bluuebunny/crossref_metadata_2025_split huggingface dataset:
Daily Use of a Facial Broad Spectrum Sunscreen Over One-Year Significantly Improves Clinical Evaluation of Photoaging
Authors: Randhawa Manpreet , Wang Steven , Leyden James J. , Cula Gabriela O. , Pagnoni Alessandra , Southall Michael D. 
Published: October 2016

BACKGROUND
Sunscreens are known to protect from sun damage; however, their effects on the reversal of photodamage have been minimally investigated.

OBJECTIVE
The aim of the prospective study was to evaluate the efficacy of a facial sun protection factor (SPF) 30 formulation for the improvement of photodamage during a 1-year use.

METHODS
Thirty-two subjects applied a broad spectrum photostable sunscreen (SPF 30) for 52 weeks to the entire face. Assessments were conducted through dermatologist evaluations and subjects' self-assessment at baseline and then at Weeks 12, 24, 36, and 52.

RESULTS
Clinical evaluations showed that all photoaging parameters improved significantly from baseline as early as Week 12 and the amelioration continued until Week 52. Skin texture, clarity, and mottled and discrete pigmentation were the most improved parameters by the end of the study (40% to 52% improvement from baseline), with 100% of subjects showing improvement in skin clarity and texture.

CONCLUSION
The daily use of a facial broad-spectrum photostable sunscreen may visibly reverse the signs of existing photodamage, in addition to preventing additional sun damage.
Methods of pushing during vaginal delivery and pelvic floor and perineal outcomes: a review
Authors: de Tayrac Renaud , Letouzey Vincent 
Published: October 2016

Purpose of review
Over the past 20 years, several randomized studies have compared Valsalva and spontaneous pushing techniques during vaginal delivery. This review summarizes current medical knowledge concerning their maternal and fetal consequences, focusing on pelvic and perineal outcomes.

Recent findings
We selected nine randomized controlled trials comparing Valsalva and spontaneous pushing, and a secondary analysis of a randomized controlled trial comparing different methods of perineal protection. Two trials showed that spontaneous pushing reduces the risk of perineal tears, but no firm conclusions can be drawn given the heterogeneity and inconsistent results of these studies. Conflicting results have been reported regarding the duration of the second stage of labor. Pushing technique does not seem to affect episiotomy, instrumental delivery or cesarean rates. Maternal satisfaction seems to be better after spontaneous pushing. Spontaneous pushing appears to have no adverse effects on neonatal well being, and one study showed a significant improvement in prenatal fetal parameters during the expulsive phase.

Summary
Valsalva and spontaneous pushing techniques currently appear comparable in terms of duration, pelvic floor, perineal, and neonatal outcomes. In the absence of strong evidence in favor of either technique, the decision should be guided by patient preference and the clinical situation. Additional, well-designed randomized controlled trials are required.
Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation
Authors: Swanson Eric 
Published: October 2016

Background:
The prevailing theory for capsular contracture after breast augmentation is a subclinical capsular infection. A capsulectomy, site change, and implant replacement are recommended. An open capsulotomy leaves the capsule in the patient. Theoretically, such a procedure would be ineffective because it does not remove the infected tissue. Recurrences occurred frequently in women treated in the 1970s when leaky silicone gel implants were in use. Open capsulotomy has not been studied in women implanted with third-generation devices.

Methods:
Seventy-five consecutive women with Baker III/IV capsular contractures after breast augmentation treated with open capsulotomies between 1996 and 2016 were retrospectively evaluated. The original implants were usually saline-filled (72.2%). Replacements were all smooth and round, and 92.6% were also saline-filled.

Results:
Seventeen women (22.7%) developed a recurrent capsular contracture. Two patients (2.7%) experienced a second recurrence. Patients with ruptured silicone gel implants (n = 13) had a significantly greater risk of recurrence (P = 0.01). There was no significant difference in recurrence rates comparing patients whose intact implants were reinserted (12.5%) with women whose intact implants were replaced (18.2%). Povidone–iodine irrigation did not affect the recurrence rate. Capsular contracture was corrected with 1 procedure in 77.3% of patients and 2 procedures in 97.3% of patients.

Conclusions:
Open capsulotomy is a safe and effective treatment that avoids the additional morbidity and cost of a capsulectomy. The findings challenge the infected biofilm theory of capsular contracture. Open capsulotomy deserves reconsideration by plastic surgeons.
Developing an Item Bank to Measure Quality of Life in Individuals With Glaucoma, and the Results of the Interview With Patients: The Effect of Visual Function, Visual Field Progression Rate, Medical, and Surgical Treatments on Quality of Life
Authors: Matsuura Masato , Hirasawa Kazunori , Hirasawa Hiroyo , Yanagisawa Mieko , Murata Hiroshi , Mayama Chihiro , Asaoka Ryo 
Published: October 2016

Purpose:
To construct a new item bank to measure quality of life (QOL) in glaucoma patients and to evaluate glaucoma patients’ QOL using the item bank.

Methods:
An item bank of questions was generated through a literature review of QOL instruments useful for glaucoma patients. Using this item bank, a cognitive survey was performed on 203 patients with glaucoma (112 males and 91 females, 61.9±11.9 y old; mean±SD). The results were then analyzed using the Rasch analysis, and the Rasch-derived disability scores were predicted using linear modelling and the following clinical parameters: age, mean total deviation (mTD) in superior and inferior visual field (mTDsup/mTDinf), mTD progression rate, better visual acuity, worse visual acuity, number of eye drops administered per day, number of trabeculectomy procedures experienced in both eyes.

Results:
A total of 23 questionnaires of QOL in glaucoma patients were identified resulting in an item bank of 187 questions related to the following tasks: reading/writing, walking, going out, eating and driving (direct disability) as well as questions concerned with worry/anxiety, social participation, and physical symptoms (indirect disability). In the optimal model for direct disability, age and mTDinf were identified as significant predictors, whereas number of eye drops administered per day and number of trabeculectomy experienced were included in the optimal model for indirect disability.

Conclusions:
A new item bank to measure QOL in glaucoma patients was developed and evaluated. Age and mTDinf were found to be related to direct disability while medical and surgical treatments were related to indirect disability.
Using Hemospray Improves the Cost-effectiveness Ratio in the Management of Upper Gastrointestinal Nonvariceal Bleeding
Authors: Barkun Alan N. , Adam Viviane , Lu Yidan , Chen Yen-I , Martel Myriam 
Published: October 2016

Goals:
We compared the cost-effectiveness of traditional recommended endoscopic hemostatic therapies and Hemospray alone or in combination when treating nonvariceal upper gastrointestinal bleeding (NVUGIB).

Background:
Hemospray (TC-325) is a novel endoscopic hemostatic powder, achieving hemostasis through adherence to actively bleeding biological surfaces.

Study:
A decision tree of patients with NVUGIB assessed 4 possible treatment strategies: traditional therapy alone (T), Hemospray alone (H), traditional therapy completed by Hemospray if needed (T+H), or Hemospray completed by traditional therapy if needed (H+T). Using published probabilities, effectiveness was the likelihood of avoiding rebleeding over 30 days. Costs in 2014 US$ were based on the US National Inpatient Sample. A third-party payer perspective was adopted. Sensitivity and subgroup analyses were performed.

Results:
For all patients, T+H was more efficacious (97% avoiding rebleeding) and less expensive (average cost per patient of US$9150) than all other approaches. The second most cost-effective approach was H+T (5.57% less effective and US$635 more per patient). Sensitivity analyses showed T+H followed by a strategy of H+T remained more cost-effective than H or T alone when varying all probability assumptions across plausible ranges. Subgroup analysis showed that the inclusion of H (especially alone) was least adapted for ulcers and was more cost-effective when treating lesions at low risk of delayed rebleeding.

Conclusions:
Hemospray improves the effectiveness of traditional hemostasis, being less costly in most NVUGIB patient populations. A Hemospray first approach is most cost-effective for nonulcer bleeding lesions at low risk of delayed hemorrhage.
Cardiac arrests within the emergency department: an Utstein style report, causation and survival factors
Authors: Tan Sing C. , Leong Benjamin Sieu-Hon 
Published: October 2016

Background
Emergency Department Cardiac Arrests are typically classified with in-hospital cardiac arrests, but are yet to be well described as a distinct clinical entity. This study provides an Utstein style report on Emergency Department Cardiac Arrests, and identifies factors associated with survival.

Patients and methods
Patients who experienced a cardiac arrest in the Emergency Department of the National University Hospital, Singapore, between January 2010 and August 2012 were studied. Data were collected retrospectively and potential survival factors were assessed with a multivariate logistic regression.

Results
One hundred and six cases were identified for analysis. Most patients were male and 43.4% had a presumed cardiac diagnosis. All arrests were witnessed and received Advanced Cardiac Life Support interventions immediately. Out of the total, 31.1% of arrests occurred during or immediately after intubation. Overall, 48.1% of patients survived to hospital discharge. Patients with a shockable rhythm had the highest survival rate (70.8%), followed by asytole (20.8%) and pulseless electrical activity (15.1%). In all, 91.3% of survivors with a premorbid Cerebral Performance Category score of 1 were discharged with a similar Cerebral Performance Category score.
Variables associated with survival to hospital discharge were a shockable initial rhythm (odds ratio 12.1; 95% confidence interval, 3.1–47.6) and a time to return of spontaneous circulation of less than 10 min (odds ratio 4.1; 95% confidence interval, 1.0–16.9).

Conclusion
This is the first Utstein style report on Emergency Department Cardiac Arrests. A high survival rate with good neurological outcomes was found in this population. The initial rhythm and time to return of spontaneous circulation have been identified as survival factors and may be used to guide decision-making during resuscitation.
The Malta Childhood National Body Mass Index Study
Authors: Grech Victor , Aquilina Samuel , Camilleri Erin , Spiteri Karl , Busuttil Maria‐Louisa , Sant'Angelo Victoria F. , Calleja Neville 
Published: October 2016

ABSTRACTObjectives:Obesity is a chronic disease that often commences in childhood. More than a quarter of Maltese children are overweight or obese. The present study was carried out to measure height and weight (and body mass index) for all school children in Malta to precisely quantify the extent of the problem.Methods:Schooling in Malta is provided by: free state schools, subsidized Roman Catholic church–run schools, and independent private schools. All were included. Physical education teachers were trained in measurements on identical stadiometers. Bespoke spreadsheets were created using World Health Organization cut‐offs for underweight, overweight, and obesity.Results:The present study included more than 46,027 children in more than 145 schools (ages 4.7–17 years). Less than 10% were unmeasured. Approximately 40% of school‐aged children in Malta are overweight or obese. The proportion of obese was greater than that of overweight. Levels of overweight and obesity were significantly different: State>Church>Independent schools. Overall, and for both sexes and for school types, there was a trend for overweight and obesity to peak in years 5 to 8, then decline slightly. Overweight and obesity was secondary>primary schools, and boys>girls. The underweight group was small with no significant difference between the school types.Conclusions:The present study has confirmed high levels of overweight and obesity in Maltese children. It also provides proof of concept of scalability by demonstrating the feasibility of undertaking a relatively inexpensive study of an entire childhood population. The modus operandi (utilizing physical education teachers) could relatively easily be up scaled for any country.
Moving In and Out of the What-Ifs
Authors: Schroeder Dawn , Duggleby Wendy , Cameron Brenda L. 
Published: October 2016

Background:
In families where genetic testing for the breast cancer 1 and 2 genes (BRCA1/2) has not identified a deleterious mutation, the risk for hereditary breast cancer (HBC) can still be high when there is a strong family history. Little is known about how an awareness of risk for HBC impacts the everyday lives of unaffected women (no personal history for breast and/or ovarian cancer) in these families.

Objective:
The aim of this study is to explore how unaffected women, living in BRCA1/2-negative families, experience living with risk for HBC.

Methods:
van Manen’s hermeneutic phenomenological approach guided this study. Unaffected at-risk women were recruited from a hereditary breast and ovarian cancer clinic in Western Canada.

Results:
Nine women participated in 20 open-ended conversations. Phenomenological reflection on the 4 life existentials (lived space, body, time, and relations) revealed “Moving In and Out of the What-Ifs” as an overarching description that was communicated through the following themes: “Just Moving Along: Living a Normal Life,” “Moving Into Those Dark Spaces,” “Is there Something Wrong With Me”? “Markings in Time,” “Living in the Moment,” “Being Cared For,” and “Keeping Me Grounded.”

Conclusions:
The findings reveal how knowledge from predictive medicine impacts the lives of women and the importance of supportive relations and provides a foundation for future research into how health is perceived.

Implications for Practice:
The findings inform the practices of healthcare professionals as they engage in discussions with women living with risk for HBC and highlight the importance of a supportive relationship.
Clinical subtypes and genetic heterogeneity: of lumping and splitting in Parkinson disease
Authors: von Coelln Rainer , Shulman Lisa M. 
Published: October 2016

Purpose of reviewRecent studies on clinical, genetic and pathological heterogeneity of Parkinson disease have renewed the old debate whether we should think of Parkinson disease as one disease with variations, or as a group of independent diseases that happen to present with similar phenotypes. Here, we provide an overview of where the debate is coming from, and how recent findings in clinical subtyping, genetics and clinico-pathological correlation have shaped this controversy over the last few years.Recent findingsNew and innovative clinical diagnostic criteria for Parkinson disease have been proposed and await validation. Studies using functional imaging or wearable biosensors, as well as biomarker studies, provide new support for the validity of the traditional clinical subtypes of Parkinson disease (tremor-dominant versus akinetic-rigid or postural instability/gait difficulty). A recent cluster analysis (as unbiased data-driven approach to subtyping) included a wide spectrum of nonmotor variables, and showed correlation of the proposed subtypes with disease progression in a longitudinal analysis. New genetic factors contributing to Parkinson disease susceptibility continue to be identified, including rare mutations causing monogenetic disease, common variants with small effect size and risk factors (like mutations in the gene for glucocerebrosidase) that fall in between the two other categories. Recent studies show some limited correlation between genetic factors and clinical heterogeneity. Despite some variations in patterns of pathology, Lewy bodies are still the hallmark of Parkinson disease, including the vast majority of genetic subgroups.SummaryEvidence of clinical, genetic and pathological heterogeneity of Parkinson disease continues to emerge, but clearly defined subtypes that hold up in more than one of these domains remain elusive. For research to identify such subtypes, splitting is likely the way forward; until then, for clinical practice, lumping remains the more pragmatic approach.
Improving trust, improving schools
Authors: Brown Chris , Daly Alan , Liou Yi-Hwa 
Published: October 2016

Purpose– Many governments worldwide are now promoting the importance of research-informed efforts at improvement. At the same time research is yet to make sustained impact on the practices of teachers. Given the importance of the issue and the lack of progress in this area, the purpose of this paper is to examine what drives teachers’ perceptions that their school: first, encourages the use of research evidence to support improvements to teaching; and second, whether school improvement strategies are grounded in research on effective practice.Design/methodology/approach– Reviewing extant literature, the authors hypothesize that teachers’ perceptions of research use are related to their perceptions of: the presence of in-school organizational learning (OL) factors; whether they work in high-trust environments; and also to the frequency and quality of their “expertise-seeking” interactions. Using a survey instrument to measure OL, trust, and school research use climate, the authors gather data from 828 teachers in 43 schools. The authors then use social network analysis to quantify teachers’ professional relationships; with hierarchical linear regression employed to explore multilevel relationships between variables. Social network diagrams are also used to visualize the patterns of relationships between teachers/study variables.Findings– The analysis indicates that teachers who report the climate of their schools to be focussed on learning, experimentation, and valuing new ideas, tend to also report more use of research/evidence. Likewise, teachers who had more frequent and useful interactions around teaching and learning also report more research/evidence use (RE Use) in their schools. Finally, and perhaps most powerfully, is that higher levels of perceived trust in the school are also associated with reporting higher levels of RE Use.Originality/value– The results illustrate the importance of learning and trust in facilitating the types of relations needed to provide teachers with access to the research/evidence centered social capital that resides within a school. The work expands the notions of what is necessary to support the use of research/evidence in schools by placing more relational elements of the improvement equation front and center.
Beam monitor calibration in scanned light‐ion beams
Authors: Palmans Hugo , Vatnitsky Stanislav M. 
Published: October 2016

PurposeTo propose a formalism for the reference dosimetry of scanned light‐ion beams consistent with IAEA TRS‐398 and Alfonso et al. [Med. Phys. 35, 5179–5186 (2008)]. To identify machine‐specific reference (msr) fields and plan‐class specific reference (pcsr) fields consistent with the definitions given by Alfonso et al. To review the literature of beam monitor calibration in scanned beams using three different methods in terms of this common formalism.MethodsFour types of msr fields are identified as those that are meant to calibrate the beam monitor for scanned beams with particular energies. Two types of pcsr fields are identified as those that are meant to apply one or more tuning factors to the entire delivery chain.ResultsThe formalism establishes the energy‐dependent relation between the number of particles incident on the phantom surface and the beam monitor reading and distinguishes three routes to determine the beam monitor calibration function: (i) the use of a calibrated reference ionization chamber in a single‐layer scanned beam, (ii) the use of a cross‐calibrated large‐area parallel plate ionization chamber in a single‐energy beamlet, and (iii) the use of a calibrated reference ionization chamber in a box field to adjust a calibration curve obtained by a Faraday cup or an ionization chamber. Examples of all three methods and comparisons between them from the literature are analysed.ConclusionsThe formalism can form the basis of future dosimetry recommendations for scanned particle beams and the analysis of the literature data in terms of this formalism can form the basis of data compilations for the application of the dosimetry procedures.
Whole‐body bone segmentation from MRI for PET/MRI attenuation correction using shape‐based averaging
Authors: Arabi Hossein , Zaidi Habib 
Published: October 2016

PurposeThe authors evaluate the performance of shape‐based averaging (SBA) technique for whole‐body bone segmentation from MRI in the context of MRI‐guided attenuation correction (MRAC) in hybrid PET/MRI. To enhance the performance of the SBA scheme, the authors propose to combine it with statistical atlas fusion techniques. Moreover, a fast and efficient shape comparison‐based atlas selection scheme was developed and incorporated into the SBA method.MethodsClinical studies consisting of PET/CT and MR images of 21 patients were used to assess the performance of the SBA method. In addition, the authors assessed the performance of simultaneous truth and performance level estimation (STAPLE) and the selective and iterative method for performance level estimation (SIMPLE) combined with SBA. In addition, a local shape comparison scheme (L‐Shp) was proposed to improve the performance of SBA. The SIMPLE method was applied globally (G‐SIMPLE) while STAPLE method was employed at both global (G‐STAPLE) and local (L‐STAPLE) levels. The evaluation was performed based on the accuracy of extracted whole‐body bones, fragmentation, and computation time achieved by the different methods. The majority voting (MV) atlas fusion scheme was also evaluated as a conventional and commonly used method. MRI‐guided attenuation maps were generated using the different segmentation methods. Thereafter, quantitative analysis of PET attenuation correction was performed using CT‐based attenuation correction as reference.ResultsThe SBA and MV methods resulted in considerable underestimation of bone identification (Dice ≈ 0.62) and high factious fragmentation error of contiguous structures. Applying global atlas selection or regularization (G‐STAPLE and G‐SIMPLE) to the SBA method enhanced bone segmentation accuracy up to a Dice = 0.66. The best results were achieved when applying the L‐STAPLE method with a Dice of 0.76 and the L‐Shp method with a Dice of 0.75. However, L‐STAPLE required up to five‐fold increased computation time compared to the L‐Shp method. Moreover, both L‐STAPLE and L‐Shp methods resulted in less than 3% SUV mean relative error and 6% SUV mean absolute error in bony structures owing to superior bone identification accuracy. The quantitative analysis using joint histograms revealed good correlation between PET‐MRAC images using the proposed L‐Shp algorithm and the corresponding reference PET‐CT images.ConclusionsThe performance of SBA was enhanced through application of local atlas weighting or regularization schemes (L‐STAPLE and L‐Shp). Bone recognition, fragmentation of the contiguous structures, and quantitative PET uptake recovery improved dramatically using these methods while the proposed L‐Shp method significantly reduced the computation time.