bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Phenylephrine Test Revisited
Authors: Barsegian Arpine , Botwinick Adam , Reddy Harsha S. 
Published: March 2017

Purpose:
To characterize the phenylephrine test in ptotic patients to help clinicians perform the test more efficiently.

Methods:
Adults with involutional ptosis (n = 24, 30 eyes) were assessed with digital photographs for response to topical 2.5% phenylephrine drop instillation. Patient characteristics (age, gender, iris color, dermatochalasis, brow ptosis, and baseline marginal reflex distance-1 [MRD-1] height) were recorded. From the photographs, change in (MRD-1), presence of conjunctival blanching, pupillary dilation, and Hering effect were recorded at specified time intervals, 1 minute to 1 hour after drop placement. Correlations between patient characteristics and measured outcomes were evaluated using analysis of variance, Pearson coefficient, or chi-square tests.

Results:
The authors found that 73% of eyes had eyelid elevation with phenylephrine. Of these, 50% reached maximal eyelid elevation by 5 minutes, and 86% by 10 minutes after drop placement, but 14% did not reach maximal MRD-1 until 30 minutes. There is a negative correlation between the maximum MRD-1 and the baseline MRD-1 eyelid height (r = −0.5330, p < 0.01). There is no significant relationship between time to pupillary dilation with either time to max eyelid elevation or max eyelid elevation. No patient characteristic studied affected the likelihood of eyelid response to phenylephrine or presence of Hering effect.

Conclusions:
Although most ptotic eyelids demonstrate a response to 2.5% phenylephrine within 10 minutes, there is a subset of patients that respond much later. More ptotic eyelids had greater eyelid elevation with phenylephrine. Pupillary dilation and conjunctival blanching are neither predictive of nor temporally associated with eyelid height elevation. The authors did not identify any patient factors (e.g., dermatochalasis, brow ptosis) that can predict the likelihood of response to phenylephrine.
Promoting Heart Health Among Rural African Americans
Authors: Abbott Laurie , Williams Christine , Slate Elizabeth , Gropper Sareen 
Published: March 2017

Background:
Cardiovascular disease is a major cause of death for people living in the United States. African Americans bear a disproportionate burden of cardiovascular disease. Interventions designed to target multiple risk factors may facilitate elimination of cardiovascular disease health disparities.

Objective:
The purpose of this study was to evaluate a culturally relevant cardiovascular health promotion intervention that could potentially reduce cardiovascular disease risk among a group of rural African American adults by improving intentions, attitudes, norms, and self-efficacy to increase produce consumption, reduce dietary saturated fat intake, and increase exercise.

Methods:
A cluster randomized controlled trial design was used to evaluate the effect of the “With Every Heartbeat Is Life” cardiovascular health promotion program among rural African Americans. The African American congregants of 12 rural churches located in northern Florida were randomly assigned to either an intervention group that received a culturally relevant cardiovascular health promotion intervention or a control group. Data analysis using linear mixed model was performed to compare group differences from pretest to posttest.

Results:
The cardiovascular health promotion intervention had a positive influence on the intentions, attitudes, norms, and self-efficacy of rural African Americans to increase produce consumption and reduce dietary saturated fat. The intervention also enhanced participants' attitudes and self-efficacy regarding exercise.

Conclusion:
The culturally relevant cardiovascular health promotion program presented to cluster groups of rural African American participants had positive influences on psychosocial variables associated with engaging in cardiovascular health recommendations. Nurse-led interventions in community settings can potentially reduce cardiovascular disease risk.
Cochlear Implants Versus Hearing Aids in a Middle-Income Country: Costs, Productivity, and Quality of Life
Authors: Montes Felipe , Peñaranda Augusto , Correa Santiago , Peñaranda Daniel , García Juan-Manuel , Aparicio Maria Leonor , Varela Andrea Ramírez , Castillo Mario 
Published: March 2017

Objective:
In Colombia there are three main treatment approaches for bilateral profound sensorineural hearing loss, also known as profound deafness (PD): cochlear implants (CI), hearing aids (HA), and no treatment (NT). The objective of this study is to determine the optimal treatment approach for PD in terms of productivity and cost-effectiveness.

Study Design:
Hearing levels and SES data were obtained from audiometric tests conducted on 100 patients with CI. For each treatment approach, productivity and cost-effectiveness assessments were estimated using influence diagrams and Monte Carlo simulations. Productivity was calculated as the net present value of a patient's lifetime income divided by total health-related and educational costs. For the CI and HA, the cost-effectiveness indicator was calculated as quality-adjusted life-years (QALYs) gained in comparison with the NT approach divided by the total cost of the treatment option.

Results:
The results for the CI, the HA, and NT in terms of productivity ratio were 1.53, 0.94, and 1.47, respectively. Patients using CI had a gain of 5.7 QALYs, whereas patients using HA had a gain of 4.6 QALYs. The results for the CI and the HA in terms of cost-effectiveness were $15,169 and $15,430 per QALY, respectively.

Conclusion:
The CI was found to be the optimal treatment for PD, as it was the most efficient and cost-effective in terms of improving patients’ productivity and quality of life. We observed that children who had received CI developed hearing and speech abilities that contributed to their productivity and quality of life to a greater extent than those with HA.
Purified Adipose-Derived Stromal Cells Provide Superior Fat Graft Retention Compared with Unenriched Stromal Vascular Fraction
Authors: Zielins Elizabeth R. , Brett Elizabeth A. , Blackshear Charles P. , Flacco John , Ransom Ryan C. , Longaker Michael T. , Wan Derrick C. 
Published: March 2017

Summary:
Cell-assisted lipotransfer has shown much promise as a technique to improve fat graft retention in both mouse and human studies. However, the literature varies as to whether fresh stromal vascular fraction or culture-expanded adipose-derived stromal cells are used to augment volume retention. The authors’ study sought to determine whether there was a significant advantage to using adipose-derived stromal cells over unpurified stromal vascular fraction cells in a mouse model of cell-assisted lipotransfer.
Enhanced Calvarial Bone Healing in CD11c-TLR4−/− and MyD88−/− Mice
Authors: Wang Dan , Taylor Gwen M. , Gilbert James R. , Losee Joseph E. , Sodhi Chhinder P. , Hackam David J. , Billiar Timothy R. , Cooper Gregory M. 
Published: March 2017

Background:
Inflammation is integral to the injury response. The inflammatory response is essential to the host defense against infection and also to tissue regeneration and repair. Toll-like receptors (TLRs) are critical activators of the innate immune response and present attractive therapeutic targets for inflammation-modulated tissue regeneration. The authors’ previous study showed that depletion of TLR4 resulted in accelerated skull bone healing concurrent with increased expression of osteoclastogenic genes. As such, in the present study, the authors used various knockout mouse models for TLR4 and its associated signaling mediators as tools to further understand the role of Toll-like receptor–mediated inflammation in calvarial bone healing.

Methods:
Calvarial defects (1.8-mm diameter) were created in wild-type, TLR4 knockout (TLR4−/−), TLR2−/−, MyD88−/−, TRIF−/−, TLR4 knockout in myeloid cell (Lyz-TLR4−/−), and TLR4 knockout in dendritic-lineage cell (CD11c-TLR4−/−) mice. Bone healing was examined using micro–computed tomographic, histologic, and histomorphometric analyses.

Results:
Micro–computed tomographic and histomorphometric analyses revealed that TLR4-deficient mice (TLR4−/−, Lyz-TLR4−/−, and CD11c-TLR4−/−) exhibited a faster intramembraneous healing response at postoperative day 7, whereas MyD88−/− and CD11c-TLR4−/− mice showed enhanced bone healing at day 28.

Conclusions:
The authors’ data suggest a detrimental role for TLR4 in CD11c+ cells, mediated by Myd88 signaling, during calvarial bone healing. The authors have demonstrated that Toll-like receptor signaling components affect calvarial bone healing, establishing a link between the skeletal and immune systems during craniofacial bone healing. Toll-like receptor signaling components might be used to initiate enhanced healing in bone defects to improve clinical outcomes.
A Prospective Randomized Trial of the Efficacy of Fibrin Glue, Triamcinolone Acetonide, and Quilting Sutures in Seroma Prevention after Latissimus Dorsi Breast Reconstruction
Authors: Hart Alexandra M. , Duggal Clarie , Pinell-White Ximena , Losken Albert 
Published: March 2017

Background:
Donor-site seroma is the most common complication following latissimus dorsi flap breast reconstruction. Various agents and techniques have attempted to minimize seroma formation. The purpose of this study was to compare the efficacy of different products and quilting sutures at seroma prevention.

Methods:
This is a single-center, double-blinded, randomized, controlled trial of a consecutive series of breast cancer patients (n = 96) undergoing latissimus dorsi flap reconstruction performed by a single surgeon. Patients were randomized to receive (1) fibrin glue (Tisseel) (n = 23), (2) triamcinolone acetonide (n = 26), or (3) normal saline (control) (n = 27) sprayed into the donor site. The fourth arm included donor-site quilting sutures (n = 20). Outcomes included seroma, drain output, and days to last drain removal. Drain removal was standardized at less than 30 cc/day.

Results:
All groups were matched evenly without differences in risk, procedures, or complications. The overall seroma rate was 31.3 percent (n = 30). The quilting group had significantly less drainage for weeks 1 (p = 0.006) and 2 (p = 0.050) postoperatively. Quilting statistically reduced the incidence of seromas to 5.0 percent (n = 1; p = 0.038) compared with other groups (control, 34.5 percent; fibrin, 27.6 percent; and triamcinolone, 37.6 percent). Drains were removed 10 days earlier with quilting (control, 35.5 days; fibrin, 39.5 days; triamcinolone, 37.4 days; and quilting, 25.8 days; p = 0.001). The incidence of all other complications was similar between groups.

Conclusion:
The use of quilting donor sites significantly decreases the incidence of donor-site seromas and leads to earlier drain removal following latissimus dorsi flap reconstruction and maintains a low complication profile.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Oncoplastic Breast Reduction Technique and Outcomes: An Evolution over 20 Years
Authors: Losken Albert , Hart Alexandra M. , Broecker Justine S. , Styblo Toncred M. , Carlson Grant W. 
Published: March 2017

Background:
Reduction mammaplasty at the time of lumpectomy is a good option in women with breast cancer and macromastia. We critically evaluated refinements and outcomes of this technique.

Methods:
A prospectively maintained database was reviewed of all women with breast cancer who received lumpectomy and reduction mammaplasty at our institution from 1994 to 2015. Patients’ demographics were reviewed. Preoperative and postoperative patient satisfaction (BREAST-Q) was determined. Comparisons were made between early and recent cases.

Results:
There were 353 patients included. Average age was 54 (range, 21 to 80 years), with the largest number having stage I disease [n = 107 of 246 (43.5 percent)]. Average lumpectomy specimen was 207 g (range, 11.6 to 1954 g) and total reduction weight averaged 545 g (range, 21 to 4102 g). Tumor size averaged 2.02 cm (range, 0.00 to 15.60 cm). The positive margin rate was 6.2 percent (n = 22). Completion mastectomy rate was 9.9 percent (n = 35). Overall complication rate was 16 percent. The recurrence rate was 5.2 percent (n = 10 of 192) at a mean follow-up of 2 years (range, 2 months to 15 years). Resection weights greater than 1000 g were associated with having a positive margin (16.7 percent versus 5.0 percent; p = 0.016), and tended to be associated with having a completion mastectomy (p = 0.069). Positive margin and completion mastectomy rates have been lower in the past 10 years. Over 1 year postoperatively, women reported increased self-confidence (p = 0.020), feelings of attractiveness (p = 0.085), emotional health (p = 0.037), and satisfaction with sex life (p = 0.092).

Conclusions:
The oncoplastic reduction technique is effective and results in improved patient-reported outcomes. Resections over 1000 g are associated with a higher incidence of positive margins and may increase the risk for completion mastectomy. Outcomes have improved with experience and refinement in technique.
Comparison of the Outcomes of Complex Orbital Fracture Repair with and without a Surgical Navigation System: A Prospective Cohort Study with Historical Controls
Authors: Zavattero Emanuele , Ramieri Guglielmo , Roccia Fabio , Gerbino Giovanni 
Published: March 2017

Background:
In severe orbital fractures, restoration of orbital shape and volume is required to avoid diplopia and posttraumatic enophthalmos. The purpose of this study was to compare outcomes between navigation-aided and conventional techniques for complex unilateral orbital fractures using titanium mesh.

Methods:
The outcomes and the computed tomography–measured orbital volume of two groups of orbital complex unilateral reconstruction cases were compared. The study group consisted of a consecutive cohort of unilateral severe orbital fracture that underwent surgery with the aid of a Brainlab navigation system. A historical control group was composed of consecutive operations performed immediately before the beginning of navigation system use. A total of 55 operations were then identified and studied for patient characteristics, diplopia and globe position, preoperative and postoperative orbital volumes, complications, need for revision surgery, and the surgeon’s performance.

Results:
Postoperative diplopia severity was lower in the study group than in the control group. Orbital volume analysis showed that reconstructed orbital volume in the study group was closer to unaffected orbital volume compared with the control group. Significant orbital volume reduction in the reconstructed orbit could be achieved in the study group, and there was no significant reduction in the control group compared with the unaffected side. The globe projection was higher compared with the preoperative situation in the study group than in the control group. The navigational platform could also contribute to reduce the learning curve.

Conclusion:
This study demonstrated that computer-assisted techniques improve outcomes compared with conventional techniques.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Quantifying the fitness benefit and cost of cefixime resistance inNeisseria gonorrhoeaeto inform prescription policy
Authors: Whittles Lilith K , White Peter J , Didelot Xavier 
Published: March 2017

AbstractGonorrhea is one of the most common bacterial sexually transmitted infections in England. Over 41,000 cases were recorded in 2015, more than half of which occurred in men who have sex with men (MSM). As the bacterium has developed resistance to each first-line antibiotic in turn, we need an improved understanding of fitness benefits and costs of antibiotic resistance to inform control policy and planning. Cefixime was recommended as a single dose treatment for gonorrhea from 2005 to 2010, during which time resistance increased and subsequently declined. We developed a stochastic compartmental model representing the natural history and transmission of cefixime sensitive and resistant strains ofNeisseria gonorrhoeaein MSM in England, which was applied to data on diagnoses and prescriptions between 2008 and 2015. We estimated that asymptomatic carriers play a crucial role in overall transmission dynamics, with about 40% of infections remaining asymptomatic and untreated, accounting for 96% of onward transmission. The fitness cost of cefixime resistance in the absence of cefixime usage was estimated to be such that the number of secondary infections caused by resistant strains is only about half as much as for the susceptible strains, which is insufficient to maintain persistence. However, we estimated that treatment of cefixime-resistant strains with cefixime was unsuccessful in 84% of cases, representing a fitness benefit of resistance. This benefit was large enough to counterbalance the fitness cost when 31% of cases are treated with cefixime, and when more than 51% of cases were treated with cefixime the resistant strain had a net fitness advantage over the susceptible strain. Our findings have important implications for antibiotic stewardship and public health policies, and in particular suggest that cefixime could be used to treat a minority of gonorrhea cases without raising resistance levels.
Outward direct investment by Chinese state-owned enterprises
Authors: Tavares Lehmann Ana Teresa , Lehmann Frederick 
Published: March 2017

Purpose
The paper aims to investigate outward foreign direct investment (OFDI) by Chinese state-owned enterprises (SOEs), aiming to unveil whether the Chinese OFDI policy acted as a country-specific advantage (CSA) that has been turned by Chinese firms, particularly SOEs, into a firm-specific advantage (FSA).

Design/methodology/approach
Using a data set spanning 18 years (1996-2013) on international mergers and acquisitions (IM&As) by Chinese companies (SOEs and private-owned enterprises – POEs) and drawing on extant literature, the paper systematically compares the behavior of Chinese SOEs and POEs, aiming to identify differences in their behavioral patterns that indicate that SOEs have benefitted more from policy-induced advantages than their private counterparts.

Findings
Among other aspects, significant differences were found regarding the behavior of SOEs vis-à-vis POEs that seem to show that SOEs had greater support from public entities, leading them to close larger deals and purchase more companies/stakes in cash; acquire firms with greater debt (implying higher interest payments); and purchase smaller stakes than POEs (indicating that there are other objectives than control). This lends support to the assumption that Chinese SOEs are “sitting on piles of cash”, and that the availability of capital acted as a CSA that has been transformed into an FSA by the companies involved, notably by SOEs.

Research limitations/implications
The comprehensive and large-scale data set used includes wholly owned SOEs, leaving out of this research partially owned SOEs. The findings of this paper have implications for the discussion on competitive neutrality and for the academic, managerial and public policy debate.

Originality/value
To the best of the authors’ knowledge, this is the only study, to date, that shows systematic differences in financing patterns of OFDI (notably via IM&As) by Chinese SOEs and POEs, among other behavioral characteristics of both types of companies when conducting FDI abroad, linking that to CSAs and FSAs induced by CSAs.
The state, employment, and regulation: making work not pay
Authors: Grady Jo 
Published: March 2017

Purpose
The purpose of this paper is to examine the role of specific active labour market policies (ALMP) and increased use of zero hour contracts (ZHCs) in creating an environment in which low-wage jobs flourish. Alongside these, it examines the role of financialization over the last 30 years in fostering the nuturalization of policies that institutionalize low wages and deregulate the economy in favour of big business.

Design/methodology/approach
This paper draws upon academic literature, official statistics, and analyses via the concept of neoliberalism.

Findings
This paper demonstrates that via a set of interconnected macro and micro factors low pay is set to remain entrenched in the UK. It has demonstrated that this is not the result of some natural response to labour market demands. Far from it, it has argued that these policy choices are neoliberal in motivation and the outcome of establishing low pay and insecure employment is a significant character of the contemporary labour market is deliberate.

Research limitations/implications
This paper encourages a re-think of how the authors address this issue of low pay in the UK by highlighting alternative forms of understanding the causes of low pay.

Practical implications
It presents an alternative analysis of low pay in the UK which allows us to understand and call into question the low-pay economy. In doing so it demonstrates that crucial to this understanding is state regulation.

Social implications
This paper allows for a more nuanced understanding of the economic conditions of the inequality caused by low pay, and provides an argument as to alternative ways in which this can be addressed.

Originality/value
The paper examines the relationship between the rise of neoliberalism and finance capital, the subsequent emergence of the neoliberal organization, the associated proliferation of ALMP and ZHCs, and the impact of these on creating a low-wage economy. It makes the argument that the UK’s low-wage economy is the result of regulatory choices influenced by a political preference for financialization, even if such choices are presented as not being so. Thus, the contribution of this paper is that it brings together distinct and important contemporary issues for scholars of employee relations, but connects them to the role of the state and neoliberal regulation.
Thailand’s dual education system: a way forward
Authors: Mongkhonvanit Jomphong 
Published: March 2017

Purpose
The purpose of this paper is to discuss the status, values, and attributes of dual education. It investigates key elements of the dual education system in four selected countries while examining and recommending dynamics and roles for governmental policy, technical and vocational institutes, and employers in developing a dual education system in Thailand to generate a competitive workforce. The tripartite system of technical and vocational institutes, employers, and government in Thailand’s dual education is central to this study.

Design/methodology/approach
This study employs a documentary study, a survey, in-depth interviews, and responses from a focus group from technical and vocational institutes, employers, and the government.

Findings
This study found growing interest among technical and vocational institutes, employers, parents, and students in dual education. Within the tripartite system framework, the nine essential factors to improve the capacity of Thailand’s dual education system are: the technical and vocational institutes, curriculum, in-school teachers, accredited qualification, students, employers, in-company trainers, government policy, and government and related agencies. The government, companies, and technical and vocational institutes must collaborate for mutual trust and benefit while ensuring the quality of dual education programs.

Originality/value
This study is the first to examine the status and development of dual education in Thailand through the collaboration of key players. This study reflects the challenges of a major developing country in developing a dual education system, which other countries might face.