bluuebunny/crossref_metadata_2025_split huggingface dataset:
From Denationalisation to Wholesale Broadband Access: A Retrospective of Regulatory Policies in the UK for the Communications Industry
Authors: Deshpande Advait , Jones Allan 
Published: February 2017

This paper examines the shifting regulatory policies in the United Kingdom (UK) across three market segments, telecommunications, radio/television and cable, starting with British Telecom's (BT's) denationalisation in 1984. For the period examined, this paper focuses on following key events – – The phased liberalisation of the UK communications industry starting with the BT-Mercury Communications duopoly in 1984 – The allocation of cable franchises as regional monopolies in the mid-1980s – Introduction of satellite broadcasting and the influence of British Sky Broadcasting (BSkyB) Corp. on broadcasting services in the 1990s – The emergence of the Internet/Web and the subsequent development of a broadband policy from mid-1990s onwards Drawing on Dodgson et al.'s concepts of Market logic, Coordination Logic, and Complex-Evolutionary Logic, the authors argue that the forms of regulation introduced shaped the ways the UK communications industry developed. Thus although the denationalisation grew out of a free market ideology, in practice the free market philosophy was tempered for a number of pragmatic reasons. Prominent among these was a need to create a competitive market in a context where competitors would be unlikely to emerge without regulatory intervention, and an emphasis on price competitiveness to ensure that the end-users benefitted from the best possible prices on available products and services. Subsequent events show that these interventions had unintended consequences. The unforeseen popular demand for Internet/Web access found regulators struggling to find ways to promote a competitive market, and incumbent operators struggling to find a way to offer a suitable product.
Incidence and Etiology of Sudden Cardiac Death: New Updates for Athletic Departments
Authors: Asif Irfan M. , Harmon Kimberly G. 
Published: February 2017

Context: Sudden cardiac death (SCD) in a young athlete is a tragic event and is the leading medical cause of death in this population. The precise incidence of SCD in young athletes has been subject of debate, with studies reporting drastically different rates (1:917,000 athlete-years (AYs) to 1:3000 AYs) depending on the methodological design of the investigation or the targeted population. Evidence Acquisition: A literature search was performed in PubMed using the terms: incidence, sudden cardiac death, sudden death, sudden cardiac arrest, etiology, pathology, registry, athlete, young, children, and adolescents. Articles were reviewed for relevance and included if they contained information on the incidence of SCD in athletes or young persons up to the age of 35 years. Study Design: Clinical review. Level of Evidence: Level 5. Results: Studies of high quality and rigor consistently yield an incidence of 1:50,000 AYs in college athletes and between 1:50,000 and 1:80,000 AYs for high school athletes, with certain subgroups that appear to be at particularly high risk, including the following: men, basketball players, and African Americans. Initial reports suggest that the most common cause of SCD is hypertrophic cardiomyopathy (HCM). However, more comprehensive investigations in the United States and international populations—athletes, nonathletes, and military—support that the most common finding on autopsy in young individuals with SCD is actually a structurally normal heart (autopsy-negative sudden unexplained death). Conclusion: SCD is the leading cause of death in athletes during exercise and usually results from intrinsic cardiac conditions that are triggered by the physiologic demands of vigorous exercise. Current rates of SCD appear to be at least 4 to 5 times higher than previously estimated, with men, African Americans, and male basketball players being at greatest risk. Emerging data suggest that the leading finding associated with SCD in athletes is actually a structurally normal heart (autopsy-negative sudden unexplained death).
Calcineurin Inhibitors in the Treatment of Primary Focal Segmental Glomerulosclerosis
Authors: Laurin Louis-Philippe , Nachman Patrick H. , Foster Bethany J. 
Published: February 2017

Purpose of review: Primary focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic syndrome in adults. Glucocorticoids have been evaluated in the treatment of primary FSGS in numerous retrospective studies. Evidence suggesting a role for including calcineurin inhibitors (CNIs) in early therapy remains limited. The aim of this study was to systematically review the literature examining the efficacy of CNIs in the treatment of primary FSGS both as first-line therapy and as an adjunctive agent in steroid-resistant patients, with respect to remission in proteinuria and renal survival. Sources of information: PubMed and EMBASE were searched from inception to August 2014 for prospective controlled trials, and case-control and cohort studies. Findings: After systematically applying our inclusion criteria, a total of 152 titles and abstracts were identified. Six randomized controlled trials and 2 cohort studies were reviewed. Three randomized controlled trials compared CNIs with placebo or supportive therapy. The pooled relative “risk” of proteinuria remission associated with cyclosporine was 7.0 (95% confidence interval, 2.9-16.8) compared with placebo/supportive therapy. There was very low heterogeneity among these studies with an I-squared of 0%. Three studies compared CNIs with another immunosuppressive agent. All prospective trials were conducted in patients with primary FSGS deemed steroid-resistant. Limitations: The relatively small number of included studies and their heterogeneity with respect to treatment protocols, and possible publication bias, limit conclusions drawn from this systematic review. Implications: The efficacy of CNIs has been evaluated in steroid-resistant primary FSGS patients. There is no evidence supporting their role as first-line therapy. Further studies are needed to determine this role.
Reformers in Medical Education and Practice
Authors: Entin Martin A 
Published: February 2017

Background The standards of professional practice are constantly shifting to keep pace with acquired knowledge. When the standards fell short of professional expectations, when the practising physician became more concerned with financial gain than effective patient care, society needed a reformer to evaluate the process and to improve it. Study Design Individual physicians and scientists were selected from throughout the history of medicine until the end of the 18th century, who conformed to our definition of reformers, namely, a person who changed the structure or ideology of medical practice. Results This survey demonstrates that reforms are produced by persons whose minds possess analytical quality and critical judgment. Reformers have influenced the directions of medical practice and teaching. Conclusion The improvement in medical practice has been achieved through intuitive leaps, rejection of conventional practice, painstaking research or administrative restructuring.
Novel Approach in the Evaluation of Flap Failure Using near Infrared Spectroscopy and Imaging
Authors: Abdulrauf Badr M , Stranc Miroslaw F , Sowa Michael G , Germscheid Shelley L , Mantsch Henry H 
Published: February 2017

Methods of tissue viability assessment should be classified into those that measure blood flow and those that monitor tissue metabolism. The problem with measuring blood flow is that it can be misleading due to the phenomenon of arteriovenous shunting. Near infrared (NIR) spectroscopy is capable of identifying certain molecules in the tissues. In this study, using the reverse McFarlane rat skin flap as a model, oxygen delivery to the tissue along the flap was demonstrated in the form of a spectrum. This was achieved by using the differential absorption of oxy- and deoxyhemoglobin between wavelengths of 650 nm and 900 nm. NIR imaging works on a similar principle, but an oxygen saturation image is obtained, with the darkest area indicating the most deoxygenated area of the flap and vice versa. There were two types of studies done. In the chronic study (n=10), NIR spectroscopy was done on the intact skin preoperatively for three days and then after elevation of the flap at various sites for three days. Preoperative measurements showed excellent reproducibility, and postoperative measurements showed progressive deoxygenation toward the distal aspect of the flap. NIR imaging at 1 h after flap elevation showed a zone of demarcation that corresponded with that noted clinically at 72 h. In the acute study (n=3), NIR spectroscopy, imaging and laser Doppler flowmetry were acquired before, immediately following and 1 h after raising the flap, and then measurements were taken after applying a vascular clamp across the base of the flap; reperfusion was evaluated after clamp release. Spectroscopy immediately following flap elevation indicated deoxygenation of the most distant part of the flap. Clamping the base of the flap caused deoxygenation of the whole flap; this was immediately evident on both spectroscopy and imaging. These changes recovered after releasing the clamp in the areas that were expected to survive. Laser Doppler flowmetry results generally correlated well with the NIR spectroscopy and imaging results. However, the method was very sensitive to fine movements during monitoring. The main advantage of NIR monitoring is that it looks directly at oxygen consumption rather than measuring blood flow. In addition, the NIR imaging gives a global picture of the eventual fate of the flap. These properties make these devices much more practical when the flap's well-being is concerned.
A novel method of grafting facial nerve defects resulting from parotidectomy
Authors: Ching Shim , Thoma Achilleas , Archibald Stuart , Jackson Stanley 
Published: February 2017

The sacrifice of the facial nerve is an uncommon consequence of parotidectomy for cancer resection. In the cases described here, the facial nerve was necessarily resected due to an infiltrating tumour. Seven cases of facial nerve sacrifice that were reconstructed with a novel, sural nerve construct are presented. The sural nerve construct facilitates facial nerve reconstruction, especially in the case of multiple branch involvement and a short, proximal nerve stump. Evaluation of these cases shows acceptable facial nerve function following this technique. The use of this technique may prove advantageous in any instance of nerve grafting where multiple nerve branches are encountered.
Part III: Reformers in medical education and practice
Authors: Entin Martin A 
Published: February 2017

Background Part I (Can J Plast Surg 2000;8:25–29) established that standards of professional practice shift constantly. When a standard falls short of professional expectation, or when a physician becomes more concerned with financial gain than patient care, society needs the action of a reformer. Part II (Can J Plast Surg 2001;9:59–68) continued the study with the contribution of reformer John Hunter (1728–1793), followed with the contributions of seven other reformers, and concluded with Wilder Penfield (1891–1976). Part III extends this project through the greater part of the 20th century. Study Design Reformers were scientists who were selected because they conformed to the definition of ‘reformer’; namely, a person whose action restored, reshaped or changed the structure or ideology of medical practice. Results This survey demonstrated that the reforms were accomplished by scientists who possessed critical judgement and analytical qualities that enabled them to influence the direction of medical education and practice. Conclusion Reforms have been achieved through intuitive leaps, alterations of conventional practice, painstaking research and administrative restructuring.
An assessment of the anatomical basis of the thoracoacromial artery perforator flap
Authors: Geddes Christopher Robert , Tang Maolin , Yang Daping , Morris Steven F 
Published: February 2017

Background Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options. Perforator flaps are becoming increasingly popular for many applications. In the present study, we set out to examine the various perforators of the thoracoacromial axis through the pectoralis major (PM) muscle with respect to their suitability for transfer to the head and neck region as a pedicled flap. Methods A series of 10 fresh cadavers were injected with lead oxide, gelatin and water (250 mL/kg) through the femoral vessels. The cadavers were cooled and the integument was removed. Perforating vessels from the underlying muscles were marked and the resulting angiograms of the integument and deep tissues were compared with the dissection notes describing the course, size and distribution of the perforating vessels. Results The perforators through the PM muscle to the overlying skin included three regional groups: perforators of the thoracoacromial axis; perforators of the medial intercostal vessels; and perforators of the lateral thoracic artery. The major group of perforators supplying the overlying skin was from the intercostal vessels. However, the thoracoacromial axis did consistently give rise to perforators in the upper portion of the PM muscle. In particular, there were reliable perforators from the clavicular and deltoid branches of the thoracoacromial artery. Discussion The present study illustrates the potential clinical applications of a series of perforator flaps based on the thoracoacromial axis, which may be useful in head and neck reconstructive surgery.
Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects
Authors: Zhong T , Gullane PJ , Pc Neligan 
Published: February 2017

Background The reconstruction of large scalp defects is occasionally required. Several methods of scalp reconstruction have previously been described. This paper presents the authors' experience with two patients in whom traditional methods were not sufficient and in whom bilateral latissimus dorsi free flaps were required. Objectives To evaluate the effectiveness of a new technique in reconstructing extensive scalp defects. Methods Two case histories are presented. These include the rationale for the choice of reconstruction used as well as a discussion on the technical features of the surgery. Results Reconstruction was effective in both cases. However, one patient died in the early postoperative period from a pulmonary embolus. Conclusions Bilateral latissimus flaps can be safely and effectively used in closing massive scalp defects in selected cases.
Part IV: Reformers in medical education and practice: Effect of managed care organization in the United States
Authors: Entin Martin A 
Published: February 2017

Background Part I (Can J Plast Surg 2000;8:25–29) established that standards of professional practice shift constantly. When a standard falls short of professional expectation or when a physician becomes more concerned with financial gain rather than patient care, society needs the action of a reformer. Parts I, II (Can J Plast Surg 2001;9:59–68) and III (Can J Plast Surg 2002;10:103–108) covered 500 BC to 1970 AD and comprised 31 physicians who introduced innovations in medical knowledge or medical philosophy. Part IV deals with a time in which new conditions have been imposed on medical practice. In the United States, medical education and practice felt the repercussions of financial institutions participating in health care management. Study Design The reformers were scientists who conformed to our definition of ‘reformer’: a person whose action restored, reshaped or advanced the structure or ideology of medical practice. Results This survey demonstrated that the reforms were accomplished by scientists possessing critical judgement and analytical qualities that enabled them to influence the direction of medical education and practice. In the last 20 years, financial institutions imposed different criteria that may require future reformers to reestablish lost objectives. Conclusion Reforms have been achieved through intuitive leaps, alterations of conventional practice, painstaking research or administrative restructuring. The present health management in the United States requires new solutions.
Ischemia of the Hand Secondary to Radial Artery Thrombosis: A Report of Three Cases
Authors: Chitte Sachin A , Veltri Karen , Thoma Achilleas 
Published: February 2017

Upper extremity arterial thrombosis, though rare, is more prevalent on the ulnar side of the circulation, with the most common etiology being repetitive blunt trauma to the hypothenar eminence. Radial artery thrombosis is even more rare and when it does occur, is associated most often with iatrogenic cannulation, producing subsequent thrombi and emboli. Three cases of spontaneous thrombosis of the radial artery extending to the superficial palmar arch and the princeps pollicis artery are presented here. Two patients underwent thrombectomies and one underwent excision of the thrombosed segment and reconstruction with a reversed saphenous vein graft. The etiology of the thrombus was consistent with cancer in two cases and trauma in one.
Transconjunctival approach in lower eyelid blepharoplasty
Authors: Korchia D , Braccini F , Paris J , Thomassin Jm 
Published: February 2017

Aim To specify interest and indications of the transconjunctival approach in lower-eyelid plastic surgery. Materials and Methods Twenty-three cases of inferior blepharoplasty performed through a transconjunctival approach are reported. The authors describe the surgical technique, its indications and results. Results The transconjunctival approach provides excellent access to the inferior fatty chambers and is cutaneous scar free. It has a lower complication rate than the classic transcutaneous approach, and no case of cyclid retraction has been reported. Conclusion In our ‘cosmetic society’, the inferior blepharoplasty through a transconjunctival approach has taken a significant place in the armamentarium of the esthetic surgeon. Juvenile palpebral lipoptosis without skin excess constitutes the best indication for this technique. It is also indicated in secondary blepharoplasty and in patients presenting with a cicatricial risk or with orbital septum distention.
Anthrax of the lower eyelid
Authors: Koçer Ugur , Aksoy Hasan Mete , Tiftikcioglu Yigit Özer , Aksoy Berna 
Published: February 2017

Because cutaneous anthrax, caused by Bacillus anthracis, is rare in developed countries, sporadic cases of anthrax may easily be over-looked because the diagnosis is often difficult to make. Lower eyelid involvement of anthrax is rare in clinical practice. A 40-year-old woman with a history of contact with animals was evaluated and treated for a left lower eyelid lesion with a black eschar on it. A diagnosis of cutaneous anthrax had been made and intra-venous penicillin had been given by the department of infectious diseases before plastic surgery consultation. Any kind of surgical intervention was delayed for three months. The lesion healed secondarily and the resulting scar did not result in ectropion of the lower eyelid. Delaying surgery is preferred because it is a safer approach when dealing with anthrax involving the lower eyelid, and secondary healing does not always result in deformity compromising function.
The Indications and Reliability of Vein Graft Use in Free Flap Transfer
Authors: Classen Dale A 
Published: February 2017

Background: Adequate recipient vessels are critical for free flap success. There are, however, situations in which the local recipient vessels are inadequate. In these situations, vein grafts are required to allow pedicle extension to recipient vessels. Objectives: To determine the indications, technique, reliability and outcome of vein graft use in free flap transfer. Methods: A retrospective review of 198 consecutive free flaps by a single surgeon. Results: Vein grafts were required in 9.6% of free flaps. The most common indication was vein graft use in a planned preoperative fashion. The vein graft was most commony placed as an arteriovenous fistula loop. There was no statistically significant difference in survival between flaps with or without vein grafts. Conclusion: Vein graft use in free flap transfer is reliable, effective and often necessary for free flap survival.
The Use of Polymethyl-Methacrylate (Artecoll) As An Adjunct to Facial Reconstruction
Authors: Mok David , Schwarz Jorge 
Published: February 2017

Background: Injectable polymethyl-methacrylate (PMMA) microspheres, or Artecoll, has been used for the last few years in aesthetic surgery as long-term tissue filler for the correction of wrinkles and for lip augmentation. This paper presents three cases of the use of PMMA microsphere injection for reconstructive patients with defects of varying etiologies. These cases provide examples of a novel adjunct to the repertoire of the reconstructive surgeon. Objectives: To evaluate the effectiveness (short- and long-term) of PMMA injection for the correction of small soft tissue defects of the face. Methods: Three case histories are presented. They include the origin of the defect; previous reconstructions of the defect; and area, volume, timing and technical particularities of PMMA administration. Results: All three cases showed improvement of the defect with the PMMA injection with respect to both objective evidence and patient satisfaction. The improvements can still be seen after several years. Conclusions: PMMA microsphere injection can be effectively used to correct selected small facial defects in reconstructive cases and the results are long lasting.
Treatment of Electrical Burns By Single Debridement Followed By Free-Flap Coverage: How Important Is Timing?
Authors: Thomson Christopher J , Miles Duncan Ag , Beveridge John , Chang Peter S 
Published: February 2017

Background: High-voltage electrical burns involving the extremities may cause marked loss of skin and subcutaneous tissue exposing underlying bone and tendon. Treatment of electrical burns has historically involved serial debridement with late wound closure. Success has been reported with the use of microvascular free-flap transfer within three days of injury. Objective: Seven patients with severe high-voltage electrical burns are presented. The application and timing of microvascular free-flap coverage is discussed. Results: Six of the seven patients achieved successful healing with the free flaps. Conclusion: Delay of microvascular free-flap coverage beyond the previously published three-day protocol may not dramatically affect treatment success.