bluuebunny/crossref_metadata_2025 huggingface dataset:
Holding the Cards: Empowering Families Through an ASD Family Goal Setting Tool
Authors: Jones Judy , Rodger Sylvia , Walpole Anna , Bobir Natasha
Published: March 2018

Collaborative goal setting is recognized as a hallmark of good practice in early intervention (EI). This qualitative study describes mothers’ and practitioners’ perceptions of the utility of the Family Goal Setting Tool: Autism Spectrum Disorder Version (FGST: ASD Version), which supports family identification and prioritization of goals and collaborative engagement in goal setting meetings. Participants included nine mothers and 11 practitioners involved in an autism spectrum disorder–specific EI service in Australia. Participants were interviewed individually or in focus groups, with conversations transcribed verbatim. Inductive content analysis was employed. Four themes emerged with both mothers and practitioners, suggesting the tool facilitated (a) a comprehensive approach, (b) collaboration, (c) goal prioritization, and (d) reduction in stress of goal setting. Practitioners also described the tool as empowering families and enabling family-centered practice. Mothers and practitioners both reported positive impacts of using the FGST: ASD Version and recommended its continued use.
Histologic Changes Associated With Placental Separation in Gilts Infected with Porcine Reproductive and Respiratory Syndrome Virus
Authors: Novakovic Predrag , Detmer Susan E. , Suleman Muhammad , Malgarin Carol M. , MacPhee Daniel J. , Harding John C. S.
Published: March 2018

The placenta is a vital organ providing the developing fetus with nutrient and gas exchange, thermoregulation, and waste elimination necessary for fetal development, as well as producing hormones to maintain pregnancy. It is hypothesized that fetal pig death in porcine reproductive and respiratory syndrome may be attributed to pathology of the maternal-fetal interface leading to premature placental separation. This study was designed to evaluate the chronologic progression of porcine reproductive and respiratory syndrome virus (PRRSV)–induced lesions at the maternal-fetal interface, with particular focus on placental separation in experimentally challenged third-trimester gilts. Fifteen gilts were inoculated with a virulent strain of PRRSV-2 on gestation day 86 ± 0.4. On multiple days postinoculation, 3 gilts along with 1 sham-inoculated control per time point were euthanized, and uterine and fetal placental tissues corresponding to each fetus were collected for histopathologic evaluation. The presence of any fetal lesion was 23 times more likely in compromised (meconium-stained and decomposed) compared with viable fetuses ( P < .001). In PRRSV-infected gilts, endometritis was more severe than placentitis, and the severity of endometrial inflammation and vasculitis increased progressively from 2 to 14 days postinoculation. Neither placental vasculitis nor a chronologic progression in the severity of placental detachment was observed. Severe placental detachment was more frequently present in PRRSV-infected compared with noninfected samples and was most significantly associated with placental inflammation, compared with other uterine lesions, viral load, or termination day. The results of this study suggest that placental separation by itself is not sufficient to significantly compromise fetal viability in reproductive porcine reproductive and respiratory syndrome.
Molecular studies of CGRP and the CGRP family of peptides in the central nervous system
Authors: Hendrikse Erica R , Bower Rebekah L , Hay Debbie L , Walker Christopher S
Published: March 2018

Background

Calcitonin gene-related peptide is an important target for migraine and other painful neurovascular conditions. Understanding the normal biological functions of calcitonin gene-related peptide is critical to understand the mechanisms of calcitonin gene-related peptide-blocking therapies as well as engineering improvements to these medications. Calcitonin gene-related peptide is closely related to other peptides in the calcitonin gene-related peptide family of peptides, including amylin. Relatedness in peptide sequence and in receptor biology makes it difficult to tease apart the contributions that each peptide and receptor makes to physiological processes and to disorders.

The focus of this review is the expression of calcitonin gene-related peptide, related peptides and their receptors in the central nervous system. Calcitonin gene-related peptide is expressed throughout the nervous system, whereas amylin and adrenomedullin have only limited expression at discrete sites in the brain. The components of two receptors that respond to calcitonin gene-related peptide, the calcitonin gene-related peptide receptor (calcitonin receptor-like receptor with receptor activity-modifying protein 1) and the AMY1 receptor (calcitonin receptor with receptor activity-modifying protein 1), are expressed throughout the nervous system. Understanding expression of the peptides and their receptors lays the foundation for more deeply understanding their physiology, pathophysiology and therapeutic use.
The Living Experience of Suffering: A Parse Method Study
Authors: Hart Judith D.
Published: March 2018

The purpose of this study was to investigate the humanuniverse living experience of suffering. The Parse method was used to answer the question: What is the structure of the living experience of suffering? The participants were 10 adults living in the community. The finding of the study, the structure of the living experience of suffering, was found to be as follows: Suffering is anguishing desolation with varied alliances arising with envisioning anew. The living experience of suffering is discussed in relation to the principles of the humanbecoming paradigm and in relation to further research inquiries.
Transformation in Teaching-Learning: Emerging Possibilities with Interprofessional Education
Authors: Yancey Nan Russell , Cahill Susan , McDowell Michael
Published: March 2018

As the global community continues to face increasing mobility, rising healthcare costs, and decreasing or inaccessible healthcare resources, healthcare providers must be able to work together effectively in addressing the needs of progressively older and diverse persons and populations. In this column, the notion of interprofessional education (IPE) is explored and a model proposed for implementation in an institution offering graduate programs in nursing and occupational therapy. While the proposed model was developed for two disciplinary programs in a specific institution, the recommendations offered may easily be adapted for use in academic institutions offering varied and unique healthcare professional programs.
Transformative Research: A New Frontier for Nursing?
Authors: Poradzisz Michele , Florczak Kristine L.
Published: March 2018

In this column, the definition of transformational research is explored followed by a discussion of mixed methods as the preferred process for those who conduct such studies. Finally, there is consideration of why transformational research may be useful and a natural approach for the specific concerns of the profession of nursing.
Quantification of tool chatter and metal removal rate using wavelet denoising and statistical approach
Authors: Kumar Shailendra , Singh Bhagat
Published: March 2018

Tool chatter is an unavoidable phenomenon encountered in machining processes. Acquired raw chatter signals are contaminated with various types of ambient noises. Signal processing is an efficient technique to explore chatter as it eliminates unwanted background noise present in the raw signal. In this study, experimentally recorded raw chatter signals have been denoised using wavelet transform in order to eliminate the unwanted noise inclusions. Moreover, effect of machining parameters such as depth of cut ( d), feed rate ( f) and spindle speed ( N) on chatter severity and metal removal rate has been ascertained experimentally. Furthermore, in order to quantify the chatter severity, a new parameter called chatter index has been evaluated considering aforesaid denoised signals. A set of 15 experimental runs have been performed using Box–Behnken design of experiment. These experimental observations have been used to develop mathematical models for chatter index and metal removal rate considering response surface methodology. In order to check the statistical significance of control parameters, analysis of variance has been performed. Furthermore, more experiments are conducted and these results are compared with the theoretical ones in order to validate the developed response surface methodology model.
Effects of blade thickness on hydraulic performance and structural dynamic characteristics of high-power coolant pump at overload condition
Authors: Gu Yandong , Pei Ji , Yuan Shouqi , Xing Lei , Stephen Christopher , Zhang Fan , Wang Xiuli
Published: March 2018

As an indispensable equipment in thermal power plants, the high-power coolant pump is necessary for high hydraulic performance with good structural safety for transferring of heat produced by fuels. However, the design of blade thickness for coolant pump especially at the off-design condition is still empirical and arbitrary. In the present work, the hydraulic performance, internal flow pattern, and structural response arising from the variations of blade thickness in coolant pump have been investigated using computational fluid dynamics and fluid–structure interaction methods. The numerical results have been verified by experimental performance and found to be good. To improve the accuracy of head calculation at the overload condition, a modified equation is proposed with the help of multi-island genetic algorithm and the average deviation is reduced from 58.50 to 1.59%. With the blade thickening process, the hydraulic performance is gradually deteriorated especially at the overload condition, and the flow behavior is changed with the proportion of high velocity near the pressure surface enlarging, the proportion of low velocity near the suction surface decreasing, and the pressure fluctuation intensity rising. Besides, increasing the blade thickness beyond 23.0 mm, the stress reduction is not effective. However, it helps to increase the natural frequency for suppressing the resonance. Finally, considering the optimal hydraulic and structural performances, the blade thickness is optimized to 23.0 mm.
A Deeper Glimpse Into the National Core Arts Standards for General Music
Authors: Zaffini Erin Dineen
Published: March 2018

The National Core Arts Standards in general music provide some exciting possibilities for music growth and understanding among our students. For those of us who are still unsure of how to read the standards or implement them in our classrooms, the standards also present some challenges for music educators. This article provides a deeper look into the rationale behind the 2014 National Core Arts Standards for general music, as well as provides an explanation behind how to better understand them and ways to begin using them in the general music setting.
An Integrated Approach to Counseling Children Diagnosed With ADHD, ODD, and Chronic Stressors
Authors: Wofford Joseph Rufus , Ohrt Jonathan H.
Published: March 2018

Families in rural, low socioeconomic status areas are often underserved related to mental health services. Additionally, attention deficit hyperactive disorder (ADHD) and oppositional defiant disorder (ODD) are common comorbid concerns for children in these areas. Further, chronic stressors are typically present in the lives of children in such a setting when a parent loses custody of the child, and another family member takes on the parenting role. In this article, we (a) review information on the confluence of ADHD, ODD, and chronic stressors; (b) present an assimilative integrated approach using behavioral therapy as the foundational theory, supplemented by techniques from play therapy and structural family therapy; and (c) present a case example in which the approach was utilized.
The sliding of the signified: multimodal sign operations in a youth-created experimental digital video
Authors: Ranker Jason
Published: March 2018

In this article, the author presents a multimodal discourse analysis of a digital video composed by five students (ages 11–12) in an urban, public-school classroom. The focal mockumentary video is distinctive in that it is difficult to interpret and has an artistic quality that turns the process of meaning-making back on itself, resisting the very idea of a single, determinable meaning. He examines this phenomenon as the sliding of the signified in the students’ video (as multimodal discourse), focusing on the ways in which the students tapped into discursive agencies that rupture meaning-making. In particular, he analyzes how visual and spoken signifiers are related or coordinated with one another across the film in the creation of multimodal discursive effects such as floating signifiers, networks of metonymic potential, and signifier condensation complexes. This study thus offers conceptualizations of multimodal discursive units that can be used to interpret and analyze the interactions of visual and spoken signifiers in films and digital videos.
Health Marketing for the Massachusetts Childhood Obesity Research Demonstration Study: A Case Study
Authors: Criss Shaniece , Blaine Rachel E. , Palamé Megan , Perkins Meghan , Davison Kirsten , Kwass Jo-Ann , Taveras Elsie M. ,   The MA-CORD Study Team
Published: March 2018

Introduction. This case study describes the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) health marketing campaign, examines the strategies used in such campaigns, and offers lessons learned to improve health marketing for future interventions. MA-CORD Health Marketing Components and Implementation. The three main components were an outdoor printed advertisement and texting campaign, social media with a focus on Facebook, and the Summer Passport Program, an event-based initiative in parks for children. The advertisements consisted of billboards, bus advertisements, and handouts. The text messaging component, which required families to actively text a keyword to join, had a low opt-in rate. Facebook page “likes” increased from 1,024 to 1,453 in New Bedford and from 175 to 1,091 in Fitchburg. Fitchburg received technical assistance and paid for ads on Facebook. The Summer Passport participation in parks ranged from 120 to 875 children with participation in the free park lunch program doubling in Fitchburg. Discussion. Key lessons learned are engage communication experts from each community at the beginning of the project, use text messaging components with in-person staff onsite to assist participants in the opt-in process, build momentum for a Facebook presence through purchasing Facebook advertisements, and partner with local park departments for programming.
Mortality, Incarceration, and African American Disenfranchisement in the Contemporary United States
Authors: Cottrell David , Herron Michael C. , Rodriguez Javier M. , Smith Daniel A.
Published: March 2018

On account of poor living conditions, African Americans in the United States experience disproportionately high rates of mortality and incarceration compared with Whites. This has profoundly diminished the number of voting-eligible African Americans in the country, costing, as of 2010, approximately 3.9 million African American men and women the right to vote and amounting to a national African American disenfranchisement rate of 13.2%. Although many disenfranchised African Americans have been stripped of voting rights by laws targeting felons and ex-felons, the majority are literally “missing” from their communities due to premature death and incarceration. Leveraging variation in gender ratios across the United States, we show that missing African Americans are concentrated in the country’s Southeast and that African American disenfranchisement rates in some legislative districts lie between 20% and 40%. Despite the many successes of the Voting Rights Act and the civil rights movement, high levels of African American disenfranchisement remain a continuing feature of the American polity.
Small Donors in Congressional Elections
Authors: Culberson Tyler , McDonald Michael P. , Robbins Suzanne M.
Published: March 2018

Candidates raise substantial sums of money to compete in federal elections. Scholars and election observers are concerned by potential corruption related to the reliance on donors who make significant contributions. One reform effort to counterbalance large donors is encouraging small donor participation. Still, some worry that ideologically extreme candidates are best able to raise small donations. We analyze internal U.S. Federal Elections Commission data to examine small donor giving in the 2006 through 2010 U.S. House elections. We find small donors may expand the scope of participation, in that the supply of small donors is unrelated to income and that all types of candidates—incumbents, their challengers, and open seat candidates—are equally adept at attracting small donors. Candidates in the most competitive races raise the most in small contributions. We temper reformers’ enthusiasm, finding that ideologically extreme incumbents tend to raise more money from small donors.
Toward efficient dynamic virtual network embedding strategy for cloud networks
Authors: Nguyen Duc-Lam , Byun Hyungho , Kim Naeon , Kim Chong-Kwon
Published: March 2018

Network virtualization is one of the most promising technologies for future networking and considered as a critical information technology resource that connects distributed, virtualized cloud computing services and different components such as storage, servers, and application. Network virtualization allows multiple virtual networks to coexist on the same shared physical infrastructure simultaneously. One of crucial factors in network virtualization is virtual network embedding which provisions a method to allocate physical substrate resources to virtual network requests. In this article, we investigate virtual network embedding strategies and related issues for resource allocation of an Internet provider to efficiently embed virtual networks that are requested by virtual network operators who share the same infrastructure provided by the Internet provider. In order to achieve that goal, we design a heuristic virtual network embedding algorithm that simultaneously embeds virtual nodes and virtual links of each virtual network request onto the physic infrastructure. Via extensive simulations, we demonstrate that our proposed scheme significantly improves the performance of virtual network embedding by enhancing the long-term average revenue as well as acceptance ratio and resource utilization of virtual network requests compared to prior algorithms.
Constrained Agency Theory and Leadership: A New Perspective to Understand How Female Police Officers Overcome the Structural and Social Impediments to Promotion
Authors: Morabito Melissa S. , Shelley Tara O’Connor
Published: March 2018

Substantial research has examined both the barriers preventing women from entering and flourishing in policing and the coping mechanisms used to adapt to the gendered institution of policing. However, there is scant research that examines the mechanisms by which some women successfully navigate the police bureaucracy. Drawing from in-depth, semi-structured interviews of 47 female officers from 30 law enforcement agencies across seven states, we apply Constrained Agency Theory as a means to identify and understand how women capitalize on conditions and opportunities to advance and/or gain promotion in gendered organizations. The purpose of our research is to explore the efficacy of this theoretical framework for the study of women in policing. Results suggest that Constrained Agency Theory offers a promising way of understanding how female officers experience and utilize opportunities and conditions for advancement across a variety of agencies, generations, and organizational cultures.
Culture of Corrections: The Experiences of Women Correctional Officers
Authors: Burdett Freda , Gouliquer Lynne , Poulin Carmen
Published: March 2018

Based on 36 interviews with women correctional officers, we examined their everyday work experiences in the Ontario Provincial correctional system. We used the Psycho-Social Ethnography of the Commonplace methodology to determine challenges and complications women endure in this highly gendered, masculine-defined culture, and the resilience approaches they used to survive. Findings indicate how sexism, hostility, paternalism, and social alienation are maintained and reinforced. Women are repetitively, implicitly and explicitly reminded of their fragile femininity, physical inferiority, and lack of fit. Policy recommendations to contravene the Culture of Corrections’ androcentric nature, and those found in other nontraditional men-dominated work environments, are offered.
Fetal growth surveillance – Current guidelines, practices and challenges
Authors: Williams Mandy , Turner Sue , Butler Emily , Gardosi Jason
Published: March 2018

Antenatal surveillance of fetal growth is an essential part of good maternity care, as lack of detection of fetal growth restriction is directly associated with stillbirth and perinatal morbidity. New algorithms and guidelines provide care pathways which rely on regular third trimester ultrasound biometry and plotting of estimated fetal weight in pregnancies considered to be at increased risk, and their implementation has increased pressures on ultrasound resources. Customised growth charts have improved the distinction between constitutional and pathological smallness and reduced unnecessary referrals. Their introduction, together with clinicians' training, e-learning and audit as the key elements of the growth assessment protocol, has resulted in increased antenatal detection of small for gestational age babies and a reduction in avoidable stillbirths. However, missed case audits highlight that further improvements are needed, and point to the need to address quality assurance and resource issues in ultrasound services.
Alteplase for the treatment of acute ischemic stroke in patients with low National Institutes of Health Stroke Scale and not clearly disabling deficits (Potential of rtPA for Ischemic Strokes with Mild Symptoms PRISMS): Rationale and design
Authors: Yeatts Sharon D , Broderick Joseph P , Chatterjee Anjan , Jauch Edward C , Levine Steven R , Romano Jose G , Saver Jeffrey L , Vagal Achala , Purdon Barbara , Devenport Jenny , Khatri Pooja
Published: March 2018

Rationale

Over half of acute ischemic stroke patients have a low National Institutes of Health Stroke Scale of 0–5 and up to two-thirds may not appear clearly disabled at presentation. The efficacy of intravenous alteplase for the latter group is not known.

Aim

Potential of rtPA for Ischemic Strokes with Mild Symptoms (PRISMS) was designed to evaluate the safety and efficacy of intravenous alteplase for the treatment of acute ischemic stroke with National Institutes of Health Stroke Scale 0–5 and without clearly disabling deficits.

Sample size estimates

A maximum of 948 subjects were required to test the superiority hypothesis with 80% power, according to a one-sided 0.025 level of significance.

Methods and design

PRISMS was a multicenter, randomized, double-blind, placebo-controlled phase 3b clinical trial. Patients were randomized to the active arm (intravenous alteplase standard dose of 0.9 mg/kg, up to a maximum of 90 mg, plus oral aspirin placebo) or the control arm (intravenous alteplase placebo plus active oral aspirin dose of 325 mg).

Study outcome

The primary efficacy endpoint was favorable functional outcome, defined as a modified Rankin Scale score 0 or 1 assessed at 90-day postrandomization.
Optimal control of production with improvement
Authors: Tamura Nobuyuki
Published: March 2018

This article considers a process that produces items and in which the process mean is observed periodically. We use a state-space model to describe the relationship between the process mean and the quality characteristic of the items. At each observation, one of the following actions can be taken: production, repair, replacement, or improvement. When production is chosen, some number of items are produced. The quality characteristic of the items has a target value, and the quality loss is expressed by an asymmetric function of the deviation of the quality characteristic from the target value. Replacement resets the process mean to an initial value. When improvement is selected, the process mean is returned to the same initial value as in replacement. When improvement is repeated, it becomes less likely that the process mean will increase. There are several kinds of repairs, and each repair returns the process mean to some value greater than the initial value. For this model, we obtain a total expected discount cost for an unbounded horizon, and we show that under several reasonable assumptions, a control-limit policy is optimal. Furthermore, we derive the sufficient conditions to ensure that the optimal control policy has monotonic structures.
Successful management of multiple pregnancies in a family with varying severity of Von Willebrand disease
Authors: Harrington Patrick , Kyle Pippa , Cutler Jacky , Madan Bella
Published: March 2018

We present the obstetric history of a family of three sisters with Von Willebrand disease, managed in our centre over the course of nine successful pregnancies. The abnormalities result from inheritance of an exon 50 skipping mutation in the Von Willebrand factor gene, resulting from consanguinity. Two of the sisters were identified as having a severe phenotype with a Von Willebrand factor level of less than 5 IU/dl, with the other having a mild phenotype. Of the sisters with a severe phenotype, one had a number of prenatal complications and required early onset prophylaxis with Von Willebrand factor concentrate, whilst the other had a less complicated clinical course, only requiring Von Willebrand factor concentrate to cover labour. The sister with mild Von Willebrand disease had a rise in Von Willebrand factor levels during pregnancy and required no specialist treatment. The report highlights the markedly different clinical courses that can occur in patients with Von Willebrand disease and the different approaches to management.
N-terminal fraction of pro-B-type natriuretic peptide versus clinical risk scores for prognostic stratification in chronic systolic heart failure
Authors: Arzilli Chiara , Aimo Alberto , Vergaro Giuseppe , Ripoli Andrea , Senni Michele , Emdin Michele , Passino Claudio
Published: March 2018

Background

The Seattle heart failure model or the cardiac and comorbid conditions (3C-HF) scores may help define patient risk in heart failure. Direct comparisons between them or versus N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) have never been performed.

Methods

Data from consecutive patients with stable systolic heart failure and 3C-HF data were examined. A subgroup of patients had the Seattle heart failure model data available. The endpoints were one year all-cause or cardiovascular death.

Results

The population included 2023 patients, aged 68 ± 12 years, 75% were men. At the one year time-point, 198 deaths were recorded (10%), 124 of them (63%) from cardiovascular causes. While areas under the curve were not significantly different, NT-proBNP displayed better reclassification capability than the 3C-HF score for the prediction of one year all-cause and cardiovascular death. Adding NT-proBNP to the 3C-HF score resulted in a significant improvement in risk prediction. Among patients with Seattle heart failure model data available ( n = 798), the area under the curve values for all-cause and cardiovascular death were similar for the Seattle heart failure model score (0.790 and 0.820), NT-proBNP (0.783 and 0.803), and the 3C-HF score (0.770 and 0.800). The combination of the 3C-HF score and NT-proBNP displayed a similar prognostic performance to the Seattle heart failure model score for both endpoints. Adding NT-proBNP to the Seattle heart failure model score performed better than the Seattle heart failure model alone in terms of reclassification, but not discrimination.

Conclusions

Among systolic heart failure patients, NT-proBNP levels had better reclassification capability for all-cause and cardiovascular death than the 3C-HF score. The inclusion of NT-proBNP to the 3C-HF and Seattle heart failure model score resulted in significantly better risk stratification.
Adaptation to Vocal Expressions and Phonemes Is Intact in Autism Spectrum Disorder
Authors: Bestelmeyer Patricia E. G. , Williams Bethan , Lawton Jennifer J. , Stefanou Maria-Elena , Koldewyn Kami , Klein Christoph , Biscaldi Monica
Published: March 2018

Several recent studies have demonstrated reduced visual aftereffects, particularly to social stimuli, in autism spectrum disorder (ASD). This putative impairment of the adaptive mechanism in ASD has been put forward as a possible explanation for some of the core social problems experienced by children with ASD (e.g., facial emotion or identity recognition). We addressed this claim in children with ASD and typically developing children by using an established methodology and morphed auditory stimulus set for eliciting robust aftereffects to vocal expressions and phonemes. Although children with ASD were significantly worse at categorizing the vocal expressions compared with the control stimuli (phoneme categorization), aftereffect sizes in both tasks were identical in the two participant groups. Our finding suggests that the adaptation mechanism is not universally impaired in ASD and is therefore not an explanation for the social perception difficulties in ASD.
Volkswagen on the Touch-stone
Authors: Bhaskaran P. Bala , Bandyopadhyay Prabir Kumar
Published: March 2018

The case is structured around the Volkswagen (VW) fiasco wherein large number of cars sold by the company was found to violate the emission norms of EPA significantly. The case traces the origin and history of the firm. Then the case narrates accidental observation of the violation of the emission-norms and response of the firm to the situation. The case contrasts the responses of other firms in the industry who were affected by similar, albeit much smaller level, violation of emission-norms. The case explores the possible courses of punitive actions and the overall impact on each of the stakeholders. The case leaves the reader to explore the responsibilities of each stakeholder and the need to balance the expectations and impacts from the course of action that need to be followed.
Economic Freedom and Private Capital Inflows in Selected South Asian Economies: A Dynamic Panel Data Evidence
Authors: Ullah Assad , Anees Muhammad , Ali Zahid , Khan Muhammad Ayub
Published: March 2018

Greater inflows of private capital are regarded to be very beneficial for the economic development. This study explores the relationship between economic freedom and private capital inflows in selected South Asian economies. The study comprises of six South Asian countries (India, Pakistan, Bangladesh, Sri Lanka, Nepal and Maldives). Data from 2002 to 2011 have been utilized, and the model is estimated by employing the system generalized method of moments (GMM) approach. Empirical results reveal a significant positive relationship between economic freedom and private capital inflows. The study transpired that economic freedom is potent determinant of private capital inflows. The results further established that growth in market size and official development assistance has significant positive association with private capital inflows, whereas exchange rate exhibits significant negative relationship with the inflows of private capital, thereby confirming the existing literature. Moreover, the relationship among inflation, natural resources and private capital inflows came out to be inconclusive. To lure more inflows of private capital towards the region, management authorities need to ensure high degree of economic freedom. Creation of investment-friendly climate, corruption-free environment, tax breaks in selective sectors, removing trade barriers, equity market liberalization and consistency in the government policies is advisable in this regard.
Auricular reconstruction for microtia: A review of available methods
Authors: Baluch Narges , Nagata Satoru , Park Chul , Wilkes Gordon H , Reinisch John , Kasrai Leila , Fisher David
Published: March 2018

Several surgical techniques have been described for auricular reconstruction. Autologous reconstruction using costal cartilage is the most widely accepted technique of microtia repair. However, other techniques have certain indications and should be discussed with patients and families when planning for an auricular reconstruction. In the present review, the authors discuss the main surgical techniques for auricular reconstruction including autologous costal cartilage graft, Medpor (Stryker, USA) implant and prosthetic reconstruction. To further elaborate on the advantages and disadvantages of each technique, the authors invited leaders in this field, Dr Nagata, Dr Park, Dr Reinisch and Dr Wilkes, to comment on their own technique and provide examples of their methods.
Double free gracilis muscle transfer after complete brachial plexus injury: First Canadian experience
Authors: Elzinga Kate , Zuo Kevin J , Olson Jaret L , Morhart Michael , Babicki Sasha , Chan K Ming
Published: March 2018

Traumatic brachial plexus root avulsions are devastating injuries, and are complex and challenging to reconstruct. Double free muscle transfer using the gracilis muscles is a potentially effective method of restoring upper extremity function. The authors report on the first two patients treated using this technique in Canada. Both sustained traumatic brachial plexus root avulsion injuries resulting in a flail arm. In the first step of this two-stage procedure, a gracilis muscle was transferred to restore elbow flexion, and wrist and digit extension. Months later, the transfer of the second gracilis muscle was performed to enhance elbow flexion and to enable wrist and digit flexion. Postoperatively, both patients achieved Medical Research Council grade 4 elbow flexion, functional handgrip and were able to return to gainful employment. Patient satisfaction was high and active range of motion improved substantially. The authors' experience supports the use of this technique following severe brachial plexus injury.
Late unilateral hematoma after breast augmentation
Authors: Peters Walter , Fornasier Victor , Howarth David
Published: March 2018

Background

Late hematoma after breast augmentation is a rare phenomenon with unproven etiology.

Methods

Five patients presented with a late unilateral hematoma after receiving bilateral, submuscular, smooth, round, silicone gel implants for cosmetic breast augmentation. All patients underwent explantation and capsulectomy. Extensive clinical and histological analysis of all capsules was performed.

Results

All patients presented with progressive unilateral breast enlargement with at least a doubling of their breast size. Breast enlargement developed nine, 12, 14, 22 and 38 years, respectively, after initial implant insertion and in the absence of any known trauma. Patients presented for treatment one, three, four, nine and 12 months, respectively, after initially noticing breast enlargement. This enabled a sequential analysis of the events occurring on the surface of the capsule and within the structure of the capsule. Macroscopic and microscopic analysis of all capsules demonstrated multiple areas of recent and older hemorrhage, both within the structure of capsules and on the surface of the capsule. Continuing recurrent bouts of acute hemorrhage were observed even nine and 12 months after initial hematoma development. The position of medium-size vessels within the capsules corresponded to the sites of recurrent bleeding within capsules.

Conclusions

Late hematomas presented from nine to 38 years after submuscular breast augmentation with a doubling of breast size. Late hematomas appeared to result from multiple recurrent bouts of bleeding within the structure of the capsules. This leads to recurrent bleeding on the surface of the capsules. Breast enlargement develops progressively over time rather than acutely. Continuing acute hemorrhage persisted up to one year after initial hematoma development. This progression suggests a process analogous to a chronic expanding hematoma that has been described in other areas of the body. Failure to remove a capsule could result in long-term continuing bleeding from vessels within the capsule.
Porous high-density polyethylene in functional rhinoplasty: Excellent long-term aesthetic results and safety
Authors: Kim Young Hyo , Jang Tae Young
Published: March 2018

Background

Experience with the use of porous high-density polyethylene (PHDPE) for reconstruction of the nasal framework has been limited.

Objective

To confirm the safety and utility of PHDPE by analyzing aesthetic outcomes and assessing the frequency of complication related to PHDPE in a large, population-based, long-term follow-up study.

Methods

A total of 151 patients who had undergone septoplasty and/or functional rhinoplasty using PHDPE were enrolled. PHDPE sheets were used for diverse purposes such as septal extension graft, spreader graft, columellar strut or dorsal augmentation graft. After a long-term follow-up period (mean [± SD] 39.5±27.8 months; range six to 101 months), postoperative aesthetic outcome was evaluated objectively (by independent surgeons) and subjectively (patient self-report). Complications related to PHDPE were estimated through review of medical records.

Results

The most common use of the PHDPE graft was for septal extension (n=80 [42.6%]) and spreader graft (n=58 [30.9%]). Results of aesthetic evaluation by surgeons were excellent in 61 cases (40.4%), good in 54 (35.8%) and fair in 34 (22.5%). According to patient self-report, 100 were ‘satisfied’ (66.2%) and 36 rated their new profile as ‘better than the preoperative profile’ (23.8%). Complications were reported in six cases (4.0% [five cases of extrusion and one case of infection]). All complications were resolved after the surgical removal of PHDPE sheets under local anesthesia.

Conclusion

The present study demonstrated that PHDPE could be used in functional primary rhinoplasty with excellent long-term aesthetic results and safety.
Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline
Authors: Shea-Budgell Melissa , Quan May Lynn , Mehling Blair , Temple-Oberle Claire
Published: March 2018

The side effects of mastectomy can be significant. Breast reconstruction may alleviate some distress; however, there are currently no provincial recommendations regarding the integration of reconstruction with breast cancer therapy. The purpose of the present article is to provide evidence-based strategies for the management of patients who are candidates for reconstruction. A systematic review of meta-analyses, guidelines, clinical trials and comparative studies published between 1980 and 2013 was conducted using the PubMed and EMBASE databases. Reference lists of publications were manually searched for additional literature. The National Guidelines Clearinghouse and SAGE directory, as well as guideline developers' websites, were also searched. Recommendations were developed based on the available evidence. Reconstruction consultation should be made available for patients undergoing mastectomy. Tumour characteristics, cancer therapy, patient comorbidities, body habitus and smoking history may affect reconstruction outcomes. Although immediate reconstruction should be considered whenever possible, delayed reconstruction is acceptable when immediate is not available or appropriate. The integration of reconstruction and postmastectomy radiotherapy should be addressed in a multidisciplinary setting. The decision as to which type of procedure to perform (autologous or alloplastic with or without acellular dermal matrices) should be left to the discretion of the surgeons and the patient after providing counselling. Skin-sparing mastectomy is safe and appropriate. Nipple-sparing is generally not recommended for patients with malignancy, but could be considered for carefully selected patients. Immediate reconstruction requires resources to coordinate operating room time between the general and plastic surgeons, to provide supplies including acellular dermal matrices, and to develop the infrastructure needed to facilitate multidisciplinary discussions.
Long-term follow-up of unoperated, nonscissoring spiral metacarpal fractures
Authors: Macdonald Brittany B , Higgins Amanda , Kean Susan , Smith Carolyn , Lalonde Donald H
Published: March 2018

Background

Spiral metacarpal fractures can result in shortening of the metacarpal shaft, which may lead to extension lag at the metacarpophalangeal joint and reduced grip strength. These fractures have been surgically treated to restore metacarpal length; however, there are complications associated with surgery, postoperative management and wound healing, which further threaten power recovery in the hand.

Objective

To determine the effect of conservative management of unoperated, nonscissoring spiral metacarpal fractures.

Methods

Sixty-one consecutive patients presenting with nonscissoring spiral metacarpal fractures were treated nonoperatively and studied prospectively to determine the natural history of their power outcome. Thumb fractures and those requiring surgical intervention for scissoring were excluded.

Results

Follow-up data of a minimum of five months (mean follow-up 87 weeks) were available for 13 patients. Mean grip strength at final follow-up was 36.18 kg on the uninjured side and 36.58 kg on the injured side. The strength-difference values did not differ significantly from zero (P=0.72).

Conclusion

The loss of metacarpal length associated with these fractures may not cause a power deficit sufficiently large to significantly affect grip strength and functional recovery in the hand. A prospective randomized controlled trial of operated versus unoperated, nonscissoring metacarpal fractures is warranted.
Propranolol therapy for infantile hemangioma is less toxic but longer in duration than corticosteroid therapy
Authors: Sawa Kathryn , Yazdani Arjang , Rieder Michael J , Filler Guido
Published: March 2018

Background

Infantile hemangioma is the most common benign, self-limiting tumour of childhood. Treatment is reserved for hemangiomas that obstruct vital structures or cause significant disfigurement. Traditionally, corticosteroids have been the medical treatment of choice. Since 2008, however, propranolol has been rapidly adopted as an effective pharmacological treatment for infantile hemangioma. Published data regarding the long-term side effects of propranolol are currently lacking.

Objective

To describe the long-term effects of propranolol and corticosteroids on anthropometric measurements (height, body mass index [BMI]) and blood pressure in children.

Methods

A prospective database analysis of all infantile hemangioma patient visits to the pediatric vascular abnormality clinic at the authors' institution between October 2007 and February 2012 was performed. Anthropometric measures (height and BMI) and blood pressure were analyzed.

Results

A total of 290 visits (119 patients) to the pediatric vascular abnormality clinic were reviewed. Of these, 18 patients received medical treatment and their anthropometry was analyzed. BMI percentile increased significantly in patients treated with corticosteroids (P=0.0039). Corticosteroid treatment also resulted in a significant decrease in height percentile (P=0.0078). Anthropometric measures did not cross percentiles in children treated with propranolol. A significant decrease in systolic blood pressure was noted in the propranolol group (P=0.03), but no hypotensive values were recorded. Median treatment duration was significantly longer when patients received propranolol (372 versus 133 days; P=0.0033).

Conclusion

Propranolol for the treatment of infantile vascular abnormalities does not share the unfavourable effects on patient anthropometry that corticosteroids exhibit; however, a longer duration of therapy is required.
Update on anaplastic large cell lymphoma in women with breast implants
Authors: Peters Walter
Published: March 2018

Since 1997, reports from the scientific community have suggested a possible association, without causation, between breast implants and anaplastic large cell lymphoma (ALCL). Analysis of these patients has been challenging. Many studies have been under-reported while others have been duplicated. In 2011, a United States Food & Drug Administration (FDA) ‘white paper’ analyzed 34 of the 60 cases reported worldwide. All 34 patients had undergone secondary surgery for breast swelling, firmness or pain. ALCL was an incidental finding. Diagnosis of ALCL is made by hematoxylin and eosin histology and immunochemistry for the CD30 marker. ALCL occurred with all types of implants. Subsequent studies have suggested that textured implants may have a greater risk. In all cases, ALCL cells were found in the capsule, in the seroma or within a mass adjacent to the implant. There was no invasion of cells beyond the capsule into the breast parenchyma. From the FDA study, the risk of developing ALCL after receiving implants appears to be approximately one in one million per year. All cases appear to be negative for the anaplastic lymphoma kinase marker. ALCL in most of these patients may represent a new entity with less aggressive behaviour. In most patients with capsule-confined disease, proper management may prove to be implant removal and capsulectomy. Patients with a distinct mass adjacent to their implant may have a more aggressive clinical course that may become systemic. They may require chemotherapy in addition to implant removal and capsulectomy. All cases of ALCL should be referred to an appropriate specialist and reported to the FDA.
The Le Fort system revisited: Trauma velocity predicts the path of Le Fort I fractures through the lateral buttress
Authors: Roumeliotis Grayson , Ahluwalia Romy , Jenkyn Thomas , Yazdani Arjang
Published: March 2018

Objective

To examine the effect of trauma velocity on the pattern of Le Fort I facial fractures.

Method

A retrospective medical record review was conducted on a consecutive cohort of craniofacial traumas surgically treated by a single surgeon between 2007 and 2011 (n=150). Of these cases, 39 Le Fort fractures were identified. Patient demographic information, method of trauma and velocity of impact were reviewed for these cases. Velocity of impact was expressed categorically as either ‘high’ or ‘low’: high-velocity fractures were those caused by a fall from >1 story or a motor vehicle collision; low-velocity fractures were the result of assaults with a blunt weapon, closed fist or falls from standing height. The vertical position of each fracture was measured at its point of entry on the lateral buttress and its point of exit on the piriform aperture. To allow for comparison across individuals, values were expressed as ratios based on their location on the face relative to these landmarks. A Wilcoxon rank-sum test was used to compare the fracture heights caused by high- and low-velocity trauma.

Results

The results revealed that high-velocity traumas to the face create Le Fort I fractures at a higher point in the lateral buttress compared with low-velocity traumas. There was no difference between heights at the piriform aperture.

Conclusion

High-velocity trauma resulted in higher Le Fort I fracture patterns compared with low-velocity trauma.