveness in Australia, the UK and the USA
Authors: Boldy D. , Jain S. , Chen G.
Published: January 2017

This paper explores and contrasts the perceptions of 855, mainly health services managers and 1452 students from three major English-speaking countries regarding the attributes needed for becoming effective managers in their country. Also addressed are country differences and similarities in the perceived relevance of particular indicators of organizational effectiveness.

Despite Australia's British heritage, respondents from this country were found to be more similar to those from the USA, than those from the UK, in their views regarding the attributes of effective managers. Australian and American respondents rated ‘nurturing’ personality skills relatively highly, as they did ‘classical’ management skills. UK respondents rated ‘classical’ management skills as more important than ‘political’ skills.
Dante’s Vision
Authors: Jenson Robert W.
Published: January 2017

If we desire God with everything in us, how can we also love our created neighbor? Gilbert Meilaender displays Dante’s Paradiso as a resolution of this ancient problem. Jenson admires the beauty of Dante-according-according-to-Meilaender, but proposes that it must be tweaked a little to be fully satisfactory.
Modeling and prediction of surface roughness in belt polishing based on artificial neural network
Authors: Qi Junde , Zhang Dinghua , Li Shan , Chen Bing
Published: January 2017

Surface roughness is a variable often used to describe the quality of ground surfaces as well as to evaluate the competitiveness of the overall polishing system, which makes it an ever-increasing concern in industries and academia nowadays. In this article, from microscopic point of view, based on the statistics analysis, and by the use of the elastic contact theory and the plastic contact theory, the model of the maximum cutting depth of abrasive grains is developed. Then based on back-propagation neural network, taking the maximum cutting depth of abrasive grains, the rotation speed of belt and the feed rate of workpiece as the input parameters, a prediction model of surface roughness in belt polishing is presented. The prediction model fully takes the characteristics of polishing tool and workpiece into consideration which makes the model more comprehensive. Compared with the model that takes the polishing force as the input parameter, the model in this article needs fewer experiment samples which will save the experiment cost and time. Moreover, it has a wider range of uses and is suitable for different polishing situations such as different workpieces and polishing tools. The results indicate a good agreement between the predicted values and experimental values which verify the model.
Investigation of effects of MgO ratio on the surface quality and tool wear in turning Al–MgO composites
Authors: Pul Muharrem
Published: January 2017

In this study, specimens of Al–MgO metal matrix composites with reinforcement–volume ratios of 5%, 10% and 15% were produced using vacuum infiltration method. The produced specimens were then tested for machining on computer numerical control lathe using carbide, cubic boron nitride and coated cubic boron nitride cutting tools. Machining tests were performed under dry cutting conditions with three different feed rates (0.075, 0.15 and 0.225 mm/rev), four different cutting speeds (150, 200, 250 and 300 m/min) and fixed depth of cut (1 mm). The test results indicate that surface roughness (Ra) values for machined composite specimens were reduced as the cutting speed was increased, but increased as the feed rate was increased. The highest Ra values were observed at cutting speed of 150 m/min and at feed rate of 0.225 mm/rev. In general, the most stable results were achieved with C tools. The scanning electron microscope images of cutting tools suggest that the tip of tools had built-up edge and abrasive wear mechanism was effective on all of the cutting tools; and C tools, in general, provided the most stable results.
Surface layer properties of ultrasonic impact–treated AA7075 aluminum alloy
Authors: Kahraman Fatih
Published: January 2017

In this work, surface layer properties of AA7075 aluminum alloys’ ultrasonic impact peened at different treatment times are investigated. Three different layers were found on the ultrasonic impact–treated surface of AA7075 aluminum alloys. The thicknesses of the layers increase with an increase in the treatment time or deformation amount. X-ray diffraction patterns indicate that the treated surfaces have no different phases from base material and are in the face-centered cubic phase. The highest hardness values of all treated AA7075 aluminum alloys were determined in nanocrystallization layer, which is the top layer of the surface because of the grain refinement and work hardening. A sharp increase at the residual stresses occurs, increasing the deformation time and amount because of the surface enlargement.
Theoretical and experimental analyses of spiral bevel gears with two contact paths
Authors: Tan Rulong , Chen Bingkui , Liang Dong , Peng Changyan
Published: January 2017

This paper investigates the geometrical design principal of the spiral bevel gears with two contact paths from spatial conjugate curve theory. Differential geometry and gearing kinematics are introduced to derive this model. In this process, the calculation method of contact paths and tooth surface generating method are presented. According to the arguments in this paper, a process of designing the tooth surface of logarithmic spiral bevel gears with two contact paths is investigated. Then, through this process, the design of a pair of logarithmic spiral bevel gears with two contact paths is completed. Besides, the prototype is manufactured and the performance experiment is completed. Results show the maximum contact stress of spiral bevel gears with two contact paths is reduced compared to those with one contact path. Besides, the transmission efficiency of the spiral bevel gears with two contact paths can reach 98.2%.
Three-dimensional printed bone scaffolds: The role of nano/micro-hydroxyapatite particles on the adhesion and differentiation of human mesenchymal stem cells
Authors: Domingos Marco , Gloria Antonio , Coelho Jorge , Bartolo Paulo , Ciurana Joaquim
Published: January 2017

Bone tissue engineering is strongly dependent on the use of three-dimensional scaffolds that can act as templates to accommodate cells and support tissue ingrowth. Despite its wide application in tissue engineering research, polycaprolactone presents a very limited ability to induce adhesion, proliferation and osteogenic cell differentiation. To overcome some of these limitations, different calcium phosphates, such as hydroxyapatite and tricalcium phosphate, have been employed with relative success. This work investigates the influence of nano-hydroxyapatite and micro-hydroxyapatite (nHA and mHA, respectively) particles on the in vitro biomechanical performance of polycaprolactone/hydroxyapatite scaffolds. Morphological analysis performed with scanning electron microscopy allowed us to confirm the production of polycaprolactone/hydroxyapatite constructs with square interconnected pores of approximately 350 µm and to assess the distribution of hydroxyapatite particles within the polymer matrix. Compression mechanical tests showed an increase in polycaprolactone compressive modulus ( E) from 105.5 ± 11.2 to 138.8 ± 12.9 MPa (PCL_nHA) and 217.2 ± 21.8 MPa (PCL_mHA). In comparison to PCL_mHA scaffolds, the addition of nano-hydroxyapatite enhanced the adhesion and viability of human mesenchymal stem cells as confirmed by Alamar Blue assay. In addition, after 14 days of incubation, PCL_nHA scaffolds showed higher levels of alkaline phosphatase activity compared to polycaprolactone or PCL_mHA structures.
Deviation analysis for C1/2 pedicle screw placement using a three-dimensional printed drilling guide
Authors: Wu Xinghuo , Liu Rong , Yu Jie , Lu Lin , Yang Cao , Shao Zengwu , Ye Zhewei
Published: January 2017

Cervical transarticular fixation is a technically demanding procedure. This study aimed to develop a safer and more accurate method for C1/2 pedicle screw placement using a three-dimensional printed drilling guide. A total of 20 patients with C1/2 fractures and dislocations were recruited, and their computed tomography scans were evaluated. Under the assistance of the three-dimensional printed drilling guide, bilateral C1/2 pedicle screws were successfully placed in the three-dimensional C1/2 models. Then, sagittal and axial computed tomography scans were obtained, and the accuracy and safety of screw placement were evaluated based on X-Y-Z axis setup. The average depths for C1 and C2 pedicle screws were 30.1 ± 1.12 and 31.81 ± 0.85 mm on the left side and 29.54 ± 1.01 and 31.35 ± 0.27 mm on the right side, respectively. The average dimensional parameters for C1/C2 pedicle screw of both sides were measured and analyzed, which showed no statistically significant differences in the ideal and the actual entry points, inclined angles, and tailed angles. The method of developing a three-dimensional printed drilling guide is an easy and safe technique. This novel technique is applicable for C1/2 pedicle screw fixation; the potential use of the three-dimensional printed guide to place C1/2 pedicle screw is promising.