bluuebunny/crossref_metadata_2025 huggingface dataset:
The Rhetoric of Social and Political Values
Authors: Roisman Joseph
Published: January 2019

Chapter 18 examines Demosthenes’ rhetorical references to social and political values in classical Athens. The Athenians’ belief in the merits of their political system was accompanied by an anxiety that it was in danger from internal enemies. Both of these perceptions were utilized by Demosthenes to portray his legal and political adversaries as foes and potential destroyers of democracy and its values. He thus characterizes democracy as a bastion of morality. In his speeches Demosthenes attributes to men active in public life multiple violations of democratic values or tenets. The chapter also considers the Athenians’ pursuit and preservation of honour as well as the avoidance of shame, the duties of the Athenian citizens and jurors in upholding the laws and providing justice, and the Athenians’ views on the private vs. public spheres.
City and Countryside
Authors: Osborne Robin
Published: January 2019

Chapter 22 examines how the city and countryside are represented in Demosthenes and other Attic orators. In a court of law, the plausibility of a story will often be contingent on the physical setting, and a speaker is expected to persuade the jury to accept his version by having them visualize where events took place. Demosthenes, even when speaking in the courts, seldom depicts action in a specific rural or urban environment. To understand why, the chapter first considers what Athenian forensic oratory generally has to offer by way of descriptions of physical settings. It then analyses the rhetorical and political reasons why the Attic orators in general, and Demosthenes in particular, provide little detailed information about the physical world in which they lived. Finally, it discusses the implications of the reticence by Demosthenes and other orators to talk about local city or country life.
Family, Formation, Extra-Political Activities
Authors: Samotta Iris
Published: January 2019

Chapter 24 examines the first three decades of Demosthenes’ life, focusing on his family and personal life, his upbringing, and the lawsuits against his guardians. Although born into a privileged family, his guardians’ neglect and scheming out of greed left Demosthenes at the mercy of other family members. It took Demosthenes several years and a large amount of stubbornness and determination to prosecute his former guardians. The chapter considers how Demosthenes’ lawsuits against his former guardians played an important role not only in securing him at least parts of his inheritance but also in laying the foundation to his prominence in Athenian society. It shows that Demosthenes’ success in the courtroom led to a professional career as a logographer, which in turn earned him the means to enter the political arena as a gifted and ambitious rhêtôr.
Rhetorical Technique
Authors: Wooten Cecil W.
Published: January 2019

Chapter 31 examines Demosthenes’ rhetorical technique. Most ancient rhetorical theorists, both Greek and Roman, considered Demosthenes to be the best of the ancient orators. As a result, much of their scholarly inquiry was focused on determining what made Demosthenes’ oratory so effective. Given the enormous emphasis on style in ancient rhetorical theory, many critics unsurprisingly viewed Demosthenes’ stylistic virtuosity, particularly his versatility, as the main reason for his success and the hallmark of his oratory. The article discusses the theoretical analyses of Demosthenes’ oratorical style by Cicero, Dionysius of Halicarnassus, and Hermogenes. It also explores the shape of Demosthenes’ speeches and sentences, along with his argumentation (logical, emotional, and ethical).
The Long Shadow of Nigeria’s Military Epochs, 1966–79 and 1983–99
Authors: Osaghae Eghosa
Published: January 2019

Nigeria was a paradigmatic case of military rule that was a defining feature of politics in developing countries between the 1960s and early 1990s. Military rule in Nigeria was symptomatic of state fragility, which provided grounds for coups and self-appointed corrective agendas of successive military governments. Attempts to address fundamental issues of political accommodation and economic development, and enhance the overall promise and potential of military rule were hampered by three major factors. These were the authoritarian and hyper-centralist character of military regimes, partisan character of coups and governments (which led to civil war in 1967–70), and regime-prolongation and self-succession ambitions of military rulers. This chapter discusses the intricacies of military intervention, the nature and legacies of military regime, how they manifested under the different governments, and how and why the changes introduced by them had epochal effects on the country.
Elections and Electoral Performance
Authors: Orji Nkwachukwu
Published: January 2019

A crucial aspect of Nigeria’s political development involves imbibing, nurturing, and sustaining the political institutions and practices it inherited after its independence in 1960. Elections are one of the most important political practices handed down to Nigeria by the British colonialists. This chapter examines the issues and forces that shape efforts to foster the institutions and practice of elections in Nigeria. Based on a survey of elections in Nigeria, the chapter notes that the country’s electoral process is essentially unstable; it then explains why Nigerian elections are volatile, and reviews measures taken to reform the electoral process in Nigeria.
Sharia Politics, the 1999 Constitution, and the Rise of the Fourth Republic
Authors: Vaughan Olufemi
Published: January 2019

Analyzed in the context of the protracted sharia crisis that dominated Nigeria’s fourth attempt at civil democratic government (the Fourth Republic), this chapter provides historical, political, and constitutional context for the challenges posed by expanded sharia to modern governance in Nigeria. Drawing on a distinctive interdisciplinary perspective that engages entrenched traditional structures in Muslim Northern Nigeria, the chapter underscores the challenges of modern governance in this critical region of the country. Specifically, the chapter discusses how the expanded sharia policies of twelve northern Nigerian Muslim states are not only embedded in Islamic structures, practices, doctrines, and discourse in the region, but also reflect fierce contestations for state power among Nigeria’s ethno-regional political classes. Finally, the chapter analyzes the implications of expanded sharia for Nigeria’s modern constitutional development that seek to advance liberal traditions such as civil rights, state rights, freedom of religion, and secularism.
Nigeria’s Response to the HIV Epidemic
Authors: Adeyi Olusoji , Odutolu Ayodeji O. , Idoko John , Kanki Phyllis
Published: January 2019

Nigeria bears one of the largest burdens of HIV infection in the world. Key features of the country’s response to the HIV/AIDS epidemic illustrate the experiences of many low- and middle-income countries. The country’s response is the result of an interplay of policy and political commitment, the work of professionals from multiple disciplines, cross-sectoral programming, and financing from domestic government budgets, household expenditures, and development partners. Sustained progress in Nigeria’s response to HIV/AIDS requires improvements in the effective coverage of services along the spectrum of prevention, treatment, care, and support for those infected. These will also benefit from an effective health system in the context of Universal Health Coverage. Achieving sustainable financing remains a key challenge.
Crime, Cults, and Informal Security
Authors: Okenyodo Kemi
Published: January 2019

This chapter looks at the evolution of informal security actors in Nigeria, their scope of operations, and how they seem to be changing the face of the security architecture in the country. Key changes include: the expanding space of operations in view of new insecurity challenges and ineffective responses to the security needs of the people by the formal security actors; a syncretic relationship between the formal and the informal security actors within the country’s security framework; and the political implications of informal groups for security sector reform, decentralization, and other possible ways forward. The chapter takes a critical look at informal policing actors in the different parts of the country (specifically at their mode of recruitment, funding sources, mode of operations, and gender representation), and the opportunities that exist for them going forward in the national security architecture.
Pastoralism, Ethnicity, and Subnational Conflict Resolution in the Middle Belt
Authors: Thaut Vinson Laura
Published: January 2019

This chapter explores the problem of rising pastoralist–farmer and ethnic (religious and tribal) violence in the pluralistic Middle Belt region of Nigeria over the past thirty to forty years. In particular, it highlights the underlying issues and conflicts associated with these different categories of communal intergroup violence, the human and material costs of such conflict, and the broader implications for the Nigerian state. The federal government, states, local governments. and communities have not been passive in addressing the considerable challenges associated with preventing and resolving such conflicts. It is clear, however, that they face significant hurdles in resolving the underlying grievances and drivers of conflict, and their efforts have not always furthered the cause of conflict resolution and peacebuilding. Greater attention to patterns of inclusion and exclusion and to the allocation of rights and resources will be necessary, particularly at the state and local government levels, to create a more stable and peaceful Middle Belt.
The Pathology of Dependency
Authors: Taylor Ian
Published: January 2019

China’s relations with Nigeria have accelerated since the 2000s, which is linked to the rise of China as a global player, its exponential economic growth and its consumption of raw materials. The material foundations upon which links have been built with China have served to reify Nigeria’s dependent position in the global economy and bear the hallmarks of an unbalanced and exploitative relationship. This fact is now recognized by many Nigerian commentators within civil society and the policymaking elites. The structural nature of Nigeria’s dependent relations with China is becoming more apparent: its trade profile with China is characterized by a lopsided dependence on the export of raw materials, and the import of manufactured goods. Since independence, the ruling cliques within Nigeria have overseen a progressive deepening of dependency on mineral products, resulting in oil and gas becoming the be-all and end-all of Nigerian economic (and thus political) life.
Women’s Protests in the Struggle for Independence
Authors: Nwankwor Chiedo
Published: January 2019

Women in precolonial Nigeria had a rich associational history, which provided a mobilizational platform for making and securing their demands during colonial rule. While patriarchal cultural practices and hierarchies imposed certain limitations on women relative to men, women nevertheless reached high political power and wielded significant influence in society. Relegated, however, by the subsequent colonial restructuring of indigenous social order and economically exploited by the pursuit of its economic imperative of benefit maximization, women protested their subjection using traditional associations and strategies of resistance and protest. This chapter argues that women’s critical role in national independence remains underappreciated and understudied until recently. Moreover, whereas women’s anticolonial protests and mobilization contributed significantly to the nationalist struggle, the gains of independence, which they jointly secured with men, continue to elude them. As such, women’s struggle for independence has continued against the postcolonial state’s instrumentalization of women’s oppression for power maintenance by rulers.
Nigeria and the Commonwealth
Authors: Donnelly Elizabeth , Neville Daragh
Published: January 2019

This chapter examines the trajectory of Nigeria’s engagement with the Commonwealth since independence, and how domestic politics and pressures, foreign policy priorities, and shifting international politics have shaped Nigeria’s influence through the Commonwealth, and how the Commonwealth in turn has influenced Nigeria. It argues that Nigeria’s ability to be strategic in its engagement as a key member state has been stymied by governance challenges at home and increasing competition from other African states as they have made gains in development and democracy. Yet Nigeria retains prominence and influence through the involvement of key individuals in the work of the Commonwealth, and since its return to civilian rule in 1999 and re-entry into the Commonwealth after its four-year suspension, has aligned with Commonwealth principles.
The Nigerian Novel and the Anticolonial Imagination
Authors: Iheka Cajetan
Published: January 2019

This chapter focuses on two Nigerian narratives, namely Chinua Achebe’s Arrow of God and Flora Nwapa’s Efuru. If the success of the colonial event was premised not only on military incursions but also on the repudiation and elision of African precolonial cultural systems, it makes sense that cultural texts would play a key role in the project of decolonization. This chapter argues that while Achebe’s text foregrounds the epistemic violence of the colonial edifice and the patriarchy of the indigenous communities, Nwapa’s work rewrites the anticolonial text by foregrounding the female script and linking the experience of women to the exploitation of the colonies.
Optimality Theory and Prosodic Morphology
Authors: Downing Laura J.
Published: January 2019

A central concern of Optimality Theory (OT) from its beginnings (McCarthy & Prince 1993a, Prince & Smolensky 1993/2004) has been to provide a coherent framework for formalizing solutions to the traditional problems posed by prosodic morphological constructions for the concatenative principles assumed by most morphological theories. This chapter surveys analyses of constructions such as reduplication, root-and-pattern morphology, truncation, and infixation in both ‘classic’ OT and alternative OT approaches. The aim of the chapter is to show how OT has brought a fresh perspective to the analysis of prosodic morphology constructions by providing a formalism that allows prosodic constraints to interact with morphological concatenative principles in a well-defined way. The chapter concludes with discussion of open issues in the OT approach to prosodic morphology.
A Short History of Morphological Theory
Authors: Anderson Stephen R.
Published: January 2019

The original distinction, in the opposing views of René and Ferdinand de Saussure, between views of word structure based on the combination of elementary, atomic signs (or ‘morphemes’) on the one hand and relations between complex words on the other, is reviewed. Early work in American linguistics associated with Boas and Sapir is noted, and the later emergence of clearly morpheme-based views in the Bloomfieldian tradition (especially as continued by Harris, Hockett, and others) is reviewed. This picture was essentially taken over unchanged in early generative grammar, although Chomsky (1965) provided (now forgotten) arguments in favor of an alternate non-morphemic view. The re-emergence of interest in morphology in later work has led to a situation in which the two views that can be identified originally in the work of the de Saussure brothers continue to characterize two conflicting scholarly positions.
Morphological Theory and Neurolinguistics
Authors: Schiller Niels O. , Verdonschot Rinus G.
Published: January 2019

This chapter describes neurolinguistic aspects of morphology, morphological theory, and especially morphological processing. It briefly mentions the main processing models in the literature and how they deal with morphological issues, i.e. full-listing models (all morphologically related words are listed separately in the lexicon and are processed individually), full-parsing or decompositional models (morphologically related words are not listed in the lexicon but are decomposed into their constituent morphemes, each of which is listed in the lexicon), and hybrid, so-called dual route, models (regular morphologically related words are decomposed, irregular words are listed). The chapter also summarizes some important findings from the literature that bear on neurolinguistic aspects of morphological processing, from both language comprehension and language production, taking into consideration neuropsychological patient studies as well as studies employing neuroimaging methods.
A Conflicted Tale of Two Novel AR Antagonists In Vitro and In Vivo: Pyrifluquinazon Versus Bisphenol C
Authors: Gray Leon Earl , Furr Johnathan R , Conley Justin M , Lambright Christy S , Evans Nicola , Cardon Mary C , Wilson Vickie S , Foster Paul M , Hartig Phillip C
Published: January 2019

Chemicals that disrupt androgen receptor (AR) function in utero induce a cascade of adverse effects in male rats including reduced anogenital distance, retained nipples, and reproductive tract malformations. The objective of this study was to compare the in vitro and in utero activities of two novel AR antagonists, bisphenol C (BPC) and pyrifluquinazon (PFQ). In vitro, BPC was as potent an AR antagonist as hydroxyflutamide. Furthermore, BPC inhibited fetal testis testosterone production and testis gene expression ex vivo. However, when BPC was administered at 100 and 200 mg/kg/d in utero, the reproductive tract of the male offspring was minimally affected. None of the males displayed reproductive malformations. For comparison, in utero administration of flutamide has been shown to induce malformations in 100% of males at 6 mg/kg/d. In vitro, PFQ was several orders of magnitude less potent than BPC, vinclozolin, or procymidone. However, in utero administration of 12.5, 25, 50, and 100 mg PFQ/kg/d on GD 14–18 induced antiandrogenic effects at all dosage levels and 91% of the males displayed reproductive malformation in the high dose group. Overall, BPC was ∼380-fold more potent than PFQ in vitro, whereas PFQ was far more potent than BPC in utero. Incorporating toxicokinetic and toxicodynamic data into in vitro to in vivo extrapolations would reduce the discordance between the in vitro and in utero effects of PFQ and BPC and combining in vitro results with a short-term Hershberger assay would reduce the uncertainty in predicting the in utero effects of antiandrogenic chemicals.
Supraphysiological Concentrations of Bisphenol A Alter the Expression of Extracellular Vesicle-Enriched miRNAs From Human Primary Granulosa Cells
Authors: Rodosthenous Rodosthenis S , Baccarelli Andrea A , Mansour Abdallah , Adir Michal , Israel Ariel , Racowsky Catherine , Hauser Russ , Bollati Valentina , Machtinger Ronit
Published: January 2019

Bisphenol A (BPA) is a widely used chemical that has been detected in follicular fluid and associated with adverse reproductive effects. Granulosa cells have an important role in follicular growth and oocyte maturation, however, little is known about the biological mechanisms of BPA toxicity on human granulosa cells. In this study, we exposed primary granulosa cells to different concentrations of BPA (0, 20, 200, 2000, and 20 000 ng/ml) and used quantitative polymerase chain reaction to measure the expression levels of miRNAs enriched in extracellular vesicles (EV-enriched miRNAs), and cellular levels of selected target genes of differentially expressed EV-enriched miRNAs. We found that exposure to 20 000 ng/ml BPA was associated with decreased levels of EV-miR-27b-3p (FC = 0.58, p = .04) and increased levels of its biologically relevant target genes FADD (FC = 1.22, p = .01), IGF1 (FC = 1.59, p = .06), and PPARG (FC = 1.73, p = .001) as compared with the control. In addition, we observed that under the same exposure conditions, the expression levels of miR-27b-3p in granulosa cells were also downregulated (FC = 0.65, p = .03) as compared with the control. Our findings suggest that both cellular and extracellular changes in gene expression may mediate BPA toxicity in granulosa cells.
Effect of Surgical Trainee Presence on Vaginal Hysterectomy Outcomes
Authors: Rajakumar Chandrew , Mallick Ranjeeta , Posner Glenn , Schramm David , Singh Sukhbir S. , Lortie Karine , Pascali Dante , Chen Innie
Published: January 2019

(Abstracted from J Minim Invasive Gynecol 2018;25:1088–1093)

Definitive relief from several disease states that burden women can be provided by hysterectomy. This procedure can be performed via vaginal, laparoscopic, robotic, transabdominal, or combined approaches.
Women's Preferences for Permanent Contraception Method and Willingness to Be Randomized for a Hypothetical Trial
Authors: Piazza Adriana , Schwirian Kelly , Scott Fiona , Wilson Machelle D. , Zite Nikki B. , Creinin Mitchell D.
Published: January 2019

(Abstracted from Contraception 2019;99:56–60

More than 20% of women in the United States use female permanent contraception to prevent pregnancy. Surgical options for women who desire permanent contraception include tubal occlusion, partial or total salpingectomy, or transcervical sterilization.
Safe Transportation in-Spica Following Surgical Treatment of Infantile DDH: Solutions and Threats
Authors: Adams Alexander J. , Johnson Mitchell A. , Ryan Kelly A. , Farrell Sharon B. , Morro Meg , Sankar Wudbhav N.
Published: January 2019

Background:

Government regulations mandate appropriate vehicular restraints for children under 4 years of age. Patients treated for infantile developmental dysplasia of the hip (DDH) with spica casts often require special accommodations. Previous work suggests that car seat loaner programs may help achieve these goals while avoiding the need for costly ambulance transportation. The purpose of this study was to evaluate our center’s experience with postdischarge transportation in a large population of DDH infants and identify future threats to our program.

Methods:

We performed a retrospective review of patients 4 years or younger of age who underwent closed or open reduction for DDH at our center between 2011 and 2018. Only the initial surgery of staged procedures was included. Patient demographic factors were recorded, as were procedure type, final restraint used for postdischarge transportation, and any potential discharge delays secondary to transportation issues. Costs were compared amongst transportation options.

Results:

Our cohort consisted of 130 patients (mean age, 1.4±0.9 y; 98 females) treated for DDH. In total 41 children (31.5%) underwent closed reduction procedures, whereas 89 patients (68.5%) underwent open reductions. After reduction, 62 (47.7%) received 2-legged spica casts and 68 (52.3%) received 1.5-legged casts. The most common restraint was a hospital-loaned Hippo car seat (73, 55.8%) followed by family-owned car seats (27, 20.8%). Eight patients (6.2%) experienced delays in discharge while waiting for adequate restraints, 6 patients (4.6%) were transported by ambulance, and 4 patients (3.1%) left against medical advice with inadequate restraints.

Conclusions:

Following surgical treatment of DDH, over 50% of patients with a spica cast were discharged using our center’s car seat loaner program. However, availability and cost can present barriers for patients, with 4.6% of patients still being transported home by ambulance and 3.1% with inadequate restraints against medical advice. Costs of car seats are significant both for patients’ families intending to purchase them, as well as for hospitals maintaining loaner programs and replacing used/lost seats. Moving forward, the recent cessation of production of the most common “spica car seat” threatens the longevity of existing loaner programs and calls renewed attention to the issue of safe transportation in-spica from providers and car-seat manufacturers alike.

Level of Evidence:

Level III.
Suture Anchor Repair of Avulsed Adductor Pollicis Injury, Secondary to Motor Vehicle Collision: Case Report and Technique
Authors: Wait Eric , Suryavanshi Joash R. , MacKay Brendan J.
Published: January 2019

The thenar eminence of the thumb is made up of 4 intrinsic muscles: abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, and the adductor pollicis (ADD). While both heads of the ADD insert on the medial base of the thumb proximal phalanx, the oblique head originates on the capitate and second and third metacarpals, and the transverse head originates on the distal half of the third metacarpal. We present the case of a 36-year-old man who was involved in a motor vehicle collision and sustained a laceration in the first webspace with 1 cm extrusion of the ADD and no neurovascular deficiencies on examination. X-ray imaging noted no bony abnormalities. The only identifiable injury was to the ADD muscle which was avulsed from its origin and was extruded through the open wound in the first webspace. A double-row running locking 3-0 fiberwire suture technique was used to have a solid anchor point with which to secure the muscle to its origin. It was secured to the second metacarpal with Mitek mini suture anchors that was sutured on the opposing side of the double-row fiberwire suture and anchored to the second metacarpal proximally and distally in the metacarpal. We report good clinical outcomes postoperative, with intact range of motion and no surgical complication at the 6-month follow-up visit. The patient has ongoing physical therapy to reduce any residual strength deficits.
Nurse Documentation of Sexual Orientation and Gender Identity in Home Healthcare
Authors: Bjarnadottir Ragnhildur I. , Bockting Walter , Yoon Sunmoo , Dowding Dawn W.
Published: January 2019

Health disparities have been documented in the lesbian, gay, bisexual, and transgender population, but more research is needed to better understand how to address them. To that end, this observational study examined what is documented about sexual orientation and gender identity in narrative home care nurses' notes in an electronic health record. Lexical text mining approaches were used to examine a total of 862 715 clinical notes from 20 447 unique patients who received services from a large home care agency in Manhattan, New York, and extracted notes were qualitatively reviewed to build a lexicon of terms for use in future research. Forty-two notes, representing 35 unique patients, were identified as containing documentation of the patient's sexual orientation or gender identity. Documentation of sexual orientation or gender identity was relatively infrequent, compared to the estimated frequency of lesbian, gay, bisexual, and transgender people in the US population. Issues related to fragmentary language emerged, and variety in phrasing and word frequency was identified between different types of notes and between providers. This study provides insight into what nurses in home healthcare document about sexual orientation and gender identity and their clinical priorities related to such documentation, and provides a lexicon for use in further research in the home care setting.
Free Diced Cartilage: Tips and Tricks of a Customized Procedure in Rhinoplasty
Authors: Garofalo Raffaella , Pagliari Marco , D’Ettorre Marco
Published: January 2019

Free diced cartilage graft represents a relatively innovative technique with multiple applications. It is conventionally used for smoothening, augmentation, or camouflaging of the nasal dorsum in primary or revision rhinoplasties. The aim of the article was to give some tips and tricks about harvesting and preparation of free diced cartilage to maximize its exploitation and make it easily repeatable, extending the field of application not only to the nasal dorsum but also other sites, such as the tip of the nose.
Vision-related Performance and Quality of Life of Patients With Rapid Glaucoma Progression
Authors: Waisbourd Michael , Sanvicente Carina T. , Coleman Haley M. , Sieburth Rebecca , Zhan Tingting , Gogte Priyanka , Muhire Remy S. Manzi , Wizov Sheryl S. , Moster Marlene R. , Pro Michael J. , Fudemberg Scott J. , Mantravadi Anand V. , Myers Jonathan S. , Katz L. Jay , Hark Lisa A. , Spaeth George L.
Published: January 2019

Purpose:

The purpose of this study was to determine how clinical measures, performance-based measures and subjective assessments of vision-related quality of life (VRQoL) are affected in patients with rapid glaucoma progression.

Methods:

Prospective longitudinal study that included 153 patients diagnosed with moderate glaucoma. A subset of patients that presented with rapid glaucoma progression (n=22), defined as visual field (VF) mean deviation (MD) loss >2.0 dB/y, were compared with patients with nonrapid progression (n=131). Groups were compared using t tests, χ2, or Fisher exact test. Main outcome measures were visual acuity (VA), VF MD, retinal nerve fiber layer thickness (RNFL), contrast sensitivity (CS), Compressed Assessment of Ability Related to Vision (CAARV), and Rasch calibrated National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores.

Results:

At baseline, patients who progressed rapidly had lower measurements of VA (P=0.041), VF MD (P<0.001), Pelli-Robson score (P=0.004), Spaeth/Richman Contrast Sensitivity (SPARCS) score (P=0.001), RNFL thickness (P=0.009), CAARV total score (P<0.001), and NEI-VFQ-25 composite score (P=0.03). A multivariable logistic regression was performed and showed VF MD to be the only baseline independent predictor of rapid progression. After 1 year, patients who progressed rapidly also had a significant decrease in SPARCS score (P=0.04).

Conclusions:

Factors associated with rapid glaucoma progression included worse VF MD decreased scores of performance-based measures and subjectively worse VRQoL. After 1 year, rapid progressors had a significant reduction in contrast sensitivity as measured by SPARCS.
A Review of Gynecologic Oncology in the Global Setting: Educating and Training the Next Generation of Women's Health Providers
Authors: Sullivan Stephanie A. , Stringer Elizabeth , Van Le Linda
Published: January 2019

Importance

Women in low- and middle-income countries (LMICs) are responsible for the stability of their families. Child survival is directly linked to the health and well-being of their mother. Cancer is the leading cause of morbidity and mortality worldwide, and the incidence and mortality for women from cancer are projected to increase over the coming decades. Gynecologic cancer outcomes are improved when women are cared for by a gynecologic oncologist; however, there are limited specialized providers in LMICs. Increasing interest and involvement from specialists in the United States will improve partnerships abroad and the care of women worldwide.

Objective

To summarize the importance of global gynecologic oncology care and the current data for US trainees in obstetrics and gynecology to participate in clinical and capacity-building opportunities.

Evidence Acquisition

We performed a PubMed literature search for articles pertaining to the topic of global health education in obstetrics and gynecology and gynecologic oncology specifically.

Results

Many obstetric and gynecologic residency programs offer international opportunities, but these are less than those in other specialties and are more frequently focused in obstetrics. Many gynecologic oncology fellowship programs offer international experiences for fellows; however, the time and resources required are limited. Several US and international programs are ongoing to improve capacity building for gynecologic oncology in LMICs with local trainees.

Conclusions and Relevance

Training and care in gynecologic oncology care worldwide are improving through efforts at multiple levels. Continued efforts are needed to improve US trainee international education and experience.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to examine the unique role of women in LMICs; identify the limitations in gynecologic oncology care in LMICs; value the importance of global health exposure during medical training for U.S. physicians; and analyze initiatives that can improve training in gynecologic oncology for global providers.
Survivorship Care Planning in Gynecologic Oncology—Perspectives From Patients, Caregivers, and Health Care Providers
Authors: de Rooij Belle H. , Thomas Teresa Hagan , Post Kathryn E. , Flanagan Jane , Ezendam Nicole P. M. , Peppercorn Jeffrey , Dizon Don S.
Published: January 2019

(Abstracted from J Cancer Surviv 2018; https://doi.org/10.1007/s11764-018-0713-9)

Survivors of gynecological cancer experience a significant level of disease- and treatment-related symptoms after the end of first-line treatment that persist and greatly impact their long-term quality of life. Fear of cancer recurrence is a significant and overwhelming psychological concern among women who survive.
Elevated Postvoid Residual Urine Volume: Identifying Risk Factors and Predicting Resolution in Women With Pelvic Organ Prolapse
Authors: Ulrich Amanda , Davis Patricia , Propst Katie , O'Sullivan David M. , Tulikangas Paul
Published: January 2019

(Abstracted from Female Pelvic Med Reconstr Surg 2018;24:444–448)

No definition of what constitutes normal postvoid residual (PVR) is universally accepted. However, a commonly used definition is a PVR less than 100 mL.
Risk of Ischemic Stroke After a Facial Bone Fracture in Elderly Patients
Authors: Kim Ryeolwoo , Kim Junhyung , Jun Youngjoon , Hong Jeong-ho , Lee Soyoung , Choi Jaehoon , Jung Woonhyeok , Shin Youngmin
Published: January 2019

Background

Ischemic stroke is a major disease in our aging society, and the incidence of facial bone fractures among the elderly has increased. However, there have been few studies evaluating stroke after facial bone fractures. The purpose of this study was to investigate the frequency and risk of stroke after facial bone fractures.

Methods

This study included patients 65 years or older with a diagnosis of facial bone fracture (study group) and patients who had previously undergone plastic surgery procedures such as mass excisions or cosmetic surgery (control group) from 2006 to 2015. We evaluated the incidence of new-onset ischemic stroke and its associated risk factors during a 1-year follow-up period. Patients were excluded if they had a history of stroke or if they were lost to follow-up during the course of the study period.

Results

There were no demographic differences between the 2 groups except in age. According to the hazard ratio, the study group had a significantly higher risk of ischemic stroke than did the control group during the follow-up period. There was an identified interaction between the sexes. Only the women in our study group had an increased risk of ischemic stroke that was statistically significant. After adjusting for the risk factors, the increased stroke risk in patients in the study group persisted at about the same level as in the unadjusted analysis. Regarding the stroke-free survival rates, the curve also showed that the study group had a significantly lower 1-year stroke-free survival rate.

Conclusions

Facial bone fractures are associated with increased risk of stroke at 1-year follow-up among elderly patients, particularly women.
Anatomic Targets for Breast Reconstruction Neurotization
Authors: Gatherwright James , Knackstedt Rebecca , Djohan Risal
Published: January 2019

The concept of providing neurotized autologous breast reconstruction is not novel, but the introduction of cadaveric nerve grafts has allowed for the development of new techniques and a resurgence in academic interest. There has been a surge in the number of publications regarding neurotized autologous breast reconstruction. However, recent articles and reviews have focused mainly on autologous, abdominal-based reconstruction. The sensory innervation of the most commonly used autologous tissues has been well described, allowing surgeons to perform accurate and reproducible dissections. However, there are numerous options for autologous breast reconstruction, and not all patients are candidates for abdominally based reconstruction. As more patients inquire to their possible reconstruction options, plastic surgeons will have to be well versed in the different neurotized options and appreciate the technical aspects associated with reconstructive success. In this review, we aim to discuss both established anatomic targets for autologous flap neurotization and future directions.
Immunomodulation in Vascularized Composite Allotransplantation
Authors: Pappalardo Marco , Montesano Luigi , Toia Francesca , Russo Antonio , Di Lorenzo Sara , Dieli Francesco , Moschella Francesco , Leto Barone Angelo A. , Meraviglia Serena , Di Stefano Anna Barbara
Published: January 2019

Hand and face transplants are becoming increasingly common, recording progressively more penile, uterus, abdominal wall, and allotransplantation cases reported worldwide. Despite current protocols allow long-term survival of the allografts, the ultimate goal of donor-specific tolerance has not been achieved yet. In fact, the harmful adverse effects related to the lifelong administration of immunosuppressive agents are the main drawbacks for vascularized composite allotransplantations. Research is very active in investigating alternative methods to induce greater tolerance while minimizing toxicity. Adipose-derived stem cells (ASCs) represent promising cell therapies for immunomodulation in preclinical and clinical settings. Their clinical appeal is due to their easy harvest in large quantities through a noninvasive and well-accepted approach; they may well promote donor-specific tolerance and potentially reduce immunosuppression. Several experimental studies exist, but lacking review articles reporting current evidence. This work proposes a literature review on the immunomodulatory role of ASCs in vascularized composite allotransplantations. In vitro and in vivo evidence will be summarized. The role that cell passaging and upstream progenitors—the so-called spheroid ASCs—may play in modulating the immune response will also be discussed. Finally, this article will summarize current knowledge on biodistribution, migration, and homing of injected stem cells. This review may well provide useful information for preclinical and clinical studies, aiming at a breakthrough for donor-specific tolerance.
Differences in Complication Rates of Gluteoplasty Procedures That Utilize Autologous Fat Grafting, Implants, or Local Flaps
Authors: Asserson Derek B. , Kulinich Andrea G. , Orbay Hakan , Sahar David E.
Published: January 2019

Background

Gluteoplasty (gluteal augmentation) procedures are increasing in popularity, but there is not a universally accepted technique to produce optimal outcomes while minimizing risk. In this systematic review, we perform a meta-analysis to evaluate rates of complication from autologous fat grafting, implants, and local flaps, which are the three most common gluteoplasty operations.

Methods

A search of the PubMed/MEDLINE database for articles including the terms “gluteoplasty” OR “gluteal augmentation” OR “buttock augmentation” OR “Brazilian butt lift” OR “gluteal autologous fat graft” OR “buttock autologous fat graft” OR “gluteal implant” OR “buttock implant” OR “gluteal flap” OR “buttock flap” generated 229 articles. This number was brought down to 134 after initial screening by title. Inclusion criteria then removed those not written in English, those without access to the full text, those without extractable data on complications, and duplicates, leaving 46 articles to examine.

Results

A total of 4362 patients who underwent gluteoplasty between 1992 and 2017 were found. The overall complication rate was 12.4%. Implants had the highest rate (31.4%), whereas fat grafting had the lowest (6.8%); flaps were intermediate (23.1%). A χ2 test yielded a statistically significant (P < 0.001) nonindependent relationship between combined complication rate and type of surgery. Individual complications, such as asymmetry, capsular contracture, fat embolism, hematoma, infection, necrosis, pain, seroma, wide scar formation, and wound dehiscence, were also analyzed.

Conclusions

Fat grafting by plastic surgeons might be the best option for gluteoplasty with regard to complications. In certain cases, however, there may only exist one choice for an operation because of anatomical limitations, which predisposes patients to those associated complications.
Staphylococcus aureus Biofilm Infection Compromises Wound Healing by Causing Deficiencies in Granulation Tissue Collagen
Authors: Roy Sashwati , Santra Suman , Das Amitava , Dixith Sriteja , Sinha Mithun , Ghatak Subhadip , Ghosh Nandini , Banerjee Pradipta , Khanna Savita , Mathew-Steiner Shomita , Ghatak Piya Das , Blackstone Britani N. , Powell Heather M. , Bergdall Valerie K. , Wozniak Daniel J. , Sen Chandan K.
Published: January 2019

Objective:

The objective of this work was to causatively link biofilm properties of bacterial infection to specific pathogenic mechanisms in wound healing.

Background:

Staphylococcus aureus is one of the four most prevalent bacterial species identified in chronic wounds. Causatively linking wound pathology to biofilm properties of bacterial infection is challenging. Thus, isogenic mutant stains of S. aureus with varying degree of biofilm formation ability was studied in an established preclinical porcine model of wound biofilm infection.

Methods:

Isogenic mutant strains of S. aureus with varying degree (ΔrexB > USA300 > ΔsarA) of biofilm-forming ability were used to infect full-thickness porcine cutaneous wounds.

Results:

Compared with that of ΔsarA infection, wound biofilm burden was significantly higher in response to ΔrexB or USA300 infection. Biofilm infection caused degradation of cutaneous collagen, specifically collagen 1 (Col1), with ΔrexB being most pathogenic in that regard. Biofilm infection of the wound repressed wound-edge miR-143 causing upregulation of its downstream target gene matrix metalloproteinase-2. Pathogenic rise of collagenolytic matrix metalloproteinase-2 in biofilm-infected wound-edge tissue sharply decreased collagen 1/collagen 3 ratio compromising the biomechanical properties of the repaired skin. Tensile strength of the biofilm infected skin was compromised supporting the notion that healed wounds with a history of biofilm infection are likely to recur.

Conclusion:

This study provides maiden evidence that chronic S. aureus biofilm infection in wounds results in impaired granulation tissue collagen leading to compromised wound tissue biomechanics. Clinically, such compromise in tissue repair is likely to increase wound recidivism.
Surgical Innovation in the Era of Global Surgery
Authors: Garas George , Cingolani Isabella , Patel Vanash , Panzarasa Pietro , Alderson Derek , Darzi Ara , Athanasiou Thanos
Published: January 2019

Objective:

To present a novel network-based framework for the study of collaboration in surgery and demonstrate how this can be used in practice to help build and nurture collaborations that foster innovation.

Background:

Surgical innovation is a social process that originates from complex interactions among diverse participants. This has led to the emergence of numerous surgical collaboration networks. What is still needed is a rigorous investigation of these networks and of the relative benefits of various collaboration structures for research and innovation.

Methods:

Network analysis of the real-world innovation network in robotic surgery. Hierarchical mixed-effect models were estimated to assess associations between network measures, research impact and innovation, controlling for the geographical diversity of collaborators, institutional categories, and whether collaborators belonged to industry or academia.

Results:

The network comprised of 1700 organizations and 6000 links. The ability to reach many others along few steps in the network (closeness centrality), forging a geographically diverse international profile (network entropy), and collaboration with industry were all shown to be positively associated with research impact and innovation. Closed structures (clustering coefficient), in which collaborators also collaborate with each other, were found to have a negative association with innovation (P < 0.05 for all associations).

Conclusions:

In the era of global surgery and increasing complexity of surgical innovation, this study highlights the importance of establishing open networks spanning geographical boundaries. Network analysis offers a valuable framework for assisting surgeons in their efforts to forge and sustain collaborations with the highest potential of maximizing innovation and patient care.
Association of Primary Ventral Hernia and Pregnancy
Authors: Oma Erling , Jensen Kristian K. , Bisgaard Thue , Jorgensen Lars N.
Published: January 2019

Objective:

To determine the optimal timing of elective repair, the primary objective of this study was to assess if parity at the time of repair and subsequent pregnancy were associated with reoperation for recurrence. The secondary objective was to examine if parity was associated with hernia formation requiring surgical repair.

Summary Background Data:

Women of childbearing age constitute 18% of patients operated on for a primary ventral hernia, but consensus is lacking on the management in women who might subsequently become pregnant.

Methods:

In this nationwide retrospective cohort-study, all women born in Denmark from 1962 to 1971 were eligible for inclusion and followed from age 15 to 45 years. The follow-up rate was 100%. Data on pregnancies and surgical procedures were obtained from the Danish Medical Birth Registry and National Patient Registry. Extended Cox regression and Poisson regression were used for statistical analysis.

Results:

In total, 470,646 women were included, of whom 2113 underwent repair of a primary ventral hernia. The 10-year cumulative incidence of reoperation for recurrence was 14.1% (95% CI 12.3%–16.0%). Parity at the time of repair was not associated with reoperation for recurrence, while a subsequent pregnancy was associated with a 1.6-fold increased risk (hazard ratio 1.58, 95% CI 1.08–2.31). Parous women had a 7-fold increased risk of undergoing hernia repair compared with nulliparous, in an age-adjusted model (incidence rate ratio 7.04, 95% CI 5.87–8.43).

Conclusion:

To reduce the risk of hernia recurrence, the optimal timing of elective repair is after the last pregnancy.