bluuebunny/crossref_metadata_2025 huggingface dataset:
The “Double Medial Malleolus”: A New Physical Finding in Talocalcaneal Coalition
Authors: Rocchi Vanna , Huang Ming-Tung , Bomar James D. , Mubarak Scott
Published: June 2016

Purpose:

It has been the observation of the senior author that there is a bony fullness or “double medial malleolus” over the middle facet as a consistent finding with most talocalcaneal coalitions (TCC). To document this observation, we reviewed records and radiographs in 3 patient groups.

Methods:

Part 1: retrospective chart review was completed for 111 feet to determine the clinical presence of a palpable “double medial malleolus.” Part 2: computed tomography (CT) scans for evaluation of tarsal coalition or symptomatic flatfoot between January 2006 and December 2014 were retrospectively reviewed for the same cohort. Soft tissue thickness was measured as the shortest distance between bone and skin surface at both the medial malleolus and the middle facet/coalition. The volume of the middle facet or coalition was measured at their midpoint. These findings were compared among feet with TCC (n=53), calcaneonavicular coalition (CNC) (n=20), and flatfoot (n=38).

Results:

Part 1—clinical: from medical records, 38 feet (34%) had documented record of a palpable medial prominence. Of the feet reviewed with a “double medial malleolus,” all had TCC (no false positives or false negatives). Clinical and CT prominence demonstrated significant correlation (r
s=0.519, P=0.001). Part 2—radiographic: CT observation of “double medial malleolus” is significantly associated with TCC (P<0.001). CT observation of double medial malleolus is 81% sensitive and 79% specific as a predictive test for TCC. The middle facet-to-skin distance was significantly closer in those with TCC versus controls (P<0.001). The ratio was larger in patients with TCC versus CNC (P=0.006) or flatfeet (P<0.001). Volume was nearly twice the size in patients with TCC versus the controls (P<0.001).

Conclusions:

TCCs have a bony prominence below the medial malleolus on clinical exam and CT scan not present in flatfeet or CNCs. This abnormal middle facet is almost twice the size of the normal middle facet. Obesity or severe valgus may mask this finding. If a palpable bony prominence is noted just below the medial malleolus during examination of a painful foot with a decrease in subtalar motion, the likely diagnosis is TCC. With this added clinical finding, appropriate images can be ordered to confirm the diagnosis of the latter. We advise CT scans with 3D images for surgical planning. The primary finding for tarsal coalitions in textbooks is decreased subtalar motion. This new finding of a palpable enlarged medial prominence just below the medial malleolus is highly associated with TCCs.

Level of Evidence:

Level III.
rhBMP-2 and Intramedullary Fixation in Congenital Pseudarthrosis of the Tibia
Authors: Richards B. Stephens , Anderson Terrence D.
Published: June 2016

Background:

In congenital pseudarthrosis of the tibia, use of intramedullary (IM) fixation and autogenous bone graft has long been the standard of care. This study was undertaken to determine whether the addition of rhBMP-2 to this treatment method further enhances healing potential.

Methods:

Twenty-one patients with congenital pseudarthrosis of the tibia were evaluated. Fifteen of these patients had neurofibromatosis type 1 (NF1). All had IM fixation and autogenous bone graft, followed by a BMP-soaked collagen sponge wrapped around both the fracture site and bone graft. A minimum 2 years’ follow-up was required.

Results:

Follow-up averaged 7.2 years (range, 2.1 to 12.8 y). Sixteen of 21 tibias achieved bone union following the index surgery, at an average 6.6 months postoperatively. The 5 persistent nonunions occurred in NF1 patients. Further surgery was undertaken in these 5 NF1 patients, including the use of BMP. One of the 5 healed, 1 had persistent nonunion, and 3 eventually had amputation. Of the 16 patients who healed initially following the index surgery, 5 refractured (3 had NF1). Of these 5 patients, the IM fixation at the index surgery did not cross the ankle joint, and refracture occurred at the rod tip in 4. Three of these 5 patients healed following further surgery, 1 had persistent nonunion, and 1 had amputation. All of those with eventual amputation had NF1. No deleterious effects related to the use of BMP-2 were recognized in any patient.

Conclusions:

The addition of rhBMP-2 appears to be helpful in shortening the time required to achieve fracture union in those who healed, but its use does not insure that healing will occur.

Level of Evidence:

Level IV—therapeutic, case series.
Treatment of Pediatric and Adolescent Pelvic Ring Injuries With Percutaneous Screw Placement
Authors: Scolaro John A. , Firoozabadi Reza , Routt Milton L. “Chip”
Published: June 2016

Background:

Pediatric and adolescent pelvic ring injuries are frequently treated without surgery. In patients with unstable injuries to the pelvic ring, surgical stabilization aids in resuscitation, provides pain relief, and allows for mobilization. Percutaneous pelvic screw fixation is commonly performed in adult patients for unstable pelvic ring injuries, but a paucity of literature exists regarding their use in pediatric patients. The purpose of this study is to review the use, outcome, and management of percutaneous posterior pelvic screws in pediatric patients with unstable pelvic ring injuries.

Methods:

A retrospective review of a prospectively collected orthopaedic trauma database was performed over a 7-year period at a regional level-1 trauma center. All patients between the ages of 7 and 17 who sustained an injury to the pelvic ring and were treated with percutaneous fixation of the posterior pelvic ring were identified. We evaluated the frequency of this technique in the described patient population, incidence of nerve injury, infection, loss of fixation, and need for hardware removal.

Results:

A total of 238 pediatric patients who sustained a pelvic ring injury were initially identified; following application of study criteria, 67 (28.1%) patients were included in the study. Additional anterior ring fixation was performed in 33 (49.2%) patients. There were no iatrogenic nerve injuries, no infections, and surgical blood loss was <50 mL in all cases. Clinical and radiographic follow-up averaged 33 weeks. No loss of reduction was observed. Eight patients (13%) reported persistent low back pain at last follow-up. Elective hardware removal was performed in 3 patients.

Conclusions:

The majority of pediatric pelvic ring injuries can be treated without surgery. In the setting of instability, percutaneous pelvic screw fixation can be performed safely. A computed tomography scan is used to evaluate the available osseous pathways for screws and intraoperative fluoroscopy is used to safely perform this technique. Screw removal should be discussed in select patients.

Level of Evidence:

Level IV.
What’s New in Pediatric and Adolescent Anterior Cruciate Ligament Injuries?
Authors: Dekker Travis J. , Rush Jeremy K. , Schmitz Matthew R.
Published: June 2016

Background:

Anterior cruciate ligament (ACL) tears in children and adolescent patients are being diagnosed and treated at an ever-increasing rates. We performed a review of recent literature regarding care of children and adolescent athletes with an ACL injury.

Methods:

PubMed database was searched for all papers related to treatment of children and adolescents with ACL injuries from October 1, 2012 to September 30, 2015, yielding 114 publications.

Results:

A total of 59 papers were found to have contributed important new findings. Papers were selected based on new findings in the following categories: epidemiology, anatomy, risk factors, sex disparity, prevention, surgical outcomes, timing and associated pathologies, and rehabilitation and return to sport.

Conclusions:

Pediatric ACL injuries continue to rise and there are multiple surgical procedures that restore clinical function with good outcomes. Early surgical treatment is favored to prevent concomitant articular injuries. Early return to play can increase risk of reinjury and should be met with caution in this age group. Prevention strategies should be further studied and implemented in hopes of decreasing the incidence of this injury and the long-term potential damage.

Level of Evidence:

Level 4—titerature review.
Continued Growth of the Femoral Neck Leads to Improved Remodeling After In Situ Fixation of Slipped Capital Femoral Epiphysis
Authors: Örtegren Jakob , Björklund-Sand Lina , Engbom Malin , Tiderius Carl J.
Published: June 2016

Background:

Globally, the most common method for in situ fixation of slipped capital femoral epiphysis (SCFE) is a threaded screw, which causes physeal arrest. The standard treatment in Sweden is unthreaded fixation using the Hansson hook-pin, which leads to continued growth of the femoral neck. Our purpose was to study remodeling during the remaining growth after fixation with the Hansson hook-pin.

Methods:

We performed a retrospective study of 54 patients with SCFE who were treated with the Hansson hook-pin between 2001 and 2009. The immediate postoperative radiograph and the radiograph taken after physeal closure (mean interval, 34 mo) were analyzed. Three radiographic assessments were used: the head-shaft angle (HSA), the alpha angle (Nötzli), and the displacement from Klein’s line.

Results:

Significant remodeling was detected in all measured parameters. The mean postoperative HSA decreased by 9.0 degrees (P<0.001). The alpha angle improved by a mean of 14.5 degrees (P<0.001). Significant correlations were found between the reduction of the alpha angle and age (P<0.001, R=0.48) and longitudinal growth of the femoral neck (P<0.001, R=0.67). Displacement from Klein’s line increased by a mean of 1.6 mm (P=0.006).

Conclusions:

Unthreaded fixation of SCFE using the Hansson hook-pin leads to substantial remodeling of the femoral neck. The positive correlation observed between the improvement of the alpha angle and femoral neck growth supports the use of a method that allows continuous growth, to reduce the risk of femoroacetabular impingement.

Level of Evidence:

Level III—retrospective comparative study.
Detection of Femoral Neck Fractures in Pediatric Patients With Femoral Shaft Fractures
Authors: Caldwell Lindsey , Chan Charles M. , Sanders James O. , Gorczyca John T.
Published: June 2016

Background:

Ipsilateral femoral neck fractures occur in 1% to 9% of adult trauma patients with femoral shaft fractures making dedicated imaging important. This is not as clear in children. Our purpose is to establish the incidence of ipsilateral femoral neck fractures in children with femoral shaft fractures and to provide recommendations regarding diagnostic imaging protocols.

Methods:

A retrospective analysis of medical records was performed for pediatric patients (below 18 y) with femoral shaft fractures seen at our trauma center over a 10-year period. Mechanism of injury, associated injuries, procedures, and follow-up data were collected, and all radiographs reviewed. Exclusion criteria included peri-implant fractures or evidence of pathologic fracture. A similar retrospective analysis was performed in a cohort of adult patients.

Results:

Of 267 pediatric patients with femoral shaft fractures, 2 patients (0.7%) had ipsilateral femoral neck fractures. One femoral neck fracture was detected on initial plain radiographs and the other on a pelvic computed tomography (CT) scan. Both of these fractures resulted from high-energy trauma, which accounted for 92 (42%) of pediatric femoral shaft fractures. The cohort of 100 adults aged 18 to 89 years with femoral shaft fractures revealed 6 adult patients (6%) with ipsilateral femoral neck fractures, all from high-energy trauma. High-energy trauma accounted for 85% of the adult femoral shaft fractures, and was more common than in the pediatric population (P<0.005). The difference in incidence of ipsilateral femoral neck fracture between the pediatric (0.7%) and the adult group (6%) was significant (P=0.007). No missed or delayed diagnoses were identified.

Conclusions:

The incidence of associated ipsilateral femoral neck fracture in pediatric patients with femoral shaft fracture is very low (0.7%). Most (58%) pediatric femur fractures are caused by low-energy trauma. We were unable to demonstrate a need for routine CT scanning of the femoral neck in children with femoral shaft fractures. Given the increased risks of radiation exposure with younger and smaller patients, it does not appear that routine CT scanning low-energy pediatric femoral shaft fractures to evaluate for femoral neck fractures is justified unless there is a high level of clinical suspicion.

Level of Evidence:

Level II.
Improving Health Care Providers' Capacity for Self-Regulated Learning in Online Continuing Pharmacy Education: The Role of Internet Self-Efficacy
Authors: Chiu Yen-Lin , Liang Jyh-Chong , Mao Pili Chih-Min , Tsai Chin-Chung
Published: June 2016

Introduction:

Although Internet-based learning is widely used to improve health professionals' knowledge and skills, the self-regulated learning (SRL) activities of online continuing education in pharmacy are seldom discussed. The main purpose of this study was to explore the relationships between pharmacists' Internet self-efficacy (ISE) and their SRL in online continuing education.

Methods:

A total of 164 in-service pharmacists in Taiwan were surveyed with the Internet Self-Efficacy Survey, including basic ISE (B-ISE), advanced ISE (A-ISE) and professional ISE (P-ISE), as well as the Self-Regulated Learning Questionnaire consisting of preparatory SRL (P-SRL) and enactment SRL (E-SRL).

Results:

Results of a 1-by-3 (educational levels: junior college versus bachelor versus master) analysis of variance and a 1-by-4 (institutions: community-based versus hospital versus clinic versus company) analysis of variance revealed that there were differences in ISE and SRL among different education levels and working institutions. The hierarchical regression analyses indicated that B-ISE and P-ISE were significant predictors of P-SRL, whereas P-ISE was a critical predictor of E-SRL. Moreover, the interaction of P-ISE × age was linked to E-SRL, implying that P-ISE has a stronger influence on E-SRL for older pharmacists than for younger pharmacists. However, the interactions between age and ISE (A-ISE, B-ISE, and P-ISE) were not related to P-SRL.

Discussion:

This study highlighted the importance of ISE and age for increasing pharmacists' SRL in online continuing education.
Effectiveness of an Evidence-Based Quality Improvement Approach to Cultural Competence Training: The Veterans Affairs' “Caring for Women Veterans” Program
Authors: Fox Annie B. , Hamilton Alison B. , Frayne Susan M. , Wiltsey-Stirman Shannon , Bean-Mayberry Bevanne , Carney Diane , Di Leone Brooke A. L. , Gierisch Jennifer M. , Goldstein Karen M. , Romodan Yasmin , Sadler Anne G. , Yano Elizabeth M. , Yee Ellen F. , Vogt Dawne
Published: June 2016

Introduction:

Although providing culturally sensitive health care is vitally important, there is little consensus regarding the most effective strategy for implementing cultural competence trainings in the health care setting. Evidence-based quality improvement (EBQI), which involves adapting evidence-based practices to meet local needs, may improve uptake and effectiveness of a variety of health care innovations. Yet, to our knowledge, EBQI has not yet been applied to cultural competence training. To evaluate whether EBQI could enhance the impact of an evidence-based training intended to improve veterans affairs health care staff gender sensitivity and knowledge (Caring for Women Veterans; CWV), we compared the reach and effectiveness of EBQI delivery versus standard web-based implementation strategies of CWV and assessed barriers and facilitators to EBQI implementation.

Methods:

Workgroups at four diverse veterans affairs health care sites were randomized to either an EBQI or standard web-based implementation condition (SI). All EBQI sites selected a group-based implementation strategy. Employees (N = 84) completed pretraining and posttraining assessments of gender sensitivity and knowledge, and focus groups/interviews were conducted with leadership and staff before and after implementation.

Results:

Reach of CWV was greater in the EBQI condition versus the SI condition. Whereas both gender sensitivity and knowledge improved in the EBQI condition, only gender sensitivity improved in the SI condition. Qualitative analyses revealed that the EBQI approach was well received, although a number of barriers were identified.

Discussion:

Findings suggest that EBQI can enhance the uptake and effectiveness of employee trainings. However, the decision to pursue EBQI must be informed by a consideration of available resources.
Primary Retroperitoneal Mucinous Cystic Neoplasm
Authors: Dayan Danit , Abu-Abeid Subhi , Klausner Joseph M. , Sagie Boaz
Published: June 2016

Introduction

Primary retroperitoneal mucinous cystic neoplasm (PRMCN) is a rare retroperitoneal tumor with female predilection. It is classified into 3 types: benign mucinous cystadenoma (MCA), borderline mucinous cystadenoma (MCAb), malignant mucinous cystadenocarcinoma (MCAc). This study retrospectively evaluates the prevalence of PRMCN among retroperitoneal neoplasms resected between June 2006 and January 2015 at a referral center. Authors’ experience with PRMCN is reviewed, and a new case of PRMCN, incidentally diagnosed during pregnancy is reported. A literature review using PubMed is also presented, discussing several issues concerning clinicopathologic features, treatment options, and long-term outcome of PRMCN.

Case report

A 36-year-old woman was incidentally diagnosed with a 12-cm retroperitoneal cyst discovered by ultrasound at 36 weeks of gestation. Eight months later the patient was referred to the department of surgery, the Tel Aviv Sourasky Medical Center. By that time, the patient has sensed local discomfort. Physical examination revealed a right abdomen mass with mild tenderness. Computed tomographic scan depicted the cyst, located along the right paracolic gutter, displacing the right colon medially. The patient underwent complete laparoscopic resection of a 15-cm cyst, without its disruption. The cyst was drained inside an endobag and retrieved. The patient was discharged home on postoperative day 1. The pathology was MCA. Long-term result was no evidence of disease for 9 months.

Discussion

The prevalence of PRMCN among resected retroperitoneal neoplasms was 1.95% (3/154 neoplasms). The treatment of choice is complete tumor resection. Surgical technique should be chosen depending on the surgeon’s expertise and tumor factors affecting safe resection. Surgery timing during pregnancy should be dictated by both risk of malignancy and obstetric considerations. As for malignant PRMCN, radical surgery does not seem justified, especially in reproductive females. Adjuvant chemotherapy should probably be reserved for metastatic disease, recurrence, and tumor rupture. Long-term follow-up is lacking, although it is important to better define the prognosis of PRMCN.
Survival of Patients With Multiple Intracranial Metastases Treated With Stereotactic Radiosurgery
Authors: Knoll Miriam A. , Oermann Eric K. , Yang Andrew I. , Paydar Ima , Steinberger Jeremy , Collins Brian , Collins Sean , Ewend Matthew , Kondziolka Douglas
Published: June 2016

Background:

Defining prognostic factors is a crucial initial step for determining the management of patients with brain metastases. Randomized trials assessing radiosurgery have commonly limited inclusion criteria to 1 to 4 brain metastases, in part due to multiple retrospective studies reporting on the number of brain metastases as a prognostic indicator. The present study reports on the survival of patients with 1 to 4 versus ≥5 brain metastases treated with radiosurgery.

Methods:

We evaluated a retrospective multi-institutional database of 1523 brain metastases in 507 patients who were treated with radiosurgery (Gamma Knife or Cyberknife) between 2001 and 2014. A total of 243 patients were included in the analysis. Patients with 1 to 4 brain metastases were compared with patients with ≥5 brain metastases using a standard statistical analysis. Cox hazard regression was used to construct a multivariable model of overall survival (OS). To find covariates that best separate the data at each split, a machine learning technique Chi-squared Automated Interaction Detection tree was utilized.

Results:

On Pearson correlation, systemic disease status, number of intracranial metastases, and overall burden of disease (number of major involved organ systems) were found to be highly correlated (P<0.001). Patients with 1 to 4 metastases had a median OS of 10.8 months (95% confidence interval, 6.1-15.6 mo), compared with a median OS of 8.5 months (95% confidence interval, 4.4-12.6 mo) for patients with ≥5 metastases (P=0.143). The actuarial 6 month local failure rate was 5% for patients with 1 to 4 metastases versus 3.2% for patients with ≥5 metastases (P=0.404). There was a significant difference in systemic disease status between the 2 groups; 30% of patients had controlled systemic disease in the <5 lesions group, versus 8% controlled systemic disease in the ≥5 lesions group (P=0.005). Patients with 1 to 4 metastases did not have significantly improved OS in a multivariable model adjusting for systemic disease status, systemic extracranial metastases, and other key variables. The Chi-squared Automated Interaction Detection tree (machine learning technique) algorithm consistently identified performance status and systemic disease status as key to disease classification, but not intracranial metastases.

Conclusions:

Although the number of brain metastases has previously been accepted as an independent prognostic indicator, our multicenter analysis demonstrates that the number of intracranial metastases is highly correlated with overall disease burden and clinical status. Proper matching and controlling for these other determinants of survival demonstrates that the number of intracranial metastases alone is not an independent predictive factor, but rather a surrogate for other clinical factors.
Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial
Authors: Turner Judith A. , Anderson Melissa L. , Balderson Benjamin H. , Cook Andrea J. , Sherman Karen J. , Cherkin Daniel C.
Published: June 2016

Cognitive behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with chronic low back pain (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (nonreactivity, nonjudging, and acting with awareness; allPvalues <0.01). Acceptance was associated positively with self-efficacy (P< 0.01) and mindfulness (Pvalues <0.05) measures. Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC (omnibusP= 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibusP= 0.001). In both the entire randomized sample and the subsample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain.
The Pain Course: exploring predictors of clinical response to an Internet-delivered pain management program
Authors: Dear B.F. , Gandy M. , Karin E. , Ricciardi T. , Langman N. , Staples L.G. , Fogliati V.J. , Sharpe L. , McLellan L.F. , Titov N.
Published: June 2016

There is significant interest in the potential of Internet-delivered pain management programs for adults with chronic pain. Understanding the characteristics of people who do and do not benefit from Internet-delivered programs will help to guide their safe and effective use. Using a large sample from a previous randomised controlled trial of an established Internet-delivered pain management program, the Pain Course, this study (n = 463) examined whether several demographic, clinical, psychological, and treatment-related variables could be used to predict clinical response in levels of disability, depression, anxiety, or average pain. Multiple univariate and multivariate stepwise logistic regressions were used to identify unique predictors of clinical improvement, which, consistent with recommendations, was defined as a ≥30% reduction in symptoms or difficulties from baseline. Several unique predictors of clinical improvement were found. However, no particularly decisive or dominant predictors emerged that were common across time points or across the outcome domains. Reflecting this, the identified predictors explained only 18.1%, 13.7%, 7.6%, and 9.5% of the variance in the likelihood of making a clinical improvement in disability, depression, anxiety, and average pain levels, respectively. The current findings suggest that a broad range of patients may benefit from emerging Internet-delivered pain management programs and that it may not be possible to predict who will or will not benefit on the basis of patients' demographic, clinical, and psychological characteristics.
Personalized treatment approach to gastroenteropancreatic neuroendocrine tumors: a medical oncologist’s perspective
Authors: Paul Davinder , Ostwal Vikas , Bose Subhadeep , Basu Sandip , Gupta Sudeep
Published: June 2016

The medical management of gastroenteropancreatic neuroendocrine tumors involves treatment of symptomatic disease related to hormone secretions or bulky unresectable metastatic disease. Combining gallium DOTA with fluorine-18 fluorodeoxyglucose-PET along with histopathological grading helps to determine tumor heterogeneity and seek reasons for poor response to therapy. In the light of adding chemotherapy in selected patients with intermediate-grade tumors, the newer scan helps in personalization of the therapy along with the biopsy. The tumor dedifferentiation over the particular time period leading to aggressive behavior, a well-known entity, is contrasted with the redifferentiation phenomenon in some patients as a result of chemotherapy or targeted drug therapy. This may support the basis for combining peptide receptor-targeted radiotherapy/octreotide therapy with chemotherapy or mTOR inhibitors such as everolimus.
Simulation in craniomaxillofacial training
Authors: Meara Daniel J. , Coffey Zern Susan
Published: June 2016

Purpose of review

Simulation in healthcare is no longer a novel idea. Simulation continues to rapidly permeate and transform both clinical practice and medical education. Craniomaxillofacial surgery is comprised of multiple surgical disciplines, including neurosurgery, plastic surgery, otolaryngology, ophthalmology, and oral and maxillofacial surgery. All of these specialties are performing surgery in an era of evolving technology, cost containment, reduced resident work hours, and a focus on patient safety. As a result, the purpose of this manuscript is to review the most recent literature and trends in craniomaxillofacial surgery simulation as it pertains to advances in: teaching methodology, technology for training, and professional development, including lifelong learning and certificate maintenance.

Recent findings

The Halstedian model of education is no longer valid in isolation as simulation continues to evolve. Advances are occurring in craniomaxillofacial simulation fidelity, via technology, validation, and implementation, though significant opportunity still exists toward total integration into training, as procedural models are limited.

Simulation in craniomaxillofacial training is not fully pervasive or integrated, but evidence exists that simulation is rapidly evolving via improvements in innovation, fidelity, teaching methodology, and ultimately, commitment to simulation as a means to improve surgical education as well as patient safety and quality.
Update in alar base reduction in rhinoplasty
Authors: Lima Leila Freire Rego , Arroyo Helena Hotz , Jurado José Roberto Parisi
Published: June 2016

Purpose of review

The purpose of this article is to further explore the techniques available for alar base reduction by a recent review in this topic, focusing in the current advances in the field, in a clear and readable format.

Recent findings

Among the numerous techniques available, the management of cases with wide nasal base and alar flaring remains limited to three options: cinching sutures to pull in the alae together; or to use alar base excisions that remove tissue from the alar lobule to decrease flare and from inside the nostril to decrease width; and flap advancement.

Surgical modification of the nasal base is not a routine part of rhinoplasty and should be performed in a conservative manner to prevent complications like nasal stenosis. Moreover, this maneuver should always be the last one in rhinoplasty, as alar base modifications cannot be properly assessed until all other steps have been carried out.

Video abstract

http://links.lww.com/COOH/A24
Four-dimensional MRI flow examinations in cerebral and extracerebral vessels – ready for clinical routine?
Authors: Schnell Susanne , Wu Can , Ansari Sameer A.
Published: June 2016

Purpose of review

To evaluate the feasibility of 4-dimensional (4D) flow MRI for the clinical assessment of cerebral and extracerebral vascular hemodynamics in patients with neurovascular disease.

Recent findings

4D flow MRI has been applied in multiple studies to qualitatively and quantitatively study intracranial aneurysm blood flow for potential risk stratification and to assess treatment efficacy of various neurovascular lesions, including intraaneurysmal and parent artery blood flow after flow diverter stent placement and staged embolizations of arteriovenous malformations and vein of Galen aneurysmal malformations. Recently, the technique has been utilized to characterize age-related changes of normal cerebral hemodynamics in healthy individuals over a broad age range.

4D flow MRI is a useful tool for the noninvasive, volumetric and quantitative hemodynamic assessment of neurovascular disease without the need for gadolinium contrast agents. Further improvements are warranted to overcome technical limitations before broader clinical implementation. Current developments, such as advanced acceleration techniques (parallel imaging and compressed sensing) for faster data acquisition, dual or multiple velocity encoding strategies for more accurate arterial and venous flow quantification, ultrahigh-field strengths to achieve higher spatial resolution and streamlined postprocessing workflow for more efficient and standardized flow analysis, are promising advancements in 4D flow MRI.
The nonmotor features of Parkinson's disease: pathophysiology and management advances
Authors: Reichmann Heinz , Brandt Moritz D. , Klingelhoefer Lisa
Published: June 2016

Purpose of review

In recent years progress has been made in the detection and evaluation of nonmotor symptoms in Parkinson's disease. The pathophysiology is better understood and new treatment is available, which will be discussed in this review.

Recent findings

The most intriguing recent finding is the fact that Parkinson's disease may be a spreading disease. From the environment a toxin, bacteria, or virus may start in genetically susceptible patients a cascade of α-synuclein aggregation which reaches via the olfactory and the enteric system of the gut the brain where further spreading causes symptoms, such as sleep disturbances, motor impairment, and neuropsychiatric symptoms. New treatment should address the abnormal α-synuclein folding. If this would be achieved premotor signs, such as hyposmia, rapid eye movement-sleep behavior disorder, constipation, or depression may be a kind of biomarkers which allow together with other diagnostic tools, such as parenchymal sonography, iodobenzamide-scintigraphy and dopamine transporter scans the prediction whether somebody might be under way to develop the full-blown Parkinson's disease syndrome.

Parkinson's disease seems to be a spreading disease which causes not only a dopaminergic deficit as major cause for the movement disorder but also impairs function of many other brain centers which leads to a multitransmitter malfunction.
Therapeutic Implications of Peripheral Nerve Hyperexcitability in Muscle Cramping: A Retrospective Review
Authors: Hurst Rebecca L. , Hobson-Webb Lisa D.
Published: June 2016

Purpose:

Muscle cramping due to peripheral nerve hyperexcitability (PNH) is poorly characterized. This retrospective study examines the prevalence of PNH and response to treatment.

Methods:

The Duke EMG Database was queried to identify patients with muscle cramping tested for PNH from 2010 to 2015. Peripheral nerve hyperexcitability was defined by compound muscle action potential after-discharges on repetitive nerve stimulation. Response to treatment was determined by the treating physician's clinical impression 6 months after diagnosis or last documented visit.

Results:

Seventy-two patients met inclusion criteria. Twenty-three (32%) patients had electrodiagnostic evidence of PNH. Of the patients with PNH, 74% had a good response to treatment whereas 37% of treated patients in the PNH-negative group (P = 0.0258). Carbamazepine and gabapentin were the most frequently used treatments with response rates of 70% and 77%, respectively.

Conclusion:

Muscle cramps associated with PNH respond well to symptomatic treatment, particularly with carbamazepine and gabapentin.
The B-cell response to foot-and-mouth-disease virus in cattle following vaccination and live-virus challenge
Authors: Grant Clare F. J. , Carr B. Veronica , Singanallur Nagendrakumar B. , Morris Jacqueline , Gubbins Simon , Hudelet Pascal , Ilott Martin , Charreyre Catherine , Vosloo Wilna , Charleston Bryan
Published: June 2016

Antibodies play a pivotal role against viral infection, and maintenance of protection is dependent on plasma and memory B-cells. Understanding antigen-specific B-cell responses in cattle is essential to inform future vaccine design. We have previously defined T-cell-dependent and -independent B-cell responses in cattle, as a prelude to investigating foot-and-mouth-disease-virus (FMDV)-specific B-cell responses. In this study, we have used an FMDV O-serotype vaccination (O1-Manisa or O SKR) and live-virus challenge (FMDV O SKR) to investigate the homologous and heterologous B-cell response in cattle following both vaccination and live-virus challenge. The FMDV O-serotype vaccines were able to induce a cross-reactive plasma-cell response, specific for both O1-Manisa and O SKR, post-vaccination. Post-FMDV O SKR live-virus challenge, the heterologous O1-Manisa vaccination provided cross-protection against O SKR challenge and cross-reactive O SKR-specific plasma cells were induced. However, vaccination and live-virus challenge were not able to induce a detectable FMDV O-serotype-specific memory B-cell response in any of the cattle. The aim of new FMDV vaccines should be to induce memory responses and increased duration of immunity in cattle.
Myocarditis in Mediterranean spotted fever: a case report and a review of the literature
Authors: Colomba Claudia , Siracusa Lucia , Trizzino Marcello , Gioè Claudia , Giammanco Anna , Cascio Antonio
Published: June 2016

Introduction:

Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused byRickettsia conorii. Most cases follow a benign course, with a case fatality rate of 3–7 % among hospitalized patients. Complications are described mainly in adult patients and include hepatic, renal, neurological and cardiac impairment. Among cardiac complications, pericarditis, myocarditis and heart rhythm disorders are uncommon complications in MSF and only a few cases have been reported in the literature.

Case Presentation:

We describe a new case of acute myocarditis complicating MSF in an immunocompetent adult patient without risk factors for severe MSF.

Conclusion:

Myocarditis is an uncommon but severe complication of MSF. Clinicians should be aware of a possible cardiac involvement in patients with MSF. Close monitoring and an aggressive approach are essential to reduce mortality rates of MSF.
Granulicatella adiacens prosthetic hip joint infection after dental treatment
Authors: Aweid Osama , Sundararajan Sabapathy , Teferi Abraham
Published: June 2016

Introduction:

Granulicatella adiacens is a Gram-positive bacteria and a normal component of oral flora. It is also found in dental plaques, endodontic abscesses and can rarely cause more serious infections.

Case presentation:

We describe a prosthetic hip joint infection in an 81-year-old fit and healthy man due to Granulicatella adiacens who underwent a prolonged dental intervention two days earlier without antibiotic prophylaxis. The infection was successfully treated with surgical intervention and a combination of antibiotics. The patient eventually succumbed to severe community-acquired pneumonia two months later.

Conclusion:

Current guidelines recommend avoidance of antibiotic prophylaxis prior to dental treatment in patients who have no co-morbidities and no prior operation on the index prosthetic joint. This case report indicates that infections of prosthetic joints may be associated with dental procedures even in fit and healthy patients without the recognized risk factors.
Contact, travel, and transmission: The impact of winter holidays on influenza dynamics in the United States
Authors: Ewing Anne , Lee Elizabeth C. , Viboud Cécile , Bansal Shweta
Published: June 2016

Background

The seasonality of influenza is thought to vary according to environmental factors and human behavior. During winter holidays, potential disease-causing contact and travel deviate from typical patterns, and we aim to understand these changes on age-specific and spatial flu transmission.

Methods

We characterized the changes to transmission and epidemic trajectories among children and adults in a spatial context before, during, and after the winter holidays among aggregated physician medical claims in the United States from 2001 to 2009 and among synthetic data simulated from a deterministic, age-specific spatial metapopulation model.

Results

Winter holidays reduced flu transmission and delayed the trajectory of flu season epidemics. The holiday period itself observed a shift in relative risk of disease from children towards adults. Model results indicated that holidays delay epidemic peaks and synchronize incidence across locations, and contact reductions from school closures rather than age-specific mixing and travel produce these observed holiday dynamics.

Conclusions

Winter holidays delay seasonal influenza epidemic peaks due to changes in contact patterns. These findings may improve the future design of influenza intervention strategies, such as the proper timing and duration of school closures, and the spatial and demographic allocation of vaccines.
Crystal structure of (acetato-κO)(ethanol-κO)[(9S,17S,21S,29S)-9,17,21,29-tetrahydroxy-18,30-dioxaoctacyclo[18.10.0.02,7.08,19.09,17.011,16.021,29.023,28]triaconta-1,3,5,7,11(16),12,14,19,23(28),24,26-undecaene-10,22-dione-κ3O18,O21,O22]caesium ethanol monosolvate
Authors: Bengiat Ravell , Gil Maayan , Klein Asne , Bogoslavsky Benny , Cohen Shmuel , Yardeni Guy , Zilbermann Israel , Almog Joseph
Published: June 2016

The title compound, [Cs(CH3COO)(C28H16O8)(C2H5OH)]·C2H5OH, is the product of the complexation between one vasarene analogue [1], bis ninhydrin naphthalene-1,3-diol and CsF, where the F−ion has reacted with residual acetic acid (AcOH), to form a [1]·CsOAc complex. The intermolecular interactions with the multiple oxygen-containing functional groups of the ligand, as well as O—H...O hydrogen bonds involving the ethanol solvent molecules, stabilize the complex, forming a chain along [100]. Additional parallel-displaced π–π stacking, with an interplanar distance of 3.669 (1) Å, connect several unit cells in a three-dimensional supramolecular structure, though, the larger size of AcO−(1.60 Å) compared to F−(1.33 Å) prevents the tight packing that was once achieved with other vasarene complexes of CsF.
[K(18-crown-6)][FeCp*(CO)2]
Authors: Mizuhata Yoshiyuki , Yanagisawa Tatsuya , Sasamori Takahiro , Tokitoh Norihiro
Published: June 2016

The title compound, (1,4,7,10,13,16-hexaoxacyclooctadecane-κ6O)potassium dicarbonyl(η5-pentamethylcyclopentadienyl)ferrate(II), [K(C12H24O6)][Fe(C10H15)(CO)2], consists of K+cations embedded in 18-crown-6 molecules and [FeCp*(CO)2]−anions. Cations and anions form ion pairs which are linked by weak C—H...O interactions.
Adapted DBT programme for individuals with intellectual disabilities and problems managing emotions: staff awareness training
Authors: Ashworth Sarah , Mooney Paul , Tully Ruth
Published: June 2016

Purpose

– The purpose of this paper is to present the development and evaluation of an original training package for staff members on an awareness of an adapted Dialectical Behaviour Therapy programme, the “I Can Feel Good” programme (Ingamells and Morrissey, 2014) designed for individuals with intellectual disabilities (ID) and problems managing emotions. The quality and effectiveness of the training was assessed and is reported in this paper.

Design/methodology/approach

– The training was delivered for staff working with individuals with ID in a UK medium-secure psychiatric hospital and was attended by nursing staff. The workshop consisted of six modules: “Introduction to the programme”, “Mindfulness”, “Managing feelings”, “Coping in Crisis”, “People skills” and “Application and summary”. Level of self-reported knowledge, confidence and motivation regarding seven aspects of the training was measured by an evaluation questionnaire completed pre and post training.

Findings

– The results of this study showed that following the training there was a significant increase in self-reported knowledge, confidence and motivation regarding the seven aspects of the training. When perceptions of staff behaviours are observed, although in the right direction, this change was found not to be significant.

Originality/value

– This study highlights the potential for staff training to increase awareness of newly adapted therapeutic programmes for individuals with ID. The staff training may increase their ability and willingness to facilitate the running of such programmes and ability to support learning transfer in group members.
Hyundai Motors India Limited: positioning towards market leadership
Authors: Kainth Jyoti , Mathur Tanmay
Published: June 2016

Subject area:

Marketing Management, Product Management, Marketing Strategy.

Study level/applicability

Bachelor of Business Studies, MBA, Executive MBA.

Case overview

The case throws light on the intensely competitive Indian passenger car market and its unique challenges faced by Hyundai Motors India Limited (HMIL). It tries to capture the evolution of this dynamic industry, which is characterized by regular product launches and re-positioning efforts. The students are expected to assess the performance of HMIL and the success of its positioning efforts through multiple quantitative and qualitative data points given in the case. The students need to come up with recommendations whether, amidst intense competition, Government regulations and changing consumer expectations, HMIL should launch new products in its portfolio? If, yes, in which segments? And what should be the guiding philosophy behind such product launches?

Expected learning outcomes

The case is expected to guide students: 1. in comprehending the various macro-environmental factors that has made India an attractive passenger car market to invest and operate in, to virtually all multinational players across all segments; 2. in analyzing how the passenger car market is segmented in India; 3. in assessing the product-driven segment-wise performance by HMIL specifically and organizations in general and what are its implications on decision-making; this is indicative of the brand portfolio management based on BCG Brand/Product Portfolio Growth Share Matrix; 4. in assessing the impact of re-positioning on the firms performance judged before and after the re-positioning efforts by the firm; 5. in analyzing the market potential of SUVs and MUVs in India and whether HMIL should launch new products/brands for these segments; and 6. in deliberating on the guiding philosophy in new product launches around the concept of “Consumer Perceived Value”.

Supplementary materials

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Subject code

CSS 8: Marketing.
Barriers to employee training in small and medium sized enterprises
Authors: Padachi Kesseven , Lukea Bhiwajee Soolakshna
Published: June 2016

Purpose

Training is an important component of successful business concerns. However, although there is growing acceptance amongst scholars that small- and medium-sized enterprises (SMEs) are engines that drive economies across nations, through their contribution in terms of job creation and poverty reduction; extant research portray that these organisations often lack the resources required to undertake training. Mauritius, as a small island developing state, is not an exception. Similar to other economies, the Mauritian business landscape is characterised by a larger number of SMEs, representing 97 per cent of the business stock and accounting for nearly 47 per cent of the national workforce. To ensure a smooth transition along the business life cycle and fulfil their objectives, it becomes important to gauge into the training practices of these SMEs. This paper therefore aims to investigate into the barriers which SMEs face in the provision of training to their employees in the Republic of Mauritius.

Design/methodology/approach

Through a survey questionnaire, the study attempted, inter alia, to mainly identify the importance and perception that owner managers of SMEs attach to the concept of training and, consequently, identifies the various barriers faced by the SMEs to impart training.

Findings

Data obtained were analysed using SPSS 20.0 through descriptive statistics and inferential statistics. The analysis of the findings showed that training practices among SMEs in Mauritius rhymes with extant general literature.

Originality/value

Research pertaining to SMEs is still in a state of infancy in the Republic of Mauritius, without mentioning that it is practically non-existent as far as the training function is concerned. This paper thus attempts to provide both policymakers and researchers’ scientific data regarding the barriers which SMEs face when indulging in training.