bluuebunny/crossref_metadata_2025 huggingface dataset:
Telethermographic Investigations in Migraine Patients before and after Flunarizine Treatment
Authors: Giacovazzo Mario , Valducci Giacomo , Martelletti Paolo , Romiti Alfredo , Gallo Maria Francesca , Valducci Marco
Published: July 2017

Fifty migraine patients were tested prior to and after a three-month period of flunarizine treatment (10 mg per day) by means of a new computerized telethermography apparatus. At completion of therapy a new computerized telethermography was carried out. The telethermographic data obtained showed an improvement in 70% of the cases; for the other patients telethermographic relevant modifications were not singled out.
Influence of Flunarizine on the Altered Electronystagmographic (Eng) Recordings in Migraine
Authors: Pini LA , Ferrari A , Guidetti G , Galetti G , Sternieri E
Published: July 2017

Flunarizine, a slow-channel calcium blocker, appeared to be effective in the prophylactic treatment of common and classic migraine in 29 out-patients included in a double-blind clinical trial. After a two-month placebo period, half the patients were treated with flunarizine, 10 mg a day for up to 120 days, half with placebo. Electronystagmographic (ENG) recordings were performed at the end of the common placebo period and after two and four months of treatment, respectively. There was a significant reduction in Headache Unit Index (HUI) and Headache Unit Index Corrected (HUIC) (42% and 40.5% respectively) in the flunarizinetreated group but not in the placebo group. Analgesic intake was reduced and intensity of pain was unchanged in both groups throughout the trial. ENG data were not significantly affected by flunarizine treatment.
Brainstem Auditory Evoked Potentials in Migraine Patients in Basal Conditions and After Chronic Flunarizine Treatment
Authors: Bussone Gennaro , Sinatra Maria Grazia , Boiardi Amerigo , Mantia Loredana La , Frediani Fabio , Cocchini Franco
Published: July 2017

BAEPs have been studied in a group of 20 migraine subjects before and after chronic flunarizine treatment. No statistically significant modifications of neurophysiological parameters have been observed. We confirm flunarizine effectiveness in migraine treatment.
Hormonal and Metabolic Changes Induced by Flunarizine Therapy: Preliminary Results
Authors: Cortelli Pietro , Santucci Margherita , Righetti Francesca , Pirazzoli Piero , Cacciari Emanuele , Albani Fiorenzo , Baldrati Anna , De Carolis Piero , Baruzzi Agostino , Sacquegna Tommaso
Published: July 2017

The effect of 30-days of flunarizine (5 mg/day) therapy on pituitary, B-pancreatic, gonadic and adrenal function was studied in five adolescents with common migraine. Baseline concentration of growth hormone was significantly reduced after flunarizine therapy. The response of prolactin to thyrotrophin-releasing hormone was significantly increased after flunarizine therapy. The percentages of HbA1 and HbA1c were significantly higher after flunarizine therapy. The drug had no apparent effect on gonadic and adrenal function. Further studies are needed to confirm the effect of flunarizine on the hypothalamus-pituitary axis and glucose tolerance.
Neuroendocrine Effects of Flunarizine Treatment in Postmenopausal Women
Authors: Facchinetti Fabio , Sances Grazia , Bakalakis Charissula , Morgillo M Gloria , Lottici Patrizia , Cicoli Claudio , Genazzani Andrea R
Published: July 2017

Flunarizine (10 mg/day for 60 days) was given to eight postmenopausal women with common migraine. Plasma LH pulsatility fluctuation, peripheral concentrations of prolactin (PRL), cortisol, β-endorphin (β-EP), β-lipotropin (β-LPH) and Pain Total Index (PTI) were evaluated before and after treatment. PTI was significantly reduced by flunarizine, which did not affect β-LPH, β-EP and cortisol plasma levels. On the contrary, both PRL values and amplitude, and length of LH pulses had increased at the end of treatment. Flunarizine reduced head pain in postmenopausal women. However, the enhancement of both PRL and LH release indicates that this calcium antagonist might interfere with the dopaminergic tonus.
Analysis of Outcome Predictors of Migraine Towards Chronicity
Authors: Baldrati Anna , Bini Lucia , D'Alessandro Roberto , Cortelli Pietro , de Capoa Daniela , De Carolis Piero , Sacquegna Tommaso
Published: July 2017

Long-term migraine evolution is still undefined. The poorest outcome is the transformation from episodic attacks to a pattern of daily attacks or continuous headache with intermittent attacks. We called these cases “chronic migraine”. The aim of our study was to investigate whether some clinical variables contributed to migraine chronicity. We interviewed 50 patients with chronic migraine from 2 to 15 years and 90 patients with episodic migraine matched for sex and age as a control group. Univariate analysis revealed two correlations with a chronic outcome: (1) In the control group a significantly higher number of women took oral contraceptives. (2) In the group who developed chronic migraine, there were a greater number of smokers, without reaching statistical significance. The stepwise multiple logistic regression method showed that these two variables influence the prognosis with a maximum likelihood estimate of 65%, hence not much higher than random probability.
Antimigraine Drugs in the Management of Daily Chronic Headaches: Clinical Profiles of Responsive Patients
Authors: Micieli Giuseppe , Piazza Domenico , Sinforiani Elena , Cavallini Anna , Trucco Marco , Gabellini Sandra , Mancuso Anna , Pacchetti Claudio
Published: July 2017

Flunarizine, a Ca-antagonist with demonstrated antimigraine properties, and indoprofen, an anti-inflammatory non-steroidal agent, were used in the treatment of daily chronic headache. Forty-two migraineurs with interval headache (MIH) were treated with flunarizine in a 6-month open trial, while indoprofen was administered to 23 patients with MIH and 7 with chronic tension headache (CTH) in a 2-month, double-blind, cross-over placebo-controlled study. Flunarizine was found effective in over 65% of the patients, while indoprofen was able to improve headache severity in only 30% of the subjects. In the responder patients, the effectiveness of both drugs is more pronounced in MIH, and seems to be ascribable to the ability of the treatments to reduce number and severity of attacks. A higher incidence of previous affective disturbances is found in non-responsive cases. The analysis of factors converting episodic into chronic headache shows slight but not significant differences between responders and non-responders. An impairment of plasma β-endorphin levels, in the presence of normal ACTH, cortisol and nociceptive RIII threshold values, characterizes daily chronic headache (DCH) patients. Moreover, indoprofen does not significantly affect these biological and neurophysiological parameters independently of the therapeutic response.
Antidepressant Drugs and Migraine
Authors: Martucci N , Manna V , Agnoli A
Published: July 2017

There is evidence that some antidepressant drugs, above all amitriptyline and mianserine, are beneficial in the prophylaxis of migraine. The mechanism of action of antidepressants in migraine is likely to be complex. Mood disturbances accompanying migraine syndromes suggest a mode of action of such a class of drugs. In the last few years some clinical studies tend to show that the antimigraine effects of these drugs seem relatively independent of the antidepressant activity.
Life Events and Headache
Authors: Invernizzi Giordano , Gala Costanzo , Sacchetti Emilio
Published: July 2017

We have evaluated the incidence and the gravity of recent and early stressful life events in 149 patients with headache and in 43 healthy controls. The incidence of early stressful events was the same for the headache patients and the controls, and for the three subtypes of headache patients. Patients with headache had undergone more recent stressful events than the control individuals, and the difference was due to patients with migraine. The mean gravity of the recent stressful events did not differ significantly. This probably indicates that appearance of headache is not so much associated with the gravity of the events as with the fact that they have occurred in the lives of patients with other biological and/or psychological characteristics with which the stress interacts.
12: Clinical Aspects of Prostaglandins and Leukotrienes in Migraine
Authors: Parantainen J , Vapaatalo H , Hokkanen E
Published: July 2017

Clinical, pathophysiological, pharmacological, and biochemical evidence support the concept that the prostanoid system may be involved in migraine. As a local defence system prostaglandins may best be linked with hyperalgesia and vascular events. The response to potent inhibitors of PG-synthesis like tolfenamic acid further supports the involvement of prostaglandins in the “inflammatory-like” aspects of migraine pain. The prostanoid system may be closely coupled with the monoaminergic mechanism; e.g. in stress reactions plasma thromboxane correlates with adrenaline levels. The possible participation of leukotrienes in migraine is only speculative. However, in cerebral hypoxia lipid peroxidation is increased and leukotrienes might participate in the cerebrovascular reactions. Prostaglandins may inhibit the formation of free radicals, antagonize some actions of leukotrienes and protect the tissues. The interplay between leukotrienes and prostaglandins may give new aspects to some cerebrovascular abnormalities in migraine.
Opening Minds in Canada: Background and Rationale
Authors: Stuart Heather , Chen Shu-Ping , Christie Romie , Dobson Keith , Kirsh Bonnie , Knaak Stephanie , Koller Michelle , Krupa Terry , Lauria-Horner Bianca , Luong Dorothy , Modgill Geeta , Patten Scott B , Pietrus Mike , Szeto Andrew , Whitley Rob
Published: July 2017

Objective

To summarize the background and rationale of the approach taken by the Mental Health Commission of Canada's Opening Minds (OM) Anti-Stigma Initiative.

Method

The approach taken by OM incorporates a grassroots, community development philosophy, has clearly defined target groups, uses contact-based education as the central organizing element across interventions, and has a strong evaluative component, so that best practices can be identified, replicated, and disseminated. Contact-based education occurs when people who have experienced a mental illness share their personal story of recovery and hope.

Results

OM has acted as a catalyst to develop partnerships between community groups who are undertaking anti-stigma work and an interdisciplinary team of academic researchers in 5 universities who are evaluating the results of these programs.

Conclusions

Building partnerships with existing community programs and promoting systematic evaluation using standardized approaches and instruments have contributed to our understanding of best practices in the field of anti-stigma programming.
Opening Minds in Canada: Targeting Change
Authors: Stuart Heather , Chen Shu-Ping , Christie Romie , Dobson Keith , Kirsh Bonnie , Knaak Stephanie , Koller Michelle , Krupa Terry , Lauria-Horner Bianca , Luong Dorothy , Modgill Geeta , Patten Scott B , Pietrus Mike , Szeto Andrew , Whitley Rob
Published: July 2017

Objective

To summarize the ongoing activities of the Opening Minds (OM) Anti-Stigma Initiative of the Mental Health Commission of Canada regarding the 4 groups targeted (youth, health care providers, media, and workplaces), highlight some of the key methodological challenges, and review lessons learned.

Method

The approach used by OM is rooted in community development philosophy, with clearly defined target groups, contact-based education as the central organizing element across interventions, and a strong evaluative component so that best practices can be identified, replicated, and disseminated. Contact-based education occurs when people who have experienced a mental illness share their personal story of recovery and hope.

Results

Results have been generally positive. Contact-based education has the capacity to reduce prejudicial attitudes and improve social acceptance of people with a mental illness across various target groups and sectors. Variations in program outcomes have contributed to our understanding of active ingredients.

Conclusions

Contact-based education has become a cornerstone of the OM approach to stigma reduction. A story of hope and recovery told by someone who has experienced a mental illness is powerful and engaging, and a critical ingredient in the fight against stigma. Building partnerships with existing community programs and promoting systematic evaluation using standardized approaches and instruments have contributed to our understanding of best practices in the field of anti-stigma programming. The next challenge will be to scale these up so that they may have a national impact.
Key Ingredients of Anti-Stigma Programs for Health Care Providers: A Data Synthesis of Evaluative Studies
Authors: Knaak Stephanie , Modgill Geeta , Patten Scott B
Published: July 2017

Objective

As part of its ongoing effort to combat stigma against mental illness among health care providers, the Mental Health Commission of Canada partnered with organizations conducting anti-stigma interventions. Our objective was to evaluate program effectiveness and to better understand what makes some programs more effective than others. Our paper reports the elements of these programs found to be most strongly associated with favourable outcomes.

Methods

Our study employed a multi-phased, mixed-methods design. First, a grounded theory qualitative study was undertaken to identify key program elements. Next, each program ( n = 22) was coded according to the presence or absence of the identified key program ingredients. Then, random-effects, meta-regression modelling was used to examine the association between program outcomes and the key ingredients.

Results

The qualitative analysis led to a 6-ingredient model of key program elements. Results of the quantitative analysis showed that programs that included all 6 of these ingredients performed significantly better than those that did not. Individual analyses of each of the 6 ingredients showed that including multiple forms of social contact and emphasizing recovery were characteristics of the most effective programs.

Conclusions

The results provide a validation of a 6-ingredient model of key program elements for anti-stigma programming for health care providers. Emphasizing recovery and including multiple types of social contact are of particular importance for maximizing the effectiveness of anti-stigma programs for health care providers.
Stigma in Canada: Results from a Rapid Response Survey
Authors: Stuart Heather , Patten Scott B , Koller Michelle , Modgill Geeta , Liinamaa Tiina
Published: July 2017

Objective

Our paper presents findings from the first population survey of stigma in Canada using a new measure of stigma. Empirical objectives are to provide a descriptive profile of Canadian's expectations that people will devalue and discriminate against someone with depression, and to explore the relation between experiences of being stigmatized in the year prior to the survey among people having been treated for a mental illness with a selected number of sociodemographic and mental health—related variables.

Method

Data were collected by Statistics Canada using a rapid response format on a representative sample of Canadians ( n = 10 389) during May and June of 2010. Public expectations of stigma and personal experiences of stigma in the subgroup receiving treatment for a mental illness were measured.

Results

Over one-half of the sample endorsed 1 or more of the devaluation discrimination items, indicating that they believed Canadians would stigmatize someone with depression. The item most frequently endorsed concerned employers not considering an application from someone who has had depression. Over one-third of people who had received treatment in the year prior to the survey reported discrimination in 1 or more life domains. Experiences of discrimination were strongly associated with perceptions that Canadians would devalue someone with depression, younger age (12 to 15 years), and self-reported poor general mental health.

Conclusions

The Mental Health Experiences Module reflects an important partnership between 2 national organizations that will help Canada fulfill its monitoring obligations under the United Nations Convention on the Rights of Persons with Disabilities and provide a legacy to researchers and policy-makers who are interested in monitoring changes in stigma over time.
When Could a Stigma Program to Address Mental Illness in the Workplace Break Even?
Authors: Dewa Carolyn S , Hoch Jeffrey S
Published: July 2017

Objective

To explore basic requirements for a stigma program to produce sufficient savings to pay for itself (that is, break even).

Methods

A simple economic model was developed to compare reductions in total short-term disability (SDIS) cost relative to a stigma program's costs. A 2-way sensitivity analysis is used to illustrate conditions under which this break-even scenario occurs.

Results

Using estimates from the literature for the SDIS costs, this analysis shows that a stigma program can provide value added even if there is no reduction in the length of an SDIS leave. To break even, a stigma program with no reduction in the length of an SDIS leave would need to prevent at least 2.5 SDIS claims in an organization of 1000 workers. Similarly, a stigma program can break even with no reduction in the number of SDIS claims if it is able to reduce SDIS episodes by at least 7 days in an organization of 1000 employees.

Conclusions

Modelling results, such as those presented in our paper, provide information to help occupational health payers become prudent buyers in the mental health market place. While in most cases, the required reductions seem modest, the real test of both the model and the program occurs once a stigma program is piloted and evaluated in a real-world setting.
Social Network: A New Perspective on Independence and Illiterate Adults
Authors: Fingeret Arlene
Published: July 2017

This study explores the social structures illiterate adults create, and their relationship to notions of dependence and independence. In-depth unstructured interviews and participant-observation were used with 43 adults in a medium-sized northeastern urban setting. Analysis shows that illiterate adults create social networks that include readers and are characterized by mutuality. Illiterate adults contribute a range of skills to their networks and see themselves as interdependent. Networks are related to the extent to which illiterate adults are involved in the larger society; this ranges from extensive, for cosmopolitans, to minimal for local adults. Dependent adults have networks that are characterized by asymmetrical relationships. Literacy programs must learn to respond to adults-in-networks.
Effects of Adult Learner Participation in Course Planning on Achievement and Satisfaction
Authors: Rosenblum Sandra , Darkenwald Gordon G.
Published: July 2017

A cardinal principle of adult education is that adults should participate in planning their own learning activities. The benefits of such participation have not, however, been documented through controlled experimental inquiry. The present study tested the hypotheses that participation in course planning would result in higher achievement and satisfaction. A post-test only control group design was employed with replication. The subjects of the initial experiment were 28 nursing supervisors randomly assigned to experimental and control conditions. The experimental group participated in planning their course in supervision. The control group completed the course as planned by the experimental group. The experiment was then replicated with 26 support service supervisors. The results were nearly identical for both experiments. No differences were found between the experimental and control groups in either achievement or satisfaction. One explanation for the findings is that control group subjects reaped the benefits of a “good course” planned by co-workers with similar needs. Nonetheless, direct participation in itself was found to have no effects, thereby raising important questions for future research.
Mentors and Protégés: A Critical Review of the Literature
Authors: Merriam Sharan
Published: July 2017

Within the last few years, mentoring has emerged as a popular topic in several fields. Articles and talk shows imply that success in life is somehow related to having a mentor or being a mentor. The purpose of this review is to evaluate the extent to which such enthusiasm can be substantiated by research. The literature on mentoring is divided into three sections: the mentoring phenomenon in adult growth and development, mentoring in the business world, and mentoring in academic settings. A concluding section summarizes findings across these three settings, speculates about the relevance of mentoring for adult educators, and suggests avenues for future inquiry.
Breast Augmentation by Tumescent Anesthesia
Authors: Kaplan Barry J.
Published: July 2017

Introduction:

Many surgical procedures are being performed using local anesthesia. Several articles about breast surgery describe tumescence; however, IV or general anesthesia is also used. This study examines submuscular implantation with only mild oral sedation and tumescence.

Materials and Methods:

Patient preparation and education was important. One hour before surgery, patients took antibiotics and pain medication. One half hour before surgery, they were given 0.11 mg of clonidine and 2 mg lorazepam. Using local anesthesia, an inframammary crease stab allowed the introduction of the infiltration sprayer under the pectoralis major muscle: 350–500 mL of 0.2% lidocaine and 1:500 000 epinephrine and bicarbonate were infiltrated and allowed to setup for 20–30 minutes. The standard implantation procedure was then performed.

Results:

All patients tolerated the procedure easily and were able to walk out of the office 15 minutes later.

Discussion:

Breast augmentation by tumescent anesthesia is a safer, more affordable alternative to general anesthesia.
Combining Cosmetic Soft Tissue and Skeletal Surgeries to Achieve Greater Total Facial Harmony Than Either Surgery Could Alone
Authors: Belinfante Louis S.
Published: July 2017

Introduction:

Oral and maxillofacial surgeons have the capability, both technically and biologically, to greatly alter the faces of patients who exhibit facial deformities along with soft tissue defects. Not only can this specialty greatly improve disharmony in a patient's underlying facial bony skeleton, but it is in a preeminent position to treat cosmetic soft tissue defects, and therefore surgically alter both functional and cosmetic deficiencies for an aesthetic conclusion.

Materials and Methods:

Five patients with both cosmetic and functional problems are presented. Their problems are analyzed and treated. Specific comments are made regarding a number of cosmetic evaluations and techniques.

Results:

The surgical approach to treat a patient's facial soft tissue and bony defects, either concomitantly or via staged approaches, indicates a much greater range of surgical capabilities that attempts to correct a patient's total facial disharmony.

Discussion:

The contemporary oral and maxillofacial surgeon now has the educational capabilities and resources to treatment plan the entire face, from the underlying bone to the overlying soft tissues, and surgically execute those plans. The results can alter the facial region both cosmetically and functionally to a degree that heretofore was only a conceptual possibility.
Wound Repair Materials: A Review
Authors: Torres Omar , Bradley Valentina , Scarborough Dwight , Bisaccia Emil
Published: July 2017

For over 2000 years, suturing has been the most popular method for wound closure. Today, numerous repair options are readily available and can address virtually any case scenario. Lower probabilities of infection, dehiscence, and improved aesthetic results are but a few of the advantages derived from an educated selection of the proper suturing and/or wound repair materials. This article provides an in-depth review of suturing and alternate wound closure materials in cutaneous and cosmetic surgery.
Tumescent Liposuction Performed Safely in a Patient with First-Degree Atrioventricular Block
Authors: Mellul Steven D. , Dryden Robert M. , Xavier Lyndon C.
Published: July 2017

Aesthetic surgery represents a mode of surgical expression that has evolved over the last 2000 years. Ostensibly it encompasses the principles of beauty, grace, and symmetry. However, today's cosmetic surgeon must not underestimate the ideals of ethical propriety, knowledge, and patient safety. This brief article describes a case report of a 49-year-old white woman undergoing liposculpture. The findings show that concentration of 32 mg/kg did not alter cardiac rhythmicity even in a patient with underlying cardiac conduction defects. Continued collection of data on lidocaine disposition kinetics will hopefully lead to the formation of safety protocols for its use in liposuction.
Analysis of 2 Prospective Open-Label Studies of Botulinum Toxin Type B for the Treatment of Glabellar Wrinkles
Authors: Sadick Neil S.
Published: July 2017

Introduction:

This is an analysis of the combined results from 2 prospective, open-label studies that evaluated the use of botulinum toxin type B at doses of 1800, 2400, and 3000 U in the treatment of glabellar frown lines. In total, 64 patients were included in the studies.

Material and Methods:

Doses were divided equally over 6 sites for glabellar lines.

Results:

All patients had rapid improvement of inter glabellar rhytides, with full response seen for the majority of patients within 2 days. The duration of effect was 8.0, 9.6, and 10.4 weeks with 1800, 2400, and 3000 U, respectively. Five patients (7.8%) complained of mild pain on injection, and 2 patients (3.1%), one each at the higher doses, had lid ptosis.

Discussion:

Taken together, the studies show that botulinum toxin type B injection is safe and effective for the treatment of glabellar wrinkles, has a very rapid onset of action, and has a dose-related duration of response.
The Pocket Protector: A New Breast Implant Device
Authors: Berman Mark
Published: July 2017

Introduction:

Although strides have been made to improve breast augmentation surgery, they have focused on the use of single implant devices, necessitating adjustments to the type of operation performed and implants used. And although some breast types obtain excellent results, many others are less than optimal. By developing a thin synthetic expanded polytetrafluoroethylene device, the Pocket Protector, that lines the breast pocket by integrating with the body without a capsule formation, smooth-surfaced gel (or saline) implants can remain soft and provide improved augmentation mammoplasty results. Even patients with Baker class III and IV breasts refractory to all types of revisional surgery can achieve soft, natural breasts after revision with the Pocket Protector.

Materials and Methods:

Augmentation mammoplasty and revision mammoplasty, often with capsulectomy, with the Pocket Protector was performed on 38 patients with smooth gel or saline implants. Since the initial prototype in April 1995, data have been collected with each patient to evaluate the efficacy of this device.

Results:

Patients involved in the current study have yielded soft, natural-feeling breasts in the normal anatomic position. Two patients who experienced a flu syndrome in the immediate postoperative period developed refractory seromas necessitating removal of the expanded polytetrafluoroethylene. Both cases have subsequently been successfully revised with Pocket Protectors and smooth-gel implants. Three patients with very thin tissues experienced rippling in spite of using smooth-gel implants.

Discussion:

The net result yields a soft, ripple-free (or near ripple-free) breast. Additionally, gel implants inside the Pocket Protector are potentially shielded from the body, should the implants rupture. Implants are easily exchangeable if necessary without need for capsulectomy or capsulotomy. The Pocket Protector may also represent an implant device appropriate to treat breasts refractory to traditionally attempted augmentations, such as subcutaneous mastectomy. Although the first case performed in April 1995 has remained successful, most of the experience has been gathered over the past year. This preliminary paper presents the experience with the past 38 cases.
Low-Level Laser-Assisted Liposuction: A 2004 Clinical Study of its Effectiveness for Enhancing Ease of Liposuction Procedures and Facilitating the Recovery Process for Patients Undergoing Thigh, Hip, and Stomach Contouring
Authors: Jackson Robert F. , Roche Gregory , Butterwick Kimberly J. , Dedo Douglas D. , Slattery Kevin T.
Published: July 2017

Introduction:

The purpose of this IRB approved, multicenter, partially double-blind study was to determine the effectiveness of low-level laser-assisted liposuction in decreasing the patients' degree of postoperative discomfort, reducing swelling, enhancing wound healing at surgical entry points, decreasing the use of recovery medications for pain management, facilitating fat extraction for the surgeon, enhancing the emulsification of extracted fat, and decreasing surgical time spent to obtain optimal results.

Materials and Methods:

The Erchonia EML, 635-nm, 14-mW dual-diode low-level laser was used to irradiate the target tissue for 12 minutes after infiltration of tumescent fluid.

Results:

Of the 36 test-group patients who received laser treatment, 75% met their major success criteria compared with 32% of the 34 placebo-group patients who received “fake” treatment. Success criteria were defined as at least a 30% difference between groups. Forty-three percent more of the test subjects than placebo subjects met success criteria, exceeding the target by 13%.

Discussion:

The Erchonia EML Laser is an effective device for assisting liposuction procedures with low-level laser therapy. It significantly enhances the ease of performing liposuction procedures; reduces the time in surgery; enhances the ease of facilitating fat extraction; enhances the emulsification of extracted fat; facilitates the recovery process; decreases the patients' degree of postoperative discomfort, decreases swelling; and decreases the use of recovery medications for pain management for patients undergoing body contouring in the areas of the thighs, hips, and stomach.
The 2-Day Light Phenol Chemabrasion for Deep Wrinkles and Acne Scars: A Presentation of Face and Neck Peels
Authors: Rullan Peter Paul , Lemon Janet , Rullan Jennifer
Published: July 2017

Introduction:

Most physicians associate the term phenol peel with the Baker-Gordon formula and have not kept up with the resurgence of modified, light phenol peels that were popularized by lay peelers from the 1920s through the 1990s. Deep dynamic rhytides and acne scars are typically resistant to current resurfacing techniques. The concepts of reapplying phenol on abraded skin and phenol neck peeling are neither well understood nor accepted.

Materials and Methods:

Seventy-eight patients were treated and followed over 3 years, with various formulations of modified light phenol formulas. High-quality before and after photographs were taken, documenting the results. Patients were separated into 3 categories: acne scars, aging, and those with both. Neck peels were done on 19 patients. Full cardiac monitoring was performed and assessed. A telephone survey and a blinded-observers evaluation of the before and after photographs was done to assess the satisfaction index, color changes, and incidence of scars. A paired comparison to evaluate the need for chemabrasion versus peel alone for the treatment of acne scars was performed. A histologic study to evaluate the depth of injury and inflammation, to compare phenol alone versus chemabrasion was done.

Results:

Forty-four percent of the patients had skin phototypes (SPT) II–IV. The use of epinephrine for nerve blocks during the initial 30 cases was associated with 1 case of asymptomatic premature ventricular contractions (PVCs) and 4 premature atrial contractions (PACs) during eyelid application. The last 48 patients had no epinephrine, and there were no further arrhythmias. Photographic evaluation showed that acne scars improved 80%, wrinkles improved 90%, and those with both conditions improved 86%. There were no facial scars and no cases of depigmentation over a 2-year follow-up. Four neck peels developed small scars that resolved completely with treatment. The paired comparison showed that chemabrasion was superior to peeling alone for scar correction. Histologic studies showed that both Exoderm-Lift and Stone 2 wounded equally and that the second-day reapplication of these formulas did not cause a deeper injury. All patients were 100% reepithelialized by day 8–9. Forty percent of patients had 10-minute spot touch-ups.

Discussion:

The 2-day light phenol chemabrasion (PCA) is a very predictable peel without the associated complications seen with Baker-Gordon peels. Premixed, stable light phenol formulas are commercially available. This avoids the variability of mixing one's own formula and facilitates the teaching of this procedure as a well-defined and reproducible resurfacing technique. The 2-day PCA has the potential of becoming the treatment of choice for deep scar and wrinkle resurfacing.
Lost in Space: Emergency Digital Camera Data Recovery
Authors: Niamtu Joseph
Published: July 2017

Introduction:

The purpose of this article is to inform clinicians about a software application that can be downloaded free from the Internet to recover damaged, corrupted, or deleted photographs from digital cameras or digital camera media cards. Digital photography has become the standard for clinical photography over the past decade. Although digital photography offers many advantages over film or slide photography, some distinct disadvantages exist. One of the biggest disadvantages is that a digital camera media card may become damaged or corrupted and hundreds of images can be lost in a fraction of a second. The average surgeon who takes many pictures each day will likely, at some point, be faced with a loss or potential loss of data.

Materials and Methods:

Many clinicians are unaware that digital images are usually recoverable in minutes with simple, free software designed specifically for that purpose.

Results:

Software designed to recover lost digital images has the potential to recover photographs, video, and audio files.

Discussion:

This article also explains precautions and caveats for avoiding data loss when dealing with digital camera media. This article is a “9-1-1” for digital camera emergencies, and clipping it out and tucking it in your desk drawer may at sometime make a bad camera day better.
Invited Review: Nutrition in the Spinal‐Injured Patient
Authors: Chin Donna E. , Kearns Patrick
Published: July 2017

The response to spinal cord injury (SCI) occurs in phases with an initial phase of muscle flaccidity and absence of spontaneous skeletal muscle function followed by a chronic phase where muscles become hyperexcitable and spastic. The eventual course after SCI depends on the extent of neural damage. Nutritional assessment presents a particular challenge in this patient population because essentially all of the traditional markers are effected by the SCI. Therefore, the use of anthropometric measurements, biochemical markers, and functional markers requires reinterpretation in this setting. Nutritional management is a further challenge because of alterations in appetite, gastrointestinal dysfunction, and possible pancreatitis. Metabolic changes include altered energy and nitrogen metabolism, hypercalcemia, hyponatremia, and initial weight loss followed by later weight gain. This review summarizes the unique nutritional problems that patients with SCI present and guidelines for nutritionally supporting the patient in both the acute and chronic phases.
Invited Review: Nutrition in the Neurologically Injured Patient
Authors: Ott Linda , Young Byron
Published: July 2017

Head injury is characterized by both the direct injury to the brain and the overall systemic response to the brain injury. The systemic response usually includes an increase in energy expenditure, which can be quantitated by using indirect calorimetry, increased urinary nitrogen excretion, hyperglycemia, hypoalbuminemia, and elevated liver function tests. The mechanism for this hypermetabolism is probably multifactorial and includes the release of mediators in response to the injury (eg, catecholamines, cytokines), steroid therapy, nutrient administration and intercurrent complications, eg, infection. The nutritional management of the patient remains controversial. The issues that have been and that continue to be investigated are the amount and type of nutrients that will optimally allow for nerve regeneration and the optimal route of nutrient administration—enteral versus parenteral. This article reviews the proposed mechanisms for the metabolic response to head injury and the experience with nutritional support in this patient population.
Barbiturate Therapy and Nutritional Support in Head‐Injured Patients
Authors: Varella Lee
Published: July 2017

A major goal of therapy after acute head injury is to prevent increased intracranial pressure. Treatments of intracranial pressure include measures such as hyperventilation, ventricular catheters, hypothermia, osmotic dehydration, sedatives, and in some cases, steroids. If these measures are not effective, barbiturate therapy is used to reduce brain metabolism, decrease cerebral blood flow, and suppress responses to stimulation. Barbiturates produce central nervous system effects that decrease gastrointestinal tone and motility. Clinicians must consider the specific effects of barbiturates and the unique nutritional needs of head‐injured patients in order to select effective nutritional support regimens.
Nutritional Support of the Severe Head‐Injured Patient
Authors: Annis Kim , Ott Linda , Kearney Paul A.
Published: July 2017

The severe head‐injured patient represents a unique nutritional challenge for clinicians involved in their care. These patients are often hypermetabolic and hyper‐catabolic, resulting in the need for calorie‐ and protein‐dense feedings. Given the hormonal, metabolic, and fluid and electrolyte abnormalities that often accompany this injury, designing an optimal feeding regimen to meet these needs is difficult. A variety of feeding modalities have been studied. Total parenteral nutrition or nasogastric tube feedings are usually initiated when the patient is hemodynamically stable. Nasogastric tube feedings may be poorly tolerated. Small bowel feedings may improve tube feeding tolerance and allow the earlier initiation of enteral nutrition support. This case report describes the clinical course and nutritional support of a severe head‐injured patient.
Nutrition in Head Trauma
Authors: Konvolinka Carl W. , Morell Victor O.
Published: July 2017

Metabolic alterations play a significant role in the human response to all forms of injury and sepsis. It is therefore logical to be concerned about the impact of these alterations on a patient with an isolated head injury. As it becomes more apparent that head injury alone results in increased energy expenditure as part of the systemic response to that injury, efforts will need to be directed to the support of those requirements and to the assessment of the host response to that effort.
Audit Committees in Scottish Local Authorities 1998—2005
Authors: Henry William , Crawford Margaret , Manochin Melina , McKendrick James , Porter Brenda , Stein William
Published: July 2017

During the last 15 years corporate governance has become increasingly prominent in the public sector. The Audit Commission's 1993 report on probity in local government recommended the establishment of audit committees. However, progress on this was slow, as demonstrated by a survey of Scottish local authorities by the authors in 1998. Recent major changes in government in Scotland at both a local and national level have prompted councils to improve the accountability, openness and integrity of their operations. One major aspect of this exercise was the formation of scrutiny committees to provide objective scrutiny of the process and audit committees were the most common vehicle for this. This article explores recent developments in Scottish local government and their impact on audit committees. The article also reports the results of a 2005 survey of Scottish local authorities and compares these with the 1998 survey. This indicates a significant growth in the number of audit committees in Scottish councils and although the level of their perceived effectiveness is patchy, they are a more important feature of local government than they were in 1998.
The Reform Agenda in the Northern Ireland Civil Service
Authors: Birrell Derek
Published: July 2017

This article examines the impact of the reform and modernization agenda of the United Kingdom Home Civil Service on the Northern Ireland Civil Service, which has always existed as a separate civil service. It seeks to identify the differentiation in responses to the main UK reform initiatives in recent years and, in particular, to consider in this context the first comprehensive reform document to be produced by the Northern Ireland Civil Service, which appeared in 2004. A typology of four different influences is examined to explain the diversity of responses categorized as parity, integration, devolution and direct rule. Consideration is given to the significance of a separate civil service in the pattern of adjustments to Home Civil Service reforms and in facilitating other distinctive approaches. Comment is also made on the possible relevance of Northern Ireland experience to the absence of a separate civil service in Scotland and Wales following devolution.
The Curious Absence of Inter-municipal Cooperation in England
Authors: Kelly Josephine
Published: July 2017

In Europe local authorities often work with their neighbouring municipalities, whether to address a specific task or goal or through the course of regular policy making and implementation. In England, however, inter-municipal co-operation (IMC) is less common. Councils may work with service providers from the private and non-profit sectors but less often with neighbouring local authorities. Why this is the case may be explained by a number of historical and policy factors that often encourage councils to compete, rather than to work collaboratively with each other. The present government has encouraged councils to work in partnership with other organizations but there are few examples of increased horizontal cooperation between local authorities. Instead the prevailing model remains fixed on vertical co-working predicated on a principal-agent relationship between higher and lower tiers of government.
The Governance of E-government
Authors: Löfgren Karl
Published: July 2017

Around the world, there are several governmental attempts, by means of new information — and communication technologies (ICTs) — to regenerate the relationship between citizen/business and governments. This article explores the Swedish electronic government reform attempts of transforming functionally specialized governmental agencies into a more coherent and integrated network administration — the so-called `24/7 Agency'. Based on a theoretical point of departure in the governance network literature, and Kingdon's different streams of problems, solutions and politics, the article investigates the twisting ways of fulfilling the vision of the reform-makers. The conclusion is that the institutional structures, in this case the Swedish model of government organization with independently managed under performance management, in many respects encumber the reform per se. In addition, the article concludes that theoretically there are many reasons to include national institutional settings in the study of governance networks in future research. Methodologically, the article is based on an interpretative policy analysis where data has been derived through interviews with central policy makers and studies of policy documents.
The Four Things You Need to Know
Authors: Quirk Barry
Published: July 2017

The best approach to appreciating the complex issues involved in public policy is to eschew single domains of specialist knowledge and instead apply three general principles of understanding. First, by establishing links between apparently unconnected specialisms; second, by adopting a conjectural approach of trial and error; and third, by framing policy questions in terms of risk and uncertainty. Finally, for those with leadership responsibilities of public institutions, a fourth factor needs to be recognized. In organizational life, political and managerial leaders need to realize that people are principally motivated to do well intrinsically and not mainly through external incentives.
Dialogue with the other as Potential and Peril in Robinson Crusoe
Authors: Fulton Gordon D.
Published: July 2017

This essay studies an important scene in the literature of European contact with non-Europeans, Robinson Crusoe's conversion of his man Friday to Christianity, drawing on recent discussion of dialogue within ethnography, and paying particular attention to the presentation of speech. It argues that when Crusoe finds Friday more than a match for him in dialogue he turns away from dialogue, to theological reverie focused on himself and to narrative report of their conversation, fashioning an account in which Christian faith and colonial dominance support each other in the establishment of Crusoe's island kingdom.
‘Folk-Speech’ and ‘Book English’: Re-presentations of Dialect in Hardy's Novels
Authors: Cooper Andrew R.
Published: July 2017

In an attempt to evaluate the fidelity of Hardy's representation of dialect speech, critics have made implicit or explicit reference to dialects actually spoken at the time Hardy wrote his novels of rural life. To this end, comparisons are often made between features of ‘Wessex dialect’ and contemporary records of dialects produced by amateur dialectologists, such as Hardy's friend William Barnes. In this article I propose a new approach to the relationship between non-fictional records of dialects in the nineteenth century and the literary representation of dialect speech in Hardy's novels. I argue that the considerable practical and theoretical difficulties that are to be found in non-fictional records of dialects, mean that Hardy's version of dialect speech cannot be read back on to authentic dialect speech. Only when the non-literary definition and representation of dialects are recognised as problematic, can questions be asked which reveal the true complexity of dialect speech in the novels. I demonstrate a reading of the language of Hardy's novels as a complex intersection of contemporary rules of definition of dialects, which are re-presented in the texts as internally and mutually contradictory discourses. Focusing upon the discursive construction of the sign of ‘Wessex dialect’, I indicate how Hardy's literary version of dialect speech can be read as a political critique of the definition and representation of the opposition between ‘folk-speech’ and ‘book English’ at the time the novels were written.