bluuebunny/crossref_metadata_2025_split huggingface dataset:
Help-Seeking for Psychiatric Disorders
Authors: Bland Roger C , Newman Stephen C , Orn Helene 
Published: January 2017

Objective: To examine demographic and clinical determinants of seeking help for mental or emotional problems. To determine the proportion of those people with a disorder who sought help. To determine what categories of professionals are sought by those who get care. Method: A 2-stage random sample of 3956 adult residents of Edmonton, Alberta, Canada was interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS) (73% completion rate). An average of 2.8 years later, a systematic random sample of 1964 subjects was reinterviewed (an 86% completion rate) using the DIS and a health care utilization questionnaire. After adjusting for age and sex, the reinterview sample was representative of those with and without a diagnosis at the first interview. Results: Of the 1964 subjects, 570 (31%) met criteria for a DIS/DSM-III diagnosis in the year preceding the interview (one-year prevalence rate). These diagnoses included generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). For those with a diagnosis, sex, age, marital status, education, employment, and income were examined as determinants of help-seeking. Only sex (female) and age (under 45) were significant predictors. Comorbidity was highly significant: the help-seeking rate for those with one diagnosis was 20.3%; for those with more than one diagnosis, the rate was 42.8% (OR = 2.94, χ2 = 31.4, df = 1, P < 0.001). Just over 28% of those with a diagnosis saw any health care professional, and 7.7% of those without a diagnosis sought help for a mental or emotional problem. A specific diagnosis made a difference: 46.7% of those with a major depressive episode sought help, but only 16.0% of those with alcohol abuse or dependence sought care. Conclusion: Major determinants of help-seeking are sex (female), age (under 45), severity of the illness, and comorbidity. A surprisingly high proportion of those with a disorder (72%) do not seek help, and over one-third of those seeking help do not have a current DIS/DSM-III disorder.
Ethical and Pragmatic Issues in the Use of Psychotropic Agents in Young Children
Authors: Jensen Peter S 
Published: January 2017

Objective: To provide an overview of the knowledge base concerning the prescribing of psychotropic agents in young children with mental disorders and related mental health problems. Method: Relevant information is reviewed concerning the knowledge base available to inform pediatric psychopharmacology prescribing practices. Results: Very few psychoactive medications have been adequately tested for safety and efficacy in young children, despite relatively high rates of prescribing. Conclusion: Behavioural and psychotherapeutic strategies are often the wisest first therapeutic intervention for this age group. Psychotropic medications may be required, but should be used cautiously in young children, while additional studies are being conducted.
Abnormal Involuntary Movements in Neuroleptic-Naive Children and Adolescents
Authors: Magulac Mark , Landsverk John , Golshan Shahrokh , Jeste Dilip V 
Published: January 2017

Objective: To determine the prevalence of and identify risk factors for abnormal involuntary movements in a well-characterized community sample of neuroleptic-naive children and adolescents. Method: The Abnormal Involuntary Movement Scale (AIMS) was administered to 390 subjects aged 3–17 years who were in foster care. Additional instruments were used to assess intellect and behaviour problems. Results: A total 12.6% of subjects had at least 1 rating of “mild” movements on AIMS; these included 4.1% with at least 2 ratings of “mild” or 2 of “moderate” severity. Significant risk factors for movement disorder were younger age, lower IQ, and more severe behaviour problems. The abnormal movements were usually orofacial, and the affected subjects were generally unaware of these movements. Conclusion: The base prevalence of abnormal involuntary movements must be considered in children and adolescents assessed for medication in order to determine the true rate of motor side effects.
Fact versus Fancy concerning the Multimodal Treatment Study for Attention-Deficit Hyperactivity Disorder
Authors: Jensen Peter S 
Published: January 2017

Findings from the Multimodal Treatment Study of Children With Attention-Deficit Hyperactivity Disorder (ADHD), the MTA, have been much discussed but frequently misinterpreted or mischaracterized. Misinterpretations regarding the specific nature of and rationale for the study design, the effectiveness of the behavioural treatment arm, the possible advantages of combined treatments over single-component (medication management or behavioural therapy) interventions, and the feasibility and applicability of MTA treatments for “real-world”practitioners are addressed. Careful interpretation of the MTA findings suggests that for ADHD symptoms, carefully crafted medication-management approaches are superior to behavioural treatment and to routine community care that includes medication. For non-ADHD areas of functioning (for example, social skills, academic performance), combined treatments may offer modest advantages over single-component approaches. Longer-term outcomes past 14 months of intensive MTA treatments (as well as their relative effectiveness with respect to each other) remain unknown, pending further MTA analyses. The MTA treatments by and large consisted of evidence-based “best practices.” Thus, rather than characterizing these treatments as in-feasible, the substantially superior outcomes of these treatments (versus routine clinical care) across diverse settings should help set the standard for future treatment practices in real-world settings. Despite important study limitations, the MTA study, by virtue of its size, scope, and length; parallel-groups design; explicit use of manualized, evidence-based treatments; and comprehensive range of outcome assessments sets an important benchmark for future trials testing new treatments for childhood ADHD and defines a new standard for optimal outcomes that can be achieved with the best of clinical care.
A New Paradigm of Surgical Management of the Atonic Face
Authors: Schwarcz Robert M. , Goldberg Robert A. , Shorr Norman 
Published: January 2017

Introduction: Consequences of facial paralysis are functionally and cosmetically debilitating. Surgical facial suspension in patients with facial nerve palsy is characterized by inexorable recurrent descent of the atonic tissues. Despite numerous variations on techniques that have been attempted over the years, including muscle and fascia flaps, deep plane or periosteal dissection, and multiple vector fixation, we have been disappointed to note substantial or complete loss of improvement effect over 1–2 years. This experience has allowed us to reassess the basic philosophy of rehabilitation for patients with facial paralysis. If the most robust and invasive surgeries are not adequately permanent to avoid the need for frequent reoperation, then perhaps a rational approach is to accept and anticipate the need for repeat procedures and use minimally invasive procedures that are designed for maintenance reoperations. Materials and Methods/Results: We report our experience with a layered multivector cable suture suspension technique to address the atonic descent of the eyebrow, eyelid, midface, and lower face in patients with facial palsy. We describe 2 approaches, a Keith needle with either Gortex or a nylon suture passed from nasolabial fold to deep temporalis fascia and a procedure involving multivector cables. To address the ocular complications in the atonic face, we review upper and lower eyelid adjunctive techniques. For facial paralysis, solutions to address ocular issues include placement of gold weight to upper eyelid, skin graft to upper eyelid, midface-lift, and lower eyelid slings. Finally, to address the lateral oral commissure droop, we discuss a localized technique involving upward positioning of the area by removal of an ellipse of tissue down to the level of the orbicularis oris muscle. Discussion: We discuss our experiences in addressing the upper face, midface, and lower face regarding static reanimation surgery of the atonic face with multivector cables and other modalities to provide a systematic approach. Many of these techniques can be used on the cosmetic patient as well.
Clinical Improvement of Photodamaged Skin after a Single Intense Pulsed Light Treatment
Authors: Nootheti Pavan K. , Pettit Kimberly A. , Yosowitz Gail , Goldman Mitchel P. 
Published: January 2017

Background and Objectives: Photoaging is clinically characterized by irregular pigmentation (freckling, lentigines, persistent hyperpigmentation), dryness/roughness, telangiectasia, wrinkling, elastosis, and inelasticity. Currently available medical literature documents using intense pulsed light (IPL) 3 to 5 times to achieve satisfactory improvement. Study Design/Materials and Methods: Twenty patients of Fitzpatrick skin types I–III, each with components of photodamaged skin including telangiectasias, dyschromia, skin roughness, enlarged pore size, and/or rhytides—participated in the study and were treated with a single Lumenis One IPL. Pretreatment and posttreatment photographs were graded by 2 independent physicians as to percent improvement. Results: After 1 treatment with the Lumenis One IPL, results showed an average improvement of 40% in resolving telangiectasias, dyspigmentation, and fine wrinkling. Conclusions: The present study demonstrates that as much as a 40% improvement in the overall appearance of photoaging can be obtained after a single treatment with the Lumenis One IPL. Previous studies with IPL using the Lumenis Photoderm, Vasculite, or Quantum systems found that 3 to 5 treatments were needed to obtain a similar improvement. These IPL systems have a smaller spot size, a different energy output profile, and a cutaneous cooling mechanism that may explain their decreased efficacy compared with the Lumenis One.
Utilizing a Curved, Perialar Advancement Flap to Maximize Esthetic Outcomes in Nasal Reconstructions
Authors: Kouba David J. , Moy Lauren , Fincher Edgar F. 
Published: January 2017

Introduction: The closure of distal nasal sidewall defects greater than 1 cm has traditionally engendered limited reconstructive options. Because the defects are too large for primary closure and because skin grafting frequently yields suboptimal esthetics, flap reconstructions are commonly employed. For these, many surgeons tend to rely on either the bilobed flap or the larger Rieger dorsal nasal rotation flap. However, while these reconstructions yield excellent results, none of their suture lines are hidden in any natural creases. Objective: The objective of this article is to present the authors' experience in using a nasal advancement flap they frequently use in their practice that has an added advantage of camouflaging a large portion of its suture lines within the alar crease to enhance cosmesis. Methods: The authors review their results with 10 patients who, after Mohs micrographic surgery, were left with distal nasal sidewall defects and underwent reconstruction using the curvilinear perialar crescentic advancement flap. Results: All patients demonstrated excellent cosmetic outcome without pin cushioning deformities or tenting at the junction of the cheek and nose cosmetic subunits. There was no alar distortion, and all patients were satisfied with the esthetic outcome. Conclusion: The curvilinear perialar advancement technique is an excellent alternative to other commonly used nasal sidewall closures such as the bilobed double transposition and the Rieger flap and can effectively complement the reconstructive armamentarium of any reconstructive surgeon.
Balloon-Assisted Transaxillary Augmentation Mammoplasty: A Simplified 3-Step Approach
Authors: Kluska Michael S. 
Published: January 2017

Introduction: Transaxillary augmentation mammoplasty has been an approach used by plastic surgeons for more than 2 decades. Considered controversial because of the potential for incomplete dissection, implant malposition, and traumatic pneumothorax secondary to blind dissection, the current trends for transaxillary augmentation mammoplasty include use of an endoscope for the entire dissection. This review of the literature presents an alternative approach to the traditional endoscopic transaxillary augmentation mammoplasty. The balloon-assisted transaxillary augmentation mammoplasty (BAAM) uses a specific 3-step sequence, enabling adequate pocket dissection with minimal risk of trauma in an efficient and timely manner. Materials and Methods: In this series BAAM was performed on 56 patients over 18 months. Patients were selected according to 5 specific criteria, including desired location of the scar, degree of ptosis, desired implant size, and minimal breast asymmetry. Using these specified criteria allowed a technique to be developed that was consistent and easily reproducible from patient to patient. Results: Of the 56 patients that were included in the study, minimal complications were noted. At 18 months, 1 person (1.8%) developed a capsular contracture grade III. There were no appreciated hematoma formations or infections of the prosthesis. In addition, 1 patient (1.8%) developed an incisional infection of the right axilla, which resolved with oral antibiotics. Seven patients (12.5%) presented with high-riding implants, 6 of which resolved over a course of 3 to 6 months with superior breast implant massage. One patient (1.8%) was taken back to the operating room where a counterincision at the inframammary crease was used to create a new inframammary fold, thus lowering the implant. During the course of the study, no ruptures were appreciated. Finally, of the 56 patients, 7 (12.5%) experienced parasthesias of the nipple, all of which resolved over a 3-month interval. Conclusion: Balloon-assisted transaxillary augmentation mammoplasty is the current method of choice for breast enhancement. In the 3-step sequence presented, the focus is on a simplified approach to achieve complete submuscular implant placement in an efficient and timely manor.
Bicipital Augmentation: A Retrospective Review of 94 Patient Cases
Authors: Chugay Nikolas V. , Chugay Paul N. 
Published: January 2017

Objective: Reality, documentary, and makeover programs have all helped to eliminate certain taboos previously associated with cosmetic surgical procedures. As a direct result of this phenomenon, men have expressed greater interest in cosmetic surgery. Over the past 5 years, Dr Chugay and colleagues have been working to promote the use of a bicipital prosthesis for aesthetic augmentation of the biceps muscle. This article is designed to further elucidate the complications that have been encountered with the procedure to date and changes in technique that have made this a viable option for male muscular enhancement. Methods: A retrospective review of prospectively collected data on 94 patients was undertaken to determine the cosmetic improvements and complications seen in the patient population. Silicone prostheses were placed below the biceps muscle in each case to provide greater definition and fullness in the region of the biceps. Results: Over a 5-year period, 94 patients underwent bicipital augmentation. Of those cases, there were 3 major complications. One patient developed a large seroma due to poor compliance with postoperative instructions for compressive garment use. A second patient suffered a dislodgement of the implant with protrusion of the implant from beneath the muscle. The third complication encountered was that of compartment syndrome in a patient who underwent both biceps and triceps augmentation. Conclusion: Despite the risks inherent in performing surgery in the upper extremity, the bicipital augmentation procedure is a means by which the male physique can be enhanced with minimal risk of complication when performed using our technique.
Total Circumferential Lower Extremity Lipoplasty
Authors: Botta Samuel A. 
Published: January 2017

A technique is explained for total circumferential lower extremity liposuction, which extends from the lateral hip to the ankle. Description of the procedure begins with proper patient positioning, and moves on to skin markings which illustrate direction and areas of liposuctioning and location of all incision sites. This preliminary description is followed by details of the operative procedure. Results of the illustrative case are shown both qualitatively as well as quantitatively. Many principles, including preoperative preparation, use of the tumescent technique, sufficient intraoperative and postoperative fluid replacement, autogenous blood administration, multiple drainage sites, and adequate postoperative compression contribute to the possibility of performing such an extensive procedure as a one-stage operation.
“Split” Umbrella Onlay Grafts for the Correction of Upper Lateral Cartilage Defects
Authors: Mignogna Frank V. , Garay Kenneth F. 
Published: January 2017

Multiple techniques have been proposed to correct cartilaginous asymmetries and defects in the nasal pyramid. Some have proven to be more successful maneuvers than others. Among the more successful are the septal—upper lateral spreader grafts popularized by Sheen. However, some upper lateral defects have proven to be incompletely correctable by this technique. This is especially the case in secondary rhinoplasty, where excessive upper lateral cartilage may have been initially resected, resulting in a step-off defect vis-a-vis the nasal bone and a depression lateral to the dorsal profile, frequently associated with a defect in the nasal valve. “Split” umbrella onlay grafts have proven to be a successful technique to correct these defects in our hands in over 350 cases performed from 1987 through 1992. Morselized alar or septal cartilage was employed to correct upper lateral defects in the primary rhinoplasty group. Contoured auricular cartilage grafts proved to be more successful in the secondary rhinoplasty or the badly traumatized nose. Valvular competence was maintained or improved in all cases. This easily performed technique is deserving of more widespread application.
Ultrasonically Assisted Liposculpturing: Physical and Technical Principles and Clinical Applications
Authors: Di Giuseppe Alberto 
Published: January 2017

The physical and technical principles of ultrasonically assisted liposculpturing (UAL) are described, and clinical experience through 4 years (1992–1996) of use of this procedure is presented. The technique relies on the surgical use of ultrasonic energy, which allows the selective destruction or emulsification of adipose tissue, producing a “cream,” which is then aspirated. The procedure produces less edema and bruising than does traditional liposuction and allows a great degree of skin retraction due to “stimulation” of the dermis of the treated areas. Clinical application of ultrasonically assisted liposculpturing is for lipodystrophy, secondary cases, and difficult areas such as the inner thigh, circumferential thigh, calf, and abdomen. There is little blood loss, and a greater volume of fat tissue can be removed in one session. UAL can be used to treat obesity. This method has been applied to surgery of the breast for volume reduction of the adipose components in the fatty breast (mostly in juvenile breast) and for skin retraction after dermis stimulation for correction of minor-degree ptosis. This technique chiefly relies on the selective destruction of mainly the fluid fraction of the adipose tissue, which represents nearly 90% of all the adipose tissue's volume. Contrary to traditional liposuction, which mechanically attacks and destroys all the structures of the dermis that may have undesired side effects, UAL selectively destroys only the target adipocytes and spares the supporting structures of the skin and dermis, such as vessels, nerves, collagenic matrix, and elastic fibers, thus conserving the elasticity of the treated areas.
Reinforced Swan-Neck, Flexible Shaft, Beveled Liposuction Cannulas
Authors: Weber Paul J. , McKerrow Kevin , Wulc Allan E. , Oleson Gale , Popp Jeffrey , Dryden Robert , Weber Robert G. 
Published: January 2017

Introduction: Traditional liposuction cannulas and ultrasonic liposuction cannulas have had the feature of relative rigidity in common. Herein we introduce a new design that allows a patient's entrance wound to act as a fulcrum, enabling the surgeon's guiding hand to redirect cannulas with long, flexible shafts and highly reinforced swan necks. The nonultrasonic version of this cannula system includes a highly beveled tip adjacent to a triport (Accellerator III) set of openings. The new cannulas easily penetrate fibrous fat, reach fat deposits distant from the entrance wounds, and curve within the subcutaneous tissue below the dermal envelope, thereby reducing the need to move a patient's body position intraoperatively. A novel Teflon entrance wound insert that resembles the shape of a calla lily aids in the use of the system, thereby reducing cannula friction inside the insert and maximizing friction via projections on the outside of the insert. This friction outside of the insert maintains the insert's position in the wound during cannula backstroke. Materials and Methods: Reinforced swan-neck, flexible shaft, triport bevel cannulas (RSFSTBCs) have been used successfully in hundreds of liposuctions performed by one of us (P.J.W.). P.J.W. has also used the Capistrano cannula tip with success. Capistrano cannulas and RSFSTBCs of 2.5 mm and 3.5 mm diameter were compared in 12 patients (eight female and four male) on contralateral but otherwise identical fat deposits. Results: No adverse effects were noted with either system; no indentations, inordinate bruising, seromas, or infections occurred. The reinforced swan-neck cannulas penetrated tissue with greater ease, and the flexible shafts allowed the operator to arc the cannulas to greater distances within the body. Thus the operator could reach more areas with fewer entrance wounds and less movement of patients on the operating table. Novel cannula motions occurred as a result of using the patient's entrance wound as a fulcrum and redirecting the distal shaft and tip of the cannula with an opposing hand. Discussion: The long, flexible shafts of the RSFSTBC system allow for a reduction in the need for cannula entrance wounds. The beveled tip provides for ease of penetration, even in fibrous tissues. The reinforced swan neck, in combination with the flexible shaft, enables the use of both mildly and highly arced cannula paths via several mechanisms.
Laser Effects On Dental Hard Tissues
Authors: Featherstone J.D.B. , Nelson D.G.A. 
Published: January 2017

The use of lasers in dentistry has been considered for over 20 years. Higher-energy density lasers were shown to fuse enamel but were potentially unsafe. Subsequently, low-energy density laser radiation was shown to affect artificial caries lesion formation. Recent studies have shown that carbon dioxide lasers can successfully be used at low-energy densities to fuse enamel, dentin, and apatite. Our studies have shown that specific wavelengths are highly efficient. These wavelengths are directly related to the infrared absorption regions of apatite. We have conducted studies with enamel and dentin, using pulsed CO2 laser radiation in the 9.32-μm to 10.49-μm region with energy densities in the 10 to 50 J.cm-2 range. This laser treatment caused surface fusion and inhibition of subsequent lesion progression and markedly improved the bonding strength of a composite resin to dentin. Similar studies have shown no pulpal damage or permanent deleterious effect on soft tissues. This improved understanding of the scientific rationale for the interaction of CO2 lasers with teeth can lead to several clinical applications. This will depend, however, on the development of a technology to direct a specific frequency laser beam precisely to a desired site.