bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous, Perioperatively Administered Lidocaine Regulates Serum Pain Modulators’ Concentrations in Children Undergoing Spinal Surgery
Authors: Kościelniak-Merak Barbara , Batko Ilona , Kobylarz Krzysztof , Sztefko Krystyna , Tomasik Przemysław J 
Published: July 2019

AbstractObjectivesWe analyzed the influence of perioperative, intravenous (i.v.) lidocaine infusion as a part of multimodal anesthesia on concentrations of selected pain modulators.DesignAn observational study.SettingUniversity Children’s Hospital in Cracow, Poland, from May 2015 to May 2018.SubjectsForty-four children undergoing extensive spinal surgery, divided into two groups after surgery: the study group (N = 23), anesthetized generally with lidocaine as a co-analgesic, and the control group (N = 22), anesthetized generally without lidocaine.MethodsWe assessed proinflammatory mediators like neuron growth factor (NGF), high mobility group box 1 (HMGB1), interleukin 6 (IL-6), and FOS protein before, immediately after, six hours and 12–15 hours after surgery. We evaluated pain intensity at corresponding time points using a 10-point numerical/graphical scale.ResultsWe observed that children in the lidocaine group had reduced pain intensity in the resting state and during movement until six hours after surgery when compared with controls. We found lower NGF concentrations in the lidocaine group vs controls only at six hours after surgery. Mean HMGB1 concentrations during the postoperative period in the study group were relatively stable, whereas we observed significant increases at six hours after surgery and a slight decrease at 12–15 hours after surgery in the control group. IL-6 concentrations at six hours were lower in lidocaine patients when compared with controls. We noted a negative correlation between HMGB1, NGF, Il-6, and lidocaine concentrations after surgery. We did not find any differences in FOS protein concentrations between the groups.ConclusionsOur findings suggest that intraoperative and postoperative i.v. lidocaine administration as a part of multimodal anesthesia may reduce inflammatory-dependent postoperative pain intensity.
Lessons learned in the provision NCD primary care to Syrian refugee and host communities in Lebanon: the need to ‘act locally and think globally’
Authors: Sibai Abla M , Najem Kteily Martine , Barazi Rana , Chartouni Mia , Ghanem Maguy , Afifi Rima A 
Published: July 2019

ABSTRACT

Background
Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations.

Methods
Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness.

Results
Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines’ supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program.

Conclusions
Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more ‘local testing’ of modified interventions within such contexts. This can then inform ‘thinking globally’ on guidelines for the delivery of NCD care in crisis settings.
A Transaction-Cost Perspective on the Multitude of Firm Characteristics
Authors: DeMiguel Victor , Martín-Utrera Alberto , Nogales Francisco J , Uppal Raman 
Published: July 2019

Abstract
We investigate how transaction costs change the number of characteristics that are jointly significant for an investor’s optimal portfolio and, hence, how they change the dimension of the cross-section of stock returns. We find that transaction costs increase the number of significant characteristics from 6 to 15. The explanation is that, as we show theoretically and empirically, combining characteristics reduces transaction costs because the trades in the underlying stocks required to rebalance different characteristics often cancel out. Thus, transaction costs provide an economic rationale for considering a larger number of characteristics than that in prominent asset-pricing models.
Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Circadian regulation of sleep in a pre-clinical model of Dravet syndrome: dynamics of sleep stage and siesta re-entrainment
Authors: Sanchez Raymond E A , Bussi Ivana L , Ben-Hamo Miriam , Caldart Carlos S , Catterall William A , De La Iglesia Horacio O 
Published: July 2019

Abstract

Study Objectives
Sleep disturbances are common co-morbidities of epileptic disorders. Dravet syndrome (DS) is an intractable epilepsy accompanied by disturbed sleep. While there is evidence that daily sleep timing is disrupted in DS, the difficulty of chronically recording polysomnographic sleep from patients has left our understanding of the effect of DS on circadian sleep regulation incomplete. We aim to characterize circadian sleep regulation in a mouse model of DS.

Methods
Here we exploit long-term electrocorticographic recordings of sleep in a mouse model of DS in which one copy of the Scn1a gene is deleted. This model both genocopies and phenocopies the disease in humans. We test the hypothesis that the deletion of Scn1a in DS mice is associated with impaired circadian regulation of sleep.

Results
We find that DS mice show impairments in circadian sleep regulation, including a fragmented rhythm of non-rapid eye movement (NREM) sleep and an elongated circadian period of sleep. Next, we characterize re-entrainment of sleep stages and siesta following jet lag in the mouse. Strikingly, we find that re-entrainment of sleep following jet lag is normal in DS mice, in contrast to previous demonstrations of slowed re-entrainment of wheel-running activity. Finally, we report that DS mice are more likely to have an absent or altered daily “siesta”.

Conclusions
Our findings support the hypothesis that the circadian regulation of sleep is altered in DS and highlight the value of long-term chronic polysomnographic recording in studying the role of the circadian clock on sleep/wake cycles in pre-clinical models of disease.
Sexual Laborers and Entrepreneurial Women: Articulating Collective Identity in India’s HIV/AIDS Response
Authors: Vijayakumar Gowri 
Published: July 2019

AbstractThis article uses ethnographic and interview methods to compare two groups of sex workers in Bangalore, both of which formed during the response to the HIV/AIDS epidemic. In this context, donor priorities fundamentally shaped the landscape for sex worker organizations, but the two groups formed very different collective identities. I argue that the content of collective identity is not predetermined by the conditions set by global Northern funding. Instead, I show how collective identity is articulated, in a locally specific process of relating political orientations to local associational fields, within, but not predetermined by, global funding constraints. As each group positioned itself in a distinct local associational field, it articulated a distinct collective identity, the Women’s Collective as entrepreneurial women (a more respectable collective identity), and the Union as sexual laborers (a more transgressive one). Articulation unfolded through material as well as symbolic processes, shaping members’ life trajectories and their understandings of them. This article complicates accounts of Northern funding and institutional opportunities as predetermining the paths and visions of social movements.
Osteosynthesis Technique for Periprosthetic Femoral Fractures: A Case of Interprosthetic Fracture Between a Total Knee Arthroplasty and a Dynamic Hip Screw
Authors: Page Jessica L. , Leighton Ross K. 
Published: July 2019

Summary:
Periprosthetic fractures remain a challenging component of every trauma practice. Total joints have become common in very elderly patients, creating a variety of implanted stress risers that make subsequent fractures unique challenges to address. This creates the need to build a construct that will allow for early weight bearing while trying to reduce the potential for further fractures in the same bone. A minimally invasive submuscular approach with long periprosthetic locking plates can be used for a periprosthetic femoral fracture.

Video available at:
http://links.lww.com/JOT/A803
Managing the Endosteal Fibula During Arthroplasty for Proximal Humeral Fracture Sequelae
Authors: Amini Michael H. 
Published: July 2019

Summary:Augmentation of proximal humeral fracture fixation with an endosteal fibular allograft has increased in popularity because it biomechanically improves construct stability and potentially may lead to a lower rate of humeral head collapse. However, the potential need for arthroplasty after proximal humeral fracture fixation may still arise. Placing a humeral stem in the presence of an existing intramedullary fibular graft is challenging because the fibula is dense cortical bone and is typically well-integrated by the time an arthroplasty would be performed. Some have proposed burring the proximal humerus open to receive a stem, or using cannulated intramedullary reamers until a humeral stem can be placed. These steps are tedious and inefficient. We have found the most efficient technique as treating the fibula as if it were a well-fixed humeral stem: freeing it up from the native bone and removing it in its entirety.Video available at:http://links.lww.com/JOT/A802
Attention-Deficit Hyperactivity Disorder, Disruptive Behaviors, and Drug Shortage
Authors: Hastings Elizabeth , Poon Jennifer , Robert Sophie , Nyp Sarah S. 
Published: July 2019

CASE:
Kyle is a 10-year-old boy with Down syndrome and intellectual disability who is being followed up by a developmental behavioral pediatrician for attention-deficit hyperactivity disorder (ADHD) and anxiety. Kyle was initially taking a long-acting liquid formulation of methylphenidate for ADHD and fluoxetine for anxiety. Several months ago, the liquid formulation was on back order, and the methylphenidate formulation was changed to an equal dose of a long-acting capsule. Kyle is not able to swallow pills; therefore, the contents of the capsule were sprinkled onto 1 bite of yogurt each morning. Over the course of the next month, Kyle's behaviors became increasingly difficult. He was not able to tolerate loud or crowded places, and despite a visual schedule and warnings, he would become aggressive toward adults when directed to transition away from preferred activities. Fluoxetine was increased from 0.4 to 0.6 mg/kg/day at that time.
One month later, his parents reported that although there may have been slight improvement in Kyle's irritability since the increase in fluoxetine, they felt he was nonetheless more aggressive and less cooperative than his previous baseline. Kyle was returned to the long-acting liquid formulation of methylphenidate at that time, and a follow-up was scheduled 2 weeks later.
On return to clinic, his parents reported that Kyle's behaviors had continued to become increasingly difficult. He was described as uncooperative and aggressive at home and school. Kyle was easily upset any time he was not given his way, his behavior was corrected, or he felt that he was not the center of attention. When upset, he would yell, bite, kick, spit, or throw his body to the ground and refuse to move. At 110 pounds, Kyle's parents were no longer able to physically move his body when he dropped to the ground. This was a safety concern for his parents because he had displayed this behavior in the parking lot of a busy shopping area. Because of Kyle's aggressive and unpredictable behavior, parents no longer felt comfortable taking him to public places. Family members who had previously been comfortable staying with Kyle while his parents were out for short periods would no longer stay with him. Overall, the behaviors resulted in parents being unable to go to dinner as a couple or provide individual attention to their other children. The parents described the family as “on edge.” How would you approach Kyle's management?
Maximizing Plastic Surgery Education Impact: Lessons from Resident Learning Styles and Experiential Learning Theory
Authors: Saldanha Francesca Y. L. , Levites Heather A. , Staffa Steven J. , Roussin Christopher , Allori Alexander C. , Rogers-Vizena Carolyn R. 
Published: July 2019

Background:
Residents in many surgical disciplines express a strong preference for hands-on learning, but no studies have focused on plastic surgery. This initial study aims to ascertain the learning styles of plastic surgery residents, and identify potential trends that may better guide curriculum development.

Methods:
Kolb Learning Style Index v. 3.1 was administered to plastic surgery residents across all training levels at three residency programs. The Kolb Learning Style Index is a 12-item questionnaire that characterizes an individual’s learning style into 1 of 4 major categories: converging; accommodating; assimilating; and diverging.

Results:
The surveyed cohort of plastic surgery residents (n = 45) demonstrated a diverse mix of learning styles: converging (38%, n = 17); accommodating (24%, n = 11); diverging (20%, n = 9); and assimilating (16%, n = 7). One resident was balanced between converging and accommodating (2%, n = 1). Despite varied learning styles, the majority (64%, n = 29) demonstrated a preference for “active experimentation,” for example, hands-on learning.

Conclusions:
A preliminary assessment of learning styles among plastic surgery residents suggests that they have mixed learning styles. This contrasts with the existing literature from other surgical specialties where a single learning style dominates. However, like these other specialties, active experimentation is particularly valued. As such, it behooves the plastic surgery educator to continue to strive for balance between book learning and hands-on experience for residents at all levels of training, to engage residents with all learning styles.
Nipple-Sparing Mastectomy and Prepectoral Implant/Acellular Dermal Matrix Wrap Reconstruction in Large Ptotic Breasts
Authors: Khalil Haitham H. , Malahias Marco N. , Youssif Sherif , Ashour Tarek , Rhobaye Saif , Faroq Tahir 
Published: July 2019

Summary:
Nipple-sparing mastectomy (NSM) with simultaneous prepectoral direct to implant reconstruction and acellular dermal matrix (ADM) is increasingly offered to patients opting for prophylactic or therapeutic mastectomies. The recent introduction of prepectoral implant/ADM in the armamentarium of breast reconstruction has proven to reduce pain and animation deformity. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat. More often they would require secondary corrective procedures and can experience high failure rate and unsatisfactory outcomes. The authors present their experience in utilizing a bipedicled nipple-areola complex dermal flap through Wise pattern to achieve a successful NSM with prepectoral implant/ADM (Braxon) wrap (IBW) as a single stage in patients with large ptotic breasts. Patients seeking NSM with large ptotic breasts were included in the study in the period between 2016 and 2018. They were offered a single-stage Wise pattern NSM and immediate prepectoral IBW breast reconstruction. The technique and outcomes were recorded. Sixteen reconstructions were performed in 8 women with a median age of 32 years (range, 27–50 years) and a median body mass index of 32 kg/m2 (range, 29–39 kg/m2). The resected breasts weight ranged from 750 to 1,600 g (median, 890 g). All procedures were completed successfully with no nipple-areola complex necrosis or failure experienced during the follow-up period (range, 3–24 months) with all patients reported excellent satisfaction. The authors’ results demonstrate that this technique could be safely planned for NSM in large ptotic breasts with excellent durable outcomes.
The Double-reverse Wedge Excision Technique: A Novel Approach to Reconstruction of Stahl’s Ear Deformity
Authors: Sinnott Catherine J. , Boutros Christina , Davenport Thomas A. , Ruotolo Rachel A. 
Published: July 2019

Summary:
Stahl’s ear deformity presents with an abnormal third crus of the antihelix and varying degrees of severity. This paper aims to describe a novel technique for reconstruction of Stahl’s ear involving a double-reverse wedge excision of the third crus cartilage and skin, as well as use of Mustardé sutures to recreate the superior crus and Furnas sutures to complete the auricular setback. This novel technique for correction of Stahl’s ear deformity produces a more stable aesthetic result versus classic otoplasty with desired auricular setback, minimal reduction in the size of the ear, and limited scarring on the anterior auricular surface. Reconstruction of Stahl’s ear deformity can be accomplished using this double-reverse wedge excision technique of the third crus cartilage and skin with Mustardé and Furnas sutures to recreate the superior crus and complete auricular setback, effectively restoring anatomic harmony to the ear.
Congenital Amniotic Constriction Band of the Pelvis: First Reported Case and Proposed Classification Criterion
Authors: Graham Emily , Garlick Jared W. , Johns Dana 
Published: July 2019

Summary:
Congenital amniotic band syndrome (ABS) is a complex disorder characterized by a spectrum of rare congenital anomalies, with constriction bands as their hallmark manifestation. Constriction bands about the thorax, abdomen, or pelvis are rare. There is no consensus in the classification criterion for constriction bands of the thorax, abdomen, or pelvis in the literature. We present the first true pelvic constriction band in a newborn female with ABS. This case adds valuable information to the literature on ABS. The authors propose a classification criterion to further classify constriction bands of the thorax, abdomen, and pelvis using accepted and reliable anatomical landmarks.
A Two-step Technique for Neo-umbilicoplasty in the Abdominal Reconstructive Population
Authors: Ngaage Ledibabari M. , Kokosis George , Kachniarz Bartlomiej , Pedreira Rachel , Rada Erin M. , Nam Arthur J. , Pearl Jonathan , Kavic Stephen , Rasko Yvonne M. 
Published: July 2019

Summary:
The umbilicus is the centerpiece of the abdomen and an important cosmetic landmark. Secondary intention healing can be used to create the illusion of an umbilicus in reconstructive surgery. However, there is a sparsity of literature on the role of neo-umbilicoplasty in this subset of patients and how they perceive their new umbilicus. We conducted a retrospective review of patients who received a neo-umbilicus during an abdominal reconstructive operation in 2016–2018. The umbilicus was amputated intraoperatively and tacking sutures were placed to create an indentation in the soft tissue; an inverted-V incision was sutured to create the illusion of an umbilicus. Postoperatively, patients were asked to rate their satisfaction with umbilicus appearance on a 5-point Likert scale. Of the 10 patients included; the majority were female (9:1), with a mean age of 37 years (range: 26–50) and mean BMI 29 (range: 21–38). The most common procedure performed at time of neo-umbilicoplasty was hernia repair (80%). There were no wound complications associated with the neo-umbilicus. Satisfaction was high (median 5, range: 1–5) and independent of time since surgery. Three patients gave scores below 5 and cited reasons of “lack of indentation” (n = 3, scores 4, 4, and 1), and “insufficiently notable scar” (n = 1, score 1). We hereby describe a simple surgical technique for neo-umbilicoplasty in patients undergoing reconstructive abdominal surgery that leads to long-lasting cosmetic satisfaction. Further studies of patient-reported outcomes and refinement of the technique will maximize the aesthetically pleasing results.
Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital Admissions
Authors: Wallins Joseph S. , Cajiao Karen M. , McCarthy Killian J. , Estrada-Roman Alisson , Gavin Michael C. 
Published: July 2019

Introduction:
Alternatives to the emergency department (ED) for expedient and high-value team-based cardiology care for patients with chest pain, volume overload, palpitations, and other urgent, but not life-threatening cardiac conditions are lacking. Here, we report on the development of the Cardiac Direct Access Unit (CDAc), an ambulatory cardiology unit with exam rooms, observation bays, and an advanced heart failure clinic.

Methods:
Patients referred to the CDAc are seen same-day by an attending cardiologist in a space independent from the ED. We performed a retrospective review of 1146 consecutive patients referred to the CDAc in its first year of operation. Among patients who were referred for urgent same-day evaluation, 60.1% were discharged home without observation.

Results:
Among the patients observed or directly discharged from CDAc, 2.4% were readmitted within 30 days for a related symptom. The highest rate of readmission (7.5%) was for heart failure, which compares favorably with guidelines for readmission benchmarks.

Conclusion:
Our first year of data suggests that a cardiology-directed observation unit may serve as a high-value alternative to the ED for appropriately selected patients.