bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Short-Term Outcomes following Orthognathic Surgery Are Associated with High-Volume Centers
Authors: Berlin Nicholas L. , Tuggle Charles T. , Steinbacher Derek M. 
Published: August 2016

Background:
Previous studies assessing outcomes following orthognathic surgery rely primarily on single-center/surgeon experience. In addition to issues of generalizability, these studies are limited in evaluating the effect of operative volume on patient outcomes.

Methods:
Orthognathic procedures were identified in the 1999 to 2011 Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Outcomes included occurrence of any in-hospital complication, extended length of stay (>2 days), and increased costs (>$10,784). High-volume hospitals were defined as the 90th percentile of case volume or higher (>31 cases/year). Univariate and multivariate analyses were conducted to identify independent predictors of outcomes. Trend analyses were performed to assess changes in the annual rate of patients treated at high-volume hospitals over the study period.

Results:
Among 101,692 orthognathic surgery patients, 19.6 percent underwent concurrent ancillary procedures (i.e., genioplasty, rhinoplasty, or septoplasty), and 37.6 percent underwent double-jaw surgery. Fifty-three percent were treated at high-volume hospitals. High-volume hospitals more often performed ancillary procedures (21.4 percent versus 17.4 percent; p < 0.001) and double-jaw surgery (41.3 percent versus 33.4 percent; p < 0.001). After adjustments for clinical and hospital characteristics, patients treated at high-volume hospitals were less likely to experience any complication (OR, 0.75; 95 percent CI, 0.70 to 0.81; p < 0.001) and extended length of stay (OR, 0.71; 95 percent CI, 0.68 to 0.75; p < 0.001). There was a 2 percent annual increase in the rate of patients treated at high-volume hospitals over the study period (incidence rate ratio, 1.02; 95 percent CI, 1.01 to 1.03; p < 0.001).

Conclusions:
The majority of orthognathic cases nationwide are performed at a small number of high-volume hospitals. These hospitals discharge patients earlier, perform more complex procedures, and have fewer complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
A Treatment Protocol for Velopharyngeal Insufficiency and the Outcome
Authors: Yamaguchi Kazuaki , Lonic Daniel , Lee Che-Hsiung , Wang Shu-Hui , Yun Claudia , Lo Lun-Jou 
Published: August 2016

Background:
A simple algorithm is applied to treat velopharyngeal insufficiency. The purpose of this study was to assess its success rate and complications.

Methods:
The diagnosis includes speech perceptual assessment and nasopharyngoscopy, focusing on velopharyngeal closure ratio. The treatment is composed of a double-opposing Z-plasty for marginal velopharyngeal insufficiency or a pharyngeal flap for moderate to severe velopharyngeal insufficiency. A retrospective chart review was conducted for 84 consecutive nonsyndromic postpalatoplasty patients undergoing velopharyngeal insufficiency surgery from August of 2007 to December of 2014. The demographic, perioperative, and follow-up data were collected. Statistical analyses were performed.

Results:
Mean age at velopharyngeal insufficiency surgery was 7.0 years. The overall improvement rate for patients was 86.9 percent. Nine patients in the double-opposing Z-plasty group and two patients in the pharyngeal flap group were refractory to velopharyngeal insufficiency surgery. The improvement rates for each surgical group were 80.4 percent for the double-opposing Z-plasty group and 94.7 percent for the pharyngeal flap group. There were no significant differences in postoperative velopharyngeal function between the coronal and noncoronal groups. Airway-associated complications were observed in nine patients (10.7 percent). The complications in the double-opposing Z-plasty group were observed in two patients (4.3 percent), and none of the patients presented obstructive sleep apnea. Seven patients (18.4 percent) in the pharyngeal flap group showed postoperative snoring, and one (2.6 percent) of them presented with obstructive sleep apnea.

Conclusion:
The authors’ algorithm is a simple patient- and surgeon-friendly strategy to obtain satisfactory improvement of velopharyngeal function for velopharyngeal insufficiency patients, with a low risk of airway complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Performance on a Surgical In-Training Examination Varies by Training Year and Pathway
Authors: Silvestre Jason , Levin L. Scott , Serletti Joseph M. , Chang Benjamin 
Published: August 2016

Background:
Few studies in surgery have addressed medical knowledge competency training as defined by the Accreditation Council for Graduate Medical Education. As in-training examinations are ubiquitous educational tools for surgical residents in the United States, insights into examination performance may help fill this void. The purpose of this study was to determine the relationship between In-Service Examination performance and training characteristics in plastic surgery.

Methods:
This retrospective cohort study reviewed performance data for the Plastic Surgery In-Service Training Examination for the years 2012 to 2015. Comparisons were made both within and between training pathways by means of Kruskal-Wallis and Mann-Whitney U tests.

Results:
Data were available for 1367 independent (37.9 percent) and 2240 integrated residents (62.1 percent). Among integrated residents, performance increased with additional years of training (p < 0.001), but no difference existed between postgraduate year–5 and postgraduate year–6 residents (p > 0.05). Similarly, independent resident examination performance increased by year of training (p < 0.001), with no difference between postgraduate year–2 and postgraduate year–3 residents (p > 0.05). At each level of training (postgraduate years 4 to 6), integrated residents outperformed their independent resident colleagues (postgraduate years 1 to 3) (p < 0.001).

Conclusions:
Performance on the Plastic Surgery In-Service Training Examination increases during residency, with integrated residents outperforming independent residents. These findings may have implications for medical knowledge competency training as defined by the Accreditation Council for Graduate Medical Education.
Improving Nurses' Peripheral Intravenous Catheter Insertion Knowledge, Confidence, and Skills Using a Simulation-Based Blended Learning Program
Authors: Keleekai Nowai L. , Schuster Catherine A. , Murray Connie L. , King Mary Anne , Stahl Brian R. , Labrozzi Laura J. , Gallucci Susan , LeClair Matthew W. , Glover Kevin R. 
Published: August 2016

Introduction
Peripheral intravenous catheter (PIVC) insertion is one of the most common invasive procedures performed in a hospital, but most nurses receive little formal training in this area. Blended PIVC insertion training programs that incorporate deliberate simulated practice have the potential to improve clinical practice and patient care.

Methods
The study was a randomized, wait-list control group with crossover using nurses on three medical/surgical units. Baseline PIVC knowledge, confidence, and skills assessments were completed for both groups. The intervention group then received a 2-hour PIVC online course, followed by an 8-hour live training course using a synergistic mix of three simulation tools. Both groups were then reassessed. After crossover, the wait-list group received the same intervention and both groups were reassessed.

Results
At baseline, both groups were similar for knowledge, confidence, and skills. Compared with the wait-list group, the intervention group had significantly higher scores for knowledge, confidence, and skills upon completing the training program. After crossover, the wait-list group had similarly higher scores for knowledge, confidence, and skills than the intervention group. Between the immediate preintervention and postintervention periods, the intervention group improved scores for knowledge by 31%, skills by 24%, and decreased confidence by 0.5%, whereas the wait-list group improved scores for knowledge by 28%, confidence by 16%, and skills by 15%.

Conclusions
Results demonstrate significant improvements in nurses' knowledge, confidence, and skills with the use of a simulation-based blended learning program for PIVC insertion. Transferability of these findings from a simulated environment into clinical practice should be further explored.
Increased CD40 Ligation and Reduced BCR Signalling Leads to Higher IL-10 Production in B Cells From Tolerant Kidney Transplant Patients
Authors: Nova-Lamperti Estefania , Chana Prabhjoat , Mobillo Paula , Runglall Manohursingh , Kamra Yogesh , McGregor Reuben , Lord Graham M. , Lechler Robert I. , Lombardi Giovanna , Hernandez-Fuentes Maria P. 
Published: August 2016

Background
An increased percentage of peripheral transitional B cells producing IL-10 has been observed in patients tolerant to kidney allografts. In healthy volunteers, the balance between the CD40 and B-cell receptor (BCR) signalling modulated IL-10 production by B cells, with stimulation via the BCR decreasing CD40-mediated IL-10 production. In this study, we evaluate whether in tolerant kidney transplant patients, the increased IL-10 production by B cells was due to an altered CD40 and/or BCR signalling.

Methods
B cells obtained from a new cohort of tolerant renal transplant recipients and those from age- and sex-matched healthy volunteers were activated via CD40 and BCR, either alone or in combination.

Results
In tolerant patients, we observed higher percentages of B cells producing IL-10 after CD40 ligation and higher expression of CD40L on activated T cells compared with healthy controls. Furthermore, B cells from tolerant recipients had reduced extracellular signal-regulated kinase signalling after BCR-mediated activation compared with healthy controls. In keeping with this, combining BCR signalling with CD40 ligation did not reduce IL-10 secretion as was observed in healthy control transitional B cells.

Conclusions
Altogether, our data suggest that the altered response of B cells in tolerant recipients may contribute to long-term stable graft acceptance.
American Clinical Neurophysiology Society Guideline 5: Minimum Technical Standards for Pediatric Electroencephalography
Authors: Kuratani John , Pearl Phillip L. , Sullivan Lucy , Riel-Romero Rosario Maria S. , Cheek Janna , Stecker Mark , San-Juan Daniel , Selioutski Olga , Sinha Saurabh R. , Drislane Frank W. , Tsuchida Tammy N. 
Published: August 2016

Summary:
This revision to the EEG Guidelines is an update incorporating the current electroencephalography technology and practice. It was previously published as Guideline 2. Similar to the prior guideline, it delineates the aspects of Guideline 1 that should be modified for neonates and young children. Recording conditions for photic stimulation and hyperventilation are revised to enhance the provocation of epileptiform discharges. Revisions recognize the difficulties involved in performing an EEG under sedation in young children. Recommended neonatal EEG montages are displayed for the reduced set of electrodes only since the montages in Guideline 3 should be used for a 21-electrode 10-20 system array. Neonatal documentation is updated to use current American Academy of Pediatrics term “postmenstrual age” rather than “conceptional age.” Finally, because therapeutic hypothermia alters the prognostic value of neonatal EEG, the necessity of documenting the patient's temperature at the time of recording is emphasized.
Savannahs of Asia: antiquity, biogeography, and an uncertain future
Authors: Ratnam Jayashree , Tomlinson Kyle W. , Rasquinha Dina N. , Sankaran Mahesh 
Published: August 2016

The savannahs of Asia remain locally unrecognized as distinctive ecosystems, and continue to be viewed as degraded forests or seasonally dry tropical forests. These colonial-era legacies are problematic, because they fail to recognize the unique diversity of Asian savannahs and the critical roles of fire and herbivory in maintaining ecosystem health and diversity. In this review, we show that: the palaeo-historical evidence suggests that the savannahs of Asia have existed for at least 1 million years, long before widespread landscape modification by humans; savannah regions across Asia have levels of C4grass endemism and diversity that are consistent with area-based expectations for non-Asian savannahs; there are at least three distinct Asian savannah communities, namely deciduous broadleaf savannahs, deciduous fine-leafed and spiny savannahs and evergreen pine savannahs, with distinct functional ecologies consistent with fire- and herbivory-driven community assembly. Via an analysis of savannah climate domains on other continents, we map the potential extent of savannahs across Asia. We find that the climates of African savannahs provide the closest analogues for those of Asian deciduous savannahs, but that Asian pine savannahs occur in climates different to any of the savannahs in the southern continents. Finally, we review major threats to the persistence of savannahs in Asia, including the mismanagement of fire and herbivory, alien woody encroachment, afforestation policies and future climate uncertainty associated with the changing Asian monsoon. Research agendas that target these issues are urgently needed to manage and conserve these ecosystems.This article is part of the themed issue ‘Tropical grassy biomes: linking ecology, human use and conservation’.
Clarifying the confusion: old-growth savannahs and tropical ecosystem degradation
Authors: Veldman Joseph W. 
Published: August 2016

Ancient tropical grassy biomes are often misrecognized as severely degraded forests. I trace this confusion to several factors, with roots in the nineteenth century, including misinterpretations of the nature of fire in savannahs, attempts to reconcile savannah ecology with Clementsian succession, use of physiognomic (structural) definitions ofsavannahand development of tropical degradation frameworks focused solely on forests. Towards clarity, I present two models that conceptualize the drivers of ecosystem degradation as operating in both savannahs and forests. These models highlight how human-induced environmental changes create ecosystems with superficially similar physiognomies but radically different conservation values. Given the limitation of physiognomy to differentiate savannahs from severely degraded forests, I present an alternative approach based on floristic composition. Data from eastern lowland Bolivia show that old-growth savannahs can be reliably distinguished by eight grass species and that species identity influences ecosystem flammability. I recommend that scientists incorporate savannahs in tropical degradation frameworks alongside forests, and thatsavannahbe qualified asold-growth savannahin reference to ancient grassy biomes orderived savannahin reference to deforestation. These conceptual advances will require attention not only to tree cover, but also to savannah herbaceous plant species and their ecologies.This article is part of the themed issue ‘Tropical grassy biomes: linking ecology, human use and conservation’.
Reconciling agriculture, carbon and biodiversity in a savannah transformation frontier
Authors: Estes L. D. , Searchinger T. , Spiegel M. , Tian D. , Sichinga S. , Mwale M. , Kehoe L. , Kuemmerle T. , Berven A. , Chaney N. , Sheffield J. , Wood E. F. , Caylor K. K. 
Published: August 2016

Rapidly rising populations and likely increases in incomes in sub-Saharan Africa make tens of millions of hectares of cropland expansion nearly inevitable, even with large increases in crop yields. Much of that expansion is likely to occur in higher rainfall savannas, with substantial costs to biodiversity and carbon storage. Zambia presents an acute example of this challenge, with an expected tripling of population by 2050, good potential to expand maize and soya bean production, and large areas of relatively undisturbed miombo woodland and associated habitat types of high biodiversity value. Here, we present a new model designed to explore the potential for targeting agricultural expansion in ways that achieve quantitatively optimal trade-offs between competing economic and environmental objectives: total converted land area (the reciprocal of potential yield); carbon loss, biodiversity loss and transportation costs. To allow different interests to find potential compromises, users can apply varying weights to examine the effects of their subjective preferences on the spatial allocation of new cropland and its costs. We find that small compromises from the objective to convert the highest yielding areas permit large savings in transportation costs, and the carbon and biodiversity impacts resulting from savannah conversion. For example, transferring just 30% of weight from a yield-maximizing objective equally between carbon and biodiversity protection objectives would increase total cropland area by just 2.7%, but result in avoided costs of 27–47% for carbon, biodiversity and transportation. Compromise solutions tend to focus agricultural expansion along existing transportation corridors and in already disturbed areas. Used appropriately, this type of model could help countries find agricultural expansion alternatives and related infrastructure and land use policies that help achieve production targets while helping to conserve Africa's rapidly transforming savannahs.
This article is part of the themed issue ‘Tropical grassy biomes: linking ecology, human use and conservation’.
The underestimated biodiversity of tropical grassy biomes
Authors: Murphy Brett P. , Andersen Alan N. , Parr Catherine L. 
Published: August 2016

For decades, there has been enormous scientific interest in tropical savannahs and grasslands, fuelled by the recognition that they are a dynamic and potentially unstable biome, requiring periodic disturbance for their maintenance. However, that scientific interest has not translated into widespread appreciation of, and concern about threats to, their biodiversity. In terms of biodiversity, grassy biomes are considered poor cousins of the other dominant biome of the tropics—forests. Simple notions of grassy biomes being species-poor cannot be supported; for some key taxa, such as vascular plants, this may be valid, but for others it is not. Here, we use an analysis of existing data to demonstrate that high-rainfall tropical grassy biomes (TGBs) have vertebrate species richness comparable with that of forests, despite having lower plant diversity. The Neotropics stand out in terms of both overall vertebrate species richness and number of range-restricted vertebrate species in TGBs. Given high rates of land-cover conversion in Neotropical grassy biomes, they should be a high priority for conservation and greater inclusion in protected areas. Fire needs to be actively maintained in these systems, and in many cases re-introduced after decades of inappropriate fire exclusion. The relative intactness of TGBs in Africa and Australia make them the least vulnerable to biodiversity loss in the immediate future. We argue that, like forests, TGBs should be recognized as a critical—but increasingly threatened—store of global biodiversity.
This article is part of the themed issue ‘Tropical grassy biomes: linking ecology, human use and conservation’.
A new approach for estimating leagile decoupling point using data envelopment analysis
Authors: Shahin Arash , Gunasekaran Angappa , Khalili Azam , Shirouyehzad Hadi 
Published: August 2016

Purpose
This paper aims to propose a new approach for determining a decoupling point in leagile chain, based on Lean and agile criteria regarding market and customer demands and internal capabilities of the chain with the ultimate goal of fulfilling customer needs and increasing chain profit.

Design/methodology/approach
In the new approach, Lean and agile criteria have been defined for assessing the effectiveness and efficiency of supply chain. The efficiency and effectiveness ratios have been calculated for Lean and agile processes using input- and output-oriented Banker, Charnes and Cooper (BCC) methods, respectively. Based on the results, inefficient and ineffective units have been addressed and the decoupling point has been determined.

Findings
Findings indicate that the decoupling point can be regarded as a borderline between two strategies of Lean and agile production, and fuzzy decoupling point and lean–agile distance can provide the basis for distinguishing the two strategies.

Practical implications
Determining the decoupling point has an important role in dynamic performance of a supply chain. By the proposed approach, managers can estimate the most probable area for the decoupling point. Moreover, by appropriate determination of decoupling point, an organization can increase its public responsibility by appropriate usage of its resources and responding faster to customers’ requirements.

Originality/value
In this study, in addition to determining a decoupling point in a supply chain with the aim of increasing productivity, the subject of leagile strategy of supply chains has been developed.
Tolerance simulation of composite wingbox assembly considering preloading-modified distribution
Authors: Wang Hua , Liu Jun 
Published: August 2016

Purpose
Tolerance simulation’s reliability depends on the concordance between the input probability distribution and the real variation. The prescribed clamp force introduced changes in parts’ variation, which should be reflected in the input probability distribution for the tolerance simulation. The paper aims to present a tolerance analysis process of the composite wingbox assembly considering the preloading-modified distribution and especially focuses on the spring-in deviation of the thin-walled C-section composite beam (TC2B).

Design/methodology/approach
Based on finite element analysis model of TC2B, the preloading-modified probability distribution function (PDF) of the spring-in deviation is obtained. Thickness variations of the TC2B are obtained from the data of the downscaled composite wingbox. These variations are input to the computer-aided tolerance tools, and the final assembly variations are obtained. The assembly of the downscaled wingbox illustrates the effect of preloading on the probability distribution of the spring-in deviation.

Findings
The results have shown that the final assembly variations estimated with the modified probability distribution is more reliable than the variation of the initial normal distribution.

Originality/value
The tolerance simulation work presented in the paper will enhance the understanding of the composite parts assembling with spring-in deviations, improve the chance to choose assembling processes that allow specifications to be met and help with tolerance allocation in composites assembly.